Cultural Recipe Analysis
Assignment: Cultural analysis recipe and report. Three to five pages total of reported content. Reference page does not count toward this total. Format requirements are outlined in the course syllabus.
- Find an “authentic” and “traditional” cultural recipe from a culture that is different then your own and different from the one covered in the Interview and Acculturation assignments.
Recipe must come from a cookbook (see “Important Information About References” below)
- Prepare the recipe for yourself and a friend or family member.
- Take a photo of the recipe to include in your report.
- Evaluate the recipe (based on the provided sensory evaluation form). Evaluate the recipe for texture, flavor, color, appearance and overall acceptability. Be detailed and descriptive. Use a variety of sensory words.
Elements of Paper:
- Introduction:
- Clearly state your own cultural identity and the culture of the recipe you have chosen.
- State why you choose this cultural recipe.
- Describe your preparation methods of the recipe that you selected to prepare.
- Evaluate the recipe for texture, flavor, color, appearance and overall acceptability (form provided below). Be detailed and descriptive. Use a variety of sensory words.
- Make sure to include your completed sensory evaluation form (does not count towards page count)
- Compare and contrast the information found in the preface of the cookbook or book and other source with the information provided in the textbook. Include a compare and contrast for the following:
- Cooking/preparation methods.
- Traditional flavor notes/principles.
- Typical staple foods.
- Meal/eating patterns or habits.
- Discuss how your cultural perceptions may have affected your perception of the food you ate and reviewed.
- Include a References page (detailed below).
- Attach a picture of the final product at the END of your paper. Do not embed or include in the body of the text.
Important Information About References:
Before you begin your search for sources, make sure that you clearly understand and can define what are considered staple foods, flavor notes or principles, cooking/preparation methods, and eating/meal patterns. Refer to the chapter readings in your Introduction Modules (chapters 1-4).
- At least 3 references should be used: 1) textbook, 2) ethnic cookbook or published book on chosen culture, 3) plus one other reference of choice.
- Locate two resources that detail food and cooking practices of this culture.
One of these resources MUST be a COOKBOOK on a specific cultural cuisine or ethnic background OR a published book on a particular culture. The book or cookbook must detail staple foods(sometimes listed as pantry items), common flavor notes (seasonings & herbs traditional used), traditional cooking and preparation methods of the culture, and traditional eating/meal patterns.
The second resource can be from a website that also provides similar detail on the culture. It does not have to be in agreement with the book or cookbook, but it should provide additional insights or details about food in the chosen culture.
NFS 3173 Culture and Foods
Cultural Recipe Analysis
Value = 100 points
Assignment: Cultural analysis recipe and report. Three to five pages total of reported content. Reference page does not count toward this total. Format requirements are outlined in the course syllabus.
1. Find an “authentic” and “traditional” cultural recipe from a culture that is different then your own and different from the one covered in the Interview and Acculturation assignments.
a. Recipe must come from a cookbook (see “Important Information About References” below)
2. Prepare the recipe for yourself and a friend or family member.
3. Take a photo of the recipe to include in your report.
4.
Evaluate the recipe (based on the provided sensory evaluation form). Evaluate the recipe for texture, flavor, color, appearance and overall acceptability. Be detailed and descriptive. Use a variety of sensory words.
Elements of Paper:
1. Introduction:
· Clearly state your own cultural identity and the culture of the recipe you have chosen.
· State why you choose this cultural recipe.
2. Describe your preparation methods of the recipe that you selected to prepare.
3. Evaluate the recipe for texture, flavor, color, appearance and overall acceptability (form provided below). Be detailed and descriptive. Use a variety of sensory words.
· Make sure to include your completed sensory evaluation form (does not count towards page count)
4. Compare and contrast the information found in the preface of the cookbook or book and other source with the information provided in the textbook. Include a compare and contrast for the following:
· Cooking/preparation methods.
· Traditional flavor notes/principles.
· Typical staple foods.
· Meal/eating patterns or habits.
5. Discuss how your cultural perceptions may have affected your perception of the food you ate and reviewed.
6. Include a References page (detailed below).
7. Attach a picture of the final product at the END of your paper. Do not embed or include in the body of the text.
Important Information About References:
Before you begin your search for sources, make sure that you clearly understand and can define what are considered staple foods, flavor notes or principles, cooking/preparation methods, and eating/meal patterns. Refer to the chapter readings in your Introduction Modules (chapters 1-4).
· At least 3 references should be used: 1) textbook, 2) ethnic cookbook or published book on chosen culture, 3) plus one other reference of choice.
· Locate two resources that detail food and cooking practices of this culture.
· One of these resources MUST be a COOKBOOK on a specific cultural cuisine or ethnic background OR a published book on a particular culture. The book or cookbook must detail staple foods (sometimes listed as pantry items), common flavor notes (seasonings & herbs traditional used), traditional cooking and preparation methods of the culture, and traditional eating/meal patterns.
· The second resource can be from a website that also provides similar detail on the culture. It does not have to be in agreement with the book or cookbook, but it should provide additional insights or details about food in the chosen culture.
Trivia Fact About TWU: The Texas Woman’s University Library has the World’s largest Cookbook Collection — Hint: This would be a wonderful place to find a recipe in a cookbook to complete this assignment. Visiting this collection in our Library will enhance this learning experience and opportunity.
** Note: Reference page(s), sensory table and the picture at the end DO NOT count towards content page requirements above. Reference page, sensory table and picture are in addition to content pages.**
Grading:
The grading rubric has been provided so you know exactly what is expected of you. Please make sure you cover ALL the components that have been requested of you. Points will be deducted if you omit any areas, even if the paper is beautifully written.
The assignment MUST be submitted using the Turn-it-in link below. E-mailed assignments WILL NOT BE ACCEPETED OR GRADED.
**Just a reminder that plagiarized papers, whether intentional or not, will result in a zero. You can submit your papers multiple times through the turn-it-in site until the due date. By using the originality report provided, you can review your similarity score and make corrections and modification as needed. I recommend that you try and submit early and use this tool to double check your paper.**
Sensory Evaluation Form
Recipe Name:
Directions: Circle one rating in the light blue boxes for each of the different categories. Additional comments for each categories can be listed in the white boxes.
Category
Score
Appearance
Extremely Attractive
Moderately Attractive
Attractive/ Matches photo
Unappetizing
Unattractive
Taste /Flavor
Tasted Great
Flavorful
Acceptable
Off Flavor
Flavor did not appeal to me
Texture Rating
Wonderful Texture
Good Texture
Acceptable Texture
Off Texture
Inappropriate texture/flat/runny
Aroma/ Smell Rating
Wonderful Aroma
Appealing Aroma
Acceptable Aroma
Aroma is not appealing
Unappetizing Aroma
Overall Acceptability
Extremely Acceptable
Moderately Acceptable
Acceptable
Moderately Unacceptable
Unacceptable
Name:
Cultural Recipe Analysis Rubric (100 points total)
Criteria |
100% |
90% |
80% |
70% |
60% |
50% |
0-points |
100%
90%
80%
70%
60%
50%
0-points
Introduction (5%)
Clearly state own cultural Identity; Clearly state culture of chosen recipe; Clearly state why this recipe was chosen.
All information was provided in thorough detail. Thoughts and points very well organized.
All information was provided in thorough detail. Thoughts and points very well organized.
n/a
n/a
n/a
Section addressed, but incorrect information provided and/or required information is missing.
Information is not provided.
Making of the Recipe (7.5%)
Provide a description of the preparation methods used for this recipe.
All information was provided in thorough detail. Thoughts and points very well organized.
All information was provided in thorough detail. Thoughts and points very well organized.
All information was provided. Additional detail would have helped with organization and readability.
Basic information provided and/or minor parts missing. Organization fair.
Information missing and/or organization is poor making it difficult to read and understand.
Section addressed, but incorrect information provided; and/or organization poor making it difficult to read and understand.
Information is not provided.
Recipe Eval (12.5%)
Evaluated the recipe for texture, flavor, color, appearance, and overall acceptability. Include Sensory evaluation form
All information was provided in thorough detail. Thoughts and points well organized. Form is included
All information was provided in detail and correct.
Organization did not distract from readability. Form is included
All information was provided. Additional detail would have helped with organization and readability. OR form is not included
Basic information provided and/or minor parts missing. Organization fair.
OR form is not included
Information missing and/or organization is poor making it difficult to read and understand. Form is not included
Section addressed, but incorrect information provided; and/or organization poor making it difficult to read and understand. Form is not inlcuded
Information is not provided.
Flavor Notes (10%)
Discuss the common flavor notes of the culture you are reviewing.
Compare and contrast what the cookbook identifies as common flavors to what other sources identify as common flavors.
All information was provided in thorough detail. Thoughts and points well organized.
All information was provided in detail and correct.
Organization did not distract from readability.
All information was provided. Additional detail would have helped with organization and readability.
Basic information provided and/or minor parts missing. Organization fair.
Information missing and/or organization is poor making it difficult to read and understand.
Section addressed, but incorrect information provided; and/or organization poor making it difficult to read and understand
Information is not provided.
Meal Patterns (10%)
Discuss the meal patterns of the culture you are reviewing.
Compare and contrast what the cookbook identifies as common meal/eating patterns and habits, to what other sources identify as common practices.
All information was provided in thorough detail. Thoughts and points well organized.
All information was provided in detail and correct.
Organization did not distract from readability.
All information was provided. Additional detail would have helped with organization and readability.
Basic information provided and/or minor parts missing. Organization fair.
Information missing and/or organization is poor making it difficult to read and understand.
Section addressed, but incorrect information provided; and/or organization poor making it difficult to read and understand
Information is not provided.
Staple Foods (10%)
Discuss the staple foods of the culture you are reviewing.
Compare and contrast what the cookbook identifies as common staple foods of the culture/region, to what other sources identify as common staples.
All information was provided in thorough detail. Thoughts and points well organized.
All information was provided in detail and correct.
Organization did not distract from readability.
All information was provided. Additional detail would have helped with organization and readability.
Basic information provided and/or minor parts missing. Organization fair.
Information missing and/or organization is poor making it difficult to read and understand.
Section addressed, but incorrect information provided; and/or organization poor making it difficult to read and understand
Information is not provided.
Preparation Methods (10%)
Discuss the common preparation methods and/or cooking practices of the culture.
Compare and contrast what the cookbook identifies as common preparation methods, to what other sources identify as common methods.
All information was provided in thorough detail. Thoughts and points well organized.
All information was provided in detail and correct.
Organization did not distract from readability.
All information was provided. Additional detail would have helped with organization and readability.
Basic information provided and/or minor parts missing. Organization fair.
Information missing and/or organization is poor making it difficult to read and understand.
Section addressed, but incorrect information provided; and/or organization poor making it difficult to read and understand
Information is not provided.
Perceptions (10%)
Discuss how your cultural perceptions may have influenced your ideas of the food you prepared and reviewed.
All information was provided in thorough detail. Thoughts and points well organized.
All information was provided in detail and correct.
Organization did not distract from readability.
All information was provided. Additional detail would have helped with organization and readability.
Basic information provided and/or minor parts missing. Organization fair.
Information missing and/or organization is poor making it difficult to read and understand.
Section addressed, but incorrect information provided; and/or organization poor making it difficult to read and understand
Information is not provided.
References (7.5%)
Use at least 3-references: textbook, cookbook, +one other. Cite your sources correctly using APA.
All references types are used.
All in-text and reference page citations are completed correctly with APA format. All information is cited correctly.
One reference type is missing. OR
One in-text and/or one reference page citations are incorrect. APA format was used.
One reference type is missing AND/OR
Two or more incorrect in-text and/or reference page citations. APA format was used.
Two reference types are missing OR
Three or more incorrect in-text and/or reference page citations.
OR
APA Format was not used.
Two reference types are missing AND/OR
In-text citations incorrect and/or not used. Reference page citations incorrect.
OR
APA Format was not used.
Incorrect reference types.
Missing citations. Incorrect format. APA not used.
No citations references at all.
Format (5%)
The paper should be at least 3-pages in length using the appropriate font and format as outlined in the syllabus.
Paper is appropriate length, font, double spaced, and format.
Paper is of appropriate length, but incorrect format and/or font are used.
Paper is slightly short (>2- pages, <3-pages), format and/or font are correct. Paper is too short, and font and/or format are incorrect. Paper is <2 pages, correct font and format are used. Paper is <2 pages and incorrect font and/or format are used. Paper is <1-page. Spelling/Grammar(7.5%) Correct. Readability. No grammar and/or spelling errors. A few minor grammar and/or spelling errors that do not distract from reliability of the paper. Several minor grammar and/or spelling errors. Errors compromise readability of the paper. Few major errors and/ or several minor grammar and/or spelling errors. Do not distract from readability of the paper. Several major grammar and/or spelling errors. Distract from readability of the paper. Spelling and grammar errors compromise ability to understand content and readability of the paper. n/a Recipe Photo (5%) Provide a picture of the final product Picture was provided. n/a n/a n/a n/a n/a Picture was not provided.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
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Food
and
Culture
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Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
7e
Food and Culture
Australia • Brazil • Japan • Korea • Mexico • Singapore • Spain • United Kingdom • United States
Pamela Goyan Kittler, MS
Food, Culture, and Nutrition Consultant
Kathryn P. Sucher, ScD, RDN
Department of Nutrition and Food Science San Jose State University
Marcia Nahikian-Nelms, PhD, RDN, LD, CNSC
Medical Dietetics, College of Medicine, The Ohio State University
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
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© 2017, 2012 Cengage Learning
WCN: 01-100-101
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v
What Is Health? 39
Cultural Definitions of Health 39
Health Maintenance 40
Disease, Illness, and Sickness 42
Cultural Definitions of Disease, Illness,
and Sickness 42
Healing Practices 46
Pluralistic Health Care Systems 50
Medical Pluralism 50
Biomedical Healing 50
3 Intercultural
Communication 56
The Intercultural Challenge 56
Intercultural Communication
Concepts 57
Verbal Communication 58
Nonverbal Communication 62
Role of Communication in Health
Care 64
Interaction between Provider
and Client 64
Responsibilities of the Health Care
Provider 66
Successful Intercultural
Communication 66
Intercultural Communication Skills 66
Intercultural Counseling 69
Intercultural Nutrition Assessment 71
Intercultural Nutrition Education 73
Culturally Relevant Program
Preparation 74
Implementation Strategies 76
Contents
Preface ix
1 Food and Culture 1
What Is Food? 1
The Omnivore’s Paradox 2
Self-Identity 2
Symbolic Use of Food 3
Cultural Identity 4
What Is Culture? 6
The Acculturation Process 6
Acculturation of Food Habits 6
Cultural Food Habits 7
Core and Complementary Foods Model 7
Flavor Principles 8
Meal Patterns and Meal Cycles 10
Developmental Perspective of Food
Culture 11
Individual Food Habits 12
Food Availability 12
Edible or Inedible? 13
Consumer Food Choice Model 13
Nutrition and Food Habits 18
The Need for Cultural Competency 18
Intercultural Nutrition Care 22
The American Paradox 23
2 Traditional Health Beliefs
and Practices 34
Worldview 34
Cultural Outlook 34
Biomedical Worldview 37
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
vi C O N T E N T S
4 Food and Religion 82
Western Religions 83
Judaism 83
Christianity 89
Islam 94
Eastern Religions 98
Hinduism 98
Buddhism 103
5 Native Americans 107
Cultural Perspective 107
History of Native Americans 107
Worldview 110
Traditional Food
Habits 112
Ingredients and Common Foods 112
Meal Composition and Cycle 120
Daily Patterns 120
Role of Food in Native American Culture
and Etiquette 121
Therapeutic Uses of Food 122
Contemporary Food Habits 123
Adaptation of Food Habits 123
Nutritional Status 126
6 Northern and
Southern
Europeans 139
Northern Europeans 139
Cultural Perspective 140
Traditional Food Habits 144
Contemporary Food Habits in the United
States 153
Southern Europeans 157
Cultural Perspective 157
Traditional Food Habits 160
Contemporary Food Habits in the United
States 169
7 Central Europeans, People
of the Former Soviet Union,
and Scandinavians 174
Central Europeans and the People
of the FSU 174
Cultural Perspective 175
Traditional Food Habits 183
Contemporary Food Habits in the United
States 192
Scandinavians 196
Cultural Perspective 196
Traditional Food Habits 199
Contemporary Food Habits in the United
States 203
8 Africans 208
Cultural Perspective 208
History of Africans in the United
States 210
Worldview 212
Religion 212
Traditional Food Habits 214
Ingredients and Common
Foods 214
Historical Influences 214
Meal Composition and Cycle 221
Daily Patterns 221
Role of Food in African American
Society and Etiquette 223
Therapeutic Uses of Food 223
Contemporary Food Habits in the
United States 224
Adaptations of Food
Habits 224
Ingredients and Common
Foods 224
Nutritional Status 225
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C O N T E N T S vii
9 Mexicans and Central
Americans 237
Mexicans 237
Cultural Perspective 238
Traditional Food Habits 242
Contemporary Food Habits in the
United States 252
Central Americans 261
Cultural Perspective 261
Traditional Food Habits 264
Contemporary Food Habits in the
United States 268
10 Caribbean Islanders
and South Americans 278
Caribbean Islanders 278
Cultural Perspective 278
Traditional Food Habits 285
Contemporary Food Habits in the United
States 295
South Americans 301
Cultural Perspective 301
Traditional Food Habits 304
Contemporary Food Habits in the United
States 312
11 East Asians 319
Chinese 319
Cultural Perspective 320
Traditional Food Habits 325
Contemporary Food Habits in the United
States 335
Japanese 340
Cultural Perspective 340
Traditional Food Habits 343
Contemporary Food Habits in the United
States 348
Koreans 351
Cultural Perspective 352
Traditional Food Habits 354
Contemporary Food Habits in the
United States 359
12 Southeast Asians
and Pacific Islanders 370
Southeast Asians 370
Cultural Perspective 370
Traditional Food Habits 380
Contemporary Food Habits in the
United States 393
Native Hawaiians and Pacific
Islanders 399
Cultural Perspective 399
Traditional Food Habits 402
Contemporary Food Habits in the
United States 406
13 People of the Balkans
and the Middle East 416
Cultural Perspective 416
History of People of the Balkans and Middle
East in the United States 416
Current Demographics and Socioeconomic
Status 419
Worldview 420
Traditional Food Habits 425
Ingredients and Common Foods 426
Meal Composition and Cycle 434
Contemporary Food Habits in the
United States 441
Adaptations of Food Habits 441
Nutritional Status 442
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
14 South Asians 450
Cultural Perspective 450
History of Asian Indians and Pakistanis
in the United States 450
Worldview 453
Traditional Food Habits 456
Ingredients and Common Foods 457
Meal Composition and Cycle 464
Role of Food in Indian Society and
Etiquette 467
Therapeutic Uses of Food 468
Contemporary Food Habits in the United
States 470
Adaptations of Food Habits 470
Nutritional Status 472
15 Regional Americans 483
American Regional Food Habits 483
What Is Regional Fare? 483
Regional Divisions 485
The Northeast 485
Regional Profile 485
Traditional Fare 487
Health Concerns 494
The Midwest 495
Regional Profile 495
Traditional Fare 496
Health Concerns 503
The South 503
Regional Profile 503
Traditional Fare 505
Health Concerns 517
The West 517
Regional Profile 517
Traditional Fare 518
Health Concerns 530
Glossary of Ethnic Ingredients 533
Resources 545
Index 549
viii C O N T E N T S
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
ix
and nutrition-related health problems of
various ethnic and racial groups.
4. Possess specific knowledge of cultural
values, health beliefs, and nutrition
practices of particular groups served,
including culturally different clients.
This book offers information fundamental
to these competencies.
How the Book Is Organized
The first four chapters form an introduction
to the study of food and culture. Chapter 1
discusses methods for understanding food
habits within the context of culture, chang-
ing demographics, and the ways in which
ethnicity may affect nutrition and health sta-
tus. Chapter 2 focuses on the role of diet in
traditional health beliefs. Some intercultural
communication strategies are suggested in
Chapter 3, and Chapter 4 outlines the major
Eastern and Western religions and reviews
their dietary practices in detail.
Chapters 5 through 14 profile North
American ethnic groups and their cuisines.
We have chosen breadth over depth, discuss-
ing groups with significant populations in the
United States, as well as smaller, more recent
immigrant groups who have had an impact on
the health care system. Other groups with low
numbers of immigrants but notable influences
on American cooking are briefly mentioned.
Groups are considered in the approximate
order of their arrival in North America. Each
chapter begins with a history of the group in
the United States and current demographics.
Worldview (outlook on life) is then examined,
including religion, family structure, and tra-
ditional health practices. This background
information illuminates the cultural context
Preface
The population of the United States is The population of the United States is Tincreasingly heterogeneous, moving Tincreasingly heterogeneous, moving Ttoward a plurality of ethnic, religious, Ttoward a plurality of ethnic, religious, T
and regional groups. Each of these groups has
traditional food habits that differ—slightly
or significantly—from the so-called typical
American majority diet. Effective nutri-
tion counseling, education, and food service
require that these variations be acknowl-
edged and understood within the context of
culture. It is our goal to provide dietitians,
nutritionists, and food service profession-
als with the broad overview needed to avoid
ethnocentric assumptions and the nutrition
specifics helpful in working with each group
discussed. We have attempted to combine the
conceptual with the technical in a way that is
useful to other health professionals as well.
We would like to draw attention specifi-
cally to the area of nutrition counseling: “In
nutrition counseling, where many thera-
peutic interventions are on a personal level,
sensitivity to the strong influence of culture
on an individual’s food intake, attitudes, and
behaviors is especially imperative. . . . Multi-
cultural competence is not a luxury or a spe-
cialty but a requirement for every registered
dietitian” (Curry, 2000, pp. 1, 142). A model
(Harris-Davis & Haughton, 2000) recom-
mended for multicultural nutrition compe-
tencies specifically lists the following:
1. Understand food selection, preparation,
and storage with a cultural context.
2. Have knowledge of cultural eating pat-
terns and family traditions such as core
foods, traditional celebrations, and
fasting.
3. Familiarize self with relevant research and
latest findings regarding food practices
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
from which ethnic foods and food habits
emerge and evolve. The next section of each
chapter outlines the traditional diet, includ-
ing ingredients, some common dishes, meal
patterns, special occasions, the role of food in
the society, and therapeutic uses of food. The
final section explains the contemporary diet
of the group, such as adaptations made by the
group after arrival in the United States and
influences of the group on the American diet.
Reported nutritional status is reviewed, and
general counseling guidelines are provided.
One or more cultural food group tables are
found in each of the ethnic group chapters.
The emphasis is on ingredients common to the
populations of the region. Important variations
within regions and unique food habits are listed
in the “Comments” column of the table. Known
adaptations in the United States are also noted.
The tables are intended as references for the
reader; they do not replace either the chapter
content or an in-depth interview with a client.
Chapter 15 considers the regional Ameri-
can fare of the Northeast, the Midwest, the
South, and the West. Each section includes
an examination of the foods common in the
region and general nutritional status. Cana-
dian regional fare is also briefly considered.
This chapter brings the study of cultural
nutrition full circle, discussing the significant
influences of different ethnic and religious
groups on North American fare.
Chapter-Specific Changes
• Chapter 1. Food and Culture—Updated
population data.
• Chapter 2. Traditional Health Beliefs and
Practices—Updated data on the use of
complementary and alternative medicine
(CAM).
• Chapter 3. Intercultural
Communications—No changes.
• Chapter 4. Food and Religion—Updated
demographics data on religious affiliation
in the United States.
• Chapter 5. Native Americans—Updated
U.S. Census data on Native American
population and other demographics.
Updated information on current diets,
nutritional status, and medical disorders
related to diet and nutrition.
• Chapter 6. Northern and Southern
Europeans—Updated U.S. Census popula-
tion and other demographics on European
groups. Updated information on current
diets, nutritional status, and medical dis-
orders related to diet and nutrition.
• Chapter 7. Central Europeans, People
of the Former Soviet Union, and
Scandinavians—Updated U.S. Census
population and other demographics on
central and eastern European groups.
Updated information on current diets,
nutritional status, and medical disorders
related to diet and nutrition.
• Chapter 8. Africans—Updated
U.S. Census population and other
demographics on African Americans
and more recent immigrant groups from
Africa. Updated information on current
diets, nutritional status, and medical
disorders related to diet and nutrition.
• Chapter 9. Mexicans and Central
Americans—Updated U.S. Census
population and other demographics on
Mexicans and Central American groups.
Updated information on current diets,
nutritional status, and medical disorders
related to diet and nutrition.
• Chapter 10. Caribbean Islanders and
South Americans—Updated U.S. Census
population and other demographics on
Caribbean and South American groups.
Updated information on current diets,
nutritional status, and medical disorders
related to diet and nutrition.
• Chapter 11. East Asians—Updated U.S.
Census population and other demo-
graphics on East Asian groups. Updated
information on current diets, nutritional
status, and medical disorders related to
diet and nutrition.
• Chapter 12. Southeast Asians and Pacific
Islanders—Updated U.S. Census popula-
tion and other demographics on East
Asian groups. Updated information on
current diets, nutritional status, and medi-
cal disorders related to diet and nutrition.
x P R E F A C E
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
• Chapter 13. People of the Balkans and the
Middle East—Updated U.S. Census popu-
lation and other demographics on Balkan
and Middle Eastern groups. Updated
information on current diets, nutritional
status, and medical disorders related to
diet and nutrition.
• Chapter 14. South Asians—Updated U.S.
Census population and other demograph-
ics on South Asian groups. Updated
information on current diets, nutritional
status, and medical disorders related to
diet and nutrition.
• Chapter 15. Regional Americans—
Updated U.S. Census regional popula-
tion and other demographics. Updated
information on current diets, nutritional
status, and medical disorders related to
diet and nutrition.
Before You Begin
Food is so essential to ethnic, religious, and
regional identity that dietary descriptions
must be as objective as possible to prevent
inadvertent criticism of the underlying culture.
Yet as members of two Western ethnic and
religious groups, we recognize that our own
cultural assumptions are unavoidable and, in
fact, serve as a starting point for our work. One
would be lost without such a cultural footing.
Any instances of bias are unintentional.
Any definition of a group’s food habits
implies homogeneity in the described group. In
daily life, however, each member of a group has
a distinctive diet, combining traditional prac-
tices with new influences. We do not want to
stereotype the fare of any cultural group. Rather,
we strive to generalize common U.S. food and
culture trends as a basis for understanding the
personal preferences of individual clients.
We have tried to be sensitive to the desig-
nations used by each cultural group, though
sometimes there is no consensus among
members regarding the preferred name for
the group. Also, there may be some confusion
about dates in the book. Nearly all religious
traditions adhere to their own calendar of
events based on solar or lunar months. These
calendars frequently differ from the Grego-
rian calendar used throughout most of the
world in business and government. Religious
ceremonies often move around according
to Gregorian dates, yet usually they are cal-
culated to occur in the correct season each
year. Historical events in the text are listed
according to the Gregorian calendar, using the
abbreviations for before common era (BCE)
and common era (CE).
We believe this book will do more than
introduce the concepts of food and culture. It
should also encourage self-examination and
individual cultural identification by the reader.
We hope that it will help dietitians, nutrition-
ists, other health care providers, and food
service professionals work effectively with
members of different ethnic, religious, and
regional groups. If it sparks a gustatory interest
in the foods of the world, we will be personally
pleased. De gustibus non est disputatum!
Acknowledgments
We are forever indebted to the many research-
ers, especially from the fields of anthropology
and sociology, who did the seminal work on
food habits that provided the groundwork for
this book, and to the many nutrition profes-
sionals who have shared their expertise with
us over the years. We especially want to thank
the many colleagues who have graciously
given support and advice in the development
of the numerous editions: Carmen Boyd, MS,
LPC, RD, Missouri State University; Bonny
Burns-Whitmore, DrPH, RD, California State
Polytechnic University, Pomona; Arlene Grant-
Holcomb, RD, MAE, California State Poly-
technic University, San Luis Obispo; Carolyn
Hollingshead, PhD, RD, University of Utah;
Tawni Holmes, PhD, RD, University of Cen-
tral Oklahoma; Claire G. Kratz, MS, RD, LDN,
Montgomery County Community College;
Yvonne Moody, EdD, Chadron State College;
Sudha Raj, PhD, Syracuse University; Stacey A.
Roush, MS, Montgomery County Community
College; Dana Wassmer, MS, RD, Cosumnes
River College; and Donna M. Winham, DrPH,
Arizona State University. We are grateful for the
expertise of Gerald Nelms, PhD, as his develop-
ment of the discussion starters during the 6th
edition revision was an important contribution
to the pedagogy for this text.
P R E F A C E xi
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
1
What Is Food?
Food, as defined in the dictionary, is any sub-
stance that provides the nutrients necessary to
maintain life and growth when ingested. When
most animals feed, they repeatedly consume
those foods necessary for their well-being, and
they do so in a similar manner at each feeding.
Humans, however, do not feed. They eat.
Eating is distinguished from feeding by
the ways humans use food. Humans not only
gather or hunt food, but they also cultivate
plants and raise livestock. Agriculture means
that some foods are regularly available, alle-
viating hand-to-mouth sustenance. This
permits the development of specific customs
associated with foods that are the foundation
of the diet, such as wheat or rice. Humans
also cook, softening tough foods, including
raw grains and meats, and combine foods to
create new textures and taste sensations. This
greatly expands the number and variety of
edible substances available. What follows are
rules regarding what can be eaten with what
and creates the meal. Humans use utensils to
eat meals and institute complex rules, com-
monly called manners, about how meals are
consumed. And, significantly, humans share
food. Standards for who may dine with whom
in each eating situation are well defined.
The term f ood h abits (also called food cul-
ture or foodways) refers to the ways in which
humans use food, including everything from
how it is selected, obtained, and distributed
to who prepares it, serves it, and eats it.
The significance of this process is unique to
Food and Culture
What do Americans eat? Meat and potatoes, according to popular myth. There’s no denying that
per person in the United States, an average
of over half a pound of beef, pork, lamb, or
veal is eaten daily, and more than one hun-
dred pounds of potatoes (mostly as chips and
fries) are consumed annually. Yet the Ameri-
can diet is as diverse as its population, and we
should no longer describe the U.S. population
as white, Anglo-Saxon, and Protestant, or the
diet as consisting of mostly meat and potatoes.
U.S. Census and other demographic data
show that close to 40 percent of Americans are
not white, 13 percent are foreign born, 11 per-
cent have one parent who was foreign born,
and one in five people in the United States are
first or second generation. More than seventy-
five different ancestry groups were reported
in 2007.1,2 In that year the fastest and largest
growing ethnic groups in America were from
Latin America, but more recently Asians
became the fastest growing race or ethnic
group.3
Each American ethnic, religious, or regional
group has its own culturally based food hab-
its. Many of these customs have been modified
through contact with American culture and, in
turn, they have changed and shaped American
food habits. Today, a fast-food restaurant or
street stand is as likely to offer pizza, tacos,
egg rolls, or falafel as it is hamburgers. It is the
intricate interplay between food habits of the
past and the present, the old and the new, and
the traditional and the innovative that is the
hallmark of the American diet.
As suggested by their
names, not even ham-
burgers and French fries
are American in origin.
Chopped beef steaks
were introduced to the
United States from the
German city of Hamburg
in the late nineteenth
century. The American
term French-fried pota-
toes first appeared in
the 1860s and was prob-
ably coined to describe
the method used in
France for deep-frying
potato pieces until crisp.
Other foods considered
typically American also
have foreign origins, for
example, hot dogs, apple
pie, and ice cream.
Data from the 2006
Canadian census indicate
more than 200 differ-
ent ethnic origins were
documented. The most
common ethnic groups
noted included English,
French, Scottish, Irish,
German, Italian, Chinese,
North American Indian,
Ukrainian, and Dutch.
Newer groups include
individuals from Mont-
serrat in the Carribean
and African countries
such as Chad, Gabon,
Gambia, and Zambia.90
1CHA
P
T
E
R
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
2 F O O D A N D C U L T U R E
humankind. Why don’t people simply feed on
the diet of our primitive ancestors, surviving
on foraged fruits, vegetables, grains, and the
occasional insect or small mammal thrown
in for protein? Why do people choose to
spend their time, energy, money, and creativ-
ity on eating? The answers to these questions,
according to some researchers, can be found
in the basic biological and psychological con-
stitution of humans.
The Omnivore’s Paradox
Humans are omnivorous, meaning that they
can consume and digest a wide selection of
plants and animals found in their surround-
ings. The primary advantage to this is that
they can live in various climates and terrains.
Because no single food provides the nutrition
necessary for survival, humans must be able to
eat enough of a variety of items, yet cautious
enough not to ingest foods that are harmful
and, possibly, fatal. This dilemma, the need to
experiment combined with the need for cau-
tion, is known as the omnivore’s paradox.4,5
It results in two contradictory psychological
impulses regarding eating—an attraction to
new foods, but a preference for familiar foods.
The food habits developed by a community
provide the framework that reduces the anxi-
ety produced by these opposing desires. Rules
about which foods are edible, how they are
procured and cooked, how they should taste,
It is thought that children
are less likely than adults
to try new foods, in part
because they have not
yet learned cultural rules
regarding what is safe
and edible. A child who
is exposed repeatedly to
new items loses the fear
of new foods faster than
one who experiences a
limited diet.11
▲ Humans create complex
rules, commonly called
manners, about how food
is to be eaten.
To
m
M
cC
ar
th
y/
Ph
ot
oE
di
t
and when they should be consumed provide
guidelines for both testing new foods (based
on previous experience with similar plants
and animals or flavors and textures) and
maintaining food traditions through ritual
and repetition.
Self-Identity
The choice of which foods to ingest is fur-
ther complicated by another psychological
concept regarding eating—the incorpora-
tion of food. This means that consumption is
not just the conversion of food into nutrients
in the human body, but also includes gaining
the food’s physical properties as well—hence
the phrase “You are what you eat.” In most
cases this refers to the physical properties of
a food expressed through incorporation. For
example, some Asian Indians eat walnuts,
which look like miniature brains, to make
them smarter, and weight lifters may dine on
rare meat to build muscle. In other cases, the
character of the food is incorporated. Some
Native Americans believe that because milk is
a food for infants, it will weaken adults. The
French say a person who eats too many tur-
nips becomes gutless, and some Vietnamese
consume gelatinized tiger bones to improve
their strength.
It is a small step from incorporating the
traits associated with a specific food to mak-
ing assumptions about a total diet. The cor-
relation between what people eat, how others
perceive them, and how they characterize
themselves is striking. In one study research-
ers listed five typical diets: vegetarian (kale
quiche, brown rice, avocado, and bean sprout
sandwich), gourmet (oysters, caviar, French
roast coffee), health food (protein shake,
wheat germ, yogurt), and fast food (ham-
burger, fried chicken, pizza). It was found that
each category was associated with a certain
personality type. Vegetarians were consid-
ered to be pacifists and likely to drive foreign
cars. Gourmets were believed to be liberal and
sophisticated. Health food fans were described
as antinuclear activists and were also liberal.
Fast-food eaters were believed to be religious,
conservative, and fond of polyester cloth-
ing. These stereotypes were confirmed by
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 3
self-description and personality tests com-
pleted by people whose diets fell into the five
categories.6
Another study asked college students to
rate profiles of people based on their diets.
Those who ate “good” foods were judged to
be thinner, more fit, and more active than
people with the identical physical character-
istics and exercise habits who ate “bad” foods.
Furthermore, the people who ate “good” foods
were perceived by some students as being
more attractive, likable, practical, methodi-
cal, quiet, and analytical than people who
ate “bad” foods. The researchers attribute the
strong morality-food effect to several fac-
tors, including the concept of incorporation
and a prevailing Puritan ethic that espouses
self-discipline.7
Food choice is, in fact, influenced by self-
identity, a process whereby the food likes or
dislikes of someone else are accepted and
internalized as personal preferences. Research
suggests that children choose foods eaten by
admired adults (e.g., teachers), fictional char-
acters, peers, and especially older siblings.
Parents have little long-lasting influence.
Group approval or disapproval of a food can
also condition a person’s acceptance or rejec-
tion. This may explain why certain relatively
unpalatable items, such as chili peppers or
unsweetened coffee, are enjoyed if intro-
duced through socially mediated events, such
as family meals or workplace snack breaks.
Although the mechanism for the internaliza-
tion of food preference and self-identity is not
well understood, it is considered a significant
factor in the development of food habits.8,9
A study on the consumption of organic
vegetables, for example, found that those who
identified themselves as green (people who are
concerned with ecology and make consumer
decisions based on this concern) predicted an
intention to eat organic items independent of
other attitudes, such as perceived flavor and
health benefits.9
Food as self-identity is especially evident
in the experience of dining out. Researchers
suggest that restaurants often serve more than
food, satisfying both emotional and physi-
cal needs. A diner may consider the menu,
atmosphere, service, and cost or value when
selecting a restaurant; and most establish-
ments cater to a specific clientele. Some offer
quick, inexpensive meals and play equipment
to attract families. Business clubs feature a
conservative setting suitable for financial
transactions, and the candlelit ambiance of
a bistro is conducive to romance. The same
diner may choose the first in her role as a
mother, the second while at work, and the
last when meeting a date. In Japan, restaurants
serve as surrogate homes where company is
entertained, preserving the privacy of family
life. The host chooses and pays for the meal
ahead of time, all guests are provided the same
dishes, and the servers are expected to partake
in the conversation. Ethnic restaurants appeal
to those individuals seeking familiarity and
authenticity in the foods of their homeland
or those interested in novelty and culinary
adventure. Conversely, exposure to different
foods in restaurants is sometimes the first step
in adopting new food items at home.10
Symbolic Use of Food
The development of food habits clearly indi-
cates that for humans, food is more than just
nutrients. Humans use foods symbolically,
due to relationship, association, or conven-
tion. Bread is an excellent example—it is
called the staff of life; one breaks bread with
friends, and bread represents the body of
Christ in the Christian sacrament of com-
munion. White bread was traditionally eaten
by the upper classes, dark bread by the poor,
but whole wheat bread is consumed today by
people concerned more with health than sta-
tus. A person with money has “a lot of bread.”
In many cultures, bread is shared by couples
as part of the wedding ceremony or left for
the soul of the dead. Superstitions about bread
also demonstrate its importance beyond sus-
tenance. Greek soldiers took a piece from
home to ensure their safe, victorious return;
English midwives placed a loaf at the foot of
the mother’s bed to prevent the woman and
her baby from being stolen by evil spirits; and
sailors traditionally brought a bun to sea to
prevent shipwreck. It is the symbolic use of
a food that is valued most by people, not its
nutritional composition.
The inability to express
self-identity through
food habits can be devas-
tating. A study of persons
with permanent feeding
tubes living at home or
in nursing facilities found
they frequently avoided
meals with families and
friends. They missed
their favorite foods, but
more important, they
mourned the loss of their
self-identities reinforced
by these daily social
interactions.106
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
4 F O O D A N D C U L T U R E
Cultural Identity
An essential symbolic function of food is cul-
tural identity. What one eats defines who one
is, culturally speaking, and, conversely, who
one is not. In the Middle East, for example,
a person who eats pork is probably Roman
Catholic or Orthodox Christian, not Jewish
or Muslim (pork is prohibited in Judaism
and Islam). Ravioli served with roast turkey
suggest an Italian American family celebrat-
ing Thanksgiving, not a Mexican American
family, who would be more likely to dine on
tamales and turkey. The food habits of each
cultural group are often linked to religious
beliefs or ethnic behaviors. Eating is a daily
reaffirmation of cultural identity (Figure 1.1).
Foods that demonstrate affiliation with a
culture are usually introduced during child-
hood and are associated with security or
good memories. Such foods hold special
worth to a person, even if other diets have
been adopted due to changes in residence,
religious membership, health status, or daily
personal preference. They may be eaten dur-
ing ethnic holidays and for personal events,
such as birthdays or weddings, or during
times of stress. These items are sometimes
called comfort foods because they satisfy the
basic psychological need for food familiarity.
For example, in the United States one study
found comfort foods for women required
little preparation and tended to be snacks,
such as potato chips, ice cream, chocolate,
and cookies; men preferred foods served by
their mothers, such as soup, pizza or pasta,
steak, and mashed potatoes.11 Occasionally,
a person embraces a certain diet as an adult
to establish association with a group. A con-
vert to Judaism, for instance, may adhere to
the kosher dietary laws. African Americans
who live outside the South may occasionally
choose to eat soul food (typically southern
black cuisine, such as pork ribs and greens)
as an expression of ethnic solidarity.
Figure 1.1
An edible map—
food-related names of
cities and towns in the
United States. Food often
means more than simply
nutrients.
Source: From All Over the Map:
An Extraordinary Atlas of the United
States: Featuring Towns That Actually
Exist! by David Jouris, copyright Exist! by David Jouris, copyright Exist!
© 1994 by David Jouris. Used by
permission of Ten Speed Press, an
imprint of Crown Publishing Group, a
division of Random House, Inc.
Feeding
Hills
Beanville Cornish
Suncook
Commons
Bakersville
CranberryCranberryCranberryCranberryCranberryCranberryCranberry
IslesIsles
FeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeedingFeeding
HillsHillsHillsHillsHillsHillsHillsHillsHillsHillsHillsHillsHillsHillsHillsHillsHillsHillsHillsHillsHills
BeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanvilleBeanville CornishCornishCornishCornishCornishCornishCornishCornishCornishCornishCornishCornishCornishCornishCornishCornishCornishCornishCornishCornishCornishCornishCornishCornishCornishCornishCornishCornishCornishCornishCornishCornishCornish
SuncookSuncookSuncookSuncookSuncookSuncookSuncookSuncookSuncookSuncookSuncookSuncookSuncookSuncookSuncookSuncookSuncookSuncookSuncookSuncookSuncookSuncookSuncookSuncookSuncookSuncookSuncookSuncookSuncookSuncookSuncookSuncookSuncookSuncookSuncookSuncookSuncookSuncookSuncook
CommonsCommonsCommonsCommonsCommonsCommonsCommonsCommonsCommonsCommonsCommonsCommonsCommonsCommonsCommonsCommonsCommonsCommonsCommonsCommonsCommonsCommonsCommonsCommonsCommonsCommonsCommonsCommons
BakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersvilleBakersville
Muttonville
Clove
Oniontown
Grill
Cress
Chewsville
Custards
NectarineNectarineNectarineNectarineNectarineNectarineNectarineNectarineNectarineNectarineNectarineNectarineNectarineNectarineNectarineNectarineNectarineNectarineNectarineNectarineNectarineNectarineNectarineNectarineNectarineNectarineNectarineNectarineNectarineCeleryville
Kitchen
SandwichSandwich
AdlaiAdlaiAdlaiAdlaiAdlaiAdlaiAdlaiAdlaiAdlaiAdlai
MustardMustardMustardMustardMustardMustardMustardMustardMustardMustardMustardMustardMustardMustardMustardMustardMustardMustardMustardMustardMustardMustardMustardMustard
Kabob
Cookville
KabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabobKabob
CookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookvilleCookville
CookstownCookstownCookstownCookstownCookstownCookstownCookstownCookstownCookstownCookstownCookstownCookstownCookstownCookstownCookstownCookstownCookstownCookstownCookstownCookstownCookstownCookstownCookstownCookstownCookstownCookstownCookstownCookstownCookstownCookstownCookstownCookstownCookstownCookstownCookstownCookstown
LeektownLeektownLeektownLeektownLeektownLeektownLeektownLeektownLeektownLeektownLeektownLeektownLeektown
BarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarleyBarley
Gloucester
GlaceGlace
SpiceSpiceSpiceSpiceSpiceSpiceSpiceSpiceSpiceSpiceSpiceSpiceSpiceSpiceSpiceSpiceSpiceSpiceSpiceSpiceSpice
PepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepperPepper
BaconBaconBaconBaconBaconBaconBaconBaconBaconBacon
Toast
Mayo
PeakPeak Oats
Veal
Rocket
Mint
Ice
DuffDuffDuffDuffDuffDuffDuffDuffDuff
LambLambLambLambLambLambLambLambLambLambLamb
Farina
BerryBerry
CrackerCrackerCrackerCrackerCrackerCrackerCrackerCrackerCrackerCrackerCrackerCrackerCrackerCrackerCrackerCrackerCrackerCrackerCrackerCrackerCrackerCrackerCrackerRabbitRabbit
Hash
Greens
BasilTaffy
Mace
Grape
Jam
Cooks
Cook
Blackberry
Frost
Kalo
CanningCanning
Buffalo
Yampa
Fruitland
FruitlandFruitland
Sugar
City
Rye
Sugarville
Honeyville
RosetteRosetteRosetteRosetteRosetteRosetteRosetteRosetteRosetteRosetteRosetteRosetteRosetteRosetteRosetteRosetteRosetteRosetteRosetteRosette
Shell
Currant
PanochePanochePanochePanochePanochePanochePanochePanochePanochePanochePanochePanochePanochePanochePanochePanochePanochePanochePanochePanochePanochePanochePanochePanochePanochePanochePanochePanochePanochePanochePanochePanochePanochePanochePanochePanochePanochePanochePanoche
Olive
Straw
Curry
Melba
Gervais
NonpareilNonpareil
Raisin
Jelly
Honeydew
Forks of SalmonForks of SalmonForks of SalmonForks of SalmonForks of SalmonForks of SalmonForks of SalmonForks of Salmon
Aromas
Tomales
Coquille
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Sweet
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Marengo
Dixie
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Fried
Newburg
Bismarck
Baxter
Kensington
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Castana
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Surprise
Cook
Hominy
Greasy
Okra
Oatmeal
Comal
Apple
Noodle
Plum
Lollipop
Ginger
Crisp
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Sandia
Platter
Apple
Platter
Apple
Corn
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Pumpkin Center
Littlefork
Plat
Sears
Cream
Rusk
Range
BlueberryBlueberry
GnawGnaw
Bone
Pimento
Napoleon
Herbs
Rice
Peck
Salty
Yum YumTomato
GumboGumbo
Cook StationCook Station
Peel
SageSage
Durian
DillDillDillDillDillDillDillDillDillDillDillDill
Eggville
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Rosemary
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MuscadineMuscadine
Almond
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Five
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Plateau
Bread Springs
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Pie Town
Cherry
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Roll
Chili
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Mango
Coconut
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Picnic
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Bayleaf
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Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 5
The reverse is also true. One way to estab-
lish that a person is not a member of a certain
cultural group is through diet. Researchers
suggest that when one first eats the food of
another cultural group, a chain of reasoning
occurs, beginning with the recognition that
one is experiencing a new flavor and ending
with the assumption that this new flavor is an
authentic marker of other group members.12
Ethnic groups may be denigrated by using
food stereotyping, and such slurs are found
in nearly all cultures. In the United States,
Germans are sometimes called “krauts,”
Chinese “cookies” or “dim sums,” Italians
“spaghetti benders,” Mexicans “beaners,” Irish
“potatoheads,” Koreans “kimchi,” and poor
white southerners “crackers” (possibly from
“corncracker,” someone who cracks corn to
distill whiskey or from early immigrants to
Georgia who survived on biscuits).
Foods that come from other cultures may
also be distinguished as foreign to maintain
group separation. K af ir , a derogatory Ara-
bic term for “infidel,” was used to label some
items found in areas they colonized, includ-
ing the knobby kaffir lime of Malaysia, and
kaffir corn (millet) in Africa. Similarly, when
some non-Asian foods were introduced to
China, they were labeled barbarian or Wester
and named after items already familiar in the
diet. Thus, sweet potatoes were called barbar-
ian yams, and tomatoes became barbarian
eggplants.13 Less provocative place names
are used, too, though the origins of the food
are often incorrect, such as T ur k ey w h eat (the T ur k ey w h eat (the T ur k ey w h eat
Dutch term for native American corn, which
was thought to come from Turkey) and Irish
potatoes (which are indigenous to Peru but
were brought to the United States by immi-
grants from Ireland). The powerful symbolic
significance of food terms leads occasionally
to renaming foreign items in an attempt to
assert a new cultural identity. Turkish coffee
(it was the Ottomans of Turkey who popu-
larized this thick, dark brew from Africa and
spread it through their empire) became Greek
coffee in Greece after tensions between the
two nations escalated in the 1920s. Examples
in the United States include renaming sauer-
kraut liberty cabbage during World War I, and
more recently, calling French fries freedom
fries when France opposed the United States
in the invasion of Iraq.
The appropriate use of food and the
behaviors associated with eating, also known
as etiquette, are another expression of group
membership. In the United States, entirely dif-membership. In the United States, entirely dif-membership. In the United States, entirely dif
ferent manners are required during a business
lunch at an expensive restaurant, when eating
in the school cafeteria, when drinking with
friends at a bar, or when dining with a date.
Discomfort can occur if a person is unfamil-
iar with the rules, and if a person deliberately
breaks the rules, he or she may be ostracized
or shunned.
Another function of food symbolism is to
define status—a person’s position or ranking
within a particular cultural group. Food can
be used to signify economic social standing:
champagne, Kobe beef, and truffles suggest
wealth; trendy hip restaurants suggest upward
mobility; and beans or potatoes are tradition-
ally associated with the poor. Status foods are
characteristically used for social interaction.
In the United States, a wife may appreciate
a box of chocolates from her husband—but
not a bundle of broccoli. Wine is considered
an appropriate gift to a hostess—a gallon of
milk is not. In general, eating with someone
connotes social equality with that person.
Many societies regulate commensalism (who
can dine together) as a means of establishing
class relationships. Men may eat separately
from women and children, or servants may
eat in the kitchen, away from their employ-
ers. In India, the separate social castes did not
traditionally dine together, nor were people
of higher castes permitted to eat food pre-
pared by someone of a lower caste. This class
Children younger than
age two will eat anything
and everything. Children
between three and six
years of age begin to
reject culturally unac-
ceptable food items. By
age seven, children are
completely repulsed
by foods that their
culture categorizes as
repugnant.107
Typically, first-generation
immigrants remain
emotionally connected to
their ethnicity, surrounding
themselves with a reference
group of family and friends
who share their cultural
background.
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Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
6 F O O D A N D C U L T U R E
segregation was also seen in some U.S. restau-
rants that excluded blacks before civil rights
legislation of the 1960s.
What Is Culture?
Culture is broadly defined as the values,
beliefs, attitudes, and practices accepted by
members of a group or community. Culture
is learned, not inherited; it is passed from gen-
eration to generation through language and
socialization in a process called encultura-
tion.14 Yet culture is not rigid and does change
over time in response to group dynamics.15
Cultural membership is defined by ethnic-
ity. Unlike national origin (which may include
numerous ethnic groups), ethnicity is a social
identity associated with shared behavior pat-
terns, including food habits, dress, language,
family structure, and often religious affili-
ation.15 Members of the same ethnic group
usually have a common heritage through
locality or history and participate together
with other cultural groups in a larger social
system. As part of this greater community,
each ethnic group may have different status
or positions of power. Diversity within each
cultural group is also common due to racial,
regional, or economic divisions as well as dif-regional, or economic divisions as well as dif-regional, or economic divisions as well as dif
fering rates of acculturation to the majority
culture.16
The Acculturation Process
When people from one ethnicity move to an
area with different cultural norms, adapta-
tion to the new majority society begins. This
process is known as acculturation, and it takes
place along a continuum of behavior patterns
that can be very fluid, moving back and forth
between traditional practices and adopted
customs. It occurs at the micro level, reflect-
ing an individual’s change in attitudes, beliefs,
and behaviors, and at the macro level, result-
ing in group changes that may be physical,
economic, social, or political in nature.17,18,19
Typically, first-generation immigrants remain
emotionally connected to their culture of ori-
gin. They integrate into their new society by
adopting some majority culture values and
practices but generally surround themselves
with a reference group of family and friends
from their ethnic background. For example,
Asian Indians living in the United States who
consider themselves to be “mostly or very
Asian Indian” may encourage their children
to speak English and allow them to celebrate
American holidays, but usually do not permit
them to date non-Asian Indian peers.20
Other immigrants become bicultural,
which happens when the new majority cul-
ture is seen as complementing, rather than
competing with, an individual’s ethnicity.
The positive aspects of both societies are
embraced, and the individual develops the
skills needed to operate within either cul-
ture.21 Asian Indians who call themselves
Indo-Americans or Asian Indian Americans
fall into this category, eating equal amounts
of Indian and American foods, thinking and
reading equally in an Indian language and in
English. Assimilation occurs when people
from one cultural group shed their ethnic
identity and fully merge into the majority cul-
ture. Although some first-generation immi-
grants strive toward assimilation, due perhaps
to personal determination to survive in a for-
eign country or to take advantage of oppor-
tunities, most often assimilation takes place
in subsequent generations. Asian Indians who
identify themselves as being “mostly Ameri-
can” do not consider Asian Indian culture
superior to American culture, and they are
willing to let their children date non-Indians.
It is believed that ethnic pride is reawakened
in some immigrants if they become disillu-
sioned with life in America, particularly if
the disappointment is attributed to prejudice
from the majority society. A few immigrants
exist at the edges of the acculturation pro-
cess, either maintaining total ethnic identity
or rejecting both their culture of origin and
that of the majority culture.22
Acculturation of Food
Habits
Culturally based food habits are often the last
practices people change through accultura-
tion. Unlike speaking a foreign language or
wearing traditional clothing, eating is usu-
ally done in the privacy of the home, hidden
Ethnocentric is the term
applied to a person
who uses his or her own
values to evaluate the
behaviors of others. It
may be done uncon-
sciously or in the con-
scious belief that their
own habits are superior
to those of another
culture. Ethnorelativism
occurs when a person
assumes that all cultural
values have equal valid-
ity, resulting in moral
paralysis and an inability
to advocate for a belief.
Prejudice is hostility
directed toward persons
of different cultural
groups because they are
members of such groups;
it does not account for
individual differences.108
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 7
from observation by others. Adoption of
new food items does not generally develop
as a steady progression from traditional diet
to the diet of the majority culture. Instead,
research indicates that the consumption of
new items is often independent of traditional
food habits.17,18 The lack of available native
ingredients may force immediate accultura-
tion, or convenience or cost factors may speed
change. Samoans may be unable to find the
fresh coconut cream needed to prepare favor-
ite dishes, for instance, or an Iranian may
find the cost of saffron prohibitive. Some
immigrants, however, adapt the foods of the
new culture to the preparation of traditional
dishes.17 Tasty foods are easily accepted—
fast food, pastries, candies, and soft drinks;
conversely, unpopular traditional foods may
be the first to go. Mexican children living in
the United States quickly reject certain cuts
of meat, such as tripe, that their parents still
enjoy. It is the foods most associated with eth-
nic identity that are most resistant to accultur-
ation. Muslims will probably never eat pork,
regardless of where they live. People from sev-
eral Asian countries may insist on eating rice
with every meal, even if it is the only Asian
food on the table.
Cultural Food Habits
Food functions vary culturally, and each
group creates categories reflective of their
priorities. In the United States, food has been
typically classified by food group (protein,
dairy, cereal and grain, fruits and vegetables),
by percentage of important nutrients (as iden-
tified in Dietary Reference Intake [DRI] for
energy, protein, fat, carbohydrates, vitamins,
and minerals), or according to recommenda-
tions for health. American models, especially
the Dietary Guidelines for Americans 2010
and the new model, ChooseMyPlate, outline
current dietary recommendations to sup-
port health guidelines. These categories also
suggest that Americans value food more for
nutritional content and impact on health than
for any symbolic use. But only limited infor-
mation is provided about U.S. food habits;
although these schemes list what foods people
eat, they reveal nothing about how, when, or
why foods are consumed.
Culturally based categories are commonly
used by members of each culture. Examples
found in both developing and industrialized
societies include cultural superfoods, usu-
ally staples that have a dominant role in the
diet; prestige foods, often protein items or
expensive or rare foods; body image foods,
believed to influence health, beauty, and well-
being; sympathetic magic foods, whose traits,
through association of color or form, are
incorporated; and physiologic group foods,
reserved for, or forbidden to, groups with cer-
tain physiologic status, such as gender, age, or
health condition.23
Researchers have proposed numerous
models to understand the food habits of dif-models to understand the food habits of dif-models to understand the food habits of dif
ferent cultures. Some of these models are help-
ful in understanding the role of food within a
culture, including:
1. C or e and c ompl ementar y f oods model:
frequency of food consumption
2. F ood- f l av or pr inc ipl es: ways a culture
traditionally prepares and seasons its
foods
3. M eal patter ns and meal c y c l es: daily,
weekly, and yearly use of food
4. Dev el opmental per spec tiv e of f ood
c ul tur e: changes in food functions that
emerge during structural growth in a
culture
Core and Complementary
Foods Model
Foods selected by a culture can be grouped
according to how often they’re consumed.
Core foods are staples regularly included in a
person’s diet, usually on a daily basis.24 These
typically include complex carbohydrates,
such as rice, wheat, corn, yams, cassava, taro,
or plantains. Foods widely but less frequently
eaten are termed secondary foods. These
items, such as chicken or lettuce or apples,
are consumed once a week or more, but not
daily. Foods eaten only sporadically are called
peripheral foods. These foods are characteris-
tic of individual food preference, not cultural
group habit.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
8 F O O D A N D C U L T U R E
A slightly different version of this model
suggests that in many cultures, the core food is
always served with fringe, or complementary,
items to improve palatability (Figure 1.2).25
Because most starchy staples are bland and
uniform in texture, these flavorful foods, eaten
in small quantities, encourage consumption of
the core food as the bulk of the diet. Legumes,
for example, are sometimes a complemen-
tary food and sometimes a secondary food.
It has been hypothesized that these core and
complementary food pairings often combine
to provide nutritionally adequate meals, espe-
cially when legumes are included. Another
example is in cultures where a grain is a core
food and additional sources of vitamins A
and C are required. Rice, breads and pastas,
and corn are frequently prepared with leafy
green vegetables, abundant herbs, or toma-
toes, which are high in these needed nutrients.
Chinese rice with pickled vegetables, Italian
noodles with tomato sauce, Mexican corn tor-
tillas with salsa, and Middle Eastern pilaf with
parsley and dried fruit are examples. When
the core diet is almost adequate nutritionally,
the addition of secondary foods—including
legumes (soybean products in China; beans or
lentils in Italy; red or pinto beans in Mexico;
and chickpeas, fava beans, and lentils in the
Middle East), small amounts of meats, poul-
try, fish, and cheeses or yogurt—can provide
the necessary balance.
Changes in food behaviors are believed
to happen most often with peripheral foods
and then core foods. A person who is will-
ing to omit foods that she or he rarely eats
is typically much more reluctant to change
those eaten daily and associated with her or
his cultural identity. Although little has been
reported on the significance of complemen-
tary foods in diet modification, presumably,
if complementary items were altered or omit-
ted, the core would no longer be palatable.
The complementary foods provide the flavor
familiarity associated with the core.
Flavor Principles
The significance of food flavor cannot be
overestimated. The ways foods are prepared
and seasoned is only second in importance
to the initial selection of ingredients. It is no
less than the transformation of feeding into
eating.
Foods demonstrate variability according
to location. Much is made, for example, of
wine ter r oir —the soil texture, natural miner-
als, drainage, source of water, sun exposure,
average temperature, and other environmen-
tal factors in which grapes are grown for wine
production. Each region and every vineyard
are distinctive, often producing appreciable
differences in the resulting product. Yet this
variation is insignificant when compared to
how foods in general are processed for con-
sumption. Every technique, from preparation
for cooking (e.g., washing, hulling or peeling,
chopping, pounding, squeezing, soaking,
leaching, and marinating) to cooking (e.g.,
baking, roasting, grilling, stewing, toasting,
steaming, boiling, and frying) and preserv-
ing (e.g., drying, curing, canning, pickling,
fermenting, and freezing), alters the original
flavor of the ingredient. Nevertheless, loca-
tion and manipulation practices alone do
not equal cuisine. For that, foods must be
seasoned.
Historians and scientists speculate there
are several reasons why herbs and spices have
assumed such an essential role in food habits.
Foremost is palatability. Salt, one of the most
widely used seasonings, prompts an innate
human taste response. It is enjoyed by most
people and physiologically craved by some.
Figure 1.2
The core and complemen-
tary foods model.
Complementary
Foods
Core
Foods
Secondary Foods
Peripheral Foods
©
C
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ga
ge
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ea
rn
in
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Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 9
Researchers also suggest that the burn of chili
peppers (and perhaps other spices) may trig-
ger the release of pleasurable endorphins.
Another recurrent theory on the popular-
ity of seasoning early on was to disguise the
taste of spoiled meats, though evidence for
this is limited. A more plausible assertion is
that spices were found effective in preserving
meats. A survey of recipes worldwide sug-
gested that the antimicrobial activity of spices
accounts for their widespread use, especially
in hot climates.26 Other researchers speculate
that eating chili peppers (and, by extension,
other hot seasonings such as mustard, horse-
radish, and wasabi) is a benign form of risk
taking that provides a safe thrill.27 Addition-
ally, the recurrent use of seasonings may pro-
vide the familiarity sought in the omnivore’s
dilemma.28
Theories aside, seasonings can be used
to classify cuisines culturally.28,29 Unique
seasoning combinations, termed f l av or
pr inc ipl es, typify the foods of ethnic groups
worldwide. They are so distinctive that few
people mistake their use. For example, a
dish flavored with soy sauce is Asian and not
European. These seasoning combinations are
often found in the complementary foods of
the core and complementary foods model,
providing the flavors associated with the
starchy carbohydrates that are the staples of
a culture. They usually include herbs, spices,
vegetables, and a fat or oil, although many
variations exist. A principle flavor combina-
tion in West Africa is tomatoes, onion, and
chili peppers that have been sauté in palm
oil. In the Pacific Islands, a flavor principle is
coconut milk or cream with a little lime juice
and salt. Yams taste like West African food
when topped with the tomato mixture and
like Pacific Islander food when served with
the coconut sauce. Some widely recognizable
flavor principles include:
• Asian Indian: garam masala (curry blend
of coriander, cumin, fenugreek, turmeric,
black pepper, cayenne, cloves, cardamom,
and chili peppers)
• Brazilian (Bahia): chili peppers, dried
shrimp, ginger root, and palm oil
• Chinese: soy sauce, rice wine, and ginger
root
• French: butter, cream, wine, boquet garni
(selected herbs, such as tarragon, thyme,
and bay leaf )
• German: sour cream, vinegar, dill,
mustard, and black pepper
• Greek: lemon, onions, garlic, oregano,
and olive oil
• Italian: tomato, garlic, basil, oregano, and
olive oil
• Japanese: soy sauce, sugar, and rice wine
vinegar
• Korean: soy sauce, garlic, ginger root,
black pepper, scallions, chili peppers, and
sesame seeds or oil
• Mexican: tomatoes, onions, chili peppers,
and cumin
• Puerto Rican: sofrito (seasoning sauce
of tomatoes, onions, garlic, bell peppers,
cilantro, capers, pimento, annatto seeds,
and lard)
• Russian: sour cream, onion, dill, and
parsley
• Scandinavian: sour cream, onion,
mustard, dill, and caraway
• Thai: fermented fish sauce, coconut milk,
chili peppers, garlic, ginger root, lemon
grass, and tamarind
It would be incorrect to assume that every
dish from each culture is flavored with its
characteristic seasoning combinations, or
that flavor principle seasonings are limited to
just those listed. It’s common to find regional
variations as well. In China, northern cuisine
often includes the flavor principle seasonings
enhanced with soybean paste, garlic, and ses-
ame oil. In the south, fermented black beans
are frequently added, although in the Szech-
wan region hot bean paste, chili peppers, or
Szechwan (fagara) pepper is more common.
In the specialty cuisine of the Hakka, the addi-
tion of red rice wine is distinctive. Further, in
any culture where the traditional seasoning
combinations are prepared at home, not pur-
chased, modifications to suit each family are
A few cuisines have
extremely limited sea-
sonings, including the
fare of the Inuits. Broadly
speaking, cuisines offer-
ing large portions of
meat and other protein
foods tend to be less
seasoned than those
with a higher proportion
of grains, fruits and veg-
etables, and legumes.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
1 0 F O O D A N D C U L T U R E
customary.30 Flavor principles are therefore
more of a marker for each culture’s cuisine
rather than a rigid rule.
Meal Patterns and Meal
Cycles
People in every culture dine on at least one
meal each day, and meal patterns and meal
cycles reveal clues about complex social rela-
tions and the significance of certain events
in a society.31 The first step in decoding
these patterns and cycles is to determine
what types of food constitute a meal within
a culture.
In the United States, for instance, cocktails
and appetizers or coffee and dessert are not
considered meals. A meal should consist of a
main course and side dishes; typically a meat,
vegetable, and starch. In the western African
nation of Cameroon, a meal is a snack unless
cassava paste is served. In many Asian cul-
tures, a meal is not considered a meal unless
rice is included, no matter how much other
food is consumed. A one-pot dish is consid-
ered a meal if it contains all the elements of
a full meal. For example, American casserole
dishes often feature protein, vegetables, and a
starch, such as tuna casserole (tuna, peas, and
noodles). In England it could be shepherd’s
pie (ground beef, green beans, and tomato
sauce topped with mashed potatoes).
The elements that define a meal must also
be served in their proper order. In the United
States, appetizers come before soup or salad,
followed by the entrée and then by dessert. In
France, the salad is served after the entrée. All
foods are served simultaneously in Vietnam
so that each person may combine flavors and
textures according to taste. In addition to con-
sidering the proper serving order, foods must
also be appropriate for the meal or situation.
Some cultures do not distinguish which foods
can be served at different meals, but in the
United States eggs and bacon are considered
breakfast foods, while cheese and olives are
popular in the Middle East for the morning
meal. Soup is commonly served at breakfast
in Southeast Asia, but in the United States
soup is a lunch or dinner food, and in parts
of Europe fruit soup is sometimes served as
dessert. Cake and ice cream are appropriate
for a child’s birthday party in the United
States; wine and cheese are not.
Other aspects of the meal message include
who prepares the meal and what culturally spe-
cific preparation rules are used. In the United
States, ketchup goes with French fries; in Great
Britain, vinegar is sprinkled on chips (fried
potatoes). Orthodox Jews consume meat only if
it has been slaughtered by an approved butcher
in an approved manner and has been prepared
in a particular way. (See Chapter 4, “Food and
Religion,” for more information on Judaism.)
Who eats the meal is also important.
A meal is frequently used to define personal
relationships. Americans are comfortable
inviting friends for dinner, but they usually
invite acquaintances for just drinks and appe-
tizers. For a family dinner, people may include
only some of the elements that constitute a
meal, but serving a meal to guests requires that
all elements be included in their proper order.
The final element of what constitutes a
meal is portion size. In many cultures, one
meal a day is designated the main meal and
usually contains the largest portions. The
amount of food considered appropriate var-
ies, however. A traditional serving of beef in
China may be limited to one ounce added to a
dish of rice. In France, a three- or four-ounce
filet is more typical. In the United States, a six-
or even eight-ounce steak is not unusual, and
some restaurants specialize in twelve-ounce
or larger cuts of prime rib. American tradi-
tion is to clean one’s plate regardless of how
much is served, while in other cultures, such
as those in the Middle East, it is considered
polite to leave some food to demonstrate that
enough was provided by the host.
Just as individual meals have cultural dif-Just as individual meals have cultural dif-Just as individual meals have cultural dif
ferences, the number of meals and when they
are eaten also varies. In much of Europe a
large main meal is customarily consumed at
noontime, for example, while in most of the
United States today the main meal is eaten in
the evening. In poor societies only one meal
per day may be eaten, whereas in wealthy
cultures three or four meals are standard.
The meal cycle in most cultures also
includes feasting or fasting, and often both.
Feasting celebrates special events, occurring
in nearly every society where a surplus of food
can be accumulated. Religious holidays such as
The sprig of parsley
added to a plate of food
may have originated as
a way to safeguard the
meal from evil.
In many homes, few
meals are eaten as a
family. The term grazing
refers to grabbing
small amounts of food
throughout the day
to consume. There are
an estimated 7 million
vending machines in the
United States, with over
100 million customers
daily.
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C H A P T E R 1 1 1
Christmas and Passover; secular holidays such
as Thanksgiving and the Vietnamese New
Year’s Day, known as Tet; and even personal
events such as births, marriages, and deaths
are observed with appropriate foods. In many
cultures, feasting means simply more of the
foods consumed daily and is considered a time
of plenty when even the poor have enough to
eat. Special dishes that include costly ingre-
dients or are time-consuming to prepare also
are characteristic of feasting. The elements of
a feast rarely differ from those of an every-
day meal. There may be more of an everyday
food or several main courses with additional
side dishes and a selection of desserts, but the
meal structure does not change. For example,
Thanksgiving typically includes turkey and
often another entrée such as ham or a casse-
role (meat); several vegetables; bread or rolls,
potatoes, sweet potatoes, and stuffing (starch);
as well as pumpkin, mincemeat, and pecan
pies or other dessert selections. Appetizers,
soups, and salads may also be included.
Fasting may be partial or total. Often it is
just the elimination of some items from the
diet, such as the Roman Catholic omission of
meat on Fridays during Lent or a Hindu per-
sonal fast day, when only foods cooked in milk
are eaten. Complete fasts are less common.
During the holy month of Ramadan, Muslims
are prohibited from taking food or drink from
dawn to sunset, but they may eat in the evening.
Yom Kippur, the day of atonement observed by
many Jews, is a total fast from sunset to sunset.
(See Chapter 4 for more details on fasting.)
Developmental Perspective
of Food Culture
Trends in food, eating, and nutrition also
reflect structural changes in society. The
developmental perspective of food culture
TA B L E 1.1 Developmental Perspective of Food Culture
Structural Change Food Culture Change
Globalization: Local to worldwide organizations Consumerization: Indigenous to mass-produced foods
Modernization: Muscle to fueled power Commoditization: Homemade to manufactured foods
Urbanization: Rural to urban residence Delocalization: Producers to consumers only
Migration: Original to new settings Acculturation: Traditional to adopted foods
SOURCE: Adapted from Sobal, J. 1999. Social change and foodways. In Proceedings of the Cultural and Historical Aspects of Food Symposium.
Corvallis: Oregon State University.
▲ Special dishes that
include costly ingredients
or are time-consuming to
prepare are characteristic of
feasting in many cultures.
(Table 1.1) suggests how changes may alter
how consumers obtain food, as well as types
of food and variety. Globalization is defined as
the integration of local, regional, and national
phenomena into an unrestricted worldwide
organization. The parallel change in cultural
food habits is c onsumer iz ation, the transition
of a society from producers of indigenous
foods to consumers of mass-produced foods.
Traditionally seasonal ingredients, such as
strawberries, become available anytime of
year from a worldwide network of grow-
ers and suppliers. Specialty products, such
as ham and other deli meats, which were at
one time prepared annually or only for festive
occasions, can now be purchased presliced,
precooked, and prepackaged for immediate
consumption.
The social dynamic of modernization
with new technologies results in socioeco-
nomic shifts, such as during the Industrial
Feasting functions to
redistribute food from
rich to poor, to demon-
strate status, to motivate
people toward a com-
mon goal (e.g., a political
fundraising dinner), to
mark the seasons and
life-cycle events, and to
symbolize devotion and
faith (e.g., Passover, Eid
al-Fitr, and communion).
Ro
be
rt
B
re
nn
er
/P
ho
to
Ed
it
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1 2 F O O D A N D C U L T U R E
Revolution when muscle power was replaced
by fuel-generated engine power or during the
1990s with the rise of the information age.
Cultural beliefs, values, and behaviors are
modified in response to the structural changes
that take place. Food habits changed, with
foods becoming more processed and meals
pre-prepared instead of cooked at home. The
fresh milk from the cow in the barn becomes
the plastic gallon container of pasteurized
milk sold online over the Internet to a con-
sumer who has limited time.
Urbanization occurs when a large per-
centage of the population abandons the low
density of rural residence in favor of higher
density suburban and urban residence. Often,
income levels do not change in the move, but
families who previously survived on subsis-
tence farming become dependent on others
for food. Delocalization occurs when the
connections among growing, harvesting,
cooking, and eating food are lost, as meals
prepared by anonymous workers are pur-
chased from convenience markets and fast-
food restaurants.
Finally, migration of populations from
their original homes to new regions or
nations creates a significant shift from a
home-bound, culture-bound society to one
in which global travel is prevalent and immi-
gration common. Traditional food habits are
in flux during acculturation to the diet of
a new culture and as novel foods are intro-
duced they become accepted into the major-
ity cuisine. Often new traditions emerge
from the contact between diverse cultural
food habits.
The developmental perspective of food
culture assumes that cultures progress from
underdeveloped to developed through the
structural changes listed. Deliberate efforts to
reverse that trend can be seen in the renewed
popularity of farmers’ markets in the United
States and attacks on fast-food franchises in
Europe. Other evidence of resistance includes
the work of the Slow Food movement—mobi-
lizing against the negative effects of indus-
trialization—and the seed banks that have
opened throughout the nation to promote
genetic diversity and save indigenous plant
populations.32,33,34
Individual Food Habits
Each person lives within his or her culture,
unaware of the influences exerted by that
culture on food habits. Eating choices are
typically made according to what is obtain-
able, what is acceptable, and what is pre-
ferred: the diet is determined by availability
and by what each person considers edible or
inedible. Beyond that, factors that influence
an individual’s food selection are taste, cost,
convenience, self-expression, well-being, and
variety, which are explained in the consumer
food choice model, discussed later in the
chapter.
Food Availability
A person can select a diet only from foods that
are available. Local ecological considerations
such as weather, soil, and water conditions;
geographic features; indigenous vegetation;
the native animal population; and human
manipulation of these resources through culti-
vation of plants and domestication of livestock
determine the food supply at a fundamental
level. A society living in the cool climate of
northern Europe is not going to establish rice
as a core food, just as a society in the hot wet
regions of southern India is not going to rely
on oats or rye. Seasonal variations are a fac-
tor, as are unusual climactic events, such as
droughts, that disrupt the food supply.
The political, economic, and social man-
agement of food at the local level is typically
directed toward providing a reliable and
affordable source of nourishment. Advances
in food production, storage, and distribution
are examples. However, the development of
national and international food networks has
often been motivated by other needs, includ-
ing profit and power. The complexity of the
food supply system has been examined by
many disciplinary approaches. Historians
trace the introduction and replacement of
foods as they spread regionally and globally.
Economists describe the role of supply and
demand, the commodity market, price con-
trols, trade deficits, and farm subsidies (as
well as other entitlements) on access to food.
Psychologists investigate how individual
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 1 3
experience impacts diet; political scientists
detail how fear of biotechnology, bioterrorism,
and disease (such as the mad-cow or bovine
spongiform encephalopathy scare in Europe)
can alter acceptability. Sociologists document
how social structures and relations affect the
obtainment of food; legal experts debate the
ethics of food policies people who are poor,
incarcerated, and terminally ill. This is only a
small sampling of the factors influencing food
availability. However, except in regions where
serious food shortages are anticipated, avail-
ability issues are usually not at the forefront of
individual food choice.
Edible or Inedible?
This approach was one of the earliest food
habits models, describing the individual pro-
cess that establishes the available, appropriate,
and personal food habits. Each person’s choice
of what to eat is generally limited to the foods
found in this dietary domain.35
1. Inedible foods: These foods are poison-
ous or are not eaten because of strong
beliefs or taboos (or taboo foods,
from the Tongan word tabu, mean-
ing “marked as holy”). Foods defined
as inedible vary culturally. Examples
of frequently prohibited foods include
animals useful to the cultural group,
such as cattle in India; animals danger-
ous to catch; animals that have died of
unknown reasons or of disease; animals
that consume garbage or excrement; and
plants or animals that resemble a human
ailment (e.g., strawberries or beef dur-
ing pregnancy to protect the infant, as
described later).
2. Edible by animals, but not by me:
These foods are items such as rodents
in the United States or corn in France
(where it is used primarily as a feed
grain). Again, the foods in this
category vary widely by culture.
3. Edible by humans, but not by my kind:
These foods are recognized as accept-
able in some societies, but not in your
own culture. Some East Africans are
disgusted by eggs, for instance, which
are associated with excrement.36 Some
rural South Africans who consider
termites a delicacy are repulsed by
the idea of eating scorpions, a spe-
cialty enjoyed by some Chinese.37
Examples of foods unacceptable in the
United States but acceptable elsewhere
include giant snails (Africa), dog meat
(Asia), iguana (the Caribbean), horse
meat or blood sausage (Europe), and
bear paw (Mongolia).
4. Edible by humans, but not by me:
These foods include all those accepted
by a person’s cultural group but not
by the individual, due to factors such
as preference (e.g., tripe, liver, raw
oysters), expense, or health reasons
(a low-sodium or low-cholesterol
diet may eliminate many traditional
American foods). Other factors, such
as religious restrictions (as in kosher
law or halal practices) or ethical con-
siderations (vegetarianism), may also
influence food choices.
5. Edible by me: These are all foods
accepted as part of an individual’s
dietary domain.
There are always exceptions to the ways
in which foods are categorized. It is generally
assumed, for instance, that poisonous plants
and animals will always be avoided. In Japan,
however, fugu (blowfish or globefish) is con-
sidered a delicacy despite the deadly toxin
contained in the liver, intestines, testes, and
ovaries. These organs must be deftly removed
by a certified chef as the last step of cleaning
(if they are accidentally damaged, the poison
spreads rapidly through the flesh). Eating the
fish supposedly provides a tingle in the mouth
prized by the Japanese. Several people die
each year from fugu poisoning.
Consumer Food Choice
Model
An individual’s dietary likes and dislikes are
established before he or she sets foot in a res-
taurant, deli, or supermarket. The consumer
food choice model (Figure 1.3) explains the
factors that influence individual decisions.38
Among the most uni-
versal of food taboos is
cannibalism, although
anthropologists have
discovered numerous
examples of prehistoric
human consumption in
European and New World
excavations.
Insects, such as termites
and ants, provide 10
percent of the protein
consumed worldwide.
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1 4 F O O D A N D C U L T U R E
Food selection is primarily motivated by
taste. Taste is defined broadly by the sensory
properties detectable in foods: color, aroma,
flavor, and texture. Humans anticipate a spe-
cific food will have certain sensory character-
istics; deviations can signal that the item is
poisonous or spoiled. Many of these expecta-
tions are developed through early exposure to
culturally acceptable and unacceptable foods.
For example, most core foods are pale white,
cream, or brown in color; however, some
West Africans prefer the bright orange of
sweet potatoes, and Pacific Islanders consider
lavender appropriate for the taro root prepa-
ration called poi. Should the core item be an
unanticipated color, such as green or blue, it
may be rejected. Similarly, each food has a
predictable smell. Aromas that are pleasur-
able may trigger salivation, while those con-
sidered disgusting, such as the odor of rotting
meat, can trigger an immediate gag reflex in
some people. Again, which odors are agree-
able and which are disagreeable are due, in
part, to which foods are culturally accepted:
Strong-smelling fermented meat products are
esteemed by some Inuit (muk tuk ) and some
rural Filipinos (itog). Strong-smelling cheese itog). Strong-smelling cheese itog
(controlled rotting of milk) appeals to many
Europeans, but even mild cheddar may evoke
distaste by many Asians and Latinos. Appro-
priate texture is likewise predictable. Ranging
from soft and smooth to tough and coarse,
each food has its expected consistency. New
textures may be disliked: Some Americans
object to gelatinous bits in liquid, as found
in tapioca pudding or bubble tea, yet these
foods are popular in China. Conversely, some
Asians find the thick, sticky consistency of
mashed potatoes unappetizing. Okra, which
has a mucilaginous texture, is well liked in
the U.S. South but is considered too slimy by
those living outside the South.
The human tongue has receptors for the
perception of sweet, sour, salty, and bitter. It
is hypothesized that food choice in all societ-
ies is driven, in part, by an inborn preference
for the taste of sugars and fats. These nutrients
are indicative of foods that are energy dense;
a predisposition for sweets and foods high in
fat ensures adequate calorie intake, an evolu-
tionary necessity for omnivores with a wide
selection of available foods. Sugars and fats are
especially pleasurable flavor elements, associ-
ated with palatability and satiety (including
the texture factor provided by fats, called
mouthfeel).
Preferences for sweets (especially when
combined with fats) are found during infancy
and childhood and peak in early adolescence.
One study found 45 percent of calories eaten
by young people came from discretionary
sugar and fat.39 This preference declines in
later years and may reduce their significance
in food choice.
The opposite is true for bitterness, which
is associated with toxic compounds found in
some foods and is strongly disliked by most
children. The ability to detect bitterness
decreases with age, however, and many adults
consume foods with otherwise unpleasant
sulfides and tannins, including broccoli and
coffee. There are some who remain especially
sensitive to certain bitter compounds, affect-
ing their other preferences as well; they tend
to dislike sweet foods and opt for bland over
spicy items. Sour alone is rarely well liked, but
is enjoyed when combined with other flavors,
especially sweet. It has been suggested that a
preference for the sweet—sour taste prompted
human ancestors to seek fruit, an excellent
source of vitamins and minerals.40,41,42
Unlike the tastes of sweet, bitter, and sour,
babies generally are indifferent to salt until
about four months of age. Similar to sugar,
children prefer higher concentrations of salt
Humans can detect
approximately 10,000
different odors, though
genetics may determine
which odors can be
detected. For example,
nearly 50 percent of peo-
ple cannot smell andro-
stenone (also called boar
pheromone), which is
found in bacon, truffles,
celery, parsnips, boar
saliva, and many human
secretions; however,
researchers have found
people can be taught to
perceive it through daily
sniffing.109
Figure 1.3
The consumer food choice
model.
Source: Adapted from A. Drewnowski,
Taste, Genetics, and Food Choice.
Copyright © 2002. Used by permis-
sion of Adam Drewnowski, PhD.
Adults
Food
Choice
Cost
Convenience
Self-
Expression
Taste
Variety
Well-Being
Health
Outcomes
Physiology/Metabolism
Children
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C H A P T E R 1 1 5
than do adults. Their preference for salt is
shaped by the frequency of exposure to it after
birth, and perhaps perinatally.43
Finally, taste is influenced by flavor prin-
ciples, the characteristic combinations of core
and complementary foods, as well as tradi-
tional grouping of meal elements. These tradi-
tions are important in providing an expected
taste experience and satisfying a need for
familiarity in food habits.
Cost is often the second most important
influence on food choice, and income level is
the most significant sociodemographic fac-
tor in predicting selection. In cultures with
a limited food supply due to environmental
conditions or in societies where a large seg-
ment of the population is disadvantaged, food
price is more than taste, dictating nutritional
sufficiency and well-being. The wealthier the
society, the less disposable income is spent on
food, and, as income increases, food choices
change. Typically, the people of poorer cul-
tures survive on a diet dependent on grains or
tubers and limited amounts of protein, includ-
ing meat, poultry, fish, or dairy foods. Only
a small variety of fresh fruits or vegetables
may be available. People with ample income
consistently include more meats, sweets, and
fats in their diet (a trend seen in the global
popularity of American fast foods), plus a
wider assortment of fruits and vegetables.44,45
When nutritious food is available and afford-
able, the prestige of certain food items, such
as lobster or prime rib, is often linked to cost.
Protein foods are most associated with status,
although difficult-to-obtain items, such as
truffles, can also be pricey.
In the United States, affordability has been
found to limit the purchasing of healthy foods,
and in some cases even families with govern-
ment subsidies find it difficult to meet nutri-
tional needs.46 It is estimated that in 2013 over
14 percent of households were considered to
be food insecure.47
A subsistence farmer may have greater
access to fresh foods than a person with the
same limited income living in a city. In urban
areas, supermarkets with a cheaper selection
of foods often choose to locate outside low-
income neighborhoods, and residents may
have access only to higher-priced convenience
stores or small, independently run groceries
with a limited selection.46,48,49 Further, access
to healthful restaurant dining varies. Studies
suggest that predominantly African American
and low-income neighborhoods have more
fast-food restaurants per square mile than
white neighborhoods, with fewer healthy
options.50,51,52,53
Convenience is a major concern in food
purchases, particularly by members of urban-
ized societies. In some cultures, everyone’s
jobs are near home, and the whole family
joins in a leisurely midday lunch. In urban-
ized societies, people often work far from
home; therefore, lunch is eaten with fellow
employees. Instead of a large, home-cooked
meal, employees may eat a quick fast-food
meal. Furthermore, family structure can
necessitate convenience. In the United States,
the decreasing number of extended families
(with help available from elder members) and
increasing number of households with single
parents, along with couples who both work
outside the home and unassociated adults liv-
ing together all reduce the possibility that any
adult in the household has the time or energy
to prepare meals. Studies show that the greater
the number of hours a woman works outside
the home each day, the fewer the hours she
spends cooking. Only 40 percent of families
report cooking at least once a day, and in more
than one-quarter of all homes cooking is done
less than once a day.54 Recent research indi-
cates that a higher amount of family meals
is correlated with more positive health indi-
cators.55 Furthermore, the quality of dietary
intake improves when there is a reduction in
spending for food away from home.56 Conve-
nience generally spurs the increasing number
of takeout foods and meals purchased at res-
taurants. In 2014, restaurant industry share of
the U.S food dollar was 47 percent.
Self-expression, the way in which we indi-
cate who we are by behavior or activities,
is important for some individuals in food
selection, particularly as a marker of cultural
identity. Although the foods associated with
ethnicity, religious affiliation, or regional
association are predetermined through the
dietary domain, it is worth noting that every
time a person makes a food choice he or she
Though the physiologi-
cal response to disgust,
nose wrinkling, retrac-
tion of the lips, gaping,
gagging, and even nau-
sea seems instinctual, it
is actually a cognitively
sophisticated feeling
that does not develop in
children until between
the ages of four and
seven years old. Which
items are disgusting in
a culture is learned from
parents and peers.110
Some researchers con-
tend that there is a fifth
type of receptor on
the tongue for umami
(from the Japanese for
“yummy”). It is the taste
associated with meats,
mushrooms, cheese,
and the flavor-enhancer
monosodium glutamate
(MSG).
In addition to salt, other
flavor preferences may
be passed on perinatally.
A study of women who
ate garlic or a placebo
before amniocentesis
found the odor of garlic
in the amniotic fluid
evident from the garlic-
ingesting women.69
In 1901, the average
American family spent
nearly half (45 percent)
of their income on food.
A century later, that
figure had decreased to
just 13 percent of total
income.111
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
1 6 F O O D A N D C U L T U R E
may choose to follow or ignore convention.
Ethnic identity may be immediate, as in per-
sons who have recently arrived in the United
States; or it may be remote, a distant heritage
modified or lost over the generations through
acculturation. An individual who has just
immigrated to the United States from Japan,
for instance, is more likely to prefer traditional
Japanese cuisine than is a third- or fourth-
generation Japanese American.
Religious beliefs are similar to ethnic iden-
tity in that they may have a great impact on
individual food habits or an insignificant
influence depending on religious affiliation
and degree of adherence. Many Christian
denominations have no food restrictions,
but some, such as the Seventh-day Adven-
tists, have strict guidelines about what church
members may eat. Judaism requires that only
certain foods be consumed in certain combi-
nations, yet most Jews in the United States do
not follow these rules strictly (see Chapter 4).
A person may also choose foods associated
with a specific region. In the United States, the
food habits of New England differ from those
of the Midwest, the South, and the West, and
local specialties such as Pennsylvania Dutch,
Cajun, and Tex-Mex may influence the cook-
ing of all residents in those areas.
Self-identity can be another factor in food
selection, as discussed previously. An envi-
ronmentalist may be a vegetarian who pre-
fers organic, locally grown produce, while
Even when supermarkets
with a greater selection
of healthful foods are
available, less-accultur-
ated immigrants may feel
more comfortable shop-
ping at stores where their
language is spoken and
ethnic ingredients are
stocked.112
The status of food can
change over time. In the
early years of the United
States, lobster was so
plentiful it piled up on
beaches after storms, but
colonists considered it fit
only for Indians or starv-
ing settlers.
▲ Regional fare differs
throughout the United
States and can be consumed
for self-expression. The
southwestern foods shown
here represent one of many
distinct regional cuisines.
Ko
st
en
ko
M
ax
im
/S
hu
tt
er
st
oc
k.
co
m
a gourmet or foodie may patronize small
markets in ethnic neighborhoods through-
out a city searching for unusual ingredients.
Advertising has been directly related to self-
expression, especially self-identity. Research
indicates that in blind taste tests people often
have difficulty discriminating between differ-
ent brands of the same food item. Consumer
loyalty to a particular brand is believed more
related to the sensual and emotional appeal
of the name and packaging.57,58 For example,
similar-tasting flake cereals such as Wheaties
(which touts itself as the “breakfast of cham-
pions”), Special K, and Total target sports
enthusiasts, dieters, and health-conscious
individuals, respectively.
Advertising also promises food-provided
pleasure, appealing to the desire of consumers
to be seen as popular, fun-loving, and trendy.
Exploitation of sex to sell hamburgers and
beer is common, as are suggestions that eat-
ing a chocolate or drinking a soft drink will
add zest to living. A study of television food
ads targeting children found that 75 percent
were associated with “good times,” 43 percent
with being “cool and hip,” and 43 percent with
feelings of happiness.59,60,61 Such advertising
is a reflection of a larger trend: food as enter-
tainment, the vicarious enjoyment of eating
through reading about it or watching food-
related programs on television, also called
food porn.62 In the United States, nearly
150 food and wine magazines are published
monthly, almost 500 million food and wine
books are sold annually, and numerous net-
work cooking and dining shows air daily.
The impact of this media on food choice is
as yet unknown. Food entertainment may
popularize certain ingredients, such as kale
or mangoes, or cuisines, such as Spanish fare
or updated traditional American dishes like
spicy meatloaf and macaroni and cheese.
They may also set such a high standard of
preparation and presentation that some home
cooks feel inadequate, choosing to dine out or
select prepackaged items instead of making
meals from scratch.
Physical and spiritual well-being is another
food choice consideration for some individ-
uals. Physiological characteristics, includ-
ing age, gender, body image, and state of
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 1 7
health, often impact food habits. Preferences
and the ability to eat and digest foods vary
throughout the life cycle. Pregnant and lac-
tating women commonly eat differently than
other adults. In the United States, women are
urged to consume more food when they are
pregnant, especially dairy products. They
are also believed to crave unusual food com-
binations, such as pickles and ice cream. They
may avoid certain foods, such as strawber-
ries, because they are believed to cause red
birthmarks.
In some societies with subsistence econo-
mies, pregnant women may be allowed to eat
more meat than other family members; in
others, pregnant women avoid beef because it
is feared that the cow’s cloven hoof may cause
a cleft palate in the infant. Most cultures also
have rules regarding which foods are appro-
priate for infants; milk is generally considered
wholesome, and sometimes any liquid resem-
bling milk, such as nut milk, is also believed
to be nourishing.
Puberty is a time for special food rites in
many cultures. In the United States, adoles-
cents are particularly susceptible to advertis-
ing and peer pressure. They tend to eat quite
differently from children and adults, reject-
ing those foods typically served at home and
consuming more fast foods and soft drinks. A
rapid rate of growth at this time also affects
the amount of food that teenagers consume.
One survey found teenage boys down an aver-
age of five meals per day, and teenage girls eat
four meals.63,64
The opposite is true of older adults. As
metabolism slows, caloric needs decrease. In
addition, they may develop a reduced toler-
ance for fatty foods or highly spiced items.
Eating problems tend to increase as we age,
such as the inability to chew certain foods
or a disinterest in cooking and dining alone.
It is predicted that the shift toward an older
population in the next two decades will result
in a change in the types of foods purchased
(an increase in fruits, vegetables, fish, and
pork because older adults consume these
items more often than younger adults do)
and reductions in the total amount of food
consumed per capita (because older adults
eat smaller amounts of food).65
Gender has also been found to influence
eating habits. In some cultures women are
prohibited from eating specific foods or are
expected to serve the largest portions and best
pieces of food to the men. In other societies
food preference is related to gender. Some
people in the United States consider steak to
be a masculine food and salad to be a femi-
nine one; or that men drink beer and women
drink white wine. Research has shown that
gender differences affect how the brain pro-
cesses satiation responses to chocolate, sug-
gesting that men and women may vary in the
physiological regulation of food intake—per-
haps accounting for some food preferences.66
A person’s state of health also has an impact
on what is eaten. A chronic condition such as
lactose intolerance or a disease such as diabe-
tes or celiac disease requires an individual to
restrict or omit certain foods. An individual
who is sick may not be hungry or may find
it difficult to eat. Even minor illnesses may
result in dietary changes, such as drinking
ginger ale for an upset stomach or hot tea for
a cold. Those who are on weight-loss diets
may restrict foods to only a few items, such as
grapefruit or cabbage soup, or to a certain cat-
egory of foods, such as those low in fat or car-
bohydrates. Those who are exceptionally fit,
such as students or professional athletes, may
practice other food habits, including carbohy-
drate loading or consumption of high-protein
bars. In many cultures, specific foods are often
credited with health-promoting qualities, such
as ginseng in Asia or chicken soup in eastern
Europe. Corn in American Indian culture may
be selected to improve strength or stamina.
Well-being is not limited to physiological con-
ditions; spiritual health is equally dependent
on diet in some cultures where the body and
mind are considered one entity. A balance of
hot and cold or yin and yang foods may be
consumed to avoid physical or mental illness.
(See Chapter 2, “Traditional Health Beliefs
and Practices.”)
The final factor in consumer food choice
is variety. The omnivore’s paradox states that
humans are motivated psychologically to try
new foods. Further, the desire for new flavors
may also have a physiological basis. Sensory-
specific satiety (unrelated to actually ingesting
Meals and snacks pre-
pared at home are lower
in calories per eating
occasion, and lower in
total fat, saturated fat,
cholesterol, and salt
per calorie than foods
prepared away from
home. IHOP’s Breakfast
Country Chicken Fried
Steak & Eggs with Gravy
contains 1,570 kcalories,
close to one full day’s
requirement (from http://
www.calorieking.com).
Another aspect of food
as entertainment is
competitive eating as
a televised sport. Elite
eaters can make more
than $50,000 a year in
winnings, with records
such as forty-six dozen
oysters in ten minutes;
8.4 pounds of baked
beans in two minutes,
forty-seven seconds; and
11 pounds of cheesecake
in nine minutes.113
Old age is a cultural
concept; among some
American Indians and
Southeast Asians, indi-
viduals become elders in
their forties.114
Lactose intolerance, the
inability to digest the
milk sugar lactose, devel-
ops as a person matures.
It is believed that only
15 percent of the adult
population in the world
(those of northern
European heritage) can
drink milk without some
digestive discomfort.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
1 8 F O O D A N D C U L T U R E
and digesting food) results when the pleasure
from a certain food flavor decreases after a
minute or two of consumption. Introduction
of a new food, or even the same food with
new added seasoning, arouses the enjoy-
ment in eating again, encouraging the search
for new flavor stimuli.67 In addition, hunger
increases the probability that a new food will
be liked.68,69 Marketers take advantage of the
innate human drive for diet diversity by con-
tinually reformulating and repackaging pro-
cessed food products to attract consumers.
Interest in the foods of other regions or cul-
tures is associated with the desire for new taste
experiences, and also with increased income
and educational attainment. Wealth permits
experimentation and education can increase
wealth. Nutritional knowledge, also affected
by educational attainment, includes the
health-promoting benefits of dietary diversity.
One study reported that college students
were more likely to try a new fruit, vegeta-
ble, or grain product if information on the
nutritional benefits were provided.70 Some
researchers have found that attitudes about
the healthfulness of certain foods is important
in food selection, and parents may purchase
foods they consider healthy for their children
even if they would not select those items for
themselves.71
The nutrition knowledge of the person
who plans meals in the home impacts food
selection for all household members.72 It has
been suggested, however, that food choices
are more often influenced by beliefs regarding
nutritional quality than the actual nutritional
value or health benefits.67,73,74,75 Whether
accurate or not, nutritional knowledge does
not always translate into knowledge-based
food choice; a poll found that six in every ten
consumers check nutrition labels frequently
for calories and fat content, but nearly half of
those who read the information still choose
items for taste even when they are aware that
the item is bad for them.76,77
The consumer food choice model’s influ-
ence on individual food habits are interre-
lated. The inborn preference for foods high
in sugar, fat, and salt can encourage the con-
sumption of items specifically formulated to
enhance those taste experiences. These foods
are often convenient, and items such as soft
drinks and sandwich meats may cost less
than fruit juice or fresh pork or beef (though
certainly some processed items are more
expensive than homemade equivalents).
Advertisers exploit the need for convenience
and the desire to try new foods. A person may
be aware of nutrition messages encouraging
a reduction in the amount of sugars and fats
in the diet, as seen in the Dietary Guidelines
for Americans, but this nutrition knowledge
is often overridden by the primary factor in
consumer food choice: taste.
Furthermore, influences on choice may
change for each person as she or he matures.
Food selection in infants (within the dietary
domain of available foods provided by par-
ents) is based almost exclusively on taste
factors, with a strong resistance to new
items. Children become more interested in
self-expression as they grow and become
sensitive to family and peer pressure. Young
adults continue to be concerned with taste
and self-expression, to which cost and conve-
nience are typically added, especially in fami-
lies with children. For middle-aged adults,
increased income may lessen cost issues; and
in older adults, health problems may become
a more significant factor in food choice than
even taste.
Nutrition and Food
Habits
The Need for Cultural
Competency
In recent years, the significance of cultur-
ally based food habits on health and diet has
been recognized, and the need for intercul-
tural competencies in the areas of nutrition
research, assessment, counseling, and educa-
tion has been cited.78 The Campinha-Bacote
model of competence outlines a process for
cultural competency in health care, involv-
ing steps from cultural awareness, cultural
knowledge, cultural skill, cultural encounter,
and cultural desire.79 Accurate data collec-
tion required for assessment and education is
dependent on respect for different values and
Research on sensory-
specific satiety suggests
people eat less food
when consuming a
monotonous meal, and
may overeat and gain
weight when abundant
variety is available.8
The Japanese say that for
every new food a person
tries, life is extended
seventy-five days.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 1 9
a trusting relationship between respondent
and researcher; effective intercultural com-
munication is a function of understanding
and accepting a client’s perspective and life
experience. New standards of nutrition care
issued by professional accreditation organi-
zations reflect similar guidelines.80,81 Look-
ing toward the future, it has been proposed
that health care professionals should move
beyond the theoretical concepts to cultural
sensitivity and relevance to the practicalities
of cultural competency. Language skills, man-
agerial expertise, and leadership are needed to
guide diverse communities in healthy lifestyle
changes, to serve hard-to-reach populations,
and to effect change in the health care system.
Diversity in the U.S. Population
The growing need for cultural competency is
being driven by current demographic trends.
Since the 1970s, the United States has moved
increasingly toward a cultural plurality, where
no single ethnic group is a majority. In 1980,
only Hawaii and the District of Columbia
had plurality populations. Since that time,
California, New Mexico, and Texas have
joined the list. Pluralities also exist in sev-
eral metropolitan area populations, includ-
ing Chicago, Houston, Los Angeles, Miami,
New York City, and Philadelphia. Nationwide,
demographers estimate that non-Hispanic
whites will become less than 50 percent of the
total population by the year 2060.
This change can be seen in the difference
in projected ethnic group growth from 2014
to 2060 (see Figure 1.4). Gains for the Asian
population are expected at more than four
times the national average, and more than
three times the national average for the His-
panic population.
In actual numbers, Hispanics surpassed
African Americans as the largest U.S. minority
population in 2008, and now represent 17 per-
cent of the total population, whereas blacks
or African Americans make up approximately
13 percent. Asians are the third largest minor-
ity at 5 percent of the total U.S. population.
Smaller numbers of Pacific Islanders and
Native Americans are 1 percent, and mixed
races are 2 percent. Notably, many U.S. ethnic
populations have an average age significantly
“Respect for diverse
viewpoints and indi-
vidual differences” is an
Academy of Nutrition
and Dietetics value.
lower than that of the total population.
Predicted demographic changes are often seen
first among children and young adults.82
This profile of the general U.S. population
is notably different than that for health care
professionals, who are mostly white. Among
registered dietitians in 2013, 82 percent
reported being white, and the next the largest
minority was Asians at 5 percent.83 Research-
ers note that clients from minority popula-
tions prefer to receive health care in settings
with minority health care providers; that
minority health care providers are more likely
to work in underserved areas; and that people
from minority groups are more likely to par-
ticipate in research studies when the investi-
gator is from the same ethnic background.84
Diversity in the Canadian Population
The Canadian census is conducted differently
from the U.S. count. Canadians in 2006 were
asked to list their ethnicity in an open-ended
question, and multiple responses listing one
or more ethnicities were accepted. More than
200 different ethnicities were identified. This
has provided a broader picture of ancestry,
particularly because single responses and
multiple responses were reported separately.
For example, of the over 1.3 million Aborigi-
nals (including Native American Indians,
Més—people of mixed Aboriginal and non-
Aboriginal heritage—and Inuit), 565,040
listed this ethnicity as a single response and
Figure 1.4
Projected U.S. population by
percentage, 2010–2060.
Source: Census.gov 2014 national
population projections. n.d. Retrieved
from http://census.gov/population/
projections/data/national/2014/
summarytables.html (accessed
January 6, 2015).
White Black Asian
Native Am/PI Mixed Race
45%
2%
2060 Projected US Population
by Percentage
2%
29%
13%
9%
2014 Projected US Population by
Percentage
2%
62%
17%
13%
1%
5%
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
2 0 F O O D A N D C U L T U R E
800,020 listed it as part of a multiple response.
A separate question inquired if the census
respondent was a member of a visible minor-
ity, defined by the Employment Equity Act
as “persons, other than Aboriginal peoples,
who are non-Caucasian in race or non-white
in color.” The act specifically lists Chinese,
South Asians (i.e., Asian Indians, Pakistanis,
Sri Lankans), blacks, Arabs/West Asians, Fili-
pinos, Latin Americans, Japanese, Koreans,
and Pacific Islanders. Immigration growth
in Canada has dramatically exceeded overall
population growth in recent years: Immi-
grants in Canada represented more than
two-thirds of the population growth from
2001 to 2006—more than 19 percent of the
total population—and the nation is second
only to Australia (22 percent) in proportion
of foreign-born citizens. Of greater impor-
tance, Canadian immigration patterns have
shifted during the past three decades. Recent
immigrants include almost 60 percent from
Asia and 20 percent from the Caribbean. Chi-
nese, South Asian, and black groups are the
three largest minority populations, though the
fastest growing populations are Arabs/West
Asians and Koreans. Nearly all (94 percent)
recent immigrants to Canada have settled in
urban areas, particularly Toronto, Vancouver,
and Montreal. Other urban areas with dis-
proportionately large recent immigrant
populations include Calgary, Edmonton, and
Ottawa-Hull.85
Ethnicity and Health
Health is not enjoyed equally by all in the
United States. Disparities in mortality rates,
chronic disease incidence, and access to care
are prevalent among many U.S. ethnic groups
(Table 1.2). Poor health status in the United
States is also associated with poverty (see
Cultural Controversy—Does Hunger Cause
Obesity? later in this chapter), low educational
attainment, and immigrant status: Immi-
grant health has been found initially better
than similar U.S.-born populations in some
research, and is shown to decline with length
of stay.86,88
Acculturation to the majority culture is
believed to be a significant factor in health
independent of socioeconomic status. First
noted in heart disease rates, moderniza-
tion has also been linked to increased blood
cholesterol levels, increased blood pressure
levels, obesity, type 2 diabetes, and some
cancers.87,88,89,90,91,92 The stress of adapta-
tion to the pressures of a fast-paced society
is believed to be significant.91 Hereditary
predisposition to developing certain health
conditions most probably plays a significant
role. It is important to note, however, that
acculturation is difficult to define accurately
and is not an inherent risk factor in itself.93
Some changes in diet—such as a reduction in
pickled food intake associated with stomach
cancer or increased availability of fruits and
vegetables—can be beneficial. Better educa-
tional opportunities and health care services
can also promote health.
The effects of ethnicity and race on health
status is not well delineated, and research-
ers caution that the research results can be
misleading.94 The Human Genome project
determined that there is no genetic basis for
use of the term r ac e, and that 99.9 percent
of all humans have the same genes. Race is
simply a category used to describe groups of
individuals.95 Many studies do not explain
how participants are categorized. Individuals
may self-select differently than investigators,
and self-identity may change over time. Even
official classifications may vary and change.
In the United States, the Office of Manage-
ment and Budget is responsible for defining
the categories used in all government work,
including the Census. In 1997, the stan-
dards were revised to include five classifica-
tions for “race”: American Indian or Native
American, Asian, Black or African American,
Native Hawaiian or other Pacific Islander, and
White. Prior to the revision, there were only
four groupings because Asians were combined
with Pacific Islanders. Additionally, the two
categories for ethnicity were expanded in
1997 (ethnic members may be of any race):
Hispanic, and Not Hispanic. These changes
from earlier definitions can lead to difficul-
ties in interpreting data trends. Further, the
factor of ethnicity is not sufficiently separated
from socioeconomic status in many studies,
calling into question whether a stated find-
ing is due to ethnicity or whether it is due to
Acculturation is so
complex that it has
been difficult to develop
accurate assessments for
use in health care and
research. Neither U.S.
nativity nor number of
years in residence has
proved completely indic-
ative, and it has been
suggested that accultura-
tion is sometimes based
more on ethnic stereo-
typing than on cultural
differences.115,116
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C H A P T E R 1 2 1
income, occupation, or educational status. For
example, evaluation of the incidence of type 2
diabetes in the Black Women’s Study indicates
a strong relationship between individual and
neighborhood socioeconomic status and type
2 diabetes even when controlling for factors
such as education and income.96
Nevertheless, ethnicity data suggesting
risks and disparities can be useful to health
care providers as long as the caveats above
are considered and care is taken to avoid ste-
reotyping a patient by group membership.
For example, Table 1.2 illustrates that not all
Asians or Hispanics have the same prevalence
for type 2 diabetes.
Ethnicity can be a significant factor in the
development of certain disease conditions, the
way they are experienced, and how they are
ultimately resolved. (See Chapter 2 for further
information.) The growth of ethnic groups in
the U.S. population since the mid-1980s, the
rapid movement toward cultural pluralism,
TA B L E 1. 2 Estimates of the Percentage of
Diagnosed
Adult Diabetes by Race/Ethnic Background
Non-Hispanic Whites 7.6%
Asian Americans 9.0%
Hispanics 12.8%
Non-Hispanic Blacks 13.2%
American Indians/Alaska Natives 15.9%
Among Asian Americans
Chinese
Filipinos
South Asians
Other Asian Americans
4.4%
11.3%
13.0%
8.8%
Among Hispanic Adults
Central and South Americans
Cubans
Mexican Americans
Puerto Ricans
8.5%
13.9%
13.9%
14.8%
SOURCE: Centers for Disease Control and Prevention. 2014. National diabetes sta-
tistics report: Estimates of diabetes and its burden in the United States, 2014. Atlanta,
GA: U.S. Department of Health and Human Services. Retrieved from http://www.cdc.
gov/diabetes/data/statistics/2014StatisticsReport.html (accessed January 27, 2015).
Does Hunger Cause Obesity?
One of the most perplexing problems in nutrition education and policy is
why socieconomic status is associated with
overweight and obesity in the United States.
Rates of overweight, defined as a body mass
index (BMI) over twenty-five but below
thirty, and obesity, defined as a BMI over
thirty, have doubled in Americans since the
late 1970s. Risk for overweight and obesity
is highest in the persons with the lowest
incomes and education levels regardless of
ethnic heritage, and the risk declines paral-
lel to socioeconomic improvement in most
studies. Additionally, overweight and obesity
rates are higher in all other ethnic groups
(except for Asians) than in whites. Because
poverty rates are also higher for all other
ethnic groups (in some cases more than three
times the rate for whites), it may be that
socioeconomic status contributes to some of
the disparity in the risk of overweight and
obesity between ethnic groups.117,118
Researchers suggest that food insecurity
in households that do not have enough to eat
sometimes or often, or do not have enough
of preferred foods to eat, may lead to over-
weight and obesity through overconsumption
of inexpensive, less nutritious foods high in
fats or sugar. First postulated by a physician
in 1995, it was observed that in the cycle of
food assistance, where monthly allocations
run out and food shortages occur episodi-
cally, a person may compensate by eating
larger portions of higher-calorie foods when
available.119 Further research has strength-
ened the hypothesis, finding that high-
energy density diets (those that include more
fast foods, snacks, and desserts than fruits,
vegetables, and lean protein) are cheaper,
more palatable, and more filling than health-
ier choices.118,120 As with obesity in adults,
obesity in children has been found to be asso-
ciated with lower household incomes, lower
education levels of parents, and consumption
of high-energy density foods; and family
meals, which improve quality of dietary
intake in adolescents (including reductions in
snacking), are significantly more frequent in
higher-income families.121,122 Biological fac-
tors, such as the taste preference for sweets
and fats; psychological factors, including
the comfort provided in such items; and an
obesigenic environment that promotes con-
sumption of energy-dense items in super-size
quantities may be other variables. Recent
studies, with larger samples sizes, did not
find statistically significant associations but
did show that food insecurity and being over-
weight go hand in hand, and that the preva-
lence of being overweight remains higher in
food-insecure children. Further, it is uncertain
whether hunger and food insecurity drive
being overweight and obese, or whether
being overweight or obese cause hunger and
food insecurity.123
C U L T U R A L C O N T R O V E R S Y
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2 2 F O O D A N D C U L T U R E
and the undeniable connection between heri-
tage and health requires the need for cultural
competency among American health care
providers.
Intercultural Nutrition Care
The study of food habits has specific appli-
cations in determining nutritional status
and implementing dietary change. Even the
act of obtaining a twenty-four-hour dietary
intake record has cultural implications. (See
Chapter 3, “Intercultural Communication.”)
Questions such as what was eaten at break-
fast, lunch, and dinner not only ignore other
daily meal patterns but also make assump-
tions about what constitutes a meal. Snacks
and the consumption of food not considered
a meal may be overlooked. Common difficul-
ties in data collection, such as underreport-
ing or overreporting food intake, may also be
culturally related to the perceived status of an
item, for example, or portion size estimates
may be an unknown concept, complicated by
the practice of sharing food from other family
members’ plates. Terminology can be particu-
larly troublesome. Words in one culture may
have different meanings in another culture or
even among ethnic groups within a culture.
Stereotyping is another pitfall in cultur-
ally sensitive nutrition applications, resulting
from the overestimation of the association
between group membership and individual
behavior. Stereotyping occurs when a per-
son ascribes the collective traits associated
with a specific group to every member of
that group, discounting individual character-
istics. A health professional knowledgeable
about cultural food habits may inadvertently
make stereotypical assumptions about dietary
behavior if the individual preferences of the
client are neglected. Cultural competency in
nutrition implies not only familiarity with
the food habits of a particular culture, but
recognition of intraethnic variation within a
culture as well.
Researchers suggest that health care pro-
viders working in intercultural nutrition
become skilled in careful observation of cli-
ent groups, visiting homes, neighborhoods,
and markets to learn where food is purchased,
what food is available, and how it is stored,
prepared, served, and consumed. Participa-
tion in community activities, such as reading
local newspapers and attending neighbor-
hood meetings or events, is another way to
gather relevant information. Informant inter-
viewing reveals the most data about a group;
individual members of the group, group
leaders, and other health care professionals
serving the group are potential sources.97,98
Combining qualitative approaches such as in-
depth, open-ended interviews with clients and
quantitative measures through questionnaires
is one of the most culturally sensitive methods
of obtaining data about a group. Qualitative
information obtained through the interviews
should alert the researcher to nutrition issues
within the group and guide development
of assessment tools; the quantitative results
should confirm the data provided through the
interview in a larger sample. (See Chapter 3
for more information.)
Cultural perspective is particularly impor-
tant when evaluating the nutritional impact of
a person’s food habits. Ethnocentric assump-
tions about dietary practices should be
avoided. A food behavior that on first obser-
vation is judged detrimental may actually have
limited impact on a person’s physical health.
Sometimes other moderating food habits are
unrecognized. For instance, a dietitian may
be concerned that an Asian patient is getting
insufficient calcium because she eats few dairy
products. Undetected sources of calcium in
this case might be the daily use of fermented
fish sauces or broths rich in minerals made
from vinegar-soaked bones.
Likewise, a food habit that the investiga-
tor finds repugnant may have some redeem-
ing nutritional benefits. Examples include the
consumption of raw meat and organs by the
Inuits, which provides a source of vitamin C
that would have otherwise been lost during
cooking, and the use of mineral-rich ashes or
clay in certain breads and stews in Africa and
Latin America. In addition, physiological dif-Latin America. In addition, physiological dif-Latin America. In addition, physiological dif
ferences among populations can affect nutri-
tional needs. The majority of the research on
dietary requirements has been conducted on
Sometimes culturally
based food habits have
vital nutritional benefits.
One example is the use
of corn tortillas with
beans in Mexico. Neither
corn nor beans alone
supplies the essential
amino acids (chemical
building blocks of pro-
tein) needed to main-
tain optimum health.
Combined, they provide
complete protein.
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C H A P T E R 1 2 3
young, white, middle-class American men.
Extrapolation of these findings to other popu-
lations should be done with caution.
Thus, diet should be carefully evaluated
within the context of culture. One effective
method is to classify food habits according to
nutritional impact: (1) food use with positive
health consequences that should be encour-
aged, (2) neutral food behaviors with neither
adverse nor beneficial effects on nutritional
status, (3) food habits unclassified due to
insufficient culturally specific information,
and (4) food behaviors with demonstrable
harmful effects on health that should be repat-
terned.99 When diet modification is necessary,
it should be attempted in partnership with
the client and respectful of culturally based
food habits. Adoption of dietary recommen-
dations is associated with an approach that
is compatible with the client’s traditional
health beliefs and practices. (See Chapter 2
for more information.) A study evaluating
women’s beliefs about weight gain during
pregnancy found that black women indicated
that a lower amount should be gained than
the recommendations and that prepregnancy
weight had no effect on how much should be
gained.100 Having this information could cer-
tainly impact the content and approach for
nutrition counseling given during pregnancy.
In another example, educators developed a
food guide for Caribbean Islanders living in
the United States that grouped cultural foods
into three categories: growth, protection, and
energy, reflecting client-group perceptions of
how food affects health.101
The American Paradox
Food habits are so intrinsic to culture that
food-related images are often use to describe
them. Melting pot suggests a blending of dif-them. Melting pot suggests a blending of dif-them. Melting pot suggests a blending of dif
ferent ethnic, religious, and regional groups
to produce a smooth, uniform identity; stew
implies a cooking of various populations to
achieve a bland sameness with only just a
touch of cultural integrity; and tossed salad
allows for maintenance of cultural identity,
randomly mixed and coated with a glistening
unity. A more accurate metaphor for the
American population is the omnivore’s para-
dox. The nation was founded by immigrants,
and most citizens today are proud of a heri-
tage that, to paraphrase the inscription on the
Statue of Liberty, accepts the tired, the poor,
and the huddled masses yearning to be free.
Yet many Americans are also suspicious of
cultural difference and comfortable with what
is familiar. The same can be said for food hab-
its in the United States.
The American paradox, in culinary terms,
is that although foods from throughout the
world are available, and often affordable, con-
sistency and conservatism are also needed.
At one end of the spectrum, people who are
exposed to new foods through travel and
those who crave new taste experiences have
driven the rapidly expanding market for
▼ Asian tofu is the main
ingredient in this vegetarian
adaptation of shepherd’s pie,
a traditional British entrée
popular in the United States.
Be
ck
y
Lu
ig
ar
t-
St
ay
ne
r/
Te
rr
a/
Co
rb
is
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2 4 F O O D A N D C U L T U R E
Pre-17th century
• Regional American Indian cuisines develop.
1500s
• Columbian Exchange: New World foods from the Caribbean and
Central/South America (corn, potatoes, tomatoes, chili peppers,
peanuts, vanilla, chocolate, etc.) are brought to Europe, Africa,
Asia; Old World foods (wheat, rice, sugar, beef, pork, apples,
etc.) introduced to the Caribbean and Central/South America.
• Ponce de Leon discovers Florida and most likely brings tomatoes
to North America.
1620s
• British traditional midday meal introduced, with meat, fowl, or
fish as its centerpiece served with cornbread or biscuit. Steamed
or boiled pudding is the first course; dessert of fruit pie or cake
follows. It is eaten with a knife, spoon, and fingers.
• First Thanksgiving occurs in 1621 at Plymouth colony, a ten-day
celebration combining European and Native American hunting
and harvest feast traditions featuring fowl and venison.
• Dutch colonists at New Amsterdam (present-day Manhattan)
introduce coleslaw, doughnuts, cookies, and waffles.
1660s
• Yams, watermelon, okra, black-eyed peas, eggplant, and
sesame seeds brought with African slaves who also introduce
the New World foods peanuts and chili peppers to North
America.
1680s
• German Mennonites settle in Pennsylvania, creating
Pennsylvania Dutch fare and popularizing dishes such as
scrapple, apple butter, and funnel cakes.
• William Penn founds first brewhouse in Philadelphia, featuring
English-style ales.
*REFERENCES FOR TIMELINE
Davidson, A. 1999. T h e O x f or d c ompanion to f ood. New York: Oxford University Press.
Hess, K. 1992. Th e C ar ol ina r ic e k itc h en. Columbia: University of South Carolina Press.
Katz, S. H. (Ed.). 2003. E nc y c l opedia of f ood and c ul tur e. New York: Scribner’s.
Trager, J. 1995. Th e f ood c h r onol ogy . New York: Henry Holt.
Randolph, M. 1993. Th e V ir ginia h ousew if e, or , meth odic al c ook . A f ac simil e of an auth entic ear l y A mer ic an
c ook book . New York: Dover.
1770s
• Boston Tea Party occurs; coffee takes hold as a protest beverage.
• Thomas Jefferson experiments with crops found in Europe,
such as rice, broccoli, cauliflower, eggplant, savoy cabbage, and
olives.
1800s
• First shipment of bananas arrives in the United States.
• First recipe for tomato-based ketchup published in 1812, called
“love-apple or tomato catchup.”
1760s
• England takes control of Canada from France: French Canadians
migrate to New England (Franco-Americans) and Louisiana
(Cajuns), bringing fish stews, pork pates, boudin sausages,
French toast, and other specialties.
• An English plantation owner in New Smyrna, Florida imports
1,500 indentured servants from Italy, Greece, and Minorca to
work his indigo fields, who in turn bring eggplant, lemons, and
olives to the region.
1790s
• Pineapples introduced to what is now Hawaii by the Spanish.
• American Cookery by Amelia Simmons in 1796 is first
American cookbook; includes recipes for stuffed turkey, a
“tasty Indian pudding,” “pomkin” pudding (pie), “American
citron”(watermelon) preserves, and cornmeal johnnycakes or
hoecakes.
1820s
• First regional American cookbook published in 1824, The
Virginia Housewife, or Methodical Cook, by Mary Randall, with Virginia Housewife, or Methodical Cook, by Mary Randall, with Virginia Housewife, or Methodical Cook
recipes for southern specialties; also foreign dishes, such as ropa
vieja and “gaspacho”(Spain), polenta and vermicelli (Italy),
curry “after the East Indian manner,”and “gumbo—a West
Indian dish”(Caribbean).
CULTURAL FOODS IN THE UNITED STATES: A TIMELINE*
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 2 5
1690s
• Rice cultivation techniques introduced to Carolinas by Africans
are so successful that excess crops sold to British.
• Tomatoes popular in coastal southern cuisines, but elsewhere
considered poisonous.
• Jesuit and Franciscan priests plant grapes, oranges, lemons,
figs, and olives at California missions.
1700s
• Potatoes popularized by Irish immigrants in Boston.
1730s
• New England codfish industry trades salt cod for slaves in Africa,
who are brought to the Caribbean and traded for molasses,
which is brought back to the colonies for production of rum.
Estimated annual consumption of rum at the time: four gallons
per person.
1740s
• First written record of ice cream in the colonies (served with
strawberries and milk).
1750s
• The Ojibwa obtain complete control of wild rice stands in the
lakes of Minnesota after defeating the Santee (Dakota) at the
Battle of Kathio.
1830s
• Avocado introduced to Florida.
1840s
• Durgin-Park’s Market Dining Room opens in Boston, featuring New England specialties such
as chowders, fried cod tongues, and Indian pudding.
• Antoine’s restaurant is founded in New Orleans, offering French Creole cuisine.
• German immigrants in numerous states found commercial breweries, introducing the lager
that became American-style beer.
• First commercial pasta factory opened by Frenchman of Italian descent in Brooklyn.
• Macao and Woosung, the first recorded Chinese restaurant in United States, opens in
San Francisco.
1850s
• Sourdough bread and biscuits, the foundation of gold miner’s diet in California and the
Yukon, is baked commercially in San Francisco.
• Swiss immigrants introduce Emmentaler cheese, which becomes known in the United
States as “Swiss” cheese.
• American Indian chef George Crum creates potato chips after a diner in his restaurant
complains about his thick-sliced potatoes.
• Hazelnut trees introduced from the Mediterranean to Oregon—nearly the entire U.S.
hazelnut crop is now grown in the state.
• Artichokes, though previously introduced to Louisiana by the French, brought to California
by the Spanish, where they have been so successful nearly the entire U.S. commercial crop
comes from the state.
1860s
• Completion of the transcontinental railway shortens the trip between coasts from 120 days
to less than one week: California fruits, vegetables, and grains head east; and eastern
shellfish, especially oysters, go west.
• French, Hungarian, Italian, and German immigrants in California introduce European
varietal wine grapes and viticulture techniques.
• Confederate soldiers sometimes survived on boiled, raw (green) peanuts, earning those
from Georgia the nickname “goober grabbers.”
• Augustus Gutkind begins Goodman’s Matzohs in Philadelphia to supply the Passover
market.
• Cajun-style hot sauce called Tabasco first formulated by Edmund McIlhenny at Avery Island,
Louisiana.
Simmons, A. 1996. A mer ic an c ook er y , or th e ar t of dr essing v iands, f ish , poul tr y , and v egetabl es, and th e
best modes of mak ing puff- pastes, pies, tar ts, puddings, c ustar ds and pr eser v es, and al l k inds of c ak es
f r om th e imper ial pl umb to pl ain c ak e. A f ac simil e of th e sec ond edition. Bedford, MA: Applewood
Books.
Smith, A. F. 1994. Th e tomato in A mer ic a. Columbia: University of South Carolina Press.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
2 6 F O O D A N D C U L T U R E
1870s
• Jewish Cookery,Jewish Cookery,Jewish Cookery first cookbook on the subject in the United States,
by Esther Levy published in Philadelphia.
• Chinese Pekin (“Peking”) ducks imported by New York farms.
• Acceptance of four-tined fork makes using a knife to eat
outmoded; American-style use (transferring the fork from right
hand to left when cutting foods) is established.
• Buffalo (a Plains Indian staple), which numbered 30 to 70 million,
are reduced to approximately 1,500 animals, in part due to
prestige of smoked buffalo tongue in urban areas.
• Navel oranges introduced to California from Brazil, by way of the
U.S. Department of Agriculture (USDA) in Washington, DC.
1950s
• Trader Vic’s restaurants in California popularize
Polynesian food, such as luau dishes and pupu
platters, as well as the mai tai cocktail, claimed
invented by the owner.
• USDA publishes Basic 4 Food Guide.
CULTURAL FOODS IN THE UNITED STATES: A TIMELINE* Continued
1880s
• Luchow’s restaurant opens in New York City, popularizing dishes
found in German American homes and local beer gardens,
such as smoked eel, bratwurst, weinerschnitzel, spatzle, and
German-style beers.
• Oscar F. Mayer, a German American butcher, opens sausage
shop in Chicago, later selling wieners to grocery stores
throughout the region.
• B. Manischewitz Co. begins production of kosher products in
Cincinnati.
• Italian immigrants from Naples introduce spaghetti made with
olive oil and tomato paste.
1890s
• Asian immigrants move into San Joaquin valley of California,
planting large tracts of land. By the 1940s, Japanese farmers
are growing two-thirds of all vegetables in the state, creating
shortages when they are interned during World War II.
• Chili powder, combining ground dried chili pepper bits with
other seasonings, such as cumin and oregano, is invented in
Texas—though attribution is uncertain. Chili stews of beef or
goat popular in the region.
1900s
• Chop suey, a Chinese American vegetable and meat dish that may have come originally from southern
China (tsap seui) is popular in “chow-chows”(Chinese restaurants) in California and New York.
• Foods prepared in the “French fashion”are popular, particularly among the upper classes who can
afford to employ cooks knowledgeable in their preparation and dine at expensive restaurants.
• Pistachio tree from Middle East introduced in California and Texas.
• Coca-Cola, combining extracts from African kola nuts, South American coca leaves, and fruit syrups,
goes on sale in Atlanta as a fountain drink.
• The Kellogg brothers at a Seventh-day Adventist spa create cereal flakes as a substitute for meat—a
year later they add malt sweetener to increase appeal.
• Loma Linda Foods begins production of health breads and cookies for patients at the Seventh-day
Adventist Loma Linda Hospital.
• Broccoli introduced to California by Italian immigrants.
• World’s Fair in St. Louis popularizes German hamburger sandwiches and frankfurters (later dubbed
hot dogs).
• First American pizzeria opened by Italian immigrant in New York City.
1960s
• Beef consumption reaches ninety-nine pounds per person in United States, surpassing pork consumption for the first time.
• Frieda’s Finest founded to market specialty produce using samples and recipes in supermarkets; popularizes items such as
Chinese gooseberries (renamed kiwifruit), Jerusalem artichokes (as sunchokes), radicchio, spaghetti squash, blood oranges,
cactus pears, and other items.
• Julia Child debuts her cooking show, The French Chef, on public television, demystifying gourmet cooking and promoting French The French Chef, on public television, demystifying gourmet cooking and promoting French The French Chef
cuisine.
• The first Taco Bell fast-food restaurant opens in Downey, California.
• Benihana of Tokyo opens teppanyaki-style restaurant in New York.
• Term soul food coined for traditional African American cuisine.soul food coined for traditional African American cuisine.soul food
• In Atlanta, Lester G. Maddox is ordered by the federal government to serve African Americans at his Pickrick Restaurant—he
closes the business instead.
• Catfish farming introduced in Arkansas, dramatically increasing production and popularizing the fish nationwide.
• Foods of the World cookbooks from Time-Life Books begin with publication of The Cooking of Provincial France by M. F. K.
Fisher—the series introduces international cuisine through twenty specialized volumes (African cooking to wines and spirits)
followed in the 1970s with seven volumes on regional American fare.
1970s
• Falafel stands and restaurants proliferate with increased immigration of Middle Easterners.
• Chez Panisse restaurant opens in Berkeley, California, emphasizing fresh, locally grown ingredients, leading to development of a new California
cuisine and promoting regional fare nationally.
• Nissin Foods USA founded in California to market instant noodle products popular in Japan, such as Top Ramen.
• Vietnamese refugees open small restaurants in California, Texas, and other locations, featuring traditional pho, sandwiches, and other items.
• Small numbers of immigrants arrive from Thailand, and many open restaurants, introducing fish sauces such as nuoc mam and noodle dishes,
including phad thai.
• Paul Prudhomme opens K-Paul Louisiana Kitchen in New Orleans, popularizing Cajun cooking nationwide, one of the first regional food trends.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 2 7
1910s
• George Washington Carver extols the virtues of peanuts,
soybeans, and sweet potatoes; he popularizes peanut
butter, formerly considered a food for people who were
sick and aging adults.
• U.S. pasta production increases when imported supplies
from Italy are cut off during World War I.
• American cheese first processed in Chicago by J.L. Kraft &
Bros. (Canadian Mennonite immigrants) by melting bits
of cheddar with an emulsifier to produce a smooth, mild
cheeselike food.
• The fortune cookie created in California.
1920s
• La Choy Food Products founded to sell canned and jarred bean
sprouts.
• Polish baker Harry Lender opens first bagel plant outside New York,
and popularity begins to spread beyond eastern European enclaves.
• Aplets candy, based on the recipe for Turkish delight, invented by
two Armenian immigrants in Washington State.
• Marriott Corp. gets its start as a root beer, tamale, and chili con
carne stand in Washington, DC.
• The Russian Tea Room opens in New York, popularizing blinis, caviar,
tea in samovars, and other Russian specialties.
• Colombo Yogurt is founded by Armenian immigrants in
Massachusetts.
1930s
• Fritos corn chips first marketed in Texas based on a tortillas
fritas (fried tortilla strips) recipe purchased from a Mexican
restaurant owner.
• Spam is created, becoming a status food in Hawaii and the best-
selling canned meat worldwide.
• Goya Foods is founded in New York by Spanish immigrants
to import olives and olive oil, later tapping into the growing
Latino food market.
1940s
• Influx of Greek immigrants seeking asylum in areas such as New York, Detroit, and
Chicago popularize items such as souvlaki and gyros in family-run restaurants and
street stands.
• Ed Obrycki’s Olde Crab House in Baltimore converts from tavern to restaurant serving
Maryland specialties such as soft-shell crab and crab cakes.
• Domestic servants and some housewives take jobs to support the U.S. war effort during
World War II, leading to an increased consumption of convenience foods.
• The Gentleman’s Companion, Being an Exotic Cookery Book or, Around the World with
Knife, Fork and Spoon by Charles Baker, a two-volume set, published in 1946, describing
dishes and drinks from throughout Europe and Asia—a second two-volume set on the
foods and beverages of South America published in 1951.
• Balducci’s specialty food shop (founded as a vegetable stand in 1916 by an Italian
immigrant) opens in New York, offering an international assortment of foods from
Europe, Asia, and Latin America as well as regional specialties, such as rattlesnake and
Cajun andouille.
• The McDonald brothers offer franchises of their hamburger stand, founded in 1940 in
Pasadena, California.
2000s
• Americans consume an average of one tortilla per person each day—representing
30 percent of all bread sales, nearly equal to white bread.
• There are more Chinese restaurants in the United States than McDonald’s,
Wendy’s, and Burger King restaurants combined.
• $1 out of every $7 in grocery purchases is spent on ethnic items in 2005.
• Wine is neck-and-neck with beer as favorite U.S. alcoholic beverage.
1980s
• Ethiopian restaurants become popular in some cities where immigrants have
settled, introducing items such as injera and berbere.
• Yaohan supermarkets of Japan open in California catering to Asian population and
offering ingredients such as bean sprouts, daikon, seaweed, pickled plums, fresh
fish, and prepared items, including sushi.
• Korean immigrants, especially in Los Angeles, introduce Korean barbecue, kimchi,
and other specialties through restaurants and markets.
• Fresh fugu fish (which can be highly toxic) is imported for first time for use in
American Japanese restaurants under FDA supervision.
1990s
• Salsa becomes the favorite U.S. condiment when sales exceed those of ketchup.
• The term fusion food is used for combining the ingredients and preparation fusion food is used for combining the ingredients and preparation fusion food
techniques of two or more cultural cuisines, such as Thai chicken pizza.
• Chicken consumption per capita first tops beef consumption.
• USDA and Department of Health and Human Services (DHHS) release first version
of the Food Pyramid.
• The Food Network begins television broadcasting.
• Spanish tapas restaurants become trendy.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
2 8 F O O D A N D C U L T U R E
imported fruits, vegetables, and meat prod-
ucts, cheeses, and condiments. The growth
in ethnic restaurants has far surpassed that
of the restaurant industry as a whole in
recent decades. A survey found that Italian,
Mexican, Japanese (sushi), Thai, Middle East-
ern, and Caribbean fare have grown most in
popularity in recent years, while interest in
French, German, Scandinavian, and soul food
has declined.102 One of the most recent devel-
opments is the success of fast-casual ethnic
restaurant chains, such as Chipotle, Curry
in a Hurry, L&L Hawaiian Barbecue, Mama
Fu’s, and Pho Hoa. Ninety-two percent of U.S
consumers have eaten some form of ethnic
food in the past three months (whether at
home or from a restaurant).103 At the other
end of the American continuum of cuisine,
some people find considerable satisfaction
in the uniformity of a meat-and-potatoes
diet. A national trends survey found “plain”
American food most well liked by respon-
dents (66 percent).104
In response to the ambivalence produced
by the American paradox, the rising interest
in new foods and the continued desire for
familiar flavors, ethnic fare is often adapted to
American tastes and standardized for national
consumption. Spicing is reduced, protein
elements (particularly meats and cheeses)
are increased, more desserts and sweets are
offered, and items considered distasteful to
the American majority are eliminated. In
considering the three most popular ethnic
cuisines in the United States, it is unlikely a
consumer will find roasted kid at an Italian
restaurant, 1,000-year-old eggs at a Chinese
takeout counter, or tripe soup at a Mexican
drive-up window. Many Americans are con-
vinced that spaghetti with meatballs, fortune
cookies, and nachos are authentic dishes, yet
they are all items created in the United States
for American preferences.105 Even cultural
foods prepared at home from cookbooks are
often modified for preparation in American
kitchens with American ingredients, los-
ing much of their original content and con-
text. Only in ethnic, religious, and regional
enclaves largely isolated from outside influ-
ences are traditional food habits maintained.
Otherwise, over time, even significant sym-
bolic practices can lose their meaning under
the pressure of acculturation. For example,
a study of Chinese Americans living in
California found that while many attempted
to balance their diet between hot and cold
foods, few understood the yin-yang principles
behind the practice.105
In many ways, U.S. cooking adapts to cur-
rent and emerging food trends. Hamburgers,
hot dogs, and fried chicken are clearly derived
from other cultural fare, yet they are changed
through the lens of the American paradox.
Cheese melted over burgers on a sesame seed
bun, chili con carne poured over frankfurters,
and cornmeal-crusted chicken served with
cream gravy and buttermilk biscuits are nearly
unrecognizable compared to their European
and African origins. And while the tamale pie
in Texas, ahi burger in Hawaii, tofu lasagna in
a vegetarian home, and avocado turkey crois-
sant sandwich in the university cafeteria are
not authentic ethnic fare, they are authentic
American foods. It is the unexpected and
exciting ways in which the familiar and the
new are combined that make the study of food
habits in the United States such a pleasurable
and appetizing challenge.
One example of a multi-
cultural culinary creation
is the California roll, the
addition of avocado to
traditional Japanese
crab sushi. It is called
“American sushi” in
Japan.
D I S C U S S I O N S T A R T E R S
Who Are You? And What Do You Eat?
● Write a short description of your cultural identity. What is your race? What is your
ethnicity? What about your parents and your grandparents? Where is your family
originally from? Think about your high school friends and classmates. What was
their race? Their ethnicity?
● Next, write a description of what you eat. What are your favorite foods? When
living at home, what foods did your family typically eat? If your parents cooked
meals, what would they typically cook?
Now, form groups of three to four and share your descriptions with each other. Imagine
that your instructor asks you to a “potluck,” a social gathering where everyone invited
is supposed to bring something for everyone else to eat. What do you want the other
members of your group to bring? What foods might they bring that you would like to try?
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 2 9
Review Questions
1. Define the terms f ood and f ood and f ood f ood h abits. How
does the omnivore’s paradox influence a per-
son’s food choices and food habits?
2. List four factors that may influence an indi-
vidual’s choice of foods. Pick one and explain
how this factor influences food choices.
3. Define the terms c ul tur e and ac c ul tur ation.
Describe an example of a change in food habits
that may reflect acculturation.
4. Describe the flavor principles, core foods, and
meal patterns of your family’s diet.
5. Which of the factors described by the con-
sumer food choice model currently influence
your food choices? Which factors do you think
will stay the same and which do you think will
change as you age?
References
1. Census.gov 2014 national population projec-
tions. n.d. Retrieved from http://www.census.gov/
population/projections/data/national/2014/
summarytables.htm (accessed January 4, 2015).
2. Grieco, E.M., Acosta, Y.D., de la Cruz, G.P,
Gambino, C., Gryn, T., Larsen, L.J., Trevelyan,
E.N., & Walters, N.P. 2012. The foreign-born
population in the United States: 2010. A mer ic an
C ommunity S ur v ey R epor ts. Washington, DC:
U.S. Department of Commerce Economics and
Statistics Administration. U.S. Census Bureau.
3. U.S. Census Bureau. 2013. Asians fastest-growing
race or ethnic group in 2012. Release Number:
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119. Dietz, W.H. 1995. Does hunger cause obesity?
P ediatr ic s, 9 5 , 766–767.
120. Jetter, K.M., & Cassady, D.L. 2005, March. The
availability and cost of healthier food items.
U niv er sity of C al if or nia A gr ic ul tur al I ssues C enter
A I C I ssues B r ief 2 9 .
121. Kumanyika, S., & Grier, S. 2006. Targeting inter-
ventions for ethnic minority and low-income
populations. T h e F utur e of C h il dr en, 1 6 , 187–207.
122. Drewnowski, A. OBESITY, diets, and social
inequalities. 2009, May. N utr ition R ev iew s.
6 7 ( Suppl 1), S36–S39.
123. Eisenmann, J.C., Gundersen, C., Lohman, B.J.,
Garasky, S., & Stewart, S.D. 2011. Is food inse-
curity related to overweight and obesity in chil-
dren and adolescents? A summary of studies,
1995–2009. O besity R ev iew s, 1 2 (5), e73–e83.
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3 4
Traditional Health
Beliefs and Practices2 CHA
P
T
E
R
$11 billion annually to nearly $40 billion.2
When biomedical care is sought, it is often
in conjunction with these other systems. The
term integr ativ e medic ine is used when there
is a combination of conventional and CAM
treatments that have demonstrated scientific
evidence of safety and effectiveness.1
Culture determines how a person defines
health, recognizes illness, and seeks treat-
ment. Traditional health beliefs and prac-
tices can be categorized in various ways:
through the etiology of illness (due to per-
sonal, natural, social, or supernatural causes)
or by the cures that are employed (the use of
therapeutic substances, physical forces, or
magico-religious interventions). There is no
consensus, however, on these classifications.
In this chapter, home remedies, popular
approaches such as folk and alternative tra-
ditions, and professional systems (including
U.S. biomedicine, traditional Chinese medi-
cine, and Asian Indian ayurvedic medicine)
are reviewed within the cultural context of
health and illness. Specific beliefs and prac-
tices are detailed in the following chapters on
each American ethnic group.
Worldview
Cultural Outlook
Each cultural group has a unique outlook on
life, based on a common understanding and
ranking of values. These standards typically
represent what is considered worthy in a life
well lived. They are a collective expression of
Health and illness in America are usually considered the specialty of mainstream biomedicine. B iomedi-
c ine is the term used to describe the conven-
tional system of health care in the United
States and other Western nations based on the
principles of the natural sciences, including
biology, physiology, and biochemistry. Fur-
thermore, health promotion is based on sci-
entific findings of researchers regarding diet,
exercise, and lifestyle issues such as smoking
cessation and stress management; disease is
treated according to the latest technologies. In
reality, health care is pluralistic in the United
States, as well as in most other cultures. Many
people in the United States never consult a
physician or allied health care provider when
physical or emotional symptoms occur, rely-
ing on home remedies and popular therapies
found readily on the Internet rather than
seeking professional help. Complementary
and alternative medicine (CAM) is popular
with many Americans. The National Cen-
ter for Complementary and Alternative
Medicine recently published data gathered
from the National Health Interview Survey
and estimates that approximately 38 percent
of all adults and approximately 12 percent of
all children used some form of CAM during
the year of 2007. This is a significant increase
since the last report in 2002. The top five CAM
therapies included natural products, deep
breathing, meditation, chiropractic and osteo-
pathic interventions, and massage.1 Consumer
spending on such practices and products has
more than tripled in the past decade, from
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 2 3 5
preferences and priorities—not absolutes—
and individuals within a society may hold a
spectrum of beliefs. However, expectations
about personal and public conduct, assump-
tions regarding social interaction, and assess-
ments of individual behavior are determined
by this cultural outlook, or worldview. This
perspective influences perceptions about
health and illness as well as the role of each
within the structure of a society.3,4,5 Majority
American values, which are shared by most
whites and to some degree by many other
ethnic groups in the United States, emphasize
individuality and control over fate (Table 2.1).
Personal accountability and self-help are
considered cultural cornerstones. One study
found that 82 percent of American consumers
believe they are directly responsible for their
own health.6 Most other cultures worldwide
believe that fate—including the will of God,
the actions of supernatural agents, or birth-
right (i.e., astrological alignment or cosmic
karma)—is a primary influence in health and
illness. Although most cultures have complex
practices regarding the maintenance of health,
the concept of preventative health care, such as
annual checkups, is unknown in some cultures
where fate dominates.
The significance of fate often coincides
with differences in perceptions of time. Many
Americans place great value on promptness
and schedules; they are also future oriented,
meaning they are willing to work toward long-
term goals or make sacrifices so that they or
their children will reap rewards in the future.
The majority members in the United States
TA B L E 2 .1 Comparison of Common Values
Majority American Culture Other Cultural Groups
Mastery over nature Harmony with nature
Personal control over the environment Fate
Doing—activity Being/becoming
Time dominates Personal interaction dominates
Human equality Hierarchy/rank/status
Individualism/privacy Group welfare
Youth Elders
Self-help Birthright inheritance
Competition Cooperation
Future orientation Past or present orientation
Informality Formality
Directness/openness/honesty Indirectness/ritual/“face”
Practicality/efficiency Idealism
Materialism Spiritualism/detachment
SOURCE: Adapted from E. Randall-David, Strategies for Working with Culturally Diverse Communities. Association for the Care of Children’s Health, 19 Mantua Rd.,
Mt. Royal, NY 08061. Copyright 1989.
▼
The concept of preventive
health care, such as annual
checkups provided by a
biomedical professional, is
unknown in some cultures
where fate is believed to
determine health.
M
ic
ha
el
N
ew
m
an
/P
ho
to
Ed
it
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3 6 T R A D I T I O N A L H E A L T H B E L I E F S A N D P R A C T I C E S
are also monochronistic, with a preference for
concentrating on one issue or task at a time
in a sequential manner. Many other cultural
groups live in the present and are often poly-
chronistic, or comfortable doing many things
at once. A Mexican American who is talking
with his grandmother while fixing an appliance
and watching a baseball game on television is
unlikely to cut the visit short just because he
has a medical appointment. Immediate inter-
ests and responsibilities, including interper-
sonal relationships, are more important than
being on time. A few cultures, such as certain
Native American nations, are past oriented,
living according to historical direction.
Most majority Americans are very task ori-
ented and desire direct participation in their
health care; they feel best when they can do
something. Other cultures place a greater value
on being and feel comfortable with inactivity.
Self-worth is based more on personal relation-
ships than on accomplishments. The expecta-
tion is that the health care practitioner will
take responsibility for treatment. The whole
idea of the provider–client partnership may be
alien to Asians, who often expect to be fully
directed in their care. While many Americans
value patient autonomy and confidentiality,
other cultural groups, such as Middle Eastern-
ers, believe that the family should be involved
in all health care decisions—the welfare of the
group outweighs that of the individual.
Many cultures prefer indirect communi-
cation, which seems vague and noncommit-
tal to Americans, who consider honest, open
dialogue essential to effective communication
(see Table 2.2). In addition, Americans often
prefer informality, compared to many cul-
tures that expect a formal relationship with
everyone but intimate family members. In
cultures where identity with a group is more
significant than individuality, social status
and hierarchy are respected, which can have
an impact on the practitioner–client relation-
ship (see Chapter 3, “Intercultural Communi-
cation,” for more information).
Worldview is especially evident in serious,
life-and-death health care decisions. Southeast
Asians may appear indifferent to a terminally ill
family member and have little interest in pro-
longing life because of a faith in reincarnation.
Some African Americans distrust white Ameri-
can health care recommendations regarding
do-not-resuscitate orders in part because they
contradict the critical role of faith in African
American healing. An Orthodox Jewish patient
may believe that physicians are mandated to
preserve life and that any person who assists
death through denial of sustaining care is a
murderer; a non-Orthodox Jew may believe
that no one should endure uncontrollable
pain and thus dying should not be prolonged.
Middle Easterners traditionally demand that
everything be done to keep a person alive
because death is in God’s hands, and one must
never give up hope. Mexican American fam-
ily members might view death as part of God’s
plan for a relative; they might be against any-
thing that would quicken death, or they may
expect the practitioner to make the decision.7,8,9
Most health care situations are not cases of
life or death, and worldview affects many other,
less catastrophic aspects of health and illness as
well. It is useful to examine the biomedical
worldview and understand the perspective of
most U.S. health care providers before learning
about other traditional health beliefs and prac-
tices. Comparisons between biomedicine and
other medical systems can reveal areas of
potential disagreement or conflict regarding
Some majority
Americans find eating a
meal a disruption of daily
tasks; others adhere to
strict meal schedules. In
polychronistic (people-
oriented versus task-
oriented) societies, meals
are usually leisurely
events, a chance to enjoy
the blessings of food in
the company of family
and friends.
TA B L E 2 . 2 Direct and Indirect Communication
Direct Communication Indirect Communication
1 Openly confront issues or difficulties
2 Communicate concerns straight-forwardly
3 Engage in conflict when necessary
4 Express views or opinions in a frank manner
Example: Get right to the point during a
conversation.
1 Focus is not just on what is said but how it is said
2 Avoid difficult or contentious issues
3 Avoid conflict if possible
4 Express opinions and concerns diplomatically
5 Count on the listener to interpret the meaning
Example: Avoid saying no; say maybe or possibly,
even if you mean no.
SOURCE: Peterson, Brooks. 2004. Cultural intelligence: A guide to working with people from other cultures. Boston: Intercultural Press.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 2 3 7
how and why illness occurs and the expecta-
tions for treatment before working with a client.
Compliance increases with clinical approaches
that concur with the client’s worldview.10,11
Biomedical Worldview
Biomedicine is a cultural subdivision of the
American majority worldview. It shares many
beliefs with the dominant outlook but differs
in a few notable areas.12,13 There are certainly
exceptions to the biomedical worldview within
certain specialties, and by some practitioners,
yet many of the underlying assumptions are
culture-specific. The tendency is for health
care providers to enforce their beliefs, prac-
tices, and values upon clients, sometimes
unknowingly because they are unaware of
cultural differences, but more often because
they believe their ideas are superior. This pro-
cess is called c ul tur al imposition, and it impacts
nearly all client care.14
Relationship to Nature
Biomedicine adheres to the concept of mas-
tery over nature. Practitioners are soldiers in
the war on cancer (or other conditions). They
fight infection, conquer disease, and kill pain.
Technology is considered omnipotent; its tools
are the arsenal used to battle pain and illness.
One factor in this approach is the attitude
that health can be measured numerically and
that there are standardized definitions of dis-
ease. Blood and urine analyses, X-rays, scans,
and other diagnostic tests are used to define
whether a patient is within normal physical or
biochemical ranges. Results falling within des-
ignated parameters mean the patient is func-
tioning normally; if the data are too high or
too low, the patient is in an abnormal state that
may indicate disease. Diagnosis occurs inde-
pendent of the idiosyncratic characteristics of
the individual, usually without consideration of
cultural factors such as ethnic background or
religious faith. Symptoms that cannot be linked
to a known medical problem are frequently
determined to be of psychosomatic origins.12
Personal Control or Fate?
The U.S. medical system leaves little room
for chance or divine intervention. Scientific
rationality dictates that there is a biomedi-
cal cause for every condition, even if it is as
yet undiscovered. Each individual inherits a
certain physiological constitution and has a
personal responsibility to make the choices
that prevent illness. Receiving immunizations
and getting regular checkups are biomedical
ways by which individuals can preserve their
health. Being obese, smoking cigarettes, con-
suming immoderate amounts of alcohol, and
failing to manage stress are biomedical exam-
ples of how individuals may endanger their
health.
When a person is ill, the biomedical
assumption is that he or she will reliably com-
ply with therapy, and that treatment, if under-
taken correctly by the patient, will alleviate
the condition. The onus of cure is dependent
on personal behavior. From the patient’s per-
spective, there is the presumption that health
care professionals will provide mistake-free
care. Malpractice suits filed when care was
less than perfect have led to extensive chart-
ing and record keeping in the U.S. biomedical
system.
State of Being
Consistent with the value placed on personal
control, biomedical patients are expected to
be active partners in their cure. Noncompli-
ance is disliked by biomedical practitioners.
Changes in lifestyle can help preserve health;
taking medications and completing therapeu-
tic regimens can relieve symptomatic pain
or cure disease. The biomedical emphasis is
on doing, not being. Other worldviews may
expect client nonparticipation and acceptance
of adverse conditions. Clients are the recipi-
ents of healing, not participants in healing.
Role of the Individual
Similar to the American majority worldview,
individuality is honored in U.S. biomedicine,
and client confidentiality is mandatory. Indi-
viduals are seen as a single, biological unit, not
as members of a family or a particular cultural
group. It is assumed that a person desires pri-
vacy, and clients are sometimes encouraged
by providers to keep medical matters quiet,
even if it means withholding information
from relatives. Typically, treatment is focused
solely on the client, in keeping with the beliefs
of personal responsibility and the provider–
patient partnership.
Some researchers have
noted that although
the biomedical com-
munity often calls clients
whose cultural back-
ground differs from the
majority “hard to reach,”
this term is equally
applicable to health
professionals who refuse
to provide culturally
appropriate care.70
The number of adults
over sixty-five years
in the United States is
expected to double by
the year 2050; figures
among some ethnic
groups, such as African
Americans, Asian Ameri-
cans, Native Americans
and Latinos, show even
greater growth.
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3 8 T R A D I T I O N A L H E A L T H B E L I E F S A N D P R A C T I C E S
Human Equality
A fundamental premise in American biomed-
icine is that all patients deserve equal access
to care, although, practically speaking, cost,
location, and convenience prevents many
patients from receiving adequate health ser-
vices. This is a relatively unique perspective;
most other societies deliberately ration health
care through assessing physical status (e.g.,
a young person may receive services denied
to a terminally ill older person) or through
socioeconomic status (e.g., the wealthy can
purchase care; the poor are left to whatever
society offers).
The biomedical worldview on human
equality differs substantially from the main-
stream American outlook in one way, how-
ever. A hierarchy of biomedical professionals
is strictly observed in the United States, with
physicians having the highest status and allied
health professionals substantially less. Health
care workers outside the professional sys-
tem, such as clerical and custodial workers,
and those beyond the reach of biomedicine,
such as folk healers, are accorded even lower
standing. Deference to those of superior rank
is expected. The client is typically inferior to
biomedical professionals within this hierarchy.
Aging
Biomedicine supports the majority American
worldview in its value on youthfulness. Many
aspects of health care practice are dedicated
to postponing the aging process, from plastic
surgery to the technological prolongment of
life. The fear of aging is so pervasive in the
U.S. culture that it influences health care out-
side the conventional biomedical system as
well. Numerous alternative traditions promise
everlasting youth through the use of certain
products. The emphasis on youthfulness is in
direct conflict with other cultural worldviews
that honor the wisdom that comes with aging
and that hold high esteem for elders.
Perceptions of Time
Biomedicine is future oriented—that is, what
can be done today so that the client will be bet-
ter tomorrow. Often treatments are unpleas-
ant, invasive, and even painful at the moment
of their application, yet the hope is that they
will benefit the client in the future. Long-term
management of disease and illness-prevention
strategies such as diet are even more oriented
toward future benefits.
Although being on time for appointments
and taking medications when scheduled are
traits valued in clients, biomedical practi-
tioners are notorious for their disrespect of
clients’ time. Clients are frequently asked to
arrange nonemergency consultations weeks
or even months in advance and may be kept
waiting on the days of their appointments.
Degree of Formality/Degree
of Directness
The established biomedical hierarchy, as
well as the emphasis on timeliness, is often
reflected in the degree of informality observed
in dialogue between provider and patient. The
provider often addresses the client by his or
her first name, yet expects the patient to use
formal titles in return. The provider usually
spends limited time on small talk and attempts
to get quickly to the problem; the expectation
is the patient will also use a direct approach.
Extensive medical jargon without explanation
is often employed.
Biomedical practitioners value honest,
open communication with patients because
it enhances their ability to diagnose and
treat disease, and it assists in issues such as
informed consent. Other cultural world-
views, however, value indirect or intuitive
communication with health care practitio-
ners (see Chapter 3 for more information).
Some cultures also believe that the family,
not the patient, should be told about serious
conditions.15
Materialism or Spirituality?
Each disease, from the biomedical viewpoint,
has its own physiological characteristics: a
certain cause, specific symptoms, expected
test results, and a predictable response to
treatment. For many biomedical health care
providers, an illness isn’t real unless it is clini-
cally significant; emotional or social issues
are the domain of other specialists. Biomedi-
cine differs from most traditional health care
approaches in the recognition of the mind–
body duality. Nearly all other cultures consider
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 2 3 9
the mind and body as a unified whole. Soma-
tization refers to the expression of emotions
through bodily complaints. In biomedical cul-
ture, somatic symptoms are often interpreted
as a maladaptive emotional response, yet they
are the most common presentation of psycho-
logical distress in patients worldwide.16 In folk
medicine and some alternative traditions, the
emotional needs of the patient are addressed
through physical therapies. Spiritual interven-
tion is frequently sought concurrently.
What Is Health?
Cultural Definitions
of Health
Meaning of Health
The World Health Organization (WHO)
describes health as “a state of complete physi-
cal, mental, and social well-being, not merely
an absence of disease or infirmity.” Although
comprehensive from a biomedical perspec-
tive, this definition does not fit the worldview
of many cultural groups because it ignores the
natural, spiritual, and supernatural dimen-
sions of health.
Most Native Americans believe that health
is achieved through harmony with nature,
which includes the family, the community,
and the environment. Africans also empha-
size a balance with nature and believe that
malevolent environmental forces such as
those of nature, God, the living, or the dead
may disrupt a person’s energy and bring
illness. Many African Americans, Latinos,
Middle Easterners, and some southern
Europeans attribute health to living accord-
ing to God’s will. Gypsies maintain health
through avoiding contact with non-Gypsies,
who are considered inherently polluted. Most
Asians believe that health is dependent on
their relationship to the universe and that a
balance between polar elements, such as yin
and yang, must be maintained. Some South-
east Asians are concerned with pleasing their
ancestor spirits, who may cause accidents or
sickness when angry. Pacific Islanders believe
that fulfilling social obligations is essential to
health and that disharmony with family or
village members can result in illness. Asian
Indians consider mind, body, and soul to be
interconnected and believe that spirituality is
as important to health as a good diet or getting
proper rest (see individual chapters on each
ethnic group for more details).
Health in other cultures is less dependent
on symptoms than on the ability to accom-
plish daily responsibilities. Among Koreans,
there is a strong desire to avoid burdening
their children with their health problems.
Mexican men may ignore physical com-
plaints because it is considered weak and
unmanly to acknowledge pain. Even within a
single culture, socioeconomic differences may
contribute to the definition of health; daily
aches are tolerated when a weekly paycheck
is essential.12
Health Attributes
As health is defined culturally, so are the
characteristics associated with health. Physi-
cal attributes are commonly linked with
well-being, including skin color, weight main-
tenance, and hair sheen. Normal functioning
of the body, such as regular bowel movements,
routine menstruation, and a steady pulse is
expected, as is the use of arms, legs, hands,
and the senses. Undisturbed sleep and not
being tired also suggests good health.
Harmony within the context of marriage,
family, and community are sometimes consid-
ered signs of well-being. The specifics of
health characteristics vary culturally. Healthy
hair in the United States is advertised as clean,
shiny, and flake-free, but in many cultures oily
hair is the norm, and dandruff is not a signifi-
cant concern. Americans count on a single,
strong pulse of about seventy-two beats per
minute when resting, while in other medical
systems there is more than one pulse of
importance to health, and these pulses are a
primary diagnostic tool in illness. Pregnancy
is a medical condition in the United States
warranting regular exams by biomedical pro-
fessionals, whereas in many societies preg-
nancy is a normal aspect of a healthy woman’s
cycle, and prenatal care is uncommon. Gener-
ally speaking, Americans expect to be content
in their lives; many other cultures have no
such assumptions and do not link happiness
with well-being.
The separation between
physical and emotional
or psychological health is
so embedded in Ameri-
can culture that no Eng-
lish word exists to even
express the concept of
mind–body unity.
The word health comes
from the Anglo-Saxon
term hal, meaning
“wholeness.”
In ayurvedic medicine,
a distinction is made
between general health
and optimal health.
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4 0 T R A D I T I O N A L H E A L T H B E L I E F S A N D P R A C T I C E S
Body Image
One area of significant cultural variation
regarding health is body image. Perceptions
of weight, health, and beauty differ world-
wide. In the United States, there is significant
societal pressure to be thin. Although there is
no scientific agreement on the definition of
ideal or even healthy weight for individuals,
being overweight is usually believed to be a
character flaw in the majority American cul-
ture. Even health care professionals report-
edly make moral judgments about obesity,
depicting overweight persons as weak-willed,
ugly, self-indulgent, and fair game for ridi-
cule.17,18,19 The health risks associated with
being overweight cause some providers to
presume ill health in their obese clients. Thin-
ness corresponds to the biomedical worldview
regarding mastery of nature, the idea that the
mind can control the appetite.20
Historically, thinness has been associated
with a poor diet and disease. In many cul-
tures today, including those of some Africans,
Caribbean Islanders, Filipinos, Mexicans,
Middle Easterners, American Indians, and
Pacific Islanders, being overweight is a protec-
tive factor that is indicative of health as well as
an attribute of beauty. Many overweight Afri-
can American women, for example, are less
concerned about weight issues and more satis-
fied with their bodies than overweight white
women.21,22 A larger ideal body image is the
norm for most black men and women regard-
less of age, education, or socioeconomic sta-
tus.23,24 Some black Caribbean Islanders and
Puerto Rican women also report a larger body
size as attractive to family and peers when
compared to Anglo, eastern European Amer-
ican, and Italian American women.25 Some
Hispanic women value a heavier profile for
themselves, and even if they opt for a slimmer
body personally, they may prefer plump chil-
dren.26,27 Researchers have found that some
young African American and Latina women
purposefully contest the majority culture
emphasis on thinness, focusing more on self-
acceptance and being caring and attentive.28
Researchers have found that attitudes about
weight sometimes change when an immi-
grant enters a culture with different attitudes
regarding health and beauty. More acculturated
Hispanic women and children were more likely
to choose a thinner figure as ideal than those
who were less acculturated, ideal body image
for Samoan women in Hawaii varied with
whether they identified with Western or non-
Western culture, and Puerto Ricans living on
the mainland United States expressed a desire
for thinness that is between that of their coun-
try of origin and that of the majority culture in
their new homeland.29,30 Among some Native
Americans, ideal body size has changed over
time. Elders are more likely than younger adults
to prefer a heavier profile, and children dem-
onstrate a desire for even thinner bodies.31,32,33
Some studies also suggest the pressure to be thin
may be impacting young persons more than
adults: the percentage of normal-weight teens
engaging in unhealthy weight control behaviors
did not vary by ethnicity in a national examina-
tion of high school students, and another study
found Asian, Hispanic, and American Indian
adolescent girls reported similar numbers of
weight-related concerns as white girls; how-
ever, African American girls had fewer weight
issues.34,35,36 Some Native American school-
children express a high level of body dissatis-
faction, and concerns about overweight were
high in a cohort of third-grade children, with
Latinas and African American girls reporting
the same or greater level of body dissatisfaction
than white and Asian girls.37,38
Health Maintenance
Health Habits
Just as with health attributes, there are some
broad areas of intercultural agreement on
health habits. Nearly all people identify a good
diet, sufficient rest, and cleanliness as neces-
sary to preserving health. It is in the defini-
tions of these terms that cultural variations
occur. For example, majority Americans typi-
cally identify three meals each day as a good
diet. Asians may indicate a balance of yin and
yang foods is a requirement. Middle Eastern-
ers may be concerned with sufficient quantity,
and Asian Indians may be concerned with reli-
gious purity of the food. To most Americans,
keeping clean means showering daily, while
some Filipinos bathe several times each day to
maintain a proper hot–cold balance.
In traditional Chinese
medicine, fifteen
separate pulses are
identified, each associ-
ated with an internal
organ and each with its
own characteristics.
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C H A P T E R 2 4 1
In the United States the National Cen-
ter for Health Statistics describes the trends
for dietary intake. These include that during
2007–2008, the average energy intake for men
was 2,504 kcalories (kcal) and for women,
1,771 kcal. The average carbohydrate intake
of 47–50 percent total kcal is slightly reduced
from previous years, whereas protein intake
was slightly higher.39 Some cultural groups
would find these data irrelevant to health sta-
tus. Macronutrient intake may not be asso-
ciated with disease prevention, and dietary
supplement use may not be familiar. Physical
labor is often a factor in preserving health, but
recreational exercise is rare throughout much
of the world. Alcohol consumption is prohib-
ited by several religions. Preventive care is
unusual in many cultures.
Culturally specific health practices differ
particularly in those beliefs passed on within
families. A small survey of U.S. college stu-
dents from many backgrounds revealed nota-
ble variation in health habits beyond general
concepts regarding diet, sleep, physical activ-
ity, and cleanliness.40 Dressing warmly (eastern
European, French, French Canadian, Iranian,
Irish, Italian, Swedish) and avoiding going
outdoors with wet hair (eastern European,
Italian) were listed by some. Daily doses of cod
liver oil (British, French, French Canadian,
German, Norwegian, Polish, Swedish) or
molasses (African American, French, French
Canadian, German, Irish, Swedish) as a laxa-
tive were frequently reported maintenance
measures. Natural amulets were traditionally
worn in some families to prevent illness, such
as camphor bags (Austrian, Canadian, Irish)
or garlic cloves (Italian). Faith was important
to many of the students, expressed as bless-
ing of the throat (Irish, Swedish) and wear-
ing holy medals (Irish), as well as daily prayer
(Canadian, Ethiopian).
Health-Promoting Food Habits
Food habits are often identified as the most
important way in which a person can main-
tain health. Nearly all cultures classify certain
foods as necessary for strength, energy, and
mental acuity. Some also include items that
maintain the equilibrium within the body
and soul.
General dietary guidelines for health
usually include the concepts of balance and
moderation. In the United States, current
recommendations include a foundation of
complex carbohydrates in the form of whole
grains, vegetables, and fruits; supplemented
by smaller amounts of protein foods such
as meats, legumes, and dairy products; and
limited intakes of fats, sugar, salt, and alco-
hol. The Chinese system of yin–yang encour-
ages a balance of those foods classified as yin
(items that are typically raw, soothing, cooked
at low temperatures, white or light green in
color) with those classified as yang (mostly
high-kcalorie foods, cooked in high heat,
spicy, red-orange-yellow in color), avoiding
extremes in both. Some staple foods, such as
boiled rice, are believed to be perfectly bal-
anced and are therefore neutral. Although
which foods are considered yin or yang vary
regionally in China, the concept of keeping
the body in harmony through diet remains the
same, usually adjusted seasonally to compen-
sate for external changes in temperature and
for physiological conditions such as age and
gender (see Chapter 11, “East Asia”).
Aspects of the yin–yang diet theory are
found in many other Asian nations, and a
similar system of balance focused on the hot–
cold classification of foods is practiced in the
Middle East, parts of Latin America, the
Philippines, and India. Hot–cold concepts
developed out of ancient Greek humoral med-
icine that identified four characteristics in the
natural world (air-cold, earth-dry, fire-hot,
water-moist) associated with four body
humors: hot and moist (blood), cold and
moist (phlegm), hot and dry (yellow/green
bile), and cold and dry (black bile). Applied to
daily food habits, this system usually focuses
on only the hot and cold aspects of food
(defined by characteristics such as taste, prep-
aration method, or proximity to the sun) bal-
anced to account for personal constitution
and the weather. In Lebanon, it is believed that
the body must have time to adjust to a hot
food before a cold item can be eaten. In Mex-
ico, the categorization of hot and cold foods is
related to a congruous relationship with the
natural world. Asian Indians associate a hot–
cold balanced diet with spiritual harmony.
In ancient China,
nutritionists were ranked
highest among health
professionals.
The neutral category
of foods is usually
expanded by those
Asians who prefer
biomedicine and
believe that traditional
health systems are
unsophisticated.71
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4 2 T R A D I T I O N A L H E A L T H B E L I E F S A N D P R A C T I C E S
Quantity of food is often associated with
health as well. Some African Americans, for
example, traditionally eat heavy meals, reserving
light foods for ill and recuperating family mem-
bers. In the Middle East ample food is necessary
for good health, and a poor appetite is some-
times regarded as an illness in itself. As dis-
cussed previously, being overweight is frequently
associated with well-being in some cultures.
In addition to balance and moderation,
specific foods are sometimes identified with
improved strength or vitality. In the United
States, milk is considered to build strong bones,
carrots are considered to improve eyesight, and
candy is considered to provide quick energy.
Chicken soup, a traditional tonic among
eastern European Jews, has become a well-
accepted cure-all. Navajos consider milk to be
a weak food, but meat and blue cornmeal are
strong foods. Asians call strengthening items
pu or bo foods, including protein-rich soups
with pork liver or oxtail in China, and bone
marrow or dog-meat soup in Korea. Puerto
Ricans drink eggnog or malt-type beverages
to improve vitality.
The sympathetic quality of a food, meaning
a characteristic that looks like a human body
part or organ, accounts for many health food
beliefs. The properties of a food entering the
mouth are incorporated into physical traits.
Some Italians drink red wine to improve their
blood, and American women sometimes eat
gelatin (which is made from animal skin,
bones, and other connective tissues) to grow
longer, stronger fingernails. Throughout Asia
and parts of the United States, ginseng, which
is a root that resembles a human figure, is
believed to increase strength and stamina.
Other foods are believed to prevent specific
illnesses. Americans, for instance, are urged
to eat cabbage-family (cruciferous) vegeta-
bles to reduce their risk of certain cancers.
Oatmeal (high in soluble fiber) and fish
(high in omega-3 fatty acids) have both been
promoted as preventing heart disease.
Some cultures believe that fresh foods pre-
pared at home are healthiest and, in the United
States, the popularity of locally grown items
and organic foods (those produced without
the use of chemical additives or pesticides)
has increased in recent years. Vegetarianism,
macrobiotics, customized diets that account
for an individual’s food sensitivities or aller-
gies, and very low-fat or low-carbohydrate
diets are a few of the other ways in which
health is promoted by some people through
food habits.
Disease, Illness,
and Sickness
Cultural Definitions of
Disease, Illness, and Sickness
When health is diminished, a person experi-
ences difficulties in daily living. Weakness,
pain and discomfort, emotional distress, or
physical debilitation may prevent an indi-
vidual from fulfilling responsibilities or
Ritualistic cannibalism,
especially when the
heart or liver of a brave
and worthy enemy was
consumed, is an extreme
example of the sympa-
thetic qualities of food.
▲ The health value
of specific foods varies
culturally. In the United
States, it is said that milk
builds strong bones. But
in certain Native American
cultures, milk is considered
a weak food. Some Latinos
believe milk is only good for
children.
M
itc
h
H
rd
lic
ka
/P
ho
to
di
sc
/G
et
ty
Im
ag
es
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C H A P T E R 2 4 3
obligations to the family or society. Research-
ers call this experience illness, referring to a
person’s perceptions of and reactions to a
physical or psychological condition, under-
stood within the context of worldview. In bio-
medical culture, illness is caused by disease,
defined as abnormalities or malfunctioning
of body organs and systems. The term sic k –
ness is used for the entire disease–illness
process. When an individual becomes sick,
questions such as how did the illness occur,
how are the symptoms experienced, and
how is it cured arise—answered primarily
through cultural consensus on the meaning
of sickness.
Becoming Sick
During the onset of a sickness, physical or
behavioral complaints make a person aware
that a problem exists. The development may
be slow, and the symptoms may take time to
manifest into a disease condition. Or symp-
toms may occur suddenly, and it is quickly
obvious that illness is present.
Except in emergencies, an individual usu-
ally seeks confirmation of illness first from
family or friends. Symptoms are described
and a diagnosis is sought. A knowledgeable
relative is often the most trusted person in
determining whether a condition is cause
for concern and whether further care should
be pursued; in many cultures, a mother or
grandmother is the medical expert within a
family. This is a major step in social legiti-
mization of the sickness. If others agree
that the person is ill, then the individual
can adopt a new role within the family or
community—sick person. In this capacity,
the sick person is excused from many daily
obligations regarding work and family, as
well as social and religious duties. A reprieve
from personal responsibility for well-being
is also given, with care provided by relatives,
healers, or health professionals. The role
of sick person provides a socially accepted,
temporary respite from the physical and
psychological burdens of everyday life, with
the understanding that sickness is not a per-
manent condition and that recovery should
occur.12,40,41
Explanatory Models
When unexpected events happen, there is a
human need to explain the origins and causes
of seemingly random occurrences. Explana-
tory models consistent with a culture’s world-
view are used to account for why good or evil
happens to a person or a community and to
calm individual fears of being victimized. In
sickness, the explanatory model details the
cause of disease, the ways in which symp-
toms are perceived and expressed, the ways
in which the illness can be healed and pre-
vented from reoccurring, and why one person
develops a sickness whereas another remains
healthy.41,42,43
The etiology of sickness is of central con-
cern because the reason an illness occurs often
determines the patient’s outlook regarding
the progression and cure of the sickness. In
biomedical culture, three causes of disease
are identified: (1) immediate causes, such as
bacterial or viral infection, toxins, tumors, or
physical injury; (2) underlying causes, includ-
ing smoking, high cholesterol levels, glucose
intolerance, or nutritional deficiencies; and
(3) ultimate causes, such as hereditary pre-
disposition, environmental stresses, obesity,
or other factors.44 The causes of illness are
generally more complex. Four theories on the
etiology of sickness prevalent in most societies
have been described (Figure 2.1): those origi-
nating in the patient, those from the natural
world, those from the social world, and those
due to supernatural causes.12 It is important to
note that in no society do all persons subscribe
to any single cause, and there is considerable
variation in degree of belief, intraculturally as
well as interculturally. Additionally, believing
in a cause does not necessarily result in a prac-
tice associated with that cause.
Sickness Due to the Patient First are those that
develop within the individual patient, usually
attributable to a person’s constitution; that is,
an individual has a genetic (physical or psy-
chological) vulnerability to illness or disease.
Sickness may also be due to lifestyle choices.
A person in the United States may be blamed
for a heart attack if he has become overweight,
Macrobiotics is a
Japanese diet based on
brown rice, miso soup,
and vegetables that was
popularized in Europe
as promoting health in
the 1920s. Serious nutri-
tional deficiencies have
been identified in infants
and toddlers on this
restricted diet.72
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4 4 T R A D I T I O N A L H E A L T H B E L I E F S A N D P R A C T I C E S
eats fatty foods, smokes tobacco, and never
exercises. A person who fails to wear a seat
belt and then is injured in an auto accident
may also be found at fault. Responsibility
for sickness falls primarily on the patient,
although in many other cultures when a
person’s actions are unfavorable to health, it
is outside forces that are thought to actually
cause an illness or accident in retaliation for
the offense.
Sickness Due to the Natural World Etiology
in the natural world includes environmental
elements such as the weather, allergens,
smoke, pollution, and toxins. Viruses, bacte-
ria, and parasites are natural biological agents
of sickness. Wind or bad air is of particular
concern in many cultural groups, includ-
ing some Arabs, Chinese, Italians, Filipinos,
and Mexicans, because it can enter the body
through pores, orifices, or wounds in the
body, causing illness. Humoral systems, which
associate various body humors with natural
elements (as described previously), connect
illness and disease with disharmony in the
environment. Astrology, which determines
an individual’s fate (including health status)
through planetary alignment at the time of
birth, is another natural world phenomenon.
Injuries due to natural forces, such as light-
ning or falling rocks, are sometimes catego-
rized with this group; however, many cultures
believe such accidents are actually the result of
supernatural injunction.
Sickness Due to the Social World Sickness
attributed to social causes occurs around
interpersonal conflict within a community. It
is common to blame an enemy for pain and
suffering. Inadvertent or purposeful malice is
the source of illness and disease in many cul-
tures. Among the most common causes is the
evil eye.
The evil eye is when an individual stares
at a person with envy, resulting in harm to
that person even if the gaze is unintentional.
It is widely believed in parts of Africa, Asia,
Europe, Greece and the Middle East, India,
Latin America, and some areas of the United
States. Children are believed to be vulner-
able to the evil eye, resulting in colic, crying,
hiccups, cramps, convulsions, and seizures.
Among adults, the evil eye can cause head-
aches, malaise, complications in pregnancy
and birth, impotence and sterility in men,
and insanity.45 Protections against the evil eye
include such practices as placing a red bag
filled with herbs on an infant’s crib in Gua-
temala; knotting black or red string around
children’s wrists in India; leaving children
unwashed (making them less admirable) in
Iran; wearing a charm in the form of a black
hand (mano negr o) in Puerto Rico; and paint-
ing a house white and blue to blend with the
sky, thus avoiding notice, in Greece. Eastern
European Jews wear a red ribbon; Sephardic
Jews wear a blue ribbon. In Scotland, a frag-
ment of the Bible is kept on the body, and in
Muslim areas of Southeast Asia a piece of the
Koran is worn.41
Conjury, invoking supernatural forces,
is another frequent social cause of sickness.
A person who is thought to have these pow-
ers can direct illness or injury toward an indi-
vidual, or sell the magic charms or substances
necessary for a normal person to inflict harm.
Conjury is practiced by witches (called br uj os
or br uj as in Spanish), sorcerers, root doctors,
herb doctors, voodoo or hoodoo doctors (see
Chapter 8, “Africans”), underworld men, and
conjure men, most of whom obtain their
powers from the devil or other evil spirit. For
example, a conjurer might sprinkle graveyard
dust under a person’s feet, causing him to
waste away, known as fading in rural African
Regarding the 1918
influenza epidemic, the
New York Post reported
that epidemics are
the punishment that
nature inflicts for the
violation of her laws and
ordinances.70,73
Figure 2.1
Client theories on the
etiology of sickness.
Source: From C.G. Helman, Culture,
Health, and Illness (2nd ed.).
© 2000 Hodder Arnold.
The Supernatural World
The Social World
The Natural World
The Patient
Other names for the evil
eye in the United States
include the bad eye, the
look, the narrow eye,
and the wounding eye.
Those who are victims
have been blinked, eye
bitten, forelooked, or
overlooked.
Fear of the evil eye is
mentioned in Talmudic
writings, the Bible, and
the Koran.
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C H A P T E R 2 4 5
American tradition. A bundle of sticks placed
in the kitchen will cause illness in people who
consume food prepared there. A br uj o can
cause illness in Latinos through contagious
magic, using bits of a person’s hair or finger-
nails when casting a spell. Native American
conjury often uses animals or natural phe-
nomena (such as lightning) to attack a victim,
or causes natural objects to be inserted into
the body, resulting in pain. The bewitched
Native American may behave in inexplicable,
disruptive ways and may be abandoned by
the community if considered incurable and
unable to change undesirable conduct.41,47
There is often an overlap between sickness
attributed to the social world and that caused
by supernatural forces.
Sickness Due to the Supernatural World In
the supernatural realm, sickness is caused
by the actions of gods, spirits, or the ghosts
of ancestors. The will of God is a prominent
factor in illness and disease suffered by many
Jews, Christians, and Muslims. Sickness is
sometimes considered a punishment for the
violation of religious covenants, and other
times it is viewed as simply a part of God’s
unknowable plan for humanity. Even those
persons who do not follow a specific faith
may ascribe illness to fate, luck, or an act of
God. Some Africans, Asians, Latinos, Middle
Easterners, American Indians, and Pacific
Islanders believe that malevolent spirits can
attack a person, causing illness. For example,
among Cambodians, death can occur when
the nightmare spirit immobilizes a victim
through sitting on his or her chest and caus-
ing extreme fright.48 In other situations spirit
possession takes place. An evil spirit inhabits
the body of a victim who then exhibits aber-
rant behavior, such as incoherent speech or
extreme withdrawal. Many Southeast Asians
associate caretaker spirits with body organs
and life forces that may desert a person when
angered or frightened, leaving that individual
vulnerable to sickness. In addition, the ghosts
of ancestors usually protect their living rela-
tives from harm, but may inflict pain and ill-
ness when ignored or insulted.
One of the most common causes of sick-
ness in many cultures is soul loss, when the
soul detaches from a person’s body, usually
due to emotional distress or spirit possession.
The symptoms typically include general mal-
aise, listlessness, depression, a feeling of suf-aise, listlessness, depression, a feeling of suf-aise, listlessness, depression, a feeling of suf
focation, or weight loss. If left untreated, soul
loss can lead to more serious illness.
Folk Illnesses
Inasmuch as sickness is culturally sanctioned
and explained through culture-specific
models, it follows that each culture recog-
nizes different disorders. Certain symptoms,
complaints, and behavioral changes are asso-
ciated with specific conditions and are termed
folk illnesses or culture-bound syndromes.
Examples of such sicknesses are not uncom-
mon, such as cases of soul loss experienced
by some Asians, Latinos (who call it susto or
espanto), Native Americans, Pacific Islanders,
and Southeast Asians. Muso, experienced
by young Samoan women as mental illness,
and sudden unexpected nocturnal death
syndrome (SUNDS) suffered by Cambodi-
ans (see the previous section, “Sickness Due
to the Supernatural World”) are cases of folk
illness due to evil spirits. Strong emotions,
particularly fright or anger, cause many folk
conditions, such as stroke precipitated in bil is
or c ol er a in some Guatemalans, the cooling
of the blood and organs in c eeb among the
Hmong, or the stomach and chest pain of
h w aby ung in some Koreans. Psychological h w aby ung in some Koreans. Psychological h w aby ung
distress is often expressed through somatic
complaints in some cultures; for instance,
an Asian Indian may present symptoms of
extreme stress as burning on the soles of the
feet, or a depressed Asian Indian man may
experience dh at, the loss of semen.
Diet-related folk illnesses are common.
High blood and low blood among some African
Americans are examples. Depending on the
cultural group, imbalance in the digestive
system results in numbness of the extremities
(si z h i ma mu) in some Chinese; nausea and the
feeling of a wad of food stuck in the stomach
(empac h o) among Mexicans; and paralysis in
some Puerto Ricans (pasmosome Puerto Ricans (pasmosome Puerto Ricans ( ). The eating dis-
orders anorexia nervosa (a fear of being fat and
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4 6 T R A D I T I O N A L H E A L T H B E L I E F S A N D P R A C T I C E S
failure to maintain body weight resulting in a
weight 15 percent or more below that recom-
mended) and bulimia nervosa (binge eating
followed by the use of self-induced vomiting,
laxatives, enemas, or medications to reduce
calorie intake, or the use of excessive exer-
cise or fasting) are sometimes described as a
culture-bound syndrome in the United States
and other Westernized nations, associated
with issues such as the drive to thinness, body
image, maturity, and control.49,50,51 In the case
of anorexia, it is usually the biomedical culture
that identifies the symptoms as a disease state.
Many anorectics do not consider themselves ill
or in need of medical intervention. Such differ-
ences in the definition of sickness account for
why some conditions, such as anorexia or other
folk illnesses, are difficult to cure with biomed-
ical approaches. Effective treatment of many
sicknesses depends on agreement between the
patient and the practitioner regarding how the
illness has occurred, the meaning of the symp-
toms, and how the sickness is healed.43
Healing Practices
Biomedical health professionals attempt to
diagnose and cure the structural and func-
tional abnormalities found in patients’ organs
or systems. In contrast, healing addresses the
experience of illness, alleviating the infirmi-
ties of the sick patient even when disease is
not evident. Healing responds to the per-
sonal, familial, and social issues surrounding
sickness.
Seeking Care
When sickness occurs, a person must make
choices regarding healing. Professional bio-
medical care, if available, is usually initi-
ated when the onset of symptoms is acute
or an injury is serious. Nearly all cultural
groups recognize the value of biomedicine in
emergencies.
Choice of care often depends on the
patient’s view of the illness in cases when the
sickness is not life threatening. In these situ-
ations, home remedies are generally the first
treatment applied.33,46 Therapies may be deter-
mined by the patient alone or in consultation
with family members, friends, or acquain-
tances. If the remedies are ineffective, if other
people encourage further care, or if the indi-
vidual experiences continued disruption of
work, social obligations, or personal relation-
ships, professional advice may be sought. The
type of healer chosen depends on factors such
as availability, cost, previous care experiences,
referrals by relatives or friends, and how the
patient perceives the problem. If the patient
suffers from a folk illness, a folk healer may
be sought immediately because biomedical
professionals are considered ignorant about
such conditions. Otherwise, biomedical care
may be undertaken, independently or simul-
taneously with other approaches. A study of
Taiwanese patients revealed that in acute ill-
ness, biomedical care was initially sought; but,
if treatment was ineffective, traditional Chi-
nese medical practitioners were employed;
if there was no progress in healing, another
traditional specialist would be tried; and if the
patient was still afflicted, sacred healers would
be sought. In chronic or recurrent sickness,
biomedical, traditional Chinese medicine, and
spiritual approaches would be attempted con-
currently.10 The use of multiple approaches is
particularly common when there are concerns
that a condition is culture specific.52,53,54,55
Research suggests that large numbers of
Americans obtain health care outside the
biomedical system for minor and major ill-
nesses.1,56,57 As many as one-third to one-half
of patients with intractable conditions (e.g.,
back pain, chronic renal failure, arthritis,
insomnia, headache, depression, gastrointesti-
nal problems), terminal illnesses such as can-
cer or acquired immune deficiency syndrome
(AIDS), and eating disorders seek unconven-
tional treatment. Nearly all do so without the
recommendation of their biomedical doctor,
integrating multiple therapies on their own.
Biomedicine is rejected by some people
because their experience with care has been
impersonal, costly, inconvenient, or inacces-
sible. Further, conventional treatments may
have been painful or harmful. Some clients
believe that biomedical professionals are hos-
tile or uninterested in ethnic health issues.44,58
Health care professionals may disregard the
patients’ explanations as to the cause of the
health problem or dismiss their complaints
as clinically insignificant. Folk healers and
▲ Body image is one area
where the viewpoint of the
client may vary from the
biomedical assumptions
of the health care provider.
Obesity in some cultures is
still considered desirable
because it indicates wealth
and having adequate
amounts of foods.
To
ny
F
re
em
an
/P
ho
to
Ed
it
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C H A P T E R 2 4 7
other alternative practitioners can provide an
understanding of an illness within the context
of the patient’s worldview and can offer care
beyond the cure of disease, including sincere
sympathy and renewed hope.
Healing Therapies
There is no consensus concerning the classifi-
cation of what is called unconventional, alter-
native, or folk medical care. Home remedies
(e.g., herbal teas, megavitamins, relaxation
techniques), popular therapies (e.g., chiro-
practic, homeopathy, hypnosis, massage),
and professional practices (i.e., those that
require extensive academic training in con-
ventionally recognized medical systems, such
as biomedicine, traditional Chinese medicine,
and ayurvedic medicine) include a variety of
treatments that fall into three broad categories:
(1) administration of therapeutic substances,
(2) application of physical forces or devices,
and (3) magico-religious interventions.13,59
Most patients use unconventional therapies
without the supervision of a biomedical doc-
tor or any other kind of health care provider.
Popular and professional practitioners, when
consulted, may use one or several of these
treatments in healing a patient.
Administration of Therapeutic Substances
Biomedical medication and diet prescriptions
are two of the most common types of thera-
peutics in this category, which also includes
over-the-counter medications, health food
preparations, and prepackaged diet meals, as
The person most likely
to use complementary
and alternative medicine
in the United States is a
middle- to upper-class
white or Asian woman
who is well educated
in consumer health
issues and lives in an
urban area in one of the
Pacific states.5
Botanical Remedies
More than 80 percent of the world’s population uses herbal remedies
to treat illness and optimize health. Techni-
cally, an herbal medicine contains only leafy
plants that do not have a woody stem.76
A more comprehensive term is botanical, botanical, botanical
including all therapeutic parts of all plants,
from the root (e.g., ginseng), the bark
(e.g., willow), the sap (e.g., from aloe), the
gum (e.g., frankincense) or oil (e.g., from
nutmeg), the flowers (e.g., echinacea), the
seeds (e.g., gingko biloba), to the fruit (e.g.,
bilberries). Botanical remedies often use
the whole plant, which practitioners claim
is superior to using a single active extract
because other components in the plant may
work together synergistically in the prepara-
tion to enhance the therapeutic value and to
buffer any side effects. For this same reason,
plants are often combined in formulary
mixtures, particularly in traditional Chinese
medicine.
Most consumers select botanical rem-
edies instead of biomedicine because they
believe they are safer and more effective than
prescription drugs or they are treating chronic
conditions for which biomedicine has little to
offer in the way of relief. Some proponents
note that botanicals have been used for
centuries and that reported deaths each year
number in only the hundreds, while it is well
known and reported in the United States
that prescription medications can cause
adverse problems, especially among older
adults.77 The key word, however, is reported.
The Dietary Supplement Health and Educa-
tion Act (DSHEA) passed by Congress in 1994
defines dietary supplements as separate
from food and drugs and thus outside the
scope of federal monitoring. Manufactur-
ers are exempt from regulations requiring
that complaints, injuries, or deaths due to
consumption of their product be reported
to the Food and Drug Administration (FDA).
Though the FDA retains the right to protect
the public from harmful products, the burden
of proof is on the government to prove that a
particular botanical remedy is unsafe. Many
manufacturers have voluntarily adopted
good manufacturing processes, and the
American Herbal Products Association has
created a botanical safety rating system that
classifies herbs as (1) safe when consumed
appropriately; (2) restricted for certain uses;
(3) use only under the supervision of an
expert; and (4) insufficient data to make a
safety classification.
Unfortunately, the explosive, unregulated
growth of the industry has resulted in numer-
ous problems. Of particular concern is the inter-
action of botanicals when used with biomedical
therapies. For example, ginkgo biloba reduces
the effectiveness of some prescription drugs,
such as certain antacids and antianxiety medi-
cations, while potentiating others, including
anticoagulants, antidepressants, and antipsy-
chotics.77 Some botanicals can react adversely
with anesthesia, and others can interact with
radiation therapy.78,79 Further, natural products
can be adulterated with pesticides, heavy
metals (such as mercury), or prescription drugs
(such as warfarin or alprazolam).80
C U L T U R A L C O N T R O V E R S Y
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4 8 T R A D I T I O N A L H E A L T H B E L I E F S A N D P R A C T I C E S
well as vitamins and mineral supplements.
In a 2007 survey, it was estimated that more
than 38 percent of all adult Americans used
complementary and alternative medicine,
including high doses of vitamins, during the
previous month.1 Home remedies and health
practitioners other than biomedical profes-
sionals often emphasize the use of botanical
medicine, which includes whole plants or
pieces (particularly herbs), and occasion-
ally animal parts, such as antlers or organs,
or certain powdered mineral elements. In
many cultures, healers specialize in the use
of herbal preparations; often they are elder
men or women with intimate knowledge of
the natural environment. Root doctors in
the American South, and the proprietors of
botá nic as (herbal pharmacies) found in some
Latino neighborhoods are a few examples. In
addition to folk healing, both traditional Chi-
nese medicine and ayurvedic medicine make
extensive use of botanical medicine (see the
chapters on each American ethnic group for
more details).
Homeopathy also prescribes therapeutic
substances, such as botanical medicine,
diluted venom, or bacterial solutions, and bio-
medical drugs. Originating in Germany,
homeopathy is based on the concept that
symptoms in illness are evidence that the
body is curing itself, and acceleration or exag-
geration of the symptoms speeds healing.
One primary tenant is that “like cures like.”
Naturopathic medicine also focuses on help-
ing the body heal itself, usually through non-
invasive natural treatments (including some
physical manipulations, as the following
section describes), although biomedical drugs
and surgery are used in certain cases. Nutri-
tional therapy, based on whole foods and
dietary supplements, is the foundation of
naturopathic health maintenance and
healing.
Application of Physical Forces or Devices
Manipulations of the body is based on the
premise that internal body function improves
with adjustments to its physical structure.
Chiropractic theory states that misalign-
ments of the spine interfere with the nervous
system, interrupting the natural intelligence
that regulates the body, resulting in disease
and disorder. Osteopathic medicine proposes
that blood and lymph flow, as well as nerve
function, improves through manipulation of
the musculoskeletal system, particularly the
correction of posture problems, mobilization
of bone joints, and spine alignment. Health
problems are treated through restoration of
mobility and improved flexibility.
Several Asian healing therapies can be
classified as the application of physical forces
or devices. Massage therapy, acupressure,
and pinching or scratching techniques are
used to release the vital energy flow through
the twelve meridians of the body identified
in traditional Chinese medicine, primarily
by relieving muscle tension so that oxygen
and nutrients can be delivered to organs
and wastes removed. Coining is a related
practice in which a coin or spoon is rubbed
across the skin instead of pressing or pinch-
ing specific points. Acupuncture is similar to
acupressure in that it attempts to restore the
balance of vital energy in the body along the
meridians, but it differs in that it stimulates
specific junctures through the insertion of
nine types of very fine needles. The needles
do not cause bleeding or pain. Acupuncture
is considered useful in correcting conditions
where too much heat (yang) is present in the
body. In conditions of too much cold (yin),
Medications using
digitalis, opiates, and
salicylates, common
today as biomedical
therapeutics, were first
used by folk healers.
▲ Ginseng, a root found in
both North America and Asia,
is one of the top ten common
herbal remedies used in the
nation. It reputedly promotes
health through increased
strength and vitality, and
may be taken specifically to
treat digestive upset, anxiety,
or sexual impotence.
M
itc
h
H
rd
lic
ka
/P
ho
to
di
sc
/G
et
ty
Im
ag
es
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C H A P T E R 2 4 9
another technique is preferred, called moxi-
bustion, in which a small burning bundle of
herbs (e.g., wormwood) or a smoldering cig-
arette is touched to specific locations on the
meridians to restore the balance of energy. A
similar method is cupping—the placement of
a heated cup or a cup with a scrap of burning
paper in it over the meridian points.60
Application of electricity is used in vari-
ous electrotherapies, primarily to stimulate
muscle or bone healing, especially in sports
medicine. Biofeedback also uses small electric
pulses to teach a person how to consciously
monitor and control normally involuntary
body functions, such as skin temperature and
blood pressure, to alleviate health problems,
which include insomnia, gastrointestinal
conditions, and chronic pain. Hydrotherapy
involves the application of baths, showers,
whirlpools, saunas, steam rooms, and poul-
tices to relieve the discomforts of back pain,
muscle tension, arthritis, hypertension, cir-
rhosis of the liver, asthma, bronchitis, and
head colds. In addition to the hydrotherapeu-
tic qualities, the mineral content of the water
is considered stimulating.
Magico-Religious Interventions Spiritual heal-
ing practices are associated with nearly all reli-
gions. They typically fall into two divisions:
those actions taken by the individual, and
those taken on behalf of the individual by a
sacred healer.
In Western religious traditions, God has
power over life and death. Sickness repre-
sents a breach between humans and God.
Healing is interrelated with salvation because
both mend broken ties.22 Living according to
God’s will is necessary to prevent illness, and
prayer is the most common method of seek-
ing God’s help in healing. Roman Catholics,
for example, make appeals to the saints iden-
tified with certain afflictions—St. Teresa of
Avila for headaches, St. Peregrine for cancer,
St. John of God for heart disease, St. Joseph
for terminal illness, and St. Bruno for cases of
possession are just a few examples. Pilgrim-
ages to the shrines of these saints are made for
special petitions. In Eastern religions, health
is determined mostly by correct conduct in
this and past lives, as well as in the virtuous
behavior of ancestors. Religious offerings are
made regularly; for instance, Hindus choose
a personal deity to worship daily at a home
shrine. Improper actions leading to dishar-
mony within a person, family, community,
or the supernatural realm can cause sickness.
Healing occurs through restoration of bal-
ance, often including offerings to the deities
or spirits of the living and dead who have been
offended.
Individual healing practices developed
out of religious ritual include meditation, a
contemplative process of focused relaxation;
yoga, the control of breathing and use of sys-
tematic body poses to restrain the functions
of the mind and promote mind–body unity;
and visualization or guided imagery, induced
relaxation and targeted willing away of health
problems. Each concentrates the power of
mind on reducing health risks, such as stress,
high blood pressure, and decreased immune
response, or on alleviating specific medical
conditions. Hypnotherapy works in a similar
manner; although it is generally done with the
aid of a hypnotherapist, self-hypnosis can be
learned for personal use.
In many cases, the spiritual skills of the
individual are inadequate for the problem,
and the help of a sacred healer is sought.
These health practitioners generally work
through interventions with the supernatural
world, which may include prayers, blessings,
chanting or singing, charms, and conjuring,
as well as the use of therapeutic substances
(e.g., herbal remedies) and application of
physical cures (e.g., the laying on of hands).
Faith healers, most of whom get their heal-
ing gifts from God, are common among many
Christian groups. Some are affiliated with
certain denominations and rites, such as the
Cajun tr aiteur s of Louisiana, who specialize in
treating one or two ailments through prayers
and charms associated with Catholicism.61,62
Others, such as the sympathy healers of the
Pennsylvania Dutch who practice powwowing
(also known by the German name B r auc h e or
B r auc h er ei), are considered the direct instru-
ments of God.63
Persons with a spiritual calling are often
employed to treat illness. N eng among the N eng among the N eng
Kur (spa) therapy is
popular throughout
Europe, particularly in
Germany.
Naturopathic doctors
trained in the United
States attend a four-year
program including many
biomedical disciplines.
Doctors of chiropractic
(DC) are the third larg-
est category of health
care practitioners in the
United States, following
physicians and dentists.
Osteopaths are licensed
to prescribe medications
and perform surgery as
doctors of osteopathy
(DO) in all fifty states.
Eighty percent of
respondents in a study
on faith and healing
in the southeastern
United States said they
believe God acts through
physicians to cure
illness.74
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5 0 T R A D I T I O N A L H E A L T H B E L I E F S A N D P R A C T I C E S
Hmong, Mexican c ur ander os (or c ur ander as),
practitioners of voodoo in the American
South, and espir itos or santer os (or santer as)
in the Caribbean may communicate with the
spirits or saints to heal their patients. Cer-
emonial invocation is the primary therapy,
although charms and spells to counteract
witchcraft and botanical preparations to ease
physical complaints are used as well.
Shamans, called medicine men among
many Native American groups, are sacred
healers with exceptional powers. They origi-
nated in Russia an estimated 20,000 years
ago and spread throughout the world to the
indigenous cultures of the Americas, South-
east Asia, Indonesia, Polynesia, and Australia.
Remote tribal groups found in Africa, India,
and Korea have similar healers. A shaman
is a composite priest, magician, and doctor;
the position is passed on from generation to
generation, or through a calling that could
include fainting spells or convulsive fits due
to attacks by spirits. Shamans typically com-
plete lengthy apprenticeships and are initiated
through a series of trials simulating death and
rebirth. In shamanic systems, sickness is due
to spiritual crisis, and healing emphasizes
strengthening of the soul through redirec-
tion of the life forces or, in cases of serious
illness, retrieval of the soul, which may have
been stolen by evil spirits. Shamanic practices
include visualization techniques to create har-
mony between the patient and the universe,
singing, chanting, predictions, dream analy-
sis, and séances. Shamans are often expert
herbalists.64,65
Pluralistic Health Care
Systems
The enduring popularity of traditional health
beliefs and practices is consistent with cultural
beliefs. Healing sickness, with or without the
services of an expert provider, takes place
according to a patient’s worldview. Humans
value what validates their beliefs and discount
anything that differs, regardless of statistical
data or scientific claims; they give dispro-
portionate authority to persons they like and
respect.
Medical Pluralism
M edic al pl ur al ism is the term for the consecu-
tive or concurrent use of multiple health care
systems.45 Although it is often assumed that
ethnic minorities, the poor, the less educated,
or recent immigrants are most likely to rely on
traditional folk medicine, studies report that
the use of healers in some groups increases
with education and income level. Further,
acculturation is not associated with a rise
in the use of biomedical services.44 Medical
pluralism is widespread in the United States.
Biomedical Healing
Clients using traditional health practices are
generally seeking to alleviate the difficulties
experienced in illness through understand-
able, flexible, and convenient treatment from
a warm and caring provider. The personal
relationship with the healer is as important as
the actual therapy (see Chapter 3).
Biomedical professionals often operate in
partnership, knowingly or not, with uncon-
ventional health care practitioners. A small
study of prostate cancer patients reported
that 37 percent used alternative therapies
in conjunction with radiation treatment.
A separate survey found that their physicians
believed only 4 percent of these patients used
any other health care practices.56 Researchers
A study of physician
beliefs about health
and religion found that
although 91 percent of
respondents said knowl-
edge of a client’s faith
practices is important
in care, only 32 percent
ask about religious
affiliation.75
When Navajos dream
frequently of death, it is
usually considered a sign
of serious illness.
Consultation with
a Native American
medicine man may take
hours to complete; some
healing ceremonies take
a week to perform and
may cost thousands
of dollars.81
▲ Acupuncture attempts to
restore the balance of vital
energy in the body through
inserting and manipulating
needles.
G
eo
rg
e
Sh
el
le
y/
Fl
irt
/A
la
m
y
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C H A P T E R 2 5 1
suggest care is optimized when providers work
together rather than at cross purposes. Patients
are sometimes put in the confusing position of
choosing between biomedical and traditional
systems that contradict or reject each other.54
Studies suggest that some unconventional
therapies are effective, benefiting the patient
physiologically or psychologically, and should
be accepted as complementary to biomedical
approaches.66,67 Cooperative monitoring by a
biomedical professional can also detect those
few instances when a home remedy or popular
practice is harmful to the patient. Furthermore,
biomedical health care providers can adopt
certain healing strategies. Understanding the
patient’s perspective on illness and attend-
ing to differences in the patient–provider
relationship is one approach.10 Recommend-
ing alternate, experimental biomedical pro-
grams in cases of advanced chronic disease is
another.59 A more comprehensive methodol-
ogy is offered through transcultural nursing
theory, developed to provide culturally com-
patible care that is beneficial, satisfying, and
meaningful to clients.14 Transcultural nursing
theory identifies three modes of effective care:
(1) cultural care preservation and/or mainte-
nance, (2) cultural care accommodation and/
or negotiation, and (3) cultural care repattern-
ing or restructuring.
Cultural care preservation and/or mainte-
nance is used when a traditional health belief
or practice is known to be beneficial in its
effect and is encouraged by the provider. Cul-
tural care accommodation and/or negotiation
is accomplished between the provider and the
patient (or the patient’s family) when there is
an expectation for care that is outside biomed-
ical convention. Cultural care repatterning or
restructuring occurs when both provider and
patient agree that a habit is harmful to health,
and a cooperative plan is developed to intro-
duce a new and different lifestyle. Applied to
food habits, the culture care theory acknowl-
edges that some traditional beliefs and prac-
tices regarding diet have beneficial or neutral
consequences, some have unknown conse-
quences, and some may be deleterious to the
health of a client (see Chapter 1).
In addition to specific provider approaches,
the health care setting can also help promote
biomedical healing through services desired
by clients in a comfortable, welcoming
atmosphere. Some health care organiza-
tions are forming therapeutic alliances with
D I S C U S S I O N S T A R T E R S
What is Your “Worldview” of Health Care?
Culture determines how each of us defines health, recognizes illness, and considers
medical treatment of illness. Reflecting on how we view health and healthcare can
tell us a lot about our cultures. Answer each of the following questions. Don’t worry
about justifying your beliefs. All you want to do here is reflect on and write down your
beliefs. There are no right or wrong answers, as long as the answers honestly express
your beliefs.
● Which most determines a person’s health: The decisions and actions of the
person herself or himself? The decisions and actions of one’s family and others
with whom one has been brought up? The decisions and actions of the govern-
ment (whether national or local or both)? The will of God? The actions of some
other supernatural agency (please identify)? Astrological alignment of the stars
and planets? Karma? Fate? Something else?
● Who is most responsible for a person’s healthcare: The health care
practitioner? The person herself or himself (or, if a child, the parents or adult
caregivers)? Someone else?
● If you became seriously ill or injured and needed dramatic treatment,
such as surgery or radiation treatment, who would most influence your
decision(s) regarding that treatment: You alone? Your family? Your church,
synagogue, tabernacle, temple, mosque, or other religious congregation? Others?
● If a loved one is terminally ill—that is, dying from a disease or injury—
which of the following would be most important to you: Trying everything
possible to cure your loved one or at least, prolonging that loved one’s life? Doing
everything possible to relieve any pain that loved one might be enduring? Praying
with that loved one and sustaining her or his faith? Helping your loved one die
in a way that she or he wants, which could involve not employing life-sustaining not employing life-sustaining not
measures?
● Which of the following is the most important way you tell whether you
are healthy or not: By whether or not you have any symptoms of disease?
By whether or not you can accomplish daily tasks and meet daily responsibilities?
By how you look in the mirror and/or how others perceive how you look?
In small groups of three or four, compare answers for about ten minutes. Restrain any
impulse to criticize. Your task is to gather as much information as possible about each
person’s worldview relating to health care in the short time that you have. Remember,
there are no right or wrong answers. Different cultures exhibit different worldviews.
When members of your group have completed sharing answers with each other,
individually write a reflection on what you’ve learned and how you feel about it
(maximum one page).
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5 2 T R A D I T I O N A L H E A L T H B E L I E F S A N D P R A C T I C E S
community folk healers or combining non-
Western practices with biomedicine in an inte-
grative approach. At a minimum, research on
traditional practices used by clients and infor-
mation about alternative community health
resources should be available to providers; staff
should be encouraged to keep up on current
trends through continuing education, diversity
training, and refresher workshops. Other use-
ful steps include increasing care accessibility by
taking education and services into client com-
munities when possible and providing flexible,
nontraditional hours for appointments. Clients
also feel more at ease with a staff representa-
tive of the community, so to some degree,
this preference should be accommodated.68,69
Successful biomedical healing is dependent on
the intercultural knowledge and sensitivity of
the health provider and setting. Care must be
undertaken in cooperation with the patient,
as well as the patient’s family and any concur-
rent traditional providers in use by the patient.
Healing should not be the sole domain of home
remedies, popular health care approaches, or
alternative medical systems. Medical plural-
ism offers the opportunity for biomedicine to
heal sickness through coordinated client care,
with understanding and appreciation for the
therapeutic value of traditional health beliefs
and practices.
Review Questions
1. If you become ill, how might your worldview
influence your expectations about your illness
and its treatment?
2. How does biomedicine in the United States
reflect the majority culture?
3. How does the U.S. biomedicine definition of
h eal th differ from that of the World Health
Organization: “a state of complete physical,
mental, and social well-being”?
4. Describe three ways that diet may be used to
promote or maintain health, using specific
examples of foods and practices.
5. What is meant by f ol k il l nesses or c ul tur e- bound
sy ndr omes? Using one example, explain how
effective treatment for the condition would
differ from the conventional biomedical
approach.
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matic R esear c h , 5 3 , 963–974.
36. Talamayan, K.S., Springer, A.E., Kelder, S.H.,
Gorospe, E.C., & Joye, K.A. 2006. Prevalence of
overweight misperception and weight control
behaviors among normal weight-adolescents in the
United States. S c ientif ic W or l d J our nal , 6 , 365–376.
37. Davis, S.M., & Lambert, L.C. 2000. Body image
and weight concerns among Southwestern Amer-
ican Indian preadolescent schoolchildren. E th nic –
ity and Disease, 1 0 , 184–194.
38. Xanthopoulos, M.S., Borradaile, K.E., Hayes, S.,
Sherman, S., Vander-Veur, S., Grundy, . . . Foster,
G.D. 2011. The impact of weight, sex, and race/
ethnicity on body dissatisfaction among urban
children. B ody I mage, 8 (4), 385–389.
39. Wright, J.D., & Wang, C.-Y. 2010. T r ends in
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Brief, No 49. Hyattsville, MD: National Center for
Health Statistics.
40. Seo, D.C., Torabi, M.R., Jiang, N., Fernandez-
Rojas, X., & Park, B.H. 2009. Cross-cultural com-
parison of lack of regular physical activity among
college students: Universal versus transversal.
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355–359.
41. Spector, R.E. 2004. C ul tur al div er sity in h eal th and
il l ness (6th ed.). Upper Saddle River, NJ: Pearson.
42. Kleinman, A., Eisenberg, L., & Good, B. (2006).
Culture, illness and care: Clinical lessons from
anthropologic and cross-cultural research.
F O C U S , 4 (1), 140–149.
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43. Kleinman, A., Eisenberg, L., & Good, B. 1978.
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curriculum in transcultural nursing and health
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45. Clark, M.M. 1983. Cultural context of medi-
cal practice. W ester n J our nal of M edic ine, 1 3 9 ,
806–810.
46. Hand, W.D. 1980. M agic al medic ine. Berkeley:
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47. Graham, J.S. 1976. The role of the curandero in
the Mexican American folk medicine system in
West Texas. In W.D. Hand (Ed.), A mer ic an f ol k
medic ine. Berkeley: University of California Press.
48. Adler, S.R. 1995. Refuge stress and folk belief:
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50. American Psychiatric Association. 2000. Prac-
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ing diseases in a w or l d out of bal anc e. New York:
Farrar, Strauss & Giroux.
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53. Ma, G. 1999. Between two worlds: The use of tra-
ditional and Western health services by Chinese
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421–437.
54. Marbella, A.M., Harris, M.C., Diehr, S., Ignace,
G., & Ignace, G. 1998. Use of Native American
healers among Native American patients in an
urban Native American health center. A r c h iv es of
F amil y M edic ine, 7, 182–185.
55. Poss, J.E., Jezewski, M.A., & Stuart, A.G. 2003.
Home remedies for type 2 diabetes used by Mexi-
can Americans in El Paso, Texas. C l inic al N ur sing
R esear c h , 1 2 , 304–323.
56. Kao, G.D., & Devine, P. 2000. Use of comple-
mentary health practices by prostate carcinoma
patients undergoing radiation therapy. C anc er , 8 8 ,
615–619.
57. Rausch, S.M., Winegardner, F., Kruk, K.M., &
Phatak, V. 2011. Complementary and alternative
medicine: Use and disclosure in radiation oncol-
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58. Hughes, C.K., & Higuchi, P. 2004. Ka Lokahi
Wahine: A culturally based training for health
professionals. P ac if ic H eal th Dial og, 1 1 , 166–169.
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healers—Unwitting partners in health care. N ew
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and practice of syndrome differentiation. C h inese
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61. Brandon, E. 1976. Folk medicine in French
Louisiana. In W.D. Hand (Ed.), A mer ic an f ol k
M edic ine. Berkeley: University of California Press.
62. Leistner, C.G., & Hirschfield, L. 2010. Cajun and
creole food practices. In C.M. Goody & L. Drago
(Eds.), C ul tur al f ood pr ac tic es (Introduction).
Chicago: American Dietetic Association.
63. Yoder, D. 1976. Hohman and Romanus: Origins
and diffusion of Pennsylvania German pow-
wow manual. In W.D. Hand (Ed.), A mer ic an f ol k
medic ine. Berkeley: University of California Press.
64. Balzer, M.M. 1987. Behind shamanism: Changing
voices of Siberian Khanty cosmology and politics.
S oc ial S c ienc e and M edic ine, 2 4 , 1085–1093.
65. Sheikh, A.A., Kunsendorf, R.G., & Sheikh, K.S. 1989.
Healing images: From ancient wisdom to modern
science. In A.A. Sheikh & K.S. Sheikh (Eds.), E aster n
and W ester n appr oac h es to h eal ing: A nc ient w isdom
and moder n k now l edge. New York: Wiley.
66. Oh, B., Butow, P., Mullan, B., Beale, P., Pavlakis,
N., Rosenthal, D., & Clarke S. 2010. The use and
perceived benefits resulting from the use of com-
plementary and alternative medicine by cancer
patients in Australia. A sia- P ac if ic J our nal of C l inic al
O nc ol ogy , 6, 342–349.
67. Lunny, C.A., & Fraser, S.N. 2010, July. The use of
complementary and alternative medicines among
a sample of Canadian menopausal-aged women.
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335–343.
68. Kaptchuk, T.J., & Millar, F.G. 2005. Viewpoint:
What is the best and most ethical model for the
relationship between mainstream and alternative
medicine: Opposition, integration, or pluralism?
A c ademic M edic ine, 8 0 , 286–290.
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poc k et guide f or w or k ing w ith div er se c ul tur es and
under ser v ed popul ations. Yarmouth, ME: Intercul-
tural Press.
70. Kumanyika, S.K., & Morssink, C.B. 1997. Cul-
tural appropriateness of weight management
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T h e h eal th pr of essional ’ s guide to under standing
and pr ac tic e. Gaithersburg, MD: Aspen.
71. Anderson, E.N. 1987. Why is humoral medi-
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72. Dagnelie, P.C., & van Stavern, W.A. 1994. Mac-
robiotic nutrition and child health: Results of a
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study in the Netherlands. A mer ic an J our nal of
C l inic al N utr ition, 5 9 (Suppl.), 1187S–1196S.
73. Garrett, L. 1994. T h e c oming pl ague: N ew l y emer g-T h e c oming pl ague: N ew l y emer g-T h e c oming pl ague: N ew l y emer g
ing diseases in a w or l d out of bal anc e. New York:
Farrar, Strauss & Giroux.
74. Chibnall, J.T., & Brooks, C.A. 2001. Religion in
the clinic: The role of physician beliefs. S outh er n
M edic al J our nal , 9 4 , 374–379.
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C H A P T E R 2 5 5
75. Gurley, D., Novins, D.K., Jones, M.C., Beals, J.,
Shore, J.H., & Manson, S.M. 2001. Comparative
use of biomedical services and traditional healing
options by American Indian veterans. P sy c h iatr ic
S er v ic es, 5 2 , 68–74.
76. DeBusk, R.M. 1999. Herbal medicines: A primer.
O n th e C utting E dge: Diabetes C ar e and E duc a-
tion, 2 0 , 4–5.
77. Bressler, R. 2005. Interactions between Gingko
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D.W. 2009. Evaluation and implications of natural
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79. Sagar, S.M. 2010. Can the therapeutic gain of
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istration of Asian botanicals? I ntegr ativ e C anc er
T h er apies, 9 , 5–13.
80. Colson, C.R., & De Broe, M.E. 2005. Kidney
injury from alternative medicines. A dv anc es in
C h r onic K idney Diseases, 1 2 , 261–275.
81. Mansfield, C.J. 2002. The doctor as God’s
mechanic? Beliefs in the southeastern United
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5 6
3
Intercultural
CommunicationCH
A
P
T
E
R
status, health condition, religion, educational
background, group membership, sexual
orientation, or political affiliation.
Most people are comfortable convers-
ing with those who are culturally similar to
themselves. Communication is sometimes
described as an action chain,2 meaning that
one phrase or action leads to the next: in the
United States, a person who extends her hand
in greeting expects the other person to take
her hand and shake it, or when a person says
“thank you,” a “you’re welcome” should follow.
Communication comprises a whole series of
unwritten expectations regarding how a per-
son should respond, and such expectations are
largely cultural in origin. If a person under-
stands the communication action chain and
responds as expected, a successful relationship
can develop. When a person does not respond
as expected, communication can break down,
and the relationship can deteriorate.1
When meeting a person for the first time,
the only data that speakers usually have to
work with come from their own cultural
norms. They use these norms to predict how
that person will respond to their words and
what conversational approaches are appropri-
ate. They may also use social roles to determine
their communication behavior. Furthermore,
speakers modify their words and actions as
they get to know a person individually, observ-
ing personal cues about communication char-
acteristics that vary from cultural or social
customs.3 An employee, for example, may
make certain assumptions about a supervisor
based on ethnicity, gender, age, and especially
Whether a person is interacting with people from diverse cultural groups at work and in social set-
tings or traveling to another country for busi-
ness or pleasure, he or she needs intercultural
communication skills to successfully negoti-
ate daily life. Intercultural communication
is a specialty in itself. The field encompasses
language and the context in which words are
interpreted, including gestures, posture, spa-
tial relationships, concepts of time, the status
and hierarchy of persons, the role of the indi-
vidual within a group, and the setting. This
chapter presents a broad and limited overview
of intercultural communication concepts, as
well as information useful in nutrition coun-
seling with individuals or with groups in edu-
cational programs. Later chapters on each
American ethnic group provide more specific
details as reported by researchers and practi-
tioners familiar with cultural communication
characteristics.
The Intercultural
Challenge
Researchers have used an iceberg analogy (see
Figure 3.1) to describe how a person’s cultural
heritage can impact communication.1 Ethnic-
ity, age, and gender are the most visible per-
sonal characteristics affecting dialogue—the
so-called tip of the iceberg. Beneath the sur-
face, but equally influential, may be degree of
acculturation or assimilation, socioeconomic
“Observe the nature
of each country; diet;
customs; the age of the
patient; speech; man-
ners; fashion; even his
silence. . . . One has to
study all these signs
and analyze what they
portend.” Hippocratic
writings, fifth century BCE.
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C H A P T E R 3 5 7
occupational status and then make adapta-
tions. An employee may start out calling his
boss “Mrs. Smith” as a sign of respect for her
position but use the more informal “Sue” when
she requests that he call her by her first name.
Interpersonal relationships between two
individuals are based mostly on personal
communication preferences; group interac-
tions commonly depend on cultural or social
norms. Misinterpretations at the cultural or
social levels of communication are more likely
to occur because they are more generalized.
As mentioned in Chapter 1, stereotyping
occurs if a person misjudges another individ-
ual’s degree of association with any particular
cultural or social group. Approximately one-
third of the people from any given group are
believed to actually behave in ways typified
by the group as a whole.3 Assumptions about
how a person of a different cultural heritage
should communicate can prompt certain
types of reactions based on norms in that per-
son’s culture: stereotyping can become a self-
fulfilling prophecy. For instance, Asians have a
reputation for being reserved in conversation
compared to the typical American approach.
A nutrition education provider teaching a
prenatal care program may respond to more
aggressive speakers during a group meeting,
failing to actively involve a Vietnamese Amer-
ican participant. The Vietnamese American
woman may feel the provider is disinterested
in her questions or comments, becoming even
less likely to offer input at the next meeting,
reinforcing the provider’s perception that all
Asians are quiet.
The challenge is to increase familiarity
with cultural communication behaviors, while
remaining aware of personal cues and mov-
ing toward an interpersonal relationship as
quickly as possible.
Intercultural
Communication
Concepts
Communication uses codes to represent
objects, ideas, or behaviors. Thoughts, emo-
tions, and attitudes are decoded into language
and nonverbal actions (e.g., gestures, posture,
eye contact) to send messages from one per-
son to another.
The two components of the message are
the content and the relationship between the
speaker and the receiver. Depending on the
situation, the content or the relationship may
assume greater prominence in interpretation
of meaning. Messages that violate cultural
expectations may be accurate in content but
have a negative impact on the relationship. If
the message consistently offends the receiver,
the relationship will deteriorate and the mes-
sage will be disregarded. For example, if a
health professional advises a Chinese client
to increase calcium intake through increased
milk consumption, this is an example of a
content message that does little to acknowl-
edge the role of milk in the Chinese diet. Is
the client lactose intolerant? Does the cli-
ent like milk? Does the client classify milk
as health promoting or as a cause of illness?
How does milk fit into the balance of the diet
according to the client? Unless the provider
gains an understanding of how the client
Figure 3.1
Iceberg model of
multicultural influences
on communication.
Source: Adapted with permission of
Sage, from Effective Communication
in Multicultural Health Care Settings,
G. L. Kreps & E. N. Kunimoto, 6.
Copyright © 1994. Permission
conveyed through Copyright
Clearance Center, Inc.
Va
d8
2/
Sh
ut
te
rs
to
ck
.c
om
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5 8 I N T E R C U L T U R A L C O M M U N I C A T I O N
a group and perceptions of power, authority,
status, and time. In addition, context in com-
munication also encompasses the significance
of affective and physical expression (termed
low or high context) and level of tolerance for
uncertainty and ambiguity (called uncertainty
avoidance). Verbal communication occurs
within these cultural premises, often oper-
ating at an unconscious level in the speaker
(Figure 3.2).
Low- and High-Context Cultures
Conversational context can be defined as the
affective and physical cues a speaker uses to
indicate meaning, such as tone of voice, facial
expression, posture, and gestures.
In most Western cultures, messages usu-
ally concern ideas presented in a logical, lin-
ear sequence. The speaker tries to say what
is meant through precise wording, and the
content of the language is more objective than
personal along the continuum of personal
and object messages. This communication
style is termed low context because the actual
words are more important than who is receiv-
ing the message, how the words are said, or
the nonverbal actions that accompany them.
Communication in a low-context culture
is so dependent on words that the underly-
ing meaning is undecipherable if wording is
chosen poorly or deliberately to mislead the
recipient. Nearly every American has also
experienced the obtuse professional languages
of attorneys or scientists who fail to convey
their message in common, everyday English.
The Swiss, Germans, and Scandinavians are
examples of low-context cultures.2
In cultures with a high-context com-
munication style, most of the meaning of a
message is found in the context, not in the
words. In fact, the wording used may be
vague, circuitous, or incomplete. The content
of the language is more personal than objec-
tive, dependent on the relationship between
speaker and listener. Attitudes and feelings
are more prominent in the conversation than
thoughts. Communication in high-context
cultures is analogous to the expression “read-
ing between the lines.” Misunderstandings
easily occur if either participant is unfamiliar
with the meaning of the nonverbal signifiers
conceptualizes the situation, the content of
the message may be ignored because the cli-
ent assumes disinterest or even disrespect for
personal beliefs and expectations. Thus, the
provider–client relationship is weakened.
Messages that demonstrate respect for the
individuality of the receiver are called per-
sonal messages and these improve relation-
ships; those that are disrespectful are termed
object messages and these often degrade rela-
tionships. Communication occurs in a contin-
uum between personal and object messages.1
Verbal messages are most useful for com-
municating content, whereas nonverbal
messages usually convey information about
relationships. If the nonverbal message is
consistent with the verbal message, it can
build the relationship and help the receiver
correctly interpret the meaning intended by
the speaker. When the nonverbal message is
inconsistent with the verbal message, both the
relationship and the content are undermined.
Successful communication is dependent on
both verbal and nonverbal skills, each signifi-
cantly impacted by cultural considerations.
Verbal Communication
The abstract nature of language means it can
be correctly interpreted only within context.
The cultural aspects of context are so embed-
ded that a speaker often believes they are
inherent—that is, that other people must com-
municate according to the same expectations.
Context includes issues common to cultural
worldview, such as the role of the individual in
Figure 3.2
Cultural context is so
embedded in the individual
that many people believe
it is innate and assume all
other people share the same
background.
Source: ID: 38626, Published in
March 10, 1980.
©
Th
e N
ew
Yo
rk
er
Co
lle
ct
io
n
19
80
Pe
te
r S
te
in
er
fr
om
ca
rto
on
ba
nk
.co
m
.
Al
lR
ig
ht
sR
es
er
ve
d.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 3 5 9
and indirect. In high-context cultures, direct
language is frequently used in intimate
relationships.
As an example of low- versus high-context
communication in different situations, con-
sider a researcher presenting current nutri-
tional data on spinach to a group of other
professionals. She will probably speak in a
relatively monotone voice and use scien-
tific jargon. She will present her points in a
sequential manner, support her thesis with
examples, and then restate her ideas in the
conclusion. She will probably stand erect and
limit the expressive use of her hands and face.
The message is almost entirely in the content
of the words she says. In contrast, this same
woman might behave very differently when
feeding her reluctant toddler spinach for
dinner. She might smile and make yummy
sounds as she offers him a spoonful or pre-
tends the spinach is a plane coming in for a
landing in his mouth. She might give him a
spoonful of meat or potato, then try the spin-
ach again. She might even dance around his
high chair a little or hum a few bars of the
old cartoon theme song about a sailor who
liked spinach. She doesn’t try to get him to eat
spinach by explaining its nutrient content, as
she did at her meeting. The message is non-
linear and not dependent on the content of
the words she uses. This is not to say that a
health care provider should burst out in song
when working with a client from a high-con-
text culture. But it does suggest that indirect,
being used, such as small eye movements or
sounds that are made when in agreement, or
disagreement, or when upset. For example,
many Americans tend to squirm a bit when
uncomfortable with a conversation, while
the Japanese will quickly suck in air. High-
context cultures are most prevalent among
homogeneous populations with a common
understanding of the affective and physical
expression used in sending the message (see
the following “Nonverbal Communication”
section). Asian, Middle Eastern, and Native
American cultures are very high context.
Latino societies are moderately high context.
American culture is thought to be toward the
low end, but more middle context than many
European societies.
In low-context cultures, communication is
usually explicit, straightforward, and unam-
biguous. The focus is on the speaker, who
uses words to send messages that are often
intended to persuade or convince the receiver.
In high-context cultures, indirect communi-
cation is preferred. Implicit language is used,
and many qualifiers are added; nonverbal cues
are significant to interpreting the message.
The locus of conversation is the receiver; the
speaker makes adjustments in consideration
of the listener’s feelings.3 Low-context lis-
teners are often impatient with high-context
speakers, wondering when the speaker will get
to the point of the conversation. Low-context
listeners also frequently miss the affective and
physical expression in the message.
Health care situations are often extremely
low context. The conversation is focused on
the provider who delivers a verbal message
to the client with little consideration for the
nonverbal message. The communication
is high on content and low on relationship.
Clients from high-context cultures are likely
to be dissatisfied, even offended, by such
impersonal, objective interactions. Commu-
nication problems may not be evident to a
low-context clinician until the client leaves
and never returns.
Interactions may range from low- to high-
context depending on the situation, regardless
of the overall cultural preference. In uncom-
fortable or embarrassing situations, a low-
context communicator may be very sensitive
▲ Only the person send-
ing the message knows the
meaning of the message: the
person receiving the message
must use what she knows
about cultural and social
norms, as well as what she
knows about the speaker
personally, to interpret the
message.
To
m
M
cC
ar
th
y/
Ph
ot
oE
di
t
One area of conflict
often found between
blacks and whites is
due to differences in
high- and low-context
communication. African
Americans tend to be
more high context than
white Americans, using
cognitive, affective, and
physical responses that
may appear disruptive
or overly emotional
to whites.90
One way to patronize
a person is to speak in
a low-context mode,
elaborating beyond
what is needed for
understanding.
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6 0 I N T E R C U L T U R A L C O M M U N I C A T I O N
expressive approaches may be more effective
in some intercultural clinical, educational, or
counseling settings. Identification of a culture
as either low or high context provides a gen-
eral framework for communication but may
be affected by other situational factors.
Individuals and Groups
The relationship of the individual to the group
is determined in part by whether a culture is
low or high context. In low-context cultures,
the individual is typically separate from the
group, and self-realization is an important
goal. Self-esteem is dynamic, based on suc-
cessful mastery or control of a situation. In
high-context cultures, the individual is usually
defined by group association, and a person
desires oneness with the group, not individu-
ation. A mutual dependency exists and self-
esteem is based on how well a person can
adjust to a situation.3 Individualism is a promi-
nent characteristic in Australia, Canada, Great
Britain, New Zealand, the Netherlands, and
the United States. Collectivism is especially
valued in the nations of Denmark, Ghana,
Guatemala, Indonesia, Nigeria, Panama, Peru,
El Salvador, Sierra Leone, Taiwan, Thailand,
and Venezuela.
In societies emphasizing individuality,
a person must communicate to gain accep-
tance by the group, whether it is the family,
the workplace, or the community. Commu-
nication is used to establish the self within
an individual or group relationship. When
meeting someone new, the action chain in the
conversation is flexible, with few expectations.
The two people may focus on one or the other
speaker and often delve into personal prefer-
ences, such as favorite restaurants or sports
teams. When group identity is the focus of a
society, there is no need for a person to seek
acceptance from the group or to communicate
individuality. Silence is highly valued. Interac-
tions between strangers tend to be ritualized,
and if the action chain is broken, communica-
tion cannot continue. The expectation is that
each speaker will indicate group affiliation
and that such identity conveys all the infor-
mation needed to know that person.
The role of the individual within the group
can have an impact on health care delivery.
Within more group-oriented cultures, greater
participation is required of their members
in matters of health and illness, and it may
be expected that relatives will participate in
giving patient histories, overseeing physical
exams, or making decisions regarding treat-
ment.4 Middle Easterners expect to go to the
hospital with an ill family member to provide
care. Next of kin is determined along blood-
lines among Latinos, and care decisions are
often the responsibility of a grandmother or
mother instead of the spouse. Koreans prefer
the whole family make decisions regarding
treatment for a terminally ill patient. Some
American Indians are so strongly associated
with the group it is difficult for them to com-
municate individual needs.
Uncertainty Avoidance
Related to the role of the individual in a group
is tolerance for uncertainty and ambiguity.
Some groups exhibit great discomfort with
what is unknown and different; these are
defined as high uncertainty avoidance cul-
tures. Members of these cultures may become
anxious about behavior that deviates from the
norm; high uncertainty avoidance cultures
desire consensus. Argentina, Belgium, Chile,
Colombia, Costa Rica, Croatia, Egypt, France,
Greece, Guatemala, Israel, Japan, Korea,
Mexico, Panama, Peru, Portugal, Turkey,
Serbia, and Spain are stronger in uncertainty
avoidance than the United States, as are most
African and other Asian nations. They typi-
cally have a history of central rule and com-
plex laws that regulate individual action on
behalf of the group.3
Cultures with low or weaker uncer-
tainty avoidance include Canada, Denmark,
Great Britain, Hong Kong, India, Indonesia,
Jamaica, the Netherlands, the Philippines,
Sweden, and the United States. People from
these nations are usually curious about the
unknown and different. They are more infor-
mal, willing to accept dissent within a group,
and open to change.
It is important to distinguish the differ-
ences between risk avoidance and uncertainty
avoidance. A person from a high uncertainty
avoidance culture may be quite willing to
take familiar risks or even new risks in order
Even within low-context
cultures, intimate con-
versations are usually
highly contextual; words
and phrases may be
significantly shortened
or abbreviated—just a
look may be enough for
understanding.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 3 6 1
to minimize the ambiguity of a situation. But
in general, risks that involve change and dif-in general, risks that involve change and dif-in general, risks that involve change and dif
ference are difficult for people with strong
uncertainty avoidance; this is especially a
concern when changes threaten acceptance
by the group. For example, researchers suggest
African American women may resist certain
preparations or seasonings if family members
object or if the foods might undermine eth-
nic identity. Furthermore, weight loss may be
avoided if being thin means the potential loss
of a peer group that values a larger figure.5
Working with family or peers in a group
setting to effect dietary change may be more
successful for persons with a low tolerance for
uncertainty, especially when the positive value
of change is accepted and group consumption
patterns are modified.
Power, Authority, and Status
The perception of power, or power distance,
can strongly influence communication pat-
terns. In low-context cultures, where individ-
uality is respected, power or status is usually
attributed to the role or job that a person ful-
fills. Power distance is small. People are seen
as equals, differentiated by their accomplish-
ments. It is common for an individual to ques-
tion directions or instructions; the belief is that
a person must understand why before a task
can be completed. A client may desire a full
explanation of a condition and expected out-
comes before undertaking a specific therapy.
In many high-context cultures, where group
identification is esteemed, superiors are seen
as fundamentally different from subordinates.
Authority is rarely questioned. For example, a
health care provider counseling an Ethiopian
patient with type 2 diabetes may believe that
a culturally sensitive approach is to ask him
about his perceptions of the disease. What does
he call it? How does he think it can be cured?
Unknown to the provider, the Ethiopian man
has a large power distance, and he assumes
that the provider is the expert. Why would she
ask such questions of him? Doesn’t she know
what she is doing? He expects her to provide
all the answers, with little participation from
him. He may even become uncooperative or
fail to return for a follow-up visit because he
questions her expertise.
Although there is usually some combina-
tion of both small and large power distance
tendencies in a culture, one tendency will pre-
dominate. Some countries with small power
distance include Austria, Canada, Denmark,
Germany, Great Britain, Ireland, Israel, the
Netherlands, New Zealand, Sweden, and the
United States. Those with larger power dis-
tance include most African, Asian, Latino, and
Middle Eastern cultures, including (but not
exclusively) Egypt, Ethiopia, Ghana, Guate-
mala, India, Malaysia, Nigeria, Panama, Saudi
Arabia, and Venezuela. Client empowerment,
particularly in setting goals and objectives,
may be resisted by people from groups who
come from cultures with a larger power dis-
tance; maximum personal responsibility may
be preferred by people from groups with a
smaller power distance.
Several cultures are gender oriented as
well. In masculine cultures, power is highly
valued. Some, such as Germany, Hong Kong,
and the United States, are considered mas-
culine due to their aggressive, task-oriented,
materialistic culture. Others, such as Italy,
Japan, Mexico, and the Philippines, are char-
acterized as masculine because sex roles are
strongly differentiated. Men are accorded
more authority in masculine societies. In more
feminine cultures, quality of life is important;
men and women share more equally in the
power structure. More feminine countries
can be task oriented and materialistic, such
as Denmark, the Netherlands, Norway, and
Sweden; but hard work and good citizenship
are seen as benefiting the whole society, not
a hierarchy of superiors within an organiza-
tion or nation. Workplace relationships and
an obligation to others are characteristically
emphasized. Nearly all other nations com-
bine masculine and feminine power qualities.
Strong gender orientation can cause conflict.
A health care team, for instance, may include
several experts, often both women and men.
An Italian American patient might show lit-
tle respect for the female members and may
ignore their directions unless restated by one
of the male practitioners, regardless of his
area of expertise. Even women from mascu-
line societies may find it difficult to accept
the authority of a female provider. Generally,
The Inuit conception of
time is governed by the
tides—one set of tasks
is done when the tide is
out, another when the
tide comes in.
The Arabs say, “Bukra
insha Allah,” which
means, “Tomorrow, if
God wills.”
To many Chinese, the
gift of a clock means the
same as saying, “I wish
you were dead.” Each
tick is perceived as a
reminder of mortality.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
6 2 I N T E R C U L T U R A L C O M M U N I C A T I O N
masculine-oriented U.S. health care practitio-
ners can communicate more successfully with
most ethnic clients by using a less assertive,
less autocratic approach that includes com-
promise and consensus.
Time Perception
Being on time, sticking to a schedule, and not
taking too much of a person’s time are valued
concepts in the United States, but these values
are unimportant in societies where the idea of
time is less structured. Low-context cultures
tend to be monochronistic, meaning that they
are interested in completing one thing before
progressing to the next. Monochronistic soci-
eties are well suited to industrialized accom-
plishments. Polychronistic societies are often
found in high-context cultures. Many tasks
may be pursued simultaneously, but not to the
exclusion of personal relationships. Courtesy
and kindness are more important than dead-
lines in polychronistic groups.2 Exceptions
occur, however. The French have a relatively
low-context culture but are polychronistic;
the Japanese can become monochronistic
when conducting business transactions with
Americans.
People who are single-minded often find
working with those performing multiple tasks
frustrating. Monochronistic persons may see
polychronistic behaviors, such as interrupting
a face-to-face conversation for a phone call or
being late for an appointment, as rude or con-
temptuous. Yet no disrespect is intended, nor
is it believed that polychronistic persons are
less productive than monochronistic people.
In fact, multitasking, the ability to do many
things simultaneously, is valued in many orga-
nizations today.
Nonverbal Communication
High-context cultures place great emphasis
on nonverbal communication in the belief
that body language reveals more about what
a person is thinking and feeling than words
do. Yet customs about touching, gestures, eye
contact, and spatial relationships vary tre-
mendously among cultures, independent of
low- or high-context communication style. As
discussed previously, such nonverbal behavior
can reinforce the content of the verbal mes-
sage being sent, or it can contradict the words
and confuse the receiver. Successful intercul-
tural communication depends on consistent
verbal and nonverbal messages. During per-
sonal and group interactions, persons move
together in a synchronized manner. Barely
detectable motions, such as the tilt of the head
or the blink of an eye, are imitated when peo-
ple are in sync and communicating effectively.
The ways in which a person moves, however,
are usually cultural and often unconscious.
Although body language is closely linked to
ethnicity, most people believe that the way
they move through the world is universal.
Misinterpretations of nonverbal communi-
cation subtleties are common and often inad-
vertent. More than 7,000 different gestures
have been identified, and meaning is easily
misunderstood when awareness of differences
is limited.6
Touching
Touching includes handshakes, hugging, kiss-
ing, placing a hand on the arm or shoulder,
and even unintentional bumping. In China,
for example, touching between strangers, even
handshaking if one person is male and the
other female, is uncommon in public. Ortho-
dox Jewish men and women are prohibited
from touching unless they are relatives or are
married. To Latinos, touching is an expected
and necessary element of every relationship.
The abr az o, a hug with mutual back patting,
is a common greeting. Touching norms fre-
quently vary according to attributes such as
gender, age, or even physical condition. In the
United States, it is acceptable for an adult to
pat the head of a child, but questionable with
another adult. Women may kiss each other,
men and women may kiss, but men may not
publicly kiss other men. It is admirable to
take the arm of an elderly person crossing the
street but rude to do so for a healthy young
adult.7
Cultures in which touching is mostly
avoided include those of the United States,
Canada, Great Britain, Scandinavia, Germany,
the Balkans, Japan, and Korea. Those in which
touching is expected include the Middle East
and Greece, Latin America, Italy, Spain,
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C H A P T E R 3 6 3
agreement and nod up and down to express
disagreement. Puerto Ricans may smile in
conjunction with other facial expressions to
mean “please,” “thank you,” “excuse me,” or
other phrases. The Vietnamese may smile
when displeased. In India, smiles are used
mostly between intimates; an Asian Indian
client may not know what to make of a health
care provider who smiles in a friendly fashion.
Good posture is an important sign of
respect in nearly all cultures. Slouching or
putting one’s feet up on the desk are generally
recognized as impolite. In many societies, the
feet are considered the lowest and dirtiest part
of the body, so it is rude to point the toe at a
person when one’s legs are crossed or to show
the soles of one’s shoes.
Eye Contact
The subtlest nonverbal movements involve
the eyes. Rules regarding eye contact are usu-
ally complex, varying according to issues such
as social status, gender, and distance apart.
Most Americans consider eye contact indica-
tive of honesty and openness, yet staring is
thought to be rude. To Germans, direct eye
contact is an indication of attentiveness. Afri-
can Americans may be uncomfortable with
prolonged eye contact, but may also find rapid
aversion insulting. In general, blacks tend to
look at a person’s eyes when speaking and look
away when listening. To Filipinos, direct eye
contact is an expression of sexual interest or
aggression. Among Native Americans, direct
Portugal, and Russia. Cultures that fall in
between are those of China, France, Ireland,
and India, as well as those in Africa, Southeast
Asia, and the Pacific Islands. Health care pro-
fessionals should take careful note of cultural
touching behaviors. Vigorous handshaking
is often considered aggressive behavior, and
a reassuring hand on the shoulder may be
insulting.6 Of special mention are attitudes
about the head. Many cultures consider the
head sacred, and an absent-minded pat or
playful cuff to the chin may be exceptionally
offensive. Conversely, persons from cultures
in which frequent touching is the norm may
be insulted if someone is reluctant to hug or
kiss, or they may be unaware of legal issues
regarding inappropriate touching in the
United States.
Gesture, Facial Expression, and Posture
Gestures include obvious movements such as
waving hello or goodbye or standing to indi-
cate respect when a person enters the room, as
well as more indirect motions such as handing
an item to a person or nodding the head in
acknowledgment. Facial expression includes
deliberate looks of attention or questioning
and unintentional wincing or grimacing. Even
smiling has specific cultural connotations.
Confusion occurs when movements have
significantly different meanings to different
people. Crossed arms are often interpreted
as a sign of hostility in the United States, yet
do not have similar negative associations
in the Middle East, where it is a common
stance while talking. The thumbs-up gesture
is obscene in Afghanistan, Australia, Nige-
ria, and many Middle Eastern nations. The
crooked-finger motion used in the United
States to beckon someone is considered lewd
in Japan; is used to call animals in Croatia,
Malaysia, Serbia, and Vietnam; and is used to
summon prostitutes in Australia and Indone-
sia. To many Southeast Asians, it is an insolent
or threatening gesture.7,8
Asians find it difficult to directly disagree
with a speaker and may tilt their chins quickly
upward to indicate “no” in what appears to
Americans to be an affirmative nod. Some
Asian Indians, Greeks, Turks, and Iranians
shake their heads back and forth to show
▼ Touching norms fre-
quently vary according to
attributes such as ethnicity,
gender, age, or physical
condition.
M
ic
ha
el
N
ew
m
an
/P
ho
to
Ed
it
Anthropologists speculate
that the handshake, the
hug, and the bow with
hands pressed together
all originated to demon-
strate that a person was
not carrying weapons.
In Japan, the small bow
used in greetings and
departures is a sign of
respect and humility.
The inferior person in
the relationship always
bows lower and longer
than the person in the
superior position.
Many Asians completely
avoid touching strangers,
even in transitory inter-
actions, such as returning
change after a purchase.
This can be offensive to
persons who consider
physical contact a sign
of acceptance, such as
African Americans and
Latinos.
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6 4 I N T E R C U L T U R A L C O M M U N I C A T I O N
eye contact is considered rude, and averted
eyes do not necessarily reflect disinterest.
When Asians and Latinos avoid eye contact, it
is a sign of respect. Middle Easterners believe
that the minute motions of the eyes and pupils
are the most reliable indication of how a per-
son is reacting in any situation.7
Spatial Relationships
Each person defines his or her own space—
the surrounding area reserved for the indi-
vidual. Acute discomfort can occur when
another person stands or sits within the space
identified as inviolate. Middle Easterners pre-
fer to be no more than two feet from whom-
ever they are communicating with so that they
can observe their eyes. Latinos enjoy personal
closeness with friends and acquaintances.
African Americans are likely to be offended
if a person moves back or tries to increase the
distance between them. Intercultural com-
munication is most successful when spatial
preferences are flexible.
In addition to distance, the way a person
is positioned affects communication in some
cultures. It is considered rude in Samoan and
Tongan societies, for instance, to speak to a
person unless the parties are positioned at
equal levels, for example, both sitting or both
standing.
Role of Communication
in Health Care
Health care providers in the United States take
pride in their technical expertise and mastery
of knowledge. They spend years understand-
ing biochemical and physiological processes,
laboratory assessments, diagnostic data, and
therapeutic strategies; yet little of that time is
devoted to how valuable information is effec-
tively communicated to the client or members
of the health care team. Skills are needed for
successful communication with these and
other participants, such as extended family
members or traditional health practitioners,
despite possible differences in language, eth-
nicity, religious affiliation, gender, age, educa-
tional background, occupation, health beliefs,
or other cultural factors.
Words are the primary tool of the clinician
following diagnosis. Whereas the surgeon
depends on the scalpel, most other providers
rely on language to inform and guide patients
in the treatment and lifestyle changes neces-
sary to maintain or improve health.9 The sur-
geon has significant control within the surgical
setting; in most cases the patient is not even
conscious. In contrast, the clinician interacts
directly with a patient who has independent,
sometimes contradictory, ideas about health,
illness, and treatment. The provider can con-
trol only her or his side of the conversation;
if the words are ineffective, the client may
reject recommended medications or thera-
pies. Although the actions of the surgeon are
generally limited to the patient, the advice of
the health care provider often impacts not
only the patient, but also the patient’s family.
Dietary modifications in particular may have
long-term implications; if cultural food habits
are changed, the new ways of eating may be
passed on for generations.
Interaction between
Provider and Client
In the time-pressured and cost-constrained
setting of health care delivery, object messages
are more common than personal messages,
and content is considered more relevant than
the relationship. Typically, the health care
professional relies on the client to provide
accurate, detailed information about his or
her medical history and current symptoms so
that the appropriate diagnosis and treatment
can be determined. The client depends on the
practitioner to explain any medical condi-
tion in terms that are understandable and to
describe treatment strategies and expectations
clearly. This basic conversation is repeated
between providers and their clients daily; it is
the essence of clinical health care. In practice,
however, this common interaction between
provider and client greatly underestimates
the complexity of intercultural communica-
tion. Confidence and caring that is established
between health care providers and patients
can also contribute to the results of the overall
health outcome.10
Numerous barriers to the sharing and
understanding of knowledge can prevent
The one-finger salute is
considered an insult in
many cultures. This ges-
ture dates back to Roman
times, when it was called
digitus impudicus (the
“impudent finger”).
The Japanese demon-
strate attentiveness by
closing their eyes and
nodding.
Koreans say, “A man
who smiles a lot is not
a real man.”
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C H A P T E R 3 6 5
Misunderstandings of meaning are
common.
The results of ineffective communication
in health care can be serious. Noncompliance
issues are among the most important for the
clinician.
Patients may reject recommendations
or fail to return for follow-up appoint-
ments because they are dissatisfied with
their relationship with their health care
provider.12,19,20 Patients with diabetes who
perceived discriminatory behavior from
their health provider due to race, age, socio-
economic status, or gender suffered more
symptoms and had higher levels of hemo-
globin A1C (a blood test for three-month
average sugar levels) than other patients.21
Conversely, patients who received treatment
by health professionals in accordance with
their desired care reported significantly bet-
ter dietary management of their diabetes in
another study.22 Patients often report better
outcomes with traditional healers than with
biomedical practitioners because there is
more time spent on explanation and under-
standing of the condition.23 Development
of the interpersonal relationship with the
practitioner is crucial to a patient’s under-
standing and accepting treatment strategies,
particularly if recommendations conflict
with cultural perceptions regarding health
and illness.24
successful communication in the health care
setting. For example, a client may be fearful
or in pain when seeking help, more focused
on immediate discomfort than on convers-
ing clearly with the provider. During times
of stress, a client is also more likely to use
her or his mother tongue than English if it
is a second language.11 The provider often
assumes the role of the expert, leaving little
room for participation of the client as the
authority on what he or she is experiencing
physically or emotionally.12,13 The provider
may rely on medical jargon because it is dif-may rely on medical jargon because it is dif-may rely on medical jargon because it is dif
ficult to interpret many terms without exten-
sive explanations or oversimplification.14,15
A provider may be most concerned with
the technical aspects of a health problem
and inadvertently ignore the interpersonal
aspects of the relationship with the patient or
may be too rushed to express care and com-
passion.1,16 Furthermore, cultural commu-
nication customs may interfere directly with
the trust and respect necessary for effective
health care.17
Researchers in effective communication
have identified five ways in which misun-
derstandings occur that are applicable to the
health care setting:3,18
1. A provider can never fully know a
client’s thoughts, attitudes, and emo-
tions, especially when the client is from
a different cultural background.
2. A provider must depend on verbal and
nonverbal signals from the client to
learn what the client believes about
health and illness, and these signals
may be ambiguous.
3. A provider uses his or her own cultural
understanding of communication to
interpret verbal and nonverbal signals
from the client, which may be inad-
equate for accurate deciphering of
meaning in another cultural context.
4. A provider’s state of mind at any given
time may bias interpretation of a
client’s behavior.
5. There is no correlation between what a
provider believes are correct interpreta-
tions of a client’s signals or behaviors
and the accuracy of the provider’s belief.
▲ The client depends on the
practitioner to explain any
medical condition in terms
that are understandable and
to describe treatment strate-
gies and expectations clearly.
A
le
xa
nd
er
R
at
hs
/S
hu
tt
er
st
oc
k.
co
m
Participatory research
on a Lakota Indian res-
ervation reported that
intercultural connections
were directly related
to the investment of
time and commitment
to establishing and
pursuing meaningful
dialogue.39
Health care providers
and consumers depend
on their abilities to com-
municate sensitively
and effectively with
one another to relieve
discomfort, save lives,
and promote health.
Ineffective communica-
tion in health care can,
and often does, result in
unnecessary pain, suffer-
ing, and death (p. 8).1
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6 6 I N T E R C U L T U R A L C O M M U N I C A T I O N
Responsibilities of the
Health Care Provider
Although communication requires the active
participation of at least two persons, the
health care provider has certain responsibili-
ties in interactions with clients. The provider
often assumes the superordinate position in
the relationship because she is accorded that
status by the client or because the client is dis-
tracted by pain or discomfort. In that role, it
is the practitioner’s obligation to understand
what is said by the client and to provide the
client with the information needed to par-
ticipate in treatment. This may require that
the clinician be familiar with cultural norms,
listen carefully and seriously to the client
(observing personal cues), and take action
based on what is said by the client. Caring
and considered communication can empower
the client within the relationship and improve
treatment efficacy.1,7,25
It is believed intercultural communica-
tion awareness occurs in four stages. First is
unconscious incompetence, when a speaker
misunderstands communication behaviors
but doesn’t even know misinterpretation
has occurred. The second stage is conscious
incompetence, when a speaker is aware of
misunderstandings but makes no effort to
correct them. Third is conscious competence,
when a speaker considers his or her own
cultural communication characteristics and
makes modifications as needed to prevent
misinterpretations. The final stage is uncon-
scious competence, when a speaker is skilled
in intercultural communication practices and
no longer needs to think about them during
conversation.26
Successful Intercultural
Communication
Effective intercultural communication begins
when the speaker is mindful of his or her own
communication behaviors and is sensitive to
misinterpretations that may result from them.
Practitioner knowledge about a culture does
not necessarily facilitate effective care without
awareness of cultural differences and personal
biases.27,28,36 A willingness to listen carefully
to a client without assumptions or bias and to
recognize that the client is the expert when it
comes to information about his or her expe-
rience is requisite to successful health care
interactions.
The mnemonic CRASH has been sug-
gested as a useful way to remember the com-
ponents to cultural competency that underlie
effective care: C—consider Culture in all
patient–practitioner interactions; R—show
Respect and avoid gratuitous familiarity and
affection; A—Assess/Affirm intracultural dif-affection; A—Assess/Affirm intracultural dif-affection; A—Assess/Affirm intracultural dif
ferences due to language skills, acculturation,
and other factors, recognizing each individual
as an expert on his or her health beliefs and
practices; S—be Sensitive to issues that may
be offensive or interfere with trust in the rela-
tionship, and show Self-awareness regarding
personal biases that may cause miscommuni-
cation; and H—demonstrate Humility, apolo-
gizing quickly and accepting responsibility for
communication missteps.29 With CRASH in
mind, the health professional can begin mas-
tery of the communication skills needed to
promote understanding and acceptance from
clients of many cultural backgrounds.
Intercultural
Communication Skills
Reading about culturally based communica-
tion differences is an intellectual undertaking.
Actually applying intercultural communi-
cation concepts is much more challenging.
Successful face-to-face interactions require
understanding cultural communication
expectations and being familiar with the dis-
tinctive style of the other person. Often there
is contradictory information to assimilate.
The Japanese, for example, come from a cul-
ture that is male dominated, assertive, and
achievement oriented, yet also high in uncer-
tainty avoidance, emphasizing consensus and
ritualistic communication practices. Should
a precise or implied approach be used when
speaking with someone of Japanese heritage?
Clearly, much depends on the circumstances
surrounding the conversation and the particu-
lar people involved. Numerous books, articles,
and courses on health care communication are
available to supplement this brief overview.
Being involved with
decision making was
significantly associated
with adherence to medi-
cal advice for whites,
whereas being treated
with dignity improved
adherence for racial/
ethnic minorities in
one survey.91
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C H A P T E R 3 6 7
Name Traditions
Determine how clients prefer to be addressed.
Americans are among the most informal
worldwide, frequently calling strangers and
acquaintances by their given names. Nearly
all other cultures expect a more respectful
approach. This can include the use of title
or prefixes (Mr., Mrs., Miss, Ms., Dr., Sir,
Madam, etc.), use of surname, and proper
pronunciation. Never use “Dear,” “Honey,”
“Sweetie,” “Fella,” “Son,” or other endearments
in place of proper names.
Name order is often different from the
United States pattern of title, given name,
middle name, and surname. In many Latin
American countries a married woman uses
her given name and her maiden surname,
followed by de (“of ”) and her husband’s fam-
ily surname. For instance, a married woman
named Ana would use her maiden name of
Lopez followed by de plus her husband’s fam-
ily surname of Perez. She would then use the
name Ana Lopez de Perez. Children typically
use their given name, their father’s surname,
and then their mother’s family surname. This
causes confusion because while most Latino
men prefer to be addressed by their father’s
family surname, it is often the name that
sequentially is placed on the “middle name”
line of forms. Persons reading the form often
assume the mother’s family surname is a
Latino’s last name.30
Middle Easterners use their title, given
name, and surname. They may also use bin
(for men) or bint (for women), meaning “of ” bint (for women), meaning “of ” bint
a place or “son/daughter of.” This is not to be
confused with the given name Ben (although it
is pronounced similarly). For example, Abdel
Al-Fakeeh bin Saud literally means Abdel son
of Saud. If the grandparent of a Middle East-
erner is well known, his or her last name may
be added to the name order, following the
surname, with another bin. The Vietnamese,
Hmong, and Cambodians place the surname
first, followed by the given name (although
many make the switch to the American name
order with acculturation). The Chinese and
Koreans use a similar system, including a
generation name following the family name
and before the given name (the generation
name is sometimes hyphenated with the given
name, or the two names are run together). For
example, a man whose name is Yung and has
a generation name of Tsing and a surname of
Wai would be referred to as Yung Tsingwai.
Married women in China and Korea do not
take their husband’s surname. In Japan, the
surname is followed by san, meaning “Mr.” or
“Ms.” Given names are only used among close
friends and intimates. Hindus in India do
not traditionally use surnames. A man goes
by his given name, preceded by the initial of
his father’s given name. A woman follows the
same pattern, using her father’s initial until
marriage, at which time she uses her given
name, followed by her husband’s given name.
Muslims in India use the Middle Eastern
order, and Christian Indians use the U.S. pat-
tern.31 There are numerous other name tra-
ditions and preferences of address. When in
doubt, it is best to ask.
Appropriate Language
Use unambiguous language when work-
ing with clients who are limited in English.
Choose common terms (not necessarily
simple words), avoiding those with multiple
meanings, such as “to address,” which may
mean to talk to someone, to give a speech, to
send an item, or to consider an issue. Vague
verbs, such as get, mak e, and do, may cause
confusion. Use specific verbs, such as pur –
c h ase, c ompl ete, or pr epar e, when directing
clients.
Slang and idioms may have no meaning
in another culture. Many new English speak-
ers interpret words literally. H ow ’ s it going?
makes no sense if one does not understand
the meaning of it in this context.it in this context.it 30 Sports
analogies, including sc or e and str ik e out, are
indecipherable if the game is unfamiliar.
Phrases that suggest a mental picture, such
as r un th at by me or easy as pie or dodge
a bul l et, are barriers to comprehension.32
Medical jargon is also likely to interfere with
communication.15 Some persons with lim-
ited English skills are embarrassed to admit
that they do not understand what is being
said or to ask that something be repeated.
When comprehension is critical, respectfully
request clients to repeat instructions in their
own words, or ask that they demonstrate
One researcher reports
that the use of cultural
food potlucks among
hospital staff members
has facilitated cultural
understanding among
employees of diverse
backgrounds.92
Studies suggest that the
provider–client relation-
ship improves when the
client is also trained in
communication skills.
A meeting with coaches
to guide clients in
formulating appropri-
ate questions and to
practice negotiation
techniques before an
appointment has been
successful in some health
care settings.41
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6 8 I N T E R C U L T U R A L C O M M U N I C A T I O N
a skill so that misunderstandings can be
corrected.
Avoid asking questions that can be
answered with a simple yes or no. For exam-
ple, “Do you understand?” will often prompt
a positive response in practitioner–client
conversations, regardless of comprehension
level. It is better to ask leading questions—for
example, “What confuses you?” or “Tell me
what you don’t understand.”30 In some Asian
cultures it is impossible to say no to a request.
The Japanese, for instance, have developed
many ways to avoid a negative response, such
as answering maybe, countering or criticizing
the question, issuing an apology, remaining
silent, or leaving the room.33
The direct communication style of major-
ity Americans also assumes that each person
is saying what he or she means. This can cause
difficulties when conversing with persons for
whom negotiation is standard practice. For
example, a practitioner offers coffee or tea
to an Iranian client. She refuses, so he sits
down and begins the discussion. The client
is upset because she was being polite and had
expected the health care professional to ask
again, and then insist that she have something
to drink.
Typically, Americans not only believe what
is said initially; they also consider answers
absolute. In some cultures it is acceptable
to make a commitment, then decide later to
change the terms of the agreement or decline
altogether. People from these groups assume
that one cannot predict intervening events
or future needs. Further, there can be differ-
ences in what is accepted as “truth.” In the
United States, truth is considered objective,
supported by facts. In many other cultures,
truth is subjective, often based on emo-
tions.30,34 A Filipino American client may
report to the practitioner that she has not lost
any weight on her low-calorie diet this week.
But when she gets on the scale, she weighs
three pounds less. Asked about it, the client
explains she is frustrated because she gained
one-half a pound yesterday and does not feel
she is progressing. Understanding that the
definitions of truth vary culturally can help
explain some miscommunication.
Use of an Interpreter
Language can be the most difficult of all inter-
cultural communication barriers to overcome.
It is estimated that nearly 30 percent of immi-
grants living in the United States have poor
English skills.35 Many are recent immigrants,
and others view their stay in the United States
as temporary and therefore see no need to
learn English.10
According to Title VI of the Civil Rights
Act of 1964, all persons in the United States
are guaranteed equal access to health care
services regardless of national origin, which
has been interpreted to mean that there can
be no discrimination based on language.
Programs not offering access to persons with
limited English skills may lose federal fund-
ing, including Medicare and Medicaid reim-
bursements. However, the regulation is vague
and difficult to enforce. Compliance is mostly
complaint driven. Most medical institutions
have professional interpreters, and in areas
where interpreters are unavailable, telephone
interpretation services may be an alternative.
Unfortunately, it is common for health care
providers to resort to nonprofessional inter-
preters, such as the client’s family or friends,
to facilitate communication. The inadequa-
cies of such interpretations are numerous.
Patients may be reluctant or embarrassed to
discuss certain conditions in front of their
relatives, or family members may decide
that the information provided by the prac-
titioner isn’t really needed by the patient, so
they do not interpret accurately. Untrained
interpreters are often unfamiliar with medi-
cal terminology. One study indicated that
23 to 52 percent of phrases were misinter-
preted by nonprofessionals; for example,
l ax ativ e was the term used for “diarrhea,” and
sw el l ing was confused with “getting fat.” The sw el l ing was confused with “getting fat.” The sw el l ing
interpreter tended to ignore questions about
bodily functions altogether.34 Even totally
bilingual individuals may not be familiar with
all dialects; the terms used in one part of a
country may be very different from those used
in another region. Ethical issues arise when
children are used as interpreters. Children
may be frightened of medical procedures, and
dependence on a child for communication
A professional interpreter
reports that unintended
results due to limited
language skills can be
confusing, insulting, or
even comic. A friendly
physician meant to
ask one of his clients,
“Cuantos años tiene
usted?” (“How old are
you?”) He mispro-
nounced the word as
anos, however, saying,
“How many anuses do
you have?”11
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C H A P T E R 3 6 9
can invert family dynamics, causing unneces-
sary intergenerational stress.
Issues regarding informed consent, patient
safety, and noncompliance occur when inter-
pretations are inadequate. Some health care
providers attempt to use their personal skills
in a foreign language, believing it is better to
try to communicate directly than to lose some
control through interpreters. Although con-
versing in the language of the client is often
greatly appreciated, it is important for the
provider not to over-estimate fluency. Obtain-
ing the services of a professional interpreter
is warranted in all but emergency situations
when a delay could be life threatening.10
When using an interpreter, the practitio-
ner should speak directly to the client, and
then watch the client rather than the inter-
preter during interpretation. If the nonverbal
response doesn’t fit the comment, confirma-
tion with the interpreter can ensure that the
meaning is clear. Sometimes an interpreter
may appear to answer for the patient; the
interpreter may be very familiar with the
patient’s history based on previous interpre-
tations for other health providers. Conversely,
it may take an interpreter considerably longer
to interpret a comment than it takes to say it
in English, in part because certain cultural
interpretations and explanations may be nec-
essary.37 The technique of back interpreta-
tion, meaning that instructions are repeated
back to the clinician, can prevent miscom-
munication and open the conversation to any
further questions by the client. Providers can
increase effective communication through an
interpreter by using a positive tone of voice
and avoiding a judgmental or condescend-
ing attitude. Short, direct phrases—avoiding
metaphors or colloquialisms—and repeating
important information more than once can
improve client understanding.
Intercultural Counseling
Practitioner attitude toward outcomes is per-
haps the most important element of success-
ful intercultural counseling. A health care
provider cannot be open minded if objectives
are completely preplanned. Participation in
a relaxed, give-and-take exchange can reveal
issues of primary concern to the client. An
invitation to share stories, for example, may
address concerns that cannot be expressed
directly. Mutual commitment to shared goals
can be developed by attentive listening to cli-
ent needs and learning about client expecta-
tions.25,38,39 This collaboration in defining and
achieving outcomes is the difference between
advocacy and manipulation. Effective inter-
cultural counseling is an ongoing process of
practice and refinement, requiring an open
attitude, cultural knowledge, and intercultural
communication skills.39,40
Pre-Counseling Preparation
Researchers have made many recommenda-
tions regarding effective intercultural com-
munication. The basic competencies needed
by practitioners include (1) information
transfer—the verbal and nonverbal ability
to convey object messages; (2) relationship
development and maintenance—the ability
to create rapport, establish trust, and dem-
onstrate empathy and respect; and (3) com-
pliance gaining—the ability to obtain client
cooperation (Table 3.1).41
Practically speaking, a health care provider
cannot be expected to become an expert in
intercultural communication or to fully
understand the communication modes best
suited to each of the many clients from dif-suited to each of the many clients from dif-suited to each of the many clients from dif
ferent cultural heritages. Most patients liv-
ing in the United States do not expect to be
treated as they would in their homeland. But
familiarity with intercultural communication
attitudes, knowledge, and skills can greatly
enhance health care efficacy.
The In-Depth Interview
The in-depth interview is essential in inter-
cultural counseling to determine many of the
iceberg issues that may affect communica-
tion and cooperation in health care, includ-
ing ethnicity, age, degree of acculturation or
bicultural adaptation, socioeconomic status,
health condition, religious affiliation, edu-
cational background, group membership,
sexual orientation, or political affiliation.
However, a client may believe that personal
questions about his background are invasive
Successful communica-
tion in the interpreter–
client relationship is
also dependent on
intercultural skills. It has
been suggested that
translators who build
rapport and trust are
more effective than those
who are emotionally
detached.75
A study on patient partic-
ipation in decision mak-
ing found that 96 percent
of clients want care
choices offered to them
and want their opinions
sought. However, 52 per-
cent preferred to leave
the final decision to their
physician. Well-educated
white women were most
likely to want shared
decision making; African
Americans and Hispanics
were least likely.93
Health care providers
note that age affects
intercultural commu-
nication because older
minority members are
often socially isolated
and may be unwilling to
communicate with health
care providers from a
different culture.94
Demographic data on
practitioners show a dis-
proportionate number of
whites (among dietitians,
81.8 percent are non-
Hispanic whites), sug-
gesting that intercultural
counseling will become
increasingly prevalent
until greater diversity in
the health care profes-
sions is achieved.95
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7 0 I N T E R C U L T U R A L C O M M U N I C A T I O N
or unnecessary, especially if he comes from
a high-context culture. Direct inquiry may
even suggest to the client that the practitioner
is incompetent because she cannot determine
the problem through indirect methods.
One culturally sensitive approach is the
respondent-driven interview, in which simple,
open-ended questions by the provider initi-
ate conversation.12 The client can express her
understanding and experience in her own
words. The practitioner exerts little control
over the flow of the response, yet elicits data
through careful prompting.23,42 Useful ques-
tions to ask during the conversation include
these:
• What do you call your problem? What
name do you give it?
• What do you think caused it?
• Why did it start when it did?
• What does your sickness do to your
body? How does it work?
• Will you get better soon, or will it take a
long time?
• What do you fear about your sickness?
• What problems has your sickness caused
for you personally? For your family? At
work?
• What kind of treatment will work for
your sickness? What results do you expect
from treatment?
• What home remedies are common for
this sickness? Have you used these home
remedies?
Furthermore, information should be
requested about traditional healers:
• How would a healer treat your sickness?
Are you using that treatment?
For nutritional assessment within the con-
text of the client’s condition, questions about
food habits are appropriate:
• Can what you eat help cure your sickness
or make it worse?
• Do you eat certain foods to keep healthy?
To make you strong?
TA B L E 3.1 Checklist for Intercultural Nutrition Counseling
Attitudes Knowledge Skills
• I am open-minded and willing to be a
learner instead of the expert when it
comes to the client’s life experiences
and ways of knowing.
• I am sincerely interested in different
cultural perspectives on reality, and I
can respect cultural worldviews other
than my own.
• I can tolerate the ambiguities of
intercultural communication.
• I can accept that some interactions will
be uncomfortable or unfamiliar to me.
• I am patient; I attempt to understand
the ideas and feelings of the client.
• I understand that although some cultural
influences on communication are readily
apparent, others are hidden and require
development of a personal relationship
so that salient factors in communication
and compliance can be identified.
• I know that body language can provide
significant information about the
client’s concerns and feelings; the
relationship can improve or deteriorate
through nonverbal communication.
• I understand that modification of
culturally held beliefs and behaviors
can have significant, long-term effects
on the client and the client’s family.
Attempts to force change may result
in ineffective communication and
noncompliance by the client.
• I am familiar with cultural food habits of
my clients.
• I have learned about traditional health
beliefs and practices.
• I explain diet rationale in common
terms within the context of a client’s
worldview, including concepts
regarding the cause, prevention, and
treatment of illness; I set realistic goals
with the client.
• I emphasize the continuation of
positive cultural food habits and
recommend modification of only those
food habits that may be detrimental to
the client’s health. I avoid personal bias.
• I attempt to send nonverbal messages
consistent with my verbal messages.
• I engage in effective intercultural
communication with all participants
in the health care system to help
clients through illness and improve
health through supportive personal
relationships, through cooperation with
families, and through the gathering
and sharing of relevant data with other
health care professionals.
SOURCE: Adapted from Cassidy, C.M. 1994. Walk a mile in my shoes: Culturally sensitive food-habit research. Journal of the American Dietetic Association, 97, 1288–1292; Gudykunst, W.B., & Nishida, T. Journal of the American Dietetic Association, 97, 1288–1292; Gudykunst, W.B., & Nishida, T. Journal of the American Dietetic Association, 97
1994. Bridging Japanese/North American differences. Thousand Oaks, CA: Sage; Kavanagh, K.H., & Kennedy, P.H. 1992. Promoting cultural diversity: Strategies for health professionals. Newbury Park, CA: Sage;
Kreps, G.L., & Kunimoto, E.N. 1994. Effective communication in multicultural health care settings. Thousand Oaks, CA: Sage; Sanjur, D. 1995. Hispanic foodways, nutrition, and health. Boston: Allyn & Bacon.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 3 7 1
• Do you avoid certain foods to prevent
sickness?
• Do you balance eating some foods with
other foods?
• Are there foods you will not eat? Why?
Learning about how a client understands
his illness, including expectations about how
the illness will progress, what the provider
should do, and what he has established as ther-
apeutic goals, allows the provider to compare
her own view of the illness and to resolve any
discrepancies that might interfere with care.
Demonstrating sincere interest in cultural
health beliefs through an open-ended con-
versation can elicit the information needed to
begin assessment and to determine the most
effective approaches for each individual.
Intercultural Nutrition
Assessment
Several difficulties in the collection and anal-
ysis of cultural health data have emerged in
recent years. Researchers have discovered that
standardized assessment tools can introduce
systematic bias into results or provide mis-
leading information when used with different
cultural populations.
Generalized approaches to the use of the
twenty-four-hour food recall, food frequency
forms, and nutrient databases can produce
large errors in assessment.12,43,44,45 Cultural
unfamiliarity with concepts, such as fiber;
terminology differences, such as using one
word for several foods or not having a name
for a certain category of food (e.g., there is no
American Indian word for “vegetables”), or
grouping foods by different categories (e.g., by
medicinal properties or status); lack of differ-
entiation between meals and snacks; checking
“phantom foods” (those not actually con-
sumed) when not enough traditional items are
available for selection; and translation mis-
takes (e.g., literal translations of food names,
use of a brand name for a generic item, or use
of the name for a traditional food for a similar
American item) are a few ways collected data
can be invalidated. Frequent consumption of
mixed dishes can result in omission of some
nutrient sources (as when rice is prepared
with dried peas or beans, yet reported as rice
by some Caribbean Islanders) and overesti-
mation or underestimation of intake due of
complications in portion-size estimates. Tre-
mendous variability in the amounts of food
eaten has been reported between individuals
and cultural groups.34 Nutritional variety may
be artificially reduced if the composition data
for a cultural food prepared in significantly
different ways among subgroups are used
without allowances for recipe modifications.
Using food composition data for similar foods
when specific listings on a cultural item are
unavailable can lead to intake miscalculations
if numerous substitutions are necessary.
Food lists derived from data on the U.S.
population as a whole may miss significant
dietary nutrient sources in subgroups. A study
comparing a generalized food frequency ques-
tionnaire with ethnic-specific tools developed
for African Americans, whites, and Mexican
Americans found improvement in assessing
total fat, vitamin A, and vitamin C intake
with the modified forms.46 Similar research
also reported a modest increase in nutrient
estimates for Hispanic, Chinese, and Japanese
respondents.47 A review of food frequency
questionnaires in minority populations, how-
ever, found that the number of published
examples was so few, and the methodologies
were so varied, that no conclusions regarding
how best to develop valid, reliable instruments
could be reported. Questions regarding how
extensive questionnaires should be (espe-
cially number of included foods), whether
food groupings need to be modified, and how
portion size should be standardized remain
unanswered.48
Other assessment tools may be question-
able in intercultural settings as well. A model
used to determine health attitudes among
whites was found unreliable when used with
Mexican Americans, even after operational
adjustments for cultural differences.49 Con-
tradictions were found, for example, between
self-administered and interviewer-directed
questionnaire responses; participants were
more likely to express disagreement about
an item when completed individually than
when asked about it by the interviewer. Cul-
tural attitudes regarding pleasing authorities
Research conducted
with African American
women found that an
interviewer-administered
food frequency question-
naire was more feasible,
and less burdensome
for staff and respon-
dents, than multiple
twenty-four-hour
dietary recalls.97
The USDA increased
the number of ethnic
and Native American/
Alaska Native foods in
the 2012 USDA National
Nutrient Database for
Composition of Foods.96
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7 2 I N T E R C U L T U R A L C O M M U N I C A T I O N
The predictive value of waist-to-hip ratios
and body mass index (BMI) may vary in
some populations.57,58,59,60 Questions about
the standard BMI cutoff for over-weight and
obesity in Asians have been raised due to a
high risk for health problems at lower num-
bers.61 When percentage of body fat data were
used instead of BMI for calculating obesity in
African Americans and whites, the difference
in rates between women was cut in half (with
blacks still more at risk than whites), and the
gap for men was widened, with far more white
men identified as obese.62 Even physiologic
calculations, such as basal metabolic rate
equations, may differ culturally.63,64
The development of culturally specific
techniques and tools is a critical need in
nutritional assessment. For an individual cli-
ent, switching from a quantitative to a more
qualitative approach can establish trust and
cooperation in initial interviews. The twenty-
four-hour recall, for instance, can be con-
ducted in an open-ended manner, requesting
simply that all foods consumed the previous
day be remembered.12 This eliminates diffi-
culties with obtaining portion sizes or differ-
entiating meals. The dietitian does not need
to predetermine food items or categories. In
subsequent meetings more information, such
as frequency and amount of given items, can
be requested after an explanation on why the
information is needed.
When working with many clients of a
single cultural heritage, it may be useful to
prepare quantitative tools based on quali-
tative research. This approach is most suc-
cessful when done by an investigator already
familiar with the specific group’s food cul-
ture. A well-intentioned but culturally biased
open-ended question (for example, asking
a participant to list “any other foods eaten
weekly”) may not prompt the recall of foods
eaten seasonally, thus underestimating a par-
ticular nutrient. The burden of negotiating
two different cultural food systems should
be on the researcher, not the study partici-
pant.47,65 Detailed interviews with individuals
can provide information on appropriate lan-
guage, categories, concepts, and formatting of
the instruments helpful in culturally specific
nutritional assessment.
are believed to have influenced respondent
answers, calling into question the use of the
interview as a valid tool for gathering data
in this ethnic group. In another study on
low-literacy populations the opposite was
found; self-reported data on food frequency
questionnaires were found unreliable when
compared to comments made by respondents
during follow-up interviews.50,98
A review of acculturation scales and
indexes found that many were unsuited for
use in dietary interventions or nutrition edu-
cation programs.49 Single-item measures of
acculturation, including broad questions such
as “How long have you lived in the United
States?” and “What language do you speak at
home?” provide only introductory informa-
tion about a client and resulted in outcome
discrepancies in data collected on dietary
fat intake and acculturation in one study.51
Acculturation scales are more comprehensive
but also do not address questions regarding
food habit changes. In addition, acculturation
scales are typically validated on homogeneous
population samples, such as college students
or hospital patients, and may not be fully
applicable to a more diverse clientele. Food-
based assessments are more promising, but
they do not provide data on the psychological
or social aspects of acculturation and are usu-
ally limited to use with a single cultural group.
Furthermore, anthropometric measure-
ment tools are sometimes inappropriate
for certain populations. Height and weight
growth curves are particularly vulnerable to
misinterpretation due to cultural variation,
especially among Asian groups. Stature pre-
diction equations for whites were inaccurate
for Latinos52,53,54,55 and African Americans.56
Standardized height
and weight growth curves
have not been validated for
all ethnic groups and should
be applied cautiously with
cultural variation in mind. JH
er
sh
Ph
ot
o/
Sh
ut
te
rs
to
ck
.c
om▲
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C H A P T E R 3 7 3
Monthly twenty-four-hour recalls of
small, representative samples are useful
in determining overall consumption pat-
terns, especially where seasonal variation
occurs.34 Focus groups have been found
effective in selecting food items to include
and quantification measures in the prepara-
tion of multicultural food frequency ques-
tionnaires.43,49 Guidance from the targeted
population is essential.49,65 Two questions
regarding the accuracy of data collection
are suggested: First, how do cultural per-
ceptions about food affect the way in which
clients report their intake? Second, how is
the report of intake affected by the client’s
relationship with the interviewer, the set-
ting, and the assessment tool? Answers to
these questions can suggest culturally sensi-
tive approaches and improve the validity of
collected data.13,29
Access to cultural foods composition data
and culturally specific anthropometric and
physiological measurements is more prob-
lematic. Requests for recipes can be used to
expand current databases, although this tech-
nique may be too time consuming to complete
with every client. Being mindful that data
analysis is often approximate and that stan-
dardized measurements may be questionable,
dietary modifications should be made care-
fully and cautiously with all clients from cul-
tural backgrounds other than the American
majority.
Intercultural Nutrition
Education
The biomedical paradigm emphasizes
behavioral change accomplished through
one-on-one work with an individual. How-
ever, many cultural groups prefer learning
about nutrition in settings with family mem-
bers or peers.66 For example, researchers
have found that while white adolescent girls
demonstrate poor outcomes when coun-
seled with their mothers, black adolescent
girls show significantly improved outcomes
when their mothers participate in weight-
loss sessions.67,68
Successful nutrition education strategies
for groups are as dependent on intercul-
tural communication skills as is nutrition
counseling with individuals. For example,
researchers have described how culture can
affect program outcomes in a group weight-
loss setting.69 Negative results are possible
at any phase of the process, from motiva-
tion and attendance to skill acquisition and
behavior change (see Figure 3.3). At each
point cultural influences may reinforce or
contradict the content and context of the
education messages conveyed by the health
care practitioner. When communication
conflict develops, an inexact period of time
exists when the client is willing to negotiate
toward resolution of the message. If dissat-
isfaction continues, a poor weight-loss out-
come results because the person (1) is never
motivated to sign up, (2) drops out of the
program before completion, (3) attends but
never learns skills, or (4) learns skills but
does not apply them in practice. Program
designers must do more than superficially
modify the program materials and the set-
ting to communicate effectively with a dif-ting to communicate effectively with a dif-ting to communicate effectively with a dif
ferent cultural group. Understanding the
cultural health beliefs, attitudes, and values
of a target audience; developing education
programs within the context of those per-
ceptions; and using culturally appropriate,
consistent verbal and nonverbal messages in
an accepted medium increase communica-
tion efficacy.
A comparison of food
composition tables in
nine European nations
exemplifies the difficulty
in obtaining accurate
nutrient data. Differences
in definitions, analysis
methods, and expres-
sion made it impossible
to compare local tables
with international data.66
Figure 3.3
Schematic illustration of
how cultural factors might
influence participation and
outcomes at various phases
of the program.
Cultural
Influence
Phase of
Process
Possible
Negative
Outcome
Tolerance for IneffectivenessNegotiation Space Negotiation Space
· Actual relevance
· Role models
· Cultural
acceptability
· Social
reinforcement
Behavior change;
weight change
Poor result
· Language
· Perceived
relevance
Learning
and skill
acquisition
Nonadherence
· Setting
· Interpersonal
component
Attendance
Drop out
· Body image
· Social
pressure
Motivation
Nonparticipation
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7 4 I N T E R C U L T U R A L C O M M U N I C A T I O N
Culturally Relevant Program
Preparation
Although health education program models
typically advise a step-by-step process of plan-
ning and execution, the reality is that some
aspects of preparation and implementation
occur concurrently. A health educator may
begin planning with a general idea of goals for
a population group, but will probably modify
and refine objectives as more information
about the target audience is gathered. Ongo-
ing evaluation may suggest better message
formats or more suitable influence channels
as the effort proceeds. Effective programs are
often nonlinear, with each element in plan-
ning and implementation connected through
feedback and assessment into a continuous
improvement loop.
Targeting the Audience
Identification of the target audience in nutri-
tion education efforts is among the most
important steps in program planning. Learn-
ing about the cultural orientation of the group
is key; campaigns to change behaviors with-
out research are usually misdirected.70 What
appear to be significant needs to the health
educator may be considered unimportant or
too difficult to remedy by members of the tar-
get population.
Definitions of health differ widely among
cultures (see Chapter 2, “Traditional Health
Beliefs and Practices”). A common belief
is that illness is a matter of heredity, fate, or
punishment by God, or is due to supernatural
causes. In a study of health perceptions held
by hard-to-reach populations in the United
States, it was found that though individu-
als believed that lifestyle might impact acute
infection, there was almost no association
between diet or exercise and chronic dis-
ease; respondents had limited motivation to
improve health behaviors because they felt
they had little personal control over their
health.71 The role of the individual within the
group can also affect responsibility for health
maintenance; in some cultures, the extended
family is held accountable for the health of
each member.
Demographic information about the target
audience can guide program development.
Primary language should be identified, as well
as gender, average age, socioeconomic status,
educational attainment, religious affiliation,
and other iceberg factors in communication.
Assessment of acculturation or bicultural
adaptation is equally important. The more
culturally homogeneous the target popula-
tion, the more appropriate are the messages
that can be created.72,78 In many cases, the
larger, heterogeneous audience may be strati-
fied into smaller, segmented target groups that
share similar cultural beliefs and attitudes.
Involving members of the targeted audi-
ence in program planning is one of the best
ways to determine cultural orientation.73 Of
special note is the role of community leaders
or spokespersons in the process. Seeking the
respect, trust, and endorsement of influen-
tial persons within the target audience for a
particular nutrition education program can
open intercultural communication channels
otherwise limited to the formal interactions
reserved for strangers.39,74,75 The educa-
tor establishes a relationship with the group
through asking for permission to present the
health message to its members.
Setting Goals and Objectives
The next step in intercultural program plan-
ning is to define clear and realistic goals and
objectives within the cultural context of the
target audience. Even culturally sensitive edu-
cation messages do not necessarily translate
into sustained modification of food habits
without follow-up support, and overly ambi-
tious expectations are a common reason for
failure.76,77 Nevertheless, strategies emphasiz-
ing continuation of positive cultural dietary
patterns or portion control rather than elimi-
nation of certain foods are reportedly of inter-
est to African Americans, Asian Americans,
Latinos, and Native Americans, as well as
whites: One study found a barrier to eating
healthfully was that participants believed they
would have to give up their cultural heritage
and conform to the dominant culture.69,71,79
Programs coordinating objectives with cul-
tural beliefs about the role of food in health,
Content of the mes-
sage can be critical. For
example, one study on
the effects of public edu-
cation efforts to reduce
bulimic eating behaviors
revealed that some
women learned about
vomiting as a weight-
control method from the
campaign.99
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C H A P T E R 3 7 5
such as balancing yin and yang foods in
Chinese meals, can reinforce dietary change.49
Consulting health care practitioners in the
targeted community can provide information
on local needs and concerns useful in defining
achievable goals and objectives.
Using Triangulation
An especially useful step in the program
design process is triangulation, a method of
confirming congruence between data col-
lected on the target audience and proposed
program goals and objectives (Figure 3.4).80
Triangulation means that information gath-
ered through one source or method is used
to confirm and extend information gathered
through other sources and methods. In addi-
tion to corroboration, triangulation can pro-
vide improved understanding of local issues
and perspectives.
In the triangulation pilot program, com-
munity nutritionists were interviewed to help
define the target population of young African
American women and for direction in pro-
gram development. Next, target group women
participated in focus groups and were asked
to discuss benefits and obstacles to healthy
eating. A final step surveyed community
resources on the availability of quality food
products. When researchers compared data
from the three qualitative studies, they found
that their target audience was confirmed as
appropriate, that the nutritionists had cor-
rectly identified the need for culturally rel-
evant skill-building messages, and that there
was a barrier to achieve program goals and
objectives due to the lack or excessive cost of
fresh and frozen foods. The triangulation pro-
cess provided concrete data on target popu-
lation needs and credible communication
channels, directing program planning toward
culturally relevant interventions and resource
development.
Developing the Message
It is believed that the more fundamental the
health message is in relation to a group’s sur-
vival, safety, or social needs, the more effec-
tive it will be interculturally.1 The message
must satisfy the individual’s need to gain
knowledge or offer a solution to a perceived
problem before it is worth the person’s time
to process the information.70 Messages should
be as direct and explicit as allowed within
cultural norms.81 Language relevant to the
group should be used in development of the
message, and translation of existing materials
should be avoided to prevent inappropriate
phrasing and terminology. Common words
used by the target audience are effective,
although it is important that they not be used
in an insincere or condescending way. Written
materials should be brief and prepared at the
reading level of the target population.
Marketing experts recognize many cul-
tural groups are high-context communica-
tors and have greater abilities than the white
American majority culture to send and receive
messages through nonverbal modes.75 Body
language must be culturally congruent with
the verbal message for successful communi-
cation to occur. The use of pictures, cartoons,
and photographic images can symbolically
enhance content meaning of a message in a
high-context culture, as well as aid target pop-
ulations with mixed English language skills or
reading abilities.
Educational messages are most effective
when they are more personal than objective;
the emotional dimension is as important
as the content. Many researchers recom-
mend the universally accepted format of
Figure 3.4
Triangulation.
Source: Based on Journal of the
American Dietetic Association,
Volume 99 (6), J. Goldberg et al,
‘Using 3 Data Sources and Methods
to Shape a Nutrition Campaign’,
pp. 717–722.
Community
Nutritionists:
Perspectives
Method:
Interviews
Community
Women:
Needs, preferences,
current activities
Method:
Focus group
discussions
Stores:
Available foods
and costs
Method:
Observation
©
T
he
A
m
er
ic
an
D
ie
te
tic
A
ss
oc
ia
tio
n.
The four barriers to
healthy eating identi-
fied by African American
women in the triangula-
tion focus groups were
taste, cost, time, and lack
of information such as
recipes, shopping tips,
and a chart comparing
healthful and unhealthful
choices.80
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7 6 I N T E R C U L T U R A L C O M M U N I C A T I O N
storytelling to deliver the message.82,83 Actors
and other celebrities are especially suited
to recounting personal experiences about
health issues. Stories can transcend many
cultural boundaries; if a message is targeted
toward one cultural group yet applicable to
many audiences, a spokesperson identified
with the intended target group also may
have broader appeal when using a narrative
approach.
A pilot test of the message with targeted
audience members can improve success.
Focus groups can be especially useful in
assessing cultural appropriateness of educa-
tion materials and in identifying any resis-
tance triggers inadvertently included in the
message.70,71,84
Implementation Strategies
Dissemination of a nutrition education
message should include analysis of cultural
influence channels and media preferences,
development of an effective marketing mix,
and evaluation of the program. Whether a
person actually hears, sees, and understands
a message is dependent on frequency, timing,
and accessibility. Exciting, informative, cul-
turally appropriate messages fail if they never
reach the target audience.70,76
Influence Channels
Influence channels are the ways in which
message materials are transmitted to the
target audience. They include television,
video, computers, the Internet, radio, maga-
zines, newspapers, newsletters, direct mail,
and telephones. Each cultural group dem-
onstrates distinct media-use patterns and
is best approached through those influence
channels. Oral traditions are strong among
some populations, while written messages are
favored by others. It is estimated that many
African Americans (97 percent) listen to the
radio for more than thirty hours each week;
Latinos enjoy television programs focusing
on family and relationship issues, watching
on average fifteen hours of Spanish program-
ming and ten hours of English programming
each week.72,85 Asians watch about six hours
of native language television weekly. In a
study of Native Americans in California, a
majority of respondents reported that they
would prefer receiving nutrition information
through newsletters (69 percent) or video-
tapes (67 percent); approximately one-quarter
indicated they would like to receive a visit
from a health professional, and only 6 percent
selected a workshop with family and friends.79
Computer-based, interactive nutrition educa-
tion programs are now an established educa-
tional tool, particularly suitable for audiences
with low literacy or limited English language
skills, as was found in a study of rural Appa-
lachian women.86 The Internet has become a
useful technology, offering twenty-four-hour
access to health education materials and easy
access to group support through bulletin
boards and chat rooms, and individualized
therapy through e-mail.87,88,89
According to marketing experts, the most
effective presentation of a message requires a
combination of pictures, sounds, and words
in the broadcast and print media.72 The use
of multiple influence channels and frequent
repetitions of the message at times when the
target audience is listening or watching is also
important. Beyond the mass media, health
fairs, neighborhood clinics, farmers’ mar-
kets and grocery stores, traditional healers,
churches, schools, food banks or social ser-
vice centers, carnivals, and sporting events
are a few of the locations where culturally
relevant nutrition education materials can
be successfully distributed on a smaller scale.
Low-income, hard-to-reach whites, blacks,
and Latinos express interest in nonjudgmen-
tal small-group support meetings similar to
Alcoholics Anonymous and Tupperware-style
home meetings with food samples and cook-
ing demonstrations as settings for nutrition
education programs.71
Marketing Mix
The four Ps of the marketing mix are prod-
uct, price, placement, and promotion.1 They
refer to a well-developed message (product)
that advances program goals and objectives
Cultural icons incorpo-
rated into educational
messages should be
selected with care. For
example, the owl repre-
sents wisdom in some
American Indian cultures;
in others, the owl is a
symbol for death.82
Mass media cam-
paigns are believed
to influence a change
in health behavior
by about 10 percent
of the targeted audi-
ence, which can be a
significant number in
a large campaign.
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C H A P T E R 3 7 7
4. What would be the culturally appropriate
verbal address for when you meet the follow-
ing individuals: an African American, a Latin
American, a Vietnamese, and an Asian?
References
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c ommunic ation in mul tic ul tur al h eal th c ar e set-
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at minimal economic or psychological cost to
target audience members (price) and presents
this message in a method congruent with tar-
get audience media preferences (placement) in
such a way that the target audience members
are encouraged to become more involved in
the program, either through phone numbers
for further information or through attendance
at group meetings (promotion). Attention to
all four areas of the marketing mix ensures
that the health care message is fully accessible
to the target audience.
Evaluation
Process evaluation keeps track of progress
throughout the program, especially the iden-
tification of larger community conditions
that may be presenting barriers to dissemina-
tion of the message. Summative evaluation is
used to assess program results after comple-
tion of the effort. Evaluation data are useful
in refining intercultural nutrition education
strategies both during implementation and
in future programs. Publication of culturally
sensitive nutrition education program results
greatly benefits other health professionals
and their clients through shared knowledge
about intercultural communication tech-
niques and tools.
Review Questions
1. Why is communication with another person
or group described as an action chain? Give an
example of an action chain that might occur
when you meet (1) a friend, (2) your new boss,
and (3) a young child.
2. Why is it important to become familiar with
other cultures’ communication behaviors?
Give three examples of nonverbal communi-
cation behaviors.
3. What is meant by low or high context and
uncertainty avoidance in describing verbal
communications? Name one culture that is low
context and one culture that is high context.
How may an individual’s relationship to the
group differ between high- and low-context
cultures? How does uncertainty avoidance dif-cultures? How does uncertainty avoidance dif-cultures? How does uncertainty avoidance dif
fer from risk avoidance? Give an example.
D I S C U S S I O N S T A R T E R S
How Does Dr. Petrocelli Improve His
Patient Relations?
Consider this situation: Dr. Petrocelli is a neighborhood doctor in a large U.S. city. His
office has been in this urban neighborhood for forty years. Originally, the neighbor-
hood was ethnically fairly homogeneous: primarily European American and African
American. Over the last decade, however, more people of various different ethnicities
(Asian, Hispanic, and Middle Eastern), mostly immigrants to the United States, have
moved into the neighborhood and are seeking health care. Dr. Petrocelli recognizes that
sometimes communications with his newer patients are strained, and he worries that he
is not fully understanding them and they are not fully understanding him. He’s consider-
ing several different options along with their drawbacks:
● Hire an interpreter. Drawback: To pay this person’s salary, he will need to increase
the fees for his patients.
● Continue to rely on patients’ relatives or friends to translate for him. Drawback: He
will continue to worry if the translations are accurate.
● Start holding an in-depth interview with each of his new patients to get to know
them better. Drawback: These interviews will take a lot of time and could mean
that either he will have to extend his hours—and pay his staff overtime—or set
a moratorium on taking any new patients until he has completed the interviews.
He worries that such a moratorium could mean that some people living in the
neighborhood might not receive adequate healthcare.
First individually and then in small groups, brainstorm which of these options might be
the best—or perhaps better yet, brainstorm a solution to Dr. Petrocelli’s problem that
combines options or offers a completely different option.
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7 8 I N T E R C U L T U R A L C O M M U N I C A T I O N
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55. Chumlea, W.C., Shumei, S.G., Wholihan, K.,
Cockram, D., Kuczmarski, R.J., & Johnson, C.L.
1998. Stature prediction equations for elderly
non-Hispanic white, non-Hispanic black, and
Mexican-American persons developed from
NHANES III data. J our nal of th e A mer ic an
Dietetic A ssoc iation, 9 8 , 137–142.
56. Hoerr, S.L., Nelson, R.A., & Lohman, T.R. 1992.
Discrepancies among predictors of desirable
weight for black and white obese adolescent girls.
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450–453.
57. Slattery, M.L., Ferucci, E.D., Murtaugh, M.A.,
Edwards, S., Ma, K.N., Etzel, R.A., . . . Lanier, A.P.
2010. Associations among body mass index, waist
circumference, and health indicators in American
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58. Yatsuya, H., Folsom, A.R., Yamagishi, K.,
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59. Huxley, R., Mendis, S., Zheleznyakov, E.,
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60. Lusky, A., Lubin, F., Barell, V., Kaplan, G., Lay-
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17-year-old Israeli males of different ethnic back-
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61. McNeely, M.J., & Boyko, E.J. 2004. Type 2 diabe-
tes prevalence in Asian Americans: Results of a
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63. Case, K.O., Brahler, C.J., & Heiss, C. 1997. Resting
energy expenditures in Asian women measured
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64. Liu, H.Y., Lu, Y.F., & Chen, W.J. 1995. Predictive
equations for basal metabolic rate in Chinese
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66. Deharveng, G., Charrondiere, U.R., Slimani, N.,
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of nutrients in the food composition tables avail-
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67. Brownell, K.D., Kelman, J.H., & Stunkard, A.J.
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appropriateness of weight management programs.
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Clark, E.M., Haire-Joshu, D., Fu, Q., . . . Bucholtz,
D. 2005. Cultural tailoring for mammography
and fruit and vegetable intake among low-income
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w ith c ul tur al l y div er se c ommunities and c l ients.
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Cantrell, B. 2002. Utilizing traditional storytelling
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84. Kiefer, E.C., Willis, S.K., Odoms-Young, A.M.,
Guzman, J.R., Allen, A.J., Two Feathers, J., &
Loveluck, J. 2004. Reducing disparities in diabetes
among African-American and Latino residents of
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S27–S37.
85. Mogelonsky, M. 1998, April. Watching in tongues.
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Mangone, C., McCrone, S., & Leslie, N. 2006.
Cookin’ up health: Developing a nutrition inter-
vention for a rural Appalachian population.
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R.E., Ramsey, D.C., Kirchhofer, A., & Reyes, M.
2011. Promising practices for the prevention and
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88. Chou, H.K., Lin, I.C., Woung, L.C., & Tsai, M.T.
2010, November 23. Engagement in e-learning
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92. Burner, O.Y., Cunningham, P., & Hattar, H.S.
1990. Managing a multicultural nurse staff in a
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8 2
4 Food and Religion
The function of religion is to explain the The function of religion is to explain the Tinexplicable, thus providing humans Tinexplicable, thus providing humans Twith a sense of comfort in a chaotic Twith a sense of comfort in a chaotic T
world. Food, because it sustains life, is an
important part of religious symbols, rites, and
customs, those acts of daily life intended to
bring about an orderly relationship with the
spiritual or supernatural realm.
In the Western world, Judaism, Christian-
ity, and Islam are the most prevalent religions,
whereas Hinduism and Buddhism are com-
mon in the East. The Western religions, origi-
nating in the Middle East, are equated with
the worship of a single God and the belief that
that God is omnipotent and omniscient. It is
for God to command and for humankind to
obey. This life is a time of testing and a prepa-
ration for life everlasting, when humans will
be held accountable to God for their actions
on earth.
The Eastern religions of Hinduism and
Buddhism developed in India. Unlike the
Western religions, they do not teach that
God is the lord and maker of the universe
who demands that humankind be righteous.
Rather, the principal goal of the Indian reli-
gions is deliverance, or liberation, of the
immortal human soul from the bondage of
the body. Moreover, nearly all Indian religions
teach that liberation, given the right disposi-
tion and training, can be experienced in the
present life.
This chapter discusses the beliefs and food
practices of the world’s major religions. Other
religions of importance to specific cultures are
introduced in the following chapters on each
ethnic group. As with any description of food
habits, it is important to remember that reli-
gious dietary practices vary enormously, even
among members of the same faith. Many reli-
gious food practices were codified hundreds
or thousands of years ago for a specific locale
and, consequently, have been reinterpreted
over time and to meet the needs of expanding
populations.
As a result, most religions have areas of
questionable guidelines. For example, fish
without scales are banned under kosher food
laws. Are sturgeon, which are born with scales
but lose them as they mature, considered fit to
eat for Jews? Orthodox Jews say no, whereas
many Conservative and Reform Jews say yes:
smoked sturgeon can be found at almost any
Jewish deli. Hindus, who avoid fish with “ugly
forms,” identify those fish that are undesirable
according to local tradition. In addition, reli-
gious food practices are often adapted to per-
sonal needs. Catholics, encouraged to make
a sacrifice during Lent, traditionally gave up
meat but today may choose to give up pastries
or candy instead. Buddhists may adopt a veg-
etarian diet only during the period when as
an elder they become a monk or nun. Because
religious food prescriptions are usually writ-
ten in some form, it is tempting to see them
as being black-and-white. Yet they are among
the most variable of culturally based food
habits. (See Table 4.1.)
C
H
A
P
T
E
R
A study on religious
affiliation in 2008 found
the percentage of self-
identified Christians in
the United States had
declined in the past
decade, whereas the
percentage that adhere
to non-Christian religions
remained relatively
constant. The biggest
gain was seen in those
who practice no religion,
nearly doubling from 8 to
15 percent. Younger per-
sons, men, Asians, and
those living in the West
were most likely to say
they have a secular out-
look (see Figure 4.1).2
U.S. law now prohibits
the census from includ-
ing mandatory ques-
tions regarding religion.
Independent national
survey data often differ
from religious group
records regarding
membership.
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C H A P T E R 4 8 3
The cornerstone of the Jewish religion is
the Hebrew Bible, particularly the first five
books of the Bible, the Pentateuch, also known
as the books of Moses, or the Torah. It con-
sists of Genesis, Exodus, Leviticus, Numbers,
and Deuteronomy. The Torah chronicles the
beginnings of Judaism and contains the basic
laws that express the will of God to the Jews.
The Torah not only sets down the Ten Com-
mandments, but also describes the right way
to prepare food, give to charity, and conduct
one’s life in all ways. The interpretation of
the Torah and commentary on it are found
Western Religions
Judaism
The Jewish religion, estimated to be 4,000
years old, started when Abraham received
God’s earliest covenant with the Jews. Juda-
ism was originally a nation as well as a reli-
gion. However, after the destruction of its
capital, Jerusalem, and its main sanctuary, the
Temple of Solomon, by the Romans in 70 ce,
it had no homeland until the birth of Israel
in 1948.
During the Diaspora (the dispersion of
Jews outside the homeland of Israel), Jews
scattered and settled all over the ancient world.
Two sects of Judaism eventually developed:
the Ashkenazi, who prospered in Germany,
northern France, and the eastern European
countries; and the Sephardim (called M isr ah i
in Israel), originally from Spain, who now
inhabit most southern European and Middle
Eastern countries. Hasidic Jews are observant
Ashkenazi Jews who believe salvation is to
be found in joyous communion with God as
well as in the Bible. Hasidic men are evident in
larger U.S. cities by their dress, which includes
long black coats and black or fur-trimmed
hats (worn on Saturdays and holidays only),
and by their long beards with side curls.
Figure 4.1
Self-described
religious affiliation in
the United States by
percentage—2014.
Source: America’s Changing Religious
Landscape. Pew Research Center:
Religion and Public Life, May 12,
2015. Available: http://www
.pewforum.org/2015/05/12/
americas-changing-religious-
landscape/.
Hindu, 0.7%
Buddhist, 0.7%
Muslim, 0.4%
Jewish, 1.9%
No Religion, 22.8%
Catholic, 23.9%
Protestant, 51.3%
In the 2011 Canadian
census, 38.7 percent of
the population was iden-
tified as Roman Catholic,
and another 30 percent
was listed as Protestant.
It is estimated that there
are 1,053,945 Muslims
(3.2 percent of the popu-
lation), 550,700 Eastern
Orthodox Christians,
329,500 Jews, 366,800
Buddhists, 498,000
Hindus, and 455,000
Sikhs. Sixteen percent of
the population adheres
to no religion.
ADV BUD EOX HIN JEW MOR MUS RCABUD EOX HIN JEW MOR MUS RCA
Beef A X
Pork X A A XA X X
All meat A A R A R R R
Eggs/dairy O O R O RO O R O R
Fish A A R R R R
Shellfish X A O R XX A O R X
Alcohol X A X X
Coffee/tea X X AX A
Meat and dairy at the same meal X
Leavened foods R
Ritual slaughter of meats 1 1
Moderation 1 1 1 11 1
NOTE: ADV, Seventh-Day Adventist; BUD, Buddhist; EOX, Eastern Orthodox; HIN, Hindu; JEW, Jewish; MOR, Mormon; MUS, Muslim; RCA, Roman Catholic. X,
prohibited or strongly discouraged; A, avoided by most devout; R, some restrictions regarding types of foods or when foods are eaten observed by some adherents;
O, permitted, but may be avoided at some observances; 1, practiced.
TA B L E 4 .1 Common Religious Food Practices
©
C
en
ga
ge
L
ea
rn
in
g
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8 4 F O O D A N D R E L I G I O N
in the Talmud. The basic tenet of Judaism is
that there is only one God, and his will must
be obeyed. Jews do not believe in original
sin (that humans are born sinful) but rather
that all people can choose to act in a right or
wrong way. Sin is attributed to human weak-
ness. Humans can achieve, unaided, their own
redemption by asking for God’s absolution (if
they have sinned against God) or by asking
forgiveness of the person they sinned against.
The existence of the hereafter is recognized,
but the main concern in Judaism is with this
life and adherence to the laws of the Torah.
Many Jews belong to or attend a synagogue
(temple), which is led by a rabbi, who is a
scholar, teacher, and spiritual leader. In the
United States, congregations are usually clas-
sified as Orthodox, Conservative, or Reform,
although American Jews represent a spectrum
of beliefs and practices. The main division
among the three groups is their position on
the Jewish laws. Orthodox Jews believe that all
Jewish laws, as the direct commandments of
God, must be observed in all details. Reform
Jews do not believe that the ritual laws are
permanently binding but that the moral law is
valid. They believe that the laws are still being
interpreted and that some laws may be irrel-
evant or out of date, and they observe only
certain religious practices. Conservative Jews
hold the middle ground between Orthodox
and Reform beliefs.1
Immigration to the United States
In the early nineteenth century, Jews, primar-
ily from Germany, sought economic oppor-
tunities in the New World. By 1860, there
were approximately 280,000 Jews living in
the United States. Peak Jewish immigration
occurred around the turn of the century
(1880–1920); vast numbers of Jews moved
from eastern Europe because of poverty and
pogroms (organized massacres practiced by
the Russians against the Jews before World
War II).
During the Great Depression, Jews con-
tinued to immigrate into the United States,
primarily to escape from Nazi Germany.
Their numbers were few, however, because of
restrictions in the immigration quota system.
Today Jews continue to come to the United
States, especially from Russia. Some come
from Israel as well. The Jewish population
in the United States was 6.34 million adults
and children in 2014, according to data com-
piled from local federations; close to half of
U.S Jews live in the northeastern region of the
nation.2 Large populations are found in New
York, California, and Florida. Most Jews in
the United States are Ashkenazi: 10 percent
identify themselves as Orthodox, 34 percent
as Conservative, 29 percent as Reform, and
the rest are not affiliated with a specific
congregation.
Kashrut, the Jewish Dietary Laws
Some people in the United States believe that
Jewish food consists of dill pickles, bagels and
lox (smoked salmon), and chicken soup. In
actuality, the foods Jews eat reflect the regions
where their families originated. Because most
Jews in the United States are Ashkenazi, their
diet includes the foods of Germany and east-
ern Europe. Sephardic Jews tend to eat foods
similar to those of southern Europe and the
Middle Eastern countries, whereas Jews from
India prefer curries and other South Asian
foods. All Orthodox and many Conserva-
tive Jews follow the dietary laws, kashrut, that
were set down in the Torah and explained in
the Talmud.
K osh er or K osh er or K osh er k ash er means “fit” and is a popuk ash er means “fit” and is a popuk ash er –
lar term for Jewish dietary laws and permitted
food items. G l att kosher means that the strictG l att kosher means that the strictG l att –
est kosher standards are used in obtaining and
preparing the food. Kashrut is one of the pil-
lars of Jewish religious life and is concerned
with the fitness of food. Many health-related
explanations have been postulated about the
origins of the Jewish dietary restrictions; how-
ever, it is spiritual health, not physical health
or any other factor, that is the sole reason for
their observance. Jews who keep kosher are
expressing their sense of obligation to God,
to their fellow Jews, and to themselves. The
dietary laws governing the use of animal foods
can be classified into the following categories:
1. Which animals are permitted for
food and which are not: Any mammal
that has a completely cloven foot and
also chews the cud may be eaten, and
its milk may be drunk. Examples of
Since 2003, sales of
kosher foods have
increased by 68 percent.
More than 50 percent of
kosher food is purchased
by non-Jews, including
Muslims, Seventh-Day
Adventists, vegetarians,
and those with food
allergies, in part due
to their reputation for
safety and purity.26,40
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C H A P T E R 4 8 5
permitted, or clean, animals are cattle,
deer, goats, oxen, and sheep. Unclean
animals include swine, carnivorous ani-
mals, and rabbits. Clean birds must have
a crop, gizzard, and an extra talon, as
do chickens, ducks, geese, and turkeys.
Their eggs are also considered clean. All
birds of prey and their eggs are unclean
and cannot be eaten. Among fish, every-
thing that has fins and scales is permit-
ted; everything else is unclean. Examples
of unclean fish are catfish, eels, rays,
sharks, and all shellfish. As discussed
previously, Orthodox rabbis consider
sturgeon a prohibited food; Conserva-
tive authorities list it as kosher. Caviar,
which comes from sturgeon, is similarly
disputed.3 All reptiles, amphibians, and
invertebrates are also unclean.
2. Method of slaughtering animals: The
meat of permitted animals can be eaten
only if the life of the animal is taken by
a special process known as sh eh itah .
If an animal dies a natural death or is
killed by any other method, it may not
be eaten. The sh oh et (person who kills sh oh et (person who kills sh oh et
the animal) must be a Jew trained and
licensed to perform the killing, which
is done by slitting the neck with a sharp
knife, cutting the jugular vein and tra-
chea at the same time. This method,
which is quick and painless, also causes
most of the blood to be drained from
the carcass.4
3. Examination of the slaughtered animal:
After the animal is slaughtered, it is
examined by the shohet for any blem-
ishes in the meat or the organs that
would render the animal tr ef ah , mean-
ing unfit for consumption. Disease in
any part of the animal makes the whole
animal unfit to eat.
4. Forbidden parts of a permitted animal:
Two parts of the animal body are
prohibited. Blood from any animal is
strictly forbidden; even an egg with a
small bloodspot in the yolk must be
discarded. H el eb (fat that is not inter-
mingled with the flesh, forms a separate
solid layer that may be encrusted with
skin or membrane, and can easily be
peeled off ) is also proscribed. The pro-
hibition against heleb applies only to
four-footed animals.
5. The preparation of the meat: For
meat to be kosher, the heleb, blood,
blood vessels, and sciatic nerve must
be removed. Much of this work is now
done by the Jewish butcher, although
some Jewish homemakers still choose
to remove the blood. This is known as
koshering, or kashering, the meat. It
is accomplished in five steps: First, the
meat is soaked (within seventy-two
hours after slaughter) in tepid water
for thirty minutes; second, it is drained
on a slanted, perforated surface so that
the blood can drain easily; third, the
meat is covered with kosher salt for at
least one hour; fourth, the salt is rinsed
from the meat; and finally, the meat is
rinsed repeatedly to make sure all blood
and salt are removed.5 The liver cannot
be made kosher in the ordinary way
because it contains too much blood.
Instead, its surface must be cut across
or pierced several times, then it must be
rinsed in water, and finally it must be
broiled or grilled on an open flame until
it turns a grayish-white color.
6. The law of meat and milk: Meat
(f l eisc h ig(f l eisc h ig( ) and dairy (f l eisc h ig) and dairy (f l eisc h ig mil c h ig) products mil c h ig) products mil c h ig
may not be eaten together. It is gener-
ally accepted that after eating meat a
person must wait six hours before eating
any dairy products, although the period
between is a matter of custom, not law.4
Only one hour is necessary if dairy
products are consumed first. Many Jews
are lactose intolerant and do not drink
milk. However, other dairy items such as
cheese, sour cream, and yogurt are often
included in the diet (kosher cheese must
be made with rennet obtained from a
calf killed according to the Jewish laws
of slaughtering). Separate sets of dishes,
pots, and utensils for preparing and eat-
ing meat and dairy products are usually
maintained. Separate linens and wash-
ing implements are often employed.
Eggs, fruits, vegetables, and grains are
Most gelatin is obtained
from processed pig tis-
sues. Kosher, gelatin-like
products are available.
In 2002, the first kosher
food in outer space was
served to astronaut Ilan
Ramon on the space
shuttle Columbia.
Tevilah is the ritual puri-
fication of metal or glass
pots, dishes, and utensils
through immersion in
the running water of a
river or ocean. Chinese
porcelain and ceramic
items are exempt.
Because it is not known
how much salt remains
on the meat after rins-
ing, Orthodox Jews with
hypertension are often
advised to restrict their
meat consumption.
The prohibition of the
sciatic nerve is based
on the biblical story of
Jacob’s nighttime fight
with a mysterious being
who touched him on the
thigh, causing him to
limp. Because the nerve
is difficult to remove, the
entire hindquarter of the
animal is usually avoided.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
8 6 F O O D A N D R E L I G I O N
pareve, neither meat nor dairy, and can
be eaten with both. Olives are consid-
ered dairy foods, prohibited with meat,
if they are prepared using lactic acid.
7. Products of forbidden animals: The
only exception to the rule that products
of unclean animals are also unclean
is honey. Although bees are not fit for
consumption, honey is kosher because
it is believed that it does not contain any
parts from the insect.
8. Examination for insects and worms:
Because small insects and worms can
hide on fruits, vegetables, and grains,
these foods must be carefully washed
twice and examined before being eaten.
Kosher-certified prepackaged pro-
duce is available from some suppliers.
A processed food product (including
therapeutic dietary formulas) is consid-
ered kosher only if a reliable rabbinical
authority’s name or insignia appears on
the package. The most common insignia
is a K , permitted by the U.S. Food and K , permitted by the U.S. Food and K
Drug Administration (FDA), indicating
rabbinical supervision by the processing
company. Other registered symbols
include those found in Figure 4.2.
Religious Holidays
The Sabbath The Jewish Sabbath, the day of
rest, is observed from shortly before sundown
on Friday until after nightfall on Saturday.
Traditionally, the Sabbath is a day devoted
to prayer and rest, and no work is allowed.
All cooked meals must be prepared before
sundown on Friday because no fires can be
kindled on the Sabbath. Challah, a braided
bread, is commonly served with the Friday
night meal. In most Ashkenazi homes the
meal would traditionally contain fish or
chicken or cholent, a bean and potato dish
that can be prepared Friday afternoon and
left simmering until the evening meal on
Saturday. Kugel, a pudding, often made with
noodles, is a typical side dish.
Rosh Hashanah The Jewish religious year
begins with the New Year, or Rosh Hasha-
nah, which means “head of the year.” Rosh
Hashanah is also the beginning of a ten-day
period of penitence that ends with the Day
Figure 4.2
Examples of kosher food
symbols.
The Union of Orthodox Jewish Congregations
New York, New York
Orthodox Rabbinical Council of S. Florida
(Vaad Harabonim De Darom Florida)
Miami Beach, Florida
Vaad Horabonim of Massachusetts
Boston, Massachusetts
Vaad Hakashrus of the Orthodox Jewish
Council of Baltimore
Baltimore, Maryland
Vaad Hakashrus of Denver
Denver, Colorado
Vaad Harabonim of Greater Seattle
Seattle, Washington
Atlanta Kashruth Commission
Atlanta, Georgia
Kashruth Council Orthodox Division
Toronto Jewish Congress
Willowdale, Ontario, Canada
Montreal Vaad Hair
Montreal, Canada
Vancouver Kashruth
British Columbia, Canada
O.K. (Organized Kashrut) Laboratories
Brooklyn, New York
Kosher Supervision Service
Teaneck, New Jersey
Asian-American Kashrus Services
San Rafael, California
The Heart “K” Kehila Kosher
Los Angeles, California
Chicago Rabbinical Council
Chicago, Illinois
Orthodox Vaad of Philadelphia
Philadelphia, Pennsylvania
Vaad Harabonim of Greater Detroit and Merkaz
Southfield, Michigan
Vaad Hakahrus of Dallas, Inc.
Dallas, Texas
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C H A P T E R 4 8 7
of Atonement, Yom Kippur. Rosh Hashanah
occurs in September or October; as with all
Jewish holidays, the actual date varies from
year to year because the Jewish calendar is
based on lunar months counted according to
biblical custom and does not coincide with
the secular calendar. For this holiday, the chal-
lah is baked in a round shape that symbolizes
life without end and a year of uninterrupted
health and happiness. In some communities,
the challah is formed like a bird representing
God’s protection. Apples are dipped in honey,
and a special prayer is said for a sweet and
pleasant year. Some families traditionally con-
sume the head of a fish or of a sheep, with the
wish that God’s will for them is to be at the
head, not the tail, of any undertakings in
the upcoming year. Foods with Hebrew names
similar to other words may also be eaten, such
as beets (similar to r emov e and used to pray
that enemies be removed). On the second
night a new fruit, one that hasn’t been con-
sumed for a long period of time, is enjoyed
with a prayer for a year of plenty. Often, the
fruit is a pomegranate, which reputedly con-
tains 613 seeds, the same as the number of
commandments listed in the Torah. No sour
or bitter foods are served on this holiday, and
special sweets and delicacies, such as honey
cakes, are usually prepared.
Yom Kippur, the Day of Atonement Yom Kip-
pur falls ten days after Rosh Hashanah and is
the holiest day of the year. On this day, every
Jew atones for sins committed against God
and resolves to improve and once again fol-
low all the Jewish laws. Yom Kippur is a com-
plete fast day (no food or water; medications
are allowed) from sunset to sunset. Everyone
fasts, except boys under thirteen years old,
girls under twelve years old, persons who are
very ill, and women in childbirth. The meal
before Yom Kippur is usually bland to prevent
thirst during the fast. The meal that breaks the
fast is typically light, including dairy foods or
fish, fruits, and vegetables.
Sukkot, Feast of Tabernacles Sukkot is a fes-
tival of thanksgiving. It occurs in Septem-
ber or October and lasts one week. On the
last day, Simchat Torah, the reading of the
Torah (a portion is read every day of the year)
is completed for the year and started again.
This festival is very joyous, with much singing
and dancing. Orthodox families build a sukkah
(hut) in their yards and hang fruit and flowers
from the rafters, which are spaced far enough
apart so that the sky and stars are visible. Meals
are eaten in the sukkah during Sukkot.
Hanukkah, the Festival of Lights Hanukkah is
celebrated for eight days, usually during the
month of December, to commemorate the
recapture of the Temple in Jerusalem in 169 ce.
Families celebrate Hanukkah by lighting one
extra candle on the menorah (candelabra)
each night so that on the last night all eight
candles are lit. Traditionally, potato pancakes,
called latkes, are eaten during Hanukkah.
Other foods cooked in oil, such as doughnuts,
are sometimes eaten as well.
Purim Purim, a joyous celebration that takes
place in February or March, commemorates
the rescue of the Persian Jews from the villain-
ous Haman by Queen Esther. It is a mitzvah
(good deed) to eat an abundant meal in honor
of the deliverance. The feast should include
ample amounts of meat and alcoholic bever-
ages. Customarily, people dress in disguise for
the day to hide from Haman, to add surprise
to gift giving, or to hide from God in order
to overindulge in anonymity. A food closely
associated with Purim is h amantasc h en (liter-
ally, “Haman’s pockets,” but usually interpreted
to mean Haman’s ears clipped in the humilia-
tion of defeat). A hamantasch is a triangular-
shaped pastry filled with sweetened poppy
seeds or fruit jams made from prunes or apri-
cots. Another pastry associated with Purim is
kreplach (a triangular or heart-shaped savory
pastry stuffed with seasoned meat or cheese
and then boiled like ravioli). Purim challah
(a sweet bread with raisins) and fish cooked
for the holiday in vinegar, raisins, and spices
are often served. Seeds, beans, and cereals are
offered in remembrance of the restricted diet
eaten by the pious Queen Esther.
Passover Passover, called P esac h in Hebrew, is
the eight-day festival of spring and of freedom.
It occurs in March or April and celebrates the
In poor Ashkenazi
homes, gefilte (filled)
fish became popular on
the Sabbath. Similar to
the concept of meatloaf,
it is made by extending
the fish through pulver-
izing it with eggs, bread,
onion, sugar, salt, and
pepper, then stewing
the balls or patties with
more onions.
Two breads, or one
bread with a smaller one
braided on top, are usu-
ally served on Fridays,
the beginning of the
Sabbath, symbolic of the
double portion of manna
(nourishment) provided
by God to help sustain
the Israelites when they
wandered in the desert
for forty years after their
exodus from Egypt.
Ashkenazi Jews tradi-
tionally avoided pepper
during Passover because
it was sometimes mixed
with bread crumbs or
flour by spice traders.
In some Sephardic
homes, matzah is layered
with vegetables and
cheese or meat for the
Passover meal.
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8 8 F O O D A N D R E L I G I O N
anniversary of the Jewish exodus from Egypt.
The Passover seder, a ceremony carried out at
home, includes readings from the seder book,
the Haggadah, recounting the story of the exo-
dus, of the Jews’ redemption from slavery, and
of the God-given right of all humankind to
life and liberty. A festive meal is a part of the
seder; in the United States and Canada, the
menu usually includes chicken soup, matzo
balls, and meat or chicken. When Moses
led the Jews out of Egypt, they left in such
haste that there was no time for their bread
to rise. Today, matz ah , a white-flour cracker,
is the descendant of the unleavened bread or
bread of affliction. During the eight days of
Passover, no food that is subject to a leaven-
ing process or that has come in contact with
leavened foods can be eaten. The forbidden
foods are wheat, barley, rye, and oats. Wheat
flour can be eaten only in the form of mat-
zah or matzah meal, which is used to make
matzo balls. In addition, beans, peas, lentils,
maize, millet, and mustard are also avoided.
No leavening agents, malt liquors, or beers can
be used.
Because milk and meat cannot be mixed at
any time, observant Jewish families have two
sets of special dishes, utensils, and pots used
only for Passover. The entire house, especially
the kitchen, must be cleaned and any foods
subject to leavening removed before Passover.
It is customary for Orthodox Jews to sell their
leavened products and flours to a non-Jew
before Passover. It is very important that all
processed foods, including wine, be prepared
for Passover use and be marked “Kosher for
Passover.”
The seder table is set with the best silver-
ware and china and must include candles,
kosher wine, the Haggadah, three pieces of
matzot (the plural of matz ah ) covered sepa-
rately in the folds of a napkin or special Pass-
over cover, and a seder plate. The following
items go on the seder plate:
1. Z’roah. Z’roah is a roasted shank bone,
symbolic of the ancient paschal lamb in
Egypt, which was eaten roasted.
2. Beitzah. Beitzah is a roasted egg, repre-
senting the required offering brought to
the temple at festivals. Although the egg
itself was not sacrificed, it is used in the
seder as a symbol of mourning. In this
case, it is for the loss of the Temple in
Jerusalem.
3. Marror. Marror are bitter herbs, usu-
ally horseradish (although not an herb),
symbolic of the Jews’ bitter suffering
under slavery. The marror is usually
eaten between two small pieces of
matzot.
4. Haroset. Haroset is a mixture of
chopped apple, nuts, cinnamon, and
wine. Its appearance is a reminder of
the mortar used by the Jews to build the
palaces and pyramids of Egypt during
centuries of slavery. The haroset is also
eaten on a small piece of matzah.
5. Karpas. A green vegetable, such as
lettuce or parsley, is placed to the left of
the haroset, symbolic of the meager diet
of the Jews in bondage. It is dipped into
salt water in remembrance of the tears
shed during this time. It also symbolizes
springtime, the season of Passover.
6. A special cup, usually beautifully deco-
rated, is set on the seder table for Elijah,
the prophet who strove to restore purity
of divine worship and labored for social
justice. (Elijah is also believed to be a
messenger of God, whose task it will be
to announce the coming of the Messiah
and the consequent peace and divine
kingdom of righteousness on earth.)
▼ Typical seder meal.
iS
to
ck
ph
ot
o.
co
m
/J
od
i J
ac
ob
so
n
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C H A P T E R 4 8 9
Shavout, Season of the Giving of the Torah
The two-day festival of Shavout occurs seven
weeks after the second day of Passover and
commemorates the revelation of the Torah to
Moses on Mount Sinai. Traditional Ashkenazi
foods associated with the holiday include blin-
tzes (extremely thin pancakes rolled with a
meat or cheese filling, then topped with sour
cream), kreplach, and knishes (dough filled
with a potato, meat, cheese, or fruit mixture,
then baked).
Fast Days
There are several Jewish fast days in addi-
tion to Yom Kippur (see Table 4.2). On Yom
Kippur and on Tisha b’Av, the fast lasts from
sunset to sunset and no food or water can be
consumed. All other fast days are observed
from sunrise to sunset. Most Jews usually
fast on Yom Kippur, but other fast days are
observed only by Orthodox Jews. Extremely
pious Jews may add personal fast days on
Mondays and Thursdays.6 All fasts can be
broken if it is dangerous to a person’s health;
those who are pregnant or nursing are exempt
from fasting.
Additional information about Jewish
dietary laws and customs associated with
Jewish holidays can usually be obtained
from the rabbi at a local synagogue. The
Union of Orthodox Jewish Congregations of
America also publishes a directory of kosher
products.
Nutrition Status
Although Judism is a religion but in many
ways Jewish people are also considered an eth-
nic group. Few studies have been conducted
to determine the nutritional status of Jews but
certain physiological conditions and medical
disorders have been reported to have a higher
incidence in Jews. It is estimated that 60 per-
cent to 80 percent of Ashkenazi Jewish people
are lactose intolerant.7 Research has identi-
fied a genetic predisposition to inflammatory
bowel disease in Ashkenazi Jews (two to eight
times more common).8
Christianity
Throughout the world, more people follow
Christianity than any other single religion.
The three dominant Christian branches are
Roman Catholicism, Eastern Orthodox Chris-
tianity, and Protestantism. Christianity is
founded on recorded events surrounding the
life of Jesus—believed to be the Son of God
and the Messiah—chronicled in the New Tes-
tament of the Bible. The central convictions of
the Christian faith are found in the Apostles’
Creed and the Nicene Creed. These creeds
explain that people are saved through God’s
grace, through the life and death of Jesus, and
through his resurrection as Christ.
For most Christians, the sacraments mark
the key stages of worship and sustain the indi-
vidual worshiper. A sacrament is an outward
act derived from something Jesus did or said,
The Torah prohibits the
drinking of wine made
by non-Jews because it
might have been pro-
duced for the worship
of idols. Some Orthodox
Jews extend the prohibi-
tion to any grape prod-
uct, such as grape juice
or grape jelly.
Cottage cheese is asso-
ciated with Shavout
because the Israelites
were late in returning
home after receiving the
Ten Commandments and
the milk had curdled.
Many dishes served dur-
ing the holiday contain
cheese fillings.
Tzom Day after Rosh Hashanah In memory of Gedaliah, who ruled after the First
Temple was destroyed
Yom Kippur 10 days after Rosh Hashanah Day of Atonement
Tenth of Tevet
Seventeenth of Tamuz
December
July
Commemorate an assortment of national
calamities listed in the Talmud
Ta’anit Ester Eve of Purim In grateful memory of Queen Esther, who fasted
when seeking divine guidance
Ta’anit Bechorim Eve of Passover Gratitude to God for having spared only the
firstborn of Israel; usually only firstborn son fasts
Tisha b’Av August Commemorates the destruction of the First and
Second Temples in Jerusalem
TA B L E 4 . 2 Jewish Fast Days
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9 0 F O O D A N D R E L I G I O N
through which an individual receives God’s
grace. The sacraments observed, and the
way they are observed, vary among Chris-
tian groups. The seven sacraments of Roman
Catholicism, for example, are baptism (enter-
ing Christ’s church), confirmation (the soul
receiving the Holy Ghost), Eucharist (partak-
ing of the sacred presence by sharing bread
and wine), marriage (union of a man and
woman through the bond of love), unction
(healing of the mind, spirit, and body), rec-
onciliation (penance and confession), and
ordination of the clergy.
Roman Catholicism
The largest number of persons adhering to
one Christian faith in the United States are
Roman Catholics (approximately 66 million
in 2014).2,9 The head of the worldwide church
is the pope, considered infallible when defin-
ing faith and morals. The seven sacraments
are conferred on the faithful.10
Although some Roman Catholics immi-
grated to the United States during the colo-
nial period, substantial numbers came from
Germany, Poland, Italy, and Ireland in the
1800s and from Mexico and the Caribbean
in the twentieth and twenty-first centuries.
There are small groups of French Catholics
in New England (primarily in Maine) and
in Louisiana. In addition, most Filipinos and
some Vietnamese people living in the United
States are Catholics.
Feast Days Most Americans are familiar with
Christmas (the birth of Christ) and Easter (the
resurrection of Christ after the crucifixion).
Other Christian feast days celebrated in the
United States are New Year’s Day, the Annun-
ciation (March 25), Palm Sunday (the Sunday
before Easter), the Ascension (forty days after
Easter), Pentecost Sunday (fifty days after
Easter), the Assumption (August 15), All
Saints’ Day (November 1), and the Immacu-
late Conception (December 8).
Holiday fare depends on the family’s coun-
try of origin. For example, the French tradi-
tionally serve bû c h e de N oë l (a rich cake in
the shape of a Yule log) on Christmas for des-
sert, while the Italians may serve panettone,
a fruited sweet bread (see individual chapters
on each ethnic group for specific foods associ-
ated with holidays).
Fast Days Fasting permits only one full meal
per day at midday. It does not prohibit the tak-
ing of some food in the morning or evening;
however, local custom as to the quantity and
quality of this supplementary nourishment
varies. Abstinence forbids the use of meat,
but not of eggs, dairy products, or condi-
ments made of animal fat, and is practiced on
certain days and in conjunction with fasting.
Only Catholics older than the age of fourteen
and younger than the age of sixty are required
to observe the dietary laws.11
The fast days in the United States are all the
days of Lent, the Fridays of Advent, and the
Ember Days (the days that begin each season),
but only the most devout fast and abstain on
all of these dates. More common is fasting and
abstaining only on Ash Wednesday and Good
Friday. Before 1966, when the U.S. Catholic
Conference abolished most dietary restric-
tions, abstinence from meat was observed on
every Friday that did not fall on a feast day.
Abstinence is now encouraged on the Fridays
of Lent in remembrance of Christ’s sacrificial
death.
Some older Catholics and those from other
nations may observe the pre-1966 dietary
laws. In addition, Catholics are required to
avoid all food and liquids, except water, for
one hour before receiving communion.
Eastern Orthodox Christianity
The Eastern Orthodox Church is as old as
the Roman Catholic branch of Christianity,
although not as prevalent in the United States.
In the year 300 ce, there were two centers of
Christianity, one in Rome and the other in
Constantinople (now Istanbul, Turkey). Dif-Constantinople (now Istanbul, Turkey). Dif-Constantinople (now Istanbul, Turkey). Dif
ferences arose over theological interpreta-
tions of the Bible and the governing of the
church, and in 1054 the fellowship between
the Latin and Byzantine churches was finally
broken. Some of the differences between the
two churches concerned the interpretation
of the Trinity (the Father, the Son, and the
Holy Ghost), the use of unleavened bread for
the communion, the celibacy of the clergy,
and the position of the pope. In the Eastern
St. Valentine’s Day tradi-
tions may date back to
Lupercalia, a Roman festi-
val held in mid-February,
at which a young man
would draw the name of
a young woman out of a
box to be his sweetheart
for a day.
The commemoration of
the Last Supper is called
Corpus Christi, when
Jesus instructed his
disciples that bread was
his body and wine his
blood. In Spain and many
Latin American countries,
Corpus Christi is cel-
ebrated by parading the
bread (called the “Host”)
through streets covered
with flowers.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 4 9 1
services on Easter Sunday. Easter eggs in the
Eastern Orthodox religion range from the
highly ornate (eastern Europe and Russia) to
the solid reddish brown used by the Arme-
nians and red by the Greeks.
Fast Days In the Eastern Orthodox religion
there are numerous fast days (see Table 4.4).
Further, those receiving Holy Communion on
Sunday abstain from food and drink before
the service. Fasting is considered an opportu-
nity to prove that the soul can rule the body.
On fast days, no meat or animal products
(milk, eggs, butter, and cheese) are consumed.
Fish is also avoided, but shellfish is generally
allowed. Older or more devout Greek Ortho-
dox followers do not use olive oil on fast days,
but will eat olives.
Protestantism
The sixteenth-century religious movement
known as the Reformation established the
Protestant churches by questioning the prac-
tices of the Roman Catholic Church and
eventually breaking away from its teach-
ings. The man primarily responsible for the
Reformation was Martin Luther, a German
Augustinian monk who taught theology.14
He started the movement when, in 1517, he
nailed a document containing ninety-five
protests against certain Catholic practices on
the door of the castle church in Wittenberg,
Orthodox Church, leavened bread, called
phosphoron, is used for Communion, the
clergy are allowed to marry before entering
the priesthood, and the authority of the pope
of Rome is not recognized.
The Orthodox Church consists of four-
teen self-governing churches, five of which—
Constantinople, Alexandria (the Egyptian
Coptic Church), Antioch, Jerusalem, and
Cyprus—date back to the time of the
Byzantine Empire. Six other churches repre-
sent the nations where the majority of peo-
ple are Orthodox (Russia, Rumania, Serbia,
Bulgaria, Greece, and the former Soviet state
of Georgia). Three other churches exist inde-
pendently in countries where only a minority
practice the religion (Poland, Albania, and the
Sinai Monastery). Additionally, there are four
churches considered autonomous, but not
yet self-governing: Czech Republic/Slovakia,
Finland, China, and Japan.12 The Orthodox
Church in America was constituted in 1970.13
The beliefs of the Orthodox churches are sim-
ilar; only the language of the service differs.
The first Eastern Orthodox Church in
America was started by Russians on the
West Coast in the late 1700s. It is estimated
that nearly 3 million persons in the United
States are members of the Eastern Orthodox
religion, with the largest following (1.5 mil-
lion) being Greek.2 Most Eastern Orthodox
churches in the United States recognize the
patriarch of Constantinople as their spiri-
tual leader.
Feast Days All the feast days are listed in
Table 4.3. Easter is the most important holi-
day in the Eastern Orthodox religion and is
celebrated on the first Sunday after the full
moon after March 21, but not before the Jew-
ish Passover. Lent is preceded by a pre-Lenten
period lasting ten weeks before Easter or three
weeks before Lent. On the third Sunday before
Lent (Meat Fare Sunday), all the meat in the
house is eaten. On the Sunday before Lent
(Cheese Fare Sunday), all the cheese, eggs, and
butter in the house are eaten. On the next day,
Clean Monday, the Lenten fast begins. Fish is
allowed on Palm Sunday and on the Annun-
ciation Day of the Virgin Mary. The Lenten
fast is traditionally broken after the midnight
▲ Italian American
Catholics often serve panet-
tone, a sweet bread with
dried fruits, on feast days,
especially Christmas.
Br
az
ilP
ho
to
s/
Sh
ut
te
rs
to
ck
.c
om
Lent is the forty days
before Easter; the word
originally meant “spring.”
The last day before Lent
is a traditional festival of
exuberant feasting and
drinking in many regions
where Lenten fasting
is observed. In France
and in Louisiana, it is
known as Mardi Gras; in
Britain, Shrove Tuesday;
in Germany, Fastnacht;
and throughout the
Caribbean and in Brazil,
Carnival.
The Ethiopian Church is
an Orthodox denomi-
nation similar to the
Egyptian Coptic Church.
Timkat (Feast of the
Epiphany) is the most
significant Christian holi-
day of the year, celebrat-
ing the baptism of Jesus.
Beer brewing, bread
baking, and eating roast
lamb are traditional.
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9 2 F O O D A N D R E L I G I O N
Germany. A decade later, several countries
and German principalities organized the
Protestant Lutheran Church based on Martin
Luther’s teachings.
Luther placed great emphasis on the
individual’s direct responsibility to God. He
believed that every person can reach God
through direct prayer without the interces-
sion of a priest or saint; thus, every believer
is, in effect, a minister. Although everyone is
prone to sin and inherently wicked, a person
can be saved by faith in Christ, who by his
death on the cross atoned for the sins of all
people. Consequently, to Luther, faith was all-
important and good works alone could not
negate evil deeds. Luther’s theology removed
the priest’s mystical function, encourag-
ing everyone to read the Bible and interpret
the scriptures. The beliefs taught by Martin
Luther established the foundation of most
Protestant faiths.
Other reformers who followed Luther are
associated with specific denominations. In
the mid-sixth century, John Calvin devel-
oped the ideas that led to the formation of the
Presbyterian, Congregationalist, and Baptist
The red Easter egg
symbolizes the tomb of
Christ (the egg) and is
a sign of mourning (the
red color). The breaking
of the eggs on Easter
represents the opening
of the tomb and belief in
the resurrection.
Koljivo, boiled whole-
wheat kernels mixed
with nuts, dried fruit, and
sugar, must be offered
before the church altar
three, nine, and forty
days after the death of
a family member. After
the koljivo is blessed by
the priest, it is distributed
to the friends of the
deceased. The boiled
wheat represents ever-
lasting life, and the fruit
represents sweetness
and plenty.
Feast Day Date
Christmas Dec. 25 or Jan. 7
Theophany Jan. 6 or Jan. 19
Presentation of Our Lord into the Temple Feb. 2 or Feb. 15
Annunciation Mar. 25 or Apr. 7
Easter First Sunday after the full moon after Mar. 21
Ascension 40 days after Easter
Pentecost (Trinity) Sunday 50 days after Easter
Transfiguration Aug. 6 or Aug. 19
Dormition of the Holy Theotokos Aug. 15 or Aug. 28
Nativity of the Holy Theotokos Sept. 8 or Sept. 21
Presentation of the Holy Theotokos Nov. 21 or Dec. 4
NOTE: Dates depend on whether the Julian or Gregorian calendar is followed.
TA B L E 4 . 3 Eastern Orthodox Feast Days
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Fast Days
Every Wednesday and Friday except during fast-free weeks:
Week following Christmas until Eve of Theophany (12 days after Christmas)
Bright Week, week following Easter
Trinity Week, week following Trinity Sunday
Eve of Theophany (Jan. 6 or 18)
Beheading of John the Baptist (Aug. 29 or Sept. 27)
The Elevation of the Holy Cross (Sept. 14 or 27)
Fast Periods
Nativity Fast (Advent): Nov. 15 or 28 to Dec. 24 or Jan. 6
Great Lent and Holy Week: 7 weeks before Easter
Fast of the Apostles: May 23 or June 5 to June 16 or 29
Fast of the Dormition of the Holy Theotokos: Aug. 1 or 14 to Aug. 15 or 28
NOTE: Dates depend on whether the Julian or Gregorian calendar is followed.
TA B L E 4 . 4 Eastern Orthodox Fast Days and Periods
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C H A P T E R 4 9 3
churches; John Wesley founded the Method-
ist movement in the eighteenth century. Other
denominations in the United States include
Episcopalians (related to the English Angli-
can Church started under King Henry VIII);
Seventh-day Adventists; Jehovah’s Witnesses;
Disciples of Christ; Church of Jesus Christ
of Latter-Day Saints (Mormons); Church of
Christ, Scientist (Christian Scientists); and
Friends (Quakers).
The most significant food ordinance in
Protestant churches is the Eucharist, also
called Communion, or the Lord’s Supper.
However, other than a liquid and a conse-
crated breadlike morsel being offered, there
is little consistency in celebration of this ordi-
nance. It can signify an encounter with the
living presence of God, a remembrance of the
Passover seder attended by Jesus, a continuity
of tradition through community, or an indi-
vidual spiritual experience. Though wine is
traditional, many churches switched to grape
juice during Prohibition and continue this
temperance practice. Some churches offer the
wine or juice in a single cup that is shared,
while others provide small, individually filled
cups. Many liturgical churches, such as the
Lutheran Church, offer wafers similar to
Catholic practice. Others, such as Method-
ists, often use a bread pellet. Some organize
their members to bake bread (of any type),
and many denominations simply cut up white
bread of some sort.15 The primary holidays of
the Protestant calendar are Christmas and
Easter. The role of food is important in these
celebrations; however, the choice of items
served is even more varied than Communion
practices, determined by family ethnicity and
preference rather than religious rite. Fasting is
also uncommon in most Protestant denomi-
nations. Some churches or individuals may
use occasional fasting, however, to facilitate
prayer and worship. Only a few of the Prot-
estant denominations, such as the Mormons
and the Seventh-Day Adventists, have dietary
practices integral to their faith.
Mormons The Church of Jesus Christ of
Latter-Day Saints is a religion that emerged
in the United States during the early 1800s.
Its founder, Joseph Smith Jr., had a vision of
the Angel Moroni, who told him of golden
plates hidden in a hill and the means by which
to decipher them. The resulting Book of
Mormon was published in 1829, and in 1830
a new religious faith was born.
The Book of Mormon details the story of
two bands of Israelites who settled in America
and from whom certain Native Americans
and Pacific Islanders are descended.16 Christ
visited them after his resurrection, and they
thus preserved Christianity in its pure form.
The tribes did not survive, but the last mem-
ber, Moroni, hid the nation’s sacred writings,
compiled by his father, Mormon.
The Mormons believe that God reveals
himself and his will through his apostles and
prophets. The Mormon Church is organized
along biblical lines. Members of the priest-
hood are graded upward in six degrees (dea-
cons, teachers, priests, elders, seventies, and
high priests). From the priesthood are cho-
sen, by the church at large, a council of twelve
apostles, which constitutes a group of ruling
elders; from these, by seniority, a church presi-
dent rules with life tenure. There is no paid
clergy. Sunday services are held by groups of
Mormons, and selected church members give
the sermon.17
To escape local persecution, Brigham
Young led the people of the Mormon Church
to Utah in 1847. Today, Utah is more than 60
percent Mormon, and many western states
have significant numbers of church mem-
bers. In North America, the estimated total
number of adherents was 5 million in 2014.2
The main branch of the church is headquar-
tered in Salt Lake City, but a smaller branch,
the Reorganized Church of Jesus Christ of
Latter-Day Saints, is centered in Indepen-
dence, Missouri. All Mormons believe that
Independence will be the capital of the world
when Christ returns.
Joseph Smith, through a revelation, pre-
scribed the Mormon laws of health, dealing
particularly with dietary matters.16 These laws
prohibit the use of tobacco, strong drink, and
hot drinks. Strong drink is defined as alco-
holic beverages; hot drinks mean tea and cof-holic beverages; hot drinks mean tea and cof-holic beverages; hot drinks mean tea and cof
fee. Many Mormons do not use any product
that contains caffeine. Followers are advised
to eat meat sparingly, and to base their diets
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
9 4 F O O D A N D R E L I G I O N
on grains, especially wheat. In addition, all
Mormons are required to store a year’s sup-
ply of food and clothing for each person in
the family. Many also fast one day per month
(donating to the poor the money that would
have been spent on food).
Seventh-Day Adventists In the early 1800s,
many people believed that the Second Com-
ing of Christ was imminent. In the United
States, William Miller predicted that Christ
would return in 1843 or 1844. When both
years passed and the prediction did not mate-
rialize, many of his followers became disil-
lusioned. However, one group continued to
believe that the prediction was not wrong
but that the date was actually the beginning
of the world’s end preceding the coming of
Christ. They became known as the Seventh-
Day Adventists and were officially organized
in 1863.18
The spiritual guide for the new church
was Ellen G. Harmon, who later became
Mrs. James White. Her inspirations were the
result of more than 2,000 prophetic visions
and dreams she reportedly had during her
life. Mrs. White claimed to be not a prophet
but a conduit that relayed God’s desires and
admonitions to humankind.
There were over a million Seventh-Day
Adventists in the United States in 2010 and
18 million worldwide.2 Besides the main belief
in Christ’s advent, or Second Coming, the
Seventh-Day Adventists practice the principles
of Protestantism. They believe that the advent
will be preceded by a monstrous war, pesti-
lence, and plague, resulting in the destruction
of Satan and all wicked people; the earth will
be purified by holocaust. Although the hour of
Christ’s return is not known, they believe that
dedication to his work will hasten it.
The church adheres strictly to the teach-
ings of the Bible. The Sabbath is observed
from sundown on Friday to sundown on Sat-
urday and is wholly dedicated to the Lord.
Food must be prepared on Friday and dishes
washed on Sunday. Church members dress
simply, avoid ostentation, and wear only func-
tional jewelry. The church’s headquarters are
in Tacoma Park, Maryland, near Washington,
DC, where they were moved after a series of
fires ravaged the previous center in Battle
Creek, Michigan.
Each congregation is led by a pastor
(more a teacher than a minister), and all the
churches are under the leadership of the presi-
dent of the general conference of Seventh-Day
Adventists. Adventists follow the apostle Paul’s
teaching that the human body is the temple
of the Holy Spirit. Many of Mrs. White’s writ-
ings concern health and diet and have been
compiled into such books as T h e M inistr y of
H eal ing, C ounsel s on H eal th , and C ounsel s on
Diet and F oods.19,20,21
Adventists believe that sickness is a result
of the violation of the laws of health. One can
preserve health by eating the right kinds of
foods in moderation and by getting enough
rest and exercise. Overeating is discouraged.
Vegetarianism is widely practiced because
the Bible states that the diet in Eden did
not include flesh foods. Most Adventists are
lacto-ovo vegetarians (eating milk products
and eggs, but not meat). Some do consume
meat, although they avoid pork and shellfish.
Mrs. White advocated the use of nuts and
beans instead of meat, substituting vegetable
oil for animal fat, and using whole grains in
breads. Like the Mormons, the Adventists do
not consume tea, coffee, or alcohol and do
not use tobacco products. Water is considered
the best liquid and should be consumed only
before and after the meal, not during the meal.
Meals are not highly seasoned, and hot spices
such as mustard, chili powder, and black
pepper are avoided. Eating between meals
is discouraged so that food can be properly
digested. Mrs. White recommended that five
or six hours elapse between meals.
Islam
Islam is the second-largest religious group in
the world. Although not widely practiced in
the United States, Islam is the dominant reli-
gion in the Middle East, northern Africa, Pak-
istan, Indonesia, and Malaysia. Large numbers
of people also follow the religion in parts of
sub-Saharan Africa, India, Russia, the former
Soviet Union, and Southeast Asia.
Loma Linda Foods began
as a bakery in 1906
providing whole-wheat
bread and cookies to
the Adventist patients
and staff of Loma Linda
University Medical Center
in Southern California.
The American breakfast
cereal industry is the
result of the dietary and
health practices of the
Seventh-Day Adventists.
In 1886, Dr. John Kellogg
became director of the
Adventists’ sanitarium in
Battle Creek, Michigan,
and in his efforts to find a
tasty substitute for meat,
he invented Corn Flakes.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 4 9 5
Islam, which means “submission” (to the
will of God), is not only a religion but also
a way of life.22 One who adheres to Islam is
called a Muslim, “he who submits.” Islam’s
founder, Mohammed, was neither a savior nor
a messiah but rather a prophet through whom
God delivered his messages. He was born in
570 ce in Mecca, Saudi Arabia, a city located
along the spice trade route. Early in his life,
Mohammed acquired a respect for Jewish and
Christian monotheism. Later, the archangel
Gabriel appeared to him in many visions.
These revelations continued for a decade or
more, and the archangel told Mohammed that
he was a prophet of Allah, the one true God.
Mohammed’s teachings met with hostility
in Mecca, and in 622 he fled to Yathrib. The
year of the flight (hegira) is the first year in
the Muslim calendar. At Yathrib, later named
Medina, Mohammed became a religious
and political leader. Eight years after fleeing
Mecca, he returned triumphant and declared
Mecca a holy place to Allah.
The most sacred writings of Islam are found
in the Qur’an (sometimes spelled K or an or
Q ur an), believed to contain the words spoken
by Allah through Mohammed. It includes many
legends and traditions that parallel those of the
Old and New Testaments, as well as Arabian
folk tales. The Qur’an also contains the basic
laws of Islam, and its analysis and interpretation
by religious scholars have provided the guide-
lines by which Muslims lead their daily lives.
Muslims believe that the one true God,
Allah, is basically the God of Judaism and
Christianity but that his word was incom-
pletely expressed in the Old and New Testa-
ments and was only fulfilled in the Qur’an.
Similarly, they believe that Mohammed was
the last prophet, superseding Christ, who is
considered by Muslims a prophet and not
the Son of God. The primary doctrines of
Islam are monotheism and the concept of the
last judgment—the day of final resurrection
when all will be deemed worthy of either the
delights of heaven or the terrors of hell.
Mohammed did not institute an organized
priesthood or sacraments but instead advo-
cated the following ritualistic observances,
known as the Five Pillars of Islam:
1. Faith, shown by the proclamation of the
unity of God, and belief in that unity, as
expressed in the creed, “There is no God
but Allah; Mohammed is the Messenger
of Allah.”
2. Prayer, sal at, performed five times daily
(at dawn, noon, mid-afternoon, sunset,
and nightfall), facing Mecca, wherever
one may be; and on Fridays, the day of
public prayer, in the mosque (a building
used for public worship). On Fridays,
sermons are delivered in the mosque
after the noon prayer.
3. Almsgiving, z ak at, as an offering to the
poor and an act of piety. In some Islamic
countries, Muslims are expected to give
2.5 percent of their net savings or assets
in money or goods. The money is used
to help the poor or to support the reli-
gious organization in countries where
Islam is not the dominant religion. In
addition, zakat is given to the needy on
certain feast and fast days (see the next
section on dietary practices for more
details).
4. Fasting, to fulfill a religious obligation,
to earn the pleasure of Allah, to wipe
out previous sins, and to appreciate the
hunger of the poor and the needy.
5. Pilgrimage to Mecca, h adj , once in
a lifetime if means are available. No
non-Muslim can enter Mecca. Pilgrims
must wear seamless white garments; go
without head covering or shoes; practice
sexual continence; abstain from shav-
ing or having their hair cut; and avoid
harming any living thing, animal, or
vegetable.
There are no priests in Islam; every Muslim
can communicate directly with God, so a
mediator is not needed. The successors of
the prophet Mohammed and the leaders of
the Islamic community were the caliphes (or
k al if ah ). No caliphes exist today. A mufti, like
a lawyer, gives legal advice based on the sacred
laws of the Qur’an. An imam is the person
appointed to lead prayer in the mosque and
deliver the Friday sermon.
If one is unable to attend
a mosque, the prayers
are said on a prayer rug
facing Mecca.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
9 6 F O O D A N D R E L I G I O N
God; they follow the Qur’an and traditional
Muslim rituals in their temple services. The
movement was originally known as the
Nation of Islam and its adherents identified as
Black Muslims. A split in the Nation of Islam
resulted in one faction of Black Muslims
becoming an orthodox Islamic religion called
the World Community of Al-Islam in the
West. It is accepted as a branch of Islam. The
other Black Muslim faction has continued as
the Nation of Islam under the leadership of
Louis Farrakhan.
Halal, Islamic Dietary Laws
In Islam, eating is considered to be a matter of
worship. Muslims are expected to eat for sur-
vival and good health; self-indulgence is not
permitted. Muslims are advised against eating
more than two-thirds of their capacity, and
sharing food is recommended. Food is never
to be thrown away, wasted, or treated with
contempt. The hands and mouth are washed
before and after meals. If eating utensils are
not used, only the right hand is used for eat-
ing, as the left hand is considered unclean.
Permitted or lawful foods are called
halal. Allah alone has the right to determine
what may be eaten, and what is permitted is
sufficient—what is not permitted is unneces-
sary.26 Unless specifically prohibited, all food
is edible. Unlawful or prohibited (haram)
foods listed in the Qur’an include:
1. All swine, four-footed animals that
catch their prey with their mouths,
birds of prey that seize their prey with
their talons, and any by-products of
these animals, such as pork gelatin or
enzymes used in cheese making. If the
source of any by-product is in question,
it is avoided.
2. Improperly slaughtered animals (includ-
ing carrion). An animal must be killed
in a manner similar to that described
in the Jewish laws, by slitting the front
of the throat; cutting the jugular vein,
carotid artery, and windpipe; and allow-
ing the blood to drain completely. In
addition, the person who kills the ani-
mal must repeat at the instant of slaugh-
ter, “In the name of God, God is great.”
The following prominent sects in Islam
have their origin in conflicting theories on
the office of caliph (caliphate): (1) Sunni,
who form the largest number of Muslims and
hold that the caliphate is an elected office that
must be occupied by a member of the tribe of
Koreish, the tribe of Mohammed. (2) Shi’ia,
the second-largest group, who believe that
the caliphate was a God-given office held
rightfully by Ali, Mohammed’s son-in-law,
and his descendants. The Shiites (followers
of Shi’ia Islam) are found primarily in Iran,
Iraq, Yemen, and India. (3) The Khawarij,
who believe that the office of caliph is open to
any believer whom the faithful consider fit for
it. Followers of this sect are found primarily
in eastern Arabia and North Africa. (4) The
Sufis, ascetic mystics who seek a close union
with God now, rather than in the hereafter.
Only 3 percent of present-day Muslims are
Sufis, and many remain outside mainstream
Islam.23,24
It is estimated that nearly 2.9 million Mus-
lims live in the United States; many came
from the Middle East.2 Most are Sunnis, with
only a small percentage of Shiites, though
there is some crossover in worship and reli-
gious celebrations.25 In addition, some Afri-
can Americans believe Allah is the one true
The Kaaba, in Mecca, is
the holiest shrine of Islam
and contains the Black
Stone given to Abraham
and Ishmael by the arch-
angel Gabriel. During
the hadj, each pilgrim
touches the stone and
circles the shrine.
No one claiming title to
the office of caliphate
has been recognized by
all Muslim sects since
its abolition by the
Turkish government in
1924 following the fall
of the Ottoman Empire.
The role of the caliph-
ate in modern Islam is
uncertain.
The status of fish varies
by sect. Most Muslims
consider anything from
the sea halal; however,
some, such as Shiites, eat
only fish with scales.26
Islamic laws consider
eating to be a matter of
worship, and Muslims are
encouraged to share meals.
N
ig
el
B
ly
th
e/
Ce
ph
as
P
ic
tu
re
L
ib
ra
ry
/A
la
m
y
▲
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 4 9 7
A Muslim can eat or drink prohibited food
under certain conditions, such as when the
food is taken by mistake, when it is forced by
others, or there is fear of dying by hunger or
disease. The term for a food that is question-
ably halal or haram is mash booh , and when in
doubt, a Muslim is encouraged to avoid the
item. Foods that combine halal items with
haram items, such as baked goods made with
lard or pizza with bacon, ham, or pork sau-
sage topping, are also prohibited.28 Muslims
vary in their observance of the halal diet,
however, with the strictest adherence found
among the most orthodox believers.29 Foods
in compliance with Islamic dietary laws are
sometimes marked with symbols registered
with the Islamic Food and Nutrition Council
of America (IFNCA) (Figure 4.3), signifying
the food is fit for consumption by Muslims
anywhere in the world.30
Fish and seafood are exempt from this
requirement.
Some Muslims believe that a Jew or a
Christian can slaughter an animal to
be consumed by Muslims as long as it
is done properly. Others will eat only
kosher meat, while some abstain from
meat altogether unless they know it is
properly slaughtered by a Muslim or can
arrange to kill the animal themselves.
Meat of animals slaughtered by people
other than Muslims, Jews, or Christians
is prohibited. Meat from an animal
that was slaughtered when any name
besides God’s was mentioned is also
prohibited.27
3. Blood and blood products.
4. Alcoholic beverages and intoxicating
drugs, unless medically necessary. Even
foods that have fermented accidentally
are avoided. The drinking of stimulants,
such as coffee and tea, is discouraged, as
is smoking; however, these prohibitions
are practiced only by the most devout
Muslims.
Figure 4.3
Examples of halal food
symbols.
© Cengage Learning
CERTIFIED
HALAL
ISLAMIC FOOD AND NUTRITION
COUNCIL OF AMERICA
MM
My name is Hafsabibi Mojy and I was a student at San Jose State Univer-
sity. I work as a dietitian in a local medical
center. Although I immigrated from India to
the United States in 1994, I am an observant
Muslim, especially when it comes to Islamic
food laws. I will shop at special stores in
order to buy halal meats, which for me
include beef, goat, chicken, veal, and turkey
and are more expensive than meat from the
supermarket. Most Americans I have met do
not know what halal means, and they often
think I am a vegetarian, probably because
I come from India. It is common for me to
call myself a “meat-eating vegetarian” as
I only eat meat at home or places where
halal is available, but otherwise I call myself
vegetarian when I am at places where halal
food is not available.
I do fast from sunrise to sunset during
Ramadan. It is not hard, but it takes a few
days in the beginning to get back to the
rhythm of fasting. To me, personally, I get
thirsty more than hungry. My favorite Islamic
holiday is Eid Al-Adha or Feast of Sacrifice.
It is the most important feast of the Muslim
calendar and lasts for three days. It concludes
the Pilgrimmage to Mecca. The feast reenacts
prophet Ibrahim’s obedience to God by sac-
rificing a cow or ram. The family eats about
a third of the meal and donates the rest to
the poor. My favorite foods include all Indian
meat curry dishes, Biryani (spicy rice pilaf
with meat or chicken), and kabobs.
Health care that includes dietary
modifications may interfere with Islamic
food laws. Say, for example, a patient is on
a clear liquid diet at a hospital . . . there will
be very few choices left to give to a Muslim
patient as Jell-O will be excluded (Jell-O,
considered a clear liquid because it is liquid
at body temperature, contains gelatin which
is usually derived from animals and hence
will be a non-halal item). Some “vegetarian”
dishes contain a chicken-broth base and
hence will be considered non-halal. Even a
vegetarian burger can have wine in it and
will be considered non-halal as all alcohol
products are also prohibited under Islamic
food laws.
N E W A M E R I C A N P E R S P E C T I V E S
Islam
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9 8 F O O D A N D R E L I G I O N
Feast Days
The following are the feast days in the Islamic
religion:
1. Eid al-Fitr, the Feast of Fast Breaking—
the end of Ramadan is celebrated by a
feast and the giving of alms.
2. Eid al-Azha, the Festival of Sacrifice—
the commemoration of Abraham’s will-
ingness to sacrifice his son, Ishmael, for
God. It is customary to sacrifice a sheep
and distribute its meat to friends, rela-
tives, and the needy.
3. Shab-i-Barat, the night in the middle
of Shaban—originally a fast day, this
is now a feast day celebrated mostly in
non-Arab nations, often marked with
fireworks. It is believed that God deter-
mines the actions of every person for
the next year on this night.
4. Nau-Roz, New Year’s Day—primarily
celebrated by the Iranians, it is the first
day after the sun crosses the vernal
equinox.
5. Maulud n’Nabi—the birthday of
Mohammed.
Feasting also occurs at birth, after the con-
summation of marriage, at Bismillah (when a
child first starts reading the Qur’anic alpha-
bet), after circumcision of boys, at the harvest,
and at death.
Fast Days
On fast days, Muslims abstain from food,
drink, smoking, and coitus from dawn to sun-
set. Food can be eaten before the sun comes
up and again after it sets. Fasting is required
of Muslims during Ramadan, the ninth month
of the Islamic calendar. It is believed that dur-
ing Ramadan, “the gates of Heaven are open,
the gates of Hell closed, and the devil put in
chains.” At sunset, the fast is usually broken by
taking a liquid, typically water, along with an
odd number of dates.
All Muslims past the age of puberty (fif-All Muslims past the age of puberty (fif-All Muslims past the age of puberty (fif
teen years old) fast during Ramadan. A num-
ber of groups are exempt from fasting, but
most must make up the days before the next
Ramadan. They include sick individuals with
a recoverable illness; people who are traveling;
women during pregnancy, lactation, or men-
struation; elders who are physically unable to
fast; people who are mentally disabled; and
those engaged in hard labor. During Rama-
dan, it is customary to invite guests to break
the fast and dine in the evening; special foods
are eaten, especially sweets. Food is often
given to neighbors, relatives, and needy indi-
viduals or families.
Muslims are also encouraged to fast six
days during Shawwal, the month follow-
ing Ramadan; the tenth day of the month of
Muhurram; and the ninth day of Zul Hijjah,
but not during the pilgrimage to Mecca.
A Muslim may fast voluntarily, preferably on
Mondays and Thursdays. Muslims are not
allowed to fast on two festival days: Eid al-Fitr
and Eid al-Azha; or on the days of sacrificial
slaughter: Tashriq—the twelfth, thirteenth,
and fourteenth days of Dhu-al-Hijjah. It is
also undesirable for Muslims to fast exces-
sively (because Allah provides food and drink
to consume) or to fast on Fridays.
Eastern Religions
Hinduism
Hinduism is considered the world’s oldest
religion, and, like Judaism, it is the basis of
other religions such as Buddhism. Although
Hinduism was once popular throughout
much of Asia, most Hindus now live in India,
its birthplace. The common Hindu scriptures
are the Vedas, the Epics, and the Bhagavata
Purana. The Vedas form the supreme author-
ity for Hinduism. There are four Vedas: the
Rigveda, the Samaveda, the Yajurveda, and
the Aatharvaveda.
The goal of Hinduism is not to make
humans perfect beings or life a heaven on
earth but rather to make humans one with the
Universal Spirit or Supreme Being. When this
state is achieved, there is no cause and effect,
no time and space, no good and evil; all duali-
ties are merged into oneness. This goal can-
not be reached by being a good person, but
it can be obtained by transforming human
consciousness or liberation, mok sh a, into a
new realm of divine consciousness that sees
individual parts of the universe as deriving
Some devout Muslims
also avoid land animals
without external ears,
such as snakes and
lizards.
The month of Ramadan
can fall during any part
of the year. The Muslim
calendar is lunar but
does not have a leap
month; thus, the months
occur at different times
each solar year.
Women who wish to
undertake voluntary fasts
must seek permission
from their husbands.
In 2006, a French
humanitarian group
was accused of racism
when it deliberately
served “identity soup”
made with pork parts
to Muslims in need in
the country.
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C H A P T E R 4 9 9
their true significance from the central unity
of spirit. The transformation of human con-
sciousness into divine consciousness is not
achieved in one lifetime, and Hindus believe
that the present life is only one in a series
of lives, or reincarnations. Hindus believe
in the law of rebirth, which postulates that
every person passes through a series of lives
before obtaining liberation; the law of karma,
that one’s present life is the result of what one
thought or did in one’s past life. In each new
incarnation, an individual’s soul moves up or
down the spiritual ladder; the goal for all souls
is liberation.
Meat Prohibitions
Scientists have calculated that animal protein comprised over 50 percent of
the total daily calories consumed by pre-
historic peoples, a far higher amount than
what most Americans eat today.41 Further, it
is believed that only 1 percent of the world
population refuses to eat all types of meat,
poultry, and fish and that total vegans, who
avoid all animal products, equal only one-
tenth of 1 percent. Humans favor protein
foods. Nevertheless, many cultures impose
some restrictions on what meats may be
consumed, mostly in accordance with pre-
vailing religious dietary laws. The devout
of each faith see little reason to ask why a
particular food is prohibited. It is considered
presumptuous or sacrilegious for humans to
question the directives of God or church.
This has not deterred researchers from
speculating on the rationale of meat taboos.
Some have investigated the whole field of
taxonomy and how animals are classified as
different or unnatural, thus abominable due
to their physical characteristics. The Jew-
ish prohibition against pork, for example,
seems to be because pigs do not chew their
cud, marking them as dissimilar from other
animals with cloven hooves.42 This theory
is supported by the omnivore’s paradox and
the psychological need for food familiarity.
Others have focused on the use of the term
unclean in relation to biblical and Qur’anic
pork prohibitions, claiming that pork con-
sumption is unhealthful. Many researchers
discard this theory because it is thought that
ancient populations could not have made
the association between eating pork and
the slow development of diseases, such as
trichinosis, not to mention that other animals
that carry fatal illnesses (e.g., spongiform
encephalitis or mad-cow disease) are not
avoided.
The socioecological theory for why
certain meats are avoided suggests that if
an animal is more valuable alive than dead
or, conversely, if it does not fit well into the
local ecology or economy, consumption will
be prohibited.43 Religious dietary codes often
reinforce preexisting food practices and prej-
udices. When reviewing the history of pork in
the Middle East, for example, archeological
records show it was part of the ancient diet.
But by 1900 BCE, pork had become unpopular
in Babylonia, Egypt, and Phoenicia, coin-
ciding with an expanding population and
deforestation of the region. Pigs compete
with humans for food sources. Additionally,
they do not thrive in hot, dry climates. Cows,
goats, and sheep, on the other hand, can
graze over large areas and survive on the
cellulose in plants unavailable to human
metabolism. And they need no protection
from the sun. The nomadic Hebrews were
unlikely to have herded pigs in their early
history, and by the time they settled there
was a broad aversion to pigs by many Middle
Easterners. The first followers of Mohammed
were also pastoral people, which may explain
why the only explicitly prohibited animal
flesh in Islam is pork.
The socioeconomic theory is useful in
examining other meat prohibitions. In India,
where beef is banned for Hindus, cattle are
the primary power source in rural farming
communities due to the expense of tractors.
Further, cattle provide dung that is dried to
produce a clean, slow-burning cooking fuel,
and cows provide milk for the dairy products
important in some vegetarian fare. Even dead
cows serve a purpose, providing the very poor
with scavenged meat to eat and skins to craft
leather products. The value of cattle in India
is reinforced by religious custom. Horsemeat
in Europe is a different example. Though
horse consumption was frequent in early
Europe, other cultures who used the animals
for travel and cavalry often banned it. Asian
nomads who roamed on horseback consumed
horse milk and blood but ate the flesh only in
emergencies. It was avoided by the Romans
and most Middle Easterners (prohibited for
Jews and by custom among Muslims). During
the eighth century, when European Christian
strongholds came under attack from Muslim
cavalry in the south and mounted nomads
from the west, Pope Gregory III recognized
the need for horses in the defense of the
church. He prohibited horsemeat as “unclean
and detestable.” However, horse consumption
was never entirely eliminated, especially dur-
ing times of hardship, and gradually religious
restrictions were eased. By the nineteenth
century, horsemeat had regained favor,
especially in France and Belgium, where it is a
specialty item today. Despite the initial need
for horsepower, the religious prohibition was
unsustainable over time because it contra-
dicted prevailing food traditions.
C U L T U R A L C O N T R O V E R S Y
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1 0 0 F O O D A N D R E L I G I O N
There is one Supreme Being, Brahman,
and all the various gods worshiped by men are
partial manifestations of him. Hindus choose
the form of the Supreme Being that satisfies
their spirit and make it an object of love and
adoration. This aspect of worship makes Hin-
duism very tolerant of other gods and their
followers; many different religions have been
absorbed into Hinduism.
The three most important functions of
the Supreme Being are the creation, protec-
tion, and destruction of the world, and these
functions have become personified as three
great gods: Brahma, Vishnu, and Siva (the
Hindu triad or trinity). The Supreme Being as
Vishnu is the protector of the world. Vishnu
is also an avatara, meaning he can take on
human forms whenever the world is threat-
ened by evil. Rama and Krishna are regarded
as two such embodiments and are also objects
of worship.
Hindus believe that the world passes
through repeating cycles; the most common
version of the creation is connected to the
life of Vishnu. From Vishnu’s navel grows a
lotus, and from its unfolding petals is born the
god Brahma, who creates the world. Vishnu
governs the world until he sleeps; then Siva
destroys it, and the world is absorbed into
Vishnu’s body to be created once again.
The principles of Hinduism are purity,
self-control, detachment, truth, and nonvio-
lence. Purity is both a ceremonial goal and a
moral ideal. All rituals for purification and
the elaborate rules regarding food and drink
are meant to lead to purity of mind and spirit.
Self-control governs both the flesh and the
mind.
Hinduism does not teach its followers to
suppress the flesh completely but rather to
regulate its appetites and cravings. The high-
est aspect of self-control is detachment. Com-
plete liberation from this world and union
with the divine are not possible if one clings
to the good or evil of this existence. Pursuit
of truth is indispensable to the progress of
humans, and truth is always associated with
nonviolence, ahimsa. These principles are
considered the highest virtues. India’s great-
est exponent of this ideal was Mahatma
Gandhi, who taught that nonviolence must
be practiced not only by individuals, but also
by communities and nations.
One common belief of Hinduism is that
the world evolved in successive stages, begin-
ning with matter and going on through life,
consciousness, and intelligence to spiritual
bliss or perfection. Spirit first appears as life
in plants, then as consciousness in animals,
intelligence in humans, and finally bliss in
the supreme spirit. A good person is closer
to the supreme spirit than a bad person is,
and a person is closer than an animal. Truth,
beauty, love, and righteousness are of higher
importance than intellectual values (e.g., clar-
ity, cogency, subtlety, skill) or biological val-
ues (e.g., health, strength, vitality). Material
values (e.g., riches, possessions, pleasure) are
valued least.
The organization of society grows from the
principle of spiritual progression. The Hindu
lawgivers tried to construct an ideal society
in which people are ranked by their spiritual
progress and culture, not according to their
wealth or power. The social system reflects
this ideal, which is represented by four estates,
or castes, associated originally with certain
occupations. The four castes are the Brahmins
(teachers and priests), the Kshatriyas (sol-
diers), the Vaisyas (merchants and farmers),
and the Sundras (laborers). Existing outside
social recognition are the dal its, or untouch-
ables (e.g., butchers, leather workers), a group
of persons who do not fall into the other four
categories; although this designation was out-
lawed by the Indian government in 1950, it
is estimated that untouchables still constitute
almost 14.4 percent of the population.31
The four castes are represented as forming
parts of the Creator’s body: respectively, his
mouth, arms, thighs, and feet. The untouch-
ables were supposedly created from dark-
ness that Brahma discarded in the process
of creation. The castes also conform to the
law of spiritual progression, in that the most
spiritual caste occupies the top and the least
spiritual the bottom. The Hindus believe that
nature has three fundamental qualities: purity,
energy, and inertia. Those in whom purity
predominates form the first caste, energy
the second caste, and inertia the third and
fourth castes. Each caste should perform its
The Seven Social Sins
according to Gandhi are
politics without prin-
ciple; wealth without
work; pleasure without
conscience; knowledge
without character; com-
merce without morality;
science without human-
ity; and worship without
sacrifice.44
Ganesh got his elephant
head when he angered
his father, Siva, who
cut off his human
head. When his mother
pleaded with Siva to
replace his head, Siva
used the head of a
nearby elephant. Hindus
honor Ganesh through
offerings of the foods
he favored.
Yoga means “yoke,”
as in yoking together
or union.
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C H A P T E R 4 1 0 1
own duties, follow its hereditary occupation,
and cooperate with the others for the com-
mon welfare. People’s good actions in this life
earn them promotion to a higher caste in the
next life.
There are thousands of subdivisions of the
four main castes. The subcastes often reflect a
trade or profession, but some scholars contend
that the latter was imposed on the former. In
reality, the subcaste is very important to daily
life, whereas what major caste one belongs to
makes little difference to non-Brahmins (see
Chapter 14, “South Asians”). The ideal life of
a Hindu is divided into four successive stages,
called asramas. The first stage is that of the
student and is devoted entirely to study and
discipline. The guru becomes an individual’s
spiritual parent. After this period of prepara-
tion, the student should settle down and serve
his or her marriage, community, and country.
When this active period of citizenship is over,
he or she should retire to a quiet place in the
country and meditate on the higher aspects of
the spirit (become a recluse). The recluse then
becomes a sannyasi, one who has renounced
all earthly possessions and ties. This stage
is the crown of human life. The goals of life
are dharma (righteousness), ar th a (worldly
prosperity), k ama (enjoyment), and mok sh a
(liberation). The ultimate aim of life is libera-
tion, but on their way to this final goal people
must satisfy the animal wants of their bodies,
as well as the economic and other demands
of their families and communities. However,
all should be done within the moral law of
dharma. Adherence to dharma reflects a
unique aspect of Hinduism, namely, that prac-
tice is more important than belief. There are
no creeds in Hinduism; it is the performance
of duties associated with one’s caste or social
position that make a person a Hindu.32
Common practices in Hinduism include
rituals and forms of mental discipline. All
Hindus are advised to choose a deity on
whose form, features, and qualities they can
concentrate their mind and whose image
they can worship every day with flowers and
incense. The deity is only a means of realiz-
ing the Supreme Being by means of ritualistic
worship. Externally, the deity is worshiped
as a king or honored guest. Internal worship
consists of prayer and meditation. Mental dis-
cipline is indicated by the word y oga. Along
with mental discipline, yoga has come to mean
a method of restraining the functions of the
mind and their physiological consequences.
Hindus can be divided into three broad
sects according to their view of the Supreme
Being. They are the Vaishnava, the Saiva, and
the Sakta, who maintain the supremacy of
Vishnu, Siva, and the Sakti (the female and
active aspects of Siva), respectively. Different
sects are popular in different regions of India.
Many Hindus do not worship one God exclu-
sively. Vishnu may be worshiped in one of his
full embodiments (Krishna or Rama) or par-
tial embodiments. In addition, there are hun-
dreds of lesser deities, much like saints. One is
Siva’s son, the elephant-headed Ganesh, who
is believed to bring good luck and remove
obstacles.
It is estimated that in 2014 there are nearly
2.2 million Hindus in the United States.2 This
number was based on the U.S. Census of
South Asian Indians, but it was adjusted by
the percentage of the Hindu population in
India.33 It was assumed that the percentage of
Hindus in the United States would be similar
to that found in India. A small percentage of
non–Indian Americans have become follow-
ers of the Hindu religion. The International
Society for Krishna Consciousness, founded
in 1966 by devotees of a sixteenth-century
Bengali ascetic, has the largest number of
converts.
Hindu Dietary Practices
In general, Hindus avoid foods believed to
hamper the development of the body or men-
tal abilities. Bad food habits will prevent one
from reaching mental purity and communion
with God. Dietary restrictions and attitudes
vary among the castes.
The Laws of Manu (dating from the fourth
century ce) state that “no sin is attached to
eating flesh or drinking wine, or gratify-
ing the sexual urge, for these are the natural
propensities of men; but abstinence from
these bears greater fruits.” Many Hindus are
vegetarians.34,35 They adhere to the concept of
ahimsa, avoiding inflicting pain on an animal
by not eating meat. Although the consumption
Some Hindu worshipers
break coconuts on the
temple grounds to sym-
bolize the spiritual expe-
rience. The hard shell
is a metaphor for the
human ego, and once it
is cracked open, the soft,
sweet meat representing
the inner self is open to
becoming one with the
Supreme Being.45
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1 0 2 F O O D A N D R E L I G I O N
free from pollution; to become pure is to
remove pollution. Certain substances are con-
sidered both pure in themselves and purifying
in their application. These include the prod-
ucts of the living cow—milk products, dung,
and urine—and water from sources of special
sanctity, such as the Ganges River. Pure and
purifying substances also include materials
commonly employed in rituals, such as tur-
meric and sandalwood paste. All body prod-
ucts (e.g., feces, urine, saliva, menstrual flow,
and afterbirth) are polluting. Use of water is
the most common method of purification
because water easily absorbs pollution and
carries it away.
Feast Days
The Hindu calendar marks eighteen major
festivals every year. Additional important
feast days are those of marriages, births, and
deaths. Each region of India observes its own
special festivals; it has been said that there is
a celebration going on somewhere in India
every day of the year. All members of the
community eat generously on festive occa-
sions, and these may be the only days that
very poor people eat adequately. Feasting is
a way of sharing food among the population
because the wealthy are responsible for help-
ing the poor celebrate the holidays.
One of the gayest and most colorful of the
Hindu festivals is Holi, the spring equinox and
the celebration of one of Krishna’s triumphs.
According to legend, Krishna had an evil
uncle who sent an ogress named Holika to
burn down Krishna’s house. Instead, Krishna
escaped and Holika burned in the blaze. It is
traditional for Indians to throw colored water
or powder at passersby during this holiday.
The ten-day celebration of Dusshera in late
September or early October commemorates
the victory of Prince Rama (one of Vishnu’s
embodiments) over the army of the demon
Ravana. It is also a grateful tribute to the god-
dess Durga, who aided Rama. The first nine
days are spent in worshiping the deity, and the
tenth day is spent celebrating Rama’s victory.
Divali, celebrated throughout India in
November, marks the darkest night of the
year, when souls return to earth and must be
shown the way by the lights in the houses. For
of meat is allowed, the cow is considered
sacred and is not to be killed or eaten. If meat
is eaten, pork as well as beef is usually avoided.
Crabs, snails, crocodiles, numerous birds (e.g.,
crows, doves, domesticated fowl, ducks, fla-
mingos, parrots, vultures, and woodpeckers),
antelopes, camels, boars, bats, porpoises, and
fish with ugly forms ( ) should also
be rejected. In addition, the laws make many
other recommendations regarding foods that
should be avoided, including foods prepared
by certain groups of people (e.g., actors, art-
ists, carpenters, cobblers, doctors, eunuchs,
innkeepers, musicians, prostitutes, liars, spies,
and thieves); foods that have been contami-
nated by a person sneezing or through contact
with a human foot, clothing, animals, or birds;
milk from an animal that has recently given
birth; and water from the bottom of a boat.
No fish or meat should be eaten until it has
been sanctified by the repetition of mantras
offering it to the gods. Pious Hindus may also
abstain from alcoholic beverages. Garlic, tur-
nips, onions, leeks, mushrooms, and red-hued
foods, such as tomatoes and red lentils, may
be avoided. Despite such lengthy prohibitions,
Hindus exert considerable personal discretion
regarding taboo foods.36
Intertwined in Hindu food customs is the
concept of purity and pollution. Complex
rules regarding food and drink are meant to
lead to purity of mind and spirit. Pollution is
the opposite of purity and should be avoided
or ameliorated. To remain pure is to remain
Hindus are encouraged
to practice moderation—
they are advised not to
eat too early, not to eat
too late, and not to eat
too much.
According to legend,
Vishnu rested on a
1,000-headed cobra
between the creation
and destruction of the
world. During the festivi-
ties of Naga Panchami,
snakes are venerated at
Hindu temples, and milk
is offered to cobras to
prevent snakebite.
Students studying the
Vedas and other celibates
are usually vegetarians
and may restrict irritating
or exciting foods, such
as honey.
▼ The numerous religious
holidays and secular events
celebrated in India include
feasting, which serves to
distribute food throughout
the community.
U
ni
te
d
N
at
io
ns
/J
. I
sa
ac
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C H A P T E R 4 1 0 3
many, Divali is also the beginning of the new
year, when everyone should buy new clothes,
settle old debts and quarrels, and wish every-
one else good fortune.
Fast Days
In India, fasting practices vary according to
one’s caste, family, age, sex, and degree of
orthodoxy. A devoutly religious person may
fast more often and more strictly than one
who is less religious. Fasting may mean eating
no food at all or abstaining from only specific
foods or meals. The fast days in the Hindu cal-
endar include the first day of the new and full
moon of each lunar month; the tenth and elev-
enth days of each month; the feast of Sivaratri;
the ninth day of the lunar month Cheitra; the
eighth day of Sravana; days of eclipses, equi-
noxes, solstices, and conjunctions of planets;
the anniversary of the death of one’s father or
mother; and Sundays.
Buddhism
Siddhartha Gautama, who later became
known as Buddha (the Enlightened One),
founded the Eastern religion of Buddhism
in India in the sixth century bce. Buddhism
flourished in India until 500 ce, when it
declined and gradually became absorbed into
Hinduism. Meanwhile, it had spread through-
out southeastern and central Asia. Buddhism
remains a vital religion in many Asian coun-
tries, where it has been adapted to local needs
and traditions.
Buddhism was a protestant revolt against
orthodox Hinduism, but it accepted certain
Hindu concepts, such as the idea that all liv-
ing beings go through countless cycles of
death and rebirth, the doctrine of karma,
spiritual liberation from the flesh, and that
the path to wisdom includes taming the
appetites and passions of the body. Bud-
dha disagreed with the Hindus about the
methods by which these objectives were to
be achieved. He advocated the Middle Way
between asceticism and self-indulgence,
stating that both extremes in life should be
avoided. He also disagreed with the Hindus
on caste distinctions, believing that all per-
sons were equal in spiritual potential.
The basic teachings of Buddha are found in
the Four Noble Truths and the Noble Eight-
fold Path.37 The Four Noble Truths are as
follows:
1. Duk k h a—The Noble Truth of Suffer-
ing: Suffering is part of living. Persons
suffer when they experience birth, old
age, sickness, and death. They also suf-
fer when they fail to obtain what they
want. At a deeper level, dukkha embod-
ies other concepts, such as imperfection,
emptiness, and impermanence.
2. S amuday a—The Noble Truth of the
Cause of Suffering: This is the arising of
dukkha. Suffering is caused by a person’s
cravings for life, which cause rebirth. It
is manifested by an attachment to plea-
sure, wealth, power, and even ideals and
beliefs.
3. N ir odh a—The Noble Truth of the
Cessation of Suffering: This is the
cessation of dukkha. A person no longer
suffers if all cravings are relinquished.
4. M agga—The Noble Truth to the Path
Leading to the Cessation of Suffer-
ing: This is the Eightfold Path. It is a
middle way between the search for
happiness through pursuit of pleasure
and the search for happiness through
self-mortification and asceticism. By
following this path (right view, right
thought, right speech, right action, right
livelihood, right effort, right mindful-
ness, and right concentration), craving
is extinguished and deliverance from
suffering ensues.
The third and fourth phases of the Eight-
fold Path (Figure 4.4), right speech and right
action, have been extended into a practical
code of conduct known as the Five Precepts.
These are (1) abstain from the taking of life,
(2) abstain from the taking of what is not
given, (3) abstain from all illegal sexual plea-
sures, (4) abstain from lying, and (5) abstain
from consumption of intoxicants because they
tend to cloud the mind.
The person who perfects Buddha’s teach-
ings achieves nirvana, a state of calm insight,
passionlessness, and wisdom. In addition, the
For Hindus, water is the
beverage of choice at
meals. Standing water
is easily defiled if it is
touched by a member
of a lower caste; flowing
water is so pure that even
an untouchable standing
in it does not pollute it.
In southern India the
rice harvest is celebrated
in the festival called
Pongal—new rice is
cooked in milk, and when
it begins to bubble, the
family shouts, “Pongal!”
(“It boils!”).
The Hindu calendar is
lunar; thus, its religious
holidays do not always
fall on the same day on
the Western calendar.
Every three to five years
the Hindu calendar adds
a thirteenth leap month
(a very auspicious period)
to reconcile the months
with the seasons.
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1 0 4 F O O D A N D R E L I G I O N
Southeast Asia and their descendants. Based
on number of meditation centers, a majority
are believed to be Mahayana.39 A small num-
ber of non-Asians also have more recently
converted to Buddhism. Vajrayana Bud-
dhism, a Tibetan Mahayana sect also known
as Tantric Buddhism, and Zen Buddhism, a
Chinese sect that spread to Japan around the
year 1200, have gained followers, especially in
the West.
Dietary Practices
Buddhist dietary restrictions vary consid-
erably depending on the sect and country.
Buddhist doctrine forbids the taking of life;
therefore, many followers are lacto-ovo vege-
tarians (eating dairy products and eggs, but no
meat). Some eat fish, and others abstain only
from beef. Others believe that if they were not
personally responsible for killing the animal,
it is permissible to eat its flesh.
Feasts and Fasts
Buddhist festivals vary according to region.
From July to October, Buddhist monks are
directed to remain in retreat and meditate,
coinciding with the rainy season and the
sprouting of rice in the fields. The first day of
retreat is a time for worshipers to bring gifts
of food and articles of clothing to the monks;
the retreat ends with pr av ar ana, the end of
the rainy season, when worshipers once again
offer gifts to the monks, invite them to a meal,
and organize processions. On three separate
days (which vary according to the regional
calendar), Mahayana Buddhists commemo-
rate the birth of Buddha, his enlightenment,
and his death; Theravada Buddhists celebrate
Magha Puja, the Four Miracles Assembly, in
February or March when Buddha appointed
the first Buddhist brotherhood of monks at
a coincidental meeting of 1,250 disciples
at a shrine. In April or May they honor the
Buddha on a single holiday called Vesak. Bud-
dhist monks may fast twice a month, on the
days of the new and full moon. They also do
not eat any solid food after noon.
person is no longer subject to rebirth into
the sorrows of existence. Because the ideal
practice of Buddhism is impractical in the
turmoil of daily life, Buddhism has encour-
aged a monastic lifestyle. The ideal Buddhists
are monks, following a life of simplicity and
spending considerable time in meditation.
They own no personal property and obtain
food by begging. They are usually vegetarians
and are permitted to eat only before noon. The
monk confers a favor or merit (good karma)
on those who give him food.
There are numerous sects in Buddhism
and two great schools of doctrine: Theravada
(also known as Hinayana) Buddhism, which
is followed in India and Southeast Asia; and
Mahayana Buddhism, which is followed in
China, Japan, Korea, Tibet, and Mongolia.37,38
Theravada Buddhism is primarily a spiritual
philosophy and system of ethics. It places
little or no emphasis on deities, teaching that
the goal of the faithful is to achieve nirvana.
In Mahayana, a later form of Buddhism,
Buddha is eternal and cosmic, appearing
variously in many worlds to make known
his truth, called dharma. This has resulted in
a pantheon of Buddhas who are sometimes
deified and, for some sects, a hierarchy of
demons. Some sects promise the worshiper a
real paradise rather than the perfected spiri-
tual state of nirvana.
The number of Buddhists in the United
States was over 2.2 million in 20142 major-
ity are immigrants from Japan, China, and
In both Theravada and
Mahayana temples,
worshipers may offer
food at the altar, such
as apples, bananas,
grapes, oranges, pine-
apples, candy, rice, dried
mushrooms, and oil.
A Zen Buddhist monas-
tery, Tassajara, located
in central California is
famous for its vegetarian
restaurant and popular
cookbook. Macrobiotics
is not associated with
Zen Buddhism (see
Chapter 2 “Traditional
Health Beliefs and
Practices”).
Buddhist monks in Tibet
carve sculptures in but-
ter (as high as fifteen
feet) and parade them
during an evening in
March, lit by lanterns,
for Chogna Choeba, the
Butter Lamp Festival.
Afterward they are dis-
mantled and thrown in
the river, symbolic of the
impermanence of life.
Figure 4.4
The Buddhist Wheel of
Law—the spokes represent
the Eightfold Path.
©
C
en
ga
ge
L
ea
rn
in
g
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C H A P T E R 4 1 0 5
Review Questions
1. What are the basic tenets of Western and
Eastern religions?
2. Pick two of the following religions and describe
the dietary laws for food preparation and con-
sumption, and any additional laws for holy
days: Judaism, Hinduism, and Islam.
3. List the Five Pillars of Faith in Islam and the
Four Noble Truths and Noble Eightfold Path
in Buddhism.
4. Describe and compare the roles of fasting in
Islam and Hinduism, using examples of fasting
practices in each faith.
References
1. Raphael, M.L. 2003. J udaism in A mer ic a. New
York: Columbia University Press.
2. America’s Changing Religious Landscape.
Pew Research Center: Religion and Pub-
lic Life, May 12, 2015. Available from:
h t t p : / / w w w. p e w f o r u m . o r g / 2 0 1 5 / 0 5 / 1 2 /
americas-changing-religious-landscape/.
3. Greenberg, B. 1989. H ow to r un a tr aditional
J ew ish h ouseh ol d. Northvale, NJ: Aronson.
4. Himelstein, S. 1990. T h e J ew ish pr imer . New York:
Facts on File.
5. Shwide-Slavin, C. 2010. J ew ish f ood pr ac tic es. In
C.M. Goody & L. Drago (Eds.), C ul tur al f ood
pr ac tic es. Diabetes C ar e and E duc ation Dietetic
P r ac tic e G r oup. Chicago: American Dietetic
Association.
6. Oxford University Press. 2002. T h e O x f or d
dic tionar y of th e J ew ish r el igion (R.J.Z.
Werblowsky & G. Weigoder, Eds.). New York:
Author.
7. Lloyd, M.L., & Olsen, W.A. 1995. Disaccharide
malabsorption. In W.S. Haubrich, F. Schaffner, &
J.E. Berk (Eds.), B oc k us gastr oenter ol ogy (5th ed.). B oc k us gastr oenter ol ogy (5th ed.). B oc k us gastr oenter ol ogy
Philadelphia, PA: Saunders, 1087–1100.
8. Shugart, Y.Y., Silverberg, M.S., Duerr, R.H.,
Taylor, K.D., Wang, M.H., Zarfas, K., . . . Brant SR.
2008, March. An SNP linkage scan identifies sig-
nificant Crohn’s disease loci on chromosomes
13q13.3 and, in Jewish families, on 1p35.2 and
3q29. G enes and I mmunity , 9 (2), 161–167.
9. National Council of Churches of Christ in the USA.
2012. Y ear book of A mer ic an and C anadian c h ur c h es
(E.W. Lindner, Ed.). Nashville: Abingdon Press.
D I S C U S S I O N S T A R T E R S
Does Your Religion Affect Your Eating Habits?
Explore your own religious and cultural dietary restrictions. Even if you are not religious, you can probably identify the major religions of your culture,
a religion or multiple religions of your parents, grandparents, or great grandparents. It’s probable that, unless you have made a conscious decision
to change your dietary habits from your childhood, you still adhere to at least some of the dietary practices of your family’s religion. Answer the
following:
● What foods and/or drinks are prohibited by your religion—or were prohibited by your family when growing up?
● Are there certain times during the year when your religion directs you—or your family directed you as a child—to avoid certain foods
and drinks or maybe even to fast (not eat at all)?
● Are there certain times during the year when your religion directs you—or when, as a child, your family directed you—to consume
particular kinds of foods or drinks?
● Do you observe certain feast days during the year, days when you are supposed to eat a lot?
After answering the questions, seek out others and compare your answers. Don’t ask only friends. Contact someone at a local mosque, synagogue,
temple, church, or other religious meeting place, and ask to interview someone about her or his religion. Be sure to explain that you are a student
studying food and religion. Another way of finding someone of a different culture and religion to interview is to look for local restaurants serving
foods of particular ethnic groups: Thai, Chinese, Vietnamese, Korean, Japanese, Mexican, Middle Eastern, Indian, Ethiopian, Cuban, Caribbean,
Greek, Italian, French, Cajun, African American, or another culture. Contact the owner or manager to request an interview, again making sure to
explain who you are and your reason for wanting to interview her or him. Because this person may be busy with work, she or he may not be able
to talk with you right away. When meeting with the person for the interview, show her or him these questions and your answers. Compare your
answers with those from your interviewee.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
1 0 6 F O O D A N D R E L I G I O N
10. Eagan, J.F. 1995. R estor ation & r enew al : T h e
c h ur c h in th e th ir d mil l ennium. Kansas City, MO:
Sheed & Ward.
11. Clancy, P.M.J. 1967. F asting and abstinenc e.
In the new Catholic encyclopedia. New York:
McGraw-Hill.
12. Fairnbairn, D. 2002. E aster n or th odox y th r ough
W ester n ey es. Louisville, KY: Westminster John
Knox Press.
13. Smart, N. 1998. T h e w or l d’ s r el igions (2nd ed.).
New York: Cambridge University Press.
14. Kolb, R. 2004. Martin Luther. In H.J. Hillerbrand
(Ed.), T h e enc y c l opedia of P r otestantism. New
York: Rutledge.
15. Sack, D. 2000. W h itebr ead P r otestants: F ood
and r el igion in A mer ic an c ul tur e. New York:
St. Martin’s Press.
16. Newell, C. 2000. L atter day s: A guided tour
th r ough six bil l ion y ear s of M or monism. New York:
St. Martin’s Press.
17. Douglas, D. 2004. Mormonism. In H.J. Hiller-
brand (Ed.), T h e enc y c l opedia of P r otestantism.
New York: Rutledge.
18. Greenleaf, F. 2004. Seventh-day Adventists. In
H.J. Hillerbrand (Ed.), T h e enc y c l opedia of P r ot-
estantism. New York: Rutledge.
19. White, E.G.H. 1905. T h e ministr y of h eal –
ing. Hagerstown, MD: Review and Herald
Publishing.
20. White, E.G.H. 1923. C ounsel s on h eal th . Hager-
stown, MD: Review and Herald Publishing.
21. White, E.G.H. 1938. C ounsel s on diet and
f oods. Hagerstown, MD: Review and Herald
Publishing.
22. Frager, R. 2002. T h e w isdom of I sl am: A n intr oduc –
tion to th e l iv ing ex per ienc e of I sl amic bel ief and
pr ac tic e. Haupage, NY: Godsfield Press.
23. Denny, F.M., & Mamiya, L.H. 1996. Islam in the
Americas. In A.A. Nanji (Ed.), T h e M usl im al ma-
nac . New York: Gale Research.
24. Waines, D. 1995. A n intr oduc tion to I sl am. New
York: Cambridge University Press.
25. Pew Report. 2007. M usl im A mer ic ans: M iddl e
c l ass and mostl y mainstr eam. Retrieved from
http : / / p e w re s e arch . org / pub s / 4 8 3 / musl i m –
americans (accessed January 17, 2011).
26. Regenstein, J.M., Chaudry, M.M., & Regenstein,
C.E. 2003. The kosher and halal food laws. C om-
pr eh ensiv e R ev iew s in F ood S c ienc e and F ood
S af ety , 2 , 111–127.
27. Chaudry, M.M. 1992. Islamic food laws: Philo-
sophical basis and practical implications. F ood
T ec h nol ogy , 4 6 , 92–93, 104.
28. Kulkarni, K.D. 2010. Asian Indian and Paki-
stani food practices. In C.M. Goody & L. Drago
(Eds.), C ul tur al f ood pr ac tic es. Diabetes C ar e
and E duc ation Dietetic P r ac tic e G r oup. Chicago:
American Dietetic Association.
29. Eliasi, J.R., & Dwyer, J.T. 2002. Kosher and halal:
Religious observances affecting dietary intakes.
J our nal of th e A mer ic an Dietetic A ssoc iation, 1 0 2 ,
911–913.
30. Hussaini, M.M. 1993. I sl amic dietar y c onc epts
and pr ac tic es. Bedford Park, IL: Islamic Food and
Nutrition Council of America.
31. Censusindia.gov.in. n.d. C ensus of I ndia— I ndia at
a gl anc e: S c h edul ed c astes & sc h edul ed tr ibes pop-
ul ation. Retrieved from http://www.censusindia
.gov.in/Census_Data_2001/India_at_Glance/scst
.aspx (accessed January 10, 2010).
32. Flood, G. 1996. A n intr oduc tion to H induism. New
York: Cambridge University Press.
33. Hindu American Foundation. n.d. H indu
demogr aph ic s. Retrieved from http://www
.hafsite.org/resources/hinduism_101/hinduism_
demographics (accessed January 10, 2011).
34. Achaya, K.T. 1994. I ndian f ood: A h istor ic al c om-
panion. Delhi: Oxford University Press.
35. Pandit, B. 2005. T h e H indu mind: F undamental s
of H indu r el igion and ph il osoph y f or al l ages. Glen
Ellyn, IL: Dharma Publishing.
36. Kilara, A., & Iya, K.K. 1992. Food and dietary
practices of the Hindu. F ood T ec h nol ogy , 4 6 ,
94–102, 104.
37. Crosby, K. 2004. Theraveda. In R.E. Buswell (Ed.),
E nc y c l opedia of B uddh ism. New York: Macmillan
Reference.
38. Schopen, G. 2004. Mahayana. In R.E. Buswell
(Ed.), E nc y c l opedia of B uddh ism. New York:
Macmillan Reference.
39. Morreale, D. 1998. Everything has changed in
Buddhist America. In D. Morreale (Ed.), T h e
c ompl ete guide to B uddh ist A mer ic a. B oston:
S h ambh al a.
40. Barrow, K. 2010, April 13. More people choosing
Kosher for health. T h e N ew Y or k T imes.
41. Cordain, L., Miller, J.B., Eaton, S.B., Mann, N.,
Holt, S.H.A., & Speth, J.D. 2000. Plant-animal
subsistence ratios and macronutrient energy
estimations in worldwide hunter-gatherer diets.
J our nal of C l inic al N utr ition, 7 1 , 682–692.
42. Douglas, M. 1966. P ur ity and danger : A n anal y –
sis of c onc epts of pol l ution and taboo. New York:
Praeger.
43. Harris, M. 1998. G ood to eat: R iddl es of f ood and
c ul tur e. Long Grove, IL: Waveland Press.
44. Pandit, B. 2005. T h e H indu mind: F undamental s
of H indu r el igion and ph il osoph y f or al l ages. Glen
Ellyn, IL: Dharma Publishing.
45. Dresser, N. 2005. M ul tic ul tur al manner s: E ssential
r ul es of etiq uette f or th e 2 1 st c entur y . New York:
Wiley.
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1 0 7
complete disappearance of many traditional
foods and food habits (Figure 5.1). This chap-
ter reviews both the past and present diet of
Native American ethnic groups.
Cultural Perspective
History of Native Americans
Settlement Patterns
It is hypothesized that the Native Ameri-
cans came to North America approximately
20,000 to 50,000 years ago across the Bering
Strait, which links Asia to Alaska, although
some evidence suggests earlier migrations
may have occurred. Archaeological research
provides little insight into the settlement pat-
terns and diversification of Native American
culture in the years before European contact
in the 1600s. Furthermore, the Native Ameri-
can languages were entirely verbal, so writ-
ten historical records are nonexistent. There
are, consequently, enormous gaps in what is
known of early Native American societies.
Observations of Native Americans by
white settlers have been well documented.
These commentaries identified three major
centers of American Indian culture during
the seventeenth century. In the Southeast the
sophisticated social organization of the Cher-
okees, Chickasaws, Choctaws, Creeks, and
Seminoles led the Europeans to call them the
“Five Civilized Tribes.” The Iroquois, in what
is now New York State, ruled a democratic
confederacy of five nations. Religion and the
Native Americans
The designation The designation T Native American, which includes the greatest number of ethnic Tincludes the greatest number of ethnic Tgroups of any minority population in Tgroups of any minority population in T
the United States, is a term for the indigenous
people of the Americas. It is used for both
American Indians and Alaska Natives, who
are comprised of American Indians, Inuit, and
Aleut. Each of the approximately 400 Ameri-
can Indian and Alaska Native nations has its
own distinct cultural heritage.
Over 5 million persons of Native American
heritage lived in the United States in 2009,
according to U.S. Census figures, represent-
ing 2 percent of the total population.1 The
vast majority of American Indians and Alaska
Natives today live west of the Mississippi
River. Roughly half live in rural areas, either
on government reservations or on nearby
farms. Native American ethnic identity varies
tremendously, from tenacious maintenance
of heritage to total adoption of the majority
culture.
Traditional Native American foods have
made significant contributions to today’s diet
in the United States. Corn, squash, beans,
cranberries, and maple syrup are just a few
of the items Native Americans introduced
to European settlers. Historians question
whether the original British colonists would
have survived their first years in America
without the supplies they obtained and the
cooking methods they learned from the Native
Americans. The diet of Native Americans has
changed dramatically from its origins, yet
recent renewed interest in American Indian
and Alaska Native culture has prevented the
5CHA
P
T
E
R
It has been suggested
that native Hawaiians
be included as Native
Americans; however,
the history and culture
of these peoples are
substantially different
from those of Native
Americans of the U.S.
mainland, Alaska, and
Canada, so they are
discussed in Chapter 12,
“Southeast Asians and
Pacific Islanders.” Native
American cultures of
Mexico, Central America,
and South America are
considered in Chapters 9,
“Mexicans and Central
Americans” and 10,
“Caribbean Islanders and
South Americans.”
The U.S. Census uses
the phrase “American
Indians and Alaska
Natives” (abbreviated
AI/AN), and notes that
approximately 15 per-
cent of this population
is also of Hispanic
ethnicity.130
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1 0 8 N A T I V E A M E R I C A N S
arts flourished in Pueblo communities adja-
cent to the Rio Grande and Little Colorado
Rivers in the Southwest.
The introduction of horses, firearms, and
metal knives changed the lifestyles of many
nations, especially those that used the new
tools to exploit the resources of the Great
Plains. This initial interaction between white
settlers and Plains Indians resulted in the
development of the stereotype of the buffalo-
hunting horseman with feathered headdress
who came to represent all American Indian
ethnic groups. European diseases and the
massacre of whole nations reduced the num-
bers of both Native American individuals and
ethnic groups. In addition, many American
Indians were forced to migrate west to accom-
modate white expansion. The hardships of
involuntary relocation and the deaths caused
by illness and assault may have caused the
extinction of nearly one-quarter of all Native
American ethnic groups.
Native American lands dwindled as
white settlers moved westward. By the late
nineteenth century, the majority of Native
Americans lived on lands held in trust for
them by the U.S. government, called federal
reservations. Still others resided in state res-
ervation communities. Although they were
not required by law to live on reservations,
there were few other viable Native American
communities.
The Bureau of Indian Affairs (BIA) took
over the administration of the reservations
near the turn of the twentieth century. It
established a program of cultural assimilation
designed to bring the Native American resi-
dents into mainstream U.S. society. Before the
1930s, Native American children were sent
to off-reservation boarding schools where
white values were encouraged. Later, public
reservation schools attempted similar indoc-
trination. The BIA program usually failed to
force Native Americans to accept white val-
ues, however. The Native Americans changed
their dress, occupation, and social structure,
but they did not fully assimilate. In many
cases their religious beliefs were strength-
ened, and their involvement in crafts, music,
and dance was deepened to support their
ethnic identity.
Current Demographics
Many Native Americans left the reservations
for the employment opportunities available
during World War II. Some joined the armed
services, where they became fluent in English
and the ways of the majority society. Others
▲ Traditional Native
American foods: Some typical
foods include beans, berries,
corn, fish, jerky, maple syrup,
squash, and tomatoes.
M
ar
ily
n
A
ng
el
W
yn
n/
G
et
ty
Im
ag
es
Figure 5.1
Native food circle: Choices
for a healthy lifestyle.
Source: Great Lakes Inter-Tribal
Council, Inc., Lac du Flambeau.
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C H A P T E R 5 1 0 9
took war-related industry jobs. In the 1950s
and 1960s, the BIA Employment Assistance
Program was a major factor in the continu-
ing out-migration of Native Americans from
the reservations to the cities. By 2000, two-
thirds of all American Indians and Alaska
Natives resided in the farms, towns, and urban
areas outside of reservations (Figure 5.2).
More recent statistics indicate that 60% live
in metropolitan areas.2,3 Among the states,
California has the highest number of resident
American Indians (fewer than 700, 000), fol-
lowed by Oklahoma and Arizona. In 2009,
the largest ethnic groups within the states of
Alaska, Montana, North Dakota, Oklahoma,
and South Dakota were Alaska natives and
Native Americans/American Indians.2
Large, urban Native American popula-
tions are found in Los Angeles, New York
City, Phoenix, Tulsa, Anchorage, Oklahoma
City, Albuquerque, and Tucson. The remain-
der of the American Indian and Alaska Native
population resides in rural areas, including
reservations where approximately 1.9 mil-
lion individuals reside. Many first-generation
urban Native Americans maintain close ties
with the reservation of their ethnic group and
travel often between the city and tribal land.
Members of the second generation living in
urban regions are more likely to think of the
city as their permanent home.
Socioeconomic Status
The socioeconomic status of Native Americans
declined drastically with the forced migra-
tions of the nineteenth century. Even those
Native American nations that were agricul-
turally self-sufficient suffered when relocated
to regions with poor growing conditions.
Further, there were few native occupations
that were valued in the job market outside the
reservations. BIA education efforts were gen-
erally unsuccessful, and most Native Ameri-
cans did not begin to find employment until
World War II and the development of the BIA
Employment Assistance Program. The Indian
Self-Determination and Education Act of 1975
was enacted to promote Native American
participation in government and education
but economic improvement continues to be
During the early nine-
teenth century, the
Cherokee had a written
language, a bilingual
newspaper, a school sys-
tem, a court system, and
a Cherokee Nation con-
stitution.131 They were a
prosperous tribe; many
owned black slaves.
Figure 5.2
Location of Native American
nations in the continental
United States.
Source: Adapted and reprinted by
permission of the publisher from
Harvard Encyclopedia of American
Ethnic Groups edited by Stephan
Thernstrom, Ann Orlov, and Oscar
Handlin, p. 61, Cambridge, Mass.;
The Belknap Press of Harvard
University Press, Copyright © 1980
by the President and Fellows of
Harvard College.
Indian Reservations in the Continental United States
Co
ur
te
sy
o
f N
at
io
na
l N
A
G
PR
A
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
1 1 0 N A T I V E A M E R I C A N S
slow. Approximately 26 percent of American
Indians and Alaska Natives work in man-
agement and professional occupations.3 The
Apache and Dakota have been active in ranch-
ing and are known for their expertise in the
rodeo circuit.4,6 In the Southwest, small-scale
agriculture and livestock grazing are still
important among some Hopi, Pueblo, and
Navajo peoples; and traditional crafts such
as weaving, pottery, and silversmithing are
significant.7,8,9 Some Alaska Natives combine
part-time paid employment with subsistence
living and often find jobs in the fishing and
forestry industries.10,11,12
The overall poverty rate for Native Ameri-
cans (nearly 26 percent) in 2012 was more
than double that of the general popula-
tion; however, significant tribal differences
are seen. The median family income for
American Indian and Alaska Natives in 2012
was $37,353. Most Alaska Natives have rates
somewhat higher than the U.S. average (15 to
23 percent), while poverty levels among the
Apache, Navajo, and Sioux approached or
exceeded three times the national rates (34 to
39 percent). In 2012, 82 percent of American
Indians and Alaska Natives over 25 years of
age have at least a high school diploma. Seven-
teen percent of American Indians and Alaska
Natives have at least a bachelor’s degree, and
6 percent have an advanced graduate degree.1
Native American Organizations
Few Native American neighborhoods develop
in urban areas. Native Americans who settle
in the cities usually arrive as individuals or
small family groups and typically do not live
near others of their nation. Sometimes long-
time city residents exhibit a sense of superior-
ity over recent arrivals from the reservations.
In general, the difficulties of adjusting to
urban white society stimulate many young
Native Americans to identify not only with
Native Americans of other nations but also
with people from other ethnic groups.
Activists for Native American rights often
come from the cities and are not always sup-
ported by Native Americans who live on tribal
lands. Native American organizations have
done much to maintain Indian identity. Most
areas with large Native American populations
have their own clubs and service associations.
Organizations to promote ethnic identity
have been founded by the Navajo, Pueblo,
Tlingit, Haida, and Pomo. Other groups such
as athletic clubs and dance groups serve the
social needs of the pan–Native American
community.
Worldview
Harmony best describes the Native American
approach to life. Each individual strives to
maintain a balance among spiritual, social,
and physical needs in a holistic approach.
Only what is necessary for life is taken from
the natural environment; the belief is that the
Earth should be cared for and treated with
respect. Generosity is esteemed and competi-
tiveness is discouraged, yet individual rights
are also highly regarded. Personal autonomy
is protected through the principle of noninter-
ference. Among the Navajo, for example, an
individual would never presume to speak for
another, even a close family member. For most
Native Americans, time is conceptualized as
being without beginning or end, and the cul-
ture is present oriented, meaning that the
needs of the moment are emphasized over the
possible rewards of the future.
Religion
Traditional Native American religions vary
from an uncomplicated belief in the power of
a self-declared evangelist to elaborate theo-
logical systems with organized hierarchies
of priests. Yet they all share one characteris-
tic: The religion permeates all aspects of life.
Rather than a separate set of beliefs practiced
at certain times in specific settings, religion is
an integral part of the Native American holis-
tic worldview. Religious concepts influence
both the physical and emotional well-being
of the individual.
Many Native American nations have
rejected all attempts at Christian conver-
sion, especially in the Southwest. The
Navajo, Arizona Hopi, Rio Grande Pueblo,
Potawatomi, Lakota, and Dakota have
retained most of their native religious val-
ues and rituals, such as sweat lodge purifica-
tion rites. Other religions unique to Native
Efforts to increase pros-
perity on reservations
include utilization of
natural resources and
establishment of gam-
bling operations, which
are legal on tribal lands.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 5 1 1 1
Americans emerged after European con-
tact, such as the Drum Dance cult and the
Medicine Bundle religions, which combine
spiritual elements from several different
ethnic groups. A Paiute visionary, Wovoka,
founded the Ghost Dance religion in the late
1880s, which prophesied an end to white
domination through prayer, abstinence
from alcohol, and ritual dancing.13 In addi-
tion, religions mixing Christianity with tra-
ditional beliefs have been popular since the
late nineteenth century; the Native Ameri-
can Church has been especially successful.
Other groups claim Christian fellowship but
continue to practice native religions as well.
Finally, many Native Americans now adhere
to Roman Catholicism or some form of Prot-
estantism, especially in urban areas where
churches have been established to serve all
Native American congregations. In Alaska,
some Alaska Natives have become adherents
of Russian Eastern Orthodoxy.
Family
The primary social unit of Native Americans
is the extended family. Children are valued
highly, and there is great respect for elders.
All blood kin of all generations are consid-
ered equal; there is no differentiation between
close and distant relatives. Aunts and uncles
are often considered like grandparents, and
cousins are viewed as brothers or sisters. Even
other tribal members are sometimes accepted
as close kin. In many Native American societ-
ies an individual without relatives is consid-
ered poor.
Many Native American nations are matri-
lineal, meaning that lineage is inherited from
the mother. Traditionally, property was often
passed down through women in these tribes,
and decision making often rested with an
elder woman in the family.14,15 Today, even in
matrilineal systems, the men are the family
providers and heads of the household; women
are typically in charge of domestic matters.
Due to the respect for the individual within
most Native American groups, men and
women hold equal standing. Native American
children are expected to assist their parents in
running the home.
Traditional Health Beliefs and Practices
In Native American culture, health reflects
a person’s relationship to nature, broadly
defined as the family, the community, and the
environment. Every illness is due to an imbal-
ance with supernatural, spiritual, or social
implications. Treatment focuses on the cause
of the imbalance, not the symptoms, and is
holistic in approach. The sick individual is at
odds with the universe, and community and
family support is focused on restoring har-
mony, not curing the disease.16 As explained
by the Cherokee medicine man, Sequoyah,
“Indian medicine is a guide to health, rather
than a treatment. The choice of being well
instead of being ill is not taken away from an
Indian.”17 Traditional Native American medi-
cine is concerned with physical, mental, and
spiritual renewal through health maintenance,
prevention of illness, and restoration of health.
Many causes account for illness. Some
Navajo believe that witchcraft, through agents
such as animals, lightning, and whirlwinds;
transgressions committed at ceremonial occa-
sions; or evil spirits (especially ghosts) may
cause fainting, hysteria, or other conditions.
Witchcraft may also take the form of insidi-
ous objects, causing pain where the object is
inserted, as well as emaciation. Possession by
a spirit may dislodge the soul, resulting in a
feeling of suffocation (or possession may be a
sign of a gift for healing). Soul loss may also
cause mental disorders. Violation of a taboo,
▲ The primary social
unit of Native Americans
is the extended family,
which includes all close
and distant kin.
H
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1 1 2 N A T I V E A M E R I C A N S
whether an actual breach by an individual
or contact with evil objects that have com-
mitted mythical breaches, results in general
seizures.18,19 Traditionally, these beliefs are
shared by many other Native Americans as
well. For example, some Iroquois believe in
a similar list of reasons for illness, adding
that unfulfilled dreams or desires may also
be a contributing factor,20 and some Inuit
believe sleep paralysis occurs when the soul
is attacked by malevolent spirits or through
witchcraft.21
Some Native Americans reject the concept
that poor nutrition, bodily malfunctions, or
an infection by a virus or bacteria can cause
sickness. An evil external source is often
identified instead. Some Dakota, for instance,
blame type 2 diabetes on disease-transmitting
foods provided by whites with the intention
of eliminating all Native Americans.22 An
outbreak of serious respiratory infections due
to the Hanta virus was explained by Navajo
healers as being due to rejection of traditional
ways and adoption of convenience foods.23
Some Native Americans attribute alcoholism
to soul loss and the cultural changes due to
domination by white society.15
Small bags of herbs (called “medicine
bundles” by certain Plains Indians), fetishes,
feathers, or symbols may be worn to protect
against malevolent forces. Fetishes are used
when an animal that has been harmed or
killed causes an ailment; a fetish in the form
of the animal is rubbed on the afflicted body
part with appropriate chants.
Traditional healers often specialize in their
practice. Navajo medicine men and women
usually exert a positive influence in preventing
disharmony through rituals such as the sweat
bath to promote peace. They also have nega-
tive powers, which can be used to counteract
witchcraft or evil acts by a person’s enemies.
Diagnosticians may be called on to identify
the cause of an illness through stargazing or
listening (if crying is heard, the patient will
die). Hand motions or trembling also may
be involved, sometimes including painting
with white-, blue-, yellow-, and black-colored
sand to produce a picture of magical healing
power. Other traditional Navajo practitioners
are singers, who cure with sacred chanting
ceremonies, and healers, who have specific
responsibility for care of the soul. Among the
Oneida, dreamers have the ability to see the
future and diagnose illness.24 In many Native
American groups, herbalists, often women,
assist in the treatment of illness through the
ceremonial collection and application of wild
plant remedies.25 (See “Therapeutic Uses of
Food” later in this chapter for examples.)
Among California Native Americans, ill-
ness was treated first with home remedies. If
that proved ineffective, non-sacred healers
such as herbalists or masseuses were con-
tacted. If the patient still did not improve,
a diviner would be consulted for a diagno-
sis. If spiritual or supernatural intervention
was needed, a shaman (medicine man) was
employed. Consultation with native healers
is often concurrent with seeking Westernized
health care.15,26,27
Traditional Food
Habits
The traditional food habits of Native Ameri-
cans were influenced primarily by geog-
raphy and climate. Each Native American
nation adopted a way of life that allowed it to
maximize indigenous resources. Many were
agriculturally based societies, others were pre-
dominantly hunters and gatherers, and some
survived mainly on fish. Most of each day was
spent procuring food.
Ingredients and Common
Foods
Indigenous Foods
Archaeological records and descriptions of
America by European settlers indicate that
Native Americans on the East Coast enjoyed
an abundance of food. Fruits, including blue-
berries, cranberries, currants, grapes, per-
simmons, plums, and strawberries, as well as
vegetables, such as beans, corn, and pumpkins,
are mentioned by the New England colonists.
They describe rivers so full of life that fish
could be caught with frying pans, sturgeon so
large they were called “Albany beef,” and lob-
ster so plentiful that they would pile up along
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 5 1 1 3
the shoreline after a storm. Game included
deer, moose, partridge, pigeon, rabbit, rac-
coon, squirrel, and turkey. Maple syrup was
used to sweeten foods. Farther south, Native
Americans cultivated groundnuts (Apios
americana, or Indian potatoes) and tomatoes,
and collected wild Jerusalem artichokes (a
starchy tuber related to the sunflower). Native
Americans of the Pacific Northwest collected
enough food, such as salmon and fruit, during
the summer to support them for the rest of the
year. Peoples of the plains hunted buffalo, and
those of the northeastern woodlands gathered
wild rice; nations of the Southwest cultivated
chile peppers and squash amid their corn (see
Table 5.1).
Native Americans not only introduced
whites to indigenous foods but also shared
their methods of cultivation and food prepa-
ration. Legend has it that the Pilgrims nearly
starved despite the plentiful food supply
because they were unfamiliar with the local
foods. One version of the tale is that Squanto,
the sole surviving member of the Pautuxet
(the other members had succumbed to small-
pox following contact with earlier European
explorers), saved the Pilgrims, who were
mostly merchants, by teaching them to grow
corn. He showed them the Native American
method of planting corn kernels in mounds
with a fish head for fertilizer and using the
corn stalks as supports for beans.
Foods Introduced from Europe
Foods introduced by the Europeans, espe-
cially the French Jesuits in the North and the
Spanish in the South, were well accepted by
Native Americans. Apples, apricots, carrots,
lentils, peaches, purslane, and turnips were
some of the more successful new foods. Settler
William Penn noted that he found peaches in
every large Native American farm he encoun-
tered barely one hundred years after they had
been introduced to the Iroquois. The Europe-
ans also brought rye and wheat. However, few
Native American nations replaced corn with
these new grains.
Livestock made a much greater impact
on Native American life than did the new
fruits and vegetables. Cattle, hogs, and sheep
reduced the Native Americans’ dependence
on game meats. The Creek and Cherokee of
the Southeast fed their cattle on corn and fat-
tened their suckling pigs and young lambs on
Fruits Berries (blackberries, blueberries, cranberries, gooseberries, huckleberries,
loganberries, raspberries, strawberries), cactus fruit (tuna), cherimoya,
cherries (acerola cherries, chokecherries, ground-cherries), grapes (e.g.,
Concord), guava, mamey, papaya, passion fruit (granadilla), pawpaw,
persimmon (American), pineapple, plums (American, beach), soursop
(guanabana), zapote (sapodilla)
Vegetables Avocado, bell peppers (sweet peppers, pimento), cactus (nopales, nopalitos),
chayote (christophine, chocho, huisquil, mirliton, vegetable pear),
pumpkins, squash, tomatillo, tomatoes
Tubers/roots Arrowroot, cassava (yuca, manioc, tapioca), groundnut, Indian breadroot,
Jerusalem artichoke, jicama, malanga (yautia), potatoes, sweet potatoes
Grains/cereals Amaranth, corn (maize), quinoa, wild rice
Nuts/seeds Brazil nuts, cashews, hickory nuts, pecans, pumpkin seeds (pepitas),
sunflower seeds, walnuts (black)
Legumes Beans (green beans, most dried beans), peanuts
Poultry Turkey
Seasonings/flavorings Allspice, chile peppers (e.g., hot and sweet ), chocolate (cocoa), maple syrup,
sassafras (filé powder), spicebush, vanilla
NOTE: Foods native to North, Central, or South America. Some items not indigenous to the United States (e.g., pineapple, potatoes) were popularized only after
acceptance in Europe and introduction by European settlers. Other foods (e.g., avocado, jicama, tomatillo) have become more common in the United States with
the growing Latino population.
TA B L E 5.1 Indigenous Foods of the Americas
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1 1 4 N A T I V E A M E R I C A N S
apples and nuts. The Powhatan of Virginia fed
their hogs peanuts, then cured the meat over
hickory smoke. Lamb and mutton became sta-
ples in the Navajo diet after the introduction
of sheep by the Spanish. In addition, the Euro-
peans brought horses and firearms, which
made hunting easier, and metal knives and
iron pots, which simplified food preparation.
They also introduced the Native Americans to
distilled spirits.
Staples
The great diversity of Native American cul-
tures has resulted in a broad variety of cui-
sines. The cooking of one region was as
different from that of another as French food
is from German food today. Native American
cooking featured local ingredients and often
reflected the need to preserve foods for future
shortages. The only staple foods common
to many, though not all, Native American
nations were beans, corn, and squash. The
cultural food groups are listed in Table 5.2.
Regional Variations
Native American fare has been divided by
regions into five major types: northeastern,
southern, plains, southwestern, and Pacific
Northwest/Alaska Native. Although each area
encompasses many different Native American
nations, they share similarities in foods and
food habits.
Northeastern The northeastern region of
the United States was heavily wooded, with
numerous freshwater lakes and a long Atlantic
coastline. It provided the local Native Ameri-
cans, including the Iroquois and Powhatan,
with abundant indigenous fruits, vegetables,
fish, and game. Most nations also cultivated
crops such as beans, corn, and squash. Many
of the foods associated with the cooking of
New England have their origins in northeast-
ern Native American recipes. The clambake
was created when the Narragansett and the
Penobscot steamed their clams in beach pits
lined with hot rocks and seaweed. Dried beans
Group Comments Common Foods Adaptations in the United States
Protein Foods
Milk/milk products High incidence of lactose
intolerance among Native
Americans with a high
percentage of Native
American heritage.
No common milk products in
traditional diets.
Powdered milk and evaporated milk
are typical commodity products,
usually added to coffee, cereal,
and traditional baked goods;
ice cream is popular with some
groups.
Some reports have been made of
frequent milk consumption.
Meat/poultry/fish/
eggs/legumes
Meat is highly valued,
considered healthful.
Meats are mostly grilled or
stewed, preserved through
drying and smoking.
Beans are an important
protein source.
Meat: bear, buffalo (including jerky,
pemmican), deer, elk, moose, opossum,
otter, porcupine, rabbit, raccoon,
squirrel.
Poultry and small birds: duck, goose, lark,
pheasant, quail, seagull, wild turkey.
Fish, seafood, and marine mammals:
abalone, bass, catfish, clams, cod, crab,
eel, flounder, frogs, halibut, herring,
lobster, mussels, olechan, oysters,
perch, red snapper, salmon, seal, shad,
shrimp, smelts, sole, sturgeon, trout,
turtle, walrus, whale.
Eggs: bird, fish.
Legumes: many varieties of the common
bean (kidney, navy, pinto, etc.), tepary
beans.
Beef is well accepted; lamb and
pork are also popular.
Canned and cured meats (bacon,
luncheon meat) may be common
if income is limited.
Game is rarely eaten.
Meats remain a favorite food.
Chicken eggs are commonly eaten.
TA B L E 5. 2 Cultural Food Groups
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 5 1 1 5
Group Comments Common Foods Adaptations in the United States
Cereals/Grains Corn is primary grain; wild
rice is available in some
areas.
Cornmeal breads (baked, steamed),
hominy, gruels, corn tortillas, piki,
toasted corn; wild rice.
Wheat has widely replaced corn;
store-bought or commodity
breads and sugared cereals are
common.
Fruits/Vegetables Indigenous plants are major
source of calories in diet
of some Native American
nations.
Fruits and vegetables
are either gathered or
cultivated; fruit is a popular
snack food.
Fruit: blackberries, blueberries,
buffalo berries, cactus fruit (tuna),
chokeberries, cherries, crab apples,
cranberries, currants, elderberries,
grapes, groundcherries, huckleberries,
persimmons, plums, raspberries,
salal, salmonberries, strawberries
(beach and wild), thimbleberries, wild
rhubarb.
Vegetables: camass root, cacti
(nopales), chile peppers, fiddleheads,
groundnuts, Indian breadroot,
Jerusalem artichokes, lichen, moss,
mushrooms, nettles, onions, potatoes,
pumpkin, squash, squash blossoms,
sweet potatoes, tomatoes, wild greens
(cattail, clover, cow parsnip, creases,
dandelion, ferns, milkweed, pigweed,
pokeweed, saxifrage, sunflower leaves,
watercress, winter cress), wild turnips,
yuca (cassava).
Cakes, cookies, pastries are popular.
Apples became common after
European introduction.
Apples, bananas, oranges, peaches,
pineapple have been well
accepted; canned fruits are
popular.
Wild berries are still gathered in
rural areas.
Some traditional vegetables are
eaten when available.
Green peas, string beans,
instant potatoes are common
commodity items.
Intake of vegetables is low; variety
is limited.
Potato chips and corn chips often
are popular as snacks.
Additional Foods
Seasonings Chiles, garlic, hickory nut cream, onions,
peppermint, sage, salt, sassafras,
seaweed, spearmint, and other
indigenous herbs and spices.
Nuts/seeds Nuts and seeds are often
an important food source;
acorns are sometimes a
staple.
Acorn meal, black walnuts, buckeyes,
chestnuts, hazelnuts, hickory nuts,
mesquite tree beans, pecans, peanuts,
piñon nuts (pine nuts), pumpkin seeds,
squash seeds, sunflower seeds, seeds
of wild grasses.
Beverages Herbal teas are often
consumed for enjoyment,
therapeutic, or spiritual
value.
Teas of buffalo berries, mint, peyote,
rose hip, sassafras, spicebush, sumac
berries, yerba buena; honey and water.
Coffee, tea, soft drinks are common
beverages. Alcoholism is
prevalent.
Fats/oils Traditional diets vary in fat
content, from extremely
low in the mostly
vegetarian cooking of
California and Nevada
Indians to very high in the
primarily animal-based fare
of Native Alaskans.
Fats rendered from buffalo, caribou,
moose, and other land mammals; seal
and whale fat.
Butter, lard, margarine, vegetable
oils have replaced rendered fats
in most regions; seal and whale
fat are still consumed by the Inuit
and Aleut.
Sweeteners Consumption of sweets is
low in traditional diets.
Maple syrup, other tree saps, honey. Sugar is primary sweetener; candy,
cookies, jams, and jellies are
popular.
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1 1 6 N A T I V E A M E R I C A N S
were simmered for days with maple syrup (the
precursor of Boston baked beans). The dish
that today is called succotash comes from
a stew common in the diet of most Native
Americans; it combined corn, beans, and
fish or game. In the Northeast it was usually
flavored with maple syrup. Clam chowder,
codfish balls, brown bread, corn pudding,
pumpkin pie, and the dessert known as Indian
pudding are all variations of northeastern
Native American recipes. In addition to clams,
the Native Americans of the region ate lobster,
oysters, mussels, eels, and many kinds of salt-
water and freshwater fish.
Game, such as deer and rabbit, was eaten
when available. Wild ducks, geese, and tur-
keys were roasted with stuffings featuring
crab apples, grapes, cranberries, or local
mushrooms. Corn, as the staple food, was
prepared in many ways, such as roasting the
young ears; cooking the kernels or meal in
soups, gruels, and breads; steaming it in pud-
dings; or preparing it as popcorn. Pumpkins
and squash were baked almost daily, and
beans were added to soups and stews. Local
green leafy vegetables were served fresh.
Sweets included cherries stewed with maple
syrup, cranberry pudding, crab apple sauce,
and hazelnut cakes.
Southern The great variety of foods found
in the northeastern region of the United
States was matched by the plentiful fauna and
lush flora of the South. Oysters, shrimp, and
blue crabs washed up on the warm Atlantic
beaches during tropical storms. The wood-
lands and swamplands teemed with fish, fowl,
and game, including bear, deer, raccoon, and
turtle, as well as ample fresh fruit, vegetables,
and nuts. The Native Americans of this region,
such as the Cherokee, Creek, and Seminole,
were accomplished farmers, growing crops of
beans, corn, and squash.
When Africans were first brought as slaves
to America, they were often housed at the
periphery of farms. Initially a great deal of
interaction took place between blacks and
local Native Americans, who taught them
how to hunt the native game without guns
and to use the indigenous plants. Some of the
Native American cooking techniques were
later introduced into white southern cuisine
by African American cooks, and many of
the flavors typical of modern southern cook-
ing come from traditional Native American
foods. Hominy (dried corn kernels with the
hulls removed) and grits (made of coarsely
ground hominy) were introduced to the set-
tlers by the Native Americans. The chicken
dish known as Brunswick stew is an adapta-
tion of a southern Native American recipe for
squirrel. The Native Americans also made
sophisticated use of native plants for season-
ing, and they thickened their soups and stews
with sassafras.
The staple foods of corn, beans, and squash
were supplemented with the indigenous
woodland fruits and vegetables. Blackber-
ries, gooseberries, huckleberries, raspberries,
strawberries, crab apples, grapes, groundcher-
ries, Jerusalem artichokes, leafy green vegeta-
bles, persimmons (pounded into a paste for
puddings and cakes), and plums were some of
the numerous edible native plants. Tomatoes
and watermelons were added after introduc-
tion by the Spanish into Florida. The Native
Americans of the South also used beechnuts,
A Native American hotel
chef, George Crum,
is attributed with the
invention of potato chips
in 1853. Today Americans
consume an average of
seventeen pounds of
potato chips per person
each year.
S A M P L E M E N U
A Traditional
Northeastern Indian Meal
Iroquois Soupa,b or Duck with Wild Ricea
Bannocksa,c
Indian Puddinga,b or Maple Popcorn Ballsa,c
Strawberry Juice
aCox, B., & Jacobs, M. 1991. Spirit of the harvest: North American Indian cooking.
New York: Stewart, Tabori & Chang.
bRecipeSource at http://www.recipesource.com/ethnic/americas/native/
cRecipe Goldmine at
http://www.recipegoldmine.com/regnativeam/nativeam.html
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 5 1 1 7
hazelnuts, hickory nuts, pecans, and black
walnuts in their cooking. The thick, cream-
like oil extracted from hickory nuts was used
to flavor corn puddings and gruels, and a tra-
ditional Cherokee specialty was kanuche, a
soup made from the nuts (often with the addi-
tion of corn, hominy, or rice), is still popular
today. Honey was the sweetener used most
frequently, and it was mixed with water for
a cooling drink. Teas were made from mint,
sassafras, or spicebush (Lindera benzoin), and
during the summer “lemonade” was made
from citrus-flavored sumac berries.
Plains The Native Americans who lived in
the area that is now the American Midwest
were mostly nomadic hunters, following the
great herds of bison across the flat plains for
sustenance. The land was rugged and gener-
ally unsuitable for agriculture. Those nations
that settled along the fertile Mississippi and
Missouri River valleys, however, developed
farm-based societies supported by crops of
beans, corn, and squash.
Bison meat was the staple food for most
plains nations such as the Arapaho, Cheyenne,
Crow, Dakota, and Pawnee. The more tender
cuts were roasted or broiled, while the tougher
ribs, joints, and other bones with marrow
were prepared in stews and soups. Pieces of
meat, water, and sometimes vegetables would
be placed in a hole in the ground lined with
cleaned buffalo skin. The stew would then be
stone boiled: rocks that had been heated in
the fire would be added to the broth until the
mixture was thoroughly cooked. All parts of
the bison were eaten, including the liver and
kidneys (which were consumed raw immedi-
ately after the animal was slaughtered), udder,
tongue, and hump. Extra meat was preserved
by cutting it into very thin strips and then
dehydrating it in the sun or over the fire. This
tough, dried meat would keep for several years
and was known as jerked buffalo or jerky. The
jerky would be pulverized and mixed with
water or corn gruel, or, in emergencies, eaten
dry. Most often it was shredded and mixed
with bison fat and berries, then formed into
cakes called pemmican.
When bison were unavailable, the plains
nations would hunt deer, rabbit, and game
birds. Fresh leafy green vegetables were con-
sumed in season, and root vegetables, such
as wild onions, prairie turnips (Psoralea
esculenta, also called breadroot, tipsin, and
timpsila), and Jerusalem artichokes, were
eaten throughout the year. Wild rice, a native
aquatic grass with an earthy, nutty flavor,
was collected in the northern parts of the
Midwest. It was served with bison, venison,
or duck and used as a stuffing for grouse, par-
tridge, and duck. Wild rice is believed to have
traditionally provided as much as 25 percent
of the total Ojibwa diet, and it was customar-
ily prepared with maple syrup.28 Blackberries,
shadberries (also called Juneberries or saska-
toon berries), cherries, crab apples, grapes,
persimmons, and plums were available in
some areas, but the most popular fruit was
the scarlet buffalo berry (Shepherdia canaden-
sis), so called because it was often served in
sauces for bison meat or dried for pemmican.
In addition, berries were traditionally boiled
with bison suet and/or blood to make a thick
pudding called wojapi.
Southwestern Some of the oldest Native
American settlements in North America
were located along the river valleys of the arid
Southwest. Despite the semidesert conditions,
many Native Americans such as the Hopi,
Pima, Pueblo, and Zuni lived in pueblo (Span-
ish for “town” or “village”) communities and
were mostly farmers, cultivating beans, chili
peppers, corn, and squash. Others, including
the Apache and Navajo, were originally rov-
ing hunters and gatherers. After the Spanish
introduced livestock, some of these nomadic
groups began to raise sheep. Mutton has since
become associated as a traditional staple food
of the region.
Until the arrival of livestock, the diet of the
region was predominantly plant based, pro-
viding a nourishing diet when supplemented
with small game such as rabbit and turkey.
Corn was the primary food, and at least five
different colors of corn were cultivated. Each
color symbolized one of the cardinal points for
the Zuni, and each had its own use in cook-
ing. White corn (East) was ground into a fine
meal and used in gruels and breads. Yellow
corn (North) was roasted and eaten in kernel
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
1 1 8 N A T I V E A M E R I C A N S
form or off the ear. The rarer red (South), blue
(West), and black (the nadir, the lowest point
beneath the observer) corn was used mostly
for special dishes, such as the lacy flat Hopi
bread made from blue cornmeal, known as
piki. Multicolored corn represented the zenith.
The Hopi also attached importance to the
color of corn and cultivated twenty different
varieties. In many areas, corn was prepared in
ways similar to those of the northern Mexican
Native Americans—tortillas (flat, griddle-
fried cornmeal bread), pozole (hominy), and
the tamale-like chukuviki (stuffed cornmeal
dough packets). Juniper ash (considered a
good source of calcium and iron) was often
added to cornmeal dishes for flavoring.29
Beans were the second most important
crop of the southwestern region. Many vari-
eties were grown, including the domesticated
indigenous tepary beans and pinto beans
from Mexico. Both squash and pumpkins
were commonly consumed, and squash blos-
soms were fried or added to soups and salads.
Squash and pumpkin seeds were also used to
flavor dishes, and chile peppers were used as
vegetables and to season stews. Cantaloupes
(also known as muskmelons) were also grown
after they were introduced by the Spanish.
When crops were insufficient, the south-
western Native Americans relied on wild
plants, and to add variety, tender amaranth
greens were eaten in summer. Piñon seeds
(also called pine nuts) flavored stews and
soups. Both the fruit (tunas) and the pads
(nopales) of the prickly pear cactus were
eaten, as were the pulp and fruit of other
succulents, such as yucca (the starchy fruit
known today as “Navajo bananas”). A unique
food popular with some Apache was the root
of the mescal plant, another desert succu-
lent. It would be baked for hours in a cov-
ered, stone-heated pit until it developed a
soft, sticky texture and a flavor similar to
molasses.5 The beans of the mesquite tree
were a staple in some desert regions; they
were ground into a flour and used in gruels,
breads, and sun-baked cakes.
Northwest Coast/Alaska Natives This culinary
region incorporates a diverse geographic area.
The climate of the Pacific Northwest coast is
S A M P L E M E N U
A Traditional
Southeastern Indian Meal
Cherokee Pepper Pot Soupa,b or Brunswick Stewa
Corn Ponea,b,
Huckleberry Honey Cakea,c or Grape Dumplingsa
Honey Water
aCox, B., & Jacobs, M. 1991. Spirit of the harvest: North American Indian cooking.
New York: Stewart, Tabori & Chang.
bRecipeSource at
http://www.recipesource.com/ethnic/americas/native/
cRecipe Goldmine at
http://www.recipegoldmine.com/regnativeam/nativeam.html
S A M P L E M E N U
A Traditional
Great Plains Indian Meal
Pemmicana,b,c
Stuffed Pumpkina or Buffalo/Bison Stewb
Broiled Jerusalem Artichokesa
Chokecherry Puddinga,b or Wojapi (pudding)Wojapi (pudding)Wojapi b
Peppermint Teab
aCox, B., & Jacobs, M. 1991. Spirit of the harvest: North American Indian cooking.
New York: Stewart, Tabori & Chang.
bNative Tech: Indigenous Foods and Traditional Recipes at
http://www.nativetech.org/recipes/index.php
cPemmican: Recipes, Stories and Stores at
http://w4.lns.cornell.edu/~seb/pemmican.html
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 5 1 1 9
temperate. The luxuriantly forested hills and
mountain slopes abound with edible plants
and game, and the sea supplies fish, shell-
fish, and marine mammals. Farther north,
in Alaska and Canada, the growing season
shortens to only a few summer months, and
temperatures in the winter regularly plunge
to minus fifty degrees Fahrenheit. Two-thirds
of Alaska is affected by permafrost, and the
vast stretches of tundra are inhospitable to
humans.
The Native American ethnic groups inhab-
iting this region include Indians as well as
the Inuit (Eskimos) and the Aleut, known as
Alaska Natives. Native American nations such
as the Tlingit and Kwakiutl inhabit the north-
west coastal area and some interior Alaskan
regions. The Aleut live on the thousand-mile-
long chain of volcanic islands that arch into the
Pacific from Alaska called the Aleutians. The
Inuit, including the Yupik and Inupiat, live in
the northern and western areas of Alaska, as
well as in Canada, Greenland, and Siberia.
The Native Americans of the Northwest
Coast had no need for agriculture. Food was
plentiful, and salmon was their staple. The fish
were caught annually in the summer as they
swam upstream to spawn. They were roasted
over the fire when fresh, and the eggs, known
today as red caviar, were a favorite treat when
dried in the sun into chewy strips. Extra fish
were smoked to preserve them for the winter.
In addition, cod, clams, crabs, halibut, her-
ring, shrimp, sole, smelt, sturgeon, and trout
were consumed. Ocean mammals such as
otter, seal, and whale were also hunted. Bear,
deer, elk, and mountain goats were eaten, as
were numerous wild fowl and game birds.
Despite the abundant fish and game, wild
plants made up more than half the diet of the
Northwest Coast Native Americans. More
than one hundred varieties of indigenous
fruits, vegetables, and even lichen were con-
sumed, including acorns, blackberries, blue-
berries, chokecherries (Prunus virginiana),
desert parsley, hazelnuts, huckleberries,
mint, raspberries, salal (Gaultheria shallon),
and strawberries. Camass roots (Camassia
quamash), a bulb related to the hyacinth,
were roasted or dried by many Indians of the
region. Fresh greens were also popular.
In contrast to the plenty of the Northwest
Coast, the diet of many Alaska Natives was
often marginal. The Inuit and Aleut were
usually seminomadic, traveling as necessary
to fish and hunt. Fish and sea mammals,
such as seal, walrus, and whale, were the sta-
ple foods. Arctic hare, caribou, ducks, geese,
mountain goats, moose, musk oxen (hunted
to extinction in Alaska by the 1870s), polar
bear, and mountain sheep were consumed
when available. Some items were boiled,
but many were eaten raw due to the lack
of wood or other fuel. The fat of animals
was especially valued as food. Muktuk (also
called muntak or onattak), still a commonly
consumed item, consists of chunks of meat
with the layer of fat and skin attached. Muk-
tuk is typically frozen before use. Walrus or
whale muktuk can also be preserved by roll-
ing it in herbs (with no salt) and fermenting
it in a pit for several months to make a treat
known as kopalchen. Akutok, a favored dish,
was a mixture of seal oil, berries, and cari-
bou fat. Even the stomachs of certain game
were examined for edible undigested foods,
S A M P L E M E N U
A Traditional
Southwestern Meal
Green Chili Stewa,b,c,d
Blue Corn Breadb,c,d or Frybreada,b,c,d
Pueblo Piñon/Feast Day Cookiesa,d or Navajo Peach Crispa,b
aCox, B., & Jacobs, M. 1991. Spirit of the harvest: North American Indian cooking.
New York: Stewart, Tabori & Chang.
bKeegan, M. 1996. Southwest Indian cookbook. Santa Fe, NM:
Clear Light Publishers.
cTraditional Native American Recipes from The Cooking Post at Traditional Native American Recipes from The Cooking Post at Traditional Native American Recipes from The Cooking Post
http://cookingpost.com/recipes.htm
dRecipe Goldmine at
http://www.recipegoldmine.com/regnativeam/nativeam.html
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1 2 0 N A T I V E A M E R I C A N S
such as lichen in elk and clams in wal-
ruses. The limited selection of wild plants
included willow shrubs, seaweed, mosses,
lichen, a few blueberries, salmonberries,
and cranberries. Leaves from an aromatic
bush known as bog shrub (Ledum palustre)
were brewed to make tundra tea (also called
Hudson Bay tea), a beverage still popular
today.
Other Native American Cuisines Many tra-
ditional Native American diets do not fit
conveniently within the five major regional
cuisines. Among them was the fare of the
population found in what is now Nevada
and parts of California, called Digger Indi-
ans by the first whites to encounter them
because they subsisted mostly on dug-up
roots, such as Indian breadroot, supple-
mented by small game and insects. In central
California, numerous nations, such as the
Miwok and Pomo, had an acorn-based diet.
Acorns contain tannic acid, a bitter-tasting
substance that is toxic in large quantities.
To make the acorns edible, Native Ameri-
can women would first crack and remove
the hard hull, grind the meat into a meal,
add water to make a dough, and then leach
the tannic acid from the dough by repeat-
edly pouring hot water through it. Acorns
were sometimes leached in sandy-bottomed
streams as well.
In the rugged northern mountains and
plains lived nations such as the Blackfeet,
Crow, Shoshone, and Dakota, who were
nomadic hunters of game. Although many
may have hunted bison at one time, they
were limited to the local bear, deer, moose,
rabbits, wildfowl, and freshwater fish when
the expansion of other Native Americans
and whites into the Midwest pushed them
northward and westward. Wild plants added
variety to their diet. For example, the Nez
Percé baked camass roots in a covered pit
with heated rocks, which caramelized the
starch providing a sweet, onion-like flavor.
The cooked roots were made into gruel or
dough for bread.30
Meal Composition
and Cycle
Daily Patterns
Traditional meal patterns varied according to
ethnic group and locality. In the Northeast,
one large, hearty meal was consumed before
noon, and snacks, such as soup, were available
throughout the day. In some tribes, no specific
meal time was standard. The men were served
first, and stood or sat while they consumed
the meal in silence. Women and children
ate next.
▲ Inuit women preparing a
dead seal for butchering.
Be
tt
m
an
n/
CO
RB
IS
S A M P L E M E N U
A Northwest Coast Indian Meal
Barbecued Clamsa or Fresh Salmonc
Elk Stew with Acorn Dumplingsa,b
Steamed Fiddlehead Fernsa,b
Whipped Raspberry (Soup)a,b
aCox, B., & Jacobs, M. 1991. Spirit of the harvest: North American Indian cooking.
New York: Stewart, Tabori & Chang.
bAstray Recipes at http://www.astray.com/recipes/
cKwakuitl Recipes at http://www.hallman.org/indian/recipe.html
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 5 1 2 1
Serving two meals per day was more com-
mon in the Southwest. The women would rise
before dawn to prepare breakfast, eaten at sun-
rise. The afternoon was spent cooking the eve-
ning meal, which was eaten before sunset. Two
meals per day was also the pattern among the
Native Americans of the Pacific Northwest.
In regions with limited resources, meals
were often monotonous. The two daily meals
of the southwestern Native Americans, for
example, regularly consisted of cornmeal
gruel or bread and boiled dehydrated vegeta-
bles. No distinction was made between morn-
ing or evening menus. Other dishes such as
game, fresh vegetables, or fruit were included
when seasonally available. The single meal
of the northeastern Native Americans often
included roasted game; the Northwest Coast
Native Americans frequently included some
form of salmon twice a day, in addition to the
many local edible greens and roots.
Food was simply prepared. It was roasted
over the fire or in the ashes or cooked in soups
or stews. The northeastern and Northwest
Coast Native Americans steamed sea-food in
pits; southwestern Native Americans baked
cornmeal bread in adobe ovens called hornos.
(After the introduction of hogs, flat breads
were commonly fried in lard.) Seasonal items
were preserved by drying them in the sun or
smoking them over a fire; for meat, fish, and
oysters, special wood was often used to impart
a distinctive flavor. Other foods were ground
into a meal or pounded into a paste. In Alaska,
meats, greens, and berries were preserved in
fermented (aged) blubber. All nations liked
sweets, but they were limited to fruits and
dishes flavored with maple syrup, honey, or
other indigenous sweeteners.
Special Occasions
Many Native American religious ceremo-
nies were accompanied by feasts. Among the
northeastern Iroquois, seasonal celebrations
were held for the maple, planting, strawberry,
green corn, harvest, and New Year’s festivals.
The southern nations held an elaborate Green
Corn Festival in thanks for a plentiful summer
harvest. No one was allowed to eat any of the
new corn until the ceremony was complete.
Each home was thoroughly cleaned, the fires
were extinguished, and all old pieces of pot-
tery and clothing were replaced with newly
made items. The adult men bathed and purged
themselves with an emetic. When everything
and everyone were thoroughly clean in body
and spirit, a central fire was lit by rubbing two
sticks together, and each hearth fire was relit
with its flames. The feasting on new corn then
began. Amnesty was granted for all offenses
except murder, and the festival signified
the beginning of a new year for marriages,
divorces, and periods of mourning.
Role of Food in Native
American Culture and
Etiquette
Historically, many Native American nations,
especially in the inland regions, experienced
frequent food shortages. As a result, food is
valued as sacred, and, in the holistic world-
view of most Native American groups, food
is also considered a gift of the natural realm.
In some nations elaborate ceremonies accom-
panied cultivation of crops, and prayers were
offered for a successful hunt.
The men in many nations were tradition-
ally responsible for hunting or the care of live-
stock. The job of food gathering, preparation,
and storage usually belonged to the women, ▼ Baking bread in a south-
western outdoor oven.
Be
tt
m
an
n/
Co
rb
is
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
1 2 2 N A T I V E A M E R I C A N S
who also made the cooking utensils, such
as watertight baskets or clay pots.8,24 In pre-
dominantly horticultural societies, both men
and women were frequently involved in cul-
tivation of the crops. Among the nations of
the Northeast, the men ate first, followed by
women and children. In the Southwest, men
prepared the game they caught and served it
to the women.
Sharing food is an important aspect of
most Native American societies today. Food
is usually offered to guests, and in some tribes
it is considered rude for a guest to refuse food.
It is also impolite to eat in front of others with-
out sharing.31 Any extra food is often given
to members of the extended family. In some
nations of the Southwest, meals are prepared
and eaten communally. Each woman makes
a large amount of one dish and shares it with
the other families, who in turn share what
they have prepared. Many Native Americans
find the idea of selling food inconceivable; it
is suggested that this is one reason there are
few restaurants featuring Native American
specialties.
Therapeutic Uses of Food
The role of food in spiritual and physical
health is still important for many Native
Americans, and many food plants provide
medicine in some form. Corn is significant in
some healing ceremonies. Cornmeal may be
sprinkled around the bed of a patient to pro-
tect him or her against further illness. Corn
pollen may be used to ease heart palpitations,
and fine cornmeal is rubbed on children’s
rashes. Navajo women drink blue cornmeal
gruel to promote the production of milk after
childbirth, and Pueblo women use a mixture
of water and corn ear smut (Ustilago maydis a
kind of fungus) to relieve diarrhea and to cure
irregular menstruation. A similar drink was
given to Zuni women to speed childbirth and
to prevent postpartum hemorrhaging. Corn
silk tea was used as a diuretic and was pre-
scribed for bladder infections.32
Numerous other indigenous plants are
used by Native Americans for medicinal
purposes. For example, agave leaves (from
a succulent common in the Southwest) are
chewed as a general tonic, and the juice is
applied to fresh wounds. Another succu-
lent, yucca, was considered a good laxative
by the Hopi. Pumpkin pastes soothe burns.
Chile peppers are used in compresses for
arthritis and applied directly to warts. Infu-
sions are used for many remedies, such as
wild strawberries or elderberry flowers for
diarrhea and mint tea to ease colic, indi-
gestion, and nausea. The Ojibwa boiled
blackberry roots to prevent miscarriages
and sumac fruit and roots to stop bleeding.
Traditionally, maple sugar lozenges were
used for sore throats. Bitter purges and
emetics are administered because they are
distasteful and repugnant to any evil spirits
that might cause illness.33
Food restrictions are still common dur-
ing illness. Depending on the nation, many
Native Americans believe that cabbage, eggs,
fish, meat, milk, onions, or organ meats
should be eliminated from a patient’s diet.
Conversely, some foods may be considered
important to maintain strength during sick-
ness, such as meat among the Seminole in
Florida,34 and both meat and blue cornmeal
among the Navajo.35 The Navajo may avoid
sweets during pregnancy to prevent having a
weak infant.16 Some foods are prohibited after
childbirth, such as cod, halibut, huckleberries,
and spring salmon for Nootka women of the
Northwest Coast.
Native Americans found many plants had
psychotherapeutic properties. They were
used to relax and sedate patients, to stupefy
enemies, and to induce hypnotic trances dur-
ing religious ceremonies. The opiates in the
roots of California poppies dulled the pain of
toothache, for example. Lobelia was smoked
as an antispasmodic for asthma and bronchi-
tis. In the Southwest, knobs from the peyote
cactus were used to produce hallucinations,
sometimes in combination with other intoxi-
cants. Jimsonweed (Datura stramonium) was
traditionally used to keep boys in a semicon-
scious state for twenty days so that they could
forget their childhood during Algonquin
puberty rites.36 It is still used today by some
Native Americans for medicinal and ritual
purposes.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 5 1 2 3
Contemporary Food
Habits
Native American ethnic identity is chang-
ing. Traditional beliefs and values are often
in direct conflict with those of the majority
society, and Native Americans’ self-concept
has undergone tremendous changes in the
process of acculturation. Three transitional
adaptations of members of the Ojibwa (also
called Chippewa) tribe, identified by three
different lifestyles, may serve as a model for
the adaptations made by members of other
Native American groups.37 The first stage of
adaptation is traditional; during this stage
parents and grandparents speak the Ojibwa
language at home, practice the Midewiwin
religion, and participate in Native American
cultural activities such as feasts and pow-
wows. The second stage is more acculturated.
English is the primary language, although
some Ojibwa also is spoken. Catholicism
is the preferred religion, and the family is
involved in activities of the majority soci-
ety. In the third Ojibwa lifestyle—the pan-
traditional stage—the family speaks either
English or Ojibwa exclusively; practices
a religion that is a combination of Native
American and Christian beliefs, such as the
Native American Church; and is actively
involved in activities of both traditional
Native American and white societies.
Adaptation of Food Habits
Food habits reflect changes in Native Ameri-
can ethnic identity. Many Native Americans
eat a diet that includes few traditional foods.
Others are consciously attempting to revive
the foods and dishes of their ancestors.
Ingredients and Common Foods
When Native Americans were uprooted from
their lands and their known food supplies,
many immediately became dependent on the
foods provided to the reservations. One study
evaluating the diets of Havasupai Indians liv-
ing on a reservation in Arizona found that
58 percent of the subjects ate only foods
purchased or acquired on the reservation
during the twenty-four-hour recall period.38
Commodity foods currently include items
such as canned and chopped meats, poultry,
fruit juices, peanut butter, eggs, evaporated
and powdered milk, dried beans, instant
potatoes, peas, and string beans. Research-
ers report that many of these foods, such as
kidney beans, noodles, and peanut butter,
are discarded by the Navajo; powdered milk
may also be rejected because it is disliked or
is considered a weak food suitable only for
infants or elderly people.19 On some reserva-
tions, large supermarkets provide a selection
of foods similar to that found throughout the
United States; however, on more remote res-
ervations and in many rural areas access to
markets is very limited.18,39,40 Other sources of
food include gardening (reportedly practiced
by between 43 and 91 percent of rural Native
Americans), fishing, hunting, gathering indig-
enous plants, and raising livestock. One study
of California Miwok, for instance, reports that
67 percent of respondents recall that their
grandparents harvested wild greens, nuts,
berries, and mushrooms, and that 47 percent
of respondents continue to supplement their
diet this way.41 A national Canadian survey
reported that 66 percent of aboriginal peoples
obtained some of their meat, poultry, and
fish through hunting and fishing; 10 percent
obtained most in this way; and 5 percent
obtained all this way.42 These supplementary
food sources are limited by seasonality and,
in some cases, by state and federal hunting
and fishing laws.39 Native Americans living in
urban areas have the same access to food as
other city dwellers.
Over the years, traditional foods were lost
and substitutions were made. For example,
beef is a commonly accepted substitute for
game among many Native American ethnic
groups. Fry bread is another example. It is a
flat bread made from wheat flour typically
fried in lard, and has been prepared in the
Southwest for about one hundred years and
in other regions for even less time. Though
made from ingredients introduced by the
Europeans, it is one of the items most often
identified as “traditional” among Indians
throughout the nation,43 and it is often served
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
1 2 4 N A T I V E A M E R I C A N S
at Native American festivals. It has been sug-
gested that the substitution of Western foods,
especially commodity items, in the prepara-
tion of traditional Indian dishes has adversely
affected the nutritional value of these foods.44
Traditional foods make up less than 25 per-
cent of the daily diet among the Hopi. Older
Hopi women lament the fact that younger
Hopi are no longer learning how to cook
these dishes.45 In a study of Cherokee women,
the degree of Native American heritage of the
woman in charge of the food supply in the
home directly affected the consumption of
traditional foods in that home.46 Corn and
corn products, such as hominy, were among
the most popular traditional foods; game
meat, hickory nuts, raspberries, and win-
ter squash were the least commonly served.
Among Cherokee teenagers, traditional items
such as fry bread, bean bread (corn bread with
pinto beans), and chestnut bread (made from
chestnuts and cornmeal) were well accepted.
Although more than 80 percent of the ado-
lescents were familiar with typical Cherokee
dishes, including native greens and game
meat (bear, deer, groundhog, rabbit, raccoon,
squirrel, and wild boar), these foods were
rarely eaten.47 Pima consume traditional
items, such as tepary beans and cactus stew,
mostly at community get-togethers.48 A small
sample of children from four different Native
American communities recorded that only
7 out of 1,308 items listed in food recalls for
the study were traditional.49 California Miwok
list mostly southwestern items such as beans,
rice, and tortillas as those they most associ-
ate with Native American foods and recall
numerous items eaten by their grandparents
but not consumed now, such as squirrel, rab-
bit, deer, acorn mush, and certain insects.
Access to wild game is limited due to hunt-
ing restrictions. Navajo women eat traditional
foods infrequently, with the exception of fry
bread, mutton, and tortillas. Blue cornmeal
mush (with ash), hominy, and sumac berry
pudding are a few of the native dishes con-
sumed occasionally.50 Dakota women of all
ages take pride in traditional foods but pre-
pare them only when it is convenient or for
special occasions. A study of Sencotan Indians
in British Columbia found that marine foods,
especially salmon, retain social and economic
importance within the community.51 Among
some Baffin Inuit, traditional foods (e.g., sea
and land mammals, fish) make up about one-
third of energy intake. Men were found to eat
more traditional items than women.52 A study
of Yupik Inuit found that younger respondents
(ages 14–19) ate significantly fewer traditional
foods than did the oldest respondents
(ages 40–81).53
Broader efforts to preserve traditional and
adapted Native American food traditions are
also underway. Notably, the group Renewing
America’s Food Traditions (RAFT), a coali-
tion of organizations dedicated to bring-
ing the foods of the past into the present,
have listed over 700 endangered food items
(see Table 5.3). Support of communities
attempting to recover and conserve food
traditions is their primary goal.54
Meal Composition and Cycle
Little has been reported regarding current
Native American meal patterns. It is assumed
that three meals per day has become the
norm, especially in families without income
constraints. Meals consumed by Native Amer-
icans vary considerably among regions. In
the text Cultural Food Practices, the diet for
Northern Plains Indians’ is described as one
centered around meats and starches with a
limited variety of fruits and vegetables. The
access to commodity food supplements also
influences food choices.18 The Navajo still use
traditional cooking methods but have also
adapted to using more fat and salt in food
preparation.18 Navajo women were found to
eat fry bread or tortillas, potatoes, eggs, sugar,
and coffee most frequently. Fried foods were
preferred for breakfast, and lunch and dinner
consisted of one boiled meal and one fried
or roasted meal. The Pima in Arizona prefer
eggs, bacon or sausage, and fried potatoes for
breakfast, while Southwest specialties, such as
tacos, tamales, and chili con carne, are com-
mon at other meals. A study comparing Indi-
ans in New England living on reservations to
those living in urban areas found baking and
boiling remain favored preparation meth-
ods by respondents living on reservations,
whereas urban residents were more likely to
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 5 1 2 5
fry items. Grilled meats and smoked fish were
also common ways of cooking.43
Special Occasions
Numerous traditional celebrations are main-
tained by Native American tribal groups.18
Among the largest is the five-day Navajo
Nation Fair held each Labor Day weekend;
the Pawnee Veteran’s Day Dance and Gather-
ing where ground meat with pecans and corn
with yellow squash are served; the Miccosukee
Arts Festival and the Seminole Fair in Miami,
where alligator meat is featured; the Iroquois
Midwinter Festival held in January to mark the
new year; the Upper Mattaponi Spring Festival
in Virginia over Memorial Day weekend; the
three-day Creek Nation Festival and Rodeo;
the Yukon International Storytelling Festival
at which wild game such as caribou and musk
ox are available; and the Apache Sunrise Cer-
emony which features gathered foods such as
amaranth leaves and the pulp and fruit from
the saguaro and prickly pear cacti. More local
festivities are also common. Pueblo Feast Days
are observed in honor of the Catholic patron
saint of each village with a soup of posole
(hominy) and beef or pork ribs. Northwest
Coast potlatches are common in the spring,
featuring herring roe, fish or venison stews,
euchalon, salmon, and other traditional foods.
In addition, there are all-Indian festivals that
draw attendees from throughout the country,
such as O’Odham Tash Indian Days in
Casa Grande, Arizona; the Red Earth Festival
in Oklahoma City; and the Gallup Intertribal
Indian Ceremonial in New Mexico. Native
Americans may also eat traditional foods on
special occasions such as birthdays, but for
holidays of the majority culture, other foods
are considered appropriate. For example, tur-
key with all the trimmings is served by the
Dakota for Thanksgiving and Christmas.55
Chapalote Corn Considered the original cultivated corn with small ears, coffee-colored kernels,
and a flinty flavor
Chiltepin Pepper Pea-sized, very hot wild chile pepper native to the Southwest considered the
ancestor of most varieties used today—drought, diminishing habitat, and
unscrupulous harvesting threatens this chile with extinction
Eulachon Smelt Pacific Northwest source of oil that has suffered serious declines in
population—further, traditional methods of processing are gradually being lost
Gulf Coast Sheep Introduced to the Southeast by the Spanish in the 1500s, this breed adapted
well to the humid conditions of the region, providing excellent meat and
wool—newer breeds are lessening their popularity
Java Chicken One of the first chicken breeds introduced to the United States, these birds now
number only about one hundred
Marshall Strawberry An heirloom fruit discovered in Massachusetts in 1890 but grown commercially
in the Pacific Northwest—very intense flavor
Native American
Sunflowers
Indigenous plants cultivated by the Native Americans for seeds and oil—
brought to Europe as an oil source—popularity of the oil led to growing a
single “improved” variety, and this one type is now susceptible to numerous rust
diseases—few sources of the original seeds remain
Pineywoods Cattle A foraging breed introduced by the Spanish to Florida, particularly suited to
conditions in the South, and popular with early Native American ranchers—
approximately 200 animals are left
Seminole Pumpkin A pear-shaped pumpkin grown on vines that use trees for support—found in
the Everglades but rarely cultivated today
White Abalone The deepest inhabitant of West Coast Abalone, it has neared extinction due
to the popularity of its sweet meat—now being bred in a recovery program
designed to save it
SOURCE: Nabhan, G.P., & Rood, A. 2004. Renewing America’s Food Traditions (RAFT): Bringing cultural and culinary mainstays of the past into the new millennium.
Flagstaff: Center for Sustainable Agriculture at Northern Arizona University.
TA B L E 5. 3 America’s Top Ten Endangered Foods
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1 2 6 N A T I V E A M E R I C A N S
Nutritional Status
Nutritional Intake
Research on the nutritional status of Native
Americans is limited. Severe malnutrition
was documented in the 1950s and 1960s,
including numerous cases of kwashiorkor
and marasmus. Today, lower socioeconomic
status and higher unemployment contribute
to an inadequate diet for some Native Ameri-
cans. In general, however, recent changes in
morbidity and mortality figures suggest that
Native Americans have transitioned from the
conditions associated with underconsump-
tion, such as infectious diseases, to conditions
associated with overconsumption, including
obesity, type 2 diabetes, and cardiovascular
disease.56
Studies of current Alaska Native eat-
ing habits suggest that diets high in refined
carbohydrates (starchy and sugary foods)
and fat, and low in fruits and vegetables, are
common. The protein and nutrient of Alaska
Natives has declined during the past several
decades, as many foods obtained through
hunting and gathering were replaced by pro-
cessed, canned, and packaged items.57 The
estimated carbohydrate content of the Alaska
Native diet before contact with Westerners
was exceptionally low (3 to 5 percent of daily
calories) due to a dependence on sea mam-
mals and fish. Within only a few generations,
that figure had increased to 50 percent of total
calories, much of it from low-nutrient-density
foods.58,59 Research on Alaska Natives has also
shown low intakes of calcium, iron, phospho-
rus, magnesium, zinc, vitamins A, C, D, and
E, riboflavin, and folic acid, as well as fiber,
omega-6, and omega-3 fatty acids. Traditional
Alaska Native diets have been found lower in
fat and carbohydrates, and higher in protein,
phosphorus, potassium, iron, zinc, copper,
magnesium, manganese, selenium, and sev-
eral vitamins, including A, D, E, riboflavin,
and B6.
60,61,62,63
A similar transition occurred in the diets of
American Indians in other parts of the nation;
and today, refined carbohydrates are promi-
nent in the diet. Studies have identified white
breads, tortillas, potato chips, French fries,
and candy as the top contributors of energy
for many Native Americans.49,64,65,66,67 Of par-
ticular note is the consumption of sweetened
beverages, including soda and fruit-flavored
drinks, estimated to be 15 to 27 percent of
all carbohydrates consumed, and as much as
17 percent of daily calories.64,67,68,69,70,71 High-
fat foods, including fried foods and processed
meats and beef dishes, are another significant
source of energy.
A low intake of fruits and vegetables is
prevalent in the diets of both Native Ameri-
can adults and adolescents.64,65 Of Indians in
California, 60 percent said they had not eaten
any fruit the previous day, and 28 percent
reported they had not consumed any vege-
tables.72 Among the Lakota of South Dakota,
nearly 60 percent stated they ate fruit only two
to eight times a month; nearly half reported
eating vegetables (including potatoes) over
five times weekly.73 A study of Catawba
showed 47 percent ate less than one fruit daily,
and 87 percent consumed only one vegetable
or less.74 The vegetable most often consumed
in a study of Native American women in
Oklahoma was French fries; and only toma-
toes, tossed salad, green beans, potato salad,
and mashed potatoes were also mentioned in
the list of the top fifty-three items most often
eaten.69 Barriers to increased consumption of
fruit and vegetables included cost, availability,
and quality.
Native American nutrient intake has been
compared to that of the general population in
a few studies. It is notable that among both
children and adults, few differences are found.
One large study in three states reported that
median intakes of vitamins A and C and folate
were low for both American Indians and the
total population.75 A comparison of dietary
calcium intake among African American,
Native American, and white women in North
Carolina found that although whites ate sig-
nificantly more high-calcium foods than did
Native Americans, none of the respondents
were consuming recommended levels of the
mineral through their food.5,76 Other research-
ers who investigated rural Native American
and white children in Oklahoma suggest that
their diets are more influenced by factors such
as poverty and living in a rural area than by
cultural or structural issues related to race or
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C H A P T E R 5 1 2 7
ethnicity.67 Nutrient deficiencies in Native
American adults and children may occur, but
with the exception of Alaska Natives, most
studies suggest dietary adequacy similar to
that of the total U.S. population.
Life expectancy has improved over recent
years, yet disparities are still found. The aver-
age life expectancy is approximately 4.2 years
less when compared to the U.S. popula-
tion. “American Indians and Alaska Natives
continue to die at higher rates than other
Americans from a variety of ailments, includ-
ing chronic liver disease and cirrhosis, diabe-
tes mellitus, unintentional injuries, assault/
homicide, intentional self-harm/suicide, and
chronic lower respiratory diseases.”77
Native American mothers are more likely
to be younger than the general population
and less likely to be married. Thirty percent of
American Indian and Alaska Native women
do not receive prenatal care during the first
trimester of pregnancy. American Indian
and Alaska Native infants die at a rate of
8.5 per every 1,000 live births, as compared
to 6.8 per 1,000 for the U.S. all races popu-
lation (2000–2008 rates).4,76 Postnatal
mortality rates are nearly 60 percent higher
for American Indians and Alaska Natives
compared to the total population; this is
mostly due to sudden infant death syndrome
(SIDS), congenital malformations, prematu-
rity, and injury.78 Breast-feeding has tradi-
tionally been considered the proper way to
feed infants among most Native Americans.
Among the Navajo in one study, elders
reported that breast-fed infants were better
able to hear traditional teachings and were
better disciplined. It also demonstrated that
the children are loved. Eighty-one percent of
subjects initiated breast-feeding. Most added
infant formula within the first week and used
this combined feeding practice for more than
five months.79 Other estimates of breast-
feeding show rates of 24 to 62 percent.80,81
Baby-bottle tooth decay, due most often to
extended use of a bottle with formula, milk,
juice, or soda, affects more than one-half of all
Native American and Alaska Native children.
Overweight and obesity are prevalent
among Native Americans. National data
suggest obesity rates of 37 percent among
American Indian adults in 2008, approxi-
mately 20 percent above the average for the
total population.4 In another survey, the
highest obesity rates were found in Native
Americans living in Alaska, and the lowest in
the Pacific Northwest.82 Though definitions of
overweight and obesity vary in other research,
the trends are consistent. Group-specific stud-
ies report 83 percent of Havasupai subjects
and 60 percent of Seminole were identified
as obese; 63 percent of Navajo women and
33 to 50 percent of Navajo men were over-
weight; and 61 percent of Indians residing in
Oklahoma were overweight or obese.83,84 In
some groups, such as the Inuit, overweight
was traditionally desirable as a visible dem-
onstration of wealth during times of priva-
tion.10 Among the Navajo, elder men and
women prefer a heavier body shape.85 Studies
of Native American school children and
adolescents show consistently higher weight-
for-height ratios than for white, black, or
Hispanic populations, while body mass index
(BMI) rates over the 85 percentile varied, up
to 50 percent for girls, and nearly 50 percent
for boys.79,86,87,88,89
Figures on obesity contradict some nutri-
tional intake data, which show the caloric
intake of many Native Americans to be nor-
mal or less than the recommended dietary
allowances. Metabolic differences in obese
Native Americans may be a factor,56,75,117 or
lower rates of energy expenditure through
exercise may contribute: American Indians
and Alaska Natives report lack of leisure-
time physical activity at higher rates than any
other U.S. ethnic group.82,83,84,85,86,87,88,89,90
However, a study of Hualapai women of
Arizona indicated that the daily caloric intake
of obese women was significantly higher than
for the non-obese women. Sweetened bever-
ages and alcoholic beverages accounted for
the differences. Researchers investigating
Zuni adolescents suggest that underreport-
ing of foods and/or alcohol may account for
low reported energy intakes.64,69,91,92 Diet-
ing behaviors among adult Native American
women mostly involve healthy approaches
such as eating more fruits and vegetables
and exercising more, according to one
study, although skipping meals, fasting, and
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1 2 8 N A T I V E A M E R I C A N S
disordered eating such as self-induced vomit-
ing were also mentioned; 10 percent engaged
in binge eating. A national survey of Native
American youth revealed that over 40 per-
cent reported binge-eating behavior with
vomiting rates of 4 to 6 percent. Frequent
dieting was also common. All disordered eat-
ing occurred more frequently among over-
weight respondents.93,94
The incidence of type 2 diabetes mellitus,
especially among some Native Americans of
the Plains and Southwest, is estimated to
be between two and four times that of the
general population. More than 16 percent
of American Indians and Alaska Natives
are estimated to have diabetes, which is
the highest rate of any ethnic group in
the United States.4 The Pima Indians are
believed to have the highest rate of type 2
diabetes in the world, affecting 70 percent of
all adults over the age of forty-five. Rates of
the disease among children are also increas-
ing substantially, and it has been noted
that acanthosis nigricans (a patchy darken-
ing of the skin) is an independent marker
for insulin resistance in Native American
youngsters.95,96,97 The death rate from type
2 diabetes is more than three times as high
for Native Americans as for the total popu-
lation.98 Notably, diabetes was rare among
Native Americans fifty years ago.99
One theory for the high rates of type 2
diabetes among Native Americans is genetic
predisposition.100 However, a comparison
of type 2 diabetes among Pima Indians liv-
ing in Arizona and those living in Mexico
found rates in Arizona to be more than five
times those found in Mexico, suggesting that
genetic predisposition alone does not account
for high prevalence in the United States and
that a Westernized environment may be a
factor.101 Research has shown a significantly
lower plasma insulin level in Pima Indians
living in Mexico when compared to the U.S.
Pima population even before diabetes is diag-
nosed. The authors state: “This finding under-
scores the importance of lifestyle factors as
protecting factors against insulin resistance in
individuals with a high propensity to develop
diabetes.”102 Higher rates of diabetes are found
among Alaska Natives who have significant
increased intake of nonindigenous protein
(e.g., beef, chicken), carbohydrates (e.g., white
bread, potatoes or rice, soft drinks), and fat
(e.g., butter, shortening), combined with a
lower intake of native foods such as salmon,
caribou, berries, and seal oil; and higher rates
are found among Pima Indians who con-
sume an Anglo diet when compared to Pima
who consume a traditional diet.103,104 Some
researchers suggest the difference is due to
the dietary change from indigenous starches
to the refined flours and sugars of the adapted
diet. Traditional starches take longer to digest
and absorb, leading to lower blood sugar lev-
els and insulin responses that may be protec-
tive in the development of diabetes.105 Other
researchers suggest the increased intake of
fat in the modern Native American diet may
be responsible for the increase in type 2 dia-
betes.106 (See Cultural Controversy—Type
2 Diabetes, Thrifty Genes, and Changing
Theories.)
Associated with obesity and type 2 diabe-
tes is a dramatic increase in the prevalence of
heart disease among Native Americans dur-
ing the last twenty-five years; heart disease
is now the leading cause of death. Rates of
cardiovascular disease for Native Americans
have surpassed those of the total popula-
tion in many locations, and are often more
fatal. Additional risk factors include high
rates of cigarette smoking, alcohol consump-
tion, elevated blood lipid levels, obesity, and
hypertension.
Chronic kidney disease is also a concern,
particularly associated with type 2 diabetes,
with incidence up to twenty times higher than
in the general population. American Indians
and Alaska Natives die at higher rates than
other Americans from tuberculosis, with esti-
mates being up to 600 percent higher.2,3,4
The incidence of alcoholism among Native
Americans has decreased in recent years, but
it still remains a significant medical and social
problem. High unemployment rates and loss
of tribal integrity, ethnic identity, and self-
esteem are frequently cited as reasons for
substance abuse among both reservation and
urban Native Americans. The rate for alcohol-
related deaths is more than eight times that of
the general U.S. population.3,4
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C H A P T E R 5 1 2 9
Counseling
A survey of Native American nurses identi-
fied attitudes, skills, and knowledge needed
to serve Native Americans successfully. They
listed being open-minded, avoiding ethnocen-
trism, and using intercultural communication
skills, especially the ability to listen carefully
and to provide respectful silence. Learning
about the Native American worldview, tra-
ditional health beliefs, differences between
nations, and the history of each group was
considered essential to effective interac-
tion.18,107 Of particular importance is recog-
nition of diversity within Native American
groups and understanding of local culture.
Access to biomedical health care may be
limited for some Native Americans because
of low income or inadequate transporta-
tion. Many are also limited to care through
the Indian Health Service (IHS), which has
a federal trust to provide health services to
all Native Americans who are members of
tribes recognized by the U.S. government.
It began operation under the BIA in 1924
and was placed under what is now called
the Department of Health and Human Ser-
vices in 1955.108,109 It has 612 IHS facilities
(46 hospitals; 494 health clinics) near or on
reservations, 80 percent tribally operated,
and 33 urban Indian programs. However,
the number of Native American health pro-
fessionals is limited, and intercultural care is
the norm rather than the exception in many
facilities.
Type 2 Diabetes, Thrifty Genes, and Changing Theories
Scientific theory sometimes takes on a life of its own, existing in the public
memory long past the time it has been
modified or disproved. Such is the case with
the thrifty gene hypothesis. In the 1960s
when researchers first proposed that certain
Native Americans might be predisposed to
developing diabetes mellitus (DM) due to a
feast-or-famine metabolism compromised
by a modern diet, type 1 DM had not yet
been fully differentiated from type 2 DM.
Four decades later, our understanding of the
disease has improved, revealing a complex-
ity that defies simple explanations.121
What is now known as type 1 DM results
from a complete lack of insulin in the body
and is not correlated to lifestyle. Type 2 DM is
more common; it is associated with normal
or reduced levels of insulin and the inability
to use insulin efficiently, and it is closely
correlated with obesity and limited physical
activity. Both types of diabetes result in high
levels of blood glucose that over time can
cause lifelong disability and death. Diagnosis
of type 2 DM has increased by more than
65 percent in the general adult population
over the past ten years. Long considered
a disease of middle age, type 2 DM was
rarely diagnosed in urban pediatric clinics as
recently as the early 1990s, but type 2 DM is
now increasing rapidly as a proportion of all
newly diagnosed cases of diabetes in chil-
dren.122 Among Native Americans, prevalence
rates vary from between 4 and 70 percent of
adults over the age of forty-five, depending
on group, with the lowest rates seen in Alaska
and the highest found in the Southwest. In a
few Native American groups a unique genetic
mutation has been identified as the cause,
as in the Oji-Cree of Canada, who have type
2 DM rates of 40 percent among adults.123
Yet attempts to find a universal thrifty
gene that predisposes other Native Americans
to the disease have been unsuccessful. It was
initially argued that a metabolism adapted to
a diet plentiful at times (feast periods) inter-
spersed with food shortages (famine periods)
could not cope with the constant abundance
of the modern diet, resulting in high insulin
responses and type 2 DM. The theory col-
lapsed when researchers were unable to find
a specific mechanism that causes an ethnic
predisposition to developing diabetes. Fur-
ther, it has been difficult to totally account
for high prevalence rates through differences
in diet and activity levels between diabetic
and non-diabetic members in certain Native
American groups.39,44,74,124,125,126
These data beg the question: Why do
some Native Americans develop type 2 DM
at rates many times above that of the white
U.S. population? Researchers propose that
the development of type 2 DM is much more
complex than previously thought, including
factors in three domains: political-economic
(such as ongoing stress, unavailability of
healthy foods, and barriers to health care
access), etiological (both genetic and non-
genetic), and cultural (including traditional
health beliefs, values regarding body image,
norms about exercise, etc.).127 Of particular
interest are theories regarding the roles of
historical trauma (similar to posttraumatic
stress syndrome)128 and prenatal adaptation
to malnutrition and gestational diabetes
in Native American mothers resulting in
increased rates of type 2 DM.129 Genes alone,
thrifty or not, cannot completely explain
what has become a problem of epidemic
proportions in much of the Native American
community.
C U L T U R A L C O N T R O V E R S Y
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1 3 0 N A T I V E A M E R I C A N S
Some Native Americans hold beliefs that
cause them to avoid biomedical treatment in
general. For example, pregnancy is often con-
sidered a healthy state, and Native American
women may not seek prenatal care for this
reason. Some older Native Americans report
fear of non–Native American providers, and
others find biomedical physicians too negative
because of impersonal care. Disclosure of risks
may also be regarded as negative, in violation
of a positive approach to life.110 Some Native
Americans may be angry about their condi-
tion and may blame illnesses such as diabetes
on a Western conspiracy. Some are suspicious
of federal and state government and may be
hesitant to sign any forms.15
One social worker reports that her clients
at a dialysis center in Arizona are so accus-
tomed to friends and family members with
kidney failure that they fatalistically expect
a similar outcome for themselves and are
sometimes relieved when it finally happens.111
Research shows that many Native Americans
believe that renal failure, amputations, and
blindness are inevitable consequences of dia-
betes.98 Traditional attitudes about time may
cause delays in seeking care—the importance
of finishing a current project or commitment
I was born in Oljato, Utah, a rural Navajo reservation located 150 miles
northeast of Farmington, New Mexico. After graduating from high school,
I worked as a nurses’ aid in a small, fifteen-bed hospital near my home
in Utah. Later, I completed a bachelor’s degree in nutrition science at
the University of Utah and a dietetic internship and a master’s degree
in public health at the University of California, Berkeley. As a regis-
tered dietitian I have worked with the Navajo nation for approximately
twelve years.
Briefly, how would you describe the Navajo foods?
Traditionally, during the fifties, sixties, and early seventies, gardening
and sheepherding was our livelihood. We hauled all our water and used
wood-burning stoves for cooking. My parents told us of Navajo native foods
when they were young, some of which I have never seen. My mother told
me she spent many days grinding corn for the winter. One stew made by
parents was ad Alth ta’ nash besh, meaning boiled with several mixtures.
It had melon seeds, local wild green plants, and a variety of plant seeds,
and wild onions, and was thickened with corn meal. When I was young we
grew watermelon, cantaloupe, fresh corn, and summer and winter squash.
Other favorites included boiled mutton backbone in green chili stew, grilled
mutton ribs, liver and greater omentum (the fatty tissue that covers the
stomach) in an open-face sandwich with onions or green chili in a tortilla.
We may not have had as much mutton as we wanted, but we had plenty of
fruits and vegetables during the summer months.
Traditional food eaten today includes corn prepared many different ways
from fresh to dried or ground into meal in varying degrees of texture. One
recipe for fresh corn is called “Kneel down Bread” because it is prepared in a
sitting position. A one-fourth cup of the ground corn is placed in corn leaves,
wrapped and tied together. It is then placed in a large hole that is dug in the
ground and is cooked by building a fire on top. All parts of the sheep and
goat are used for food. This includes the head, intestine, organs, skin, hoofs,
and blood. Blood sausage and liver sausage are very popular. The stuffed
intestine is made by wrapping the greater omentum with the intestine. It is
then grilled on hot coals until crispy.
Most elderly like simple, unmixed foods. Older people dislike marinated
meats. They prefer the meats cooked plain. I would say Navajo native food is
fairly bland, although men like to eat with very hot chili and raw, fresh onions.
How much has Western food culture influenced
the current diet?
In the past three to four decades our diet has changed significantly. Our
level of physical activity also decreased at the same time. Popular foods now
include spam, canned meat, cold cuts, ramen noodles, chips, candy, sodas,
and flavored fruit drinks.
Are there any foods that would be difficult or easy to
modify in the diet?
Yes. Fried bread would be hard to modify. People enjoy the texture of bread
cooked in hot oil, which makes the recipe difficult to alter. Intestine wrapped
P R A C T I T I O N E R P E R S P E C T I V E S
Native American
LORRAINE WHITEHAIR, RD, MPH, RN, CDE • Worked at Indian Health Services for over ten years,
Tribal RD for a number of years, and currently works for CDC
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C H A P T E R 5 1 3 1
may outweigh that of keeping an appointment
with a health provider.
In general, both verbal and nonverbal com-
munication with Native Americans must take
into account cultural traditions. Among the
Navajo, the patient should be asked directly for
his medical history, because even family mem-
bers may believe that they have no right to speak
for another. However, family members are often
consulted in making medical decisions.
It is estimated that more than one-half of
Native Americans speak their native language
in addition to English. Native American lan-
guages are primarily verbal, and some Native
Americans may experience difficulties with
written information or instructions. Further,
some English words, such as germ, may not
exist in Native American languages.23 It has
been reported, for example, that increasing
vegetables in the diet of some Native Ameri-
cans has met with resistance because the
closest equivalent Native American word for
vegetable is weeds.112 Many Native Americans
are comfortable with periods of silence in a
conversation, using the time to compose their
thoughts or to translate responses. A yes or
no response may be considered a complete
answer to a question, and a Native American
in greater omentum is the one that could be easy to modify. Replace the
intestinal fat with thick sliced vegetables like onions, carrots, cabbage, green
peppers, and celery. Ramen noodles, a non-traditional food, are easier to
modify as well—I suggest to my clients that they add a variety of vegetables
(frozen and fresh) and muscles from beef, chicken, or pork and decrease the
serving size, since the noodles contain fat. People seem to like it with fresh
ginger as well.
What advice would you give to new RDs working
with Native Americans?
Learn about the history of the people. Learn about the way of life then
and now. The Navajo people value family and community. There is a say-
ing which states, “Know who you are and where you came from.” That
is to know your clan system. Introductions are a very important part of
interaction with people on the Navajo reservation. As time consuming as
it may be, establishing good introductions helps establish trust, kinship,
and credibility. Making a good introduction about your family clan (family
background) is a cultural practice, and it is believed to help make busi-
ness meetings successful. For elderly clients you may address them as your
mother (Shi ma’ ) or your father (Shi yes ah’ ) even though they are not
related to you.
For the middle-aged and elderly population, living in harmony with the
surroundings is important. Parents and grandparents spend a great deal of
time talking about being respectful of kinship, elderly people, and nature,
including land and living creatures. We are to look toward living in harmony
with our surroundings. Illness is often thought of as a result of an interruption
of harmony.
We enjoy laughing. There is great pleasure in tastefully teasing when
appropriate. We have many jokes about life on the reservation, our first
boarding school experiences, interaction with people in towns, schools,
and medical clinics, and meeting with public health officials. We have many
animal stories that are funny, and they also teach. For example, I use this
story to help teach my clients about diabetes:
Two Birds
Two birds, Jay and Woody, lived near the Interstate 40 highway fifty miles
west of Albuquerque, New Mexico. Jay loves to pick up foods that are
left by humans who were traveling back on Interstate 40 highway from
Albuquerque, New Mexico. The most common foods that were left along
the highway were French fries, hamburgers, shakes, pies, cookies, ice
cream, fried chicken, biscuits, potato chips, fried bread, and candy bars.
Jay always invited Woody to help him eat the leftover foods that were
thrown near the highway. He would tell Woody about the “delicious” food
he had for the day. He would say, “You do not have to hunt for your food.
It is there along the road.” Woody told Jay the food he was eating was
not good for him. Woody faithfully hunted for his food supply. He worked
to store his food daily so that he would have enough for an emergency
during the winter months. Daily, Woody flew long distances to get his
food. Meanwhile, Jay had been steadily gaining weight. He also had dif-food. Meanwhile, Jay had been steadily gaining weight. He also had dif-food. Meanwhile, Jay had been steadily gaining weight. He also had dif
ficulty flying moderate distances. In the fall both birds wanted to visit
distant relatives near Albuquerque. Jay was not able to complete the trip
to Albuquerque. He experienced shortness of breath and exhaustion half
way to Albuquerque. Jay and Woody decided that Woody should go alone
to see their distant relatives. In early spring Jay became very ill after a
flu he had developed following a large snowstorm. He had frequency of
urination, tiredness, sores on his toes not healing, and blurred vision. His
doctor told him he had diabetes. Jay took the news very hard. He did not
want to change his diet. Woody begged Jay to eat more healthfully. In
the end Jay’s diet changed back to eating whole grains, nuts, and seeds
to help control his blood sugars. He also had to retrain his wings to fly
longer distances daily, which helped bring his good cholesterol (HDL)
in excellent ranges. His doctor was very happy to see Jay living more
healthfully.
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1 3 2 N A T I V E A M E R I C A N S
may answer “I don’t know” if he or she thinks
that a question is inappropriate or does not
wish to discuss the topic. Stories or metaphors
may be used to make a point.15 Information
may be withheld until she feels she can trust
the provider. Saving face and avoiding con-
flict are crucial, and a Native American may
not ask questions during an interview because
that would suggest that the health care pro-
vider was not communicating clearly. Among
the Navajo, direct questioning by the provider
suggests that the practitioner is unknowledge-
able or incompetent. Open-ended questions
are preferred. The very concept of a dietary
interview may be interpreted by some Native
Americans as interference with their personal
autonomy. Emphasis on how personal health
promotes the welfare of the client’s family and
community can be effective.113
Nonverbal communication is very sophis-
ticated among some Native Americans. It has
been reported that some children may not be
taught to speak until other senses are devel-
oped.114 A Native American client may expect
the practitioner to intuit the problem through
nonverbal techniques rather than through an
interview.115 Although a smile and a hand-
shake are customary, a vigorous handshake
may be considered a sign of aggressiveness.
Native Americans often sit at a distance, and
direct eye contact may be considered rude—
the health professional should not interpret
averted eyes as evidence of disinterest. Quiet,
unhurried conversations are most conducive
to successful interaction.
Researchers note that one-on-one diet
education in a clinical setting is often inef-education in a clinical setting is often inef-education in a clinical setting is often inef
fective with Native Americans.39 Counseling
can be improved through recognition of the
strong oral tradition found in most Native
American groups. The preferred learning
style for many Native Americans is in an
interactive, informal, and cooperative set-
ting. Talking with clients, instead of to cli-
ents, can improve efficacy. For many Native
Americans, it is the relationship established
with the caregiver, not the content of the
conversation, which is important. The shar-
ing of personal stories, in particular, can
elicit information and address issues that are
uncomfortable for clients to address directly.
In group settings, talking circles can be effec-
tive because they facilitate communication
and demonstrate equality among all partici-
pants.79,113,116 In the text Cultural Food Prac-
tices, it is noted that visual learning is key so
the use of food models, pictures, or videos
may be successful as teaching tools.18 Devel-
oping a nutrition model that tells the story of
changes to traditional foodways and resulting
consequences, using culturally appropriate
narrative and imagery, has also been recom-
mended (Figure 5.1).117
A client may have misconceptions about
biomedicine. Because the Navajo health
system classifies illness by cause rather than
by symptom, clients may have difficulty
understanding the necessity for a physical
exam or medical history. There may also be
the expectation that medication can cure ill-
ness and that an injection is needed for every
disorder.19 Very low compliance rates among
some Native Americans on special diets have
been reported.122 A Native American may be
confused about recommendations for weight
loss because slimness is associated with
disease or witchcraft.
Native American clients may follow tra-
ditional health practices instead of, or in
D I S C U S S I O N S T A R T E R S
Who Are You? And What Do You Eat?
After reading about the different regional, traditional Native American diets, decide
which one you think would be the healthiest. Why? Then decide which one you think
would taste the best to you. Why? Once you’ve considered the traditional diets, reflect on
the differences between the traditional diet you see as the healthiest and the contempo-
rary diet of many Native Americans. Consider the following questions:
● What needs to be done to improve the diets of many Native Americans today?
● What are the major cultural obstacles in improving contemporary Native
American diets?
Imagine that you are a member of a research institution that has been asked to recom-
mend dietary policy for a contemporary Native American community. In a small group,
compose a list of your major recommendations for such a policy that the majority of
your group can agree to. Also provide advice to health care professionals serving that
community about how to implement those dietary changes.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 5 1 3 3
conjunction with, biomedical therapies.18
In one rural Navajo community, 62 per-
cent of patients received care from “Native
healers,” defined as a consultation with a
“medicine man,” and 39 percent used such
ser vices more than once per year.118 A
study of Native American veterans found a
greater use of traditional therapies in areas
where biomedical facilities were less acces-
sible.20 Other research suggests that though
combining traditional and biomedical
approaches is common, up to 40 percent of
some American Indians use only traditional
healing.119 Some Indians believe a biomedi-
cal practitioner is needed to cure any “white
man’s disease,” and traditional healers, such
as herbalists and medicine men and women,
or shamans, will frequently decline to
treat conditions unfamiliar to them, refer-
ring patients to Westernized health care
instead.44,112,120 Compliance is most effec-
tive when traditional practices are accepted
and encouraged as an integral part of com-
plete care.
An in-depth interview is necessary to
determine not only ethnic identity but also
degree of acculturation. Traditional medical
beliefs and customs, if practiced, should be
acknowledged. Personal dietary preferences
are of special importance due to the variety of
Native American foods and food habits. Note
taking may be considered exceptionally rude,
so memory skills or a tape recorder may be
preferable during the interview.
Review Questions
1. In Native American culture, what is considered
the cause of illness? How may this influence
the treatment of a medical disorder such as
type 2 diabetes?
2. Pick two regional classifications of traditional
Native American cuisine. Describe the simi-
larities and differences between these two clas-
sifications in food and their preparation.
3. Describe three therapeutic uses of corn and
one therapeutic use of a non-corn item by
Native Americans.
4. What is Indian fry bread? Is it a traditional
food? Why or why not?
5. What factors may have increased the incidence
of type 2 diabetes among Native Americans?
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104. Williams, D.E., Knowler, W.C., Smith, C.J., Han-
son, R.L., Roumain, J., Saremi, A., . . . Nelson,
R.G. 2001. The effect of Indian or Anglo dietary
preference on the incidence of diabetes in Pima
Indians. Diabetes Care, 24, 811–816.
105. Brand, J.C., Snow, B.J., Nabham, G.P., & Traswell,
A.S. 1990. Plasma glucose and insulin responses
to traditional Pima Indian meals. American Jour-
nal of Clinical Nutrition, 51, 416–420.
106. Gittelsohn, J., Wolever, T.M., Harris, S.B., Har-
ris-Giraldo, R., Hanley, A.J., & Zinman, B. 1998.
Specific patterns of food consumption and prep-
aration are associated with diabetes and obesity
in a Native Canadian community. Journal of
Nutrition, 128, 541–547.
107. Weaver, H.N. 1999. Transcultural nursing with
Native Americans: Critical knowledge, skills, and
attitudes. Transcultural Nursing, Transcultural Nursing, Transcultural Nursing 10, 197–202.
108. Artiga, S., Arguello, R., & Duckett, P. 2013.
Health coverage and care for Amer ican
Indians and Alaska Natives. Kaiser Family
Foundation. Retrieved from http://kff.org/
report-section/health-coverage-and-care-for-
american-indians-and-alaska-natives-issue-
brief/ (accessed February 3, 2015).
109. Indian Health Ser vices. 2015. Factsheets.
Retrieved from http://www.ihs.gov/newsroom/
factsheets/ (accessed February 3, 2015).
110. Carrese, J.A., & Rhodes, L.A. 2000. Bridging cul-
tural differences in medical practice: The case of
discussing negative information with Navajo
patients. Journal of General Internal Medicine,
15, 92–96.
111. Juarez, C.A.B. 1990. Professional practice at a
Native American community. Contemporary
Dialysis and Nephrology, 11, 23–28.
112. Jackson, M.Y., & Broussard, B.A. 1987. Cultural
challenges in nutrition education among Ameri-
can Indians. Diabetes Educator, 13, 47–50.
113. Hodge, F.S., Paqua, A., Marquez, C.A., &
Geishirt-Cantrell, B. 2002. Utilizing traditional
storytelling to promote wellness, in American
Indian communities. Journal of Transcultural
Nursing, Nursing, Nursing 13, 6–11.
114. Wilson, C.S. 1985. Nutritionally beneficial cul-
tural practices. World Review of Nutrition and
Diet, 45, 68–96.
115. Galanti, G.A. 2004. Caring for patients from dif-Caring for patients from dif-Caring for patients from dif
ferent cultures (3rd ed.). Philadelphia: University
of Pennsylvania Press.
116. Kavanagh, K., Absalom, K., Beil, W., & Schliess-
mann, L. 1999. Connecting and becoming cul-
turally competent: A Lakota example. Advances
in Nursing Science, 21, 9–31
117. Conti, K.M. 2006. Diabetes prevention in Indian
country: Developing nutrition models to tell the
story of food-system change. Journal of Transcul-
tural Nursing, tural Nursing, tural Nursing 17, 234–245.17, 234–245.17
118. Gurley, D., Novins, D.K., Jones, M.C., Beals, J.,
Shore, J.H., & Manson, S.M. 2001. Comparative
use of biomedical services and traditional heal-
ing options by American Indian veterans. Psychi-
atric Services, 52, 68–74.
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119. Novins, D.K., Beals, J., Moore, L.A., Spicer, P.,
Manson, S.M., & AISUPERPFP Team. 2004.
Use of biomedical services and traditional heal-
ing options among American Indians: Sociode-
mographic correlates, spirituality, and ethnic
identity. Medical Care, 42, 670–679.
120. Conley, R.J. 2000. Cherokees. In R.V. Das-
sanowsky & J. Lehman (Eds.), Gale encyclopedia
of multicultural America, Farmington Hills, MI:
Gale Group.
121. Neel, J.V. 1999. The “thrifty genotype” in 1998.
Nutrition Reviews, 57, S2–S9.57, S2–S9.57
122. Kaufman, F.R. 2002. Type 2 diabetes mellitus
in children and youth: A new epidemic. Jour-
nal of Pediatric Endocrinology and Metabolism,
15(Suppl.), 737–744.
123. Hegele, R.A. 2001. Genes and environment in
type 2 diabetes and atherosclerosis in Aborigi-
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3, 216–221.
124. Edwards, K.A., Pryor, S., Campbell, J., Jacobsen,
S., & Booton-Hiser, D. 2000. Calorie use and obe-
sity among diabetic and non-diabetic Mvskoke
Indians. Journal of Cultural Diversity, 7, 36–40.7, 36–40.7
125. Swinburn, B.A., Boyce, V.L., Bergman, R.N.,
Howard, B.V., & Bogardus, C. 1991. Deteriora-
tion in carbohydrate metabolism and lipopro-
tein changes induced by modern, high fat diet in
Pima Indians and Caucasians. Journal of Clinical
Endocrinology and Metabolism, 73, 156–165.
126. Weyer, C., Vozarova, B., Ravussin, E., &
Tataranni, P.A. 2001. Changes in energy metab-
olism in response to 48 h of overfeeding and
fasting in Caucasians and Pima Indians. Inter-
national Journal of Obesity Related Metabolic
Disorders, 25, 593–600.
127. Smith-Morris, C.M. 2004. Reducing diabetes in
Indian country: Lessons from the three domains
influencing Pima diabetes. Human Organization,
63, 34–46.
128. Benyshek, D.C. 2005. Type 2 diabetes and fetal
origins: The promise of prevention programs
focusing on prenatal health in high prevalence
Native American communities. Human Organi-
zation, 64, 192–200.
129. Brave Heart, M.Y.H. 1999. Gender differences
in the historical trauma response among the
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(Eds.), Health and the American Indian. New
York: Haworth Press.
130. Ogunwole, S.U. 2006. We the people: American
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an eastern Cherokee township. Ecology of Food
and Nutrition, 14, 63–70.
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1 3 9
Although quite northern, the climate is tem-
perate due to the warming influence of the
Gulf Stream, and the lowlands are suitable for
growing crops.
Just across the English Channel is France,
regarded for centuries as the center of Western
culture politically, as well as in the arts and
sciences. Its capital, Paris, is one of the world’s
most beautiful and famed cities. France con-
tains some of the best farmland in Europe,
and three-fifths of its land is under cultiva-
tion. It is especially well known for premium
wine production.
In 1607, people from Great Britain began
immigrating to what has become the United
States. They brought with them British
trade practices and the English language,
literature, law, and religion. By the time the
United States gained independence from
Britain, the British and their descendants
constituted one-half of the American popu-
lation. They produced a culture that remains
unmistakably British-flavored, even today.
The French came to the United States later
and in smaller numbers, yet they have made
significant regional contributions. Belgium,
situated northeast of France, shares many
French food habits but has had very little
influence on the American diet due to the
relatively low number of immigrants to
the United States. The traditional foods of
northern Europe and their influence on
American cuisine are examined in the next
section.
Northern and
Southern Europeans
Some of the largest American ethnic groups come from northern and south-ern Europe (see the map in Figure 6.1).
Immigrants from these regions began arriving
in what is now the United States in the sixteenth
century and are still coming, significantly influ-
encing American majority culture. Many foods
and food habits we consider to be American
were introduced by these settlers. The northern
European idea of a meal, consisting of a large
serving of meat, poultry, or fish with smaller
side dishes of starch and vegetable, was quickly
adopted and expanded in the United States to
include even bigger portions of protein foods.
Adaptations of some southern European spe-
cialties have become commonplace Ameri-
can fare. Each ethnic group from northern
and southern Europe has brought a unique
cuisine that was combined with indigenous
ingredients—blended with the cooking of
Native Americans, other Europeans, and Afri-
cans; and flavored with the foods of Latinos,
Asians, and Middle Easterners—to form the
foundation of the typical American diet. This
chapter discusses the traditional foods and food
habits of Great Britain, Ireland, France, Italy,
Spain, and Portugal and examines their con-
tributions to the cooking of the United States.
Northern Europeans
Great Britain includes the countries of
England, Scotland, Wales, and Northern
Ireland. Ireland is now a sovereign country.
6CHA
P
T
E
R
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1 4 0 N O R T H E R N A N D S O U T H E R N E U R O P E A N S
Cultural Perspective
History of Northern Europeans
in the United States
Immigration Patterns
Great Britain The British who immigrated
in the seventeenth century settled primar-
ily in New England, Virginia, and Maryland.
Although many originally came to avoid reli-
gious persecution, such as the Puritans in
New England and the Catholics in Maryland,
most later immigrants earned their passage to
America by signing on as indentured servants.
By the eighteenth century, British immigra-
tion had slowed. After independence, British
immigration to the United States further
declined due to American hostility and dis-
approval by the British government. However,
reported arrivals of British in the nineteenth
century increased substantially. Early in the
century, most immigrants were families from
rural areas of southern and western England
and Wales. In the latter half of the century,
the majority of immigrants were from large
English towns; many were seasonal unskilled
workers who repeatedly returned to Britain.
Figure 6.1
Northern and southern
Europe.
BrusselsBrusselsBrusselsBrusselsBrusselsBrusselsBrusselsBrusselsBrusselsBrussels
The
Hague
Paris
MadridL
is
bo
n
London
DublinDublin
FRANCE
SPAIN
P
O
R
T
U
G
A
L
UNITED
KINGDOM KINGDOM KINGDOM KINGDOM KINGDOM KINGDOM
IRELAND
NORTHERN
IRELAND
SCOTLAND
ENGLAND
North
Sea
Atlantic
Ocean
Mediterranean Sea
Tyrrhenianhenianrrhenianrr
Sea
Bay of
Biscay
Bay of
Biscay
Bay of
Adriatic Sea
Rome
Rome
ITALY
Adriatic Sea
WALES
BELGIUM
©
2
01
7
Ce
ng
ag
e
Le
ar
ni
ng
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C H A P T E R 6 1 4 1
It is said there have been Scots in America
as long as there have been Europeans on the
continent. More than one hundred towns and
cities in the United States bear Scottish names,
and it has been estimated that 1.5 million
Scots immigrated to America. Although the
majority of Scots came during the eighteenth
and nineteenth centuries, 400,000 immigrated
between 1921 and 1931, when Scotland suf-Scotland suf-Scotland suf
fered a severe economic depression. The
Scottish settled over most of the United
States and were often professionals or skilled
laborers.
Although British immigration did not
decline in the early twentieth century, the
United States was no longer the country of first
choice for those leaving Great Britain. During
the Great Depression in the 1930s, more Brit-
ish people returned to Britain than came to
America. After World War II, an increase in
immigration was attributable to British war
brides returning to the United States with
their American husbands. Since the 1970s,
British immigration has been constant at
about 10,000 to 20,000 persons per year.
Ireland The first Irish people to immigrate
in substantial numbers to the United States
were the descendants of Scottish Presbyteri-
ans who had settled in Northern Ireland in the
seventeenth century. Large-scale immigration
began in the eighteenth century, and by 1775
there were an estimated 250,000 Scotch Irish
living in the American colonies. Most of the
immigration was the result of an economic
depression brought on by a textile slump
in Ireland.
Initially, the Scotch Irish settled in Penn-
sylvania. Before long the direction of Scotch
Irish immigration was westward to the fron-
tier, first up the Delaware River and then
beyond the Susquehanna into the rich farm-
lands of the Cumberland Valley. The Scotch
Irish played an important role in the settle-
ment of the trans-Allegheny region and even-
tually clustered around the site of Pittsburgh
and in other areas of southwestern Pennsyl-
vania. They also settled in the frontier regions
of western Maryland, the Shenandoah Valley
of Virginia, and the backcountry of Georgia.
Irish Catholics started to arrive in the
United States by 1820, and their immigration
reached an apex between 1840 and 1860,
when approximately 2 million people arrived.
The impetus to leave Ireland was not only
religious persecution but also repeated crop
failures. The potato blight that destroyed their
principal crop in 1845 resulted in death by
starvation of 1 million Irish people.
The Irish Catholics were the first great
ethnic minority in American cities, and their
early history set the pattern for later minority
immigrant groups. They settled in the north-
eastern cities and were at the bottom of the
socioeconomic ladder. The Scotch Irish, who
were often of relatively high economic stand-
ing and Protestant, found it fairly easy to move
into mainstream American society; however,
the Irish Catholics were often stereotyped as
drunkards, brawlers, and incompetents. The
Irish achieved success with painful slowness.
For many, their first entry into the American
mainstream came by way of city politics.
France Immigration directly from France has
been the smallest, yet most constant, of that
from any European country, but the return
rate has been high. Most of the estimated
1 million persons who have immigrated to the
United States from France have been middle-
class and skilled and have come for economic
opportunity.
A smaller number came because of reli-
gious persecution. More than 12,000 Hugue-
nots (French Protestants) settled in the
American colonies in the eighteenth century.
They were considered to be excellent skilled
workers. Generally, French people who settled
in the United States were eager to assimilate
and able to do so because they were economi-
cally successful.
Few pockets of French culture remain
in the United States, with the exception of
southern Louisiana, originally a French hold-
ing, and northern New England. However,
the Frenchness of these areas is probably due
more to the influence of French Canadian
immigration than to direct French immigra-
tion. French Canadians are the descendants of
explorers and settlers who came from France,
primarily Normandy and Brittany, during the
seventeenth century. They established New
France in what is today known as Canada.
When the English gained control of Canada,
Canadian census data
from 2001 reported
5.9 million of English
ancestry (almost
20 percent of the total
population), 4.6 million
of French heritage (over
15 percent of the total
population), 4.1 million
of Scottish heritage
(almost 14 percent of
the total population),
and 3.8 million of Irish
background (about
12 percent of the total
population).
The Scots have been
stereotyped as thrifty.
“Scotch” tape was so
named with the hope
it would suggest an
economical product.1
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1 4 2 N O R T H E R N A N D S O U T H E R N E U R O P E A N S
many French Canadians moved to the United
States; in some instances they were deported
from Canada. Most settled in northern New
England, especially Maine, and their descen-
dants are known as Franco-Americans. Others
from Acadia (Nova Scotia, New Brunswick,
Prince Edward Island, and part of Maine)
relocated, often not by choice, to central and
southern Louisiana; their descendants are
known as Cajuns.
Current Demographics and
Socioeconomic Status
British and Irish The British assimilated into
American mainstream society easily. Distinct
groups from specific regions of Great Britain
can still be found, however. For example,
Cornish immigrants of the nineteenth cen-
tury were often miners, and their descendants
are still living in certain old mining regions,
such as Grass Valley, California; Butte City,
Montana; and the areas around Lake Superior.
The Welsh who immigrated in the nineteenth
century were miners and mill workers. They
settled in the mid-Atlantic and midwestern
states, especially Ohio and Pennsylvania;
many were Baptist, Calvinist, or Method-
ist. Remnants of Welsh communities in the
United States still celebrate St. David’s Day
(the feast day of the patron saint of Wales) and
the annual festival of the National Gymanfa
Ganu Association (an assembly that sings
Welsh folk songs).2 It is estimated that there
were nearly 25.3 million Americans of English
or British ancestry in 2013.
Close to 5 million Irish Catholics have
immigrated to the United States, and in 2012
there were approximately 34.7 million Ameri-
cans who claimed Irish descent.3 Although they
started out on a lower economic rung than other
older immigrant groups, they are now scattered
throughout the occupational structure.
In the 1950s, the Irish were overrepresented
as clergymen, firefighters, and police officers.
Today, there are disproportionately more in
law, medicine, and the sciences; and Irish
Catholics are more likely than other whites to
attend college and to pursue advanced gradu-
ate degrees.3 Although Irish Catholics have
to some extent assimilated into mainstream
American society, they still remain an identi-
fiable ethnic group.
Persons identifying themselves as of Scot-
tish and Scotch Irish heritage totaled over
8.3 million in the 2013 census estimate.4
They are well assimilated, though pockets of
Scotch-Irish populations can still be found in
certain Appalachian communities.
French Over 8 million Americans listed
French as their ancestry in the 2013 U.S.
Census estimate. An estimated fewer than
25 percent of French Americans are descended
from immigrants who came to the United
States directly from France.4
More than 2.1 million people of French-
Canadian descent live in the United States as
of 2005, many of whom make their home in
the Northeast.4 The French Canadians who
settled in the New England states worked in
factories that processed textiles, lumber, and
bricks. Since 1950 there has been an increase
in the percentage of Franco-Americans hold-
ing white-collar jobs, but they still lag behind
other ethnic groups economically. Compared
to the French who immigrated directly from
France and assimilated rapidly into American
culture, the descendants of French Canadians
have clung to their heritage, including lan-
guage, customs, and religious affiliation.
In Louisiana, more than 12 percent of the
population has French ancestry, with smaller
populations located along sections of the
Gulf Coast, and one small colony remaining
in northeastern Maine.5 The Cajuns settled
in rural and inaccessible areas of southern
▼ Traditional foods of
northern Europe. Some
typical foods include apples,
bacon, beef, cheese, cream,
French bread, oatmeal, salt
cod, and tripe.
Ki
ch
ig
in
/S
hu
tt
er
st
oc
k.
co
m
The Welsh honor the
patron saint of Wales,
St. David, by wearing a
leek stalk on the lapel.
St. David identified
his followers by plac-
ing a leek in the brim
of their caps.
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C H A P T E R 6 1 4 3
Louisiana, the bayous, and along the Missis-
sippi River. Primarily farmers, fishermen, and
herders, they were self-sufficient and kept to
themselves. Today they are still rural, but their
occupations reflect local economic conditions.
Worldview
Religion
British Nearly all early British immigrants
to America were Protestant. Although many
came to escape persecution by the Church
of England, others maintained this faith and
established congregations throughout the
American colonies. The Church of England
in the United States became the Episcopal
Church during the late eighteenth century.
British ethnicity was often expressed
through religious affiliation, particularly with
the Episcopal, Methodist, Baptist, and Quaker
faiths. Many immigrants established distinc-
tively English congregations, but within a gen-
eration most became indistinguishable from
other American churches. Today, Americans
of British descent participate in most U.S.
faiths.
Irish Religion is a cornerstone of Irish Catho-
lic society, and in the United States it is cen-
tered on the parish. Over time, the Catholic
Church in America came to be dominated
by the Irish, often to the resentment of other
Catholic immigrants. The church spared
no effort to aid its members; it established
schools, hospitals, and orphanages across the
United States. The church helped to bridge
the cultural gap for many Irish immigrants
through advice, job placement, savings clubs,
and temperance societies. Today, religion
plays a less important role in Irish Catho-
lic life, although the role of the Irish in the
church is still significant.
French Among French Americans, Franco-
Americans, and Acadians, the Catholic
Church provided the nucleus of the commu-
nity, gave it stability, and helped preserve the
language and traditions of the people. The
church today still plays a central role.
Family
British The immigrant English family formed
the model for the typical American family. It
included a father, a mother, and their children.
This family group sometimes resided near
other relatives, but more often established
solitary households. The father was in charge
of the public and business aspects of the fam-
ily, while the mother controlled the domes-
tic and social responsibilities. Traditionally,
the oldest children in the home were well
educated and were sent to private schools, if
affordable. Such an education was considered
an investment in the future, and children were
expected to continue the family business and
to maintain the family’s social position. Due
to the similarities between the British fam-
ily and the emerging American family, new
immigrants from England assimilated quickly.
It was very common for British immigrants to
marry non-English spouses.
Irish Many of the characteristics of the Irish
family in the nineteenth century persisted into
the twentieth century. Irish Catholics tended
to marry at a late age, have large families, and
divorce rarely. Today, however, most first- and
second-generation Irish Catholics are likely to
marry outside their group and, with increas-
ing frequency, outside Catholicism. Tradition-
ally, the father was the breadwinner in the
Irish Catholic family, but the mother’s posi-
tion was a strong one. Daughters were often
as well educated as sons. The Irish people’s
relatively egalitarian attitudes toward sex roles
may be responsible for the high concentration
of Irish American women in professional jobs
and white-collar work.
French The Franco-Americans in New
England maintained many French traditions
through their continued contact with French
relatives in Quebec. They had little desire
to acculturate. During the 1930s, due to the
Great Depression and new laws restricting
reentry into the United States, the bond to
Canada weakened, which diminished new
French Canadian immigration. Today the
descendants of the French Canadians speak
French infrequently and often marry outsid-
ers. Family ties are still strong, but, as with
the Cajuns, family size has decreased. Franco-
American women have traditionally had
higher status and more authority than their
counterparts in France.
Until the twentieth century, Cajuns lived
in rural areas in extended family households
New England Puritans
and English Quakers
were among the first
in the United States to
promote free public
education.
Historically, Mac before a
family name meant “son
of,” whereas O signified
“descended from.”
A “pub,” or public house,
is a bar that serves beer,
wine, hard liquor, and
light meals. The British
pub is often the place
where friends and family
meet to socialize.
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1 4 4 N O R T H E R N A N D S O U T H E R N E U R O P E A N S
with as many as ten or twelve children per
couple. The whole family worked as a unit,
and decisions that affected the group were
made jointly by all the adults. Until 1945,
many Cajuns were illiterate and spoke only
Cajun French. The use of Cajun French was
prohibited by the public schools in 1921; as
a result, many younger Cajuns today do not
speak or understand French. The average
family size today is smaller, and there is more
marriage outside the community, but Cajuns
still retain strong ties to their families.
Traditional Health Beliefs and Practices Many
of what are characterized as American major-
ity cultural beliefs regarding health originated
in northern Europe. For example, when stu-
dents were surveyed on family home rem-
edies,6 those of British, Irish, and French
descent shared similar health maintenance
practices such as a good diet, plentiful sleep,
and daily exercise. Fresh air, cleanliness, and
keeping warm and dry were also commonly
mentioned. The Irish traditionally wear pro-
tective religious medallions.
Among the British and the Irish there is
the more generalized belief that good health is
dependent on proper attitude (which includes
religious faith) and a rigorous, regular life-
style. Many northern Europeans associate a
moderate diet with maintaining bowel regu-
larity, and laxative use is common. Stomach
ailments may be explained as due to food that
is too spicy, spoiled, or incompatible (causing
an allergic reaction).
The traditional French lifestyle, which
features leisurely meals and little structured
exercise, presents a paradox to researchers.
Although the French consume more total
saturated fat and cholesterol than Americans,
their death rate from heart disease is less than
one-half of that in the United States. Scientists
speculate that some other protective factor in
the French diet or lifestyle may account for
this discrepancy, such as the higher intake of
wine or more frequent walking. Genetic fac-
tors do not appear to be a cause. Studies com-
paring the French with Americans of French
ancestry have not been reported.
The French Canadians who settled in
Louisiana brought numerous traditional rem-
edies. Today, Americans of French descent in
Louisiana, including the Cajuns and urban
dwellers of all socioeconomic groups, often
use home remedies and consult folk healers.
Salves of whiskey and camphor or sheep’s
tallow and turpentine are considered benefi-
cial for colds. Tobacco smoke is blown into the
ears to cure earaches. A string of garlic is tied
around the neck of a baby with worms. Red
flannel pouches filled with camphor or asa-
fetida are worn to prevent illness. It should be
noted that some Americans of French descent
living in the region may also consult practi-
tioners of voodoo for health problems (see
Chapter 8 for more details).
Traditional Food Habits
The influence of France on the food habits
of Great Britain and Ireland and vice versa
has led to many similarities in the cuisines of
these countries, although the ingredients of
southern French cooking differ in that they
are more like those of Mediterranean coun-
tries. The influence of these northern Euro-
pean cuisines on American foods and food
habits has been extensive.
Ingredients and Common Foods
Staples and Regional Variations
Great Britain and Ireland Animal products
are of key importance in Great Britain and
Ireland. Some form of meat, poultry, or fish
is present at most meals, in addition to eggs
and cheese. In Britain and Ireland, lamb is a
commonly eaten meat, as is roast beef, which
is often made for Sunday dinner with York-
shire pudding (a popover cooked in meat
drippings). Pork is often served as sausages
(bangers) and bacon. Various game birds
are also eaten. The cultural food groups list
(Table 6.1) includes a more complete detailing
of ingredients.
The British and Irish diets also contain a
variety of seafood. A well-known fast-food
item is fish and chips. The fish is battered and
deep-fried, served with fried potatoes, and
seasoned with salt and malt vinegar. Salt-dried
fish, including ling, cod, and pollack, was
traditionally served with a white sauce and
potatoes for meatless days by Irish Catholics.7
Preserved fish is also found as an appetizer
or at breakfast. Examples are smoked Scottish
salmon and kippers, which are a salted and
smoked fish.
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C H A P T E R 6 1 4 5
Group Comments Common Foods
Adaptations in the
United States
Protein Foods
Milk/milk
products
The English and Irish drink milk
as a beverage. Cheese is eaten
daily.
Cheese (cow’s, sheep’s, and goat’s milk), cream, milk,
sour cream, yogurt
Meat/poultry/
fish/ eggs/
legumes
Meat, poultry, or fish is usually
the centerpiece of the meal.
Meats are generally roasted or
broiled in Great Britain; also
prepared as stews or in pies.
Smoked, salted, or dried fish is
popular in England.
Meat: beef (roasts; variety cuts such as brains,
kidneys, liver, sweetbreads, tongue, and tripe),
horsemeat, lamb, oxtail, pork, rabbit, snails, veal,
venison
Poultry and small birds: chicken, duck, goose,
partridge, pheasant, pigeon, quail, thrush,
turkeyFish and shellfish: anchovies, bass, clams,
cod, crab, crawfish, haddock, herring, lobster,
mackerel, mullet, mussels, oysters, perch, pike,
pompano, salmon, sardines, scallops, shad, shrimp,
skate, sole, sturgeon, trout, whiting
Eggs: poultry and fish
Legumes: kidney beans, lentils, lima beans, split peas
The Irish consume more
animal protein.
Cereals/Grains Wheat bread usually
accompanies the meal.
In Britain and Ireland oatmeal
or porridge is common for
breakfast.
Barley, hops, oats, rice, rye, wheat Corn and corn products
are consumed more.
Fruits/Vegetables Potatoes are frequently eaten
in Ireland.Arrowroot starch is
used as thickener, and tapioca
(from cassava tubers) is eaten.
Fruits: apples, apricots, cherries, currants,
gooseberries, grapes (many varieties), lemons,
melons, oranges, peaches, pears, plums, prunes,
raisins, raspberries, rhubarb, strawberries
Vegetables: artichokes, asparagus, beets, brussels
sprouts, cabbage, carrots, cauliflower, celery,
celery root, cucumbers, eggplant, fennel,
green beans, green peppers, kale, lettuce
(many varieties), leeks, mushrooms (including
chanterelles, cèpes), olives, onions, parsnips, peas,
potatoes, radishes, salsify, scallions, sorrel, spinach,
tomatoes, turnips, truffles, watercress
Native and transplanted
fruits and vegetables,
such as bananas,
blueberries, okra, and
squash, were added to
the diet.
Additional Foods
Seasonings British and Irish dishes
emphasize naturalness of
foods with mild seasoning,
served with flavorful
condiments or sauces used to
taste. French dishes are often
prepared with complementary
sauces or gravies that enhance
food flavor.
Angelica (licorice-flavored plant), bay leaf, capers,
chile peppers, chives, chocolate, chutney,
cinnamon, cloves, coffee, cognac, fennel seeds,
garlic, ginger, horseradish, juniper berries, mace,
malt vinegar, marjoram, mint, mustard, nutmeg,
oregano, paprika, parsley, pepper (black, white,
green, and pink), rosemary, saffron, sage, shallots,
sweet basil, Tabasco sauce (and other hot sauces),
tarragon, thyme, vanilla, Worcestershire sauce
Cajun and Creole
cooking are highly
spiced. Stews are
thickened with filé
powder (sassafras).
Nuts/seeds Nuts especially popular; used
primarily in desserts.
Nuts: almonds (sweet and bitter), chestnuts, filberts
(hazelnuts), pecans, walnuts (including black)
Seeds: sesame
Beverages Alcoholic beverages consumed
as part of the meal.
Beer (ale, stout, bitters), black and herbal tea
(mint, anise, chamomile, etc.), cider, coffee, gin,
hot chocolate, liqueurs, port, sherry, whiskey, wine
(red, white, champagne, and fruit/vegetable)
TA B L E 6 .1 Cultural Food Groups: Northern European
(Continued )
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
1 4 6 N O R T H E R N A N D S O U T H E R N E U R O P E A N S
Dairy products and eggs also play an
important role in the diet of the British and
Irish. Eggs are traditionally served for break-
fast, and cheese is the key ingredient in the
traditional ploughman’s lunch served in pubs.
It consists of a piece of cheddar cheese, bread,
pickled onions, and a pint of beer. Other
cheeses produced in England are the slightly
nutty Cheshire and Stilton, a blue cheese. In
Ireland, a market for hand crafted farmhouse
cheeses has developed over the past decade.
They include both fresh, soft cheeses and aged
types (often flavored with herbs or other sea-
sonings), from cow’s or goat’s milk. One cheese
that has gained international acclaim is Cashel
blue, which is produced in Tipperary, Ireland.
Devonshire, England, is known for its rich
cream products, such as double cream (which
has twice as much butter fat as ordinary
Group Comments Common Foods
Adaptations in the
United States
Fats/oils Butter used extensively in
cooking of northern and
central France; olive oil more
common in southern regions
of the country.
Butter, goose fat, lard, margarine, olive oil, vegetable
oil, salt pork
Sweeteners Honey, sugar Molasses and maple
syrup are used as
sweeteners.
Irish Americans use more
sugar than members
of other groups.
TA B L E 6 .1 Cultural Food Groups: Northern European (C on t in u e d )
cream) and clotted cream, a slightly fer-
mented, thickened cream. It is often spread
on scones, biscuits made with baking powder.
Though not the main focus of the meal,
breads are not overlooked. In Ireland, soda
bread, a bread made with baking soda instead
of yeast, was traditionally prepared every day
to accompany the meal and remains popular
today. Another version was made of cornmeal.
Wheat flour is commonly used for baking, and
oatmeal is eaten as a porridge for breakfast in
Scotland or used in making bread and biscuits
throughout Britain and Ireland. Biscuits, or
biskcake, in England can refer to bread, cake,
cookies, crackers, or what are known in the
United States as biscuits. Scottish shortbread
is an example of a sweet, buttery biscuit.
Fruits and vegetables are limited to those
that grow best in cool climates. Potatoes,
brought to Ireland from the New World in
the seventeenth century, are the mainstay of
the Irish diet and are found in British fare
as well. Potatoes are found in stews or pies,
such as stobhach Gaelach, an Irish stew of
lamb’s neck, and shepherd’s or cottage pie, a
meat pie made of leftover ground meat and
onions and topped with mashed potatoes.
Mashed potatoes are often just referred to as
mash, as in bangers and mash (sausages and
mashed potatoes). Some side dishes made of
potatoes are boxty, a type of potato pancake
or dumpling; bubble and squeak, a dish made
of leftover cabbage and potatoes chopped and
fried together; and colcannon, mashed and
seasoned boiled white vegetables with onions
or leeks. Berries are popular in puddings, pies,
▼ Fish and chips are classic
pub food in England and
Ireland, typically served with
malt vinegar.
m
ar
go
ui
lla
t p
ho
to
/S
hu
tt
er
st
oc
k.
co
m
©
C
en
ga
ge
L
ea
rn
in
g
Oatcakes, called
bannocks, were tradition-
ally eaten to celebrate
the pagan Celtic holiday
of Beltane on May 1.
One section was burnt
or covered with ash; the
unlucky person who
received the marked
portion was sacrificed
(in more recent times
the victim would leap
through a small bonfire
three times instead).
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 6 1 4 7
and jams. Kitchen gardens are still found in
many areas, providing tomatoes, cucumbers,
watercress, and other items. Farmers’ markets,
featuring fresh local produce, are increasingly
popular.
One unusual vegetable of the region is sea-
weed. Laver is a purple seaweed (called nori
in Japan) that is a specialty in Wales and parts
of northern coastal England. It is customar-
ily boiled into a gelatinous paste, then mixed
with oatmeal and formed into patties that are
fried. Known as laverbread, these cakes are
traditionally served at breakfast with bacon.
Dulse, a red algae eaten in Ireland, can be con-
sumed fresh, but is usually dried, then chewed
like beef jerky for a snack, or flaked and added
to soups or warm milk.
The most common beverages consumed
by adults in Ireland and England are tea, beer,
and whiskey. Tea, which has become synony-
mous with a meal or break in the afternoon,
was introduced to England in 1662 by the wife
of Charles II. Drunk with most meals and as
a refreshment, strong black tea is preferred,
served with milk and sugar. Frequently con-
sumed alcoholic beverages include beer and
whiskey. The British and the Irish do not
drink the bottom-fermented style of beer
common in the United States. Instead, in
Britain the pubs usually serve bitters, an
amber-colored, top-fermented beer, strongly
flavored with hops, while in Ireland, a favor-
ite is stout, a dark, rich beer that can provide
substantial calories to the diet. Both beers are
served at cellar temperature and are naturally
carbonated.
Whiskey is made in both Ireland and Scot-
land, but the Irish are usually credited with
its invention and name. In Ireland, it is dis-
tilled from mashed, fermented barley. Scotch,
or Scotch whisky (spelled without an e), is
distilled from a blend of malted whiskey (in
which the barley germinated before fermen-
tation) and unmalted whiskey. Scotch is tra-
ditionally a much stronger, smokier-tasting
beverage than Irish whiskey. Other alcoholic
drinks popular in Britain are gin, Port (a
brandy-fortified wine made in Portugal), and
Sherry (a fortified wine from Spain). A less
common beverage but still popular in some
regions is mead, a type of honey wine made
from the fermentation of honey and water.
The Welsh prefer a stronger, highly spiced
variety called metheglyn.
France The cooking of France has tradition-
ally been divided into classic French cuisine
(haute or grande cuisine) and provincial or
regional cooking.8 Classic French cooking
is elegant and formal, mostly prepared in
restaurants using the best ingredients from
throughout the country. Provincial cuisine is
simpler fare made at home or local cafes fea-
turing fresh local ingredients. Broadly speak-
ing, butter and cream enriches many dishes
in the northeastern and central regions of the
country, while lard, duck fat, and goose fat
flavor foods in the northwest and south cen-
tral areas.9 In the southeast, olive oil is promi-
nent. Seafood and lamb are specialties of the
north, while pork is common in the regions
bordering Belgium and Germany. Beef and
veal are favorites in the central areas, and in
the southernmost regions near Spain, fish is a
specialty. Cold weather fruits and vegetables
are featured in northern dishes, while temper-
ate, Mediterranean produce is the mainstay in
southern areas. In the north, foods are subtly
seasoned. In the south, garlic flavors many
dishes.
S A M P L E M E N U
An Irish Pub Supper
Steak/Beef and Guinness Piea,b,c
Brown Breada,b,c
Apple Crumblea,b,c
Stout
aJohnson, M.M. 2006. The Irish pub cookbook. San Francisco: Chronicle Books.
bRecipes from the Irish Kitchen at http://www.littleshamrocks.com/Irish-Food-
Recipes.html
cIrish Recipes and Baking at http://www.irelandseye.com/aarticles/culture/recipes/index.shtm
Colcannon was
customarily served for
the harvest dinner and
on Halloween in Ireland.
For Halloween, coins
were wrapped and
buried in the dish so
the children could find
them as they ate.
The term honeymoon
originated with the
European custom of
newlyweds drinking
mead for the first lunar
month following their
wedding.
Tomatoes were intro-
duced to Europe in 1523
from the New World.
Reaction was mixed;
some people thought
they were poisonous,
while others believed
they brought luck.
Tomato-shaped pin
cushions developed from
the latter superstition.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
1 4 8 N O R T H E R N A N D S O U T H E R N E U R O P E A N S
The ancestors of most French Americans
are from two of France’s northern provinces,
Brittany and Normandy. Brittany, known
as Bretagne, is located in the northwest; its
shores are washed by the English Channel
and the Bay of Biscay. Seafood, simply pre-
pared, is common, and delicate Belon oysters
are shipped throughout France. Mutton and
vegetables from the region are said to have a
naturally salty taste because of the salt spray.
Apples are the prevalent fruit, and cider is
widely exported.
Located along the English Channel and
east of Brittany is Normandy, also known for
its seafood and apples. Calvados, an apple
brandy, is thought to be the mother of apple-
jack, an alcoholic apple drink used to clear
the palate during meals in Louisiana. Another
alcoholic drink produced in the region is
Bénédictine, named after the Roman Catho-
lic monks who still make it at the monastery
in Fecamp. Normandy is also renowned for
its rich dairy products; its butter is consid-
ered one of the best in France. Camembert,
a semisoft cheese with a mild flavor, and
Pont-l’Évêque, a hearty aromatic cheese, are
produced in the area. Dishes from Normandy
are often prepared with rich cream sauces.
Crêpes, very thin, unleavened pancakes, origi-
nated in this region; they are typically served
topped with sweet or savory sauces or rolled
with meat, poultry, fish or seafood, cheese, or
fruit fillings.
Champagne, bordered by the English
Channel and Belgium, has a cuisine influenced
by the Germanic cultures. Beer is popular, as
are sausages, such as andouille and andouil-
lette, large and small intestinal casings stuffed
with pork or lamb stomach. Charcuterie, cold
meat dishes such as sausages, pâtés, and ter-
rines, which often are sold in specialty stores,
are especially good from this region. Pâté is
a spread of finely ground, cooked, seasoned
meats. A terrine is commonly made with left-
over meats cut into small pieces, mixed with
spices and a jelling substance, then baked in
a loaf pan. Throughout the world, Cham-
pagne is probably best known for its natu-
rally carbonated wines. Only sparkling wines
produced in this region can be legally called
champagne in France.
The province that borders Germany,
Alsace-Lorraine, has been alternately ruled
by France and Germany. One of its princi-
pal cities is Strasbourg. Many German foods
are favored in the region, such as goose,
sausages, and sauerkraut. Goose fat is often
used for cooking, and one of the specialties
of the area is pâté de fois gras, pâté made
from the enlarged livers of force-fed geese.
Another famous dish is quiche Lorraine, pie
pastry baked with a filling of cream, beaten
eggs, and bacon. Alsace-Lorraine is a wine-
producing area; its wines are similar to the
German Rhine wines but are usually not
as sweet. Distilled liquors produced in the
region are kirsch, a cherry brandy, and the
brandy eau de vie de framboise, made from
raspberries.
Located south of Normandy and Brittany
in the west-central part of France is Touraine,
the province that includes the fertile Loire val-
ley. Along the river one can see the beautiful
chateaux or palaces built by the French nobil-
ity. Known as the “garden of France,” Touraine
produces some of the finest fruits and veg-
etables in the country. A dry white wine
produced in the area is Vouvray. In the north-
central region is the area surrounding the city
of Paris called the Ile-de-France, the home of
classic French cuisine. Some of the finest beef
and veal, as well as a variety of fruits and vege-
tables, are produced in this fertile region. Brie,
semisoft and mild flavored, is the best-known
▲ Tea time in Great Britain
has become an afternoon
meal, with small sandwiches,
scones (on the second rack
of the silver tray), and an
assortment of cookies and
pastries.
M
ag
da
na
tk
a/
Sh
ut
te
rs
to
ck
.c
om
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 6 1 4 9
cheese of the area. Dishes of the Ile-de-France
include lobster à l’américaine, lobster pre-
pared with tomatoes, shallots, herbs, white
wine, and brandy; potage St. Germain, pea
soup; filet de bœuf béarnaise, filet of beef with
a béarnaise sauce; and tarte tatin, an upside-
down apple and caramel tart.
Located southeast of Paris is Burgundy,
one of the foremost wine-producing regions
of France. Burgundy’s robust dishes start to
take on the flavor of southern France; they
contain garlic and are often prepared with
olive oil. Dijon, a principal city, is also the
name of the mustards of the region, prepared
with white wine and herbs. Dishes of the area
are escargot, or snails (raised on grape vines)
cooked in a garlic butter and served in the
shell; coq au vin, rooster or chicken cooked
in wine; and bœuf bourguignon, a hearty red
wine beef stew. In Burgundy, the red wines
are primarily made from the pinot noir grape
and the white wines from the chardonnay
grape. The great wines of the area are usu-
ally named after the villages in which they are
produced; for example, Gevrey-Chambertin,
Vosne-Romanée, and Volnay. Cassis, a black
currant liquor, is also produced in the region,
and brandy from Cognac is a specialty. To the
east, along the border with Switzerland, is the
mountainous Franche-Comte region, known
for its exceptionally tender and flavorful
Bresse chicken.
The other major wine-producing region of
France is Bordeaux, which is also the name of
its principal city. Famous for its hearty dishes,
the term à la bordelaise can mean (1) prepared
in a seasoned sauce containing red or white
wine, marrow, tomatoes, butter, and shallots;
(2) use of mirepoix, a finely minced mixture
of carrots, onions, and celery seasoned with
bay leaves and thyme; (3) accompanied by
cèpes, large fleshy mushrooms; or (4) accom-
panied by an artichoke and potato garnish. A
red Bordeaux wine is full-bodied and made
primarily from the cabernet sauvignon grape.
(In Great Britain, Bordeaux is called claret.)
Among the wines produced are St. Julien,
Margaux, Graves, St. Emilion, Pomerol, and
Sauternes, a sweet white dessert wine.
In the south of France is Languedoc, famous
for cassoulet, a complex dish containing duck
or goose, pork or mutton, sausage, and white
beans, among other ingredients. Provence,
located on the Mediterranean Sea, is a favor-
ite vacation spot because of its warm Riviera
beaches. Provence is also known for the large
old port city of Marseilles, its perfumes from
the city of Grasse, and the international film
festival in Cannes.
The cooking of Provence is similar to
that of Italy and Spain. Staple ingredients are
tomatoes, garlic, and olive oil; à la Provençal
means that a dish contains these three items.
Other common food items are seafood from
the Mediterranean, artichokes, eggplant, and
zucchini. Popular dishes from the region are
bouillabaisse, the famed fish stew made with
tomatoes, garlic, olive oil, and several types of
seafood, seasoned with saffron, and usually
served with rouille, a hot red pepper sauce;
ratatouille, tomatoes, eggplant, and zucchini
cooked in olive oil; salade Niçoise, a salad
originating in Nice, containing tuna, toma-
toes, olives, lettuce, other raw vegetables, and
sometimes hard-boiled eggs; and pan bagna,
a French bread sandwich slathered with olive
oil and containing a variety of ingredients,
Belgians are renowned
for their beers. One
specialty ale is lambic,
a fruity brew distinctive
for its use of unmalted
(raw) wheat and open-
tank fermentation with
wild yeast.
Fresh cream in France,
called fleurette, is often
added to sauces or
whipped for dessert. Also
popular is crème fraîche,
cream that is fermented
until it is thickened and
slightly tangy.
The first eating chocolate
was introduced by the
British in 1847. Euro-
peans now consume
twenty to twenty-five
pounds of chocolate per
person each year—twice
the amount eaten by
U.S. citizens.
S A M P L E M E N U
A French Lunch
P â t é a,b* and Baguette
Q uich e (Seafood, Onion, or Lorraine)a,b
Green Salad
Selection of Cheeses (e.g., Br ie , P on t- l’ E v ê q u e )
Fresh Fruit or T ar t e au x P omme s (Apple Tart)a,b
Wine
aChild, J., Bertholle, L., & Beck, S. 2001. Mastering the art of French cooking
(Vol. I). New York: Knopf.
bFrench Food and Cook at http://www.frenchfoodandcook.comFrench Food and Cook at http://www.frenchfoodandcook.comFrench Food and Cook
*Can be purchased at a specialty cheese shop or delicatessen.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
1 5 0 N O R T H E R N A N D S O U T H E R N E U R O P E A N S
such as anchovies, tomatoes, green peppers,
onions, olives, hard-boiled eggs, and capers.
One unique specialty item in the region asso-
ciated with haute cuisine is black truffles. This
costly, pungent underground fungus flavors
or garnishes many classic French dishes.
Cooking Styles Although the ingredients used
in the countries on the opposite sides of the
English Channel are not substantially differ-
ent, their cooking styles vary greatly. British
and Irish food is described as simple and
hearty fare that developed out of rural, sea-
sonal traditions.10 French cuisine is admired
for its fresh ingredients, attention to detail,
and technical proficiency—and it is imitated
around the world.
Great Britain and Ireland Both the British and
the Irish take pride in the naturalness of their
dishes and their ability to cook foods so the
flavors are enhanced rather than obscured. In
recent years, the eating local movement (see
Chapter 15 for more details) and government
programs promoting regional specialties have
led to a renewed interest in traditional fare.11
Meat is usually roasted or broiled, depend-
ing on the cut, and lightly seasoned with
herbs and spices. Strong-flavored condiments
such as Worcestershire sauce (flavored with
anchovies, vinegar, soy, garlic, and assorted
spices) on roast beef or mint jelly on lamb are
often served. Chutneys, highly spiced fruit or
vegetable pickles originally from India, are
also popular. Leftover meat is finely chopped,
then served in a stew, pie, or pudding. Offal,
parts of the animal often discarded, such as
lamb’s brains, pig’s tail, and calf ’s heart, have
become trendy items in England, appreci-
ated for both their traditional heritage and
the ecological or ethical value of using the
whole animal.
While most Americans think of pies and
puddings as being sweet desserts, in Britain
and Ireland this is not necessarily the case.
A pie is a baked pastry consisting of a mixture
of meats, game, fish, and vegetables, or fruit,
covered with or enclosed in a crust. A Cornish
pasty is an individual pillow-shaped pie filled
with meat, onions, potatoes, and sometimes
fruit. Another well-known British dish is steak
and kidney pie.
Pudding is a steamed, boiled, or baked
dish that may be based on anything from
custards and fruits to meat and vegetables.
An example of a sweet pudding is plum pud-
ding, which is served traditionally at Christ-
mas. It is a steamed dish of suet, dried and
candied fruit, and other ingredients. Trifle is
a layered dessert made from custard, pound
cake, raspberry jam, whipped cream, sherry,
and almonds.
France Classic French cuisine implies a care-
fully planned meal that balances the texture,
color, and flavor of the dishes, similar to the
harmony found in musical compositions
or paintings.12 The soul of French cooking
is its sauces, often painstakingly prepared
from stocks simmered for hours to bring out
the flavor. A white stock is made from fish,
chicken, or veal; and a brown stock is made
from beef or veal.13
Sauces are subtly flavored with natu-
ral ingredients, such as vegetables, wine,
and herbs. They must never overwhelm the
food, but rather complement it. The five
basic sauces are espagnole (or brown sauce),
made with brown stock, mirepoix, and roux
(thickening agent made from flour cooked in
butter or fat drippings); velouté, made with
white stock, roux, onions, and spices; bécha-
mel (or cream sauce), made with white stock,
milk, and roux; tomato, made with white
stock, tomatoes, onions, carrots, garlic, and
roux; and, hollandaise, which combines egg
yolks and drawn butter (béarnaise is similar,
flavored with tarragon). Examples of classic
cold sauces are mayonnaise and vinaigrette, a
mixture of vinegar and oil.
Some common rules in preparing French
dishes are (1) never mix sweet and sour fla-
vors in the same dish; (2) never serve sweet
sauces over fish; (3) do not undercook or
overcook food; (4) with the exception of
salad and fruit, do not serve uncooked food;
(5) always use the freshest, best-tasting
ingredients; and (6) wine is an integral part
of the meal and must complement the food.
French breads and pastries are particularly
noteworthy. Breads are typically made with
white flour, shaped into long loaves (e.g.,
thin baguettes), rounds, braids, or rings,
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 6 1 5 1
then baked in a wood-fired oven. Sweeter
breads, such as eggy brioche or buttery, flaky
croissants, are between breads and pastries.
Specialty doughs, such as cream puff pas-
try, multilayered puff pastry, and the clas-
sic sponge cake génoise, are used to create
the numerous desserts of France, such as
cakes, petits fours (small, bite-size pastries),
and tarts. Chocolate, fresh fruits, and pastry
cream thickened with egg yolks enrich these
pastries.
In recent years, classic French cuisine has
merged with a rediscovery of regional fare
to create what is known as nouvelle cuisine
(new cuisine).12 The practice of nouvelle cui-
sine has popularized French cooking world-
wide and influenced the development of
local specialties with an emphasis on fresh
ingredients. An appreciation for the cooking
of other nations, especially those of Asia, has
occurred in France, and many dishes now use
foreign seasonings or use exotic techniques
and presentations.
Meal Composition and Cycle
Daily Pattern
Great Britain and Ireland In Britain, four
meals are traditionally served each day—
breakfast, lunch, tea, and an evening meal
(dinner). In the nineteenth and early twenti-
eth centuries, breakfast was a very substantial
meal, consisting of oatmeal; bacon, ham, or
sausage; eggs (prepared several ways); bread
fried in bacon grease; toast with jam or mar-
malade; grilled tomatoes or mushrooms; and
possibly smoked fish or deviled kidneys. All
this was washed down with tea. Today, in
Scotland, oatmeal is usually eaten for break-
fast, while in England, packaged breakfast
cereals are often eaten during the week, and
the more extensive breakfast is reserved for
weekends and special occasions.
Lunch was originally a hearty meal and
still is on Sundays, but during the week it
is squeezed in between work hours. It may
include a meat pie, fish and chips, or a light
meal at the pub with a pint of bitters or stout.
Both Sunday lunch and the weekday dinner
are much like a U.S. dinner. The meals con-
sist of meat or fish, vegetable, and starch. The
starch is often potatoes or rice, and bread also
accompanies the meal. Dessert (often called
“pudding”) follows the main course.
In the late afternoon in Britain and Ireland,
most people take a break and have a pot of
tea and a light snack. In some areas a high
tea is served. This can be a substantial meal
that includes potted meat, fish, shrimp, ham
salad, salmon cakes, fruits, and a selection
of cakes and pastries. High tea is associated
with working-class or rural families who have
maintained the custom of a large lunch, with
high tea serving as dinner. It is thought that
the upper British classes add the term high to
tea as a dinner when it is served occasionally
in place of dinner as a novelty or to children
as an informal substitute for dinner. Whether
snack or meal, the British often just call it tea.
France The French eat only three meals a
day—breakfast, lunch, and dinner. Second
helpings are uncommon, and there is very
little snacking between meals. Breakfast,
in contrast to the British meal, is very light,
consisting of a croissant or French bread with
butter and jam, and strong coffee with hot
milk or hot chocolate. The French breakfast
is what is known in the United States as a con-
tinental breakfast. Lunch is traditionally the
largest meal of the day and, in some regions
of France, businesses close at midday for two
hours so people can return home to eat. The
▲ French breads are
consumed at every meal, and
include baguettes, braids,
rings, and sweeter versions
such as brioche (with little
topknots).
G
re
g
D
al
e/
G
et
ty
Im
ag
es
Potted is an English term
for fish, meat, poultry, or
game pounded with lard
or butter into a coarse
or smooth pâté, then
preserved in jars or pots.
Deviled describes a dish
prepared with a spicy hot
sauce or seasoning.
In the small town of
Palmiers, the city council
has banned any ready-
made or mass-produced
food (e.g., frozen pizza)
from the local school
cafeteria to “ensure our
kids stay healthy, teach
them the taste of proper
French food, and help
keep our small farmers
in business.”15
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
1 5 2 N O R T H E R N A N D S O U T H E R N E U R O P E A N S
meal usually starts with an appetizer (hors
d’oeuvre) such as pâté. The main course is a
meat, fish, or egg dish accompanied by a veg-
etable and bread. If salad is eaten, it is served
after the main course. Dessert at home is usu-
ally cheese and fruit. In a restaurant, ice cream
(more like a fruit sherbet or sorbet), cakes,
custards, and pastries are served in addition to
fruit and cheese. Wine is served with the meal
and coffee after the meal. Dinner is similar,
but traditionally a lighter meal with a starter
course of soup or appetizer, then a main dish,
followed by a cheese course. However, meal
patterns are changing in France. The popu-
larity of fast foods and shorter lunch periods
is resulting in a more American pattern of
smaller lunch followed by larger dinner.
Etiquette The fork is not passed from the
right hand to the left hand when cutting
food in England and Ireland. Instead the fork
remains in the left hand, and the knife in
the right. The two are often used together to
scoop food onto the fork. All dishes are passed
to the left. When not eating, the hands should
be placed in one’s lap. In Ireland, a small plate
to the left of the setting is used for placing
potato peelings.14
France is similar to Great Britain in the
use of the fork and knife. For example, lettuce
in a salad should not be cut, but folded into
a small, easy-to-eat packet. The French also
pass dishes to the left. They do not usually use
bread plates but place their portions of bread
directly on the table. In contrast to England
and Ireland, it is considered impolite to put
your hands on your lap. The wrists should
be rested on the table with the hands in view.
Chocolates are appropriate gifts to bring to a
dinner. In England, a bottle of champagne is
appreciated, while in Ireland a bottle of wine
to serve with the meal is also common. In
France, a dessert-style wine or after-dinner
liqueur is the best beverage to give.
Special Occasions Christmas and Easter
are the most important Christian holidays
celebrated in England, Ireland, and France.
Ireland and France are predominantly Catho-
lic countries and tend to observe all the holy
days of obligation and patron saints’ days.
France commemorates the beginning of the
French Revolution on July 14, Bastille Day.
Great Britain and Ireland The British cel-
ebrate Christmas by serving hot punch or
mulled wine; roast beef, goose, turkey, or
ham; plum pudding and mincemeat (or just
“mince”) pies; and, afterward, port with nuts
and dried fruit. The plum pudding is tradi-
tionally splashed with brandy and then flamed
before being served. Mincemeat pies were
originally prepared with seasoned, ground
meats, suet, and fruit, but today they are usu-
ally made with only dried and candied fruit,
nuts, and spices. Boxing Day, the day after
Christmas, is when friends and relatives visit
one another.
Foods served at Easter include hot cross
buns and Shrewsbury simnel. In ancient
times, the cross on the buns is believed to
have symbolized both sun and fire; the four
quarters represented the seasons. Today the
cross represents Christ and the resurrection.
Shrewsbury simnel is a rich spice cake topped
with twelve decorative balls of marzipan
originally representing the astrological signs.
(It is also served on Mother’s Day.) Another
holiday celebrated throughout Great Britain
is New Year’s Day on January 1.
The Scottish traditionally eat haggis on
New Year’s Eve. Haggis is a sheep’s stom-
ach stuffed with a pudding made of sheep’s
innards and oatmeal. After it is served, adult
diners drench their portions with Scotch
whisky before eating. It is also the traditional
entrée (served with “neeps,” mashed turnips,
and “tatties,” mashed potatoes) on Burns’s
Night, commemorating the national poet
Robert Burns (January 25). St. Patrick’s Day
began as a religious commemoration for the
patron saint of Ireland. The Irish American
custom of eating a corned beef and cabbage
meal on March 17 is now as popular in Ireland
as it is in the United States.16
France In France, the main Christmas meal
is served after mass on the night of Decem-
ber 24. Two traditional dishes are a boudin
noir and boudin blanc, also known as black
pudding and white pudding (dark blood sau-
sage or a light-colored one made from veal,
chicken, or pork with milk) and a goose
In Britain, a piece of
mincemeat pie is eaten at
midnight on New Year’s
Eve while making a wish
for the upcoming year.
Robert Burns once
wrote that haggis was
the “great chieftain
o’ the puddin’ race.”
Nevertheless, Scottish
government officials rec-
ommended in 2006 that
haggis be served to chil-
dren no more than once
a week due to its high fat
and sodium content.
The members of the
French Foreign Legion
are nicknamed “boudin,”
because the red blanket
roll they wear across their
chests resembles a black
pudding.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 6 1 5 3
or turkey with chestnuts. In Provence, the
Christmas Eve meal is meatless, usually cod,
but the highlight is that it is followed by thir-
teen desserts.
On Shrove Tuesday (Mardi Gras), the
French feast on pancakes, fritters, waffles, and
various biscuits and cakes. During Lent, no
eggs, fat, or meat are eaten. Dishes served dur-
ing Lent often contain cod or herring. Cod is
also the traditional dish served on Good Fri-
day; in some regions, lentils are eaten to wash
away one’s sins. Easter marks the return of the
normal diet, and eggs are often served hard-
boiled (also colored), in omelets, or in breads
and pastries. French toast (croûtes dorée) is a
traditional Easter dish. Also common are pies
filled with minced meats.
Therapeutic Uses of Food Most northern
Europeans share a belief that a good diet is
essential to maintaining health. Traditional
home remedies for minor illnesses include
chicken soup, tea with honey or lemon or
whiskey, hot milk, or hot whiskey with cloves.
Practices less common today are taking sulfur
with molasses as a laxative and regular use of
cod liver oil. Some Irish Americans may use
senna (Cassia actifolia) weekly to cleanse their
bowels.18
Home remedies popular with Americans of
French descent include infusions made from
magnolia leaves, elderberry flowers, sassafras,
or citronella, which are prescribed for colds.
Sore throats are treated by gargling herbal teas
or hot water with dissolved honey, salt, and
baking soda. Sassafras tea is used to cleanse
the blood, and garlic is ingested for worms.
Contemporary Food Habits
in the United States
Adaptations of Food Habits
Ingredients and Common Foods
British and Irish Many U.S. dishes have their
origins in Great Britain. The Puritans, adapt-
ing Native American fare, made a pudding
with cornmeal, milk, molasses, and spices.
Today, this is called Indian pudding. Pump-
kin pie is just a custard pie to which the Native
American squash, pumpkin, is added. Apple
pie has been so well accepted that we say,
“American as apple pie,” despite its English
heritage. Syllabub, a milk and wine punch
drunk in the American South at Christmas-
time, is also an English recipe.
French French cooking has had less influ-
ence on everyday American cooking (except
for French fries), but there are probably few
large cities that don’t have a French restaurant.
French Americans adapted their cuisine
to the available ingredients and other ethnic
cooking styles. The best example of this is
found in Louisiana, where Creole and Cajun
cooking developed. Creole cooking is to
Cajun cooking what French grande cuisine is
to provincial cooking. Some dishes may sound
typically French, such as the fish stew known
as bouillabaisse, but this is made with fish
from the Gulf of Mexico, not from the Medi-
terranean. Even the coffee is slightly different,
flavored with the bitter chicory root.
Ingredients for Cajun cooking reflect the
environment of Louisiana: Bayou Cajun foods
are from lake and swamp areas, whereas prai-
rie Cajun dishes are found in inland areas.
Fish and shellfish abound, notably crawfish,
crabs, oysters, pompano, redfish, and shrimp,
to name just a few. Shellfish is commonly
eaten raw on the half shell (oysters) or boiled
in a spicy mixture. Gumbo and jambalaya are
often made with seafood. Gumbo is a thick,
spicy soup made with a variety of seafood,
meat, and vegetables. It is thickened with
either okra or filé powder and then ladled
over rice. Jambalaya, also a highly seasoned
▲ St. Patrick’s Day in
Savannah, Georgia.
Ro
be
rt
B
re
nn
er
/P
ho
to
Ed
it
Gumbo is the African
Bantu word for “okra.”
The name for the popu-
lar Cajun music style,
zydeco, is derived from
the French term for
“green bean,” haricot
(pronounced “ar-ee-ko”)
because it is snappy, like
a bean.
Crawfish are also known
as crayfish (especially in
New Orleans), crawdads,
crawdaddy crab (in
the Great Lakes area),
clawfish, and mudbugs,
among others. They are
small crustaceans that
look like miniature lob-
sters, found in the fresh
waters of Louisiana, Lake
Michigan, California, and
the Pacific Northwest.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
1 5 4 N O R T H E R N A N D S O U T H E R N E U R O P E A N S
stew made with a combination of seafood,
meats, and vegetables, was brought to New
Orleans by the Spanish. Originally made only
with ham (jambon), it was later modified. The
base for these stews and gravies is roux; how-
ever, the Cajun roux is unique in that the flour
and fat (usually vegetable oil) are cooked very
slowly until the mixture turns brown and has
a nutlike aroma and taste.
Other key ingredients in Cajun cooking are
rice (which has been grown in Louisiana since
the early 1700s), red beans, tomatoes, chayote
squash, eggplant, spicy hot sauce, and a vari-
ety of pork products. One of the better-known
hot sauces, Tabasco, is produced in the bayous
of southern Louisiana from fermented chile
peppers, vinegar, and spices. Tasso, a seasoned
smoked pork product, is also used to flavor
dishes. A deep-fried rice fritter, calas, is the
Louisiana version of a doughnut. Other rice
dishes are red beans and rice and dirty rice.
Dirty rice derives its name from the fact that
its ingredients, bits of chicken gizzards and
liver, give the rice a brown appearance. Cajun
boudin sausages are a specialty. Boudin blanc
is made with pork and rice; boudin rouge has
pork blood added to it. Cochon de lait, a suck-
ling pig roasted over a wood fire, is prepared
at Cajun festivals in central Louisiana. Fricot
is a popular soup made with potatoes and sau-
sage or shredded meat. Cracklings, known as
gratons, are bite-size bits of fried pork skin
(often with meat attached) popular in some
regions.
Pecan pralines are a famous New Orleans
candy. Pecans are native to Louisiana; pralines
are large, flat patties made from brown sugar,
water or cream, and butter. Another confec-
tion eaten often with coffee is beignets, round
or square puffed French doughnuts dusted
with powdered sugar. French toast, or pain
perdu, is another French specialty that was
transported to New Orleans and is now famil-
iar to most Americans.
The cuisine of French Americans in New
England tends to be traditionally French, but it
is influenced by common New England foods
and food habits. Franco-Americans use more
herbs and spices than other New Englanders
and take time to prepare the best-tasting food.
Traditional French dishes are pork pâté, called
creton by the Franco-Americans, and the tra-
ditional Yule log cake (bûche de Noël) served
at Christmas. Franco-American cuisine offers
numerous soups and stews. One of the most
elaborate of the stews, which is also called a
pie, is cipate, known as cipaille, si-pallie, six-
pates, and sea pie in some areas. A typical
recipe calls for chicken, pork, veal, and beef,
plus four or five kinds of vegetables layered
in a heavy kettle, covered with pie crust. It is
slowly cooked after chicken stock has been
added through vents in the crust.
Maple syrup is commonly used. One
unique breakfast dish is eggs poached in
the syrup. Maple syrup is also served over
bread dumplings or just plain bread. Franco-
Americans appreciate wine and distilled
spirits. One unusual combination of both
is caribou, a mixture of white whiskey (a
distilled, colorless liquor) and red wine,
which is drunk on festive occasions. (See also
Chapter 15.)
Meal Composition and Cycle
British and Irish American food habits have
been greatly influenced by British and Irish
immigrants. Meal patterns and composition
are very similar to those in Great Britain. The
typical meal of a meat, poultry, or fish main
dish served with vegetable and starch side
dishes, and often bread, continues to this day.
Though English Americans also consumed a
hearty breakfast that often included ham or
bacon and eggs, in more recent years, time
▼ La boucherie:
French-speaking Cajuns
in Louisiana maintain the
hog-butchering traditions of
their past. Before the days of
refrigeration, everyone in the
community helped prepare
the meat and lard. Partici-
pants went home with fresh
pork cuts and spicy sausages
called boudin. La boucherie
continues today at many
Cajun festivals.
Ed
w
in
R
em
sb
er
g/
A
la
m
y
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 6 1 5 5
constraints and health concerns have changed
this pattern on weekdays; weekend breakfast
sometimes reverts to the more British-style
meal.
Festive meals also reflect the British and
Irish influence. A traditional Christmas din-
ner includes roast turkey or ham, stuffing,
and mashed vegetables. For dessert, a pie is
customary, often mincemeat. Two holidays
Americans think of as being typically Ameri-
can, Thanksgiving and Halloween, are actu-
ally of British and Irish origin. Thanksgiving
combined the tradition of an old British har-
vest festival with the Pilgrims’ celebration
of surviving in their new environment. In
Great Britain and Ireland, Halloween, or All
Hallow’s Eve, is believed to have originated
in ancient times. Ghosts and witches were
thought likely to wander abroad on Hallow-
een night.
French Americans of French descent have
adopted the U.S. meal cycle with the main
meal in the evening. In Louisiana, the best-
known celebration is Mardi Gras, culmi-
nating on Shrove Tuesday, just before the
beginning of Lent. In New Orleans there are
parades, masquerading, and general revelry;
the festival reaches its climax at a grand ball
before midnight. After this day and night of
rich eating and grand merriment, the forty
days of fasting and penitence of Lent begin.
In the Cajun countryside, Mardi Gras is cel-
ebrated with “run”: Men on horseback ride
from farmhouse to farmhouse collecting
chickens and sausages to add to a commu-
nity gumbo. Participants enjoy beer, boudin,
and faire le maque (“make like a monkey,” or
clowning around) at each stop. During the
rest of the year, Cajuns sponsor many local
festivals, such as the crawfish, rice, and yam
festivals.
Franco-Americans, like their French
ancestors, serve meat pies on religious holi-
days. The special pie for Easter has sliced
hard-boiled eggs laid down on the bottom
crust and then a layer of cooked meat topped
with well-seasoned pork and beef meatballs.
For Christmas, tourtière, a pie made with
simmered seasoned pork, is eaten cold after
midnight Mass.
Nutritional Status
The influence of the British and French on
American cuisine is undoubtedly one rea-
son the U.S. diet is high in cholesterol and
fat, and low in fiber and complex carbohy-
drates. Current research in Europe suggests
continuing similarities. A survey of dietary
habits found that consumption of potatoes,
animal protein, processed foods, margarine
and butter, and sweets is relatively high in the
United Kingdom.19 In France, consumption of
added animal fats and oils is high.20 The esti-
mated prevalence of overweight and obesity
in France in adults is 40 percent and 10 per-
cent, respectively, and in the United Kingdom
is 66 percent and 25 percent, respectively.21
Although few studies have been conducted
on the nutritional status of Americans who
are of French, Irish, and British descent, it is
assumed that they have the same nutritional
advantages and disadvantages as the general
U.S. population.
Nutritional Intake Ver y little has been
reported on the diets of northern Europeans
living in the United States. A study to deter-
mine differences in mortality from coronary
heart disease examined Irish brothers—one
group in Ireland, one group living in the
United States (Boston)—and a third control
group of first-generation Irish Americans
in Boston.22 Although there was no signifi-
cantly different relative risk for death from
heart disease among the three groups, it was
found that their diets varied significantly. The
Boston brothers and the first-generation Irish
Americans had a higher intake (as a percent-
age of caloric intake) of animal protein, total
fat (more vegetable and less animal), sugar,
fiber, and cholesterol, and a lower intake of
starch. The Irish brothers had a higher caloric
intake than the Boston brothers and the first-
generation Irish Americans, yet their relative
weight was significantly lower.
It is commonly assumed that a high rate of
alcoholism prevails among Irish Americans;
however, little has been reported confirm-
ing or refuting this belief. One comparative
study found that Irish American men had
higher rates of excessive drinking, and more
Cornish pasties are
still popular in parts
of the country where
immigrants from Corn-
wall came to work in
the mines, such as the
Upper Peninsula in
Michigan, where May 24
was declared Pasty Day
in 1968.
A study in France found
that consumption of
mineral water provided
up to 25 percent of
total daily intake of
calcium and 6 to 7 per-
cent of magnesium in
participants.17
Some Cajuns think
that being thin means
a person is puny or
unattractive.28
Cajuns may believe that
milk and fish should
not be consumed at the
same meal.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
1 5 6 N O R T H E R N A N D S O U T H E R N E U R O P E A N S
physical, psychological, sexual, and/or occu-
pational problems with alcohol misuse than
did Puerto Rican men.23
Prevalence for hereditary hemochroma-
tosis, which may be treated with a low-iron
diet (and avoidance of alcohol and foods or
supplements high in vitamin C), are higher
in northern Europeans (estimated to be
0.54 percent in whites).24 Though it is hypoth-
esized that the gene for the disease is Celtic
in origin,25 a study of French Canadians also
noted a high prevalence rate.26 (It should be
noted that hemochromatosis is often unde-
tected in these populations, and may not
show overt clinical symptoms until middle
or late adulthood.) A study on the causes of
inherited chylomicronemia indicates that the
frequency of lipoprotein lipase deficiency is
very high among French Canadians.27 Franco-
Americans may also have high rates of this
genetic defect, leading to elevated triglycer-
ides and the necessity of a very low-fat diet.
Counseling Studies of people in France
suggest that the French are likely to under-
take many activities at once, change plans
frequently, ignore schedules, and commu-
nicate indirectly with enthusiastic body
language. 29 Direct, intense eye contact is
important. Among the English and Irish, less
eye contact between strangers or acquain-
tances is common. The English are low con-
text in their communication style, yet prefer
understatement and somewhat indirect dis-
cussion compared to Americans. The Irish
are high context, direct, and often effusive.
The French are very low context and can
be exceptionally direct.14 Most northern
Europeans use a quick, light handshake when
greeting one another. It is important to note,
however, that most Americans of British,
Irish, or French descent are completely
acculturated.
Americans of British and Irish descent are
often stoic in the face of illness and reserved in
the communication of their symptoms. Some
Irish believe that the best way to stay healthy
is to avoid doctors unless very ill. The British,
Irish, and French all tend to be more formal
than Americans and politeness is expected.
Socioeconomic status and religious practice
are likely to have greater impact on foods
J O H N C A S E Y , R e tire dC A S E Y , R e tire dC A S E Y
Icame to the U.S. in 1956 from Ireland when I was twenty-six years old. I first
lived in New York City where plenty of other
Irish live. When I left Ireland, it wasn’t as
well-off as it is now, and food was not
plentiful, and it was mostly grown locally.
You raised pigs and killed two a year, and
that provided the bacon for the rest of a
year. The foods we ate every day were bread,
butter, milk, and eggs. My dad owned a
food shop, so we had a bit more of other
foods. When I came to America, I was over-
whelmed by the amount of food available
and all the different types. I had never had
juice with breakfast, didn’t know what a
grapefruit was—thought it was a very big
lemon. Other foods that I tried for the first
time were watermelon, turkey, hamburgers,
corn on the cob, and French fries. I like all of
them except the watermelon.
In Ireland the main meal of the day was
lunch, and what we usually had was all
boiled together, like a New England boiled
dinner but without as much meat and usually
no meat. On sick days we got toast and tea.
But the bread was only toasted on one side.
When I first got toast here, it was toasted on
both sides, and I wasn’t sure if you buttered
both sides as well. The three biggest holidays
in Ireland are Christmas, Easter, and St.
Patrick’s Day. Christmas was the biggest feast
day—bacon, eggs, and sausage for breakfast
and for the main meal we had goose with
dressing and mashed potatoes, plus custard
for dessert. For Easter we often had mutton,
and the children—if it was affordable—
got chocolate Easter eggs, just like here.
St. Patrick’s Day wasn’t as much fun because
it fell during Lent, and the pubs were closed.
I eat a lot of different foods now, more
than I did when I was younger, and I like
Chinese and German food, but I miss Irish
bacon. My grandchildren are still trying to
get me to order different flavors of ice cream,
but I will only eat vanilla. When I first came
to America, Ireland didn’t have enough food,
and Americans ate too much. Today, both the
Irish and Americans eat too much.
N E W A M E R I C A N P E R S P E C T I V E S
Irish
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 6 1 5 7
and food habits than country of origin. The
in-depth personal interview should reveal any
notable ethnically based preferences.
Southern Europeans
Southern European countries lie along the
Mediterranean Sea and include Italy, south-
ern France, Spain, and Portugal. Italy, shaped
like a boot, sticks out into the Mediterranean
and includes the island of Sicily, which lies off
the boot toe. Italy is separated from the rest of
Europe by the Alps, which form its northern
border. Spain, located to the west of France
(the Pyrenees Mountains form a natural bor-
der between the two countries), occupies
the majority of the Iberian Peninsula. Portu-
gal sits on the western end of the peninsula
and includes the Azore and Madeira Islands
located in the Atlantic Ocean (the Cape Verde
Islands were formerly a Portuguese territory,
but they gained independence in 1975). Most
of southern Europe enjoys a warm Mediter-
ranean climate except in the cooler mountain-
ous regions.
Immigration to the United States from
southern Europe has been considerable, pri-
marily from the poorer regions of southern
Italy. Many Americans, even those of non-
European descent, enjoy Italian cuisine in
some form. The foods of Spain and Portugal
are similar to those of Italy and France due
to the shared climate and history of Greek
and Roman influence in the region, but their
preparations differ. The following section
reviews the traditional diets of Italy, Spain,
and Portugal. The influence of these cuisines
on U.S. fare is also discussed.
Cultural Perspective
History of Southern Europeans
in the United States
Immigration Patterns The majority of immi-
grants from southern Europe were Italians,
who swelled the population of U.S. cities on
the Eastern Seaboard during the late nine-
teenth and early twentieth centuries. Next in
number were the Portuguese, primarily from
the Azore Islands. Smaller numbers of Span-
ish immigrants have been reported.
Italians According to immigration records,
more than 5 million Italians have settled in
the United States. The majority came from
the poorer southern Italian provinces and
from Sicily between 1880 and 1920. Although
earlier immigrants from northern Italy settled
on the West Coast of the United States during
the gold rush, most of these later immigrants
settled in the large industrial cities on the East
Coast. Many Italians who arrived faced dis-
crimination and hostility, and, in response,
formed concentrated communities within
urban centers, often called Little Italies.30
Several cities still boast Italian neighborhoods
such as the North End in Boston and North
Beach in San Francisco.
Many Italians came to the United States
for economic reasons; more than one-half
of the immigrants, mostly men, returned to
their homeland after accumulating sufficient
money. Peasants in their native land, Italians
in the United States often became laborers in
skilled or semiskilled professions, especially
the building trades and the clothing indus-
try. Immigration from Italy fell sharply after
World War I; however, more than 1.6 million
Italians have immigrated since World War II.31
According to the 2013 census estimates, over
17.3 million Americans claim Italian descent.5
Spaniards More than one-quarter of a
million people from Spain have immigrated
to the United States since 1820. However,
▼ Traditional foods of
southern Europe. Some
typical foods include
almonds, artichokes, basil,
cheese, eggplant, garlic,
chickpeas, olive oil, olives,
onions, pasta, prosciutto,
salt cod, sweet bread, and
tomatoes.
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1 5 8 N O R T H E R N A N D S O U T H E R N E U R O P E A N S
the majority of the Spanish-speaking popu-
lation in the United States comes from the
U.S. acquisition of Spanish territories and the
immigration of people from Latin American
countries (see Chapters 9 and 10 for more
detail).
The earliest Spanish settlers arrived dur-
ing colonial times, establishing populations
in what is now Florida, New Mexico, Califor-
nia, Arizona, Texas, and Louisiana. A major-
ity were from the poorest regions of southern
Spain and the Canary Islands.32 Half of all
other Spanish immigrants to the United States
came later in the nineteenth and early twen-
tieth centuries, due to depressed economic
conditions in Spain. In 1939, after the fall of
the second Spanish republic, a small number
of refugees immigrated for political reasons.
Additional Spanish immigrants were from
the Basque region, located in northeastern
Spain on the border with France (there are also
French Basques). The Basques are thought to
be one of the oldest surviving ethnic groups
in Europe; they lived in their homeland before
the invasion of the Indo-Europeans around
2000 bce. Their language, Euskera, is not
known to be related to any other living lan-
guage. Though the earliest Basque immigrants
to the United States were fishermen and whal-
ers who probably arrived before Columbus,
most came in the mid-nineteenth century,
arriving first in California for the gold rush,
then spreading north and east throughout the
West. Many emigrated from South America,
where they had first settled, and were listed as
Chileans (the umbrella term used for all South
Americans at the time). An accurate estimate
of their numbers is impossible.33
Portuguese Over 1.4 million Portuguese
Americans live in the United States.5 Begin-
ning in the early nineteenth century, two
waves of Portuguese immigrants arrived in
the United States. Early immigrants were pri-
marily from the Azore Islands and Cape Verde
Islands, and they often located in the whaling
ports of New England and Hawaii. They were
followed in the 1870s by immigrants hoping
to escape poverty. They arrived with little edu-
cation and few skills, but were willing to do
farm labor in California and Hawaii, and work
in the service trades of northeastern cities.
After World War II, a small number of
Portuguese from Macao, a Portuguese settle-
ment on the coast of China near Hong Kong,
settled in California. They were well educated
and many held professional jobs. A much
more significant number of Portuguese, more
than 150,000, entered the United States after
1958, again mostly from the Azore Islands,
following a series of volcanic eruptions
that devastated the region. Since 1965 over
210,000 Portuguese have immigrated to the
United States.
Current Demographics and
Socioeconomic Status
Italians In the United States in 2010 there
were over 17 million Americans of Italian
descent, most of whom live in or around
major cities.5 Economic conditions improved
during the 1980s in Italy, and immigration
from the nation slowed significantly.
Economically, Italian Americans shared
in the general prosperity after World War
II, and today most are employed in white-
collar jobs or as skilled laborers. Four gen-
erations of Italians living in the United States
have been identified. Elderly people living in
urban Italian neighborhoods are one group;
those who are middle-aged and living in
either urban or suburban settings are the
second group; the well-educated younger
Italian Americans of subsequent generations
live mostly in suburban areas are the third
group; and the very recent immigrants from
Italy are the fourth.34 These groupings can be
expected to change as each grouping ages and
with increased assimilation: only 20 percent
of Italian Americans born after 1940 married
other Italian Americans.
Spaniards People who report Spanish, Span-
iard, or Spanish American heritage were
over 1.1 million in the 2005 U.S. Census esti-
mates and are now grouped with Hispanics
in the U.S. Census. Seven percent were born
in Spain. Most are well integrated into their
communities, although larger populations
are found in New York and Tampa, Florida.
A distinctive group of Isleños, descendants of
Canary Island immigrants, is found in south-
ern Louisiana. The Basques settled mostly in
the rural regions of California, Nevada, Idaho,
Among the Basques,
it is said that the devil
once came to the region
to learn their language,
Euskera, so that he could
entrap the inhabit-
ants. He gave up after
seven years when he
was able to master only
two words: bai and ez
(“yes” and “no”).
There are approximately
1.5 million Canadians of
Italian ancestry, accord-
ing to the 2011 Census
figures.
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C H A P T E R 6 1 5 9
Montana, Wyoming, Colorado, New Mexico,
and Arizona and became ranchers. Some
Basque immigrants, however, were drawn to
the mining jobs of West Virginia and the rub-
ber and steel plants of Ohio, Illinois, Michigan,
and Pennsylvania.33 Though the 2008 Census
estimates report 58,000 Basque Americans, it
is thought that this number may underrep-
resent the total population, which may be as
high as 100,000. Today most Basque descen-
dants are involved in some aspect of animal
husbandry or small business; few have entered
other professions. Newer Basque communi-
ties now exist in Connecticut and Florida
because jai alai (a Basque sport) facilities were
established there.
Portuguese As of 2010 over 1.3 million Amer-
icans were of Portuguese descent.5 In 2000,
50,000 claimed Cape Verdean ancestry, and
4,000 reported Azore Islands heritage. (Immi-
grants from the Cape Verde and Azore Islands
and those from Madeira may not feel Portu-
guese. Instead, they identify with their island
or city of origin.) Initially, the Portuguese
Americans on the West Coast were farmers
and ranchers, but eventually their descen-
dants moved into professional, technical, and
administrative positions.35 On the East Coast,
the descendants of the Portuguese who settled
in the whaling ports now make up a signifi-
cant part of the fishing industry, though only
3 percent of all Portuguese Americans work
in this occupation. The percentage of Portu-
guese families living in poverty is half that of
the U.S. average.
Worldview
Religion
Italians In Italy, the Roman Catholic Church
was a part of everyday life. Immigrants to the
United States, however, found the church to
be more remote and puritanical, as well as
staffed by the Irish. The church responded
by establishing national parishes (parishes
geared toward one ethnic group with a priest
from that group) that helped immigrants
adjust to the United States. Some religious
festivals, part of daily spiritual life in Italy,
were transferred to the United States and are
still celebrated today, such as the Feast of San
Gennaro in New York’s Little Italy.
Spaniards Most Spaniards are Roman
Catholic. The Jesuit Order was founded in
Basque country and has significantly influ-
enced Basque devotion. Basque Americans
are involved in their parishes, and there is the
expectation that religion is part of daily life
and sacrifice.
Portuguese The Roman Catholic Church also
helped the Portuguese ease into the main-
stream of U.S. life. Local churches and special
parishes often sponsor traditional religious
fiestas that include Portuguese foods, dances,
and colorful costumes.
Family
Italians The social structure of rural villages
in southern Italy was based on the family,
whose interests and needs molded each indi-
vidual’s attitudes toward the state, church, and
school. The family was self-reliant and dis-
trusted outsiders. Each member was expected
to uphold family honor and fulfill familial
responsibilities. The father was head of the
household; he maintained his authority with
strict discipline. The mother, although subor-
dinate, controlled the day-to-day activities in
the home and was often responsible for the
family budget. Once in the United States, the
children broke free of parental control due to
economic necessity. Although sons had always
been allowed some independence, daughters
soon gained freedom, as well, because they
were expected to work outside the home
like their brothers. Education eventually also
changed the family. Early immigrants repeat-
edly denied their children schooling, sending
them to work instead. However, by 1920, edu-
cation was considered an important stepping-
stone for Italian Americans.
Spaniards In the traditional Spanish fam-
ily, the father spent much of his time work-
ing and socializing outside the home, while
the mother devoted her life to her children.
Typically, one daughter would choose not to
marry and would care for her parents as they
aged. In the United States, Spanish Ameri-
can families are usually limited to immediate
members, although the obligation to parents
remains stronger than for most Americans.
An elder may live part of the year with one
child, then part of the year with another child.
Boise, Idaho, is consid-
ered the Basque capital
of the United States.
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1 6 0 N O R T H E R N A N D S O U T H E R N E U R O P E A N S
Independent living and retirement homes are
also common. The Basque family was cus-
tomarily an extended one. Basques in Spain
are prohibited from marrying non-Basques,
but in the United States many Basques marry
other nationalities. Basques accept all mem-
bers who marry into their families.
Spanish women hold unique status among
southern Europeans. Class distinctions are
more important than gender when it comes to
educational and professional attainment. The
Basque women are historically recognized for
their equality. Since ancient times, their duties
have been as valued as those of men, and jobs
are often not gender-specific.
Portuguese Like the Italians, the Portuguese
have close family solidarity and have had
some success in maintaining the traditional
family structure. Grown sons and daughters
often live in close proximity to their par-
ents, and family members try to care for the
sick at home. Family structure is threatened,
however, when women must work or genera-
tional values change. Men tend to dominate
the family, and, as a result, some Portuguese
American women marry outside the group.
Traditional Health Beliefs and Practices Tradi-
tional Italian health beliefs include concepts
common in the American majority culture as
well as concerns associated with folk medi-
cine. Fresh air is believed necessary to health,
and some older Italian Americans maintain
that the heavy air of the United States is con-
sidered unhealthy compared to the light air
of Italy. Well-being is defined as the ability to
pursue normal, daily activities. There is the
expectation that health declines with age.
Some Italian Americans believe that ill-
ness is due to contamination (through an
unclean or sick person) or heredity (blood).
Older immigrants may also think that sick-
ness occurs because of drafts (surgery may
be avoided so that organs will not be exposed
to air), the suppression of emotions (i.e.,
anxiety, fear, grief ), or supernatural causes.
Some Italians believe that a minor illness can
be attributed to the evil eye and that seri-
ous conditions result from being cursed by
a malicious person or God.6,35,37 Saints may
be implored for protection, good luck charms
worn, or, more traditionally, the practices of a
maghi (witch) used to avoid illness. Although
many Italians do not profess a belief that God
punishes sin with a curse, there is often a fatal-
istic approach to terminal illness as being the
result of God’s will. Italian Americans, espe-
cially those of older generations, sometimes
believe that problems in pregnancy are due to
diet. Unsatisfied cravings are reputed to cause
deformities, and if a woman does not eat a
food she smells, she may suffer a miscarriage.
Little has been reported regarding Spanish
and Portuguese health practices.
Traditional Food Habits
Although the foods of the southern European
countries are similar, as detailed in the cul-
tural food groups list in Table 6.2, there are
notable differences in preparation and presen-
tation. Many Americans think of Italian cook-
ing as consisting of pizza and spaghetti. In
reality, these dishes are only a small part of the
regional cuisine of southern Italy, the original
homeland of most Italian Americans. Spanish
food is mistakenly equated with the hot and
spicy cuisine of Mexico. Although Mexico was
a colony of Spain, the foods and food habits of
the two countries differ substantially. Portugal
and Spain have very similar cuisines, but most
of the Portuguese immigrants to the United
States are from the Azore Islands and the
island of Madeira. Their diet was less varied
than that of the mainland Portuguese.
Ingredients and Common Foods
Foreign Influence The Phoenicians and
Greeks, who settled along the Mediterra-
nean coast in ancient times, are believed to
have brought the olive tree and chickpeas
(garbanzo beans) to the region. In addition,
fish stew, known as bouillabaisse in France
and zuppa di pesce alla marinara in Italy, may
be of Greek origin. The Muslims brought egg-
plants, lemons, oranges, sugarcane, rice, and
a variety of sweetmeats and spices. Marzipan,
a sweetened almond paste used extensively
in Italian desserts, and rice flavored with saf-in Italian desserts, and rice flavored with saf-in Italian desserts, and rice flavored with saf
fron, as in the northern Italian dish risotto alla
Milanese, are both believed to have Muslim
origins. In Spain the Muslim influence is also
The market for pro-
cessed spaghetti sauce
in the United States is
more than $500 million
annually.
A tortilla in Spain is an
egg omelet, not the
cornmeal flatbread eaten
by the Mexicans. It is
believed that the Spanish
called the Mexican bread
by that name because of
its similar shape.
An Italian proverb states
that after age forty, a
person can “expect a new
pain every morning.”
Some Italians believe
that wine mixed with
milk in the stomach
causes too much acid, so
milk is avoided at meals
and consumed mostly
with snacks.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 6 1 6 1
©
C
en
ga
ge
L
ea
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in
g
Group Comments Common Foods
Adaptations in the
United States
Protein Foods
Milk/milk
products
Most adults do not drink milk but
do eat cheese.
Dairy products are often used
in desserts. Many adults suffer
from lactose intolerance.
Cheese (cow, sheep, buffalo, goat), milk It is assumed that
second- and third-
generation southern
Europeans drink
more milk into their
adulthood than their
ancestors did.
Meat/poultry/
fish/eggs/
legumes
Dried salt cod is eaten frequently.
Small fish, such as sardines,
are eaten whole, providing
substantial dietary calcium.
Meat: beef, goat, lamb, pork, veal (and most
variety cuts
Poultry: chicken, duck, goose, pigeon, turkey,
woodcock
Fish: anchovies, bream, cod, haddock, halibut,
herring, mullet, salmon, sardines, trout, tuna,
turbot, whiting, octopus, squid
Shellfish: barnacles, clams, conch, crab, lobster,
mussels, scallops, shrimp
Eggs: chicken
Legumes: chickpeas, fava and kidney beans,
lentils, lupine seeds, white beans
More meat and less
fish are eaten than in
Europe.
Cereals/Grains Bread, pasta, or grain products
usually accompany the meal.
Cornmeal, rice, wheat (bread, farina, a variety
of pastas)
Fruits/Vegetables Fruit is often eaten as dessert.
Fresh fruits and vegetables are
preferred.
Fruit: apples, apricots, bananas, cherries,
citron, dates, figs, grapefruit, grapes, lemons,
medlars, peaches, pears, pineapples, plums
(prunes), pomegranates, quinces, oranges,
raisins, Seville oranges, tangerines
Vegetables: arugala, artichokes, asparagus,
broccoli, cabbage, cardoon, cauliflower,
celery, chicory, cucumber, eggplant, endive,
escarole, fennel, green beans, lettuce, kale,
kohlrabi, mushrooms, mustard greens, olives,
parsnips, peas, peppers (green and red),
pimentos, potatoes, radicchio, swiss chard,
tomatoes, turnips, zucchini
First- and second-
generation southern
Europeans generally
eat only fresh fruits
and vegetables.
Fruit and vegetable
consumption tends
to reflect general
American food
habits by the third
generation.
Additional Foods
Seasonings Dishes using similar ingredients
in Italy, Spain, and Portugal
often differentiated by
distinctive use of herbs and
spices. Seasoning in Azore
Islands and Cape Verde Islands
is usually very mild.
Basil, bay leaf, black pepper, capers, cayenne
pepper, chocolate, chervil, cinnamon,
cloves, coriander, cumin, dill, fennel, garlic,
leeks, lemon juice, marjoram, mint, mustard,
nutmeg, onion, oregano, parsley (Italian and
curley leaf ), rosemary, saffron, sage, tarragon,
thyme, vinegar
Nuts/seeds Nuts commonly used in desserts
and added to some entrees
and side dishes.
Almonds, hazelnuts, pignolis (pine nuts),
walnuts, lupine seeds
Beverages Coffee, chocolate, liqueurs, port, Madeira,
sherry, flavored sodas (e.g., orzata), tea, wine
Fats/oils Olive oil flavors numerous dishes;
used for deep-frying in Spain.
Butter, lard, olive oil, vegetable oil Use of olive oil has
decreased.
Sweeteners Honey, sugar
TA B L E 6 . 2 Cultural Food Groups: Southern European
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
1 6 2 N O R T H E R N A N D S O U T H E R N E U R O P E A N S
seen in saffron-seasoned rice and in the use
of ground nuts in sauces, candies, and other
desserts.
It was the food of the New World colonies,
however, that shaped much of Italian, Spanish,
and Portuguese cuisine. Chocolate, vanilla,
tomatoes, avocados, chile peppers, pineapple,
white and sweet potatoes, corn, many variet-
ies of squash, and turkey were brought back
from the Americas. The tomato is of particu-
lar importance to the character of southern
European cooking. Asian ingredients have
had a significant impact on the fare of Portu-
gal and, to a lesser degree, the dishes of Spain
and Italy. From India and the Far East came
coconuts, bananas, mangoes, sweet oranges,
and numerous spices, such as pepper, nutmeg,
cinnamon, and cloves.
Staples
Italy Although the cooking styles and ingre-
dients vary from region to region in Italy,
some general statements can be made about
ingredients. Pasta is the quintessential dish
throughout the nation. It is prepared fresh,
from dough made with the addition of
eggs, or dried, from a dough made without
eggs. It is traditionally served three ways:
with sauce (asciutta), in soup (en brodo),
or baked (al forno). There are literally hun-
dreds of pasta shapes, such as thin, round
strips that include spaghetti (from the Italian
word for “string”) and capelli d’angelo (angel
hair); flat strips such as linguini and fettucini
(ribbon); tubular forms, such as macaroni,
penne, and the larger manicotti; and sheets
such as lasagna and pappardelle. There
are additional forms, such as spirals (e.g.,
fusilli, rotelle), shells (conchiglie), little ears
(orechiette), bowties (farfalle), and small
barley- or rice-shaped orzo. The most com-
mon pasta in Italy is tagliatelle, a medium-
width flat noodle.9
In the north, fresh pastas are more com-
mon, and stuffed versions made with bits of
meat, cheese, and vegetables, such as ravioli,
are especially popular. Pasta in the north is
also frequently topped with rich cream sauces.
In the agriculturally poorer south, the pasta
is generally dried, and it is usually served
unfilled with a tomato-based sauce.
Other broad differences are that northern
fare uses more butter, dairy products, rice,
and meat than the south, which is notable for
the use of olive oil, more fish, and more beans
and vegetables, such as artichokes, eggplants,
bell peppers, and tomatoes. Garlic is found
throughout the nation, though it is more pop-
ular in the north. Other seasonings common
to all of Italy are parsley, basil, and oregano.
Anise, cinnamon, nutmeg, mace, and cloves
are also used in many dishes.
Spain The rugged terrain in Spain is suitable
for raising small animals and crops, such as
grapes and olives. Spain is the largest pro-
ducer of olives in the world. Entrées usually
feature eggs, lamb, pork, poultry, or dried and
salted fish (especially cod, called bacalao).
Eggs are consumed day and night. They are
enjoyed fried in olive oil, often topped with
migas (fried bread crumbs combined with
garlic, bacon, and ham). Tortilla española
(potato omelet) is perhaps the national dish,
eaten as appetizers, entrées, snacks, and as a
filling for bocadillos (sandwiches). Sausages,
such as the paprika- and garlic-flavored cho-
rizo and the blood sausage called morilla, are
common. Serrano (meaning “from the moun-
tains”) ham is a salty, dry-cured meat served
in paper-thin slices that has gained worldwide
acclaim. Seafood is popular in coastal regions.
Meats are often combined with vegetables in
savory stews. Each region has its own recipe
for paella, which typically includes saffron-
seasoned rice topped with chicken, mussels,
shrimp, sausage, tomatoes, and peas. Cocido,
a stew of chickpeas, vegetables (e.g., cab-
bage, carrots, potatoes), and meats (e.g., beef,
chicken, pork, meatballs, sausages), also var-
ies from area to area, but is always served in
three courses. The strained broth with added
noodles is eaten first, followed by a plate of
the boiled vegetables, and concluded with a
plate of cooked meats. Crusty bread is served
with the meal.
Garlic and tomatoes flavor many Spanish
dishes, for example, gazpacho, a refreshing
pureed vegetable soup that is usually served
cold, and zarzuela (meaning “operetta”), a
fresh seafood stew. Olive oil is also a common
ingredient used in almost all cooking, even
“Cods’ tongues” are a
specialty enjoyed by all
southern Europeans.
Though they are an
especially succulent strip
of meat from inside the
fish’s mouth, they are not
actually tongues.
Olive oil is labeled
according to method
of processing and the
percentage of acidity,
from extra virgin to virgin
(or pure) olive oil. In the
United States, only the
oils derived from the first
press of the olives can
be called virgin or extra
virgin depending on its
acidity (extra virgin is
lower); a blend of olive
oil, produced by refining,
which does not alter its
fat structure, and virgin
olive oils developed to
reduce acidity and must
be labeled “pure.”
The Italians eat more rice
than any other Europe-
ans. Thomas Jefferson
supposedly smuggled
rice out of Italy to the
United States, where his
first attempts to cultivate
it were unsuccessful.
Espresso, which may
mean “made expressly
for you,” is made from
finely ground dark roast
coffee through which
water is forced by steam
pressure. Cappuccino is
espresso topped with
frothy steamed milk.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 6 1 6 3
deep-frying pastries, such as the ridged, cylin-
drical doughnuts known as churros. Sauces
accompany many dishes. Alioli is made from
garlic pulverized with olive oil, salt, and a little
lemon juice. It is served with grilled or boiled
meats and fish. Another popular sauce, called
romescu, is sometimes mixed with alioli to
taste by each diner at the table. It combines
pureed almonds, garlic, paprika, and tomatoes
with vinegar and olive oil. Fruit, particularly
oranges, is popular for dessert, sometimes
served in custard. One favorite is membillo,
a quince paste served with slices of a salty
sheep’s-milk cheese known as Manchego.
Spain’s best-known dessert is flan, a sweet
milk-and-egg custard topped with caramel.
Wine usually accompanies the meal. Sangria,
made with red or white wine and fresh fruit
juices, is served chilled in the summer. Spain
is probably most famous in the United States
for its Sherries, which are wines fortified with
added brandy. Sherries can be dry or sweet
and are categorized by the length of time they
are aged. They are often described as having
a nutty flavor.
Portugal Portuguese fare shares some simi-
larities in ingredients with Spanish cuisine,
but a more generous addition of herbs and
spices, including cilantro, mint, and cumin,
distinguishes the cooking. Fish dominates the
diet of the Portuguese; they are said to have as
many recipes for bacalhau (dried salt cod) as
there are days in the year.39 Sardines are often
grilled or cooked in a tomato and vegetable
sauce. Lamprey is a popular food in north-
ern Portugal, where it is often prepared with
curry-like seasonings. Shellfish, such as clams,
are often combined with pork or other meats
in stewed dishes. Chouriço, similar to the
Spanish pork sausage, chorizo, and linguiça,
a pork and garlic sausage, are often eaten at
breakfast. Other typical dishes are cacoila,
a stew made from pig hearts and liver, then
served with beans or potatoes; isca de figado,
beef liver seasoned with vinegar, pepper, and
garlic, then fried in olive oil or lard; and assada
no espeto, meat roasted on a spit. A common
soup is caldo verde, or green broth, made from
kale or cabbage and potatoes. A unique dry
soup of bread moistened with oil or vinegar
and topped with anything from meat, chicken,
or shellfish and vegetables is called açordu.
Fava beans, chickpeas, and lupine seeds (tre-
mocos) are added to some dishes. Rice and
fried potatoes are so popular they are often
served together. Crusty country breads and,
in the north, a cornmeal bread called broa
also accompany the meal. Portuguese sweet
The name gazpacho
may have come from the
vinegar-and-water drink
called posca, report-
edly offered to Christ
on the cross.
Alcohol consumption
among the Basques in
Spain is high, especially
for men.41
▼
m
ar
go
ui
lla
t p
ho
to
/S
hu
tt
er
st
oc
k.
co
m
Pasta comes in dozens
of forms in Italy, including
thin strings, flat ribbons,
tubes, spirals, sheets, and
shapes that resemble wheels,
bowties, little ears, hats, rice,
and other items. It is found
fresh or dried.
S A M P L E M E N U
An Italian Lunch
Cr os tin ia,b,c
S pagh e tti c on C oz z e (Spaghetti with Mussels)a,c
Chicken S altimb oc ab,c
Sauteed Spinach
Bis c otti and and Bis c otti E s pr e s s ob,c
aHazin, M. 2004. Marcella says . . . New York: HarperCollins.
bCasella, C. 2005. True Tuscan. New York: HarperCollins.
cMario Batali at http://www.mariobatali.com/
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1 6 4 N O R T H E R N A N D S O U T H E R N E U R O P E A N S
Venice, located on the east coast and
known for its romantic canals (although the
city actually consists of 120 mud islands), has
a cuisine centered on seafood. Its best-known
dish is scampi, made from large shrimp sea-
soned with oil, garlic, parsley, and lemon juice.
Inland is Verona, famous for its delicate white
wines, such as Soave. Turin, the capital of the
western province of Piedmont, is known for
its grissini, the slender breadsticks popular
throughout Italy, and bagna cauda (meaning
“hot bath”), a dip for raw vegetables consisting
of anchovies and garlic blended into a paste
with olive oil or butter. A summer favorite is
vitello tonnato, braised veal served cold with
a spicy tuna sauce. Located on the northwest
coast of Italy, Genoa is known for its burrida,
a fish stew containing octopus and squid, and
pesto, an herb, cheese, and nut paste (usually
made with basil), which has become popular
in the United States.
Moving westward, the city of Bologna is
the center of a rich gastronomic region known
as Emilia-Romagna. Pasta favorites of the
area include lasagne verdi al forno, spinach-
flavored lasagna noodles baked in a ragu (a
meat sauce typically made with four differ-
ent meats and red wine), and a white sauce,
flavored with cheese; and tortellini, egg pasta
stuffed with bits of meat, cheese, and eggs,
served in soup or a rich cream sauce. It is tra-
ditionally served on Christmas Eve. A similar
stuffed pasta is cappelleti, named for its shape,
a little hat. Cured meats are a specialty of the
region, including salami and sopresseta (simi-
lar to salami but rougher textured); mortadella,
a pork sausage (similar to American bologna);
pancetta (a salt-cured bacon); prosciutto, a
raw, smoked ham (served thinly sliced, often
as an appetizer with melon or fresh figs); and
culatello (a milder and creamier ham than
prosciutto). Parmesan cheese, a sharply fla-
vored cow’s milk cheese with a finely grained
texture, also comes from the area, as does aceto
balsamico di Modena (or di Reggio Emilia), a
vinegar made from the white Trebbiano wine
grapes. When labeled tradiziolone, it means
the vinegar has been twice fermented and aged
in wood casks for at least twelve years, which
intensifies and sweetens the flavor, and thick-
ens it into a syrupy consistency. Those labeled
breads, pan doce, and doughnuts, malassa-
das, are also specialties. Desserts often feature
fruit, such as bananas, grapes, and figs, as well
as eggs and almonds. Puddings, custards, and
sponge cakes are popular.
Regional Variations
Italy Some of the regional specialties in the
northern area of Lombardy, around Milan,
are risotto, a creamy rice dish cooked in but-
ter and chicken stock, flavored with Parmesan
cheese and saffron; polenta, cornmeal mush
(thought to have been made originally from
semolina wheat), often served with cheese or
sauce; and panettone, a type of fruitcake. Veal
is very popular, served in the stew known as
osso buco and in veal piccata (chops that are
pounded very thin, then breaded and pan-
fried, topped with lemon juice, capers, and
minced parsley). The cheeses of the region
include Gorgonzola, a tangy, blue-veined
cheese made from sheep’s milk, and Bel paese,
a soft, mild-flavored cheese. The area is also
known for its aperitifs, such as bittersweet
Vermouth.
Linguiça comes from
the Portuguese word
meaning “tongue,” a
reference to the shape
of the sausage.
Sweets were a traditional
source of income for
Portuguese convents,
and the names of many
pastries reflect this
past, including papas-
de-anjo (angel puffs)
and gargantas de friera
(nun’s wattles).39
Italian folklore has it that
basil can develop its full
flavor only if the gar-
dener curses daily at it.
Forks were originally
two-pronged—the
three-pronged fork
was created in Italy for
eating pasta.
▲
Olives and olive oil are
found in numerous southern
European dishes. Spain is the
primary producer of olives
worldwide.
Cu
rio
so
/S
hu
tt
er
st
oc
k.
co
m
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C H A P T E R 6 1 6 5
condimento are imitations of vinegar blends
and reduced aging.
Florence, the capital of Tuscany, has a
long history of culinary expertise. In 1533,
Catherine de’ Medici (the Medici family
ruled Florence) married into the royal family
of France. She is often credited with introduc-
ing Italian fare—at the time the most sophisti-
cated cuisine in Europe—to France. Florence
is renowned for its green noodles (colored by
bits of spinach) served with butter and grated
Parmesan cheese, called fettucini Alfredo. The
term alla Fiorentina refers to a dish garnished
with or containing finely chopped spinach.
Whole grilled fish and wild game dishes are
popular. Rosemary flavors many dishes of
the region. Tuscany is also famous for its full-
bodied red wine, Chianti, and its use of chest-
nuts, which are featured in a cake eaten at Lent
called castagnaccio alla Fiorentina.
Rome, the capital of Italy, has its own
regional cooking and is probably best known
for fettucine Alfredo, long, flat egg noodles
mixed with butter, cream, and grated cheese.
Another dish is saltimbocca (meaning “jumps
in the mouth”)—thin slices of veal rolled with
ham and cooked in butter and Marsala wine.
Gnocchi, which are dumplings, are eaten
throughout Italy, but in Rome they are made
out of semolina and baked in the oven. Fried
artichokes are popular at Easter time, as is
roast baby lamb or kid. Pecorino romano is
the hard sheep’s milk cheese of Rome, similar
to Parmesan but with a sharper flavor.
The capital of Campania in southern Italy
is Naples, considered the culinary capital of
the south. Pasta is the staple food, and a favor-
ite way of serving it is simply with olive oil
and garlic, or mixed with beans, in the soup
pasta e fagiole. Pizza is native to Naples and is
said to date back to the sixteenth century, per-
haps originating with toppings for the savory
flatbread known as foccacia. Another form of
pizza is calzone, which is pizza dough folded
over a filling of cheese, ham, or salami, then
baked or fried. The area’s best-known cheeses
are Mozzarella, an elastic white cheese origi-
nally made from buffalo milk; Provolone,
a firm smoked cheese; and Ricotta, a soft,
white, unsalted cheese made from sheep’s
milk and often used in desserts. Sicily and
other regions of southern Italy use kid and
lamb as their principal meats. It is sometimes
prepared alla cacciatore (hunter’s style), with
tomatoes, olives, garlic, wine, or vinegar (and
sometimes anchovies)—a method also used
with wild boar, venison, and chicken. Along
the coast, fresh fish, such as tuna and sar-
dines, are used extensively; baccala, dried salt
cod, is often served on fast days. The North
African influence shows up in Sicily in the
use of couscous, called cuscus in Italy, which
is commonly served with fish stews. South-
ern Italy’s cuisine is probably best known for
its desserts. Many examples can be found in
Italian American bakeries and espresso bars:
cannoli, crisp, deep-fried tubular pastry shells
filled with sweetened ricotta cheese, shaved
bittersweet chocolate, and citron; cassata, a
cake composed of sponge cake layers with
a ricotta filling and a chocolate- or almond-
flavored sugar frosting; gelato, fruit or nut
(e.g., black currant or pistachio) ice cream;
and granita, intensely flavored ices. Spumoni
is chocolate and vanilla ice cream with a layer
of rum-flavored whipped cream contain-
ing nuts and fruits. Another popular sweet
is zeppole, a deep-fried doughnut covered
with powdered sugar. The sweet white wine
S A M P L E M E N U
Spanish Tapas
Cr oque tas a,b
Spanish Potato T or tilla (omelet)a,b
E mpan ad as a,b
G ambas (grilled shrimp)a,b
Fried Almonds, Pieces of Cheese, Sausage Bites
Sherry, Beer, or S an gr iaa,b
aVon Bremzen, A. 2005. The new Spanish table. New York: Workman.
bTapas Bonitas at http://www.tapasbonitas.com/food/Tapas_Recipes.php
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
1 6 6 N O R T H E R N A N D S O U T H E R N E U R O P E A N S
fortified with grape spirits, Marsala, is also
a specialty in the region. It develops a deep-
tawny color when aged.
Spain The cooking of Spain can be divided
broadly by preparation methods. In the
north, stewing is most common. In the cen-
tral regions, roasting is favored. Although
deep-fried foods are found in every region of
the nation, they are especially popular in the
southern regions.40
Most Spanish dishes prepared in the United
States reflect the cooking of Spain’s southern
region, with its seafood, abundant fruits and
vegetables, and Muslim influence. Fried fish,
arroz negro (rice blackened with squid ink),
and salmorejo (a fresh tomato soup thick-
ened with bread crumbs and garnished with
Serrano ham and hard-boiled egg) are popu-
lar dishes. Central Spain has a more limited
diet; roast suckling pig and baby roast lamb
are favorites. Garlic soup starts many meals.
In the northwest, fish is common, and often
fills empanadas (small pastry turnovers).
Octopus flavored with paprika is a specialty.
In the Basque provinces lamb is the primary
meat, and charcoal-grilled lamb is a specialty.
Seafood, such as bacalao al pil-pil (dried salt
cod cooked in olive oil and garlic), bacalao a
la vizcaina (dried salt cod cooked in a sauce
of onions, garlic, pimento, and tomatoes), and
angulas (tiny eel spawn cooked with olive oil,
garlic, and red peppers), is a favorite in some
Basque areas. Other popular dishes include
garlic soup, babarrun gorida (red beans with
chorizo), and pipperrada vasca (eggs with
peppers). Simple rice puddings or fruit com-
potes are typical desserts.
Portugal Though Portuguese cuisine var-
ies from north to south, from hearty soups
and stews to a more refined, lighter style of
entrée, the largest regional differences occur
between the mainland and the islands. The
foods of the Madeiras, the Azores, and the
Cape Verde Islands include tropical ingre-
dients imported from both Africa and the
Americas. In Madeira, which attracts many
tourists from throughout Europe, avocados,
cherimoya, guava, mango, and papaya are
featured in its dishes. Corn is common, as is
couscous. Honey cakes and puddings reflect
the influence of other European nations. In
the Azores and Cape Verde Islands, fare var-
ies significantly from island to island and even
city to city. Bananas, corn, cherimoya, passion
fruit, pineapples, and yams are prominent.
Açorda d’azedo is one specialty—a mixture
of cornbread, vinegar, onions, garlic, saffron,
and a little lard boiled together and eaten for
breakfast. Beef is the preferred meat, and sea-
food, such as cockles, limpets, crab, lobster,
and octopus, is eaten in many areas. Little fat
or oil is added to dishes; and spicing is mild,
often limited to onion, garlic, salt, and pep-
per. Tea is the preferred beverage. Portugal
is famous for its rich sweet wines: Port (from
the northern region) and Madeira (from the
islands), which are fortified with grape spir-
its at the start of fermentation. They can be
consumed young, or aged for forty or more
years, becoming drier, nuttier, and smoother
in flavor. They are popular with dessert or as
after-dinner drinks.
Meal Composition and Cycle
Daily Patterns
Italy A traditional Italian breakfast tends
to be light, including coffee with milk (caffe
latte), tea, or a chocolate drink, accompanied
by bread and jam. Lunch is the main meal
of the day and may be followed by a nap. It
The art of making ice
cream is credited to the
Chinese, who brought
it to India; from there it
spread to the Persians
and Arabs. The Muslims
brought it to Italy, and it
was a Sicilian, Francisco
Procopio, who intro-
duced ice cream to Paris
in the 1660s. The British
discovered it soon after
and later brought ice
cream to America.
During the nineteenth
century, Madeira wine
was sent to other Euro-
pean nations in the
holds of ships where
it became very hot.
Instead of ruining the
wine, it aged it more
quickly—Madeira that
had circumnavigated
the globe twice became
popular in England.
Today, it is heated during
aging to simulate voyage
conditions.
▲
Co
le
G
ro
up
/S
to
ck
by
te
/G
et
ty
Im
ag
es
Fish and shellfish are
a favorite in Italy, Spain,
and Portugal.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 6 1 6 7
usually starts with an appetizer course of
antipasti, such as ham, sausages, pickled veg-
etables, and olives; or crostini, crispy slices of
bread with various toppings, such as tomatoes
or cheese. Next is minestra (wet course), usu-
ally soup, or asciutta (dry course) of pasta,
risotto, or gnocchi. The main course is fish,
meat, or poultry, roasted, grilled, pan-fried,
or stewed. It is served with a starchy or green
vegetable, followed by a salad. Bread is served
with the meal, often with olive oil and bal-
samic vinegar for dipping. Dessert often con-
sists of fruit and cheese; pastries or biscotti
(crunchy twice-baked cookie slices) and
ice creams are served on special occasions.
Dinner is served at about 7:30 p.m. and is a
lighter version of lunch. Wine usually accom-
panies lunch and dinner. Coffee or espresso
is enjoyed after dinner, either at home or in
a coffeehouse. Marsala may be served with
cheese before the meal for a light appetizer
course, or after dinner. It is also often used in
the preparation of desserts. One such sweet,
now prepared all over Europe, is zabaglione,
a wine custard.
Spain By U.S. standards, the Spanish appear
to eat all the time. The traditional pattern, four
meals plus several snacks, is spread across the
day. A light breakfast (desayuno) of coffee or
chocolate, bread, or churros is eaten about
8:00 a.m., followed by a midmorning break-
fast around 11:00 a.m. of grilled sausages,
fried squid, bread with tomato, or an omelet.
A light snack, tapas, is consumed around
1:00 p.m. as a prelude to a three-course lunch
(comida) at around 2:00 p.m., consisting of
soup or salad, fish or meat, and dessert, which
is often followed by fruit and cheese. Many
businesses close for several hours in the after-
noon to accommodate lunch and a nap. Tea
and pastries (merienda) are eaten between
5:00 and 6:00 p.m. and more tapas are enjoyed
at 8:00 or 9:00 p.m. Finally supper, including
three light courses such as soup or omelets
and fruit, is consumed between 10:00 p.m.
and midnight. Tapas are usually served in bars
and cafés and are accompanied by Sherry or
wine; the variety of tapas is tremendous; it is
not unusual for more than twenty kinds to be
offered on a menu. They are differentiated
from appetizers in Spain in that they are
strictly finger foods, such as olives, almonds,
croquetas (fried croquettes with fish, ham,
cheese, etc.), stuffed mushrooms, shrimp,
sausage bits, pieces of cheese, and other small
bites. The evening meal may be skipped if a
substantial number of tapas are eaten at night.
The main meal of the day is lunch, which is
generally eaten at home and consists of three
hefty courses.
Portugal Portuguese meal patterns are simi-
lar to those of Spain, often starting out with
the day around 8:00 a.m. with espresso coffee
and a roll with marmalade, or pastel de nata,
a cinnamon-flavored custard tart in puff pas-
try. A morning coffee break, including coffee
served with hot milk, is followed by lunch in
the early afternoon. This is traditionally the
largest meal of the day, and even in urban
areas often includes several courses. Unlike
the Spanish pattern, the evening meal in
Portugal is usually eaten earlier. As in Spain,
red wine usually accompanies the meal.
Etiquette Italy, Spain, and Portugal share
many etiquette rules. The fork remains in the
left hand, and the knife remains in the right
hand. The knife can be used to help scoop
food onto the fork. Bread is not served with
butter and should be placed on the edge of the
main plate, or next to it on the table. Manners
regarding the consumption of pasta include
using your fork to twirl the pasta against the
▲ Traditional Italian
lunches are large, often
ending with fruit and
cheese. On special occasions,
pastries, such as twice-baked
cookies called biscotti, or ice
cream are served with coffee
or espresso.
Tr
ib
un
e
Co
nt
en
t A
ge
nc
y
LL
C/
M
cC
la
tc
hy
-T
rib
un
e/
A
la
m
y
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1 6 8 N O R T H E R N A N D S O U T H E R N E U R O P E A N S
edge of the plate or bowl (never use a spoon to
help with this), and never slurping. Bread may
be used daintily to soak up extra sauce, but
should not be used to mop the plate. When
not eating, the hands should be kept above the
table with the wrists resting on the edge.14
When in someone’s home, or at a hosted
meal, never start eating until the host has
said buòn appetito (in Italy), buen apetito (in
Spain), or bom appetite (in Portugal). In Italy,
when invited to someone’s home, it is consid-
ered rude to discuss any serious topic before
a meal is shared. Chocolates are considered a
good hostess gift when invited for dinner in
all three nations. In Italy, wine is appreciated if
enough is brought for all guests; wine should
be avoided as a gift in Spain and Portugal,
where hosts have likely chosen favorites to
accompany the meal.
Special Occasions
Italy Italy celebrates few national holidays,
probably because of its divided history.
Most festas are local and honor a patron
saint. Other significant religious holidays
are usually observed by families at home,
although some cities, such as Venice, have
a public pre-Lenten carnival. In some areas
of the United States where southern Italians
predominate, St. Joseph, the patron saint of
Sicily, is honored during Lent. Breads in the
shape of a cross blessed by the parish priest,
pasta with sardines, and other meatless
dishes are featured. Among Italian Ameri-
cans, it is traditional to serve seven seafood
dishes on Christmas Eve. During the Easter
holidays, Italian American bakeries sell an
Easter bread with hard-boiled eggs still in
their shells braided into it. Special desserts
may accompany the holiday meal, such as
panettone, amaretti (almond macaroons),
and torrone (nougats) at Christmastime
and cassata at Easter. Colored, sugar-coated
Jordan almonds, which the Italians call con-
fetti (meaning “little candies”), are served at
weddings.
Spain The most elaborate of Spanish festi-
vals is Holy Week, the week between Palm
Sunday and Easter. It is a time of Catholic
processions; confections and liqueurs such
as coffee, chocolate, and anisette (licorice
flavored) are served. Holiday sweets include
tortas de aceite, which are cakes made with
olive oil, sesame seeds, and anise; cortados
rellenos de cidra, or small rectangular tarts
filled with pureed sweetened squash; torteras,
or large round cakes made with cinnamon
and squash and decorated with powdered
sugar; and yemas de San Leandro, which is
a sweet made by pouring egg yolks through
tiny holes into boiling syrup. It is often served
with marzipan.
Special dishes are also prepared for Christ-
mas and Easter. The Basques eat roasted
chestnuts and pastel de Navidad, or individ-
ual walnut and raisin pies, at Christmas; an
orange-flavored doughnut, called causerras, is
featured on Easter. At New Year’s, it is custom-
ary for the Spanish (and the Portuguese) to eat
twelve grapes or raisins at the twelve strokes
of midnight to bring luck for each month of
the coming year.
Portugal Christmas Eve typically features
two meals in Portugal: dinner and a post–
midnight Mass buffet in the early hours of
Christmas morning. Dinner often includes a
casserole of bacalhau and potatoes, as well as
meringue cookies known as suspiros (sighs).
The buffet offers mostly finger foods, such as
fried cod puffs and sausages.
In the United States, the Holy Ghost
(Spirit) Festival is the most popular and col-
orful social and religious event in the Portu-
guese community. It is not widely celebrated
in Portugal and probably came to the United
States with immigrants from the Azores.
Although the origins of the event are obscure,
it is believed to date back to Isabel (Eliza-
beth) of Aragon, wife of Portugal’s poet-king
Dom Diniz (1326). One story is that the fes-
tival derives its character from the belief that
because Isabel was particularly devoted to the
Holy Ghost, she wanted to give an example
of charity in the annual distribution of food
to the poor.
The week long festival is usually scheduled
sometime after Easter and before the end of
July. It is held at the local church or Hall of
the Holy Ghost (also called an IDES Hall).
The main event of the festival takes place on
the last day, Sunday, with a procession to the
Legend has it that
zabaglione was created
to increase male vigor
by a Franciscan monk
who tired of hearing the
confessional complaints
from women about
their husbands.
The word tapas means
“lids,” and the first tapas
were pieces of bread
used to cover wine
glasses to keep out flies.
In the 1600s, the Spanish
were the first to add
sugar to the bitter choco-
late beverage native to
Mexico. Its popularity
spread quickly through
Europe, even though
certain clerics tried to
ban it due to its associa-
tion with the “heathen”
Aztecs. Although the
Spanish are fond of
chocolate, it is used
mostly as a beverage and
is rarely added to pastries
or confections.
In the Portuguese town
Amarante, the Festa de
São Gonçalo is held the
first weekend in June.
Dating back to pagan
times, it is traditional
for unmarried men and
women to exchange
phallus-shaped cakes as
tokens of their affection
for each other.
In rural areas of Portugal,
people traditionally col-
lect medicinal plants
for home remedies on
Quinta-Feira da Espiga
(Ear of Wheat Thursday
or Ascension Day), the
fortieth day after Easter.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 6 1 6 9
church and the crowning of a queen after the
service. The donated food (originally distrib-
uted to persons in need on Sunday afternoon
but now often served at a free community
banquet) is blessed by the priest. The most
traditional foods at the feast are a Holy Ghost
soup of meat, bread, and potatoes, and a
sweet bread called massa sovoda. The bread
is sometimes shaped like little doves, called
pombas. Also celebrated in the United States
is the Feast of the Most Blessed Sacrament,
which was started in New Bedford, Massachu-
setts, by four Madeirans in gratitude for their
salvation from a shipwreck en route to the
United States in 1915. It attracts over 150,000
visitors on the first weekend in August for
music, dancing, and traditional foods such
as linguiça, bacalhau, fava beans, assada no
espeto, and cacoila. The Festa de Sennor da
Pedra is held later in the month. This Azore
Islands tradition includes a parade and similar
traditional foods. Other festivities not men-
tioned here are associated with the Madeiran
cult of Our Lady of the Mount (a shrine on the
island of Madeira).
Therapeutic Uses of Food
Little has been reported on the therapeutic
uses of food by Americans of southern Euro-
pean descent. Some Italians, particularly older
immigrants, categorize foods as being heavy
or light, wet or dry, and acid or nonacid.35,37
Heavy foods, such as fried items and red
meats, are considered difficult to digest; light
foods, including gelatin, custards, and soups,
are regarded as easy to digest and appropri-
ate for people who are ill. Wet and dry refers
to how foods are prepared (with or without
ample broth or fluid), as well as to their inher-
ent qualities. For example, leafy greens such
as escarole, spinach, and cabbage are consid-
ered wet. A wet meal is served once a week
by some Italian Americans to “cleanse out
the system.” Wet meals, especially soups, are
considered necessary when a person is sick
because illness is associated with dryness in
the body. Citrus fruits, raw tomatoes, and
peaches are thought to be acidic foods that
may cause skin ailments and are avoided if
such conditions exist.
Other Italian beliefs about foods are that
liver, red wine, and leafy vegetables are good
for the blood and that too many dairy prod-
ucts make the urine hard (kidney stones).
A clove of garlic may be eaten each day to
prevent respiratory infections, and a raw egg
or dandelion greens may be consumed for
strength and vitality.36 Both balsamic vinegar
and olive oil, which are served with bread at
meals, are believed to be health-promoting
foods in Italy.
Contemporary Food Habits
in the United States
Adaptations of Food Habits
It is generally assumed that second- and third-
generation Americans of southern European
descent have adopted the majority American
diet and meal patterns, preserving some tra-
ditional dishes for special occasions. These
assimilated Americans consume more milk
and meat but less fish, fresh produce, and
legumes than their ancestors. Olive oil is still
used often, although not exclusively; pasta
remains popular with Italians.
Nutritional Status
Nutritional Intake Little research has been
conducted on the nutritional intake of south-
ern European Americans. It can be assumed
that they suffer from dietary deficiencies and
excesses similar to those of the majority of
Americans. A study of elderly Portuguese
immigrants in Cambridge, Massachusetts,
found that dinner was the main meal of the
day, and the subjects had moderate intake of
breads and grains and low intake of fruits,
vegetables, and dairy products. Although
dairy intake was low, many of the subjects ate
sardines, a rich source of calcium. The sub-
jects reported low consumption of sweets and
alcohol, although the researcher stated that
the Americanized Portuguese diet tends to be
high in sugar and fat.42 One study comparing
body weights of American and Italian women
with polycystic ovary syndrome found that
though the BMIs for the American women
were significantly higher, the total calorie
intake and dietary constituents were similar,
The Spanish American
Isleños of Louisiana mari-
nate shrimp in vinegar
with olives and onions,
make almond-honey
nougat, and use ample
olive oil (instead of the
butter and lard favored in
nearby Cajun cooking).
Descendants of southern
Europeans may have
a higher incidence of
lactose intolerance than
other European groups.
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1 7 0 N O R T H E R N A N D S O U T H E R N E U R O P E A N S
suggesting unknown genetic or lifestyle com-
ponents may play a role.44
According to a survey of European dietary
habits, a majority of the population in Italy
consumes more plant products than protein,
and approximately equal amounts of both are
consumed in Spain.19 In addition, meat con-
sumption is highest in the northern regions
of these nations, and lowest in the southern
areas.20 In general, the Mediterranean diet,
which is typified in southern Italy and Spain,
has been characterized as health promoting
due to a high intake of complex carbohydrates,
a high intake of protective phytochemicals,
and a low intake of fat with a higher propor-
tion of monounsaturated fats from olive oil
as compared to saturated animal fats.45,46 The
greater emphasis on grains, legumes, veg-
etables, and fruits; lower intakes of meat and
dairy foods; and promotion of wine in mod-
eration differentiate the Mediterranean diet
from that recommended by U.S. health offi-
cials.47 However, a study by the Italian Asso-
ciation for Cancer Research has found that
cancer rates increased as food habits changed
in Italy; pasta consumption has fallen, and
meat intake has quadrupled since 1950;
changes toward a more Westernized diet are
found in Spain and Portugal as well.43,48 Rates
of overweight and obesity in Italian women
are 45 percent, but are over 66 percent in men.
In Spain, rates exceed 82 percent for men and
61 percent in women; in Portugal, overweight
and obesity in women approach 64 percent,
and in men, 71 percent.21
Counseling The conversational style of
southern Europeans is animated, warm, and
expressive. Feelings are more important than
objective facts in a discussion. Shaking hands
with everyone in the room in greeting and
leaving is appropriate; some men include
pats on the back, and women may quickly
embrace or kiss on the cheeks. Eye contact
among elders tends to be frequent and quick,
whereas younger people may prefer steady eye
contact. Touching is very common, especially
between members of the same sex. It has been
noted that Italian American clients are open,
willing to detail symptoms with their health
care professional, and expressive with chronic
pain—although some women may demon-
strate high levels of modesty and may resist
discussing personal topics.6,36 Italian Ameri-
cans may seek medical advice from family
and friends before consulting a health profes-
sional. They express preference for providers
who are warm and empathetic (simpatico) and
disdain those who are perceived as arrogant
and unapproachable (superbo).
Recent Italian immigrants or those who
are older adults may be very concerned about
the qualities of their blood or may have many
gastrointestinal complaints. There may be
confusion regarding hypertension, which is
considered high or too much blood, and ane-
mia or low blood pressure, which is associated
with low blood.37
Dietary requirements should be carefully
detailed for some Italian Americans. Restric-
tions recommended for clients with diabetes
may be ignored if daily social activities (i.e.,
coffee and pastries with friends) must be
modified. Language difficulties may occur
among elders or new immigrants.
Information regarding the counseling of
Spanish Americans or Portuguese Americans
is limited. The people of Spain and Portugal
are traditionally high-context communica-
tors and very polychromic (multi tasking),
though many urban residents have more
Western monochronic viewpoints. A quick
handshake is the customary greeting, and
clients from southern Europe will typi-
cally sit and stand closer to each other than
many Americans prefer. Direct eye contact is
important.14 A high rate of illiteracy has been
reported in the Portuguese American popula-
tion (40 percent of surveyed elders; 15 percent
of recent immigrants). This should be taken
into consideration when preparing educa-
tional materials. An in-depth interview can
be used to assess the client’s degree of accul-
turation and traditional health practices, if
any. Personal food preferences should be
determined.
Recently, research has
related the traditional
food habits of the
Mediterranean diet
pattern to a lower inci-
dence of coronary heart
disease, various types
of cancer, and other
diseases. It appears that
the traditional diet of
southern Europe is pro-
tective against several
chronic diseases.38
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 6 1 7 1
Review Questions
1. Summarize the immigration patterns of north-
ern and southern Europeans.
2. Describe the American majority cultural
beliefs regarding health, and the origins of
these beliefs.
3. Describe the traditional food habits of Eng-
land, Ireland, and Italy. List five of your favorite
foods. Do any of these foods have their roots in
Europe? Describe your typical meal cycle and
meal composition. Are these similar to those
of Europe?
4. What is the difference between Cajun and
Creole cooking? What are the origins of both
styles of cooking?
5. Compare and contrast the immigrant experi-
ences of the Irish and Italians.
6. How did the New World foods (tomatoes, pota-
toes, corn, etc.) influence European foodways?
7. Why is the Mediterranean diet considered
healthy?
References
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D I S C U S S I O N S T A R T E R S
Let’s Open a Pub!
Americans often have an inaccurate view of British and Irish pubs. Many of us tend to identify these pubs with our American bars, but in fact, pubs
are much more like American “bar and grills,” “sports taverns,” and restaurants that serve beer and wine. Most British and Irish pubs serve hot lunches
and dinners as well as alcoholic beverages. Traditional British pub fare includes fish and chips (what Americans call French fries), shepherd’s pie or
cottage pie (beef or mutton, mashed potatoes, maybe green peas, and a potato crust on top or cooked in a pie crust), steak or steak and kidney pie,
bangers and mash (sausages and mashed potatoes), Yorkshire pudding (a batter such as a pancake batter, covered with beef gravy), Quaker pudding
(a grayish spiced pudding), Cornish pastry, and mince pies. The name pub is short for public house, and historically, these pubs functioned as local
meeting places and served to strengthen cultural ties within the community.
Imagine that you plan to open an “authentic” British and Irish pub in your college community. In a small group, decide what your food menu
should include. Remember that you will need to balance your effort to be authentic with your need to attract college students and serve students
who eat only vegetarian meals.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
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13. Claiborne, C., & Franey, P. 1970. Classic French
cooking. New York: Time-Life.
14. Foster, D. 2000. The global etiquette guide to
Europe. New York: Wiley.
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17. Galan, P., Arnaud, M.J., Czernichow, S.,
Delabroise, A.M., Preziosi, P., Bertrais, S., . . .
Hercberg, S. 2002. Contribution of mineral waters
to the dietary calcium and magnesium intake in a
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Dietetic Association, 102, 1658–1662.
18. Wilson, S.A. 2003. People of Irish heritage. In
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health care (2nd ed.), Philadelphia: F.A. Davis.
19. Slimani, N., Fahey, M., Welch, A.A., Wirfalt, E.,
Stripp, C., Bergstrom, E., . . . Riboli, E. 2002.
Diversity of dietary patterns observed in the
European Prospective Investigation into Can-
cer and Nutrition (EPIC) project. Public Health
Nutrition, 5, 1311–1328.
20. Linseisen, J., Bergstrom, E., Gafa, L., Gonzalez,
C.A., Thiebaut, A., Trichopoulou, A., . . . Slimani,
N. 2002. Consumption of added fats and oils in
the European Prospective Investigation into Can-
cer and Nutrition (EPIC) centres across 10 Euro-
pean countries as assessed by 24-hour recalls.
Public Health Nutrition, 5, 1227–1242; Inter-
national Obesity Task Force. 2010. Overweight
and obesity among adults in the European Union.
Retrieved from http://www.iaso.org/site_media/-
uploads/AdultEU27March2010notonwebyetup-
datev2 (accessed February 11, 2015).
21. Sassi, F. 2010. Obesity and the economics of pre-
vention—fit not fat. Organisation for Economic
Co-operation and Development (OECD).
Retrieved from http://www.keepeek.com/
Digital-Asset-Management/oecd/social-issues-
migration-health/obesity-and-the-economics-of-
prevention_9789264084865-en#page1 (accessed
February 11, 2015).
22. Kushi, L.H., Lew, R.A., Stare, E.J., Curtis, R.E.,
Lozy, M., Bourke, G., . . . Kevaney, J. 1985. Diet
and 20-year mortality from coronary heart dis-
ease: The Ireland-Boston diet-heart study. New
England Journal of Medicine, 312, 811–818.
23. Johnson, P.B. 1997. Alcohol-use-related prob-
lems in Puerto Rican and Irish-American males.
Substance Use and Misuse, 32, 169–179.
24. Phatak, P.D., Sham, R.L., Raubertas, R.F., Dunni-
gan, K., O’Leary, M.T., Braggins, C., & Cappuccio,
J.D. 1998. Prevalence of hereditary hemochroma-
tosis in 16031 primary care patients. Annals of
Internal Medicine, 129, 954–961.
25. Ryan, E., O’Keane, C., & Crowe, J. 1998. Hemo-
chromatosis in Ireland and HFE. Blood Cells,
Molecules, and Diseases, 24, 428–432.
26. Girouard, J., Giguere, Y., Delage, R., & Fousseau,
F. 2002. Prevalence of HFE gene C282Y and
H63D mutations in a French-Canadian popula-
tion of neonates and in referred patients. Human
Molecular Genetics, 11, 185–189.
27. Ma, Y., Murthy, V., Roderer, G., Monsalve, M.V.,
Clarke, L.A., Normand, T., . . . Hayden, M.R.
1991. A mutation in the human lipoprotein lipase
gene as the most common cause of familial chylo-
micronemia in French Canadians. New England
Journal of Medicine, 324, 1761–1766.
28. Leistner, C.G. 1996. Cajun and Creole food prac-
tices, customs, and holidays. Chicago: Ameri-
can Dietetic Association/American Diabetes
Association.
29. Hall, E.T., & Hall, M.R. 1990. Understanding cul-
tural differences: Germans, French, and Ameri-
cans. Yarmouth, ME: Intercultural Press.
30. Pozzetta, G. 2000. Italian Americans. In
R.V. Dassanowsky & J. Lehman (Eds.), Gale ency-
clopedia of multicultural America. Farmington
Hills, MI: Gale Group.
31. Cavaioli, F. 2008. Patterns of Italian immigration
to the United States. The Catholic Social Science
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32. Colahan, C. 2000. Spanish Americans. In
R.V. Dassanowsky & J. Lehman (Eds.), Gale ency-
clopedia of multicultural America. Farmington
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33. Shostak, E. 2000. Basque Americans. In
R.V. Dassanowsky & J. Lehman (Eds.), Gale ency-
clopedia of multicultural America. Farmington
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34. Harwood, A. 1981. Ethnicity and medical care.
Cambridge, MA: Harvard University Press.
35. Norden, E.E. 2000. Portuguese Americans. In
R.V. Dassanowsky & J. Lehman (Eds.), Gale ency-
clopedia of multicultural America. Farmington
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36. Hillman, S.M. 2003. People of Italian heritage. In
L.D. Purnell & B.J. Paulanka (Eds.), Transcultural
health care (2nd ed.). Philadelphia: F.A. Davis.
37. Ragucci, A.T. 1981. Italian Americans. In
A. Harwood (Ed.), Ethnicity and medical care.
Cambridge, MA: Harvard University Press.
38. de Lorgeril, M., & Salen, P. 2008, December. The
Mediterranean diet: Rationale and evidence for
its benefit. Current Atherosclerosis Reports, 10(6),
518–522.
39. Pessoa e Costa, A. 2005. Portugal: A dialogue
of cultures. In D. Goldstein & K. Merkle (Eds.),
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40. Valverde Villena, D. 2005. Spain: Agape and con-
viviality at the table. In D. Goldstein & K. Merkle
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(Eds.), Culinary cultures of Europe. Strasbourg,
France: Council of Europe Publishing.
41. Aranceta, J., Perez, C., Gondra, J., Gonzalez de
Gai-deano, L., & Saenz de Buruaga, J. 1993. Fat
and alcohol intake in the Basque country. Euro-
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42. Poe, D.M. 1986. Profile of Portuguese elderly
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Boston, MA.
43. Fernandez San Juan, P.M. 2006. Dietary habits
and nutritional status of school aged children in
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44. Carmina, E., Legro, R.S., Stamets, K., Lowell, J., &
Lobo, R.A. 2003. Differences in body weight
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45. Ferro-Luzzi, A., & Branca, F. 1995. Mediterranean
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Manios, Y., & Galli, C. 2006. Local food and car-
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47. Willet, W.C., Sacks, F., Trichopoulou, A., Drescher,
G., Ferro-Luzzi, A, Helsing, E., & Trichopoulos,
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48. Marquez-Vidal, P., Ravasco, P., Dias, C.M., &
Camilo, M.E. 2006. Trends of food intake in
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Nutrition, 60, 1414–1422.
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1 7 4
7
Central Europeans, People
of the Former Soviet
Union, and ScandinaviansCH
A
P
T
E
R
Germany, Austria, Hungary, Romania, the
Czech Republic, Slovakia, and Poland, as well
as Switzerland and Liechtenstein. Most of the
countries share common borders; Austria,
Hungary, the Czech Republic, Romania,
and Slovakia are situated south of Germany
and Poland. Switzerland, an isolated nation,
is surrounded by Germany, Austria, France,
Italy, and Liechtenstein. The climate of cen-
tral Europe is harsher and colder than that
of southern Europe, but much of the land
is fertile.
The FSU includes the Commonwealth
of Independent States or CIS (the Russian
Federation, Armenia, Azerbaijan, Belarus,
Georgia, Kazakstan, Kyrgyzstan, Republic of
Moldavia, Tajikistan, Turkmenistan, Ukraine,
and Uzbekistan) and the Baltic states (Estonia,
Latvia, and Lithuania), extending east to the
border with China and the Pacific Ocean. Its
vast geography includes the Arctic and parts
of the Middle East. Except in the southern
republics, the harsh winters of the region
affect agricultural capacity.
The large number of immigrants from
central Europe and parts of the FSU made
significant contributions to the literature,
music, and cuisine of the United States.
Many central European foods have become
standard American fare. Imagine a baseball
game without hot dogs and beer or a picnic
without potato salad. This section explores
these and other food customs of central
Europe and the FSU and their impact on the
American diet.
The European settlers from central The European settlers from central TEurope, the former Soviet Union (FSU), TEurope, the former Soviet Union (FSU), Tand Scandinavia were some of the earliTand Scandinavia were some of the earliT -
est and largest groups to come to the United
States. Though many arrived as early as the
1600s and most had come before the begin-
ning of the twentieth century, the upheavals of
two world wars and the collapse of the Soviet
Union have led to continuous immigration
from these regions during the last century (see
the map in Figure 7.1).
The influence of immigrants from cen-
tral Europe, the FSU (especially Russia), and
Scandinavia on American majority culture,
especially in the area of cuisine, is substantial.
Bread baking, dairy farming, meat process-
ing, and beer brewing are just a few of the
skills these groups brought with them. Their
expertise permitted the expansion of food
production and distribution that encour-
aged nationwide acceptance of their ethnic
specialties, leading to the creation of a typical
American cuisine. This chapter focuses on the
traditional and adapted foods and food habits
of Germans, Poles, and other central Euro-
pean groups; Russians and other FSU popu-
lations; and Danes, Swedes, and Norwegians.
Central Europeans and
the People of the FSU
Central Europe stretches from the North
and Baltic Seas, south to the Alps, and east
to the Baltic states. It includes the nations of
Eastern Europe is the
term sometimes used to
define the region that
is also called “European
Russia” (the western
half of the country; east
of the Ural Mountains
is known as Siberia or
“Asian Russia”). Before
the breakup of the
USSR, eastern Europe
was sometimes used to
describe those countries
under Soviet control
(e.g., Czechoslovakia,
Hungary, East Germany).
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C H A P T E R 7 1 7 5
Cultural Perspective
History of Central Europeans and
Russians in the United States
Immigration Patterns
Ge rmans For almost three centuries,
Germans have been one of the most signifi-
cant elements in the U.S. population. Accord-
ing to U.S. 2010 Census figures, one in every
six Americans is of German descent, making
this the largest ethnic group in the nation.1
Germans are also one of the least visible of
any American group.
The earliest German settlement in the
American colonies was Germantown, Penn-
sylvania, founded in 1681. By 1709 large-scale
immigration began, primarily from the Palati-
nate region of southwestern Germany. Many
of the immigrants, who were mostly of Amish,
Mennonite, or other religious minority faiths
Figure 7.1
Central Europe, Scandinavia,
former Soviet Union.
GERMANYGERMANYGERMANYGERMANYGERMANY
Black Sea
C
a
sp
ia
n
S
e
a
C
a
sp
ia
n
S
e
a
C
a
sp
ia
n
S
e
a
C
a
sp
ia
n
S
e
a
C
a
sp
ia
n
S
e
a
AUSTRIAAUSTRIAAUSTRIAAUSTRIAAUSTRIAAUSTRIAAUSTRIAAUSTRIAAUSTRIAAUSTRIAAUSTRIA
POLAND
HUNGARYHUNGARYHUNGARYHUNGARYHUNGARY
CZECH CZECH CZECH CZECH CZECH CZECH CZECH CZECH CZECH CZECH CZECH CZECH CZECH CZECH CZECH CZECH CZECH CZECH CZECH
REPUBLICREPUBLICREPUBLICREPUBLICREPUBLICREPUBLIC
SWITZERLANDSWITZERLANDSWITZERLANDSWITZERLANDSWITZERLANDSWITZERLANDSWITZERLANDSWITZERLANDSWITZERLAND
LIECHTENSTEINLIECHTENSTEINLIECHTENSTEINLIECHTENSTEINLIECHTENSTEINLIECHTENSTEINLIECHTENSTEINLIECHTENSTEINLIECHTENSTEIN
ESTONIA
LATIVIA
LITHUANIA
BELARUSBELARUSBELARUSBELARUSBELARUSBELARUSBELARUS
UKRAINE
RUSSIAN FEDERATION
KAZAKSTANMOLDOVAMOLDOVAMOLDOVAMOLDOVAMOLDOVAMOLDOVAMOLDOVAMOLDOVAMOLDOVAMOLDOVAMOLDOVAMOLDOVAMOLDOVAMOLDOVA
UZBEKISTANTURKMENISTAN
TURKMENISTAN
TURKMENISTAN
TURKMENISTAN
TAJIKISTAN
KYRGYZSTAN
AZERBAIJAN
ARMENIA
GEORGIAGEORGIAGEORGIAGEORGIA
SLOVAKIASLOVAKIA
ROMANIAROMANIAROMANIAROMANIAROMANIAROMANIAROMANIAROMANIAROMANIAROMANIAROMANIAROMANIAROMANIA
©
C
en
ga
ge
L
ea
rn
in
g
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
1 7 6 C E N T R A L E U R O P E A N S , P E O P L E O F T H E F O R M E R S O V I E T U N I O N , A N D S C A N D I N A V I A N S
of second- and third-generation Germans
living in urban areas. Cities with consider-
able German populations included Cleve-
land, New York, Toledo, Detroit, Chicago,
Milwaukee, and St. Louis. German Russians,
however, tended to settle in rural areas, espe-
cially in Colorado.
During the 1930s, many of the German
immigrants were Jewish refugees. After World
War II, displaced persons of German descent
and East German refugees made up the siz-
able German immigrant group who settled in
the United States.
Poles Poles have arrived in the United States
continuously since 1608. The largest wave
of immigration occurred between 1860 and
1914, mostly for economic reasons. The
early phase was dominated by Poles (approx-
imately 500,000) from German-ruled areas
of Poland (Pomerania and Poznan) and by
Poles who worked in western Germany.
German Poles often became part of the
German or Czech communities or estab-
lished farming settlements in the Southwest
and Midwest.
The number of Polish immigrants from
Germany began to decline after 1890, but the
slack was taken up by the arrival of more than
2 million Poles from areas under Russian and
Austrian rule. The German Poles left their
homeland to become permanent settlers, but
the Russian and Austrian Poles came as tem-
porary workers. Although 30 percent returned
to Poland, many eventually moved back to the
United States permanently. The Austrian and
Russian Poles tended to settle in the rapidly
developing cities of the Mid-Atlantic and mid-
western states, especially Chicago, Buffalo,
and Cleveland.
Polish emigration after World War I was
usually not for economic reasons. Most (more
than 250,000) left because of political dissat-
isfaction: government instability and dicta-
torship in the 1920s and 1930s, the German
invasion and occupation from 1939 to 1945,
and the pro-Soviet communist government
after 1945. Many settled in urban areas in
which there were substantial existing Polish
populations. More recently, small numbers
of younger Poles have taken advantage of the
seeking freedom from discrimination, settled
in Pennsylvania. The majority were farmers
who steadily pushed westward searching for
new lands for their expanding families. Those
in Pennsylvania, Ohio, and Indiana became
known as the “Pennsylvania Dutch.” Immi-
gration dropped off after 1775, but an eco-
nomic crisis in Europe once again prompted
numerous Germans to come to the United
States. Approximately 5 million Germans
immigrated to the United States between
1820 and 1900. Like the earlier settlers, most
were farmers who arrived with their families,
although by the end of the century there were
increasing numbers of young, single people
who were agricultural laborers and servants.
Many of these settled in the Mississippi,
Ohio, and Missouri River valleys, the Great
Lakes area, or the Midwest. Most Germans
avoided the southern United States, but there
are sizable German settlements in Texas and
New Orleans.
A third significant phase of immigration
began after the turn of the twentieth century,
when approximately 1.5 million Germans
arrived. Many were unmarried indus-
trial workers seeking higher pay, and oth-
ers were the descendants of Germans who
had settled in ethnically isolated colonies
in Russia as early as the sixteenth century.
Discrimination and the revolution of 1917
led to their departure. Most of these third-
phase immigrants joined growing numbers
▼ Traditional foods of
central Europe and the FSU.
Some typical foods include
beets, cabbage, ham,
herring, kasha, potatoes,
rye bread, sausages, and
sour cream.
yo
rk
01
0/
A
la
m
y
Small numbers of
Schwenk-felders from
southern Germany,
members of a pacifist
religious sect similar
to Quakers, settled in
Pennsylvania in the mid-
1700s. They introduced
crocus flowers, source of
the spice saffron.
The word Dutch is a
corruption of Deutsch,
meaning “German,” and
has nothing to do with
the Netherlands.
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C H A P T E R 7 1 7 7
freedom resulting from post-communist rule
to come to the United States.
Other Central Europeans Nearly 4 million
Austrians, Hungarians, Czechs, Slovaks, and
Swiss have come to the United States, primar-
ily during the late nineteenth and early twen-
tieth centuries, for economic and political
reasons.
Austrian immigration patterns are not
entirely known because Austrians and Hun-
garians were classified as a single group in
U.S. statistics until 1910. More than 2 million
Austrians are believed to have come to the
United States searching for economic oppor-
tunities in the decade following 1900. Most
were unskilled, and many were fathers who left
families in Austria with the hopes of making
their fortune. Many Austrians never found the
advancement they were seeking, and approxi-
mately 35 percent returned home. A second,
smaller wave of immigration occurred in the
1930s, when 29,000 well-educated, urban
Austrian Jews fled Hitler’s arrival.
The first group of Hungarians arriving in
the United States was several thousand politi-
cal refugees following the revolution of 1848.
Most were men—well educated, wealthy, and
often titled. Later Hungarian immigrants
who arrived at the turn of the century were
often poor, young, single men who found job
opportunities in the expanding industrial
workplace. Many worked in the coal mines of
eastern Ohio, West Virginia, northern Illinois,
and Indiana. Cities that developed large Hun-
garian populations were primarily located in
the Northeast and Midwest. More than 50,000
additional Hungarians entered the United
States as refugees after World War II and the
1956 uprising against the communist govern-
ment. They first settled in the industrial towns
populated by earlier Hungarian immigrants,
but many, mostly professionals, soon moved
to other cities that offered better jobs.
Czech immigrants initially tended to be
farmers or skilled agricultural workers who
settled in the states of Nebraska, Wiscon-
sin, Texas, Iowa, and Minnesota, often near
the Germans. Later Czech immigrants were
skilled laborers; they settled in the urban
areas of New York, Cleveland, and especially
Chicago.
The majority of the Slovak immigrants
were young male agricultural workers who
arrived before World War II. Those who
decided to remain in the United States later
sent for their wives and families. The major-
ity settled in the industrial Northeast and
Midwest; they labored in coal mines, steel
mills, and oil refineries.
Immigrants from Switzerland came to the
United States for economic opportunities. The
majority arrived prior to World War I, seeking
jobs as artisans or professionals in the urban
areas of New York, Philadelphia, Chicago,
Cincinnati, St. Louis, San Francisco, and Los
Angeles.
Another group without national boundar-
ies found throughout central Europe (as well
as in northern and southern Europe) is the
Gypsies, also known as Roma. Gypsy immi-
grants to the United States are not counted in
U.S. Census figures. There are an estimated
100,000 to 1,000,000 Gypsies in America,
from a variety of Gypsy groups and speak-
ing different dialects.2 Though they origi-
nate from numerous European countries,
the majority living in the United States are
believed to have come from central Europe.
Russians and People of the FSU Russian immi-
grants originally came to Alaska and the West
Coast, rather than to the eastern states. Most
of their settlements were forts or outposts
used to protect their fur trade and to shelter
missionaries. When Russia sold Alaska to
the United States in 1867, half of the settlers
returned home and many of the others moved
to California. Subsequent immigration was
primarily to the East Coast, although some
Russians (Molokans, followers of a religion
that had rejected the Russian Eastern Ortho-
dox Church) immigrated to the West Coast in
the early twentieth century.
Russians, mainly impoverished peasants
seeking a better life, began to arrive in large
numbers during the 1880s. Over 1.5 million
were Jews seeking freedom from persecu-
tion as well as economic opportunity. A sec-
ond wave of immigrants came after the 1917
revolution, when more than 2 million people
fled the country; 30,000 settled in the United
States. After World War II, only small num-
bers of Soviet refugees, primarily Jews, were
The Gypsies are an insu-
lar ethnic group found
throughout the world.
When they first arrived
in Europe in the 1300s
from India, they were
mistaken for Egyptians.
Their name derives from
this error. Those from
eastern and southeastern
Europe are the Rom,
and some Gypsies prefer
the name Roma.
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1 7 8 C E N T R A L E U R O P E A N S , P E O P L E O F T H E F O R M E R S O V I E T U N I O N , A N D S C A N D I N A V I A N S
allowed to emigrate. Following the breakup
of the Soviet Union, nearly 200,000 Russians
settled in the United States between 1990 and
1993. The settlement patterns of Russians are
similar to those of other immigrants from
central Europe. For the later wave of immi-
grants, the port of entry was New York City.
Many remained in New York, and others
settled in nearby industrial areas that offered
employment in the mines and factories.
The largest populations of immigrants
from the FSU are from Ukraine, Lithuania,
and Armenia. Lengthy Russian domination
of the region hinders estimates of the total
numbers in the United States because some
settlers were listed as Russians in immigra-
tion figures. It is believed that the first signifi-
cant number of Lithuanians, approximately
300,000, arrived in the United States follow-
ing the abolition of serfdom in 1861.3 Nearly
30,000 refugees fleeing Soviet control came
following World War II. The largest influx of
Ukrainian immigrants occurred in the 1870s,
when almost 350,000 men were recruited to
work the Pennsylvania mines as strikebreak-
ers. A majority settled in that state, though
smaller numbers found factory work in Ohio,
New York, and Michigan. Later immigrants,
including 80,000 Ukrainians displaced by
World War II, favored the urban centers of
the Northeast.
Significant Armenian immigration began
in 1890, when immigrants came for economic
opportunity. A second wave of Armenians
from Turkey who were seeking escape from
persecution arrived following the two world
wars. More than 60,000 Armenian refugees
have come since the 1980s, settling primarily
in Los Angeles, with smaller numbers joining
the older American communities in Boston,
New York, Detroit, Chicago, and the agricul-
tural region of Fresno, California.
Current Demographics and
Socioeconomic Status
Germans There are more than 47 million
Americans of German heritage in the nation
today, according to 2010 Census estimates.1
Wisconsin-Minnesota-North Dakota-South
Dakota-Nebraska-Iowa is considered the
German belt; however, only the Pennsylvania
Dutch, the rural-dwelling Germans from
Russia who settled in the Midwest, and a few
concentrated communities in Texas retain
some aspects of their cultural heritage.4
Germans differ little from the national
norms demographically, although they are
slightly higher in economic achievement and
are generally conservative in attitudinal rat-
ings. The high degree of German accultura-
tion is attributed to their large numbers, their
occupations, and the time of their arrival in
the United States. Furthermore, entry of the
United States into World War I created a storm
of anti-German feeling in America. German-
composed music was banned, German-named
foods were renamed, and German books were
burned. As a result, German Americans rap-
idly assimilated, abandoning the customs
still common in other ethnic groups, such as
ethnic associations and use of their oral and
written language.
Poles Polish Americans form one of the larg-
est ethnic groups in the United States today.
In 2011, it was estimated that there were over
9 million Americans of Polish descent;5 many
still live in the urban areas of the Northeast
and upper Midwest where their ancestors
originally settled. Economically, the third-
generation Polish American has moved
upward, and the majority of Polish Americans
live at a solidly middle-class level. Poles have
been active in the formation and leadership
of U.S. labor unions. More recent immigrants
usually possess higher occupational skills
and educational backgrounds than earlier
immigrants.8
Other Central Europeans There is contin-
ued confusion over Austrian ethnicity, dat-
ing back to changing national boundaries
and names. It is believed that although only
772,000 Americans identify themselves as
being of Austrian descent in the 2010 U.S.
Census figures,1 as many as 4 million U.S.
citizens may actually be of Austrian ances-
try.6 Though early immigrants settled mostly
in the Northeast, the largest populations
of Austrian Americans are now found in
New York, California, Pennsylvania, Florida,
and New Jersey. At the turn of the century,
Austrians were involved in clothing and
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C H A P T E R 7 1 7 9
tailoring, mining, and the food industry,
including bakeries, meatpacking operations,
and restaurants. Today, Austrians are found
in a diverse range of occupations.
In the 2010 U.S. Census figures, 1.5 million
Hungarian Americans were estimated to be in
the United States.1 Most settled originally in
the Northeast, but younger generations have
migrated to California and Texas, while many
Hungarian retirees have moved to Florida.7
Economically, the Hungarians differ little
from other central European immigrants.
Most live in urban areas and work mostly in
white-collar occupations. First- and second-
generation Hungarian Americans encouraged
their children to become engineers, a science
that was respected by the Hungarian aristoc-
racy at the turn of the century.
Nearly 1.5 million Americans of Czech
descent were identified in the 2011 U.S.
Census estimates. Most Czechs now live in
cities or rural nonfarm areas5 and are accul-
turated. Cities and states with large Czech
populations are California, Chicago, Iowa,
Minnesota, Nebraska, New York City, Texas,
and Wisconsin. Occupationally, only a small
number of Czech Americans are still farmers;
a majority of Czechs now hold sales, machin-
ist, or white-collar jobs. Many Czechs have
been successful in industry, founding busi-
nesses that produce cigars, beer, and watches.
There are over 730,000 Americans of
Slovak descent, according to the 2011 U.S.
Census figures.5 Actual numbers may exceed
2 million when those originally misidenti-
fied as Czechoslovakian or Hungarian are
included.9 The first two generations of Slovaks
grew up in tightly knit communities anchored
by work, church, family, and social activities.
The third and fourth generations have sought
higher education, work in white-collar jobs,
and live in the suburbs; median family income
is far above the national average. Cultural ties
are still strong among the later generations of
Slovaks.
There were less than 1 million citizens
who declared Swiss ancestry in the 2010 U.S.
Census estimates.5 Most Swiss were multi-
lingual and often multicultural when they
arrived, assimilating quickly into U.S. culture.
The few Swiss who come to the United States
today work mostly in the U.S. branches of
Swiss companies.10
After arrival in the United States, Gypsies
(Romas) retained their tradition of roving;
their exact numbers are unknown, and they
are a very mobile population, often living in
trailer parks. Many renovate apartments and
houses to accommodate large social gather-
ings, then pass the homes on to other Gypsy
Americans when they move. It is estimated
that approximately 1 million Gypsies live in
the United States. The cities with the largest
concentrations of Gypsies are Los Angeles,
San Francisco, New York, Chicago, Boston,
Atlanta, Dallas, Houston, Seattle, and Port-
land. Traditionally tinkers and traders, Gyp-
sies have been very successful at independent
trades, such as house painting and asphalt
paving, and service work such as body-
fender repair and dry cleaning. Gypsies have
also entered the car dealership profession in
large numbers. Women are a strong presence
in the mystical arts, including fortunetell-
ing. The Gypsies divide the urban regions of
the United States to minimize competition
between Gypsy-owned businesses.
Russians and People of the FSU In 2010,
approximately 3 million Russian Americans
were living in the United States.1 They have
mostly moved out of the inner-city settlements
to the suburbs, especially in the Northeast.
Figures from the 2011 Census reported close
to 1 million Americans of Ukrainian descent,
660,000 of Lithuanian heritage, and 464,000 of
Armenian ancestry. In the past decade, one-
third of FSU immigrants are from Russia,
one-third are from Ukraine, and the remain-
ing third are from all other FSU nations.
These recent immigrants have settled in urban
areas, including New York, Chicago, Los
Angeles, Boston, Detroit, and San Francisco.
Today, 40 percent of Ukrainians are found in
Pennsylvania, and 60 percent of Armenians are
living in California.11
Since World War II, the relations between
the Russian American community and Amer-
ican society have largely been dependent on
the political relations between the United
States and Russia. During the 1950s, anti-
Soviet and anticommunist sentiments in the
Based on 2011 Census
data, it is estimated that
there are over 3 million
Canadians of German
descent and over 1 mil-
lion of Polish ancestry.
In addition, more than
1 million Canadians list
their heritage as Ukrai-
nian, and over 500,000
report Russian origins.64
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1 8 0 C E N T R A L E U R O P E A N S , P E O P L E O F T H E F O R M E R S O V I E T U N I O N , A N D S C A N D I N A V I A N S
United States caused many Russian Ameri-
cans to assume a low profile that hastened
their acculturation. Since the bulk of Ukrai-
nian and Lithuanian immigration occurred
several generations past, most of these popu-
lations are assimilated. Armenians, who are
typically well educated and English speaking
on arrival, have also found it easy to adapt to
U.S. society.
Immigrants recently arriving from Rus-
sia and the FSU have come from relatively
advanced educational and professional back-
grounds. Estimates are nearly half of Russian
immigrants have a university degree. Most
have professional experience, many as engi-
neers, economists, scientists, or physicians.
Worldview
Religion
Germans The majority of German immi-
grants were Lutheran; a minority were Jewish
or Roman Catholic. Today the Pennsylvania
Dutch and the rural Germans from Russia
faithfully maintain their religious heritage.
Both groups are primarily Protestant,
mostly Lutheran or Mennonite. Menno-
nites are a religious group derived from the
Anabaptist movement, which advocated
baptism and church membership for adult
believers only. They are noted for their simple
lifestyle and rejection of oaths, public office,
and military service. The Amish, a strict sect
of the Mennonites, follow the Bible literally.
They till the soil and shun worldly vanities
such as electricity and automobiles. Their life
centers on Gelassenheit, meaning submis-
sion to a higher authority through reserved
and humble behavior, and placing the needs
of others before the needs of the individual.
Poles Most Polish immigrants were devout
Catholics; they quickly established parish
churches in the United States. The Catholic
Church is still a vital part of the Polish Ameri-
can community, although Polish Americans
have been found to marry outside the church
more than other Catholics.
Central Europeans Austrians are mostly
Roman Catholic and have been actively
involved in promoting Catholicism in
America. In 1829 the Leopoldine Stiftung
was founded in Austria to collect money
throughout Europe to introduce religion to
the U.S. frontier, resulting in more than 400
Catholic churches established in the East, the
Midwest, and in what was known as “Indian
country.” There are also small numbers of
Austrian Jews. The majority of Hungarians are
Catholic, although in the United States, nearly
25 percent are Protestant.
In Europe most Czechs were Roman
Catholics, but one-half to two-thirds of
nineteenth-century Czech immigrants from
rural areas left the church and were consid-
ered free thinkers who believed in a strong
separation of church and state. Subsequent
generations now belong to a variety of faiths.
Religion is still an important factor in the
lives of Slovaks. Most are Roman Catholics
who attend services regularly. First- and
second-generation Slovaks usually send their
children to parochial schools supported by
the ethnic parish.
Traditional spirituality for the Gypsies
(Romas) is derived from Asian Indian reli-
gions, such as Hinduism and Zoroastrianism
(see Chapter 2 regarding Eastern religions,
and Chapter 14 for more information on
Asian Indian faiths). While traditions and
customs vary by tribe and to a certain degree
by the host culture, Gypsies are thought to be
united in their worldview, called romaniya.
Many believe in God, the devil, ghosts, and
predestination. Most of all they adhere to the
concept that persons and things are either
pure or polluted. Gypsy culture is structured
to preserve purity and to avoid contami-
nation through contact with non-Gypsies.
Some Gypsy Americans are Christians, often
members of fundamentalist congregations,
and several churches have specifically com-
bined Gypsy spiritual concepts with Christian
practices.
Russians and People of the FSU Except for the
Soviet Jews, the primary organization of
the Russian American community today
is the Russian Orthodox Church. Religion
has always played a central role in the Russian
community, and the Orthodox Church has
tried to preserve the culture. However, the
largest branch of the Eastern church, officially
Seventy-three percent
of the population in
Switzerland speaks Swiss
German, 20 percent
speaks Swiss French, and
5 percent speaks Swiss
Italian; in addition, most
Swiss speak one or two
other languages.
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C H A P T E R 7 1 8 1
known as the Orthodox Church in America
(formerly the Russian Orthodox Church out-
side Russia), now includes people from other
central European and FSU countries, and the
Russian traditions have been deemphasized.
Among Ukrainian Americans, more
belong to the Roman Catholic Church than
to the Eastern Orthodox faith. Lithuanians are
also predominantly Roman Catholic; however,
there are small numbers of Protestants, Jews,
and Eastern Orthodox followers. Most Arme-
nians are members of the Armenian Apostolic
Church (an Eastern Orthodox faith noted for
allowing its members to make decisions on
issues such as birth control and homosexu-
ality without religious influence), although
some Americans of Armenian descent are
Protestants or members of the Armenian Rite
of the Roman Catholic Church.
Family
Germans The traditional German family was
based on an agricultural system that valued
large families in which every member worked
in the fields to support the household. Even
when German immigrants moved to urban
areas, family members were expected to help
out in the family business. Most German fam-
ilies today are assumed to have adopted the
smaller American nuclear configuration. The
exception may be among the Pennsylvania
Dutch, particularly the Amish, who continue
to have large families of seven to ten children.
It is not unusual for an Amish person to know
as many as seventy-five first cousins or for a
grandparent to have thirty-five grandchil-
dren.12 Many Amish families are finding it
difficult to maintain traditional values due
to growing contact with the majority culture
through suburban sprawl.
Poles Traditionally the Polish American
family was patriarchal, and the father exerted
strong control over the children, especially
the daughters. The mother took care of the
home, and, if the children worked, it was near
the home or the father’s workplace. Since the
1920s, the overwhelming majority of Polish
American families have been solely supported
by the father’s income; wives and children
have rarely worked.
Other Central Europeans Tight nuclear fami-
lies typify traditional Austrian households.
Although the father is in charge of family
finances, it is the mother who rules home life.
Assimilation in the United States has led to a
deterioration of the nuclear family, including
an increased divorce rate. Traditional Czech
and Hungarian families were male dominated
and included many relatives. In the United
States, participation in church activities, fra-
ternal societies, and political organizations
often served to replace the extended family
for both men and women. The role of women
has become less circumscribed; children are
typically encouraged to pursue higher edu-
cation and professional careers. Family ties
are strong among the Slovaks. Parents are
respected; they are frequently visited and
cared for in their old age. Weddings are still a
major event, although they are not celebrated
for several days, as they once were.
Gypsies customarily maintain extended
families, although in the United States more
nuclear families have been established. When
traveling was common, multifamily groups
(smaller than tribes) would temporarily band
together. Affiliation with this group, called a
k umpania, often continues today. The father
is in charge of all public matters, but women
may make most of the family income and
manage all money matters. Women also retain
some power through their ability to commu-
nicate with the supernatural world. Usually
Gypsies do not date, and arranged marriages
are still common.
Russians Traditionally, Russians lived in
very large family groups with women legally
dependent on their husbands. This structure
changed, however, with the education and
employment opportunities offered to women
during the communist rule of the Soviet
Union. Most women worked, and families
became smaller. Even when employed full
time, however, women remained respon-
sible for all household chores. In the United
States, Russian family structure has shrunk
even further. Russian couples have sig-
nificantly fewer children than the national
average for American families. Education is
emphasized, especially if it can be obtained
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1 8 2 C E N T R A L E U R O P E A N S , P E O P L E O F T H E F O R M E R S O V I E T U N I O N , A N D S C A N D I N A V I A N S
Traditional Health Beliefs and Practices
German biomedicine makes extensive use
of botanical remedies, though continued use
is not documented in German Americans.
A study of German Americans elders in Texas
showed that many believe illness is caused by
infection or stress-related conditions.14 Some
Germans believe sickness is an expected con-
sequence of strenuous labor. Health is main-
tained by dressing properly, avoiding drafts,
breathing fresh air, exercising, doing hard
work, and taking cod liver oil. A few respon-
dents mentioned the importance of religious
practices and that suffering from illness is a
blessing from God. Numerous home remedies
are common (see “Therapeutic Uses of Foods”
section for more information).
The Pennsylvania Dutch traditionally
believed a hearty diet high in meats, dairy
products, and grain foods was important for
maintaining good health. Many use home
remedies, homeopathic preparations, and
healers to treat illness. Sympathy healing is
especially well developed. This traditional
folk practice uses charms, spells, and blessings
to cure the symptoms of disease. It is called
either “powwowing” (though not related to
Native American beliefs and practices) or
by its German name, B r auc h e or B r auc h er ei.
There is a strong religious foundation to the
practice, and the healer acts as God’s instru-
ment, requesting God’s direct assistance in
treatment. Powwow compendiums still in
use today offer everything from household
tips to cures for warts, burns, toothache, and
the common cold. The Amish in particular
subscribe to sympathy healing, the laying on
of hands to diagnose illness, and reflexology
(foot massage thought to benefit other areas
of the body, such as the head, neck, stomach,
and back), as well as the use of herbal home
cures, especially teas.15,16,17,18
Polish American elders in Texas have
reported that a shortage of medical supplies in
Poland led to the widespread use of faith heal-
ers.14 Although such healing practices are not
documented in the United States, many Pol-
ish Americans are deeply religious and believe
that faith in God and the wearing of religious
medals will help prevent illness. Other health-
maintenance beliefs include avoidance of sick
at a Russian-language school. Many first-
generation immigrants attempted to maintain
ethnic identity by restricting their children to
spouses from their immediate group, but mar-
riage to non-Russians is now the norm.
Since many of the Ukrainian and Lithu-
anian immigrants in the nineteenth century
were men, most were forced to intermarry
with other ethnic groups. The men dominated
the household, the women ran the home, and
the extended family was the norm. Ukrainian
and Lithuanian families have since moved
toward a more typically American composi-
tion with just two working parents and chil-
dren. In many ways, Armenian homes are
also similar to the average U.S. household.
Both parents usually work, and education is
a high priority. Nearly 70 percent of second-
generation Armenian Americans obtain a col-
lege degree. It has been noted, however, that
most Armenian children retain respect for
elders after acculturation, which is uncom-
mon in other cultures, and tight-knit families
have allowed many Armenians to pass on
traditional customs.13
▼ Eastern Orthodox priest
blesses combine harvesters
and the drivers during
celebrations marking the
start of the harvest.
Va
si
ly
F
ed
os
en
ko
/R
eu
te
rs
The Amish and Men-
nonites are referred to
as the “Plain People.” The
more liberal and worldly
members of the Lutheran
and Reformed Churches
are called the “Gay
Dutch,” “Fancy Dutch,”
or “Church People.”
In 301 CE, Armenia
became the first nation
to adopt Christianity as
its state religion.
Symptoms of colic
in Amish infants are
attributed to a condition
known as livergrown,
which can be cured only
with sympathy healing.
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C H A P T E R 7 1 8 3
people, a healthy diet, sleep, keeping warm,
exercise, a loving home, and avoidance of
gossip.
Gypsies have unique health beliefs.19
Health is maintained through mar imé , a sys-
tem of purity and pollution that may be related
to Asian Indian beliefs (see Chapter 14). The
separation of clean from unclean dictates
much of Gypsy life. The body is an example of
this dichotomy. The upper body is pure, as are
all its secretions, such as saliva. The lower half
is impure and shameful. Care is taken to avoid
contamination through contact of the upper
body by the lower body (only the left hand
is used for personal care). Menstrual blood is
especially impure. Purity is also maintained by
avoiding public places that non-Gypsies (who
are considered unclean) frequent and by not
touching contaminated surfaces, as well as by
the use of disposable utensils, cups, and towels
when in impure locations (e.g., hospitals).
Gypsies divide illnesses into those that are
due to contact with non-Gypsies, and those
that are Gypsy conditions caused by spirits,
ghosts, the devil, or breaking cultural rules.
Home remedies and Gypsy healers (usually
older women versed in medicinal lore) are
considered best for Gypsy illnesses. Non-
Gypsy conditions are suitable for treatment by
non-Gypsy physicians, though a non-Gypsy
folk healer such as a c ur ander o may be con-
sulted as well.
Natural cures and alternative medicine are
used extensively in Russia and the nations of
the FSU, and they are often integrated with
a biomedical therapy.17 For example, cupping
is used for respiratory illnesses. Saunas, mas-
sage, steam baths, and balneotherapy (bath-
ing in mineral springs) are often prescribed in
conjunction with biomedical approaches; mud
baths may be used for hypertension, and sul-
furated hydrogen baths for cardiac ailments.
In addition, homeopathic preparations and
herbal remedies are popular.17,20,21,22 Magic
and the occult may be used to cure illnesses
due to supernatural causes. Psychics and
z nak ar k i (elder women who whisper charms
and sprinkle water with magic powers) may
be employed for chronic conditions that bio-
medicine cannot ameliorate. In the Siberian
region of Russia, sickness was traditionally
attributed to spiritual crisis, soul loss, evil
spirits, breach of taboos, or curses. Treatments
used by shamans (magico-religious healers)
included realigning life forces or retrieving
the soul through visualization techniques,
singing, chanting, prognostication, dream
analysis, and séances.23,24 Russians who do
not believe in any occult practices may blame
illness on other factors outside their control,
including social conflict, political problems,
war, poor medical care, and starvation.25
Traditional Food Habits
Ingredients and Common Foods:
Staples and Regional Variations
The regional variations in central European
and FSU cuisine are minor. The exceptions
are the foods of the southern CIS nations,
such as Armenia. (See “Exploring Global
Cuisine—Armenia” on page 188.) The tem-
perate climate of the region and proximity to
the Arabs, Turks, and Greeks have resulted
in a cuisine similar to Middle Eastern fare
(see Chapter 13). Ingredients in traditional
central European and FSU dishes were dic-
tated by what could be grown in the cold,
often damp climate. Common ingredients are
potatoes, beans, cabbage and members of the
cabbage family, beets, eggs, dairy products,
pork, beef, fish and seafood from the Baltic
Sea, freshwater fish from local lakes and rivers,
apples, rye, wheat, and barley (see Table 7.1
for the cultural food groups). Foods were
often dried, pickled, or fermented for preser-
vation—for example, cucumber pickles, sour
cream, and sauerkraut.
Bread is a staple item, and there are more
than one hundred varieties of bread. Because
the climate in central Europe and FSU makes
wheat harder to grow, bread is often made
with rye and other grains; thus it is darker
in color than bread made from wheat flour.
Common types are whole wheat, cracked
wheat, white, black, rye, pumpernickel,
caraway, egg, and potato. Cornmeal breads
are found in more southern nations such
as Romania. Soft pretzels are a favorite in
Germany and in Switzerland; they are some-
times sliced to make sandwiches. Noodles
and dumplings abound and are often served
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1 8 4 C E N T R A L E U R O P E A N S , P E O P L E O F T H E F O R M E R S O V I E T U N I O N , A N D S C A N D I N A V I A N S
Group Comments Common Foods Adaptations in the United States
Protein Foods
Milk/milk
products
Dairy items, fresh or fermented,
are frequently consumed.
Whipped cream is popular
in some areas; sour cream
popular in other regions.
Milk (cow’s, sheep’s) fresh and fermented
(buttermilk, sour cream, yogurt), cheese,
cream
Milk products are still
frequently consumed or
increased.
Meat/poultry/
fish/eggs/
legumes
Meats are often extended by
grinding and stewing.
Russians tend to eat their meat
very well done.
Meat: beef, boar, hare, lamb, pork (bacon, ham,
pig’s feet, head cheese), sausage, variety
meats, veal, venison
Fish: carp, flounder, frog, haddock, halibut,
herring, mackerel, perch, pike, salmon,
sardines, shad, shark, smelts, sturgeon, trout
Shellfish: crab, crawfish, eel, lobster, oysters,
scallops, shrimp, turtle
Poultry and small birds: chicken, Cornish hen,
duck, goose, grouse, partridge, pheasant,
quail, squab, turkey
Eggs: hens, fish (caviar)
Legumes: kidney beans, lentils, navy beans,
split peas (green and yellow)
Consumption of meat and
poultry has increased; use of
variety meats has decreased.
Sausages and other processed
meats are often eaten.
Cereals/Grains Bread or rolls are commonly
served at all meals. Dumplings
and kasha are also common.
Numerous cakes, cookies, and
pastries are popular.
Rye flour is commonly used.
Barley, buckwheat, corn, millet, oats, potato
starch, rice, rye, wheat
More white bread, less rye
and pumpernickel breads
are eaten.
Breakfast cereals well
accepted.
Fruits/Vegetables Potatoes are used extensively,
as are all the cold-weather
vegetables.
Cabbage is fermented to make
sauerkraut.
Fruits and vegetables are often
preserved by canning, drying,
or pickling.
Fruit is often added to meat
dishes.
Fruits: apples, apricots, blackberries,
blueberries, sour cherries, sweet cherries,
cranberries, currants, dates, gooseberries,
grapefruit, grapes, lemons, lingonberries,
melons, oranges, peaches, pears, plums,
prunes, quinces, raisins, raspberries, rhubarb,
strawberries
Vegetables: asparagus, beets, broccoli,
brussels sprouts, cabbage (red and green),
carrots, cauliflower, celery, celery root,
chard, cucumbers, eggplant, endive, green
beans, kohlrabi, leeks, lettuce, mushrooms
(domestic and wild), olives, onions, parsnips,
peas, green peppers, potatoes, radishes,
sorrel, spinach, tomatoes, turnips
Tropical fruits may be eaten.
Greater variety of vegetables
consumed; salads popular.
Additional Foods
Seasonings Central Europeans tend to
season their dishes with sour-
tasting flavors, such as sour
cream and vinegar.
Allspice, anise, basil, bay leaves, borage,
capers, caraway, cardamom, chervil, chives,
cinnamon, cloves, curry powder, dill, garlic,
ginger, horseradish, juniper, lemon, lovage,
mace, marjoram, mint, mustard, paprika,
parsley, pepper (black and white), poppy
seeds, rosemary, rose water, saffron, sage,
savory (summer and winter), tarragon,
thyme, vanilla, vinegar, woodruff
Saffron is a popular spice in
Pennsylvania Dutch fare.
Nuts/seeds Poppy seeds are often used in
pastries; caraway seeds flavor
cabbage and bread.
Nuts: almonds (sweet and bitter), chestnuts,
filberts, pecans, walnuts
Seeds: poppy seeds, sunflower seeds
TA B L E 7.1 Cultural Food Groups: Central European and Russian/FSU
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 7 1 8 5
as side dishes. Boiled dumplings (called kned-
liky in Czech, Knödel in German, and kletski
in Russian) can be made with flour or pota-
toes and with or without yeast. Spätzle are tiny
dumplings common in southern Germany.
They are made by forcing the dough through
a large spoon with small holes into the hot
water. Stuffed dumplings, filled with meat,
liver, bacon, potatoes, or fruit, are called
Maultaschen (German), pierogi (Polish),
pelmeni (Russian), or varenyky (Ukrainian).
Related to the filled dumpling is stuffed pastry
dough, which is baked or fried. It is custom-
arily filled with meat or cabbage. Small indi-
vidual pastries are called pirozhki in Russian,
and a large oval pie is known as a pirog (also
called a kulebi). One elaborate version, kule-
biaka, usually includes a whole fish, such as
salmon, with mushroom and rice filling. In
Lithuania, lamb-stuffed pockets served with
sour cream are called kulduny. A specialty
product of Russia is buck-wheat (an Asian
grain), which has a very distinctive, nutty fla-
vor, especially when it is toasted. The groats
(hulled and crushed grains) are prepared in
ways similar to rice, especially as side dishes
and stuffings.26 Buckwheat meal is used to
make baked goods.
Next to bread, meat is the most important
element of the diet. Pork is the most popu-
lar. Schnitzel is a meat cutlet, often lightly
breaded and then fried. Ham is served fresh or
cured. Poland is famous for its smoked ham,
and in Germany, Westphalian ham is lightly
smoked, cured, and cut into paper-thin slices.
Beef is also common. In Germany, Sauerbra-
ten, a marinated beef roast, is the national
dish. It is also rolled around various fillings,
such as bacon, onions, and pickles, to make
Rouladen. Veal is especially popular in Lith-
uania. Poultry is well liked. Germans often
eat roast goose stuffed with onions, apples,
and herbs on holidays. In Russia, chicken
is stewed on special occasions, and breaded
chicken cutlets called kotlety are common.
A famous Russian dish is chicken Kiev—
breaded, fried chicken breasts filled with her-
bed butter. Game meats are a favorite in many
areas, especially deer, wild boar, and rabbit.
A well-known German dish is Hasenpfeffer—
hare cooked in red wine with black pepper.
In Poland, bigos (“hunter’s stew”), made of
venison, hare, and vegetables (some form of
cabbage is always added), is traditional. Geese
and duck are widely eaten, also.
In the past, meat was often scarce and
expensive; thus many traditional recipes
stretched it as far as possible. Dishes com-
mon throughout the region consist of sea-
soned ground meat mixed with a binder such
as bread crumbs, milk, or eggs, then formed
into patties and fried. In Germany, ground
beef (and sometimes pork or veal) is served
raw on toast as steak tartare. Ground meat is
also used to stuff vegetables (such as stuffed
cabbage) or pastry, or is cooked as meatballs,
such as Königsberger Klopse topped with
capers and a white sauce. Cut-up meat is often
served in soups, stews, or one-pot dishes. In
Germany a slowly simmered one-pot dish
Legend has it that it
was the Mongols who
showed the central
Europeans how to broil
meat, make yogurt and
other fermented dairy
products, and preserve
cabbage in brine.
Gypsy women are tradi-
tionally prohibited from
touching food, water,
or utensils intended for
other family members
during their period or
following childbirth.
The Poles say “A doctor’s
mistakes are covered
in earth.”
Group Comments Common Foods Adaptations in the United States
Beverages Central Europeans drink coffee;
Russians drink tea.
Many varieties of beer are
produced.
Hungarians and Austrians tend
to drink more wine than other
central European people.
Beer, hot chocolate, coffee, syrups and juices,
fruit brandies, herbal teas, milk, tea, kvass,
vodka, wine
Fats/oils Butter, bacon, chicken fat, flaxseed oil, goose
fat, lard, olive oil, salt pork, suet, vegetable oil
Soft drinks common.
Sweeteners Honey, sugar (white and brown), molasses Commercial salad dressings,
nondairy creamers added
to diet.
©
C
en
ga
ge
L
ea
rn
in
g
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
1 8 6 C E N T R A L E U R O P E A N S , P E O P L E O F T H E F O R M E R S O V I E T U N I O N , A N D S C A N D I N A V I A N S
of meat, vegetables, potatoes, or dumplings
is called Eintopf. Hungary is known for its
gulyás, a paprika-spiced stew known as gou-
lash in the United States. Sweet Hungarian
paprika is ground, dried, red chile peppers to
which sugar has been added. As chile peppers
are a New World food, it is thought that the
Hungarians used black pepper to season their
food before the discovery of the Americas.
Ground meats are also made into sau-
sages. In Germany there are four basic cat-
egories of sausage (Wurst). Rohwurst, similar
to American-style liverwurst, is cured and
smoked by the butcher and can be eaten as
is. Examples include Teewurst, a raw, spiced
pork sausage that is spreadable like pâté, and
Mettwurst, a mild, sliceable pork sausage.
Bruhwurst (the frankfurter or Wienerwurst
is one type) is smoked and scalded by the
butcher; it may be eaten as is or heated by
simmering. Knockwurst, which is like a cold
cut, may be smoked and is fully cooked by the
butcher. Leberwurst (liverwurst), Blutwurst
(blood sausage), and Süize (head cheese) are
examples. Bratwurst, similar to sausage links,
is sold raw by the butcher and must be pan-
fried or grilled before eating. The Polish are
famous for kielbasa, a garlic-flavored pork
sausage. In Austria, some sausages are called
Wieners. Two popular sausages with both the
Czechs and Slovaks are jaternice, made from
pork, and jelita, a blood sausage, which can be
boiled or fried.
Freshwater and saltwater fish and sea-
food are often eaten fresh, smoked, or cured.
Trout, carp, and eel are popular throughout
much of the region. In Germany herring is
commonly pickled and eaten as a snack or
at the main meal, sometimes as Rollmops,
wrapped around a bit of pickle or onion. In
Russia, smoked salmon and sturgeon are con-
sidered delicacies, as is caviar, which is roe
from sturgeon. Caviar is classified according
to its quality and source. Beluga, the choic-
est caviar, is taken from the largest fish and
has the largest eggs; its color varies from
black to gray. Sevruga and osetra, taken from
smaller sturgeon, have smaller eggs and are
sometimes a lighter color. Sterlet, or imperial
caviar, is from a rare sturgeon with golden roe.
The finest caviar is sieved by hand to remove
membranes and is lightly salted. Less choice
roes are more heavily salted and pressed
into bricks. Though some fish is consumed
in Poland, it is not a popular food, and is in
some cases associated with shortages endured
during Soviet rule.27
Dairy products are eaten daily. Cheeses
may be served at any meal, from the fresh,
sweet varieties, such as Lithuanian farmer’s
cheese, to the strongly flavored aged types
like German Limburger. Fresh milk is drunk;
butter is the preferred cooking fat. Buttermilk
(a thick type called kefir is popular in south-
ern areas of the FSU), sour cream, and fresh
cream are also common ingredients in sauces,
soups, stews, and baked products. In Austria
and Germany, whipped cream is part of the
daily diet, served with coffee or pastries.28
Traditionally, cold-weather fruits and veg-
etables added variety to the diet. Red and
green cabbage is ubiquitous—found fried,
boiled, fermented as sauerkraut, and added
to stuffings, soups, and stews. Potatoes are
equally popular. They are most often boiled,
or roasted and sliced. One German specialty
found in the northern area of the country is
called Himmel und Erde (“heaven and earth”),
a boiled dish of potatoes and sliced apples
topped with fried bacon and onions. Other
root crops such as beets and kohlrabi accom-
pany many meals. Cucumbers are frequently
pickled or served dressed with vinegar for a
salad. Onions and mushrooms flavor numer-
ous dishes. Wild mushrooms are so popular
in Poland that they are often used as a meat
substitute on religious fast days.27 Temperate
vegetables, including tomatoes and eggplant,
are found in the more southern nations of the
FSU, and are now widely available throughout
the region. Cauliflower and tomatoes are the
favorite vegetables in Germany today.29 Com-
mon fruits include apples, cherries, plums,
and berries, though imported bananas are a
favorite in Russia.30
In much of central Europe, sweets are
enjoyed daily. They are eaten at coffee-houses
in the morning or afternoon, or bought at the
local bakery and served as dessert. There are
numerous types, such as cheesecakes, cof-numerous types, such as cheesecakes, cof-numerous types, such as cheesecakes, cof
fee cakes, doughnuts, and nut- or fruit-filled
individual pastries. Apple, cherry, raspberry,
Frankfurter means a sau-
sage from the German
city of Frankfurt; Weiner
means one from Vienna.
In the United States the
term hot dog became
popular in the late 1800s
because of the sausage’s
resemblance to a dachs-
hund; stories about a
cartoonist inventing the
nickname are myth.
After diners eat smoked
eel on pumpernickel
bread in some res-
taurants of northern
Germany, the server
pours inexpensive
Schnapps over their
hands to rid them of
a fishy odor.
The national dish of
Switzerland is cheese
fondue (chunks of bread
dipped into melted
cheese). The Swiss are
known for their zesty
cheeses with holes,
such as Emmenthal (the
original Swiss cheese)
and Gruyère.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 7 1 8 7
chocolate, almond, and poppy seed are favor-
ite flavors. Austria is reputed to be the home
of apple strudel, made from paper-thin sheets
of dough rolled around cinnamon-spiced
apple pieces.31 It is also known for Sacher-
torte, a chocolate sponge cake with apricot or
cream filling. Germany is famous for Schwar-
zwälder Kirschtorte (Black Forest cake), a
rich chocolate cake layered with cherries,
whipped cream, and Kirsch (cherry liqueur).
“Branch” cake, galęziak, which looks simi-
lar to a gnarled log, is a popular pastry from
Lithuania that is also found in Poland, where
is it is known as sękacz or “pyramid” cake.
Dobosch torte, a multilayered sponge cake
with chocolate filling and caramel topping, is
a favorite in Hungary. Though fresh fruits are
eaten infrequently, cooked fruits, such as the
berry pudding called kisel in Russia, are com-
mon desserts throughout the region.
In central Europe, the most common
hot beverage is coffee. In Russia, strong tea
diluted with hot water from a samovar is
consumed instead. A samovar is a brass urn,
which may be very ornate, heated by charcoal
inserted in a vertical tube running through
the urn’s center. Although southwestern
Germany, Austria, and Hungary produce
excellent white wine, the most popular alco-
holic drink in the region is beer. The Czechs
are known for pilsner beer, which is bitter
tasting but light in color and body. German
beers can be sweet, bitter, weak, or strong and
are typically bottom-fermented (meaning the
yeast sinks during brewing). Lager, a bottom-
fermented beer that is aged for about six
weeks, is the most common type. Bock beer is
the strongest flavored, has a higher than aver-
age alcohol content, and is sometimes called
“liquid bread.” Märzenbier, a beer midway
between a pilsner and a bock beer, is served
at Oktoberfest (see section titled “Special
Occasions”) in Munich. Weissbier is a light,
top-fermented beer brewed from wheat, and
often mixed with a lemon or raspberry fruit
syrup for a refreshing summer beverage. In
Russia and other FSU nations, a sour beer fer-
mented from rye bread or beets, called kvass,
is popular. It is slightly sweet and fizzy and
sometimes flavored with black currant leaves,
caraway, mint, or lemon. Mead, a beerlike
product fermented from honey, is a Polish
specialty. Schnapps, a fruit brandy made from
fermented fruit, such as cherries, is popular in
Germany. Vodka, which is commonly drunk
in Poland and Russia, is a distilled spirit made
from potatoes. It is served ice cold and often
flavored with seasonings, such as lemon or
black pepper. In Poland, the vodka goldwas-
ser contains flakes of pure gold.
Meal Composition and Cycle
Daily Patterns
Central Europe In the past, people of this
region ate five or six large meals a day, if
they could afford it. The poor, and usually
the people who worked the land, had fewer
meals, which were often meatless. Today,
modern work schedules have changed the
meal pattern, resulting in three meals with
snacks each day.
In Germany and the countries of central
Europe, the first meal of the day is breakfast,
which consists of bread served with butter and
jam. Sometimes breakfast is accompanied by
soft-boiled eggs, cheese, and ham. In Poland,
tea served in glasses is the traditional bever-
age. Traditionally, tea was sucked through a
sugar cube held between the teeth. At mid-
morning many people have their second
breakfast, which may include coffee, tea, or
hot chocolate, and pastries, bread, and fruit,
or a small sandwich. Lunch is the main meal
of the day. In the past, people ate lunch at
home, but today they are more likely to go to a
cafeteria or restaurant. A proper lunch begins
with soup, followed by a fish course, and then
one or two meat dishes served with vegetables,
and perhaps stewed fruit. Dessert is the final
course, usually served with whipped cream.
A quicker and lighter lunch may consist of
only a stew or a one-pot meal.
A break is taken at midafternoon, if time
permits. It typically includes coffee or tea and
cake or cookies. The evening meal tends to be
light, usually including salads and an assort-
ment of pickled or smoked fish, cheese, ham,
and sausages eaten with a selection of breads.
In Germany this meal is called Abendbrot,
meaning “evening bread.” However, Western-
ization and shorter lunch hours mean that
nearly a third of Germans now eat smaller
Green vegetables as
a group are called
wloszczyzna in Polish,
meaning “Italian com-
modities,” since so many
were originally imported
from the southern
nation.65
Sachertorte was the
subject of a famous
Viennese court battle
regarding who had the
rights to claim the origi-
nal recipe—it was known
as the “Sweet Seven Years
War” due to the length of
the case.66
Sharing food is essential
to Gypsy culture. The
harshest punishment
that can be imposed
on an individual is
to be banned from
communal meals.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
1 8 8 C E N T R A L E U R O P E A N S , P E O P L E O F T H E F O R M E R S O V I E T U N I O N , A N D S C A N D I N A V I A N S
late afternoon. Meals are typically social
occasions, featuring the dishes common
in their adopted homeland; stews, fried
foods, and unleavened breads are especially
popular.
Russia and the FSU In czarist times, the aris-
tocracy ate four complete meals per day;
dinner was the largest. The majority of the
population never ate as lavishly or as often.
The meal that peasants ate after a long day’s
work is still the basis of a typical diet in pres-
ent-day Russia, as well as in some parts of the
FSU, including Ukraine. Three hearty meals
a day are common, with the largest meal con-
sumed at lunch. Snacking is rare. The staples
are bread; soup made from beets (borscht,
which is of Ukrainian origin), cabbage
(shchi), or fish (ukha); and kasha (cooked
porridge made from barley, buckwheat, or
millet).31 In Lithuania, soup is often replaced
by salads. Tea, kvass, vodka, or beer usually
accompanies meals.
Legend is that following the flood, Noah’s Ark first found land in Armenia
and that the nation was founded by his
descendants. One of the first countries
to adopt Christianity, Armenia has been
ruled by a succession of conquerors, from
Rome to Russia, and today is surrounded
by Muslim nations. Its fare reflects this
unique past. Bread is so important there
that the Armenian word for it is also used
colloquially for meal or food in general.69
Lamb is a staple, though chicken and beef
are also popular. Pork is rarely consumed,
dating back to pre-Christian biblical pro-
hibitions. Freshwater fish such as trout
and sturgeon (including its roe, caviar) are
well liked. Yogurt, known as mahdzoon,
is consumed daily in soups, salad dress-
ings, and beverages, as are cheeses such
as feta and mozzarella-like string cheese,
which are often flavored with spices or
herbs. Numerous fruits and vegetables are
cultivated, used fresh, dried, and pickled.
Apricots, grapes, lemons, persimmons,
pomegranates, quince, bell peppers,
cabbage, cucumbers, eggplants, okra,
squash, and tomatoes are examples. Olives
and olive oil are common; however, lamb
fat is often preferred for cooking. Dishes
are seasoned with onions, garlic, lemon
juice, sesame seeds, allspice, basil, cumin,
fenugreek, rosemary, and mint. Honey
flavors most desserts.70
Armenian cuisine has been significantly
influenced by neighboring Greeks, Turks,
Persians, Syrians, and other Arabs. Shared
dishes include the chickpea puree called
hummus, tabouli bulgur salad, grilled
kebabs, kufta (meatballs), meat turnovers
known as boereg, meat- or grain-stuffed
vegetables called dolma, and paklava
(baklava). Many dishes have a distinctly
Armenian twist. Pilaf, also called plov, is pre-
ferred with bulgur and vermicelli instead of
rice in many areas. Lahjuman, an Armenian
pizza made with lamb, vegetables, and feta
cheese, is a favorite, as is keshkeg, a lamb
or chicken stew that includes whole hulled
wheat kernels called zezads.
Dinner begins with a selection of mezze
(appetizers) served with the anise-flavored
aperitif raki. Soups follow, made with
yogurt, eggs, and lemon, or tomatoes, often
with added lentils, meatballs, or even fruit.
Salads are also served regularly, often with
the main course of kebabs, stew, or cas-
serole. Every meal includes bread, such as
pita, lavash, or choereg—Armenian yeast
rolls. Dessert is usually fruit, with pastries
on special occasions. Traditional beverages
include coffee, tea, and tahn—yogurt
thinned with water and flavored with mint.
Armenians are world-acclaimed vintners.
Wine and brandy made from grapes, rai-
sins, apricots, or other fruits are frequently
consumed.
E X P L O R I N G G L O B A L C U I S I N E
Armenia
▼ Many German foods have
been adopted in the United
States, including lager-style
beer, pork or veal sausages,
and pretzels.
Ei
si
ng
/P
ho
to
di
sc
/G
et
ty
Im
ag
es
lunches with a larger meal than Abendbrot in
the evening.29
Gypsies customarily eat two meals each
day, first thing in the morning and in the
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C H A P T E R 7 1 8 9
dumplings with a knife is an insult to the
cook or host because it suggests that these
items are tough. When not eating, keep your
hands above the table with the wrists resting
on the edge. Pass all dishes to the left. Wine
and vodka may be poured in tumblers instead
of glasses specific for each beverage, and will
usually be refilled as soon as they are emptied.
Vodka is traditionally consumed in one shot.
Special Occasions The majority of central
European holidays have a religious signifi-
cance, although some traditions date back
to pre-Christian times. The two major holi-
days in the region are Christmas and Easter.
Many of the familiar symbols and activities
associated with these holidays, such as the
Christmas tree and the Easter egg hunt, were
brought to the United States by central Euro-
pean immigrants.
Germany Germany is a land of popular festi-
vals. Nearly all are accompanied by food and
drink. Probably the best-known celebration is
Munich’s Oktoberfest, which lasts for sixteen
One part of the traditional czarist eve-
ning meal, z ak usk i (meaning “small bites”),
is still part of dinner in Russia today. This
traditional array of appetizers starts the meal,
and may range from two simple dishes, such
as pickled herring and cucumbers in sour
cream, to an entire table spread with count-
less hors d’oeuvres. An assortment of zakuski
usually includes a variety of small, open-
faced sandwiches topped with cold, smoked
fish; anchovies or sardines; cold tongue and
pickles; and ham, sausages, or salami. Caviar,
the most elegant of zakuski, is served with
an accompanying plate of chopped, hard-
boiled eggs and finely minced onions. Other
zakuski include marinated or pickled veg-
etables, hot meat dishes, and eggs served a
variety of ways.
Etiquette Central Europeans tend to be more
formal than most Americans. In Germany
guests are generally not invited for dinner but
may be asked for dessert and wine later in the
evening. If you are invited for a meal at a home
or restaurant, the invitation may indicate “c.t.”
(cum tempore), meaning you can arrive up to
fifteen minutes late, or “s.t.” (sine tempore)
meaning to be exactly on time. Do not begin
the meal before the host says “Guten Appetit.”
In Poland people do not begin a meal until
everyone is served and the host says “smac-
znego.” In the Czech Republic and Slovakia
the host says “dobrochot”; in Hungary it is “jo
atvadyat.” In Russia, wait for the host to say
“pree yat na vah appeteetah.” The word for
“hospitality” in Russia is k h l ebosol ’ stv o, mean-
ing “bread” and “salt.” Bread is traditionally
served with butter and a small bowl of salt for
dipping to welcome diners.32
Appropriate hostess gifts are good qual-
ity dessert wines, candies, or pastries. Do not
bring vodka in regions where it is commonly
served, because it suggests your host does not
have enough on hand. In the Czech Republic,
Slovakia, and Hungary, Jack Daniels whiskey
is particularly appreciated.32
The continental European style of eating
with the fork in the left hand and the knife in
the right is common throughout the region.
Do not switch utensils when eating. In Ger-
many, knives are only used when absolutely
necessary. Cutting potatoes, pancakes, or
S A M P L E M E N U
German Abendbrot
A Selection of Sausages, Sliced Ham, and Cheeses
(We s tph alian Ham, T e e wur s t , etc.)* T e e wur s t , etc.)* T e e wur s t
Herring (Salad) in Cream Saucea,a,c,*
Pumpernickel Bread, Small Rolls
Potato Salad,a,b,c Beet Salad,a,b,c Pickles
M oh n k uch e n (Poppyseed Cake)a,b
Beer or White Wine
aHeberle, M.O. 1996. German cooking: The complete guide to preparing classic and
modern German cuisine, adapted for the American kitchen. New York:
HP Books.
bGerman Recipes at http://www.myrecipes.com/german-recipes/
cGerman Recipes at http://www.food.com/recipes/german
*Can be purchased at German-style delicatessens.
Fast foods, including
U.S. hamburger fran-
chises, are very popular
throughout the region.
In Germany, street stands
offering bratwurst and
currywurst (sausage with
curry seasoning) and
French fries are common.
Döner kebabs, Turkish-
style lamb in pita bread,
are another favorite in
Germany and in Russia.
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1 9 0 C E N T R A L E U R O P E A N S , P E O P L E O F T H E F O R M E R S O V I E T U N I O N , A N D S C A N D I N A V I A N S
traditional Christmas sweets. Other desserts
prepared during the season are spice cakes
and cookies (Pfeffernüsse and Lebkuchen),
fruit cakes (Stollen), cakes in the shape of a
Christmas tree (Baumkuchen), and ginger-
bread houses.
On Easter Sunday, the Easter bunny hides
colored eggs in the house and garden for the
children to find. Ham and pureed peas are
typically served for Easter dinner. Candy
Easter eggs and rabbits are also part of the
festivities.
Poland Christmas and Easter are the two
most important holidays in Poland, a pre-
dominantly Catholic country. On Easter, the
festive table may feature a roast suckling pig,
hams, coils of sausages, and roast veal. Always
included are painted hard-boiled eggs, grated
horseradish, and a Paschal lamb sculptured
from butter or white sugar. Before the feast-
ing begins, one of the eggs is shelled, divided,
and reverently eaten. The crowning glory of
the meal is the babka, a rich yeast cake. All
the foods are blessed by the priest before being
served. On Christmas Eve, traditionally a fast
day, a meal of soup, fish, noodle dishes, and
pastries is served when the first star of the
evening is seen.27 One popular soup, barszcz
Wigilijny, a cousin to Russian borscht, is made
with mushrooms as well as beets. Carp is usu-
ally the fish served on Christmas Eve. A rich
Christmas cake, makowiec, is shaped like a
jelly roll and filled with black poppy seeds,
honey, raisins, and almonds. Jelly doughnuts,
or paczki, are eaten on New Year’s Eve, while
on New Year’s Day bigos, a hearty stew con-
taining meats, cabbage, and other vegetables
plus dried fruit, is washed down with plenty
of vodka.
Austria, Hungary, the Czech Republic, and
Slovakia At Christmastime, the Czechs eat
carp four different ways: breaded and fried,
baked with dried prunes, cold in aspic, and
in a fish soup. The Christmas Eve meal
might also include pearl barley soup with
mushrooms, as well as fruits and decorated
cookies. Christmas dinner features giblet
soup with noodles, roast goose with dump-
lings and sauerkraut, braided sweet bread
(vanocka or houska), fruits and nuts, and
days from late September through early Octo-
ber. Founded in 1810 to commemorate the
marriage of Prince Ludwig of Bavaria, it is
now an annual festival with polka bands and
prodigious sausage-eating and beer-drinking.
Advent and Christmas are the holi-
est seasons in German-speaking countries.
The Christmas tree, a remnant of pagan
winter solstice rites, is lit on Christmas Eve
when the presents, brought not by Santa
Claus but by the Christ Child, are opened.
The Christmas tree is not taken down until
Epiphany, January 6. A large festive dinner is
served on Christmas Day, and it is custom-
ary for families to visit one another. Foods
served during the Christmas season include
carp on Christmas Eve and roast hare or
goose accompanied by apples and nuts on
Christmas Day. Brightly colored marzipan
candies in the shape of fruits and animals are
Marzipan, a paste of
ground almonds and
sugar, is commonly used
in desserts and candies
throughout central
Europe.
In the Polish Easter meal,
the dairy products,
meats, and pastries
symbolize the fertility
and renewal of spring-
time, while the horserad-
ish is a reminder of the
bitterness and disap-
pointments in life.
▼ Russian appetizers, called
zakuski, often feature blini
topped with sour cream,
smoked salmon or caviar,
and chives.
Lo
tt
ie
D
av
ie
s/
D
ig
ita
l V
is
io
n/
G
et
ty
Im
ag
es
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 7 1 9 1
In addition to Christmas and Easter, the
Austrians celebrate Fasching (a holiday also
known in southern Germany). Originating
as a pagan ceremony to drive out the evil
spirits of winter in which a procession would
parade down the main street of a town ring-
ing cowbells, it developed into a multiday
carnival associated with Lent. In Vienna,
over 300 sumptuous balls are held during
the event, including those hosted by the cof-the event, including those hosted by the cof-the event, including those hosted by the cof
fee brewers and the confectioners of the city.
Doughnuts, fritters, and other sweets are
typical festival food.
Russia and the FSU Before the 1917 revolu-
tion, Russians celebrated a full calendar of
religious holidays, including 250 fast days.26
Fish was significant on days when it was
allowed, but at other fast meals, mushrooms
were so common as entrees that they became
known as forest meat.30 Today, the observant
still does not eat any animal products during
fasts (see Chapter 4 for the fast days in the
Eastern Orthodox Church).
The most significant holiday is Easter,
which replaced a pre-Christian festival that
marked the end of the bleak winter season.
The Butter Festival (maslenitas) precedes the
forty days of Lent. One food eaten during this
period is blini, raised buckwheat pancakes.
Blini can be served with various toppings such
coffee. Kolaches, round yeast buns filled with
poppy seeds, dried fruit, or cottage cheese,
are served at the Christmas meal and on most
festive occasions. For Easter, a baked ham or
roasted kid is served with mazanec (vanocka
dough with raisins and almonds shaped into
a round loaf ).
The Slovaks break the Advent fast on
Christmas Eve by eating oplatky, or small,
wafer-like Communion breads spread with
honey. The meal may contain wild mush-
room soup, cabbage and potato dumplings,
stuffed cabbage (holubjy), and mashed potato
dumplings covered with butter and cheese
(halusky). A favorite dessert is babalky, pieces
of bread that are sliced, scalded, and drained
and then rolled in ground poppy seeds, sugar,
or honey. Mulled wine usually accompanies
this meal, as do assorted poppy seed and nut
pastries and a variety of fruits. For Easter, the
Slovaks prepare paska, a dessert in the form
of a pyramid containing cheese, cream, but-
ter, eggs, sugar, and candied fruits, decorated
with a cross. The meal, blessed by the priest
on Holy Saturday, includes ham, sausage
(klobása), roast duck or goose, horseradish,
an Easter cheese called syrek, and an imitation
cheese ball made from eggs (hrudka).
In Hungary, the most important religious
holiday is Easter. Starting before Lent, pan-
cakes are traditionally eaten on Shrove Tues-
day; sour eggs and herring salad are served
on Ash Wednesday. During Easter week,
new spring vegetables are enjoyed, as well as
painted Easter eggs. The Good Friday meal
may include a wine-flavored soup, stuffed
eggs, and baked fish. The biggest and most
important meal of the year is the feast of
Easter Eve, which consists of a rich chicken
soup served with dumplings or noodles, fol-
lowed by roasted meat (ham, pork, or lamb),
then several pickled vegetables, stuffed cab-
bage rolls, and finally a selection of cakes and
pastries served with coffee. The Christmas
Eve meal, which is meatless, usually features
fish and potatoes. The Christmas Day meal
often includes roast turkey, chicken, or goose
accompanied by roast potatoes and stuffed
cabbage, followed by desserts of brandied
fruits or fruit compote and poppy seed and
nut cakes.
One customary Christ-
mas Eve dish in Poland
is karp po zydowsku,
chilled slices of carp in
a sweet-and-sour aspic
with raisins and almonds.
It is of Jewish origin, dat-
ing to when Poland was
a haven for Jews in the
fourteenth century.
Vanocka, a Christmas
bread popular in the Czech
Republic.
▼
Vi
kt
or
1/
Sh
ut
te
rs
to
ck
.c
om
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
1 9 2 C E N T R A L E U R O P E A N S , P E O P L E O F T H E F O R M E R S O V I E T U N I O N , A N D S C A N D I N A V I A N S
mistrusted as not being fresh. Many Gypsies
believe that non-Gypsies carry disease, and
they may insist on using disposable plates
and utensils anytime they must eat in a public
place. Insufficient intake of lucky foods, such
as salt, pepper, vinegar, and garlic, can predis-
pose a person to poor health. Home remedies,
such as tea with crushed strawberries, asafet-
ida (called “devil’s dung”), and ghost vomit
(Fuligo septica), are common.19,35
Russians and people of the FSU ascribe
health benefits to many different foods. Butter
is considered good for eyesight, dill for dys-
pepsia, and honey for flatulence.23 Respira-
tory infections may be treated with gogomul,
a mixture of egg yolk, sugar, milk, and baking
soda.20 Teas made from raspberry, chamomile,
eucalyptus, and cornsilk are used for numer-
ous complaints. Some alcoholic beverages
are of particular therapeutic repute. Kvass,
the slightly fermented beverage made from
bread, is believed to be good for digestion and
to cure hangovers. Balsam, flavored vodka, is
traditionally used to cure everything from the
common cold to alcoholism. More recently,
vodka distilled with medicinal herbs, such as
ginseng or schizandra berries, has become a
favorite supplement consumed as a shot or
added to tea or coffee. Full, hearty meals are
considered important in maintaining health.36
Contemporary Food Habits
in the United States
Adaptations of Food Habits
Ingredients and Common Foods The central
European and Russian diet is not significantly
different from U.S. fare. Immigrants made few
changes in the types of foods they ate after they
came to the United States. What did change did change did
was the quantity of certain foods. Most cen-
tral European immigrants were not wealthy in
their native lands, and their diets had included
meager amounts of meat. After immigrating
to the United States, they increased the quan-
tity of meat they ate considerably.
The people of eastern Pennsylvania, where
there is a large concentration of German
Americans, still eat many traditional German
dishes adapted to accommodate available
ingredients. Common foods include scrapple
as butter, jam, sour cream, smoked salmon,
or caviar. Butter is the traditional topping
because it cannot be eaten during Lent. Tra-
ditional foods served on Easter after midnight
Mass are pascha, similar to the Slovak paska
but decorated with the letters X B (“Christ is
risen”); kulich, a cake made from a very rich,
sweet yeast dough baked in a tall, cylindrical
mold; and red or hand-decorated hard-boiled
eggs. On Pentecost (Trinity) Sunday (fifty
days after Easter), kulich left over from Easter
is eaten.
Twelve different dishes, representing the
twelve apostles, are traditionally served dur-
ing the Russian and Ukrainian Christmas Eve
meal. One of the dishes is kutia, or sochivo,
a porridge of wheat grains combined with
honey, poppy seeds, and stewed dried fruit
consumed when the first stars of Christ-
mas Eve appear. A festive meal is served on
Christmas Day. On New Year’s Day children
receive gifts, and spicy ginger cakes are eaten.
A pretzel-shaped sweet bread, krendel, is
eaten on wedding anniversaries and name
days (saint’s days are celebrated as birthdays
in the Eastern Orthodox faith).
Therapeutic Uses of Foods A study of German
American elders found that they sometimes
use home remedies to treat minor illnesses.
Chicken soup is used for diarrhea, vomiting,
or sore throat. Tea is taken for an upset stom-
ach, and milk with honey is commonly used
for a cough.14 Traditionally, the Pennsylvania
Dutch believe cold drinks are unhealthy and
that eating meat three times a day is the cor-
nerstone of a good diet. Herbal teas are con-
sumed for a variety of complaints.18,33,36
Polish American elders reportedly believe
that sauerkraut is good for colic, as are tea and
soda water. Chamomile tea is used for cramps,
tea with dried raspberries and wine for colds,
cooked garlic for high blood pressure, and
warm beverages (milk, tea, or lemonade) for
coughs. Tea with honey and alcoholic spirits
may be used to help sweat out an illness.14,34
Gypsies have unique health beliefs, many
involving food. For example, Gypsies tra-
ditionally think that fresh food is the most
nourishing and that leftovers are unwhole-
some. Canned and frozen items may be
The term pascha comes
from the Hebrew word
for Passover, “Pesach.”
Most Christmas food
traditions in Russia did
not survive the Soviet-
ruled period when reli-
gious ceremonies were
discouraged.30
Ukrainians set a place at
the table for the spirits
of dead ancestors at
Christmas.
Malzbier is a German
beer (1 percent alcohol)
that is considered appro-
priate for young children
and nursing mothers.
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C H A P T E R 7 1 9 3
sausages may be eaten. Some traditional foods
and ingredients may not be available in areas
without large central European or Russian
populations.
Little dietary acculturation was found in a
study of recent immigrants from Russia and
other FSU countries.36 An increased quantity
of familiar foods, particularly soured milk,
sour cream, kefir, homemade cheeses, cold
cuts, and eggs, and a greater variety of fruits
(including citrus, bananas, mangoes, pine-
apples, kiwis, and fruit juices) and vegetables
(especially broccoli, cauliflower, spinach, red
cabbage, and mixed salads) are consumed in
the United States, but are incorporated into
traditional dishes and meal patterns. Break-
fast cereals are well accepted, and traditional
grains such as barley, buckwheat, and millet
are consumed less often. Favorite American
items include soft drinks, ice cream, yogurt,
commercial salad dressings, nondairy cream,
and whipping cream. Coffee is consumed
more often and soups less often, especially
at dinner. Snacking on fruit, milk, bread,
pastries, sandwiches, and candy is becoming
more common.
(also called ponhaus), a pork and cornmeal
sausage flavored with herbs and cooked in
a loaf pan, served for breakfast with syrup;
sticky buns, little sweet rolls thought to be
descended from German cinnamon rolls
known as Schnecken; schnitz un knepp
(apples and dumplings), a one-pot dish made
from boiled ham, dried apple slices, and
brown sugar, topped with a dumpling dough;
boova shenkel, beef stew with potato dump-
lings; hinkel welschkarn suup, a rich chicken
soup brimming with tender kernels of corn;
apple butter, a rich fruit spread, very much like
a jam; schmierkaes, a German cottage cheese;
funnel cake, a type of doughnut; shoofly pie,
a molasses pie thought to be descended from
a German crumb cake called Streuselkuchen;
fastnachts, doughnuts originally prepared and
eaten on Shrove Tuesday to use up the fat that
could not be eaten during Lent; and sweets
and sours, sweet-and-sour relishes, such as
coleslaw, crabapple jelly, pepper relish, apple
butter, and bread-and-butter pickles, served
with lunch and dinner. Saffron crocuses were
cultivated in parts of Pennsylvania, and the
seasoning was used to color many dishes dark
yellow, from soups to a traditional wedding
cake known as Schwenkfelder.
Much of German cooking has been incor-
porated into U.S. cuisine. Many foods still have
German names, although they are so com-
mon in the United States that their source is
unrecognized (e.g., sauerkraut, pretzels, pick-
les). Other foods contributed by the Germans
are hamburgers, frankfurters, braunschweiger
(liver sausage), thuringer (summer sausage),
liverwurst, jelly doughnuts, and pumpernickel
bread. Beer production, especially in Milwau-
kee, was dominated by the Germans for more
than one hundred years. German immigrants
created a lager-style beer that is milder, lighter,
and less bitter than typical German beer; it
can now be described as American-style beer
(see also Chapter 15).
Meal Composition and Cycle Third- and
fourth-generation central European, Russian,
and FSU Americans tend to consume three
meals a day (with snacks), and meal com-
position is similar to that of a typical Ameri-
can meal, although more dairy products and
S A M P L E M E N U
A Russian Dinner
P ir oz h k i (Baked Turnovers)P ir oz h k i (Baked Turnovers)P ir oz h k i a,b
S h ch i (Cabbage Soup)S h ch i (Cabbage Soup)S h ch i a,b
K otle t y (Chicken Cutlets)K otle t y (Chicken Cutlets)K otle t y a,b
K as h a with Mushrooms (Buckwheat Groats)a,b
Fruit Compote
Vodka and Beer
aVisson, L. 2004. The Russian heritage cookbook. Woodstock, NY:
The Overlook Press.
bRussian Cuisine at http://www.ruscuisine.com/
Ghost vomit (Fuligo
septica) is a myxomycete
or slime mold. The thin,
yellow, creeping mass is
found on rotting wood
and other decaying
material, where it eats
bacteria.
Some Russian American
mothers fear that cold
milk may cause illness in
their child and leave milk
at room temperature for
hours to warm it.36
“Sauerkraut Yankees”
was a derogatory
nickname for the
Pennsylvania Dutch
during the Civil War.
On average, Americans
drink over 28 gallons
of beer per person
annually.67
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
1 9 4 C E N T R A L E U R O P E A N S , P E O P L E O F T H E F O R M E R S O V I E T U N I O N , A N D S C A N D I N A V I A N S
Many central European and Russian Amer-
ican families serve traditional foods at special
occasions. On October 11, Polish Ameri-
cans celebrate Pulaski Day, a national day of
remembrance that features a large parade in
traditional apparel down the streets of New
York City. The Austrians and Czechs typically
observe St. Nicholas Day (December 6), when
apples and nuts are put in the stockings of
well-behaved children, and coal is given to the
naughty ones. Hungarian Americans observe
three unique holidays in the United States
with a combination of patriotic and religious
activities. The first is March 15, commemo-
rating the revolution of 1848; the second is
August 20, St. Stephen’s Day; and the third is
the attempted revolt known as the Revolution
of 1956 on October 23.
Among the Amish, many national holidays,
such as the Fourth of July and Halloween, are
not observed. A second day of celebration is
added to Christmas, Easter, and Pentecost: the
first day is reserved for sacred ceremonies, the
second day for social and recreational activi-
ties. Most Amish celebrate all holidays quietly
with family.
Nutritional Status
Nutritional Intake Ver y little has been
reported on the nutritional intake of accul-
turated central European or Russian Ameri-
cans. Recent European-wide studies show
the diets of central Europeans are among the
highest in animal products, potatoes, sweets,
and refined or processed items in Europe.37
Consumption of fats and oils of animal ori-
gin was highest in Germany: the mean daily
intake for added fats and oils was 66 grams
for men living in Potsdam.38 Rates of over-
weight and obesity are 50 percent for German
women and nearly 66 percent for German
men. Slightly lower rates are found in the
Czech Republic, Slovakia, and Hungary.
Polish men scored higher than Germans, but
Polish women scored lower.39 Recent immi-
grants from Russia and other FSU nations
were found to consume a diet high in satu-
rated fats, sodium, and sugar.36 In 2010, the
World Health Association ranked Russia
ninth in the world for death from cardio-
vascular disease. Russian Americans may be
at risk of developing cardiovascular disease
and other conditions associated with high-
fat items (particularly red meats, processed
meats, and dairy products) popular both in
their traditional cultures and in U.S. fare.
Recent immigrants from Russian and FSU
nations may suffer some nutritional deficien-
cies due to inadequate consumption of fruits
and vegetables. Low intakes of riboflavin and
vitamin C are reported.37 In the Chuvash
Republic of Russia, significant dietary sele-
nium deficiency and moderate iron and
manganese deficiencies have been reported.40
High rates of diabetes, hypertension, hyperlip-
idemia, and cardiovascular disease are found
in Russian-speaking immigrants. Tuberculosis
and HIV incidence has been increasing dra-
matically in Russia in recent years and is thus
a concern for new immigrants. Nearly 80 per-
cent of immigrants from Russia are thought
to be from the regions most affected by the
Chernobyl nuclear power accident of 1979.
Increases in leukemia and thyroid cancer in
this population have been noted.41
A study of recent immigrant Russian
mothers found strong support for breast-
feeding. All but one of ninety participants
breast-fed their infants exclusively or par-
tially for an average of twenty-eight to thirty
weeks, regardless of whether the babies had
been born in Russia or the United States.42
This contrasts with health reports from Rus-
sia, where breast-feeding is discouraged, and
infant nutrition has been compromised by
inadequate supplies of formula. High rates
of iron-deficiency anemia (affecting 25 to
50 percent of children) and endemic goiter
have been reported.43 Older Russian women
use a variety of complementary and alterna-
tive medicine (CAM).44 Since the Chernobyl
nuclear power accident, some Russians may
resist having X-rays taken because they fear
radiation exposure.20
Heavy alcohol use has been reported in
Russia, certain FSU nations, and Poland.45,46,47
Some researchers are concerned that immi-
grants from these countries may continue
similar drinking patterns; however, data are
limited.17,34 Low rates of alcoholism have
been reported among Russian-speaking
immigrants.46
In the 1800s, fried
oysters with a glass of
Schnapps was a popular
Pennsylvania Dutch
breakfast for men.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 7 1 9 5
and respectful and expect to be treated in a
similar manner. Modesty is important to the
Amish, and wearing conservative clothing
when counseling clients is appropriate. Mod-
ern health technology is not in conflict with
traditional Amish religious precepts; however,
it may be avoided unless absolutely neces-
sary, such as during a medical emergency.17
Photos are not allowed, though X-rays and
other scans are accepted if their necessity is
explained. Educational materials should not
include pictures of the Amish, nor illustra-
tions representing human faces. A survey of
physicians with experience treating the Amish
noted more problems with digestive disorders,
obesity, and chronic bed-wetting than with
non-Amish clients.33 The doctors’ opinion
was that the Amish eat a diet higher in fat and
salt than the non-Amish, which may contrib-
ute to these problems; however, the Amish
showed fewer symptoms of heart disease and
alcoholism than non-Amish patients. Condi-
tions regarding maternal and child health are
common, and hereditary diseases, including
phenylketonuria and other metabolic disor-
ders, are more prevalent among the Amish
than the U.S. population as a whole.17
In working with Gypsy American clients,
health care providers should be aware that
English is usually a second language and that
illiteracy is common. However, Gypsies are
often very adaptive and may use many forms
of communication, depending on the situ-
ation. Gypsies believe that the measure of a
A small study of Gypsies in Boston found
high rates of hypertension, type 2 diabetes,
and vascular disease, affecting between 80
and 100 percent of the population over age
fifty. Approximately 85 percent were obese.
Chronic renal insufficiency was also a prob-
lem.48,49 In Europe, researchers have found
high rates of dyslipidemia, obesity, and insu-
lin resistance, suggesting a predisposition
for metabolic syndrome (for more infor-
mation on this topic, see Chapter 14).50,51
Genetic problems due to high rates of con-
sanguinity—being descended from the same
ancestor as another person—show Gypsies
worldwide at risk for several metabolic con-
ditions, including phenylketonuria, galacto-
kinase deficiency, citrullinaemia, Wilson’s
disease, and metachromatic leukodystrophy.
Rates of both infant mortality and unfavor-
able birth outcomes are high; overall life
expectancy is low.52
Counseling Communication difficulties may
occur with recent or older central European or
Russian immigrants. Language barriers may
necessitate the use of a competent translator.
Good manners and formality are expected in
German conversations. Education is respected,
and the use of titles is important.32 Honesty
and directness are appreciated. Germans are
monochronistic and prefer to deal with one
topic at a time. Direct eye contact is a sign of
attentiveness and trust. A handshake is used
in greeting, but there is little other touching
between acquaintances. Poles tend to speak
more quietly than Americans and feel uncom-
fortable with loud behavior. Discussions about
politics are avoided. Direct eye contact and a
handshake during a greeting and when leav-
ing are appropriate.
German Americans, as well as other cen-
tral European Americans, emphasize self-
reliance and may avoid health care. Polish
Americans may be reluctant to express pain
and often deny symptoms of illness.34 Compli-
ance problems develop if medication is seen
as a last resort, taken only until symptoms
disappear.
Many Amish still speak a German dia-
lect, so an interpreter may be necessary to
provide care. The Amish are often reserved
▲ Pennsylvania Dutch
funnel cake is an unusual
“doughnut” made by pouring
the batter through a funnel
or from a pitcher into the hot
oil in a swirled pattern.
Br
en
t H
of
ac
ke
r/
Sh
ut
te
rs
to
ck
.c
om
High rates of gastric
cancer in Lithuania are
believed to be due in
part to a high consump-
tion of salted and cured
meats and fish.68
Eggs are sometimes
used raw in uncooked
dishes by Russian and
FSU Americans, putting
them at risk for Salmo-
nella poisoning.
Gypsies may reject
injections for fear that
something impure
from the outside
will contaminate the
pure inner body.
Health care providers
working with Russians
report that some immi-
grants believe potatoes
cause type 2 diabetes.
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1 9 6 C E N T R A L E U R O P E A N S , P E O P L E O F T H E F O R M E R S O V I E T U N I O N , A N D S C A N D I N A V I A N S
man’s worth is in his girth—weight gain is
associated with health, weight loss with ill-
ness.2 Gypsies will often not seek treatment
until an emergency develops. Numerous fam-
ily members will come with a client to pro-
vide support, often bringing food, because
most Gypsies consider food prepared by non-
Gypsies impure.19
Russians expect formality between
acquaintances, and first names are saved for
close friends and relatives. Some Russians may
initially respond to any question that requires
an affirmative or negative answer with a no; in
most cases, however, communication is direct,
and may be loud or expressive.17 Direct eye
contact is the norm. A quick three kisses on
the cheeks or a handshake is used in greeting,
and touching becomes more prominent with
familiarity. Russians may consider it impolite
to sit with the legs splayed or with an ankle
resting on the knee. Preventive screenings
or prophylactic therapies are uncommon in
the FSU, and clients may not understand the
need for the procedures.20 They may not be
compliant with medication or lifestyle modi-
fications. Counseling and mental health issues
were avoided by elderly Russian immigrants
in one study, perhaps due to the social and
economic stigma associated with psychologi-
cal disorders in Russia.24 These Russian clients
expected extensive help with personal prob-
lems and information on social services from
their primary provider. An increased percep-
tion of pain and somatic symptoms are com-
mon; many Russian Americans do not believe
U.S. physicians understand their ailments or
treatments.21 Culture-specific illnesses, such
as “avitaminosis” or “dysbacteriosis,” are
unfamiliar diagnoses in the United States.23
Medical care in Russia mainly provides drug
therapy regimes mixed with alternative ther-
apies, thus Russians may expect medications
in order to believe they are being helped, and
they may believe care is incomplete if it does
not include alternative treatments. Injec-
tions are preferred over oral medications.
One study found that patients frequently
self-medicate with drugs obtained from the
FSU and often cut the dosage of prescriptions
obtained in the United States because they are
considered “too strong.”20 Russian clients are
often very assertive in their requests because
aggressive behavior was necessary to receive
attention in the Russian health care system.
However, some Russian-speaking immigrants
may be reluctant to discuss any infectious dis-
eases for fear of being ostracized within their
community.
Many Americans of central European and
Russian decent are highly acculturated. An
in-depth interview can determine any com-
munication preferences or traditional health
practices.
Scandinavians
The Scandinavian countries include Sweden,
Norway, Denmark, Finland, and Iceland.
With the exception of Denmark and the
island of Iceland, they are located north of
the Baltic and North Seas and share common
borders with each other and Russia. Most of
the population in Scandinavia is concentrated
in the warmer southern regions; the harsher
northern areas extend above the Arctic Cir-
cle. Norway’s weather is more moderate than
that of Finland and Sweden because its long
western coastline is washed in the temperate
North Atlantic Drift. Denmark juts into the
North Sea to the north of Germany, and its
capital, Copenhagen, is directly opposite from
Sweden. Numerous Scandinavians have made
their homes in the United States. This section
reviews the traditional foods of Scandinavia
and the Swedish, Norwegian, and Danish
contributions to the U.S. diet.
Cultural Perspective
History of Scandinavians in
the United States
Legend is that the Norsemen (ancient Scan-
dinavians), renowned seafarers and explorers,
first discovered North America and colonized
as far west as Minnesota in the thirteenth and
fourteenth centuries. The documented pres-
ence of Scandinavians in the United States
dates back to the seventeenth century. Jonas
Bronck, a Dane, arrived in 1629 and bought a
large tract of land from the Native Americans
that later became known as the Bronx in
New York City.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 7 1 9 7
Immigration Patterns The majority of Scan-
dinavians arrived in the United States in
the 1800s, led by the Norwegians and the
Swedes. During the nineteenth century, no
other country except Ireland contributed as
large a proportion of its population to the
settlement of North America as Norway.
During the 1900s, an additional 363,000
Norwegians, more than 1,250,000 Swedes,
363,000 Danes, and 300,000 Finns entered
the United States.
The peak years of Scandinavian immigra-
tion to the United States were between 1820
and 1930. The population of all the Scandi-
navian countries had grown substantially,
resulting in economies that could not absorb
the unemployed and landless agrarian work-
ers. In Sweden, the problem was magnified
by a severe famine in the late 1860s. For the
Norwegians there was the additional lure of
freedom that the United States offered, and
the chance for emancipation for the peasant
class. Scandinavian immigrants typically set-
tled in homogeneous communities.
Norwegians and Swedes often moved to
the homestead states of the Midwest, espe-
cially Illinois, Minnesota, Michigan, Iowa, and
Wisconsin. One-fifth of all Swedish immi-
grants settled in Minnesota. Pockets of Finns
and Danes also settled in this region, but they
were fewer in number. Many Norwegians and
Swedes later moved to the Northwest, work-
ing in the lumber and fishing industries. The
shipping industry attracted some Norwegians
to New York City, where they still live in an
ethnic enclave in Brooklyn. Although Swedes
and Norwegians are often associated with the
rural communities of the Midwest, by 1890
one-third of all Swedes lived in cities, and
many Norwegians were seeking opportunity
in the urban areas. Chicago and Minneapolis
still have large Scandinavian populations.
C L A R A S C H M I D T
Iemigrated from the Moldova Republic (formerly Moldavia in the former Soviet
Union), first to Israel in 1988, and then to
the United States to be near my son. I was
an English professor in the Soviet Union and
Israel. My family was originally from Romania.
In the Soviet Union, we had enough
food but not in abundance. Food was very
important to us because of previous short-
ages, and as a result we were forced to finish
everything we were served. Food was never
thrown away. In the morning we might have
tea with a bread sandwich of butter and jam
and/or possibly an egg. Snacks were not typi-
cal, but it might be a sandwich or fruit. It was
something you brought with you if you went
out, since you couldn’t purchase them. Dinner
was at lunch time (1:00–3:00 p.m.) and was
the biggest meal of the day. We ate at home,
and the meal was served when my father
came home. The meal included soup (veg-
etable, chicken, or beet/cabbage), salad of
several types of vegetables, meat, or fish with
potatoes/rice, and fruit for dessert. We drank
soft drinks with the meal. Supper was from
6:00 to 8:00 p.m. and could include sausage,
vegetables, bread, and maybe leftovers, dairy
(yogurt, cottage cheese), or cottage cheese
pancakes with sour cream.
My diet changed the most after I immi-
grated to Israel. We ate less soup, less fat,
and more fresh fruit and vegetables year
round. We ate much less meat and of course
no pork. In Israel I learned to love avocados
and hummus (chickpea dip), and I still eat
them here. In the United States, we started
to eat the American way. Dinner, now the
main meal, was closer to 5:00 or 6:00 p.m. It
might include chicken soup with vegetables,
lamb, cooked fish (not fried), and vegetables.
One thing I love here is barbequed lamb ribs.
Breakfast has changed to cereal/oatmeal,
yogurt, and fruit. Lunch is now a sandwich or
salad. I have switched from tea to coffee, and
it is something I can’t do without. Other things
I couldn’t change in my diet would be limiting
fruit, vegetables, and dairy products. For spe-
cial occasions I still prepare family recipes, like
Georgian chicken with walnuts, chicken necks
stuffed with chopped liver, and a three-layer
sour cream cake with honey and nuts.
My impression of American eating is that
some Americans count every calorie they eat,
but the food they eat is not tasty, and that
most Americans eat a lot of very tasty but
unhealthy food. Fast foods taste good, but
the amount of fat is awful—seems like it is
all meat and fried food. I prefer plain food,
but made at home.
N E W A M E R I C A N P E R S P E C T I V E S
Russian
Few Icelanders have
made their home in
the United States; the
2011 U.S. Census indi-
cates approximately
44,000 Americans claim
Icelandic descent.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
1 9 8 C E N T R A L E U R O P E A N S , P E O P L E O F T H E F O R M E R S O V I E T U N I O N , A N D S C A N D I N A V I A N S
The Danes, in an effort to preserve their
ethnicity, developed twenty-four rural com-
munities between 1886 and 1935, in which,
for a set number of years, land could be sold
only to Danes. The best known of these com-
munities are Tyler, Minnesota; Danevang,
Texas; Askov, Minnesota; Dagmar, Missouri;
and Solvang, California. Today, most Danes
live in cities, primarily on the East or West
Coasts. The largest concentrations of Danes
are in the Los Angeles area and in Chicago.
Following World War I, U.S. immigra-
tion from Finland dropped significantly as
Finns chose other countries for emigration.
As the Finnish population stagnated, eth-
nic identity became very difficult to main-
tain. Second- and third-generation Finns are
highly acculturated.
Current Demographics and Socioeconomic
Status According to the 2010 U.S. Census,
there are approximately 1.4 million Danes,
4.1 million Swedes, 4.5 million Norwegians,
and 650,000 Finns and their descendants
now living in the United States.1 Most Scan-
dinavians assimilated rapidly into U.S. soci-
ety, rising from blue-collar to white-collar jobs
within a few generations.
A majority of Scandinavian immigrants
were literate in their own language and often
produced local newspapers, periodicals,
and books. Education was valued as a way
to improve economic standing. The Danes
opened folk schools designed to foster a love
of learning in their communities, as well as
two liberal arts schools. Norwegians and
Swedes established many colleges. The Finns
founded summer schools where traditional
Finnish culture and religion were taught.
Women often had educational opportunities
in these schools that were unavailable to them
in Scandinavia.
Today, many Norwegians and Swedes
have continued farming in the Midwest or
have taken jobs in the construction industry.
However, nearly one-third of Norwegians
are employed in management or specialty
professions, while many Swedish Americans
have moved into engineering, architecture,
and education.53,54 Danes entered a variety of
occupations, but they were most prominent in
raising livestock and dairying. Urban Danes
today are not associated with specific occu-
pations.55 Finnish American men have been
active in fields such as natural resources man-
agement, mining engineering, and geology,
while women have been attracted to nursing
and home economics.56
Worldview
Religion The majority of Scandinavians
who immigrated to the United States were
Lutheran, though each nationality had its own
branch of the church, and within each branch
numerous sects were represented. Factional-
ism was common until many of the Scandi-
navian and German Lutheran churches joined
together to create the Evangelical Lutheran
Church in America (ELCA) in 1987. Those
Scandinavians who are not Lutheran often
belong to other Protestant churches, including
Methodist, Mormon, Seventh-Day Adventist,
Baptist, Quaker, and Unitarian.
Family The nuclear Scandinavian family
was at the center of rural life. Families were
typically large, and the father was head of the
household. Kinship ties were strong: families
were expected to pay the way for relatives
remaining in Scandinavia to come to the
United States, where they would be given a
room, board, and help in finding employ-
ment. The power of the father diminished
and family size decreased as the Scandinavian
Americans became more integrated in main-
stream society. Among the Finns, it has been
noted that when both parents work, they may
choose to have only one child.56
Traditional Health Beliefs and Practices Infor-
mation on traditional Scandinavian health
beliefs and practices is very limited. Fish was
considered necessary for good health. In Nor-
way, cough and cold confectionaries (such as
lozenges and pastilles) are very popular over-
the-counter remedies. A current Norwegian
study also found that 56 percent of cancer
patients use herbs and dietary supplements
primarily to boost immune function.57 The
Finns believe in natural health care, prac-
ticing massage, cupping, and bloodletting.
Further, the sauna (a traditional steambath)
is reputed to have therapeutic qualities. It is
The Scandinavians
introduced the cast-
iron stove to the United
States in the early 1800s.
Cooking was previously
done in fireplaces and
brick ovens.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 7 1 9 9
used by Finns when ill and even by midwives
during childbirth. It is considered a remedy
for colds, respiratory or circulatory problems,
and muscular aches and pains.56
One health practice in Sweden that has
been widely adopted in the United States is
Swedish massage, also known as therapeutic
massage. It is a deep muscle technique that
uses five main strokes to provide relaxation,
increase circulation, and promote healing.
Traditional Food Habits
Scandinavian fare is simple and hearty, featur-
ing the abundant foods of the sea and making
the best use of the limited foods produced on
land. Scandinavian cooking often reflects the
preservation methods of previous centuries.
Fish was traditionally dried, smoked, or pick-
led, and milk was often fermented or allowed
to sour before being consumed. Scandina-
vians still prepare a large variety of preserved
foods and prefer their food salty. The basics of
the Scandinavian diet are given in the cultural
food groups list (Table 7.2).
Ingredients and Common Foods: Staples
and Regional Variations
The traditional cooking of Scandinavia is
hearty. Spices were expensive in the past,
and most dishes feature the natural flavors of
ingredients with subtle seasoning. Black pep-
per, onions, and dill are used in many recipes,
and juniper berries add interest in others.
Caraway, cloves, nutmeg, and cardamom fla-
vor many baked goods.
Scandinavians are probably best known
for their use of fish and shellfish, such as cod,
herring, mackerel, pike, salmon, sardines,
shrimp, and trout. It is so common that in
restaurants the lunch special is often listed
simply as dagensratt (“fish of the day”).26
In Norway the fish-processing industry is
believed to date back to the ninth century, and
today, Scandinavian dried salt cod is exported
all over the world. Popular fish dishes include
salmon marinated in dill, called gravlax;
smoked salmon, known as lox; and the many
varieties of pickled herring. Fish sticks and
fish baked with cheese and breadcrumbs are
common homestyle dishes.
Cream and butter are used in many dishes,
especially in Denmark, which has a slightly
warmer climate than the other Scandinavian
nations. White sauce made with milk and
minced parsley tops many Danish dishes,
such as roast bacon, eel, and herring, as well
as boiled and cured meats.58 One Swedish spe-
cialty is known as Jansson’s frestelse (“temp-
tation”) and includes anchovies and grated
potatoes baked in a cream and onion sauce.
Considerable quantities of fermented dairy
products are used throughout the region, such
as sour cream, cheese, buttermilk, and yogurt-
like products, including filmjok (Sweden)
and skyr (Iceland). Sour cream in particular
is added to soups, sauces, and dressings for
salads and potatoes. In Norway, it is tradi-
tional to prepare an oatmeal porridge known
as rømmegrøt with sour cream, and the dish
is still found at many festive occasions. Fish,
such as fried trout or herring, is also cus-
tomarily served with a sour cream sauce and
boiled potatoes. Denmark is renowned for
its cheeses, such as semifirm, mellow, nutty-
tasting Tybo (usually encased in red wax);
firm and bland Danbo; semisoft, slightly
acidic Havarti; rich, soft Crèma Dania; and
Danish blue cheese. Jarlsberg, a Swiss-style
cheese, is a well-known Norwegian product,
but brunost, a sweet, brown cheese made from
cow’s milk mixed with goat’s milk and served
in thin slices on brown bread, is most popu-
lar in the nation.59 Cheese is eaten daily for
breakfast, on sandwiches, and as snacks.
Though fish is popular in many parts of
Scandinavia, the more inland areas feature
many meat dishes. In the southern regions
pork is particularly common. Roast loin
stuffed with prunes and apples is a favorite
in Denmark, which is also noteworthy for
its smoked ham and bacon. Though beef is
available, veal is more commonly consumed.
Mutton and lamb are used in roasts and stews,
such as the Norwegian fårikål (lamb with cab-
bage), and are also dried or salt-cured, then
thinly sliced and used like ham. In the more
northern areas reindeer is raised and is a
popular meat. Other game meats such as elk,
venison, and hare are hunted in the fall and
considered a delicacy. Poultry is not especially
well liked; however, pickled goose and stuffed
In Scandinavia they
say “Danes live to eat,
Norwegians eat to live,
and Swedes live to drink.”
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
2 0 0 C E N T R A L E U R O P E A N S , P E O P L E O F T H E F O R M E R S O V I E T U N I O N , A N D S C A N D I N A V I A N S
Group Comments Common Foods Adaptations in the United States
Protein Foods
Milk/milk products Dairy products, often fermented,
are used extensively.
Buttermilk, milk, cream (cow, goat, reindeer);
cheese, sour cream, yogurt
Meat/poultry/fish/
eggs/legumes
Fish is a major source of protein,
often preserved by drying,
pickling, fermenting, or
smoking.
Meat: beef, goat, lamb, hare, pork (bacon,
ham, sausage), reindeer, veal, venison
Fish and shellfish: anchovies, bass, carp,
cod, crab, crawfish, eel, flounder, grayling,
haddock, halibut, herring, lobster,
mackerel, mussels, oysters, perch, pike,
plaice, roche, salmon (fresh, smoked,
pickled), sardines, shrimp, sprat, trout,
turbot, whitefish
Poultry and small birds: chicken, duck, goose,
grouse, partridge, pheasant, quail, turkey
Eggs: chicken, goose, fish
Legumes: lima beans, split peas (green and
yellow)
More meat and less fish are
consumed.
Cereals/Grains Wheat is used less than other
grains.
Rye is used frequently in breads.
Barley, oats, rice, rye, wheat More wheat used, fewer
other grains.
Fruits/Vegetables Fruits with cheese are frequently
served for dessert.
Preserved fruits and pickled
vegetables are common.
Tapioca (from cassava) is eaten.
Fruits: apples, apricots, blueberries, cherries,
cloudberries, currants, lingonberries,
oranges, pears, plums, prunes, raisins,
raspberries, rhubarb, strawberries
Vegetables: asparagus, beets, cabbage (red
and green), carrots, cauliflower, celery,
celery root, cucumber, green beans,
green peppers, nettles, kohlrabi, leeks,
mushrooms (many varieties), onions,
parsnips, peas, potatoes, radishes, spinach,
tomatoes, yellow and white turnips
A greater variety of fruits
and vegetables are
obtainable in the United
States than in Scandinavia
but may not be eaten.
Additional Foods
Seasonings Savory herbs and spices
preferred. Cardamom is
especially associated with
Scandinavian sweets.
Allspice, bay leaf, capers, cardamom, chervil,
cinnamon, cloves, curry powder, dill,
garlic, ginger, horseradish, lemon juice,
lemon and orange peel, mace, marjoram,
mustard, mustard seed, nutmeg, paprika,
parsley, pepper (black, cayenne, white),
rose hips, saffron, salt, tarragon, thyme,
vanilla, vinegar
Nuts/seeds Marzipan (sweetened almond
paste) is used in many sweets.
Almonds, chestnuts, walnuts
Beverages Coffee, hot chocolate, milk, tea, ale, aquavit,
beer, vodka, wine, liqueurs
Fats/oils Butter is often used. Butter, lard, margarine, salt pork
Sweeteners Sugar (white and brown), honey, molasses
TA B L E 7. 2 Cultural Food Groups: Scandinavian
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C H A P T E R 7 2 0 1
fresh goose are eaten, as are certain game
birds, such as grouse.
Historically, meat was in limited supply,
so it was stretched by chopping it and com-
bining it with other ingredients, resulting in
many traditional dishes. Scandinavians eat
many vegetables, such as onions and cabbage,
stuffed with ground pork, veal, or beef. The
Swedes are known for their meatballs served
in cream gravy or brown sauce, and the Danes
for frikadeller, which are patties of ground
pork and veal, breadcrumbs, and onion fried
in butter. The Norwegians prepare kjøttkaker,
minced beef cakes seasoned with a bit of gin-
ger that are panfried, then boiled, and served
with brown gravy. Beef hash made with beets
and onions is another example. Sausages are
also very common.
Cold-weather vegetables, including pota-
toes, cabbage, kale, brussels sprouts, car-
rots, celery root, cucumber, beets, turnips,
onions, and leeks are widely available. Ruta-
bagas, sometimes called “Nordic oranges” or
“swedes,” are a customary side dish.63 Yellow
and green split pea soups with pieces of ham
or pork are a winter specialty throughout
Scandinavia, sometimes served with pan-
cakes. Wild mushrooms are a specialty in
some areas of Finland and Norway. Though
vegetables were traditionally served cooked,
fresh salads have become popular in recent
years. Apples, cherries, prunes, and several
varieties of berries (particularly lingonber-
ries) are typical fruits, often stewed or made
into preserves that are sometimes served
with meat.
Bread is a staple food item and is often pre-
pared from rye flour, although wheat, barley,
and oats are also used. Scandinavian breads
may or may not be leavened, vary in size and
shape, and may be white, brown, or almost
black in color. Some are crisp, such as Norwe-
gian flatbrød Swedish knäckebröd are similar
to hardtack or crackers. A thin, round bread
called lefse (also known as lompe in Norway)
is made with a potato and wheat flour dough,
then cooked on an ungreased griddle. It may
be used to wrap a sausage, or be eaten with
butter and sugar or jam and folded like a
handkerchief. In Sweden a recent innovation
is Tunnbrød, a very thin, wheat tortilla-like
bread that is sold as fast food, rolled around
fillings such as mashed potatoes, sausages, or
shrimp salad and condiments such as pickles,
mustard, and ketchup. Dumplings are a favor-
ite in Norway, often made from potatoes.
Desserts, whether they are served after
a meal or at a coffee break, are rich but not
overly sweet. Most are made with butter and
also contain cream or sweetened cheese and
the spice cardamom. Aebleskivers are spheri-
cal Danish pancake puffs, sometimes stuffed
with fruit preserves. During Advent, they are
filled with whole almonds. Another popu-
lar dessert is pancakes or crêpes served with
preserved berries or jam. The Scandinavians
use almonds, almond paste, or marzipan in
desserts as often as Americans use chocolate.
One regional dessert specialty is kransekake, a
stack of progressively smaller frosted almond
pastry rings. The Danes are best known for
their pastries or, as they call them, Wienerbrød
(“Vienna bread”). The pastries were brought
to Denmark by Viennese bakers a century ago
when the Danish bakers went on strike. When
the strike was over, the Danes improved the
buttery yeast dough by adding jam and other
fillings. A Finnish specialty is pulla, a braided
sweet bread popular at breakfast.
Milk is well liked as a beverage in Scandi-
navia. Other common drinks are coffee, tea,
beer, wine, and aquavit. A q uav it, which means
“water of life,” is liquor made from the distil-
lation of potatoes or grain. It may be flavored
with an herb such as caraway and is served ice
cold in a Y-shaped glass. It is downed like a
shot and often followed by a beer chaser.
Meal Composition and Cycle
Daily Patterns The Scandinavians eat three
meals a day, plus a coffee break midmorn-
ing, late in the afternoon, or after the evening
meal. Breakfast is usually a light meal consist-
ing of bread or oatmeal porridge, cold cereal,
eggs, small pastries, cheese, fruit, potatoes, or
herring. Sour cream or yogurt-like fermented
milk may be served to eat with cereal. Fruit
soups may be served in the winter. Milk and
coffee or tea accompany the meal.
Traditionally, lunch in Denmark is smør-
rebrød, which means “buttered bread,” an
open-faced sandwich eaten with a knife and
The cooking of Finland
mixes Swedish and
Russian elements, such
as smörgåsbords, pirozh-
kis (meat turnovers), and
blini (thin buckwheat
pancakes). Vodka is pre-
ferred over aquavit.
Whey, a by-product of
cheese making, was
traditionally mixed with
water to make a refresh-
ing beverage in Norway,
northern Sweden,
and Iceland.
When Scandinavians
toast, they say “skoal,”
which probably derives
from the word for skull.
Ancient Norsemen used
the empty craniums of
their enemies as drinking
vessels.
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2 0 2 C E N T R A L E U R O P E A N S , P E O P L E O F T H E F O R M E R S O V I E T U N I O N , A N D S C A N D I N A V I A N S
If lunch is light sandwiches, dinner is
complete, often including an appetizer, soup,
entrée, vegetables, and dessert. Potatoes are
usually served with the evening meal. If a hot
meal is eaten at lunch, a more informal supper
with convenience foods is preferred. Italian
items are especially popular. For example, the
three most common dishes served in Swed-
ish homes today are boiled Falun sausage
(a Swedish specialty made of beef, veal, and
pork), spaghetti with meat sauce, and pizza.61
Milk, beer, or wine accompanies the meal.
Coffee or wine may be served with dessert. If
a dessert wine is served, coffee will follow the
end of the meal.
Etiquette As with many other Europeans,
the fork remains in the left hand, and the
knife remains in the right one. Despite the
prevalence of sandwiches in Scandinavian
menus, only bread is eaten with the hands
at the table; sandwiches are consumed using
the fork and knife. Pass dishes to the left.
When not eating, keep your hands above
the table with the wrists resting on the edge.
In Finland, it is important to wait for the
host to initiate eating. In Norway, a male
guest of honor is expected to thank the
hosts on behalf of all guests. Wine is expen-
sive throughout Scandinavia, so it is always
appreciated as a hostess gift.32
Special Occasions Social occasions are usually
marked with food in Scandinavia. In Sweden,
conferences and meetings always offer milk
and coffee with sweets, such as cinnamon
buns, open-faced sandwiches, or fruit. Sand-
wich cakes, which are layers of bread with fill-
ings such as pâté, ham, and sliced sausages,
garnished with mayonnaise, shrimp, and
herbs, are served midafternoon whenever a
crowd gathers for an event.
December is the darkest month of the
year in Scandinavia, and Christmas celebra-
tions are a welcome diversion. The Christmas
season lasts from Advent (four weeks before
Christmas) until January 13, Saint Canute’s
Day. In Sweden, on the morning of Decem-
ber 13, St. Lucia’s Day, the eldest daughter in
the home, wearing a long white dress and a
crown of lingonberry greens studded with
fork. Buttered bread is topped with anything
from smoked salmon to sliced boiled potatoes
with bacon, small sausages, and tomato slices.
Smørrebrød may also be served as a late after-
noon or bed-time snack. Today, Danes are
as likely to pick up a quick sandwich made
with a bagel or Italian bread as they are to eat
smørrebrød.
A buffet meal in Sweden is the smörgås-
bord (bread and butter table), a large variety
of hot and cold dishes arrayed on a table and
traditionally served with aquavit. Ritual dic-
tates the order in which foods are eaten at a
smörgåsbord.60 The Swedes start with her-
ring, followed by other fish dishes, such as
smoked salmon and fried fins. Next are the
meats and salads (pâtés and cold cuts), and
the final course before dessert is comprised
of hot dishes, such as Swedish meatballs and
mushroom omelets. Today, the smörgåsbord
is rarely served except at special occasions.
More typically, Swedes consume a hot lunch
that might include pea soup, brisket or hash,
and mashed rutabaga at the school or work
cafeteria.61
▲ Danish smørrebrød:
Danish Fontina and Havarti
cheeses, ham, salami, and
smoked salmon are a few
of the toppings typical of
the open-faced sandwiches
known in Denmark as
smørrebrød.
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ck
.c
om
Veal Oscar, veal topped
with a béarnaise sauce,
white asparagus, and
lobster or crab, is named
after Swedish King
Oscar II (1872–1907), a
renowned gourmet.
Eating lutefisk has
become a symbol of
ethnic identity in some
Scandinavian American
communities.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 7 2 0 3
fish accompanied by boiled new potatoes and
wild strawberries are eaten; in Norway, røm-
megrøt is served; and in Finland, new pota-
toes with dill and smoked salmon are typical
festive fare.
Contemporary Food Habits
in the United States
Adaptations of Food Habits
Scandinavians assimilated quickly into
American society, yet their diet did not change
significantly because many of their food habits
are similar to the diet of the American major-
ity, including three meals per day containing
ample dairy products and animal protein.
Many Scandinavian foods have been adopted
by all Americans (see Chapter 15 for more
information).
Nutritional Status
Nutritional Intake Very little has been pub-
lished on the nutritional status of Americans
of Scandinavian descent. In Scandinavia,
lit candles, serves her parents saffron yeast
buns and coffee in bed. However, the climax
of the season is on Christmas Eve, when the
biggest, richest, and most lavish meal of the
year is eaten.
In Norway, traditional foods eaten on
Christmas Eve begin with rice porridge
sprinkled with sugar and cinnamon. Buried
in the dish is one blanched almond; the per-
son who receives it will have good fortune
in the coming year. Lutefisk, a dried salt cod
soaked in lye, then boiled, is customary in
the north. In the east, pork ribs and sausages
with cabbage are served; in the west, a dried
lamb rib specialty with mashed rutabaga is
favored, while in the south, cod or halibut
served with a white sauce and green peas is
preferred. Boiled potatoes are a common side
dish at all the meals. A selection of cookies
and cakes complete the meal. Women tra-
ditionally demonstrated their proficiency in
the kitchen by offering at least seven types of
sweets, a custom still followed in many homes
today.59
In Sweden, a Christmas smorgasbord with
twenty or thirty dishes featuring ham, her-
ring, and other traditional fare is served. In
Denmark, roast duck, goose, or pork is served
with brown gravy. Typical side dishes are red
cabbage and caramelized potatoes. Rice pud-
ding with whipped cream and hot cherry
sauce is also traditional. In Finland, the meal
starts with pickled herring and salmon, then
continues with ham, and vegetable casse-
roles of potatoes, carrots, or turnips. Prunes
are usually featured in one dessert, followed
by cookies and pies. In recent years, other
European Christmas specialties such as Stol-
len, panettone, and bûche de Noël have also
become popular.62
Dozens of cookies and cakes are prepared
for the Christmas season. The cookies are
often flavored with ginger and cloves; the
Christmas tree may be hung with gingerbread
figures. Deep-fried, brandy-flavored dough,
known as klejner, klener, or klenätter, is also
popular. The traditional holiday beverage is
glögg, a hot alcoholic punch.
Midsummer’s Day (June 24) is a popu-
lar secular Scandinavian holiday. It features
maypoles, bonfires, and feasting. In Sweden,
St. Urho’s Day (March
16) was invented by
Finnish Americans as
a spoof on St. Patrick’s
Day. It commemorates
the saints driving out
the grasshoppers from
Finland.
Midsummer’s Day is
still observed by many
Scandinavian Americans.
In some areas of the
United States, it has
become Svenskarnas
Dag (Swede’s Day),
celebrating Swedish
culture and solidarity.
▼ Crawfish are a specialty
in Scandinavia, where they
are boiled and seasoned
with dill, then served chilled
at summer festivals with
aquavit, vodka, or beer.
Su
sa
nn
a
Bl
av
ar
g/
G
et
ty
Im
ag
es
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
2 0 4 C E N T R A L E U R O P E A N S , P E O P L E O F T H E F O R M E R S O V I E T U N I O N , A N D S C A N D I N A V I A N S
D I S C U S S I O N S T A R T E R S
Which Cuisines Dominate in U.S. Restaurants?
Whenever Americans go out to eat at an ethnic-based restaurant, they typically end up at an Italian, Asian, or Mexican institution. French restaurants
also tend to carry a certain cache with Americans. German and other central European and Scandinavian restaurants are less common, however, and are
typically concentrated in areas of the country with a tradition of central European or Scandinavian immigration. Fast-food Italian, Asian, and Mexican
restaurants are also widespread in the United States, while there are few fast-food Scandinavian, German, or Russian restaurants.
Individually and then in small groups, brainstorm why ethnic cuisines are distributed in this way. What possible reasons could explain why central
European and Scandinavian restaurants are not more widespread, even though immigration from these countries has been as large historically as that
from Italy, China, and Mexico?
alcoholism, depression, and lactose intoler-
ance.56 Because both their traditional diet
and the well-accepted typical U.S. diet are
high in cholesterol and saturated fat, Scan-
dinavian Americans may be at increased
risk of developing cardiovascular disease
and other conditions associated with the
Westernized diet.
Counseling Scandinavians are often low-
context communicators and highly analyti-
cal. Emotions are controlled; superficiality
and personal inquiries are avoided. Swedes
and Finns are comfortable with silence dur-
ing a conversation. As a rule, Danes are a lit-
tle more informal than other Scandinavians
or northern Europeans and may use first
names. Danes and Swedes make and maintain
direct eye contact, whereas Norwegians and
Finns make direct eye contact intermittently.
A brief, firm handshake is used in greetings.
Other touching is infrequent, reserved for
friends and relatives.
Scandinavians are likely to avoid discus-
sion of illness until necessary. Some may
consider sickness indicative of either physi-
cal or moral weakness. An in-depth interview
should be used to establish any traditional
health beliefs of clients, as well as dietary
patterns.
S A M P L E M E N U
A Swedish Lunch
Yellow Split Pea Soupa,b
Swedish Meatballsa,b
New Potatoes with Dilla,b
P e ppar k ak or (Gingersnaps)P e ppar k ak or (Gingersnaps)P e ppar k ak or a,b
Milk or Beer
aHenderson, H. 2005. The Swedish table. Minneapolis: University of Minnesota
Press.
bScandinavian Cooking at http://scandinaviancooking.com
estimated prevalence of over weight and
obesity in Finland is nearly 40 percent for
women and almost 60 percent for men.
Figures are somewhat lower in Denmark,
Norway, and Sweden.39,63 Finns purport-
edly have high rates of heart disease, stroke,
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 7 2 0 5
Review Questions
1. Briefly describe the traditional health prac-
tices and beliefs of the Russians, Germans, and
Scandinavians.
2. What were the common staples of central
Europeans, Scandinavians, and people of the
former Soviet Union (FSU)? What were their
methods of preservation?
3. List two well-known prepared foods associated
with Germany, Poland, FSU, one Scandinavian
country, and one other central European coun-
try. Describe three sausages that can be found
in Germany or Poland. List four U.S. foods
that are thought to be descended from eastern
European countries.
4. What is zakuski in a Russian meal? What foods
may be included? What is a smorgasbord in
Scandinavian countries? What foods might be
included?
5. Describe a traditional Christmas or Easter
dessert for three countries in central Europe,
FSU, and one Scandinavian country.
6. Describe the religion, worldview, and food and
health beliefs attributed to Gypsies.
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Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
2 0 8
C
H
A
P
T
E
R
Africans
African Americans are one of the largest cultural groups in the United States, including nearly 45 million
people in 2013, more than 12 percent of the
total American population.1 The majority are
blacks who came originally from West Africa,
although some arrived from the Caribbean,
Central America, and, more recently, from
the famine- and strife-stricken East African
nations. A small number of Americans of
African heritage are white, primarily immi-
grants from the nation of South Africa.
Most African Americans are the only U.S.
citizens whose ancestors came by force, not
choice. Their long history in America has
been characterized by persecution and segre-
gation. At the same time, blacks have contrib-
uted greatly to the development of American
culture. The languages, music, arts, and cui-
sine of Africa have mingled with European
and Native American influences since the
beginnings of the nation to create a unique
American cultural mix.
African Americans live with this difficult
dichotomy. They are in many ways a part of
the majority culture because of their early
arrival, their large population, and their role
in the development of the country. Much of
their native African heritage has been assimi-
lated, and their cultural identity results more
from their residence in the United States
than from their countries of origin. Yet they
are often more alienated than other ethnic
groups from white American society. This
chapter discusses sub-Saharan African cui-
sines (North African fare is more similar
to that of the Middle East; see Chapter 13)
and their contributions to U.S. foods and
food habits. The historical influence of West
African, black slaves, and southern cuisines
on current African American cuisine is
examined.
Cultural Perspective
Africa is the second largest continent in the
world and has a population estimated in 2013
at more than 1 billion people. It straddles the
equator, and much of its climate is tropical, yet
rainfall varies tremendously (see Figure 8.1).
Rain forests, grassland savannas, high moun-
tain forests, and temperate zones are found in
the far south and along the Mediterranean.
In the north, the Sahara, the largest desert
in the world, stretches from the Atlantic to
the Red Sea, separating the Arabic northern
African nations (Morocco, Algeria, Tunisia,
Libya, and Egypt) from the sub-Saharan west-
ern, eastern, and southern regions. Numerous
ethnic groups have evolved in Africa, and it is
estimated that between 800 and 1,700 distinct
languages are spoken. Cultural identity is
strong. The long history of conflict and con-
quest on the continent has never completely
eliminated tribal affinity; most destabiliza-
tion in individual nations today arises over
ethnic issues.
8
The terms African
American, black, and
black American are
used interchangeably
in research literature.
African American is usu-
ally the preferred term
because it emphasizes
cultural heritage. How-
ever, black or black
American is used by
many African Americans
who feel these terms
more accurately reflect
their current identity.
Some recent immigrants
from Africa resent the
use of African American
by persons who have
lived in the United States
for generations.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 8 2 0 9
Figure 8.1
Sub-Saharan Africa.
Republic of CongoRepublic of CongoRepublic of CongoRepublic of CongoRepublic of CongoRepublic of Congo
Nouakchott
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Monrovia
Freetown
Bissau
Accra
Abuja
Bangui
N'Djamena
Addis Ababa
Khartoum
Lusaka
Lilongwe
Cape Town
Harare
Gaborone
Windhoek
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Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
2 1 0 A F R I C A N S
History of Africans in the
United States
The arrival of black indentured servants taken
forcefully from West Africa preceded the
arrival of the M ay f l ow er in America. In 1619, M ay f l ow er in America. In 1619, M ay f l ow er
Dutch traders sold twenty West Africans to
colonists in Jamestown, an early English set-
tlement. More than 425,000 slaves were sub-
sequently imported legally, ancestors of the
majority of black Americans residing in the
United States today.
Enslavement
The institution of slavery was well established
before the first blacks were brought to North
America. European slave traders negotiated
with African slave suppliers for their human
cargo; which West Africans became slaves
and which sold slaves depended on inter-
tribal conditions. The European traders kept
some records of tribal affiliation, but none of
place of origin. It is believed that more than
one-half of the slaves in the United States
came from the coastal areas of what are now
Angola and Nigeria. Others came from the
regions that are today Senegal, Gambia, Sierra
Leone, Liberia, Togo, Ghana, Benin, Gabon,
and the Democratic Republic of Congo
(formerly Zaire).
These political identities are relatively
recent, however, and the slaves identified with
their tribal groups, such as Ashanti, Bambara,
Fulani, Ibo, Malinke, or Yoruba, rather than
with a specific country or Africa as a whole.
The tribal villages of West Africa were pre-
dominantly horticultural. Individuals viewed
their existence in relation to the physical
and social needs of the group. The extended
family and religion were the foundations of
tribal culture. It was especially difficult for
individuals to be separated from their tribe
because identity was so closely associated
with the group. It is perhaps for this reason
that enslaved individuals held on tenaciously
to their African traditions. African language,
ornamentation (e.g., scarification and teeth
filing), and other customs were very threat-
ening to slave owners. New slaves, usually in
small groups from eight to thirty, were often
housed at the perimeter of plantations until
they became acclimated. They learned English
in two or three years through contact with
Native Americans or white indentured ser-
vants. When they became sufficiently accul-
turated, they would be allowed to work in
positions closer to the main plantation house.
This initial period of separation allowed
slaves to maintain many cultural values
despite exposure to slaves from other tribal
groups, indentured servants of different eth-
nic groups, and the majority culture of the
white owners. At the same time, frontier farm-
ing was sufficiently difficult that slave own-
ers were quite willing to learn from the slaves’
agricultural expertise; therefore, intercultural
communication was inevitable. Instead of
becoming totally acculturated to the ways of
the owners, slaves developed a black Creole,
native-born culture during the early slave
period, combining both white and West
African influences.
After the end of slave importation in 1807,
the black Creole population swelled. By law,
slavery was a lifelong condition, and the
children of female slaves were slaves as well.
Although most slaves worked on farms and on
cotton, tobacco, sugar, rice, and hemp planta-
tions, many others worked in mines and on
the railroads. A large number of slaves were
found in the cities doing manual labor and
service jobs. It was during this period of rapid
growth in the African American population
that separate racial group identities began to
form in the United States.
Emancipation
The movement to free the slaves began with
the American Revolution. Many of the north-
ern states banned slavery from the beginning
of independence. By the 1830s, there were
300,000 free persons of color living in urban
areas outside the South. Tension between
states that supported slavery (the Confed-
eracy) and those that opposed it (the Union)
was one factor that led to the Civil War (called
the War between the States in the South)
in 1861.
In 1862, President Abraham Lincoln signed
the Emancipation Proclamation. Union vic-
tory over the Confederacy in 1865 and the
subsequent ratification of the Thirteenth
Slaves working in
kitchens built outside
plantation living quarters
(due to fire danger) were
asked to whistle as they
brought food to the main
house to prevent them
from sampling along
the way.
The word Creole has
numerous definitions,
mostly describing
Africans and Europeans
who moved to the U.S.
South and Latin America
during the colonial
period. Creole Negro
(typically translated
“black Creole”) was the
term used for Africans
who developed their
own American culture
influenced by the British,
Spanish, and French
settlers in the region.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 8 2 1 1
Amendment gave all blacks living in the
United States their freedom. Some left the
South immediately, searching for relatives and
a better life. However, most remained in the
South because they lacked the skills needed to
begin an independent life; for instance, fewer
than 2 percent of former slaves were liter-
ate. After emancipation, former slave owners
continued to exploit African American labor
through tenant farming and sharecropping.
Under this system, black farmers were perpet-
ually in debt to white landowners. Slowly, as
competition for skilled farm labor increased,
working conditions for black Americans in
the South improved. Literacy rates and politi-
cal representation increased. At the same
time, racial persecution by white suprema-
cists, such as members of the Ku Klux Klan,
became more frequent.
At the turn of the twentieth century,
depressed conditions in the South and
industrial job opportunities in the northern
states prompted more than 750,000 African
Americans to settle in the Northeast and Mid-
west. Most were young men, and the major-
ity moved to large metropolitan areas, such
as New York, Boston, Detroit, Chicago, and
Philadelphia. The influx of southern blacks
was resented by both whites and the small
numbers of middle-class blacks who had been
well accepted in the northern cities. Laws that
established racial segregation were enacted for
the first time in the early 1900s, resulting in
inner-city African American ghettos.
Because of poor economic conditions
throughout the country, there was a pause
in African American migration north during
the Great Depression. The flow increased in
the 1940s, and in the following thirty years
more than 4 million African Americans left
the South to settle in other regions of the
country. This migration resulted in more
than a change in regional demographics. It
meant a change from a slow-paced rural life-
style to a fast-paced, high-pressured, urban
industrial existence.
In the 1960s, the movement against the
injustices of “separate but equal” laws (which
permitted segregation as long as comparable
facilities, such as schools, were provided for
African Americans) gained momentum under
the leadership of blacks such as Martin Luther
King Jr. Violent riots in city ghettos under-
scored the need for social reform. Civil rights
activism resulted in the repeal of many overtly
racist practices and passage of compensatory
laws and regulations meant to reverse past
discrimination, as typified by federal affirma-
tive action requirements.
Current Demographics
Today, slightly more than one-half of African
Americans live in the U.S. South (55 per-
cent), most in suburban areas. Since 1988,
more blacks have been moving to the South
than to the northern states, reversing the
demographic trend northward established
in 1900. The remaining African American
population is found predominantly in north-
eastern and midwestern urban areas.2 The
most recent Census data indicate that most
African Americans live in geographic areas
that are predominantly African American
or Hispanic.3 As of 2010, approximately
1.6 million immigrants to the United States
were of African descent. About 29 percent of
African immigrants in the United States are
from West Africa, including the countries
Nigeria and Ghana. Approximately 17 percent
are from East Africa, including the countries
Kenya, Ethiopia, and Somalia.4 In addition,
small populations from Eritrea (27,000) and
Sudan (83,000) have arrived in recent years,
many of whom are refugees seeking escape
from ethnic and civil conflicts in the region.4
Less than 1 percent of the black population
is of Caribbean or Central American descent.
Socioeconomic Status
African Americans continue to suffer from
the discriminatory practices that began
with their enslavement, yet it is estimated
that 70 percent are making steady economic
progress. The black middle class is growing,
and the economic gap between blacks and
whites is narrowing as blacks increasingly
enter fields such as business, health care, and
law. Nevertheless, according to 2013 Census
data, the poverty rate for African Americans
was close to twice the rate for non-Hispanic
white families nationally.5,6 According to
2013 Census data, high school graduation
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
2 1 2 A F R I C A N S
rates were close to 84 percent but below the
national average of 86 percent.5 The African
American unemployment rate is more than
double that of whites, and median income
is substantially lower. In 2013, nearly one in
every four black households (27.2 percent)
lived below the poverty line, which is double
the national average of 14.5 percent.6
Many African Americans believe they are
not completely accepted in U.S. society. Blacks
isolated in urban ghettos frequently experience
alienation. Frustration, hopelessness, and hos-
tility often result. At the same time, discrimi-
nation has promoted ethnic identity among
African Americans, due in part to a shared
history of persecution. Although Americans
of African descent are geographically, politi-
cally, and socioeconomically diverse, there is
a strong feeling of ethnic unity.
Socioeconomic status for recent immi-
grants from Africa varies greatly. Nigerians
often come to the United States for educa-
tional opportunities, and 61 percent have
advanced college degrees.4 Over 41 percent of
foreign-born Africans have obtained college
degrees.
Worldview
Religion
Spirituality was integral to African tribal soci-
ety, and indigenous religious affiliations were
maintained by most slaves, despite attempts
to convert blacks to Christianity. Although
the first black church, a Baptist congregation,
was founded in the 1770s in South Carolina,
it was only after U.S. religious groups became
involved in the antislavery movement that the
black Creole community responded with large
numbers of conversions.
Religion is as essential to African Ameri-
can culture today as it was to African society.
For many black Americans, the church rep-
resents a sanctuary from the trials of daily
life. It is a place to meet with other African
Americans, to share fellowship and hope.
More than 75 percent of African Americans
belong to a church. The largest denomina-
tion is the National Baptist Convention of the
U.S.A. Others with large African American
followings include the Methodist Episcopal
churches and Pentecostal denominations,
such as the Church of God in Christ. A small
percentage of African Americans who are
Muslim are members of either the World
Community of All Islam or the Nation of
Islam (see Chapter 4 for more information
about this religion).
Recent immigrants from Africa adhere
to a variety of faiths. Those who immigrated
from northern Africa or the northeast coast
are more likely to be Muslim while those from
sub-Saharan are more Christian, primarily
Protestant.7 Many Ethiopians and Eritreans
follow an Eastern Orthodox faith that is simi-
lar to, but separate from, the Egyptian Coptic
Church. In addition, it is believed that nearly
one-half of the African population partici-
pates in traditional tribal religions or combine
elements of several faiths.
Family
The importance of the extended family to
African Americans has been maintained
since tribal times. It was kinship that defined
the form of African societies. During the
early slave period, the proportion of men
to women was two to one, and the family
structure included many unrelated members.
As the black Creole population increased,
nuclear families were established but were
often disrupted by the sale or loan of a parent.
The extended family provided for dislocated
parents and children.
In 2012, 50 percent of African American
families were headed by single women (com-
pared to 19 percent of white families).8 The
family network often includes grandparents,
aunts, uncles, sisters, brothers, deacons or
preachers, and friends. Such extended kin-
ship still supports and protects individuals,
especially children, from the problems of a
discriminatory society. The extended family
has been found to be equally valued by both
wealthy and poor African Americans.
Traditional Health Beliefs and Practices
Africans view life as energy rather than mat-
ter. A person lives transitionally on earth,
interacting with all environmental forces,
from those of the gods and nature to those
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 8 2 1 3
exerted by the living and dead. Life events can
be influenced by these forces, and a person
can, in turn, influence these forces toward
good or evil.
Health is maintained through harmony.
Disharmony and illness occur when some-
one (living or dead), the gods, or nature is
intentionally malevolent. As described by one
African expert:
Even if it is explained to a patient that he
has malaria because a mosquito carry-
ing malaria parasites has stung him, he
will still want to know why that mosquito
stung him and not another person. The
only answer which people find satisfac-
tory to that question is that someone has
“caused” (or “sent”) the mosquito to sting a
particular individual, by means of magical
manipulations (p. 169).10
One example of how a person may become
ill is the evil eye, whereby one person causes
illness and misfortune by sending negative
energy through an evil gaze.9 A traditional
African healer must first diagnose the illness,
determine the supernatural cause of the ill-
ness, then dislodge the evil and take measures
to prevent reoccurrence. The healer often uses
herbs and other natural prescriptions to treat
the symptoms and may depend on the spirits
of the ancestors to transmit medical knowl-
edge. Bleeding, massage, dietary restrictions,
chants, and charms may complete the cure.
The health beliefs and practices of some
African Americans reflect traditional African
concepts as well as those encountered through
early contact with both Native Americans
and whites. It is often difficult to determine
the origins of a specific practice, and it is also
likely that both blacks and whites adhere to
similar beliefs. Some Americans of African
heritage maintain health by eating three meals
each day, including a hot breakfast. Laxatives
may be used regularly, and cod liver oil may be
taken to prevent colds. Vicks® VapoRub® may
also be ingested for colds. A copper or silver
bracelet is sometimes worn for protection; if it
is removed, harm will occur. If the skin dark-
ens around the bracelet, illness is impending
and precautions, such as more rest and a better
diet, should be undertaken.11,12,13
One study of black men found that they
defined health as more than simply lack of ill-
ness. The ability to support their family, ful-
fill social obligations, and maintain emotional
and spiritual well-being was also important.
Self-empowerment was one method used to
combat the difficulties of racism and poverty
thought to undermine good health.14 Prayer
for health is common, practiced by a sig-
nificant amount of this population.15 Some
African Americans believe that illness is a
punishment from God, and many feel that
God acts through physicians to heal patients.10
Stress is frequently cited as the cause for poor
health. It is considered by some blacks to be
the source of hypertension; likewise, “worria-
tion” results in diabetes.14,16,21,23 Others, espe-
cially in the rural South, believe that illness
is due to evil spirits or witchcraft. A person
may be “hexed,” “fixed,” “mojoed,” or “rooted”
by someone with supernatural skills. Healers
and conjurers are needed to “fix” or “trick”
the evil. The resulting illness can be cured
by herbal treatments, incantations, or magi-
cal transference. For example, a toad is placed
on the head of someone with a headache, and
when the toad later dies, the headache will
disappear.11,16
Best known of traditional healers are the
practitioners of voodoo, also called hoo-doo.
This combination of African and Catholic
beliefs is thought to have originated in the
Caribbean (see Chapter 10); where it is still
practiced in the South, it was also likely influ-
enced by European witchcraft.17 The men and
women practitioners can use voodoo magic
for good or evil. They cure unnatural illnesses
(those of supernatural cause) through casting
spells, the use of magic powders and gris-gris,
bags worn around the neck with powders,
animal bones or teeth, stones, and/or herbs.
Other healers include traditional herbalists or
root doctors, and spiritual, sympathy, or faith
healers who derive their powers from God.
A patient may choose to use one or all such
healers to treat an illness, and the specialty of
one may overlap into another.18 A root doctor,
for example, may apply home remedies or may
use charms like a conjurer to remove (or even
send) evil. In most cases, healers of all kinds
use a holistic approach and spend a great deal
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
2 1 4 A F R I C A N S
changed significantly due to the introduction
of New World foods such as cassava (M anih ot
esc ul enta, a tuber that is also called manioc),
corn, chiles, peanuts, pumpkins, and tomatoes
during the fifteenth and sixteenth centuries.
The slaves brought a diet based on these new
foods and native West African foods, such as
watermelon, black-eyed peas, okra, sesame,
and taro. Adaptations and substitutions were
made based on available foods. Black cooks
added their West African preparation meth-
ods to British, French, Spanish, and Native
American techniques to produce American
southern cuisine, emphasizing fried, boiled,
and roasted dishes using pork, pork fat, corn,
sweet potatoes, and local green leafy veg-
etables. The cuisines of other African regions
have had little impact at this point on the
typical U.S. diet, although recent immigrants
may continue to prepare and consume tradi-
tional fare.
African Fare
West African Knowledge of West African
food habits before the nineteenth century is
incomplete. It is mostly based on the records
of North African, European, and U.S. trad-
ers, many of whom considered the local cui-
sine unhealthy. Most West Africans during
the slave era lived in preliterate, horticultur-
ally based tribal groups. There was a heavy
dependence on locally grown foods, although
some items, such as salt and fish (usually salt
cured), could be traded at the daily markets
held throughout each region.
Historically, staple foods varied in each
locality. Corn, millet, and rice were used in
the coastal areas and Sierra Leone. Yams were
popular in Nigeria. Cassava (often roasted
and ground into a flour known as gari) and
plantains formed the dietary foundation of the
more southern regions, including the Congo
and Angola. The arid savanna region of West
Africa bordering the Sahara Desert was too
dry for cultivation, so most tribes were pasto-
ral, herding camels, sheep, goats, and cattle. In
the north, these animals were eaten; in other
regions, local fish and game were consumed.
Insects such as termites and locusts were con-
sumed in many regions of Africa and are still
considered a treat in some areas. Chickens
of time on a patient, providing a feeling of
spiritual as well as physical well-being.
Few African Americans today believe in
African witchcraft or employ root doctors.
However, the influence of traditional heal-
ing practices is still found in the idea that ill
health is due to bad luck or fate, in the fre-
quent use of home remedies, and in a prefer-
ence for natural therapies by some blacks,9,19,20
as in the popularity of garlic pills found in one
study.14
Traditional Food Habits
What are traditional African American foods:
foods of Africans in the seventeenth and eigh-
teenth centuries, foods of the slaves, or foods
of the black South since emancipation? Afri-
can American cuisine today often includes
elements from each of these diets.
Ingredients and
Common Foods
Historical Influences
African American foods offer a unique
glimpse into the development of a cuisine.
Even before West Africans were brought
to the United States, their food habits had
▲ Traditional African
American foods. Some typical
foods of the southern black
diet include bacon, black-
eyed peas, chayote squash,
corn, greens, ham hocks,
hot sauce, okra, peanuts,
watermelon, and sweet
potatoes.
W
ar
re
n
Pr
ic
e
Ph
ot
og
ra
ph
y/
Sh
ut
te
rs
to
ck
.c
om
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 8 2 1 5
were also raised, though in many tribes the
eggs were frequently traded, not eaten, and
the chicken itself was served mostly as a spe-
cial dish for guests. Chicken remains a presti-
gious meat in many regions today.
There were many similarities in cuisine
throughout West Africa. Most foods were
boiled or fried, and then small chunks were
dipped in a sauce and eaten by hand. Starchy
vegetables including yams, plantains, cas-
sava, sweet potatoes, and potatoes were often
boiled, then pounded into a paste (called
fufu). Each diner formed the dough into bite-
size scoops that were used like spoons to eat
stew. Palm oil was the predominant fat used
in cooking, giving many dishes a red hue.
Peanut oil, shea oil (from the nuts of the Afri-
can shea tree), and occasionally coconut oil
were used in some regions. The addition of
tomatoes, hot chile peppers, and onions as
seasoning was so common that these items
were simply referred to as “the ingredients.”
Most dishes were preferred spicy, thick, and
sticky (mucilaginous).
Legumes were popular throughout West
Africa. Peanuts were especially valued and
were eaten raw, boiled, roasted, or ground
into meal, flour, or paste. Cow peas ( V igna
ungul c ul ata, neither a standard pea nor a
bean—black-eyed peas are one type of cow
pea) were eaten as a substitute for meat, often
combined with a staple starch such as corn,
yams, or rice. Bambara groundnuts, similar to
peanuts, were also common. Nuts and seeds
were frequently used to flavor and thicken
sauces. Mango seeds (called agobono, og
bono, or apon), cashews, egusi (watermelon
seeds, usually dried and ground), kola nuts,
and sesame seeds were popular.
Many varieties of tropical and subtropical
fruits and vegetables were available to West
Africans, but only a few were widely eaten.
Ackee apples, baobab (both the pulp and
seeds from the fruit of the baobab tree), guava,
lemon, papaya (also called pawpaw), pineap-
ple, and watermelon were the most common
fruits. Many dishes included coconut milk. In
addition to starchy staple roots and the flavor-
ing ingredients of onions, chile peppers, and
tomatoes, the most popular vegetables were
eggplant, okra, pumpkin, and the leaves from
plants such as cassava, sweet potato, and taro
(also called callaloo or cocoyam).
West African cuisine today remains very
similar to that of the past. Fish is favored, and
little meat is consumed. A mostly vegetarian
fare has developed based on regional staples
such as beans, yams, and cassava. Gari foto is
a popular Nigerian specialty often eaten for
breakfast; it combines gari (cassava meal) with
scrambled eggs, onions, chiles, and tomatoes
and is sometimes served with beans. Stews
featuring root vegetables, okra, or peanuts and
flavored with small amounts of fish, chicken,
or beef are common. Curries are popular in
Nigeria, often served with dozens of condi-
ments and garnishes, such as coconut, raisins,
chopped dates, peanuts, dried shrimp, and
diced fruits. Pili-pili, a sauce of chile peppers,
tomatoes, onion, garlic, and horseradish, is
usually offered at the table so that each diner
may spice dishes to taste.
Deep-fried fish, fried plantain chips, and
balls made from steamed rice, black-eyed
peas, yams, or peanuts are snack foods avail-
able at street stalls in urban areas. The favorite
West African sweet is kanya, a peanut candy.
Chin-chins, sweet fried pastries topped with
sugar and flavoring such as cinnamon or
orange zest, are also popular. Bananas are
commonly baked and flavored with sugar,
honey, or coconut for dessert. Sweetened
dough balls prepared from millet or wheat
flour are a specialty in many areas; in Ghana
they are called togbei (“sheep balls”) and are
brightly colored with food dye before being
deep fried. They are served for special occa-
sions such as birthdays and weddings.
Ethiopian, Eritrean, Somali, and Sudanese
Mountainous plains and lowland valleys cover
much of Ethiopia, Eritrea, and Somalia, and
the climate is mostly arid. Though Ethiopia is
landlocked, Eritrea and Somalia have lengthy
coastal access along the horn of Africa. Mil-
let (including a variety unique to the region
called teff ), sorghum, and plantains are the
staple foods produced, and coffee is the lead-
ing export crop. Other foods common to
the region include barley, wheat, corn, cab-
bage, collards, onions, kale, and potatoes, as
well as peanuts and other legumes. Enset, a
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
2 1 6 A F R I C A N S
on religious dietary practices). More signifi-
cant has been the Ethiopian Eastern Orthodox
religion, which has facilitated the develop-
ment of vegetarian fare due to the restricted
intake of animal proteins. Examples include
yataklete kilkil, a garlic- and ginger-flavored
casserole, and yemiser selatta, a lentil salad.
A mixture of ground legumes called mitin
shiro is added to most vegetarian stews. Wat,
meaning stew, is the national dish of Ethio-
pia. Typically thick and spicy, wat may include
legumes, meats, poultry, or fish. Milder ver-
sions are known as alechas, and most stews
can be prepared either way.21 Doro wat is one
popular example, featuring chicken and whole
hard-boiled eggs. Yemiser wat is made with
red lentils, sega wat with beef, and yebeg wat
with lamb. Wat is served with rice or the tradi-
tional Ethiopian flat bread called injera. Injera
is prepared with a spongy, fermented dough
made from teff cooked in a very large circular
loaf on a griddle. (Sometimes wat is prepared
with added pieces of injera in the stew, known
as fitfit.) Another variation of this flat bread,
known as kocho, is made with enset.
Ethiopian foods are frequently flavored
with a hot spice mixture known as berbere,
which includes allspice, cardamom, cayenne,
cinnamon, cloves, coriander, cumin, fenu-
greek, ginger, nutmeg, and black pepper. Niter
kebbeh, clarified butter with onions, garlic,
ginger, and other spices, is added to many
dishes, including kitfo, a raw ground beef spe-
cialty. Salted and sweet cheeses are common.
Honey (sometimes consumed with the bee
grubs) is especially popular as a sweetener and
is used in savory dishes such as alechas, and
desserts such as baklava, a drier version of the
Greek pastry.22 It is also fermented to make
tej, a meadlike beverage. Tella, home-brewed
millet or corn beer, is commonly consumed,
as is coffee, especially espresso (introduced by
the Italians).
Eritrean and Somali food is very similar
to Ethiopian, with the exception of more fre-
quent use of seafood. For example, a typical
meal includes a spicy stew, often with beef,
lamb, kid, or fish, eaten with injera-like breads,
known in Somalia as anjeero. The Eritreans
often consume their bread with shuro, a thick
paste made from chickpeas, onions, tomatoes,
plantain-like plant, is a staple in the high
mountainous regions of Ethiopia. Some
chicken, fish, mutton, goat, and beef are
available.
Historically, Ethiopian cuisine had minimal
outside influences, though a large number of
Muslims now living in the nation have intro-
duced certain halal dietary practices in some
regions (see Chapter 4 for more information
▲ Market scene in Ghana,
West Africa.
iS
to
ck
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ot
o.
co
m
/s
an
je
ri
S A M P L E M E N U
A West African Meal
Spicy Fried Plantainsa,b
Groundnut Chop/Stew over Ricea,b
Ginger Beera,b or Green Tea with Mint
Tropical Fruit Salada,b
aJackson, E.A. 1999. South of the Sahara: Traditional cooking from the lands of
West Africa. Hollis, NH: Fantail.
bThe Congo Cookbook at http://www.congocookbook.comThe Congo Cookbook at http://www.congocookbook.comThe Congo Cookbook
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 8 2 1 7
doughy cornmeal porridge. Ugali is also
found in Tanzania. Mashed beans, lentils,
corn, plantains, and potatoes are also popu-
lar. Coconut milk, chili peppers, and curry
spice blends flavor many dishes. In Uganda,
which is inland and less influenced by foreign
cuisines, peanuts are a staple food used in
everything from stews—such as beef, tomato,
and onion stew with peanut butter sauce—
to desserts. Plantains are the core food of
Tanzania. They are used in soups (with or
without beef ), stews, fritters, custards, and
even wine. Coconut milk is a frequent fla-
voring, as is curry powder. Throughout the
region, dishes made with taro greens or other
leafy vegetables and side dishes of local grains
and produce, such as eggplant and papaya,
round out the cuisine.
South African South Africa has a very tem-
perate climate favorable to many fruits and
vegetables uncommon in the rest of the con-
tinent, such as cucumbers, carrots, apricots,
tangerines, grapefruit, quinces, and grapes.
The cuisine has been strongly influenced by
the European settlers of the region, including
and a touch of berbere, similar to Ethiopian
mitin shiro. In addition, though many Eritre-
ans belong to the Coptic Eastern Orthodox
faith and adhere to the proscriptions on meat,
nearly all Somalis are Muslim and follow halal
dietary practices. Camel milk is consumed in
some areas, and in Somalia, sweetened tea is
consumed frequently. In Eritrea, coffee is pre-
ferred, and a bitter, fermented barley bever-
age called sowa is served at most meals. On
special occasions a wine similar to tej, called
mez, is popular.
Former Italian occupation of the region
introduced numerous dishes. Favorites include
spaghetti, lasagna, pasta, seafood, and frittata,
a scrambled egg dish made with green pep-
pers and onions.21 In some parts of Ethiopia
and Eritrea and throughout Somalia, Asian
Indian–influenced items, such as curried
dishes, unleavened breads such as roti and
chapati, and vegetable- or meat-stuffed fritters
known as sambosa are also common.22
The Sudan, which bridges the desert
regions of North Africa and the tropical for-
ests of West and East Africa, has a cuisine
reflecting both Middle Eastern and African
influences. For example, fava beans or a salad
of cucumber and yogurt might be served at
the same meal as an okra stew and kisra, the
Sudanese staple bread similar to injera.
East African The climate and topography of
Kenya, Tanzania, and Uganda are well suited
to farming and ranching. Cassava, corn, mil-
let, sorghum, peanuts, and plantains combine
to form the foundation of the diet. Crops
grown for export include coffee, tea, cashews,
and cloves. Cattle are raised in the northern
plateaus of Kenya; they are considered a gift of
the gods (especially among the Maasai tribe),
and they indicate wealth. The abundant game
animals are also often sacred, although spe-
cific taboos vary from region to region. Eating
fish and seafood is common along the coast.
The cuisines of East Africa are predomi-
nantly vegetarian, influenced in part by
Arab, Asian Indian, and British fare. Breads
are common at every meal, including chapa-
tis, kitumbua, a rice fritter, and mandazi,
slightly sweetened doughnut-like bread. In
Kenya, the national dish is ugali, a very thick,
S A M P L E M E N U
An Ethiopian Dinner
Kitfoa,b,c
Doro Wata,b
Bamia Alich’ab or V e ge table Alechac
Injeraa,c
Fruit juice, Tejc , or E th iopian Coffee
aHafner, D. 2002. A taste of Africa: Traditional and modern African cooking.
Berkeley, CA: Ten Speed Press.
bHarris, J.B. 1998. The Africa cookbook: Tastes of a continent. New York:
Simon & Schuster.
cEthiopian Recipes at http://ethiopianrecipes.net/
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
2 1 8 A F R I C A N S
The Slave Diet
When West Africans were forcefully taken
from their tribes, they were not immediately
separated from their accustomed foods. Con-
ditions on the slave ships were appalling, but
most slave traders did provide a traditional
diet for the tribal members on board. The
basic staples of each region, plus dried salt cod
(which was familiar to most West Africans),
were fed to the slaves in minimal quantities.
Chile peppers and the native West African
malagueta peppercorns were used for season-
ing because they were believed to prevent dys-
entery. It wasn’t until the Africans were sold in
the United States that significant changes in
their cuisine occurred.
The diet of the field workers was largely
dependent on whatever foods the slave
owners provided. Salt pork and corn were
the most common items. Sometimes rice
(instead of corn), salted fish, and molasses
were included. Greens, legumes, milk, and
sweet potatoes were occasionally added. The
foods provided, as well as their amount, were
usually contingent on local availability and
agricultural surplus.
Hunger was common among the slaves.
Some slave owners allowed or required their
slaves to maintain garden plots or to plant
needed vegetables around the periphery of the
cotton or tobacco fields. Okra and cow peas
from Africa were favored, as well as American
cabbage, collard and mustard greens, sweet
potatoes, and turnips. Herbs were collected
from the surrounding woodlands, and small
animals such as opossums, rabbits, raccoons,
squirrels, and an occasional wild pig were
trapped for supplementary meat. Children
would often catch catfish and other freshwa-
ter fish.
During the hog-slaughtering season in
the fall, variety pork cuts, such as chitterlings
(intestines, pronounced c h itl ins), maw (stom-
ach lining), tail, and hocks, would some-
times be given to slaves. Some slaves were
encouraged to raise hogs and chickens. The
eggs and the primary pork cuts were usually
sold to raise cash for the purchase of luxury
foods. Chickens, a prestigious food in West
Africa, continued to be reserved for special
occasions.
the Dutch, British, and French. Muslim slaves
imported from Malaysia and India have also
had a significant impact on South African
fare. Mutton, beef, pork, fish, and seafood are
popular.
South African meat specialties include
sosaties, or skewered, curried mutton; bredie,
a mutton stew that may include onions, chiles,
tomatoes, potatoes, or pumpkin; frikkadels,
braised meat patties; bobotie, a meatloaf fla-
vored with curry and topped with a custard
mixture when baked; and biltong, meat strips
dried and preserved over smoke. Grape-
stuffed chicken or suckling pig is sometimes
served for special occasions. Spicy fruit or
vegetable relishes called chutney (for more
information see Chapter 14); atjar, or unripe
fruit or vegetables preserved in fish or veg-
etable oil with spices like tumeric and dried
chiles; and fresh grated fruit or vegetable sal-
ads flavored with lemon juice or vinegar and
chiles accompany the dishes.
Sweets are very common. Dried fruits, fruit
leathers called planked fruit, and fruit pre-
serves or jams are popular. Many pastries are
available, too, such as tarts made with raisins,
sweet potatoes, coconut, or custard. Cookies
are a favorite. Koeksister are braided crullers
that are deep fried and dipped in a cinnamon
syrup, and soetkoekies are spice cookies fla-
vored with the sweet wine Madeira.
▼ Many traditional south-
ern foods, such as fried
chicken, corn bread, spicy
stews, bean dishes, and
simmered greens, reflect
West African influences.
Bo
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C H A P T E R 8 2 1 9
West African cooking methods were
adapted to slave conditions. Boiling and fry-
ing remained the most popular ways to pre-
pare not only meats but also vegetables and
legumes. Bean stews maintained popularity as
main dishes. Corn was substituted for most
West African regional staple starches and was
prepared in many forms, primarily as corn-
meal pudding, cornmeal breads known as
pone or spoon bread, grits (coarsely ground
cornmeal), and hominy (hulled, dried corn
kernels with the bran and germ removed).
Pork fat (lard) replaced palm oil in cooking
and was used to fry or flavor everything from
breads to greens. Hot pepper sauces were
used instead of fresh chiles for seasoning. No
substitutions were available for many of the
nuts and seeds used in West African recipes,
although peanuts and sesame seeds remained
popular.
Food for the slave field workers had to be
portable. One-dish vegetable stews were com-
mon, as were fried cakes, such as hush puppies
(perhaps named because they were used to
quiet whining dogs), and the cornmeal cakes
baked in the fire on the back of a hoe, called
hoecakes. Meals prepared at home after a full
day of labor were usually simple.
The slaves who cooked in the homes of
slave owners had a much more ample and
varied diet. They popularized fried chicken
and fried fish. They introduced sticky vege-
table-based stews (thickened with okra or the
herb sassafras, which when ground is called
filé powder), such as the southern specialty
gumbo z’herbes, nearly identical to a recipe
from the Congo. Green leafy vegetables (sim-
ply called greens) became a separate dish
instead of being added to stews, but they were
still cooked for hours and flavored with meat.
Ingredients familiar to West Africans, such
as nuts, beans, and squash, were used for pie
fillings.
Foods after the Abolition of Slavery
The food traditions of African Americans did
not change significantly after emancipation,
and they differed little from those of white
farmers of similar socioeconomic status. One
exception was that pork variety cuts and salt
pork remained the primary meats for blacks,
while whites switched to beef during the post–
Civil War period.
African American Southern Staples
The traditional South African American cui-
sine that evolved from West African, slave,
and postabolition fare emphasizes texture
before flavor; the West African preference
for sticky foods continues. Pork, pork prod-
ucts, corn, and greens still form the founda-
tion of the diet. The cultural food groups list
(Table 8.1) includes other common south-
ern black foods. (For information about the
food habits of blacks from the Caribbean, see
Chapter 10; for more information on foods of
the South, see Chapter 15)
Pork variety cuts of all types are used.
Pig’s feet (or knuckles) are eaten roasted or
pickled; pig’s ears are slowly cooked in water
seasoned with herbs and vinegar and then
served with gravy. Bits of pork skin (with meat
or fat attached) are fried to make cracklings.
Chitterlings also are usually fried, sometimes
boiled. Sausages and head cheese (a seasoned
loaf of meat from the pig’s head) make use of
smaller pork pieces. Barbecued pork is also
common. A whole pig (or just the ribs) is
slowly roasted over the fire. Each family has
its own recipe for spicy sauce, and each has
its opinion about whether the pork should
be basted in the sauce or the sauce should be
ladled over the cooked meat. Other meats,
such as poultry, are also popular.
Occasionally, the small game that was
prevalent during the slave period, such as
opossum and raccoon, is eaten. More often
the meal includes local fish and shellfish, such
as catfish, crab, or crawfish. Frog legs and tur-
tle are popular in some areas. Meats, poultry,
and fish are often combined in thick stews
and soups, such as gumbos (still made sticky
with okra or filé powder) that are eaten with
rice. They may also be coated with cornmeal
and deep-fried in lard, as in southern-fried
chicken and catfish.
The vegetables most characteristic of South
African American cuisine are the many vari-
eties of greens. Food was scarce during the
Civil War, and most southerners were forced
to experiment with indigenous vegetation, in
addition to cultivated greens such as chard,
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
2 2 0 A F R I C A N S
TA B L E 8 .1 Cultural Food Groups: African American (Southern United States)
Group Comments Common Foods Adaptations in the United States
Protein Foods
Milk/milk products Dairy products are uncommon
in diet (incidence of lactose
intolerance estimated at
60–95 percent of the population).
Milk is widely disliked in some
studies; well accepted in others.
Few cheese or fermented dairy
products are eaten.
Milk (consumed mostly in desserts,
such as puddings and ice cream),
some buttermilk; cheese
Blacks in urban areas may
drink milk more often than
rural blacks.
Meat/poultry/fish/
eggs/legumes
Pork is most popular, especially
variety cuts; fish, small game,
poultry also common; veal and
lamb are infrequently eaten.
Bean dishes are popular.
Frying, boiling are most common
preparation methods; stewed
dishes preferred thick and
sticky.
Protein intake is high.
Meat: beef, pork (including chitterlings,
ham hocks, sausages, variety cuts)
Poultry: chicken, turkey
Fish and shellfish: catfish, crab, crawfish,
perch, red snapper, salmon, sardines,
shrimp, tuna
Small game: frogs, opossum, raccoon,
squirrel, turtle
Eggs: chicken
Legumes: black-eyed peas, kidney
beans, peanuts (and peanut butter),
pinto beans, red beans
Pork remains primary protein
source; prepackaged
sausages and lunch meats
are popular.
Small game is rarely
consumed.
Variety cuts are considered
to be “soul food” and eaten
regardless of socioeconomic
status or region.
Frying is still popular, but
more often at evening
meal; boiling and baking
are second most common
preparation methods.
Cereals/Grains Corn is primary grain product;
wheat flour is used in many
baked goods.
Rice is used in stew-type dishes
Biscuits; corn (corn breads, grits,
hominy); pasta; rice
Store-bought breads often
replace biscuits (toasted
at breakfast, used for
sandwiches at lunch).
Fruits/Vegetables Green leafy vegetables are most
popular, cooked with ham, salt
pork, or bacon, lemon and hot
sauce; broth is also eaten.
Intake of fresh fruits and
vegetables is low.
Fruits: apples, bananas, berries,
peaches, watermelon
Vegetables: beets, broccoli, cabbage,
corn, greens (chard, collard, kale,
mustard, pokeweed, turnip, etc.),
green peas, okra, potatoes, spinach,
squash, sweet potatoes, tomatoes,
yams
Fruits are eaten according to
availability and preference;
intake remains low.
Green leafy vegetables
(“greens”) are popular in all
regions; other vegetables
are eaten according to
availability and preference;
intake remains low.
Additional Foods
Seasonings Dishes are frequently seasoned
with hot-pepper sauces.
Onions and green pepper are
common flavoring ingredients.
Filé (sassafras powder), garlic, green
peppers, hot-pepper sauce, ham
hocks, salt pork or bacon (added to
vegetables and stews), lemon juice,
onions, salt, pepper
Nuts/seeds Nuts often used in ways similar to
traditional West African dishes,
such as nut- or seed-based
desserts.
Peanuts, pecans, sesame seeds,
walnuts
Beverages Coffee, fruit drinks, fruit juice, fruit
wine, soft drinks, tea
Fats/oils Butter, lard, meat drippings, vegetable
shortening
Sweeteners Honey, molasses, sugar Cookies (and candy) are
preferred snacks
©
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C H A P T E R 8 2 2 1
The West African tradition of frequent
snacking continued through the slave period
and after emancipation. Meals were often
irregular, perhaps due to the variable hours of
agricultural labor. The traditional southern-
style meal pattern was adopted as economic
conditions for both blacks and whites
improved. Breakfast was typically large and
leisurely, always including boiled grits and
homemade biscuits. In addition, eggs, ham or
bacon, and even fried sweet potatoes would
be served. Coffee and tea were more common
beverages than milk or juice.
Lunch, called dinner, was the main meal
of the day. It was eaten at midafternoon and
featured a boiled entrée, such as legumes or
greens with ham, or another stew-type dish.
Additional vegetables or a salad may have
been served, as well as potatoes and bread or
biscuits. Dessert was mandatory and was usu-
ally a baked item, not simply fruit. In some
homes a full supper of meat, vegetables, and
potatoes was served in the evening. Poorer
agricultural families often ate only two of these
hearty meals a day. Today, few South African
Americans, or whites, continue this tradi-
tional meal pattern in full. The southern-style
collard greens, kale, mustard greens, spin-
ach, and turnip greens. Dockweed, dande-
lion greens, lamb’s quarter, marsh marigold
leaves, milkweed, pigweed, pokeweed, and
purslane were added as acceptable vegetables.
Traditionally, the greens are cooked in water
flavored with salt pork, fatback, bacon, or
ham, plus hot chile peppers (or hot-pepper
sauce) and lemon. As the water evaporates,
the flavors intensify, resulting in a broth called
“pot likker.” Both the greens and the liquid
are served; hot sauce is offered for those who
prefer a spicier dish. Other common vegeta-
bles include black-eyed peas, okra, peas, and
tomatoes. Onions and green peppers are fre-
quently used for flavoring.
Corn and corn products are as popular
in southern black cuisine today as they were
during the slave period. Corn bread and fried
hominy are served sliced with butter. Wheat
flour biscuits are also served with butter or,
in some regions, gravy. Dumplings are some-
times added to stews and greens.
Squash is eaten as a vegetable (sometimes
stuffed) and as a dessert pie sweetened with
molasses. Sweet potatoes are also used both
ways. Other common desserts include bread
pie (bread pudding), crumb cake, chocolate
or caramel cake, fruit cobblers, puddings, and
shortcake, as well as sesame seed cookies and
candies.
Meal Composition
and Cycle
Daily Patterns
Historically, two meals a day were typical in
West Africa, one late in the morning and one
in the evening. Snacking was common; in
poorer tribes, snacks would replace the morn-
ing meal and only dinner would be served.
Food was eaten family style or, more formally,
the men were served first, then the boys, then
the girls, and last the women. Sometimes men
gathered together for a meal without women.
Mealtimes often were solemn; people concen-
trated on the attributes of the food, and con-
versation was minimal.
S A M P L E M E N U
A Traditional Black Southern Supper
Fried Chickena,b with Biscuitsa,b
Macaroni and Cheesea,b
Collard Greensa,b
Sweet Potato Piea,b or Pound Cakea,b
Fruit Juice or Iced Tea
aTillery, C.Q. 1996. The African American heritage cookbook. New York:
Citadel Press.
bThe Chitterling Site at http://www.chitterlings.com
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
2 2 2 A F R I C A N S
It was a time to eat and share favorite foods
with friends and relatives, a time to extend
hospitality to neighbors.
Many South African Americans still enjoy
a large Sunday dinner, usually prepared by the
mother of the house, who begins cooking in
the early morning. The menu would probably
include fried chicken, spareribs, chitterlings,
pig’s feet (or ears or tail), black-eyed peas or
okra, corn, corn bread, greens, potato salad,
rice, and sweet potato pie. Homemade fruit
wines, such as strawberry wine, might also be
offered.
Other holiday meals, especially Christmas,
feature menus similar to the Sunday meal, but
with added dishes and even greater amounts
of food. Turkey with cornbread stuffing and
baked ham are often the entrees; other veg-
etable dishes, such as corn pudding, sweet
peas, and salads, are typical accompaniments.
A profusion of baked goods, including yeast
rolls, fruit cakes and cobblers, custard or
cream pies, and chocolate, caramel, and coco-
nut cake, round out the meal. Some blacks
eat symbolic foods on New Year’s Eve, such
as fish for motivation, greens for money,
black-eyed peas for good luck, and rice for
prosperity.6
Southern black cuisine is particularly well
suited to buffet meals and parties. A pan of
gumbo, a pot of beans, or a side of barbecued
ribs can be stretched to feed many people on
festive occasions. Informal parties to celebrate
a birthday, or just the fact that it’s Saturday
night, are still common. Traditional southern
food is also served at Juneteenth celebrations
held in many African American communi-
ties to commemorate the emancipation of the
slaves.
The African American holiday of Kwanzaa
has gained popularity in recent years. Created
in Southern California in 1966, Kwanzaa rec-
ognizes the African diaspora and celebrates
the unity of all people of African heritage.
It begins on December 26 and runs through
New Year’s Day. Each day, a new candle is lit to
symbolize one of seven principles: unity, self-
determination, collective work and respon-
sibility, cooperative economics, purpose,
creativity, and faith. The holiday culminates
with a feast featuring dishes from throughout
breakfast might be served just on weekends
or holidays, for example. As in the rest of the
country, a light lunch has replaced the large
dinner on most days, and supper has become
the main meal.
Meal traditions vary for recent Afri-
can immigrants to the United States today.
Throughout West Africa, three meals a day
are typical, though in some areas, only two
meals are consumed during periods of priva-
tion, such as just before the harvest.24 Ethio-
pians, Eritreans, and Somalis usually eat one
or two meals a day, snacking in between. In
Eritrea and Somalia, fool, which is a puree
made from chickpeas in Eritrea, and pinto
beans in Somalia, is a popular breakfast item.
Food is typically offered on a communal plate,
and individuals use bread to scoop up what
is desired. Meals are often joyous and noisy.
Three meals each day are common in East
Africa, and in Kenya many people also stop
for British-style tea in the afternoon. However,
in many areas meals are limited to two daily
when food is in short supply. Traditionally,
men were served first, followed by women,
and then children dined. In South Africa, a
Westernized pattern of three meals, with din-
ner the largest, is usually followed.
Special Occasions
Sunday dinner had become a large family meal
during the slave period, and it continued to be
the main meal of the week after emancipation.
▼ Kwanzaa, the African
American holiday celebrated
from December 26 through
January 1 each year, culmi-
nates with a feast featuring
dishes from throughout
Africa, the Caribbean, the
U.S. South, and other regions
where Africans now live.
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C H A P T E R 8 2 2 3
Africa, the Caribbean, the U.S. South, and any
other region where Africans were transported.
Recent African immigrants may celebrate
many religious holidays, especially those
associated with the Eastern Orthodox and
Islamic faiths. In Nigeria, child-naming cer-
emonies are particularly important celebra-
tions.10 A grandmother performs the ritual,
offering symbolic foods to the infant, includ-
ing water (purity), oil (power and health),
alcohol (wealth and prosperity), honey
(happiness), kola nuts (good fortune), and salt
(intelligence and wisdom). Following the tast-
ing, the name is whispered to the child, then
announced aloud to the attendees. The family
and guests then enjoy a meal together. Many
Nigerian Americans continue the custom in
the United States.
Role of Food in African
American Society and
Etiquette
In the American South, food has tradition-
ally been a catalyst for social interaction, and
southern hospitality is renowned. For some
blacks, eating is an intimate or a spiritual expe-
rience that is shared with others.6,26,27,29 Food
is lovingly prepared for family and friends,
and food is considered an important factor in
the cohesiveness of African American society.
In Africa today, sharing food is still an
important social activity, often accompa-
nied by loud conversation and gaiety. Food
is offered to anyone who is in the home, and
in some nations, such as Nigeria, it is com-
mon for extended family members to drop
by unannounced for a meal.28 In many urban
areas, Western styles of dining are practiced.
However, in rural regions meals are often
served communally and consumed with the
hands. Only the right hand may be used for
eating, and the left hand should not touch
anything on the table. Although it is usually
a sign of respect or affection to feed a bite of
food directly into another person’s mouth, it
is considered exceptionally rude to pass food
from one person’s hand to another person’s
hand.25 In Uganda diners stay seated until
all people have finished eating, and sticking
one’s legs out or leaning on an elbow is not
acceptable.26 In Eritrea, an invitation to coffee
means a visit of over an hour, with a mini-
mum of three cups consumed in a ritual that
includes the burning of incense.27
Therapeutic Uses of Food
Many African Americans maintain health by
eating three hearty meals each day, including
a hot breakfast. Numerous other beliefs about
food and health are noted among small num-
bers of African Americans living in the rural
South. Some of these dietary concepts were
brought to other regions of the country during
the great migrations and may be found among
black elders. The conditions known as “high
blood” and “low blood” are one example.
High blood (often confused with high blood
pressure and high blood sugar levels) is most
prevalent and thought to be caused by excess
blood migrating to one part of the body, typi-
cally the head. High blood is caused by eating
excessive amounts of rich foods, sweet foods,
or red-colored foods (beets, carrots, grape
juice, red wine, and red meat, especially pork).
Low blood, associated with anemia, is believed
to be caused by eating too many astringent
and acidic foods (vinegar, lemon juice, garlic,
and pickled foods) and not enough red meat.
Other blood complaints include “thin blood”
that cannot nourish the body, causing a per-
son to feel chilly; “bad blood,” due to heredi-
tary, natural, or supernatural contamination;
“unclean blood” when impurities collect over
the winter months and the blood carries more
heat; and “clots,” when the blood thickens and
settles in one area, associated with menstrua-
tion or stomach and leg cramps.28,30
Tea made from the yellowroot shrub (X an-
th or h iz a simpl ic issima) is thought to cure
stomachache and fever and used to treat dia-
betes. Some blacks also believe peppermint
candies are helpful in diabetes. Sassafras tea or
hot lemon-flavored water with honey is con-
sidered good for colds, and raw onion helps
break a fever. Turpentine sweetened with
sugar reputedly cures intestinal worms when
consumed orally, while a mixture of figs and
honey will eliminate ringworm. Goat’s milk
with cabbage juice is used to cure a stomach
infection. In some areas, eggs and milk may
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2 2 4 A F R I C A N S
be withheld from sick children to aid in their
recovery.13,31,32
Pica, the practice of eating nonnutritive
substances such as clay, chalk, and laundry
starch, is one of the most perplexing of all
food habits practiced by African Americans,
whites, and other ethnic groups. Studies have
determined that pica is most often prac-
ticed by black women during pregnancy and
the postpartum period, and that rates are
unchanged since the 1970s (information on
pica among other ethnic groups or age groups
in the United States is limited). It is common
in the South, where anywhere from 16 to
57 percent of pregnant African American
women admit to pica. But pica is also found
in other areas of the country where large
populations of African Americans reside. In
rural regions the substance ingested is usually
clay. In urban areas, laundry starch is often
the first choice, though instances of women
who ate large amounts of milk of magnesia,
coffee grounds, plaster, ice, and paraffin have
also been reported. Many causes for pica have
been postulated—a nutritional need for min-
erals, hunger or nausea, a desire for special
treatment, and cultural tradition are the most
common hypotheses. One study found pica
was more common among women with lim-
ited social support. Another theory suggests
it may be related to obsessive-compulsive
disorder (OCD). Reasons for pica reported
by women include flavor, anxiety relief, tex-
ture, and the belief that clay prevents birth-
marks or that starch makes the skin of the
baby lighter and helps the baby slip out during
delivery.18,32,33
Recent immigrants from Africa may hold
traditional beliefs about maintaining health
through a balance of proper diet, exercise,
good relations with family and community,
emotional well-being, and spirituality.9 Poor
diet is identified as a tangible cause of some
conditions, and overweight is often valued as
a sign of health. Meat consumption may be
associated with longevity. Many people in
Africa have limited access to biomedical care
and make extensive use of botanical home
remedies. In Nigeria, for example, unripe
plantains and dried soursop (a tropical fruit)
are two treatments used for diabetes.35
Contemporary Food
Habits in the
United States
Most researchers have noted that the food
habits of African Americans today usually
reflect their current socioeconomic status,
geographic location, and work schedule more
than their African or southern heritage. Even
in the South, many traditional foods and meal
patterns have changed due to the pressures of
a fast-paced society. Nevertheless, the same
foods consumed by blacks and by whites
are likely to have different meanings within
each cultural context, and blacks often report
that their food habits are uniquely African
American.3
Adaptations of Food
Habits
Ingredients and Common
Foods
Food preferences do not vary greatly between
blacks and whites in similar socio-economic
groups living in the same region of the United
States. Comparisons do show that African
Americans choose items such as pork (espe-
cially chops, bacon, and sausage), poultry,
fresh fish and seafood, sugar, and noncar-
bonated fruit drinks far more often than
the general population. African American
households also purchase fewer fruits and
vegetables, fewer dairy products, less cereal
and baked goods, fewer snack foods (such
as potato chips), and less coffee than do any
other households, however.36 Fast foods are
popular, and one study determined that there
are nearly 60 percent more fast-food restau-
rants in predominantly black neighborhoods
than in mainly white neighborhoods.37
The popularity of soul f ood—a term coined
in the 1960s for traditional southern black
cuisine—is notable. It is associated with fresh
meats and vegetables made from scratch
and thoroughly cooked. Items are preferred
well spiced.28 Many African Americans have
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C H A P T E R 8 2 2 5
adopted this cuisine as a symbol of ethnic
solidarity, regardless of region or social class.
Today soul food serves as an emblem of iden-
tity and a recognition of black history for
many African Americans.
Meal Composition and Cycle
While the common foods that African Ameri-
cans eat reflect geographic location and socio-
economic status, meal composition and cycle
have changed more in response to work hab-
its than to other lifestyle considerations. The
traditional southern meal pattern of the large
breakfast with fried foods, followed by the
large dinner with boiled foods and a hearty
supper, has given way to the pressures of
industrial job schedules. One seminal study
showed that southern breakfast habits were
maintained for only eighteen months after
migration to the North and then were replaced
with a meal typically consisting of sausage and
biscuits or toast.37
Research indicates that some African
Americans no longer identify certain foods
or preparation methods, such as okra and
yams, and one-pot meals, as African in ori-
gin.26 Many of the items known to be tradi-
tional fare are not eaten often, including pig’s
feet and chitterlings (some of these foods are
also associated with the poor, and respon-
dents may be reluctant to admit eating such
items). The exception was greens, which were
identified most often as a traditional African
American food.38
African Americans throughout the coun-
try now eat lighter breakfasts and consume
sandwiches at a noontime lunch. Dinner is
served after work, and it has become the big-
gest meal of the day. Snacking throughout the
day is still typical among most African Ameri-
cans. In many households meal schedules are
irregular, and family members eat when con-
venient. It is not unusual for snacks to replace
a full meal.
Frying is still one of the most popular
methods of preparing food. An increase in
consumption of fried dinner items suggests
that the customary method of making break-
fast foods has been transferred to evening
foods (which were traditionally boiled) when
time constraints prevent a large morning
meal.37 Boiling and baking are second to fry-
ing in popularity.43 African Americans use
convenience foods and fast foods as income
permits.
Research is limited on the food habits of
more recent African immigrants. It has been
noted that among Somalis, cheese, sodas, and
sweetened fruit drinks are very popular. Reci-
pes are being adapted to available ingredients.
For example, wheat flour or pancake mix is
now used to make anjeero.42 A study of Suda-
nese Americans found that foods typically
consumed at breakfast and lunch included
fava or lentil beans made with feta cheese,
vegetables, and sesame oil; eggs, fried liver,
meat and vegetables stews, bread, salad, fresh
fruit, yogurt, custard, Jell-O, and highly sweet-
ened tea. Frying, stewing, sautéing in sesame
oil (which was called “boiling”), fermenting,
and grilling were the most common methods
of preparation. Baking and steaming were
extremely rare.43
Nutritional Status
The nutritional status of African Americans is
difficult to fully characterize because a limited
number of studies have addressed this popu-
lation, and conflicting data exist. In general,
however, research has shown that African
Americans’ nutritional intake is similar to that
of the general population and varies more by
socioeconomic status than by ethnicity.
Nutritional Intake
A larger percentage of African Americans
have poor diets compared to the total popu-
lation, with low intakes of dairy products,
vegetables, whole fruit, and total grains.44,45,46
African Americans have also been reported to
have diets high in fat—similar to that of the
typical U.S. diet—associated with high meat
intake, the popularity of frying, and fast food
consumption.28,39,40,41,46,48,49,50,51 The percent-
age of calories from animal proteins for blacks
is often greater than for whites, due in part to
a high intake of fatty meats, such as bacon and
sausage.52 In a one year-long study, 90 percent
of midlife African American women reported
they intended to reduce their fat consump-
tion, yet 77 percent consumed over 30 percent
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2 2 6 A F R I C A N S
of their daily calories as fat, and 61 percent
consumed more than 10 percent of their total
calories as saturated fat.31 High intake of cho-
lesterol has been found in some studies.53
Approximately 60 to 95 percent of adult
Americans of African descent are lactose
intolerant. Some studies show that milk is
widely disliked and avoided; others indicate
milk is consumed as often by blacks as it is
by whites. One trial found that lactose diges-
tion in African American adolescent girls
improved on a dairy-rich diet.54 The neces-
sity of consuming dairy products is debatable,
and research on older women reported that
dietary calcium intake was similar between
blacks and whites; however, grain products,
such as fortified cereals, were the primary
source of the nutrient for the African Ameri-
can respondents.55,59
Even as income increases, fresh produce
is sometimes ignored in favor of increased
expenditure on meat and other protein foods.
However, it is noteworthy that many dietary
comparisons use food frequency data without
defined portion sizes. A study of rural blacks
found that when portion size was explained,
participants ate on average larger portions of
fruits and most vegetables than standard defi-
nitions, increasing their daily intake of fruits
and vegetables by a significant two-thirds
serving.56 Further, national surveys suggest
that prevalence of low fruit and vegetable
intake among blacks is only slightly higher
than among whites and may be more typical
of the general American food pattern than of
ethnic variation, except among some lower-
income groups with limited access to fresh
produce.56,60
Nutrient intake deficiencies may be found
among some African Americans living at
or near poverty levels in the United States,
especially among older study subjects. Rural
African American elders consumed fewer
servings of meats, fruits, and vegetables, and
fats, oils, sweets, and snacks than whites in
one survey.58 The most frequent insufficien-
cies are of calories, iron, and calcium.20,47,55,61
Deficiencies in vitamins D, E, B6 , B12, folate,
potassium, copper, selenium, and zinc have
also been reported.58,62,63,65 Insufficient
intakes are often similar to, or only marginally
lower than, those of whites living in the same
location, however.55,68 Although significant
dietary differences have been reported in
some studies, a review of the literature on
black elders’ low nutrient intake compared
to white elders questioned the significance
of reported deficiencies: study samples were
small, and actual anthropometric, clinical, and
biochemical data confirming differences were
sparse.57 In deficiencies typical of the stan-
dard American diet, it is noteworthy that use
of vitamin and mineral supplements, which
sometimes provides sufficiency in whites, is
lower in the black population.55,64,65,66
On average, black men live 4.4 years less
than white men in the United States, and black
women live 4.1 years less than white women.
However, the gap in life expectancy is far
greater for certain subpopulations. African
American men living in high-risk inner-city
neighborhoods are likely to die twenty-one
years earlier than Asian American women in
general.67
Morbidity and mortality rates for black
mothers and their infants are also dispro-
portionately high. Maternal deaths are over
three times higher for African Americans
than for whites, and infant deaths are more
than two times higher.69,70 Dietary factors,
a large number of teenage pregnancies, and
inadequate prenatal care may contribute
to a higher incidence of low-birth-weight
infants (12.4 percent, over double the rate for
whites)69,70 African American mothers are
also 50 percent more likely than non-Hispanic
white mothers to have preterm births, and the
rate for sudden infant death syndrome mortal-
ity is twice that of non-Hispanic whites.71
Over 58 percent of African American
mothers breast-feed their infants, which is
a higher rate than white mothers, but only
27.5 percent continue to breast-feed past six
months postpartum, which was less than
white mothers. African Americans reported
concerns about breast milk quality—if their
diet wasn’t healthy or if they become sick,
the illness would be passed to the infant. In
addition, they also indicated that they are
reluctant to breast-feed in public.68,72,73 Some
blacks differ somewhat from whites in regard
to which solid foods they feed their infants
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C H A P T E R 8 2 2 7
and how soon after birth these are introduced.
One-third of low-income mothers offered
non-milk liquids or solids to their infants at
seven to ten days, 77 percent did so by sixteen
weeks, and 93 percent by sixteen weeks.74
Overweight is a common problem for
adult Americans of African descent. African
American women have the highest rates for
overweight and obesity in the United States—
about four out of five women. In 2011, all
African Americans were 1.5 times more
likely to be obese than non-Hispanic whites.2
Adolescents and children are also at risk, espe-
cially girls, who are 80 percent more likely to
be obese compared to non-Hispanic white
girls.2 Fat patterning has also been shown to
differ between African Americans and whites.
African Americans may have more upper-
body and deep-fat depositions than whites.76
Excess weight gain may be attributed to
many factors, including difference in body-
size ideal, preference in body shape by mem-
bers of the opposite gender,77,78,79 and a more
permissive attitude regarding obesity.80,81
Though some research suggests income and
education levels are inversely associated with
the risk for obesity, especially among chil-
dren,75,81,82 one large study of adolescents
found that the prevalence of overweight
remained elevated or even increased with
socioeconomic status among African Ameri-
can girls.83 An environment that promotes
high intake of fast foods and limits access to
healthy items may be another factor.75,84,85,86,87
A sedentary lifestyle is also more prevalent
among African Americans and is not asso-
ciated with income, education, occupation,
marital status, poverty levels, or other indica-
tors of social class.34,79,87 Data from one study
found families living in low-income areas and
those with higher percentages of minority
residents were significantly less likely to have
access to recreational facilities.83 In addition, a
desire to consume traditional African Ameri-
can foods and to care for others through cook-
ing, as well as a lack of family support were
barriers to weight loss cited in studies.83,84
Some researchers have suggested that stan-
dard anthropometric measures may be inap-
propriate for African Americans. One study
found that when body mass index (BMI)
values were compared to body fatness, black
women had lower body fatness than did
white women with identical BMI numbers.88
A similar evaluation reported that when the
percentage of body fat is used to measure
obesity instead of BMI, rates for African
American women drop dramatically, and
rates for white men exceed those for black
men.89 BMI does not account for differences
in fat-free mass, such as muscle and bone,
which accounts for the discrepancy between
measures. Weight-for-height growth charts as
indicators of percentage of body fat and the
use of waist-to-hip ratios in defining heart
disease risk have also been found misleading
in some studies.90,91 However, a study of over-
weight and obesity in children did not find
significant differences in rates when using
national standards for assessment compared
to African American specific standards, and
cautioned that ethnicity-specific standards
may be confounded by differences in socio-
economic status.92
Studies propose that African American
women do not necessarily equate being over-
weight with being unattractive and that they
are less preoccupied with dieting than are
white women.93,94 Research on disordered
eating in African Americans has been lim-
ited and contradictory. Some studies suggest
black women have lower rates of dieting and
are protected from eating disorders due to a
collective acceptance of larger body size.95,96,97
Other researchers suggest low rates are due to
an assumption that disordered eating does
not affect blacks (hence African American
girls are often excluded from studies) and
that pressures to conform to societal norms
regarding weight are eroding any possible
preexisting cultural buffers, especially among
children and adolescents.98,99,100,101
Concurrent with obesity is a dispropor-
tionately high rate of type 2 diabetes mellitus
among African Americans—twice the rate of
diabetes and twice the number of incidents of
complications compared to whites.102 There
is a genetic predisposition for type 2 diabe-
tes mellitus, but also a significant relation-
ship with lifestyle factors such as obesity,
sedentary lifestyle, and westernized dietary
habits.103,104,105,106
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2 2 8 A F R I C A N S
Hypertension is a significant health prob-
lem for African Americans. In 2011, the prev-
alence of high blood pressure was 1.4 times
more likely when compared to whites.102,107
Hypertension has been found to be a potent
risk factor for coronary heart disease (CHD)
in blacks, especially women (whereas having
diabetes was not predictive for CHD). Afri-
can American adults are twice as likely to
have a stroke than their white adult counter-
parts. Further, men are 60 percent more likely
to die from a stroke than their white adult
counterparts.103
Rates of iron-deficiency anemia among
African Americans are higher than for whites
at every age, regardless of sex or income level.
This incidence remains excessive even after
adjustments for differences in hemoglobin
distributions are made using reference stan-
dards appropriate for blacks.108 Pica may
result in anemia among pregnant women and
newborns. Hookworm can also be a cause
in the rural South. Other blood disorders
resulting in anemias prevalent in African
Americans include alpha-thalassemia, sickle-
cell disease, and glucose-6-phosphate dehy-
drogenase deficiency. Researchers have also
suggested that undiagnosed celiac disease in
blacks may underlie some cases of iron-defi-
ciency anemia.109,110
Little has been reported on the nutritional
adequacy of the traditional diet of recent
Africans. Studies in Israel of Ethiopian immi-
grants found deficiencies in vitamin D (result-
ing in rickets in children), iodine (due in part
to food goitrogens), and calcium. Vitamin
A deficiency has led to xerophthalmia and
blindness in many regions. Consumption of
foods made from enset, a banana leaf plant,
common in many parts of Ethiopia, is associ-
ated with esophageal cancer.111,112,113 Among
Sudanese immigrants in the United States,
blindness due to trachoma is also common.
High rates of extreme malnutrition, malaria,
typhoid, hepatitis B, HIV infection, dengue
fever, tuberculosis, syphilis, dental problems,
diabetes, and parasitic infection have also
been reported.114
Dietary changes of Ethiopians in Israel are
marked. A survey of teens found that within
eighteen months of arrival, only 30 percent
maintained a traditional diet, 60 percent con-
sumed a mixed diet, and 15 percent ate only
Israeli foods.115,116 More than half of daily
calories came from snacks and fast foods,
especially sweets and soft drinks. Most milk
products were disliked, with the exception of
hot chocolate, a favorite with the youth. Fat
intake increased, while fruit and vegetable
intake decreased. Though obesity is unusual,
glucose intolerance is common, and the
prevalence rate of type 2 diabetes increased
from 0.4 percent to between 5 and 8 percent
within a few years. Over 20 percent of men
also developed hypertension after immigra-
tion.116 In Australia, immigrants from Ghana
experienced similar changes in diet and health
status. Fat intake accounted for 33 to 35 per-
cent of total calories, and overweight was
observed in 71 percent of men and 66 percent
of women. High rates of diabetes, hyperten-
sion, and dyslipidemia were reported.117
In Nigeria, some women believe that
edema during pregnancy is an indication that
the infant is male, and treatment may not be
sought for the condition.118 Studies of Ethio-
pian women in the United States found that
most breast-fed their infants on average four
months, and breast-feeding is acceptable in
public. Going back to work and reduction in
mother’s milk were the primary reasons given
for cessation.119,120 Somali immigrants often
associate fatness with health and may over-
feed their children.121 The Somali Bantus are
in particularly poor health due to acute or
chronic malnutrition when living in African
refugee camps prior to arrival in the United
States. Most have little knowledge of Ameri-
can foods. The prevalence of low-birth-weight
infants is high, and weaning often occurs
before six months due to subsequent preg-
nancy. Diarrheal diseases and infections are
common. Posttraumatic stress syndrome is
also frequently found.122
Counseling
Access to health care for African Americans
has improved since 2009. Eight-five percent of
blacks were covered by health insurance dur-
ing all or part of 2013. Nationally, 86.6 percent
of all races were covered by health insur-
ance.123 Cost, including time off from work,
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C H A P T E R 8 2 2 9
is often an issue. Self-reliance is highly valued
and may lead to delay in seeking care or mini-
mization of symptoms. Furthermore, an atti-
tude that fate determines wellness may restrict
medical visits. When a doctor’s care is sought,
it is usually for treatment of symptoms (often
after home remedies have been tried) rather
than for prevention of illness and health main-
tenance.124 Many blacks are present-oriented,
and flexible scheduling and on-time policies
may be helpful.125
Some African American clients feel patron-
ized by nonblack providers and may choose to
suffer at home rather than submit to humili-
ation. Others may be suspicious or hostile
when working with nonblack health care pro-
fessionals. Such attitudes are rarely directed
specifically at the health care worker; instead,
they are an adaptation to what is perceived
as a prejudicial society.124,125 Some African
Americans may not consider themselves
active participants in their interaction with
providers and may not communicate needs or
questions. This is sometimes done to test the
competency of the provider, who is expected
to diagnose without help from the client.126 It
may also be a reflection of the belief that their
health care is out of their control, up to luck
or destiny.9
African American conversational style is
fully engaged and very expressive.9 Interjec-
tions of agreement or disagreement are fre-
quent. Words are often spoken rhythmically
and passionately. Response time is very quick.
When counseling African Americans, it is
helpful to be direct yet respectful. Eye con-
tact is made while speaking, but prolonged
eye contact is considered rude.30 African
Americans may avert their eyes while listen-
ing; however, some blacks may interpret rapid
eye aversion as an insult. Attentive listening
is more important than eye contact to many
blacks. A firm handshake and smile are the
expected greeting; hugging and kissing may
also be included. Touching is common, and
reluctance to touch may be interpreted as per-
sonal rejection.
Nonnutritive food intake during preg-
nancy may be missed unless information
about pica is solicited during the interview.
Most women who eat clay, laundry starch,
or other nonfood items will willingly list the
items consumed when asked directly about
the habit. The nutritional effects of pica are
uncertain. Possible problems include exces-
sive weight gain (from laundry starch), aggra-
vated hypertension (from the sodium in clay),
iron-deficiency anemia, and hyperkalemia.75
Furthermore, over-the-counter remedies for
the gas and constipation that can accompany
pica may be harmful during pregnancy.127
Traditional health practices, such as using
diet to cure high and low blood, may com-
plicate some nutrition counseling. Pregnancy
is sometimes considered to be a high blood
state, and pregnant women will avoid red
meats. Patients who confuse hypertension
with high blood may eat astringent foods,
which are often high in sodium, to balance the
condition. Home remedies for diabetes, such
as peppermint candies or yellowroot bush tea,
should also be investigated. A client is unlikely
to mention any use of other healers.128 It may
be useful to directly inquire whether a rural
African American believes an illness is due
to outside forces or witchcraft and what addi-
tional treatment is being sought.
Counseling recommendations should be
action- or task-oriented. Several studies of
African Americans have suggested family-
oriented programs and group classes may
be more successful than individual counsel-
ing, and use of community resources, such as
churches, can provide additional support for
nutritional change.85,129 Culturally relevant
education may include elements of spiritual-
ity, ethnic pride, group planning, and the use
of peer counselors.130,131,132,133 Diets that limit
traditional African American foods are often
resisted by clients, due to preference, expense,
family desires, and ethnic identity.85,134 One
study found that blacks felt socially isolated
when restricted to nontraditional foods.135
Researchers have suggested that because
many African Americans take pride in the
adaptations made in their cuisine due to his-
torical circumstances, the potential for dietary
improvement associated with environmental
change is high.26
Little information is available regarding
counseling recent immigrants from Africa.
Recommendations for Ethiopians include
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2 3 0 A F R I C A N S
Review Questions
1. Describe the cuisine that West African slaves
brought to America and one American food
recipe that has its origins in Africa. What tra-
ditional food might be served on Juneteenth?
2. Compare similarities and differences in
West and East African traditional cuisines.
What countries have influenced East African
cuisine?
3. Name the presented symbolic foods used in
the Nigerian child-naming ceremonies, and
explain what they symbolize.
4. Describe three therapeutic uses of food among
African Americans. What is pica, and why is it
practiced?
5. For African Americans, how might diet affect
the incidence and treatment of hypertension
and type 2 diabetes mellitus?
use of an interpreter from the client’s com-
munity; a warm, personable communica-
tion style; a positive outlook; and disclosure
of poor prognosis or terminal illness to the
patient’s family (preferably not the wife or
mother) or friend, who will then inform the
patient.136,137 Ethiopians and Somali Bantus
may view illness as a punishment from God
or angry spirits, and they may employ herbal
remedies or prefer spiritual healing.119,121
Injections may be requested by Ethiopians
instead of oral prescriptions, and Sudanese
may stop taking medications as soon as
symptoms subside, saving them for a later
recurrence of illness in themselves or among
family members or friends.114 It has been
noted that Eritreans have faith in certain
botanical cures, and if they are unobtain-
able in the United States, they may return to
Africa for treatment.119
An in-depth interview is especially impor-
tant with African American clients. Variability
in diet related to region, socioeconomic con-
ditions, and degree of ethnic identity should
be considered. Information regarding coun-
try of origin may be significant: Clients from
the Caribbean or Central America are more
likely to identify with the foods and food hab-
its of Latinos than with those of blacks in the
United States. Religious affiliation may also
be important, such as among Americans of
African descent who are members of Islam or
an Eastern Orthodox faith.
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D I S C U S S I O N S T A R T E R S
Health Risks of African Americans
As this chapter makes clear, African Americans today often suffer from obesity, diabetes,
hypertension, infant and maternal morbidity and mortality, and depression in greater
numbers than other American races. Make a list of all the possible reasons for this phe-
nomenon. Don’t limit yourself to just one or two, and look back at the diet and culture
of the geographical area from which the ancestors of most modern African Americans
came. In a small group, share your lists of reasons and come up with one group list.
Again, your task is to list all the possible reasons that you can.
After making this group list, individually take a blank sheet of paper and cluster the
items on that list. That is, look the listed items and identify reasons that you see as possi-
bly being somehow linked. On the blank sheet of paper, rewrite the reasons on the group
list but locate them as best you can near to other reasons that you as somehow related.
Circle each reason and draw lines between the ones that you believe are connected.
Finally, imagine that you have been hired by a local health department in an area
of the country with a large African American population to write a brief (one-page)
resource handout for local health professionals on the reasons why many of their African
American clients may have the above health problems. As you plan this short paper,
consider whether—or not—it might have made a difference had most African slaves
come from East Africa.
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K.M., & McAuley, E. 2006. Is the current BMI
obesity classification appropriate for black and
white post menopausal women? I nter national
J our nal of O besity , 3 0 , 837–843.
89. Cawley, J., & Burkhauser, R.V. 2006. B ey ond B M I :
T h e v al ue of mor e ac c ur ate measur es of f atness and
obesity in soc ial sc ienc e r esear c h . National Bureau
of Economic Research (NBER). Retrieved from
http://papers.nber.org/papers/w12291
90. Croft, J.B., Keenan, N.L., Sheridan, D.P., Wheeler,
F.C., & Speers, M.A. 1995. Waist-to-hip ratio in a
biracial population: Measurement, implications,
and cautions for cardiovascular disease. J our nal
of th e A mer ic an Dietetic A ssoc iation, 9 5 , 60–64.
91. Hoerr, S.L., Nelson, R.A., & Lohman, T.R. 1992.
Discrepancies among predictors of desirable
weight for black and white obese adolescent girls.
J our nal of th e A mer ic an Dietetic A ssoc iation, 9 2 ,
450–453.
92. Dwyer, J.T., Stone, E.J., Minhua, Y., Webber, L.S.,
Must, A., Feldman, H.A., . . . Parcel, G.S. 2000.
Prevalence of marked overweight and obesity in
a multiethnic pediatric population: Findings from
the Child and Adolescent Trial for Cardiovascular
Health (CATCH) study. J our nal of th e A mer ic an
Dietetic A ssoc iation, 1 0 0 , 1149–1156.
93. Kumanyika, S., Wilson, J.F., & Guilford-
Davenport, M. 1993. Weight-related attitudes and
behaviors of black women. J our nal of th e A mer i-
c an Dietetic A ssoc iation, 9 3 , 416–422.
94. Stevens, J., Kumanyika, S.K., & Keill, J.E. 1994.
Attitudes towards body size and dieting: Dif-Attitudes towards body size and dieting: Dif-Attitudes towards body size and dieting: Dif
ferences between elderly black and white
women. A mer ic an J our nal of P ubl ic H eal th , 8 4 ,
1322–1325.
95. Neumark-Sztainer, D., Croll, J., Story, M.,
Hannan, P.J., French, S.A., & Perry, C. 2002.
Ethnic/racial differences in weight-related con-
cerns and behaviors among adolescent girls and
boys: Findings from Project EAT. J our nal of
P sy c h osomatic R esear c h , 5 3 , 963–974.
96. Rhea, D.J. 1999. Eating disorder behaviors of
ethnically diverse urban female adolescent ath-
letes and non-athletes. J our nal of A dol esc enc e, 2 2 ,
379–388.
97. White, M.A., Kohlmaier, J.R., Varnado-Sullivan,
P., & Williamson, D.A. 2003. Racial/ethnic dif-P., & Williamson, D.A. 2003. Racial/ethnic dif-P., & Williamson, D.A. 2003. Racial/ethnic dif
ferences in weight concerns: Protective and risk
factors for the development of eating disorders
and obesity among adolescent females. E ating
and W eigh t Disor der s, 8 , 20–25.
98. Mitchell, K.S., & Mazzeo, S.E. 2004. Binge eating
and psychological distress in ethnically diverse
undergraduate men and women. E ating B eh av -
ior s, 5 , 157–169.
99. Perez, M., & Joiner, T.E. 2003. Body image dis-
satisfaction and disordered eating in black and
white women. I nter national J our nal of E ating
Disor der s, 3 3 , 342–350.
100. Robinson, T.N., Chang, J.Y., Haydel, K.F., &
Killen, J.D. 2001. Overweight concerns and
body image dissatisfaction among third-grade
children: The impacts of ethnicity and socio-
economic status. J our nal of P ediatr ic s, 1 3 8 ,
181–187.
101. Williamson, L. 1998. Eating disorders and the
cultural forces behind the drive for thinness:
Are African American women really protected?
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tension whose blood pressure is under control,
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over, by selected characteristics: United States,
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104. Shai, I., Jiang, R., Manson, J.E., Stampfer, M.J.,
Willett, W.C., Colditz, G.A., & Hu, F.B. 2006.
Ethnicity, obesity, and risk of type 2 diabetes
in women: A 20-year follow-up study. Diabetes
C ar e, 2 9 , 1585–1590.
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105. Diaz, V.A., Mainous, A.G., Koopman, R.J., &
Geesey, M.E. 2005. Are ethnic differences in
insulin sensitivity explained by variation in car-
bohydrate intake? Diabetol ogia, 4 8 , 1264–1268.
106. Banini, A.E., Allen, J.C., Allen, H.G., Boyd, L.C.,
& Lartey, A. 2003. Fatty acids, diet, and body
indices of type II diabetic American whites and
blacks and Ghanaians. N utr ition, 1 9 , 722–726.
107. National Center for Health Statistics. 2008.
H eal th , U nited S tates, 2 0 0 8 . Hyattsville, MD:
National Center for Health Statistics. Retrieved
from http://www.cdc.gov/bloodpressure/facts.
htm (accessed April 7, 2011).
108. Jones, D.W., Chambless, L.E., Folsom, A.R.,
Heiss, G., Hutchinson, R.G., Sharrett, A.R., . . .
Taylor, H.A, Jr. 2002. Risk factors for coronary
heart disease in African Americans, 1987–
1997. A r c h iv es of I nter nal M edic ine, 1 6 2 (22),
2565–2571.
109. Beutler, E., & West, C. 2005. Hematologic differ-
ences between African-Americans and whites:
The roles of iron deficiency and a-thalassemia
on hemoglobin levels and mean corpuscular vol-
ume. B l ood, 1 0 6 , 740–745.
110. Brar, P., Lee, A.R., Lewis, S.K., Bhagat, G., &
Green, P.H. 2006. Celiac disease in African-
Americans. Digestiv e Diseases and S c ienc es, 5 1 ,
1012–1015.
111. Belachew, T., Nida, H., Getaneh, T., Woldemar-
iam, D., & Getinet, W. 2005. Calcium deficiency
and causation of rickets in Ethiopian children.
E ast A f r ic an M edic al J our nal , 8 2 , 153–159.
112. Fogelman, Y., Rakover, Y., & Luboshitzky, R.
1995. High prevalence of vitamin D deficiency
among Ethiopian women immigrants to Israel:
Exacerbation during pregnancy and lactation.
I sr ael i J our nal of M edic al S c ienc es, 3 1 , 221–224.
113. Mengesha, B., & Ergete, W. 2005. Staple Ethio-
pian diet and cancer of the oesophagus. E ast
A f r ic an M edic al J our nal , 8 2 , 353–356.
114. Ackerman, L.K. 1997. Health problems of refu-
gees. J our nal of th e A mer ic an B oar d of F amil y
P r ac tic e, 1 0 , 337–348.
115. Rasbridge, L.A. 2006. Sudanese. R ef ugee h eal th —
I mmigr ant h eal th . Baylor University. Retrieved
from http://www3.baylor.edu/~Charles_Kemp/
refugees.htm (accessed February 21, 2015).
116. Trostler, N. 1997. Health risks of immigration:
The Yemenite and Ethiopian cases in Israel.
B iomedic ine and P h ar mac oth er apy , 5 1 , 352–359.
117. Bursztyn, M., & Raz, I. 1993. Blood pressure,
glucose, insulin and lipids of young Ethiopian
recent immigrants to Israel and in those resident
for 2 years. J our nal of H y per tension, 1 1 , 455–459.
118. Salah, A., Amanatidis, S., & Samman, S. 2002.
Cross-sectional study of diet and risk factors for
metabolic diseases in a Ghanaian population of
Sydney, Australia. A sia P ac if ic J our nal of C l inic al
N utr ition, 1 1 , 210–216.
119. Okafor, C.B. 2000. Folklore linked to pregnancy
and birth in Nigeria. W ester n J our nal of N ur sing
R esear c h , 2 2 , 189–202.
120. EthnoMed. 2006. E th iopian c ul tur al pr of il e.
University of Washington, Harborview Medical
Center. Retrieved from http://ethnomed.org/
ethnomed/cultures/ethiop/ethiop_cp.html
121. Meftuh, A.B., Tapsoba, L.P., & Lamounier, J.A.
1991. Breastfeeding practices in Ethiopian
women in Southern California. I ndian J our nal
of P ediatr ic s, 5 8 , 349–356.
122. Rasbridge, L.A. 2006. Sudanese. R ef ugee h eal th —
I mmigr ant h eal th . Baylor University. Retrieved
from http://www3.baylor.edu/~Charles_Kemp/
refugees.htm
123. Owens, C.W. 2004. Somali Bantu refugees. Eth-
noMed, University of Washington Harborview
Medical Center. Retrieved from http://eth-
nomed.org/cultures/somali/somali_bantu.html
124. U.S. Census Bureau, Newsroom. F ac ts fo r fe a-
tur es: B l ac k ( A f r ic an- A mer ic an) h istor y month :
F ebr uar y 2 0 1 5 . Retrieved from http://www.
census.gov/newsroom/facts-for-features/2015/
cb15-ff01.html (accessed February 21, 2015).
125. Giger, J.N., Davidhizar, R.E., & Turner, G. 1992.
Black American folk medicine health care
beliefs: Implications for nursing plans of care.
T h e A B N F J our nal , 3 , 42–46.
126. Galanti, G.A. 2004. C ar ing f or patients f r om dif -C ar ing f or patients f r om dif -C ar ing f or patients f r om dif
f er ent c ul tur es (3rd ed.). Philadelphia: University
of Pennsylvania Press.
127. Jackson, B. 1976. The other kind of doctor: Con-
jure and magic in black American folk medicine.
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Berkeley: University of California Press.
128. Boyle, J.S., & MacKay, M.C. 1999. Pica: Sorting it
out. J our nal of T r ansc ul tur al N ur sing, J our nal of T r ansc ul tur al N ur sing, J our nal of T r ansc ul tur al N ur sing 1 0 , 65–67.
129. Graham, R.E., Ahn, A.C., Davis, R.B., O’Connor,
B.B., Eisenberg, D.M., & Phillips, R.S. 2005. Use
of complementary and alternative medical ther-
apies among racial and ethnic minority adults:
Results from the 2002 National Health Interview
Survey. J our nal of th e N ational M edic al A ssoc ia-
tion, 9 7 , 535–545.9 7 , 535–545.9 7
130. Peregrin, T. 2006. Cooking with soul: A look into
faith-based wellness programs. J our nal of th e
A mer ic an Dietetic A ssoc iation, 1 0 6 , 1016–1020.
131. Fitzgibbon, M.L., Stolley, M.R., Ganschow, P.,
Schiffer, L., Wells, A., Simon, N., & Dyer, A.
2005. Results of a faith-based weight loss inter-
vention for black women. J our nal of th e N ational
M edic al A ssoc iation, 9 7 , 1393–1402.9 7 , 1393–1402.9 7
132. Kieffe, E.C., Willis, S.K., Odoms-Young, A.M.,
Guzman, J.R., Allen, A.J., Two Feathers, J., &
Loveluck, J. 2004. Reducing disparities in dia-
betes among African-American and Latino resi-
dents of Detroit: The essential role of community
planning focus groups. E th nic ity & Disease, 1 4 ,
S27–S37.
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2 3 6 A F R I C A N S
133. Kreuter, M.W., Sugg-Skinner, C., Holt, C.L.,
Clark, E.M., Haire-Joshu, D., Fu, Q., . . . Bucholtz,
D. 2005. Cultural tailoring for mammography
and fruit and vegetable intake among low-
income African-American women in urban
public health centers. P r ev entiv e M edic ine, 4 1 ,
53–62.
134. Williams, J.H., Auslander, W.F., de Groot, M.,
Robinson, A.D., Houston, C., & Haire-Joshu, D.
2006. Cultural relevancy of a diabetes preven-
tion nutrition program for African American
women. H eal th P r omotion P r ac tic e, 7 , 56–67.7 , 56–67.7
135. Patel, C., & Nicol, A. 1997. Adaptation of
African-American cultural and food preferences
in end-stage renal disease clients. A dv anc es in
R enal R epl ac ement T h er apy , 4 , 30–39.
136. Horowitz, C.R., Tuzzio, L., Rojas, M., Monteith,
S.A., & Sisk, J.E. 2004. How do urban African
Americans and Latinos view the influence of diet
on hypertension? J our nal of H eal th C ar e f or th e
P oor and U nder ser v ed, 1 5 , 631–644.
137. Beyene, Y. 1992. Medical disclosure and refugees:
Telling bad news to Ethiopian patients. W ester n
J our nal of M edic ine, 1 5 7 , 328–332.1 5 7 , 328–332.1 5 7
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2 3 7
Latinos from the Caribbean Islands and
South America.
Mexicans
Estados Unidos Mexicanos, the United
Mexican States, is the northernmost Latin
American country. Though Mexico seems
logically a part of Central America, it is geo-
graphically a part of North America. It is
more than one-fourth the size of the United
States, with 756,065 square miles of territory.
The varied geography includes a large central
plateau surrounded by mountains except to
the north. Coastal plains edge the country
along the Gulf of Mexico and the Pacific.
The separate Baja peninsula is found in the
west, and the Yucatán peninsula juts out in
the southeast. Snow-capped volcanoes, such
as Orizaba, Popocatépetl, Ixtacchiuatl, and
El Chichón, and frequent earthquakes also
affect the landscape. The climate ranges from
arid desert in the northern plains to tropical
lowlands in the south.
O ver 80 percent of Mexicans are
mestizos—that is, of mixed Indian and
Spanish ancestry, based on genomics, while
European and indigenous ancestr y are
approximately even. Spanish is the official
language. Only 1.5 percent of Mexicans speak
a single Indian language, mostly Nahuatl.1
Mexicans and
Central Americans
Hispanics are the largest non-European ethnic group in the United States, representing 17 percent of the total
population. Yet they are not a single cultural
group, coming from more than twenty-five
Latin American nations with diverse ethnic
populations. Though a majority share Spanish
as a common language of origin, others speak
English, French, Portuguese, or a native
Indian dialect as their mother tongue.
Immigrants from Mexico and the coun-
tries of Central America bring a rich cul-
tural history (see Figure 9.1). The Olmec
culture, known for its sophisticated sculp-
ture, existed in southeastern Mexico as early
as 1200 bce. The great Aztec, Mayan, and
Toltec civilizations thrived while Europe was
in its Dark Ages. Their independent mas-
tery of astronomy, architecture, agriculture,
and art astonished later explorers. Spanish
occupation of Mexico and Central America
introduced new ideas and traditions, most
notably Roman Catholicism; British, French,
and Austrian intrusions also provided minor
contributions. The foods of Mexico and Cen-
tral America reflect the native Indian and
European heritage of the region. This chap-
ter examines Mexican cuisine and the food
habits of Americans of Mexican descent.
An overview of recent immigration from
Central America and the traditional fare is
also included. The following chapter reviews
9CHA
P
T
E
R
The terms Latino and
Latina describe men and
women, respectively,
who are originally from
Mexico, the Caribbean,
and Central and South
America. It suggests
culture of Latin heri-
tage, not exclusively of
Spanish background.
For example, Haitians
and Brazilians are both
Latinos but speak
French and Portuguese,
respectively. Hispanic
is preferred by some,
though there is no clear
definition of this term. It
can mean “born in Latin
America,” “ancestors
born in Latin America,”
“Spanish surnames,” or
“Spanish speaking.”
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2 3 8 M E X I C A N S A N D C E N T R A L A M E R I C A N S
Cultural Perspective
History of Mexicans in the United States
Immigration Patterns Mexican immigration
patterns have changed over the years since the
Mexican-American War clearly defined the
U.S.–Mexican border. Today, Mexicans living
in America and their descendants can be clas-
sified in the following groups: (1) Chicanos—
those who are born in the United States (from
the descendants of the wealthy Mexican
landowners who controlled the area from
California to Texas in the eighteenth and
early nineteenth centuries to the children of
the most recent arrivals), as well as those who
immigrated from Mexico and became U.S. cit-
izens; (2) Braceros—those who worked here
legally but remained Mexican citizens; and
(3) unauthorized migrants—those who enter
the country illegally. It should be noted, how-
ever, that use of identifiers may vary region-
ally or by generation. For example, many who
live in New Mexico prefer the terms Spanish
American or Hispano, while in Texas, Tejano
is popular.
Mexicans lived in what is now the Ameri-
can Southwest for hundreds of years before
the United States declared its independence
in 1776. Although they welcomed American
settlers, they soon found themselves out-
numbered, and their economic and political
control of the region weakened. At the end
of the Mexican-American War in 1848, the
75,000 Mexicans living in the ceded territories
became U.S. citizens.
Between 1900 and 1935, it is estimated
that 10 percent of the Mexican population,
approximately 1 million persons, emigrated
north to the United States. Then, during the
Great Depression, tens of thousands of unau-
thorized migrants, plus those admitted legally
under the 1917 contract labor laws, were repa-
triated and sent back to Mexico.
Gulf of MexicoNorthrthrt
Pacific
Ocean
BELIZE
EL SALVADORLVADORLV
GUATEMALA
HONDURAS
UNITED STATESTATESTA
NICARAGUA
COSTA RICA
PANAMA
MEXICO
Mexico
City CUBA
Figure 9.1
Mexico and Central America.
©
C
en
ga
ge
L
ea
rn
in
g
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C H A P T E R 9 2 3 9
After the Great Depression, the need for
cheap labor increased. The Bracero program
was created to meet this need. Thousands of
Mexicans were offered jobs in agriculture and
on the railroads. Following World War II, the
continued need for farm workers encouraged
additional immigration, resulting in a total
of over 4.5 million contracts (some individu-
als obtained multiple contracts over several
years) issued to Mexican nationals between
1942 and 1964. In the past thirty-five years,
Mexicans have been the largest single group of
legal immigrants to the United States.2
Current Demographics More than half of the
growth in the total population of the United
States between 2000 and 2010 was due to the
increase in the Hispanic population, with
Mexican Americans accounting for 75 per-
cent of the increase in the Hispanic commu-
nity. Population estimates from 2009 show
Mexican Americans in the United States (of
whom over 11.5 million were born in Mexico)
accounting for 59 percent of the Latino popu-
lation.3 The majority of Mexican Americans
live in California, Texas, and Arizona. How-
ever, the settlement pattern for new immi-
grants has changed since the 1990s, becoming
more nationwide as evidenced by Illinois
having over one and a half million Mexican
American residents.4 Eighty percent of the
immigrants from Mexico settle in U.S. cities
such as San Diego, Los Angeles, San Antonio,
and Chicago—and more recently, Dallas,
Houston, Las Vegas, Minneapolis, New York
City, and Phoenix.5 Many recent immigrants,
legal and unauthorized, settle in the urban
Latino neighborhoods called barrios.
Research on unauthorized Mexican immi-
grants suggests that approximately 8 million
were living in the United States in 2009.6
Economic pressures in Mexico have increased
the number of Mexican immigrants entering
the United States each year. Many are attempt-
ing to escape the life-threatening poverty
affecting many of the populace.
Socioeconomic Status Mexican Americans
occupy three main socioeconomic classes.
There are the migrant farmworkers, who
maintain a culturally isolated community;
the residents of the urban barrios, who also
are segregated from much of American
society; and a growing number of accultur-
ated middle-class Chicanos. Unauthorized
migrants tend to move in with family mem-
bers who already reside in the United States.
Usually, this is in a predominantly Latino
neighborhood where they can live incon-
spicuously among the residents while becom-
ing familiar with the American social and
economic systems. Specific data on Mexican
Americans are limited because they are often
grouped with data for all Hispanics.
Despite a rapidly growing Mexican
American middle to upper class, many Amer-
icans of Mexican descent have low median
incomes and more than 25 percent of fami-
lies fall below the poverty level. This is due in
part to a disproportionate number of Mexican
Americans employed in unskilled or semi-
skilled labor. Although some work in agricul-
tural jobs, more than 27 percent are employed
in manufacturing or service occupations.
Approximately 20 percent hold professional
or managerial positions. The skill level is ris-
ing with increasing education. Eighty percent
of Mexican Americans graduate from high
school, compared to 60 percent for adults who
were born in Mexico.6
Worldview
Mexican Americans and unauthorized
migrants frequently live in culturally homo-
geneous communities. Many proudly main-
tain their ethnic identity, speaking Spanish
and enjoying Mexican music and food. The
concept of la raza (meaning “the people”)
was first promoted in the 1960s as a pride and
solidarity movement for all persons of Latin
American heritage.
When exposed to the mainstream
American society, however, immigrants
from Mexico can be highly adaptive. Some
Chicanos are completely assimilated. They
may speak no Spanish and consider them-
selves white or simply American. Others are
successfully bicultural. Cross-cultural mar-
riages are becoming more common, especially
in the northern regions of the United States.
Religion Approximately 61 percent of Ameri-
cans of Mexican descent are Roman Catholics,
The terms Chicano and
Chicana, for men and
women, respectively,
came from the Aztec
word for Mexicans,
Meshicano.
Some immigrants from
Mexico seeking migrant
agricultural jobs are
Mexican Indians (mostly
Mixtecos from Oaxaca),
who speak neither
English nor Spanish.
The 2011 Canadian
Census listed more than
381,280 residents of Latin
heritage, which repre-
sents 5 percent of the
Canadian population.
When a girl turns fifteen
years old, her family
hosts a quinceañera, an
elaborate coming-out
party with music, feast-
ing, and dancing.
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2 4 0 M E X I C A N S A N D C E N T R A L A M E R I C A N S
which is less than the percentage found in
Mexico (81 percent). Traditional religious cer-
emonies, such as baptism, communion, con-
firmation, marriage, and the novenas (nine
days of prayer for the deceased), are important
family events (see Chapter 4).
A strong faith in the will of God influences
how many immigrants from Mexico perceive
their world. Many believe they have no direct
control over their own fate. Nearly all Mexican
Americans who are not Catholic practice
Protestant faiths. Evangelical churches are
particularly popular in urban areas.
The Mexican American Family The most
important social unit in this community is the
family. In contrast to American majority soci-
ety, the well-being of the family comes before
the needs of the individual.
The father (or eldest male relative) is typi-
cally the head of the household. He is the
primary decision maker and wage earner.
Machismo, roughly translated as “manhood,”
is the word for the pride and self-worth a man
feels when fulfilling his obligations and duties
to his family and community. In traditional
Mexican culture the wife is a homemaker, the
person who provides all child care and holds
the family together. Women are expected to
be subservient to their husbands. In America,
however, this role is changing. One-half of
Mexican American women work outside the
home, are responsible for household manage-
ment, and are likely to be involved in family
decisions. Men rarely increase involvement
in chores as women increase their hours of
employment. Some women find that their
new roles are occasionally in conflict with
their self-concept as mother and caregiver.
Children are cherished in the Mexican
American family. Families are typically large
among new immigrants and first-generation
families, but research suggests lower rates of
marriage and improvements in educational
attainment and socioeconomic status for
women of subsequent generations result in
the birth of fewer children and smaller fami-
lies.8 Children are taught to share and to work
together; sibling rivalry is minimal. When pos-
sible, an extended family is the preferred living
arrangement for many Mexican Americans.
Grandparents are honored and are often
involved in child care. Because of space limita-
tions in the United States, however, many elders
live in separate apartments. During periods of
hardship, other relatives such as aunts, uncles,
and godparents willingly accept the care of
children. Girls were traditionally raised differ-
ently from boys and were kept at home to learn
household skills; they were carefully chaper-
oned in public. Although such strict supervi-
sion diminished with successive generations
born in the United States, family expectations
may limit the educational and professional
attainments of some young women.
Traditional Health Beliefs and Practices Tradi-
tional health care in Mexico includes elements
of Indian supernatural rituals combined with
European folk medicine introduced from
Spain. Beliefs and practices are closely inter-
related with the culture, resulting in a health
system widely shared throughout Latin
America. Most Mexican Americans are famil-
iar with the conditions specific to the culture,
and many use the traditional cures.
Health is a gift from God, and illness is
almost always due to outside forces (unless
one is being punished by God for one’s sins).
An individual must endure illness as inevi-
table. Prayer is appropriate for all illness, and
beseeching the saints for intervention through
the lighting of candles on behalf of a sick per-
son is common. Pilgrimages may be made to
religious shrines, especially those devoted to
the Virgin Mary or St. Francis.
Health care is traditionally sought from
a hierarchy of healers.8,9 Treatment is first
discussed with señoras or abuelas—mothers,
grandmothers, wives, or older female neigh-
bors who are the health experts in each family.
Home remedies, especially teas and over-the-
counter remedies such as Pepto Bismol, Alka
Seltzer, and Vicks Vapo-Rub, are nearly always
tried first before outside help is sought.8
Laxatives and enemas are common. If a cure
is not found, a yerbero (herbalist), sobador
(massage therapist or occupational therapist),
or a patera (midwife who also specializes in
the care of small children) may be consulted.
Traditional herbal remedies, homeopathic
cures, and amulets are available at pharmacies
Aztec medicine was a
highly developed system
featuring an elite group
of certified practitioners
with access to a zoo and
a herbarium for research.
It was abolished during
the Spanish conquest.
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C H A P T E R 9 2 4 1
called botánicas.10 Therapeutic items may also
be sold at religious fiestas.
When an ailment is unresponsive to
these cures, the services of a healer known
as a curandero (or curandera if the healer is
female) are sought. Curanderos are esteemed
members of each community who see patients
without an appointment and customarily do
not charge for their services, though they
may accept gratuities.11,12 Their healing pow-
ers may be God-given at birth, learned, or
received through a calling.13 Curanderos are
sought for a broad range of complaints, such
as marital problems, infertility, alcoholism,
and business failure, as well as for specific ill-
nesses, including diabetes and cancer. They
are important in diagnosing the underlying
causes of a condition, which may be natural or
supernatural in nature. Thus, diabetes in a cli-
ent may be due to lifestyle and diet, amenable
to biomedicine, or it may be due to evil spirits
or witchcraft, in which case biomedicine is
ineffective.11 Curanderos specialize in somatic
ailments and are essential to curing illnesses
due to supernatural causes. In regions where
witchcraft is practiced, a curandero can coun-
teract the hexes or spells of a brujo (a person
who works on behalf of the devil). Faith is
crucial to the success of a curandero. Prayer
is his or her primary treatment; the lighting
of candles or the use of wood or metal effi-
gies formed in the shape of the afflicted body
part (called milagros or exvoto) may also be
used. Cleansing rituals are applied in certain
conditions.
Illness is believed to be due to (1) exces-
sive emotion, (2) dislocation of organs,
(3) magic, (4) an imbalance in hot or cold,
or (5) an Anglo disease, such as pneumonia
and appendicitis.13 Treatment is based on the
cause of the disorder.
Susto is an ailment considered due to
excessive emotion—such as smoldering anger
or shame—usually associated with a specific
event. The response may be physical, physi-
ological, or psychological, and symptoms
include anxiety, depression or sadness, lack
of appetite, paleness, shaking, headaches, bad
dreams and too much sleep, and ennui.10,14,15
A type of susto known as espanto, which
occurs when an individual is so frightened
by a ghost that the soul leaves the body, is
the most typical form of the disorder. Susto
is considered a serious condition, associ-
ated with other illnesses such as epilepsy and
infectious diseases. Mild susto is sometimes
treated at home with sugar or sugar water.
More serious susto, particularly when the soul
is involved, must be cured by a curandero and
may require lengthy treatment. Susto is also
believed to be a cause of nervios, a condition
affecting primarily adult women (nervios may
also cause susto). Symptoms include crying
attacks, sleep problems, headache, trembling,
sadness or hopelessness, ill-temper, lack of
appetite, stomachache, feeling of choking,
chills, itching, and general body ache. Nervios
responds best to sedatives (provided by a bio-
medical physician), prayer, or massage. Unlike
susto, nervios cannot be cured by a traditional
healer. Nervios is often a chronic condition in
response to poor diet, alcoholism, drug use,
or other underlying health behaviors. Some
Mexicans believe that nervios can cause dia-
betes if not cured.
Feeling too much rage and suffering from
revenge fantasies can result in bilis, a condi-
tion where excess bile is thought to spill into
the blood, causing symptoms such as loss of
appetite, vomiting, headaches, nightmares,
and inability to urinate. Envidia is another
ailment taking the form of various illnesses
(some terminal) caused by the emotion of
envy among one’s friends and neighbors.
A person’s success may be tempered by the
misfortune of envidia.
A problem caused by the displacement
of organs in infants is caida de la mollera, or
fallen fontanel. It occurs from a fall, yanking
the nipple out of a baby’s mouth too quickly,
or holding a baby vertically when it is too
young. The fontanel appears depressed, and
the palate is believed to drop, preventing the
infant from feeding. The inability to suckle
and a change in stools are symptoms, and
serious weight loss may occur. Tight caps on
the infant can help prevent the condition, and
the application of salt poultices or olive oil
(followed by a dip in water accompanied by
prayers) may be used to treat it. The baby may
be held upside down and shaken gently, the
hair pulled, the fontanel sucked, or the palate
Studies report that susto
is associated with an
increased risk for other
illnesses and a higher
mortality rate.158
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2 4 2 M E X I C A N S A N D C E N T R A L A M E R I C A N S
pressed up with a finger or thumb to reposi-
tion the fontanel.
Mal de ojo (evil eye) is a condition with
supernatural origins. Children are consid-
ered especially vulnerable to the ailment,
which has flulike symptoms, including fever
and headache. It is caused when one per-
son, usually inadvertently, casts a strong,
admiring look on another person. Irrational
behavior and mental disabilities are often
attributed to mal de ojo. This condition can
result in death, so prompt diagnosis and cure
are imperative. A curandero is required for
treatment. A cleansing ritual is performed
that includes sweeping over the ill individual
with an egg, then breaking the egg into a sau-
cer. The egg is read to see whether the cure
has been effective. It may be read immedi-
ately or left under the bed overnight before
examination. Prayers, herb teas, and sweep-
ing with herb bundles may also be part of the
treatment. Mal aire (bad air or wind) may
cause headaches and colds,10 and mal puesto
(witchcraft) accounts for certain other disor-
ders, such as swelling, trembling, or paralytic
twitching.
Empacho, a digestive ailment character-
ized by nausea, gas, and weakness, is widely
known throughout Latin America. Empacho
is sometimes classified as an illness due to
eating too many hot or cold foods, or a
hot–cold imbalance in the stomach due
One researcher has
shown that some
Mexican dishes reflect
Islamic culinary traditions
(which arrived via
Spain), such as aromatic
nut-thickened sauces,
fruit pastes, and sugar
figurines (see Chapters 6
and 13).159
The scientific name
for the cacao tree is
Theobroma, meaning
“food of the gods.”
Chile (with an e) comes
from the Nahuatl word
chilli. Foods like the pow-
ders, sauces, and stews
made with chile peppers
are conventionally called
chili (with an i).
to emotional upset (see the “Therapeutic
Uses of Food” section in this chapter). The
direct cause is believed to be a ball or wad of
food adhered to the stomach. Herb teas are
administered at home, and if they are inef-administered at home, and if they are inef-administered at home, and if they are inef
fective, a curandero is employed. Treatment
consists of prayer, pinching the spine, and
stomach massage to restore a proper hot–
cold balance.
Traditional Food Habits
Mexicans are very proud of their culinary
heritage, which is a unique blend of native
and European foods prepared with Indian
(mostly Aztec) and Spanish cooking tech-
niques. There are even some French and
Viennese influences from the Maximilian
reign. The resulting cuisine is both spicy and
sophisticated.
Ingredients and Common Foods
Many people associate the cooking of Mexico
with chile peppers. Although chile peppers
are used frequently, not all Mexican dishes
are hot and spicy. Other New World foods
such as beans, cocoa (from the Aztec word
for “bitter”), corn, and tomatoes add equally
important flavors to the cuisine. These indig-
enous ingredients were the basis of Indian fare
throughout Mexico before the arrival of the
Spanish.
Aztec Foods The Aztec Empire had an esti-
mated population of 25 million people at its
peak in the fifteenth century. About one-
quarter of the population was an elite class of
nobles supported by the remaining 75 percent
of the Indian slave populace. The capital city
of Tenochtitlán was surrounded by lakes on
which were built chinampas, rich agricultural
fields of mud scooped from the lake bottoms.
These drought-resistant fields are believed to
have produced enough food to feed 180,000
people annually. The monarchy stored surplus
crops to protect against famine. The Aztecs
were also known for their animal husbandry
and game protection laws.
Documents from early Spanish expedi-
tions recorded in glowing terms the enormous
variety of foods enjoyed by the Aztec nobil-
ity.16 More than 1,000 dishes are described.
▼ Traditional Latin
American foods. Some
typical foods include achiote,
avocado, bacalao, black
beans, cassava (yucca),
chile peppers, cilantro, corn
tortillas, jícama, papaya,
plantains, pinto beans, pork,
tomatillos, and tomatoes.
Ra
gn
ar
S
ch
m
uc
k/
fS
to
p/
Co
rb
is
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C H A P T E R 9 2 4 3
Montezuma II reportedly ate up to thirty dif-Montezuma II reportedly ate up to thirty dif-Montezuma II reportedly ate up to thirty dif
ferent items per meal, each kept warm on a
pottery brazier. These items included roast
turkey, quail, and duck; fish, crab, lobster, frog,
turtle, newt, and insect dishes garnished with
red, green, or yellow chiles; squash blossoms;
and sauces of chiles, tomatoes, squash seeds,
or green plums.17 Chocolatl, a hot, unsweet-
ened chocolate drink made from native cacao
beans, was the most popular beverage.
Corn was the staple grain. Legumes, fruits,
and vegetables were plentiful; turkeys and
dogs were domesticated for meat; and some
game was available, including deer, peccary,
and rabbits. The notable deficiency of the
Aztec diet was a consistent source of fat or oil,
and the average Indian ate a mostly vegetarian
diet of corn and beans.16
Spanish Contributions The Spanish arrived
in Mexico with cinnamon, garlic, onions,
rice, sugarcane, wheat, and, most impor-
tantly, hogs, which added a reliable source
of domesticated protein and lard to the
native diet. These additions combined with
indigenous ingredients produce the classic
flavors and foods of Mexican cuisine, such
as corn tortillas with pork filling; tomato,
chile, and onion sauces or salsas; rice and
beans; and panfried boiled beans, known
as frijoles refritos, or, as they are incorrectly
called in English, refried beans. The Spanish
also introduced the distillation of alcohol to
native Mexican fermented beverages; tequila
and mescal were the result.
Staples The cuisine of Mexico is very diverse,
and many inaccessible regions have retained
their native diets. Others have held on to tra-
ditional foods and food habits despite Aztec
or Spanish domination. The diets of still other
areas differ because of the availability of local
fruits, vegetables, or meats. The majority of
poor Mexicans have little variety in their diet;
some subsist almost entirely on corn, beans,
and squash. This divergence makes it difficult
to typify Mexican foods in general (Table 9.1).
Nevertheless, some foods are found, in vary-
ing forms, throughout Mexico.
Tortillas are the flat bread of Mexico.
Traditionally they are made by hand. Corn
kernels are heated in lime solution until the
skins break and separate. The treated ker-
nels, called nixtamal, are then pulverized on a
stone slab (metate). The resulting flour, masa
harina, is combined with water to make the
tortilla dough. Small balls of the dough are
patted into round, flat circles, about six to
eight inches across. The tortillas are cooked
on a griddle (often with a little lard) until soft
or crisp, depending on the recipe.
Beans are ubiquitous in Mexican meals.
They are served in some form at nearly every
lunch and dinner and are frequently found
at breakfast, too. They are often the filling in
stuffed foods and are common in side dishes,
such as simmered frijoles de olla (“out of the
pot”) and frijoles refritos.
One-dish meals are typical, almost always
served with warm tortillas. Hearty soups or
stews called caldos are favorite family din-
ner entrées. Casseroles known as sopas-secas,
using stale tortilla pieces, rice, or macaroni,
are eaten as main dishes. Stale tortillas can
also be broken up and softened in a sauce to
make chilaquiles, which are served as a side
dish or light entrée. They can also be soaked
in milk overnight, and then pureed to make
a thick dough. This dough is used to prepare
gordos, which are fat-fried cakes, or bolitos,
which are added to soup and are similar to
dumplings.
Meats are normally prepared over high
heat. They are typically grilled, as in carne
▼ Handmade tortillas,
made from masa harina
(a type of cornmeal) or
wheat flour, are the staple
bread of Mexico. In this pho-
tograph, taken in a tortilla
factory, the lime-soaked
corn kernels are pulverized
on a stone metate. Below, a
tortilla is patted into a flat
circle by hand.
iS
to
ck
ph
ot
o.
co
m
/R
ob
er
t I
ng
el
ha
rt
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2 4 4 M E X I C A N S A N D C E N T R A L A M E R I C A N S
Group Comments Common Foods Adaptations in the United States
Protein Foods
Milk/milk products Few dairy products are
used (incidence of lactose
intolerance estimated at
two-thirds of the population).
Dairy products are used more
in northern Mexico than in
other regions.
Milk (cow, goat), evaporated milk, café con
lèche, hot chocolate; atole; cheese
Aged cheese is used in place
of fresh cheese; more milk
(usually whole) is consumed;
ice cream is popular.
Meat/poultry/fish/
eggs/legumes
Vegetable protein is the
primary source for majority of
rural and urban poor.
Pork, goat, poultry are common
meats. Beef is preferred in
northern areas and seafood in
coastal regions.
Meat is usually tough, prepared
by marinating, chopping,
grinding (sausages are
popular), or slicing thinly. It
is cooked by grilling, frying,
stewing, or steaming, and is
usually mixed with vegetables
and cereals.
Meats: beef, goat, pork (including
chicharrónes and variety cuts)
Poultry: chicken, turkey
Fish and seafood: camarónes (shrimp),
huachinango (red snapper), other firm-
fleshed fish
Eggs: chicken
Legumes: black beans, chickpeas (garbanzo
beans), kidney beans, pinto beans
Traditional entrées remain
popular. Fewer variety cuts
are used. Protein intake
may decline in second-
generation Mexican
Americans.
Beans are eaten less
frequently.
Cereals/Grains Corn and rice products are
used throughout the country;
wheat products are more
common in the north.
Principal bread is tortilla;
European-style breads and
rolls are also popular.
Corn (masa harina, pozole, tortillas); wheat
(breads, rolls, pan dulce, pasta); rice
Wheat tortillas are used
more than corn tortillas;
convenience breads are
used.
Increased consumption
of baked sweets, such
as doughnuts, cake, and
cookies, is noted.
Increased consumption
has occurred of sugared
breakfast cereals.
Fruits/Vegetables Vegetables are usually served as
part of a dish, not separately.
Semitropical and tropical fruits
are popular in most regions
(limited availability in north).
Fruits: bananas, carambola, casimiroa,
cherimoya, coconut, custard apple,
granadilla (passion fruit), guanábana,
guava, lemons, limes, mamey, mangoes, mamey, mangoes, mamey
melon, oranges, papaya, pineapple,
strawberries, sugarcane, sweet sop, tuna
(cactus fruit), zapote
Vegetables: avocados, cactus (nopales
or nopalitos), calabaza criolla (green
pumpkin), chile peppers, corn, jícama,
lettuce, onions, peas, plantains, potatoes,
squashes (chayote, pumpkin, summer,
etc.), squash blossoms, sweet potatoes,
tomatillos, tomatoes, yams, yuca (cassava)
Fruit remains popular
as dessert and snack
item; apples and grapes
are accepted after
familiarization.
Additional Foods
Seasonings Food is often heavily spiced; 92
varieties of chiles are used.
Regional sauces are typical.
Anise, achiote (annatto), chiles, cilantro
(coriander leaves), cinnamon, cocoa,
cumin, epazote, garlic, hoja santa, mace,
onions, vanilla
Use of spices depends on
availability.
TA B L E 9.1 Cultural Food Groups: Mexican
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C H A P T E R 9 2 4 5
asada (beef strips), or fried, as in chicharrónes
(fried pork rind). Slow, moist cooking (stew-
ing, braising, etc.) may also be used. These
techniques help tenderize the tough cuts that
are generally available, as does marinating,
another common preparation method. Nearly
all parts of the animal are used, including the
variety cuts and organs. Sausage, such as spicy
pork or beef chorizo, is especially popular.
Mexico is famous for its stuffed foods, such
as tacos, flautas, enchiladas, tamales, quesadil-
las, and burritos. These are found throughout
the country, with regional variations. Tacos are
the Mexican equivalent of sandwiches. Torti-
llas, either soft or crisply fried, are filled with
anything from just salsa to meat, vegetables,
and sauce. Flautas (“flutes”) are a variation on
the taco, with tortillas tightly rolled around
the filling, then fried until crispy. They may
be served with a red or green chile sauce or
guacamole. Enchiladas are tortillas softened
in lard or sauce and then filled with meat,
poultry, seafood, cheese, or egg mixtures.
The tortilla rolls are then baked covered with
sauce. Tamales are one of the oldest Mexican
foods, dating back at least to the Aztec period.
Dough made with either masa harina or left-
over pozole (hominy) is placed in corn husks
(in the north) or young leaves of avocados or
bananas (in the south). The leaves are folded
and then baked in hot ashes or steamed over
boiling water. The tamale may be plain, filled
Corn is believed to have
been domesticated from
extinct wild varieties in
southern Mexico some-
where between 8000 and
7000 BCE. It spread south
into Central America and
north into what is now
the United States.
with a meat or vegetable mixture, or sweet-
ened for a dessert (tamales dulce). After
cooking, the husk or leaf is unfolded, reveal-
ing the aromatic tamale. Quesadillas are tor-
tillas filled with a little cheese, leftover meat,
sausage, or vegetable, then folded in half and
heated or crisply fried. Burritos are popular
in northern Mexico. They are similar to tacos,
but large, thin, wheat flour tortillas—instead
of corn tortillas—are folded around a filling
such as beans with salsa.
Vegetables are usually part of the main dish
or served as a substantial garnish. Potatoes,
greens, tomatoes, and onions are most com-
mon. Chile peppers are used extensively in
seasonings and sauces, and are stuffed, as in
chiles relleños and the Independence Day dish
chiles en nogada, garnished with the colors of
the Mexican flag—white sauce, green cilantro,
and red pomegranate seeds.
Sugarcane grows well in Mexico, and
sweets of all kinds are popular. Dried fruits
and vegetables, candied fruits and vegetables,
and sugared fruit or nut pastes are eaten alone
and used in more complex desserts. The
Spanish make many desserts with eggs, and
some of these recipes have been adopted in
Mexico. Flan, a sweetened egg custard topped
with caramelized sugar, is the most common.
Huevos reales is another popular dessert,
made with egg yolks, sugar, sherry, cinna-
mon, pine nuts, and raisins. Dulce de leche is
Group Comments Common Foods Adaptations in the United States
Nuts/seeds Seeds are often used in
flavoring.
Piñons (pine nuts), pepitas (pumpkin
seeds), sesame seeds
Beverages Atole, beer, coffee (café con lèche), hot
chocolate, soft drinks, pulque, mescal,
tequila, whiskey, wine
Noted are increased
consumption of fruit juices,
Kool-aid, soft drinks, and
beverages with caffeine;
and decrease in use of hard
spirits.
Fats/oils Traditional diet is relatively low
in fat.
Butter, manteca (lard) Fat intake increases, including
use of mayonnaise and salad
dressings.
Sweeteners Spanish-influenced pastries,
candies, and custards and
puddings are popular.
Sugar, panocha (raw brown cane sugar)
©
C
en
ga
ge
L
ea
rn
in
g
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2 4 6 M E X I C A N S A N D C E N T R A L A M E R I C A N S
Epazote, a pungent
herb with minty over-
tones, is added to many
dishes, especially those
with beans, because it
is thought to reduce
flatulence.
Menudo is a tripe and
hominy soup believed
to have curative prop-
erties, particularly for
hangovers. It is a popular
weekend breakfast dish.
made by boiling condensed milk down until
the sugars caramelize and it thickens. It is
used as a spread or hardened to make candy.
A similar, distinctive, Mexican specialty is
cajeta, made like dulce de leche but using
goat’s milk flavored with cinnamon. It is eaten
by itself as a pudding or used to top fresh fruit
or ice cream.
The most common beverage in Mexico
is coffee, which is grown in the south. Soft
drinks and fresh fruit blended with water and
sugar, called aguas naturales, are also favored.
Adults drink milk infrequently, except in
sweetened, flavored beverages such as hot
chocolate with cinnamon, or café con leche
(coffee with milk). The most popular alco-
holic beverage in Mexico is beer. The Mexi-
can wine industry is also developing rapidly,
in part due to a 1982 ban on the import of
foreign wine. Men may drink alcoholic bev-
erages at occasions when they gather socially.
In addition to tequila and mescal, whiskey is
typically served at these times.
Regional Variations
Mexican Plains The northern and central
regions of Mexico, nearly half the nation,
consist of mostly arid plains and high moun-
tain valleys. The Indians who originally
inhabited the area were called Chichimecs
(“sons of the dog”) by the Aztecs because
of their seminomadic lifestyle. Their diet
probably consisted of corn, beans, squash,
greens, cactus fruit (tuna), and young cac-
tus leaves (nopales). They also hunted small
game and ate domesticated poultry, such as
turkey. When the Mexican Indians mixed
with the Indians of the American Southwest,
they adopted piñons (also called pine nuts or
pignolis), pumpkin, and plums. Some special-
ties of the region, such as hominy-based stews
known as pozoles and salads made with sliced,
cooked nopales, reflect this history. Due to the
limited variety of foods available, traditional
preparations emphasize the natural flavors of
the ingredients; and sauces, when used, fea-
ture simple seasoning.
The Spanish introduced longhorn cattle to
the northern plains, as well as dairy cows and
wheat. It is the only area in Mexico where beef
is frequently consumed, often served as steaks
or in stews. Another favorite way to prepare
beef is to air-dry it in thin slices called cecinas,
which are similar to American chipped beef
but more assertive in flavor. Cecinas can be
used in stews or soups; they can be fried or
used as fillings for other foods. In Chihuahua,
beef is shredded and then fried to make a
snack known as móchomos. Goat and sheep
are also raised. Spit-roasted kid, cabrito al
pastor, is served in the Monterrey area, and
birria—kid or lamb stewed in a sauce fla-
vored with roasted chiles and vinegar—is
a specialty in Guadalajara. This area is also
known for barbacoa, a method of pit-roasting
meats that are first wrapped in maguey leaves
(see below). Cow cheeks (or more tradition-
ally, the whole head) and kid are commonly
prepared this way in the more northern sec-
tions, while in the more central regions lamb
is preferred.18
In the Baja peninsula and along the Gulf
of California and Gulf of Mexico coasts, fish
is important in the diet. Huachinango, red
snapper, is a specialty, cooked in orange sauce,
used as a filling in tacos, or served chilled,
marinated in vinegar with onions and chiles.
Shark is found on the eastern coast, shredded
A large variety of chile
peppers are used in Mexican
cuisine, providing complexity
of flavor, heat (very mild
to incendiary), and color
(yellow, orange, red, green,
brown, and black).
▲
N
at
io
na
l G
eo
gr
ap
hi
c
Im
ag
e
Co
lle
ct
io
n/
A
la
m
y
Placement of a worm
from the maguey
plant in a bottle of
mescal or tequila—
supposedly a signature
of authenticity—was
actually begun as a
marketing gimmick.
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C H A P T E R 9 2 4 7
and layered between tortillas and beans in
the dish from Campeche known as pan de
cazón.19 Shrimp and clams are other favorites.
In the more inland areas, fish from freshwater
lakes are available, such as pescado blanco, a
small whitefish that is popularly served fried
or added to soups.
Cheese (see Table 9.2) is more common in
the north than in other parts of Mexico, and
one specialty is queso flameado (called queso
fundido in the Guadalajara area), which is a
fondue-like dish sometimes topped with cho-
rizo crumbles and served with fresh tortillas
and salsa. Wheat products are more popular
as well, particularly wheat tortillas.
A very popular dessert of northern Mexico
is buñuelos, which may be made at home or
purchased at street stands. Circles of sweet
pastry dough are fried until they slightly puff.
They are eaten fresh, sprinkled with sugar
and cinnamon, or broken up and added to
hot cinnamon-laced syrup. Café con leche is
a common accompaniment to buñuelos.
The sap of the maguey cactus (century
plant) is credited with being a reliable substi-
tute for fresh water in the arid countryside; it
is called aguamiel or “honey water.” Tequila
is probably the best-known beverage of the
region, made from the distillation of fer-
mented aguamiel, known as pulque. Pulque
is the sour, mildly alcoholic beverage that was
drunk throughout Mexico before the arrival
of the Spaniards. The Spaniards, lacking grain,
tried their distillation methods on pulque,
producing mescal, a harsh brew. Tequila is
the more refined, twice-distilled version of
mescal. It is produced in the central-western
state of Jalisco around the towns of Tequila
Fresh: Unripened cheeses that do not melt, but soften when heated. Often used in stuffed foods and as a garnish on
top of dishes.
Queso blanco Crumbly cow’s milk cheese similar to a soft, dry, fresh mozzarella. Sometimes made
by using lemon juice to coagulate the milk, providing a distinctive flavor. Sold
commercially in blocks.
Queso fresca A fine-grained, creamy farmer’s cheese or pot cheese. Sometimes called queso
metate when formed in a traditional stone grinder. Often made daily in homes;
sold commercially in small rounds.
Queso panela A salty, semisoft white cheese formed in small baskets that leave an imprint. Is often
served cubed or sliced with chorizo sausage or guava paste.
Ranchero seco Drier version of queso fresco with much stronger flavor (similar to Romano); curds
are broken apart and remolded during processing. Used grated over foods.
Requesón Milky, ricotta-like cheese good for fillings, spreads, and desserts.
Soft: Smooth, aged cheeses that melt well when heated, often used for baked dishes.
Queso añejo Aged queso fresco that is firm and salty, similar to feta.
Queso asadero Buttery, mild cheese that tastes like Provolone but with the slightly stringy texture
of aged Mozzarella; used in queso flameado.
Queso Chihuahua Mild, cheddar-like yellow cheese formed in large wheels, introduced by
Mennonites in the farming communities of Chihuahua.
Queso Oaxaca Tangy string cheese from the city of Oaxaca. Sold in balls.
Firm: Semihard or hard aged cheeses, often eaten thinly sliced or added for flavoring to dishes.
Queso añejo
enchilada
Strong, salty cheese made from longer-aged añejo, coated with spicy ground chiles.
Queso Cotija Sharp goat’s milk cheese that is crumbled over beans or salads, sometimes called
“Mexican Parmesan.” From the Michoacan city of Cotija.
Queso Manchego Spanish-style, full-bodied, hard cheese that is served shaved with fruit or eaten with
snacks, beer, or other drinks.
TA B L E 9. 2 Traditional Mexican Cheeses
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2 4 8 M E X I C A N S A N D C E N T R A L A M E R I C A N S
and Tepatitlan from the maguey subspecies
Agave tequiliana.
Tropical Mexico The southern coastal areas
of eastern Mexico include hot lowlands and
tropical forests. Seafood and freshwater fish
are prominent in the cuisine. Red snapper
with a Spanish-influenced sauce of tomatoes,
garlic, onions, olives, capers, and chiles, called
Huachinango a la Veracruzana (“from Vera-
cruz”), is a specialty. Arroz a la Tumbada, rice
cooked and seasoned with tomatoes and gar-
lic, topped with fresh fish, shrimp, octopus,
crabs, and clams, is another favorite. It is often
served in individual clay pots. Tamales and
tostadas stuffed with shrimp are also popular.
One unusual food enjoyed in some areas is
black iguana.20
Tomatoes, green tomato-like tomatil-
los, chayote squash, onions, jícama (a sweet,
crispy root), bananas and starchy plantains,
carambola (star fruit), cherimoya (custard
apple), guanábana (soursop), guava, mamey
(a type of plum), mango, pineapple, yucca
(a tuber also called cassava or manioc), and
zapote (the fruit of the sapodilla tree) are just
a small sampling of the produce available in
this area. Avocados are also cultivated. They
vary in size from two to eight inches across,
in skin color from light green to black, and in
flavor from bland to bitter. Their succulent,
smooth flesh is added to soups, stews, and sal-
ads. They are most popular in guacamole—
mashed avocado with onions, tomatoes,
chile peppers or ground chiles, and cilan-
tro, the pungent leaf of the coriander plant.
Guacamole is used as a side dish, a topping,
or a filling for tortillas.
More than ninety varieties of chile peppers
are found in the region, varying enormously
in degree of hotness (see Figure 9.2). In gen-
eral, the smaller the chile the hotter it is, and
each variety develops more heat as it ripens.
The heat also intensifies when it is dried.
Some of the more common varieties include
ancho (dried, red-ripened poblano chiles),
chilaca (thin, ribbed, dark green chiles which
are often cut into very thin strips after roast-
ing), chipotle (dried, smoked jalapeño chiles),
de arbol (long, very thin, curved green or red
chile used fresh and dried), guajillo (long,
thin, dark red chile used primarily dried),
habañero (lantern-shaped, yellow, orange, or
dark red, added fresh to sauces but removed
before serving, or roasted and chopped into
dishes), pasilla (dried chilaca chiles), jalapeño
(short, three-inch chiles with smooth green or
red skin and blunt end, used fresh in salsas
and sauces, or sliced and pickled), mulato
(dried chile with very dark brown, wrinkled
skin, and sweet overtones, often used to make
moles—see below), pequin (tiny, oval chiles
used whole in stews, added pureed in sauces,
soups, salsas, or pickled as a table condiment),
poblano (large, heart-shaped, black-green
chiles that are often stuffed), and serrano
(small, two-inch dark green or red, torpedo-
shaped chiles that are often chopped to add
zest to salsa and cooked dishes or sliced and
pickled, known as escabeche).
Yucatán The cuisine of the Yucatán penin-
sula reflects its unique history. It was isolated
from the rest of the country by dense, moun-
tainous jungles until modern times. Many of
the residents are descendants of the Mayans,
the early Indian dynasty of the region. Some
regional favorites date from this time. For
example, one popular preparation method
is to steam foods wrapped in banana leaves,
called píbil. Traditionally, food was cooked
this way in an outdoor pit, but today it is pre-
pared more often in a covered pot. Salbutes,
small corn tortillas (some made with black
bean paste so that they are black in color), are
often fried until they puff, then layered with
lettuce or cabbage, tomato, onion, bell pepper,
and píbil-cooked meats. In some versions the
black beans are stuffed inside the pocket of
the puffed tortilla, in which case the treat is
known as panucho.
Citrus fruits flavor some dishes of the
region. For example, in the recipe for chicken
píbil, the poultry is marinated in sour orange
juice, garlic, and cumin before steaming.
A popular sliced pork dish, poc chuc, also uses
sour orange juice to tenderize the meat before
grilling. Bitter lime juice is featured in a spe-
cialty of the area called sopa de lima, a chicken
and vegetable soup made with bits of fried
tortillas. Lime juice is also found in frijoles
con puerco, a traditional dish of black beans
Avocado comes from
the Nahuatl word for the
fruit, ahuactl, meaning
“testicle,” which avocados
resemble while hanging
from the tree.
The chemical heat of
chiles comes from the
alkaloid capsaicin, found
mostly in the fleshy ribs
and seeds inside the fruit.
One theory as to why
eating chiles is pleasur-
able is that capsaicin may
cause the body to release
pain-killing endorphins
in reaction to the irrita-
tion, creating a comfort-
able, gratified feeling.
Achiote is called annatto
in the United States.
Made from the seeds of
a tropical tree, achiote is
sometimes used to color
cheddar-style cheeses,
ice creams, margarine,
and some baked goods.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 9 2 4 9
with pork served weekly in most homes of the
region. Some foods are pickled in citrus juice,
including vegetables such as onions, and other
items, including fish and oysters. Achiote is
the other hallmark seasoning of the region,
a bright red, nutty-flavored seed mixed with
sour orange juice and mild spices to make a
flavorful paste called recado colorado, used to
coat foods before cooking.
Shrimp are a local specialty; the long coast-
line of the Yucatán along the Gulf of Mexico
provides ample seafood. Grouper with recado
baked in banana leaves is one example, and
fish soups are also common. Eggs are promi-
nent, served with tortillas, black beans, cheese,
tomato sauce, and fried plantains, or wrapped
in tortillas and served with a pumpkin seed
sauce. Sauces of the region are often thickened
with toasted squash seeds.
Southern Mexico The foods of southern
Mexico are similar to those of the Yucatán in
that they are more tropical and more Indian-
influenced than the foods of other regions.
Cacao trees are cultivated in this area, and
chocolate flavors both savory and sweet
dishes. In particular, the renowned sauces of
the region, moles (probably from the Aztec
word for “sauce with chiles,” molli), some-
times include unsweetened chocolate. Chiles,
tomatoes, nuts, raisins, sesame seeds, avocado
leaves, and seasonings are other typical ingre-
dients. The complex, spicy sauces are the base
for thick stews with added pork, beef, poul-
try, or game, though some recipes call for the
mole to be poured over the top of the meat.
In Oaxaca mole manchamanteles (meaning
“stew that stains the tablecloth”) is a deep-red
sauce with yams, pineapple, plantains, and
chicken or pork. Mole negro, another Oaxacan
specialty, includes dark-roasted chiles, black-
ened tortillas, and chicken. The best-known
mole in Puebla is poblano de guajolote, a
rich brown sauce served with turkey. Other
variations include mole amarillo (an orange-
colored sauce) and mole coloradito (a brick-
red version also known as mole roja). Mole
verde is yet another example, popular along
the coast, made with green chiles and tomatil-
los. Hoja santa (Piper sanctum), an herb with
a peppery, anise flavor, seasons the sauce—the
large leaves of the herb are also used to wrap
steamed and grilled foods in the region.
Poultry, goat, and pork are the most popu-
lar meats of the region. One favorite is pork
cut into thin strips and coated with ground
chiles to make cecina enchilada (a version of
the northern recipe above). It is frequently
served as a topping on crunchy, platter-sized
baked tortillas called tlayuda, which also
include layers of black beans (more popular
in the south than pintos), cabbage, salsa, tes-
ajo (thinly sliced beef ), asiento (bits of pork
skin fried in lard), chorizo, and cheese. Game,
such as venison and quail, are eaten in some
areas. One delicacy of the region is chapu-
lines, a grasshopper found in the cornfields.
They are panfried with chiles, garlic, salt, and
lemon juice and traditionally served with beer
or mescal.21
Figure 9.2
Scoville Scale of Hotness
for Selected Chile Peppers:
Scoville units, defined as
the amount of sugar water
needed to dilute chile
pungency to the point it no
longer burns the mouth,
is one measure of chile
hotness. It is a subjective
scale, and hotness may vary
within each variety due
to seed lineage, soil, and
climate, as well as taster
individuality. High pressure
liquid chromotography
(HPLC) is another measure,
but does not account for
differences in capsaicin
release properties, which
also affect chile heat.
PuPure Capsaicin
Habañero
Scotch Bonnet Scotch Bonnet
Tepin (wild)
Pequin
Cayenne
Ají
De Arbol
Serrano
Chipolte
Jalapeño
Guajillo
New Mexico
Anahei
Pasilla
Mulato
Ancho
Chilaca
Poblano
Pimento
Sweet Bell
15,000,000-16,000,000
150,000-577,000
150,000- 325,000
80,000-240,000
70,000-100,000
30,000-50,000
30,000-50,000
15,000-30,000
8,000-22,000
5,000-8,000
2,500-8,000
2,500-5,000
500-2,500
500-2,500
1,000-2,000
1,000-2,000
1,000-2,000
1,000-2,000
1,000-2,000
0
0
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2 5 0 M E X I C A N S A N D C E N T R A L A M E R I C A N S
Hot chocolate, coffee, atole (a warm bev-
erage of thin cornmeal and milk gruel) and
horchata, a sweetened rice-based drink, are
favorite beverages. Ice creams, including those
made with fresh vanilla bean, and fruit ices are
popular, as is chocolate flan.
Meal Composition and Cycle
Daily Patterns In families where income
is not limited, the preferred meal pattern is
four to five daily meals: desayuno (breakfast),
almuerzo (coffee break), comida or almuerzo
(lunch), merienda (late afternoon snack), and
cena (dinner). Most meals are eaten at home
and served family-style. If there are too many
people to sit at the table, each one is served
individually from the stove.
Desayuno is a quick, early breakfast, which
features pan dulce (sweet bread, pastry, or
cake) or fresh fruit, served with café con lèche.
Late morning is when almuerzo (similar to
brunch) is eaten, often including tortillas,
eggs, meat, beans left over from the previous
night, bolillos (wheat rolls), pan dulce, and
fruit. Coffee and hot chocolate are the pre-
ferred beverages.
Comida is traditionally the largest meal
of the day, traditionally eaten in the early
afternoon. A complete comida includes sev-
eral courses, individually served. Custom-
arily this would include a soup, a sopa-seca
(including items that would be considered
side dishes in the United States, such as sea-
soned rice), a main course, beans, salad, and
dessert. Today, the courses may be combined
or, often, fewer are served. For example, soup,
a sopa-seca, or a vegetable dish may precede
the entrée. When possible, an afternoon rest
period (siesta) follows this meal. Merienda is
a light meal of sweet rolls, cake, or cookies
eaten around 6:00 p.m. Coffee, hot chocolate,
or atole accompanies the sweets. Cena, a light
supper (often leftovers), follows between 8:00
and 10:00 p.m. This meal may be skipped
entirely or expanded into a substantial feast on
holidays or other formal occasions. Recently,
many Mexicans have adopted the American
habit of eating a light lunch (sometimes called
almuerzo) and a heavy supper, eliminating
merienda altogether.
Snacking is frequent in urban Mexico;
munching occurs from morning to midnight.
Antojitos, or “little whims,” include foods
made with masa, such as tostadas (called
chalupas in northern Mexico), fried tortillas
topped with shredded lettuce, cheese, or meat.
These may be eaten as a snack or served for a
light supper. Nearly every block offers street-
side food vendors, providing everything from
fresh fruits to grilled meats. Pastelerías offer
coffee, chocolates, and pastries. In addition,
many neighborhoods feature an open-air
market that also sells ready-to-eat foods. Can-
tinas are popular gathering places. Originally
males-only drinking establishments, many
now welcome women and families. Botanas,
roughly translated as “cocktail foods,” are
small plates of items that go well with alco-
holic beverages (especially beer), such as
cheese, sausages, fritters, tortillas with beans
or salsa, and sometimes Anglicized Mexican
dishes such as guacamole with tortilla chips,
or other non-Mexican items, such as hum-
mus. The term is often used for appetizers of
any kind.
Special Occasions Sundays, family celebra-
tions (such as weddings, baptisms, and quince-
añeras), and holidays are typically times when
more difficult preparations are served. For
example, homemade tamales or moles are
labor intensive and may require numerous
ingredients, so these foods are often reserved
for special occasions.7 Turkey, arroz con leche
(rice pudding), and pastel de tres leches, a
rich sponge cake lightly soaked in three types
of milk (whole or cream, condensed milk,
and evaporated milk) and then topped with
whipped cream, are other festive foods eaten
throughout the year.
Many foods are associated with specific
holidays. For example, Día de los Santos Reyes
(also called Día de los Reyes Magos, or Three
Kings Day) on January 6 is customarily cel-
ebrated with rosca de reyes, a raisin-studded,
ring-shaped loaf of bread. Baked inside the
bread is a figurine of the infant Jesus, and
the person who receives it is obligated to
give a party on Candelaria Day (February 2).
Candelaria Day includes a mass, followed by
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 9 2 5 1
games and sweets such as tamales dulce and
pink-tinted atole.22
During Lent, capirotada is a traditional
dessert. Many families have their own recipe
for this holiday bread pudding, often made
with honey or brown sugar, cinnamon, nuts,
raisins, and cheese. Another holiday food is
bread decorated with a skull and crossbones
(pan de muerto) eaten on Días de los Muertos
(Days of the Dead, November 1 and 2) as
part of a large feast honoring the deceased
(the first day for children, the second for
adults—additional days, for deaths due to
certain causes, such as accidents, are identi-
fied in some regions). Sugar paste is used to
mold skulls and skeletons of the dead, known
as alfeñique (a word of Arab origin), which are
colorfully decorated with icing. Altars for the
dead are set up in homes with a bowl of water
to quench the thirst of the spirit, his or her
favorite foods, pan de muerto, sugar skulls,
fruit pastes, and dulce de calabaza (pumpkin
cooked with brown sugar). Coffee, chocolate,
atole, soft drinks, and preferred alcoholic
beverages are offered as well.23 After the
departed soul has absorbed the essence of the
meal through the aromas, the family eats the
remaining food.
Christmas festivities, called posadas, fre-
quently feature piñatas, or brightly deco-
rated papier-mâché animals and figures that
are filled with sweets. Blindfolded children
take turns swinging a large stick at the hang-
ing piñata until it breaks and candies fly
everywhere. In some regions buñuelos are a
Christmastime treat, drenched in syrup and
served in pottery bowls that, when empty,
are smashed on the street for good luck. On
Christmas Eve a salad of fruits, nuts, and beets
is served.
Role of Food and Etiquette
in Mexican Society
In family-centered Mexican society, food-
related activities facilitate interactions
between family members and help delineate
family roles. Meal planning is usually the
wife’s responsibility. Depending on economic
status, food is prepared by the wife or by ser-
vants supervised by her, because Mexican
foods can be laborious to prepare.17 The final
dishes are greatly appreciated by all who par-
take in the meal, and it is considered an insult
not to eat everything that is served. In rural
areas, food sharing is an important social
activity, reflecting the Indian worldview. To
reject offered food or drink is a severe breach
of social conduct. Even refusal of an invita-
tion to dine may be considered rude, though
not attending an agreed upon event is often
completely acceptable.26
No guest should begin eating at a Mexican
meal until the host says “¡Buen provecho!,”24
which translates to “Enjoy your meal!”
Mexicans share many dining rules with
Europeans. The fork remains in the left hand
and the knife in the right one. No switching
is done when cutting food. When not eat-
ing, the hands should remain above the table,
with the wrists resting on the edge. Dishes
are passed to the left. Portions are usually
large, and it is all right to leave some food on
your plate. Leaving the table for any reason
before others are finished with the meal is
impolite.
S A M P L E M E N U
A Traditional Oaxacan Comida
Ch ilaquile s (Tortilla Casserole)a,b
Chicken or Pork C olor ad it o (M ole R ojo)a,b,c
Simmered Black Beansa,b and Rice
Fresh Tropical Fruit or Fruit Ice/Sherbeta,b
Fruit Juice or Beer
aMartinez, Z. 1997. The food and life of Oaxaca: Traditional recipes from
Mexico’s heart. New York: Macmillan.
bOaxaca’s Tourist Guide (Cultural Attractions): Recipes at
http://www.oaxaca-travel.com/guide/index.php?lang5us
chttp://allrecipes.com/Recipe/Mexican-Mole-Sauce/
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2 5 2 M E X I C A N S A N D C E N T R A L A M E R I C A N S
Therapeutic Uses of Food
Some Mexican Indians and rural poor prac-
tice a hot–cold system of diet and health. It is
believed to have derived from the Arab system
of humoral medicine brought to Mexico by
the Spanish, combined with the native Indian
worldview. Although it has parallels with other
classification systems, such as the Asian prac-
tice of yin–yang (see Chapter 11 for details),
the Mexican system is applied only to foods
and to the prevention and treatment of illness.
It does not encompass moral or social beliefs.
The Mexican hot–cold theory is based
on the concept that the world’s resources are
limited and must remain in balance. People
must stay in harmony with the environment.
Hot has the connotation of strength; cold,
of weakness. When the theory is applied to
foods, items can be classified according to
proximity to the sun, method of preparation,
or how the food is thought to affect the body.
Meals balanced between hot and cold foods
are considered to be health promoting. Unbal-
anced meals may cause illness. Thus a typical
comida in a rural village would consist of rice
(hot), soup (made with hot and cold ingredi-
ents), and beans (cold).
Although the hot–cold classification of
foods does vary, items generally considered
hot are alcohol, aromatic beverages, beef,
chiles, corn husks, oils, onions, pork, radishes,
and tamales. Cold foods include citrus fruits,
dairy products, most fresh vegetables, goat,
and tropical fruits. Some foods, such as beans,
corn products, rice products, sugary foods, and
wheat products, can be classified as either hot
or cold depending on how they are prepared.
Illnesses are also believed to be hot or cold
and are usually treated with a diet rich in
foods of the opposite classification. Examples
of hot conditions include pregnancy, hyper-
tension, diabetes, indigestion, susto, bilis,
and mal de ojo.and mal de ojo.and 9 In particular, many Mexi-
can women increase their intake of cooling
fruits, such as melons, mangoes, and bananas,
and avoid hot, spicy foods and chiles during
pregnancy. Some also believe that very cold
foods, including cucumbers, tomatoes, and
watermelon, can create a sudden imbalance.
Examples of cold conditions are pneumonia,
colic, and empacho. Sour foods are thought
by some to thin the blood and are avoided
by menstruating women because they are
thought to increase blood flow; acidic foods
may also be avoided because they are said to
cause menstrual cramps (menstruation is con-
sidered a hot condition by some, and a cold
condition by others).
Though the hot–cold system of food clas-
sification is practiced by small numbers of
Mexicans, one study reported that Latinos
are more likely than non-Latinos to con-
sider certain foods herbal medicines, and
other research suggests home remedies are
common.25,26,27 For example, chamomile is
believed by many to cure colic, menstrual
cramps, anxiety, insomnia, and itching eyes.
Mint and anise tea are also prepared for nau-
sea, gas, diarrhea, and colic. Garlic is chewed
for yeast infections in the mouth, toothache
pain, and stomach disorders; boiled peanut
broth is used to cure diarrhea; boiled corn
silk is taken for kidney pain; honey and water
are given to infants for colic; oregano is used
for fever, dry cough, asthma, and amenorrhea;
and papaya is thought to help cure digestive
ailments, asthma, tuberculosis, and intestinal
parasites.9,13
Of particular interest are remedies for
hypertension and diabetes. Hypertension may
be treated with garlic, passion flower, or linden
flowers. The leaves of the sapodilla tree, known
as zapote blanco, which act as a strong sedative,
are also used in a tea to lower blood pressure.9,26
For diabetes, several botanical remedies are
used. Sage tea is common, as are infusions
made from tronadora root (trumpet flower)
and prodigiosa leaves and flowers (brickle-
bush). Preparations made with Indian plan-
tains (matarique), papayas, bitter gourds, aloe
vera juice, and prickly pear cactus (both the
tuna and nopales) are also popular.26,28 Several
of these remedies have been shown to have
potent diuretic or hypoglycemic properties.
Contemporary Food Habits
in the United States
The foods of Mexico have significantly
influenced cooking in regions of the United
States bordering the nation. Four separate
regional variations have been identified (see
Early researchers were
perplexed by the
absence of the niacin-
deficiency disease, pel-
lagra, in Mexicans who
consumed a corn-based
diet. Pellagra was com-
mon in the southern
United States, where
corn was also a staple.
It was found that when
the corn kernels were
prepared for masa
harina, the alkaline lime
solution used to soften
them released the niacin
that was bound to a
protein.160
Some Mexicans avoid
cold air and drafts after
eating chiles (which are
classified as hot) to avoid
causing a sudden imbal-
ance in their bodies.
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C H A P T E R 9 2 5 3
Chapter 15 on regional U.S. foods for more
information).29 The first region is Texas,
where Mexican food has often been modi-
fied into completely American dishes, such
as tamale pie and nachos. Other foods retain
slightly more of their Mexican heritage, such
as chili con carne, which was developed just
after the Mexican-American War in the 1850s.
It probably began as a chile colorado (red chile
stew), but was tamed by reducing the spicing
and diluting the traditional meat dish with
beans. Barbecued chile-spiced meat kebobs
called anacuchos and capriotada with whiskey
sauce known as “drunken pudding” are other
examples of Tex-Mex creativity. The most
commonly used chiles in Tex-Mex cooking are
anchos and jalapeños, though pequins are also
popular in some dishes, and a favorite season-
ing is cumin. Beef is commonly ground rather
than shredded for stuffed dishes.30 The Mexi-
can restaurant staple in the United States—
known as a combo plate, featuring a selection
of enchiladas, tacos, and other stuffed items
served with rice and beans all at one time—is
also thought to be a Texas invention.29
The second region is New Mexico, where a
single chile pepper developed for the region,
known as the New Mexico chile, dominates
seasoning. It is mildly pungent, used green in
chile verde and red in chile colorado. Unlike
the complex sauces of southern Mexico that
include numerous types of ground chiles and
different seasonings, these northern-Mexico-
influenced sauces are often made simply with
ground red chile pepper, water, garlic, oreg-
ano, and salt to taste. Pork replaces beef, kid,
and lamb in many dishes. The third region
is Sonora, encompassing both the Mexican
state and southern Arizona. As in New Mex-
ico, milder chiles are preferred (in this case,
Anaheims), and in some recipes the season-
ing is so tepid that “chile” has been dropped
from the name, resulting in “carne verde,” for
example.29 Beef is the favored meat, and a tra-
ditional dried beef jerky, machaca, is still used,
shredded, for stuffed foods. Large, finely tex-
tured wheat tortillas are a specialty, and this
region may be the original home of burritos
and their deep-fried version, chimichangas.
The fourth and final region is along the
California border, where the fluid movement
of people back and forth between the nations
has resulted in fare that cannot be claimed
by either nation as its own, nor as a cuisine
unique to the area.31 Numerous American
fast-food franchises are established in Mex-
ico, and on the U.S. side taco shops and Latino
grocery stores offer Mexican dishes. However,
most businesses provide a mix of products,
even the franchise restaurants. For example,
Mexicans can purchase hamburgers and fries
with jalapeños on the side, and diners in the
United States can order “American burritos”
filled with refried beans, carne asada, and
French fries.
The market for Latino foods through-
out the United States has grown dramati-
cally since the 1980s, when the fare of Texas,
New Mexico, and Arizona gained national
recognition. It was expected to be a $10 billion
a year industry in 2014.32 In the 1990s sales of
salsa surpassed those of ketchup for the first
time, and salsa has continued to dominate the
condiment market. Tortillas and tortilla chips
are also selling well. At the same time that
Americanized Mexican foods, such as tacos in
S A M P L E M E N U
A Border Dinner
Fresh Red Salsaa,b and Tortilla Chips
Ch imich an gas a,b,c
A r r oz a la Mexicana (Red Rice)a,b
Refried Beans
Almond Puddinga,b
aTausend, M. 1997. Cocina de la familia: More than 200 authentic recipes from
Mexican-American home kitchens. New York: Simon & Schuster.
bSouthwestern Recipes at
http://www.recipegoldmine.com/sw/sw.html
cChimichanga History and Recipe at
http://whatscookingamerica.net/History/Chimichanga.htm
In the late nineteenth
and early twentieth
century, chile con carne
stands were common
in San Antonio, offer-
ing a spicier version of
the Texas stew made
by Latina women in the
community, who were
known as the “Chile
Queens.” They were shut
down in the 1930s due
to supposed health
concerns.29
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2 5 4 M E X I C A N S A N D C E N T R A L A M E R I C A N S
hard shells and fajitas, are spreading through-
out the country, an appreciation of authentic
regional Mexican fare is also increasing.
Adaptations of Food Habits
Ingredients and Common Foods Many Mexi-
cans in the United States eat a diet similar to
that of their homeland. Recent immigrants,
those who live near the U.S.–Mexican bor-
der, and migrant workers are most likely to
continue traditional food habits. In a compre-
hensive review of published research on the
effect of acculturation on the diet of Latinos
in the United States, no relationship between
acculturation and dietary fat intake or per-
centage of energy from fat was evident. How-
ever, the source of the fat differed depending
on acculturation. Less acculturated fat sources
were from consumption of whole milk and
fat added during food preparation, whereas
among the more acculturated Latinos, fat
sources were fast food, snacks, and added fats.
In addition, the less acculturated individuals
consumed more fruit, rice, and beans and
fewer sugar and sugar-sweetened beverages
than the more acculturated Latinos.33
Chicanos and Mexicans who are well estab-
lished in the United States often become quite
acculturated. An early marketing study noted
that Mexican immigrants living in the south-
western United States are more likely to eat
a diet with a high intake of red meats, white
bread, sugared cereals, caffeine-containing
beverages, and soft drinks than their socio-
economic counterparts in Mexico or white
neighbors. This suggests that, rather than
adopting a diet that falls somewhere between
the food habits of Mexico and those of the
United States, the Mexican immigrants in the
survey accepted the stereotypical American
consumption patterns of the 1950s through
1970s.34 In the intervening years, other studies
have offered confirmation of these data. Stud-
ies on Latinos in Southern California (who
would be predominantly Mexican American)
and Mexican Americans living in Washington
have found higher intakes of fast foods, con-
venience items, salty snacks, chocolate, and
added fat at the table with bread and pota-
toes, combined with lower intakes of beans,
peas, fruits, and vegetables associated with
acculturation.35,36,37,38
A more comprehensive study has detailed
these changes. In a large sample of Mexican
Americans, it was found that the greatest
dietary changes occurred between the first
generation born in Mexico and the sec-
ond generation born in the United States—
changes between the second generation and
third generation were less significant. The
exception was consumption of corn tortillas,
which decreased 69 percent between the first
and second generations, with an additional
30 percent drop observed between the second
and third generations.39,40 Conversely, intakes
of some items remained relatively constant
between generations, particularly those of
beef, green vegetables other than salad, and
some fruits (bananas, apples, oranges and
orange or grapefruit juice, and cantaloupe).
Specific changes seen between the
Mexican-born subjects and the first genera-
tion of U.S.-born subjects included reduced
consumption of legumes, most vegetables,
rice, and pasta, and increased consumption of
breads, cereals, margarine, mayonnaise, but-
ter, potato chips, and French fries.39,40 Intake
of eggs and of American-style cheese also
increases with these subjects. Whole milk,
which is preferred among Mexican-born sub-
jects, is replaced with low-fat or nonfat milk
by U.S.-born subjects. Soda intake is high in
all generations, although the U.S.-born sub-
jects prefer diet sodas. Coffee is popular in all
groups. Alcohol intake in general increases,
with beer consumption among males espe-
cially popular (increasing 51 percent).41
A preference for sweet or carbonated bev-
erages usually increases in the United States.
Soft drinks, Kool-Aid, and juices are popular
with meals and as snacks. More acculturated
Mexican Americans buy many prepared and
convenience foods. Baked goods are usually
purchased, including tortillas (often wheat
tortillas are chosen over corn), breads, pan
dulce, and even special desserts like flan.
Extra income is usually spent on meats, espe-
cially more expensive cuts such as steaks and
pork chops, and processed meats, such as hot
dogs and bologna.31,39,42
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C H A P T E R 9 2 5 5
Meal Composition and Cycle
Daily Patterns Few current data on the meal
patterns of Mexican migrant farmworkers
have been reported, but older data indicate
that traditional foods are preferred for most
meals. These include eggs, beans or meat,
and tortillas or pan dulce for breakfast; a large
lunch of beans, tortillas, and meat, or a soup
or stew; and a lighter dinner of tortillas, beans
or meat, and rice or potatoes. As in Mexico,
vegetables tend to be served as part of a soup
or stew. Fruit remains a typical snack and
dessert, especially familiar varieties such as
bananas, oranges, mangoes, guava, pineapple,
strawberries, and melon.43,44
Chicanos more often adopt the Ameri-
can meal pattern of small breakfast, small
lunch, and large dinner; and meal-skipping
may occur. As tortilla consumption declines,
breads and breakfast cereals have become
popular with all family members, and sand-
wiches are a common lunch item. Meats
and cheese become more prevalent at meals,
beans are eaten less frequently, and vegetables
are served as side dishes. Snacking has been
found to increase, especially in the evenings,
and is associated with education. College
graduates are more likely to snack daily than
are those who attended only elementary or
high school.22,45,46,47 Soda, Kool-Aid, juice,
beer, and coffee are consumed with meals or
snacks throughout the day. Milk is considered
a superfood for children, but adults, especially
men, may consider it to be a juvenile drink.
Milk is often flavored with chocolate, eggs,
and bananas in a drink called licuado; mixed
with coffee; or mixed with cornmeal to make
atole. Some adults reject milk completely,
saying that they are allergic to it (it is esti-
mated that 50 percent of Latinos are lactose
intolerant).48
Changes in preparation methods may also
occur. Recent immigrants may not know how
to use the baking and broiling apparatus on an
oven and may continue to fry and grill foods
outdoors. Newer immigrants sometimes
avoid canned and frozen foods because they
do not know how to prepare them. Soup is
prepared at home three times more often by
Hispanics than by non-Hispanics, according
to one marketing survey, but this rate drops
significantly with acculturation.49 General
spending patterns, however, suggest that
cooking at home is still common: Hispanics
spend more than double the average for flour
and 166 percent more on dried beans.42 Single
women, those with larger families to feed, and
those who identify more with their Mexican
heritage have been found more likely to shop
at small ethnic groceries or convenience stores
that often have fewer healthy food options and
may charge more for items such as low-fat
milk compared to whole milk.35,50,51
Hispanics frequent restaurants more than
any other ethnic group in the United States.
Among Mexican Americans’ favorite types
of establishments (in order of popularity) are
fast food, pizza, Mexican fast food, Chinese,
coffee shops, and full-service Mexican.52 One
study of Latina women in the Los Angeles
area found that younger, employed women
with lower incomes who had lived more years
in the United States preferred fast-food res-
taurants, stating that distance, price, and a
child-friendly environment were deciding
factors in choice of establishment.35 In 2010 it
was reported that over 13 percent of Hispanic
children eat at a fast-food or sit-down restau-
rant three or more times a week.53
Special Occasions The Mexican custom of
reserving foods requiring extensive prepa-
ration, such as tamales and enchiladas, for
Sunday and holiday meals is continued in the
United States.6 Even if such dishes are served
only occasionally at family celebrations, Mexi-
can Americans reconnect with their heritage
through the preparation and consumption
of these traditional items.29 In one study that
included holiday practices of migrant work-
ers,43 no main dish preferences were found for
Easter, and tamales were favored for Christ-
mas. Turkey with mashed potatoes was the
most popular Thanksgiving entrée, indicating
that this American holiday was adopted along
with its traditional foods.
In addition to religious holidays, two
secular celebrations are significant in the
Mexican American community. The first is
Mexican Independence Day on September 16,
Though consumption
decreases with accul-
turation, it is estimated
that Mexican Americans
eat more beans than
any other group in the
United States—thirty-
four pounds per person
annually, compared to six
pounds per person each
year for whites.30
In Mexico, the prevalence
of malnutrition resulting
in stunting of children
varies between 10 and
35 percent depending
on region.168
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2 5 6 M E X I C A N S A N D C E N T R A L A M E R I C A N S
commemorating the war of liberation from
Spain. Observations emphasize ethnic unity,
such as mariachis and traditional clothing.
Foods the color of the Mexican flag, such as
white rice, green avocado, and red or green
chile peppers, are eaten. Cinco de Mayo
(May 5), the second secular holiday celebrated,
is more widely recognized by all ethnic groups
throughout the United States even though the
meaning of the event (remembrance of a his-
toric victory over France) is often forgotten
amid the parades, piñatas, and Aztec dancing
that typify the day.
More recently, Mexica Aztec New Year’s
Day has emerged as a celebration in some
Mexican American communities. It welcomes
the beginning of the Aztec solar year, com-
prised of eighteen periods of twenty days each,
plus several separate days of reflection. Four
signs—“rabbit,” “reed,” “flint,” and “house”—
are used to designate each year, along with
a number between one and thirteen, result-
ing in a fifty-two-year cycle. Each new cycle
begins with an elaborate New Fire Ceremony
that involves fasting and sacrifice. The annual
event emphasizes indigenous Indian identity,
as opposed to the Latino or Hispanic ethnicity
that incorporates aspects of European culture,
such as use of the Spanish language. Some
Catholic Latinos disapprove of the holiday.54
Nutritional Status
Nutritional Intake It can be difficult to deter-
mine health statistics on Chicanos, Braceros,
and unauthorized migrants because they
are often grouped with whites or other Lati-
nos in collected data. Information from
research on Latinos can be used cautiously,
since Mexicans comprise a majority of the
total Latino population. Nevertheless, some
nutritional problems have been identified in
both new and acculturated immigrants from
Mexico through studies of Spanish-surnamed
patients, especially those residing in Texas, the
Southwest, and California.
Life expectancy for Mexican Americans
is similar to that of whites in the United
States despite disadvantages such as higher
rates of poverty, lower levels of educational
achievement, and reduced access to health
care. Overall mortality rates as well as
cause-specific mortality rates are lower for
Mexican Americans compared to whites when
controlled for gender, age, nativity, marital sta-
tus, socioeconomic status, and demographic
variables. (One notable exception is mortal-
ity among younger Mexican Americans, aged
eighteen to forty-four, who have elevated
mortality risks, mostly due to external causes
of death.)55,56,57 Researchers propose several
reasons for the lower-than-expected mortality
rates in Mexican Americans. Some report that
nativity outside the United States is a factor,
accounting for health-promoting lifestyle dif-accounting for health-promoting lifestyle dif-accounting for health-promoting lifestyle dif
ferences.58 Another theory is that older immi-
grants return home to Mexico before they die
and are therefore not listed in vital statistics
figures, resulting in a mortality advantage
due to what has been dubbed “salmon-bias”
effect.59,60
Similar trends are seen in infant mortal-
ity statistics. The birthrate among Hispanic
women is nearly twice that of white women,
and the birthrate among women aged fif-and the birthrate among women aged fif-and the birthrate among women aged fif
teen to eighteen is more than three times as
high. Nearly 25 percent of Mexican American
women receive no prenatal care during the
first trimester of pregnancy.61,62 Despite these
risk factors, rates for low-birth-weight infants
and infant mortality are lower for Mexican
Americans than for the total population (see
Cultural Controversy: Breaking the Mold).
In a multisite study of Mexican mothers,
it was found that over 95 percent breast-fed
their infants in the first week of life.63 Over
80 percent of Mexican American women in a
national survey breast-fed, and by six months,
23 percent were still breast-feeding.64,65 In
Mexico breast-fed babies are often given
other fluids, including formula, water, and
sweetened herbal teas to reduce colic or cure
diarrhea,63 a practice that may continue in the
United States. Babies are usually weaned from
the breast to the bottle. Long-term use of the
bottle or sleeping with one at night, with milk
or sweetened liquids (e.g., Kool-Aid, fruit
juice, tea), is sometimes a problem, resulting
in iron-deficiency anemia and tooth decay
among toddlers (baby-bottle tooth decay).66,68
In 2002, Mexican Americans had the
highest component scores on the USDA
Healthy Eating Index (HEI) of all ethnic
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 9 2 5 7
groups in the United States, indicating good
compliance with the Food Guide Pyramid
recommendations, especially dietary vari-
ety and high fruit consumption, but also a
high intake of sodium. Respondents born
in Mexico had slightly higher scores than
U.S.-born respondents.69 Most studies agree
with the HEI findings that dietary qual-
ity may decline with acculturation. Fat and
cholesterol intake increases, while intake of
beta-carotene, vitamin C, and fiber decreases
due primarily to increased consumption of
high-fat snacks, fried foods, eggs, cheese, and
milk and decreased consumption of legumes,
fruits, and vegetables.36,37,70,71,72 Research-
ers caution, however, that acculturation is
difficult to measure, and different methods
may result in different findings. A study of
low-income Hispanic women in San Diego
found that when acculturation was defined
Breaking the Mold: The Mexican American
Immigrant Experience
One of the assumptions regarding assimilation is that life improves
continually for immigrants the longer they
reside in the United States. Yet recent stud-
ies of the largest immigrant population
contradict this model. Foreign-born Mexican
Americans are found to be healthier
overall, to eat slightly better diets, and to
have lower rates of infant mortality than
U.S.-born Mexican Americans with foreign-
born parents and for U.S.-born Mexican
Americans with U.S.-born parents—despite
higher rates of poverty and less access to
medical care.45,161,162,163,164
The scientific community expressed
little interest about differences in immigrant
health status associated with place of birth
until researchers in the late 1980s discovered
a startling trend. Poor, disadvantaged women
who had immigrated from Mexico were
giving birth to babies who were as healthy
as those of white U.S. women with overall
higher levels of income and education.
Rates of premature births, low-birth-weight
rates, and newborn death rates among the
immigrant women were equal to or less than
those for whites.98,165,166 The foreign-born
women also demonstrated better birth
outcomes and fewer maternal disorders than
Mexican American women who were born in
the United States.170,171 One study even sug-
gests that internal migration also improves
health, showing that Mexican American
women born outside the U.S. community
where they give birth have better pregnancy
outcomes than women born in the commu-
nity.167 A comprehensive review of statistics
on adolescents was even more revealing.
The longer a subject’s family had lived in
the United States, the poorer the subject’s
health and the more likely the subject was to
engage in risky behaviors, even after control-
ling for neighborhood, family, education,
and income variables. Mexican Americans
who were born in the United States with
U.S. parents had significantly higher rates of
health problems (including obesity, asthma,
and missing school due to illness) compared
to those who were born in Mexico. Health
risk behaviors, determined by sexual experi-
ence, delinquency, violent behavior, and use
of controlled substances, were more than
double in U.S.-born Mexican American ado-
lescents with U.S. parents than in Mexican
American youth born in Mexico.163
Suddenly, the assimilation model of
health was in question. What accounts for
such significant differences? Most hypotheses
have addressed the disparities in birth out-
comes, suggesting that selective migration
occurs (only healthy women come to the
United States), that deaths during pregnancy
may be greater (thus skewing the data),
or that infant deaths are underreported in
the foreign-born Mexican American com-
munity (which may include high numbers
of unauthorized residents). Other theories
emphasize the protective factors of the
Mexican culture.168 Research suggests that
pregnant, foreign-born Mexican American
women behave in ways different from
those who are born in the United States.
Intake of nutrients, including protein,
folate, vitamin C, iron, and zinc, is better;
smoking and alcohol consumption rates are
substantially lower.79,169,170 Other factors
considered important to positive pregnancy
outcomes, such as adequate weight gain and
prenatal care, are less likely in foreign-born
Mexican Americans. Researchers suggest
these negatives may be compensated for
by greater community, family, and spousal
support, and less accumulative acculturation
stress.78,154,164,170 Determining the reasons
that place of birth is so significant will help
researchers devise a new assimilation model
and suggest approaches for improving the
diet, pregnancy, and health outcomes for all
Mexican Americans.
C U L T U R A L C O N T R O V E R S Y
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2 5 8 M E X I C A N S A N D C E N T R A L A M E R I C A N S
as number of years in the United States, fat
intake did not change. When defined as being
born in the United States, greater consump-
tion of convenience foods and chocolate was
found. When preference for speaking English
at home was considered, lower intake of beans
and peas was noted. When acculturation was
defined as being born in the United States and
a preference for speaking English at home, a
higher consumption of salty snacks, high-fat
foods, lower fiber, and convenience items was
reported.38,72,73,74
Initial research indicated total protein
intake may have declined with the length of
stay in the United States, but recent research
indicates that protein intake has leveled off in
the last decade.45,74,75 Low protein consump-
tion, combined with low iron and vitamin C
intake, sometimes results in low hemoglobin
levels among young children and pregnant
women.67,76 However, excessive rates of low
iron intake or low blood iron status among
Americans of Mexican descent have not been
confirmed.
Deficiencies of calcium and riboflavin
are common, often due to low consumption
of dairy products. Although the traditional
Mexican diet includes good sources of vita-
mins A and C, thiamin, niacin, B6, folate,
phosphorus, zinc, and fiber, low intakes of
these nutrients by Mexican Americans have
been reported; inadequate income or lack of
traditional ingredients may limit consump-
tion of these nutrients.77,78,79,80
Nutritional inadequacies may contribute
to other diseases. More tuberculosis cases
were reported among Hispanics than any
other racial/ethnic population in 2008, for
five consecutive years.81 However, the rate
has decreased over this period. In contrast to
the problem of undernutrition is the preva-
lence of being overweight or obese in adults
of Mexican descent—36 percent of men, and
47 percent of women in 2012.82 Overweight in
children (when defined as BMI $95 percen-
tile) has also been reported as being higher
than for whites, between 22.4 and 24.3 per-
cent for girls and boys, respectively.45,82,83 Low
socioeconomic status and less leisure-time
physical activity are thought to be factors in
high rates of overweight.82,84,85,86 Cultural
ideal weight may be greater for some Mexi-
cans than for Anglo-Americans, and tradi-
tionally, Latina women believed it was normal
to gain weight after marriage. Extra weight
may indicate health and well-being, not only
for adults but also for children, and some par-
ents may not recognize that their children are
overweight.87 However, research suggests that
many Hispanic adults and children perceive
themselves as being overweight and are dissat-
isfied with their body image.88,89,90 Unhealthy
dieting practices are prevalent in some Lati-
nos, and it is believed that Hispanic girls are
at high risk of developing eating disorders.91,92
Prevalence of type 2 diabetes in Hispanic
Americans is 1.7 times that for whites; how-
ever, Hispanics were 70 percent more likely
than whites to be diagnosed.82 This high rate is
not explained by the incidence of obesity, age,
or education, but may be related to percent-
age of Indian heritage.93,94 Research suggests
that Hispanics have greater insulin resistance
than African Americans and whites, and their
lower sensitivity may be due to a higher intake
of carbohydrates.95 Type 2 diabetes in His-
panic adolescents is three times that of white
youth.96 Complications from diabetes, includ-
ing kidney failure and diabetic retinopathy,
are also more prevalent.82,96 Death rates from
diabetes are estimated to be over 50 percent
higher for Hispanics than for whites, and this
difference is even greater in the counties along
the Mexican border.97 Further, diabetes mor-
tality rates are higher for Mexican Americans
than for any other Hispanic group.98
Hispanic Americans have very high rates
of metabolic syndrome, a clustering of con-
ditions related to type 2 diabetes and heart
disease, including insulin resistance, hyper-
tension, and dyslipdemia.99 Interestingly,
Mexican Americans have similar rates of
hypertension to that of whites, but data on dys-
lipdemia show higher prevalence in Mexican
Americans than in whites and African Ameri-
cans.82,100,101 The incidence of cardiovascular
disease in American Hispanics is lower than
the incidence in whites, and they are less
likely to have heart disease but are 30 percent
more likely to have a stroke.82 Researchers
have noted the heart-healthy elements of the
traditional Mexican diet.77 Though studies
A study on the preva-
lence of iron overload
disorders in Hispanics
suggests the rate may
be slightly higher than
among whites. 172
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C H A P T E R 9 2 5 9
on cardiovascular mortality risk relative to
whites are contradictory,102,103,104,105 and sub-
population risk varies, cardiovascular dis-
eases are the number one cause of death in
Hispanic adults.56,57 A higher prevalence of
gallbladder disease has been found in Mexi-
can Americans, and a higher rate is found in
those born in the United States, compared to
those born in Mexico. Diet may be involved in
some cases, but more recent research suggests
a genetic vulnerability may be a more impor-
tant factor.106,107
Knowledge of osteoporosis and risk-
reducing behavior was low among Hispanic
women in Chicago.108 Cavities are common
among Americans of Mexican descent, as is
gingivitis. Studies show that nearly one-third
of all immigrants from Mexico never receive
any dental care. Migrant workers and their
children are especially at risk.109,110
Alcohol intake was found to increase by
47 percent between Mexican Americans who
were born in Mexico and the first generation
of Mexican Americans born in the United
States.45 Mexican American men drink greater
quantities of alcoholic beverages less often
and have lower rates of dependency than
non-Hispanic men, and Mexican American
women have low alcohol consumption rates
that increase with acculturation.111,112
Counseling Access to biomedical health care
may be limited for unauthorized migrants of
Mexican descent. Income may restrict doctor
visits, and transportation to clinics may be
unavailable. In addition, 43 percent of Mexi-
can Americans report that they speak Span-
ish at home and that they are not proficient
in English.2 Spanish-speaking clients may be
uncomfortable with interviews conducted in
English. Those who believe God or fate deter-
mines health may be unwilling to undertake
preventive procedures.116
The communication style of Latinos is high
context and nonconfrontational; a warm, dig-
nified relationship is most effective and cru-
cial in difficult health care situations. Words
are chosen carefully, and silence may be used
to defuse disagreement.24 Kindness and gra-
ciousness are appreciated.116 Touching a cli-
ent with a hand-shake is important, although
men should wait for women to extend their
hands first. Eye contact varies, and some
Mexican Americans consider prolonged
eye contact impolite. However, it is best to
maintain eye contact initiated by a client, as
looking away may be thought rude. Mexican
Americans often sit and stand closer together
than Anglos do. Most Latinos are present
oriented and polychronic (able to do several
things at once). Inflexible appointments can
be problematic for some Latino clients, who
may prefer walk-in clinics.13 Latinos may be
uninterested in lengthy indirect discussion
of a condition and prefer a direct, action-
oriented approach.
Attitudes may differ from American bio-
medical beliefs. For instance, it is sometimes
considered inappropriate for men to acknowl-
edge illness.112 People who go on working
despite bad health are respected. Modesty and
privacy are highly valued; thus a woman may
wish to be treated by a female caregiver and a
man by a male caregiver.
Studies suggest that anywhere from 20 to
81 percent of Mexican Americans use folk
remedies,11,12,112 and Latinos in one sur-
vey used the services offered at their local
botánica interchangeably with those offered
by their biomedical provider.53 Another study
found that increased use of herbal remedies
by Mexican American women corresponded
with fewer visits to biomedical practitioners.
This association may be related to lack of
medical insurance, which was also found to
be a factor in use of traditional medicines.13
Sixty-one percent of surveyed Hispanic elders
in New Mexico reported drinking herbal
teas to maintain health, alleviate stress, and
cure minor ailments.2 The most commonly
consumed infusions included peppermint
(called both yerba buena and poleo), chamo-
mile (manzanilla), lavender (alhucema), and
osha (related to parsley). However, it is impor-
tant not to assume adherence to certain folk
beliefs, such as the hot–cold classification of
foods and illness. Though prevalent among
some people in Mexico, these traditional
practices may be limited in the United States
(even among healers), and younger, urban
clients may be offended by use of such “back-
ward” theories.11,112 Traditional healers, such
A study was done of
Tarahumara Indians in
Mexico to observe the
effects of a high-calorie,
high-fat, low-fiber diet
on a population that
traditionally consumes
a low-fat, high-fiber
diet. After five weeks,
blood cholesterol levels
increased 31 percent,
and triglyceride levels
increased 18 percent;
all subjects also gained
weight.173
Licorice root, known as
yerba dulce or orozús,
may be used as a general
tonic or for infections,
coughs, ulcers, and
menstruation problems.
It can be toxic in large
quantities or taken over
long periods, and may
potentiate the effects of
hypotensive drugs.26
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2 6 0 M E X I C A N S A N D C E N T R A L A M E R I C A N S
as curanderos, are consulted by anywhere
from 4 to 21 percent of the Mexican American
population.25,113,114,115,116 Those who con-
sult curanderos often believe that healers are
most effective for symptoms caused by folk ill-
nesses. In one small sample, nearly 26 percent
of Mexican American women had personally
used the services of a curandero; however,
even larger numbers (almost 39 percent)
had seen a sabadores (manual therapists).112
However, it should be noted that use of tradi-
tional healers does not prevent a client from
also seeking biomedical care concurrently.117
Although traditional practices are most com-
mon in poor, rural regions, most Mexican
Americans are knowledgeable about folk
conditions: Studies in Texas report that mal
de ojo had been diagnosed and treated in
63 to 70 percent of Mexican American homes
surveyed, susto was known in 37 to 62 per-
cent, and empacho in 27 to 48 percent. Mal
de ojo was known in 70 percent of homes,
and caída de mollera in 34 percent.and caída de mollera in 34 percent.and 11,115,116
Another study showed 71 percent of homes
had a family member who had suffered from
nervios, and that 46 percent had experienced
it personally.14 Mexican American women in
southern California also demonstrated famil-
iarity with these illnesses.112 Sometimes mul-
tiple etiologies are integrated. For example,
some Mexican Americans believe that diabe-
tes, which is an Anglo disease, is caused by
eating a diet high in fat and sugar, but also due
to experiencing strong emotions or chronic
susto.28,118
Most traditional health beliefs and prac-
tices among Mexican Americans support
the emotional well-being of a client and do
not interfere with therapy. Many researchers
have suggested that folk conditions provide
an important release valve in Latino cultures,
especially for men who are expected to endure
pain. Disorders due to outside causes are not
blamed on an individual, and the resulting
irrational behavior or lethargy is excused.13
Several potentially harmful situations are
noteworthy. Suboptimal medication use has
been noted, especially in diabetes treatment
where intake is inconsistent, and in situations
where prescription drugs are mixed with
home remedies.119,120 For example, diabetes
and hypertension may be treated with botan-
ical remedies in addition to prescribed oral
medications, risking excessive hypoglycemic
and hypotensive activity, respectively. Clients
consult friends and neighbors about effective
treatments and are unlikely to disclose home
remedies to their physicians.121 Digestive
complaints such as empacho are sometimes
treated with toxic lead- or mercury-based
medications, such as greta, azarcón, and
asogue.122 The condition of caída de la mollera
in infants has been associated by some health
practitioners with severe diarrhea and dehy-
dration, resulting in the depressed fontanel.122
Failure to thrive syndrome may also be a con-
cern. Providers should be aware of these pos-
sibilities when presented with this disorder. In
some regions, a tea made from the psychoac-
tive wormwood (the toxic ingredient formerly
found in the alcoholic beverage absinthe) is
used for diarrhea. Though not widely used,
vibora de cascabel (dried rattlesnake powder) vibora de cascabel (dried rattlesnake powder) vibora de cascabel
can be a source of salmonella and botulism.
Finally, babies may be given home remedies
made with honey, a known cause of infant
botulism. In one study, Latinos were the eth-
nic group least likely to discuss the use of
alternative and complementary therapies with
their biomedical care providers.123
Family participation in health care is com-
mon, and members should be consulted in
both making a diagnosis and prescribing
treatment. They may have specific ideas about
the cause of an illness and the best approach
for a cure; their confidence and coopera-
tion can help ensure client compliance. One
study found that family involvement in seri-
ous choices about issues such as life support
is more important to Mexican Americans
than patient autonomy.124 Dietary changes
may affect family members and social inter-
actions; thus, gaining family support has also
been suggested to increase compliance.125,126
An older study of Mexican American
families living on the Texas–Mexico border
found that the husband traditionally exer-
cised control of the food budget and food
purchases.127 The wife did the actual meal
planning, shopping, and preparation. Women
identified strongly with their food-related
tasks within the family structure. Because
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C H A P T E R 9 2 6 1
their self-concept and status in the family and
community are related to their abilities as a
cook and homemaker, nutrition intervention
and advice may be perceived as an accusa-
tion of inadequacy. More recent research
shows that Mexican American women who
are more acculturated are likely to have a
shared meal decision-making style. However,
they face greater barriers to making healthy
eating changes due to resistance from family
members, and they are more likely to eat at
fast-food restaurants, eat more saturated fat,
and make fewer efforts to increase fiber intake
than are women who maintain traditional
meal preparation roles.127
Children are also an important influence
on food habits in some households. Those
raised in the United States may be the only
English-speaking members of the family and
may be responsible for translating in the mar-
ket. These children have been found to prefer
foods that they have seen advertised on tele-
vision. The adoption of new foods is influ-
enced by the presence of bilingual children
in the family.44 Researchers studied newly
immigrated Latinos in the San Francisco area
and found that the importance of the family
unit can be used to motivate changes in food
habits.128,129 Adults unwilling to make changes
that would benefit their own health may make
those same changes to improve the well-being
of their children.
As with all clients, an in-depth interview
is crucial in effective nutrition counseling.
Experts in the health care of Latinos recom-
mend that health professionals who work
often with Latinos learn Spanish. Familiar-
ity with Spanish medical terminology is the
minimum proficiency needed for meaning-
ful communication. Further, interventions
should be tailored to account for differences
in acculturation.35
Central Americans
The seven nations of Belize, Guatemala, El
Salvador, Honduras, Nicaragua, Costa Rica,
and Panama make up Central America, an
isthmus connecting North America to South
America. The eastern coastal region edges the
Caribbean Sea. An 800-mile chain of active
volcanoes and mountains, beginning at the
Mexican border in the north and continuing
with only one break into central Panama in
the south, forms the temperate backbone of
the region. Central America is similar to the
rest of Latin America in history of foreign
intervention and heterogeneous culture.
Cultural Perspective
History of Central Americans
in the United States
Immigration Patterns Central American
immigrants to the United States have arrived
in two distinct waves. Early records are inex-
act because separate statistics on Central
Americans were not kept by the U.S. Census
Bureau until the 1960s and were reported in
the 2010 census and not listed in with the
South American data. Until the early 1980s,
immigrants to the United States were of two
groups. The first were well-educated profes-
sional men who arrived in search of employ-
ment opportunities. The second were women,
who often outnumbered the men two to one,
coming in search of temporary domestic jobs.
These Central American immigrants were
largely urban residents and settled mostly in
New York, Los Angeles, San Francisco, Miami,
and Chicago, where they blended into existing
Latino communities.
The second major wave began in the late
1970s and early 1980s, with the exodus of
refugees from the brutal civil wars in El Sal-
vador, Guatemala, and Nicaragua. Millions of
residents are estimated to have been displaced
in these countries, about one-third of whom
have emigrated. Many moved to Mexico, and
a substantial number have continued on to
the United States. They are known as the “foot
people” because many have literally walked
to the United States.130 Less is known about
this group, except that they are often younger,
poorer, and less educated than the previous
immigrants from the region.
Current Demographics and Socioeconomic
Status Just under 8 percent of U.S. Hispanic
are from six nations of Central America, a
majority of whom arrived since 1980. Exact
figures are unknown, however, because it is
Queso fresco, tradition-
ally made from raw milk,
is responsible for more
food-borne illness than
any other cheese in the
United States.175
Latinos listen to radio
programming in greater
numbers than do Anglos.
An evaluation of a
Spanish radio nutrition
course found it improved
both nutrition-related
knowledge and selected
practices in both rural
and urban sample
populations.174
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2 6 2 M E X I C A N S A N D C E N T R A L A M E R I C A N S
believed that many Central Americans may
enter the United States illegally at the bor-
der with Mexico and are undistinguished
from unauthorized Mexicans.82 The larg-
est populations are the 1.65 million Salva-
dorans, 1.04 million Guatemalans, 633,000
Hondurans, and 348,000 Nicaraguans.131 It is
believed that there may be an equal number of
unauthorized migrants from these countries
living in the United States as well.132,133 Immi-
gration from Costa Rica, Belize, and Panama
is minimal at less than 1 percent of Hispanics.
Nearly one in every four Central Ameri-
cans is born in the United States. Central
American immigrants, even those from the
first wave, are slow to naturalize, and only
31 percent of Central Americans in the United
States have obtained citizenship.135 Those
who are not refugees often return to Central
America for visits and maintain active con-
tact with their homeland. Those who are have
sought asylum, and those who are unauthor-
ized migrants, cannot visit their homelands
without fear of persecution or difficulties in
returning to the United States.
A third of Central Americans live in Los
Angeles, New York, and Washington, DC, and
live in neighborhoods where other Central
Americans reside. Central Americans are a
very heterogeneous population, however, and
it is a mistake to assume similar settlement
patterns for each group. Identity is some-
times more related to race and class than to
country of origin. The majority of immi-
grants before the 1980s were white profession-
als; more recent refugees are predominantly
Ladino (mixed Spanish and Indian heritage)
or Indian campesinos (peasants). Even among
recent immigrants, differences in associations
are found. Hispanic Guatemalans, for exam-
ple, may assimilate into the broader Latino
community, while Mayan Guatemalans, some
of whom do not speak Spanish, often establish
ethnic enclaves.136
According to U.S. Census data, 45 percent
of Central Americans work in service and
personal care occupations. Approximately
50 percent have graduated from high school.
Central American immigrants are more likely
to live in poverty (23 percent) than those born
in the United States (15 percent) or foreign
born overall (20 percent).135
Information on unauthorized residents is
scanty. It is thought that they often face dif-scanty. It is thought that they often face dif-scanty. It is thought that they often face dif
ficulties in obtaining employment and educa-
tion opportunities.132 In addition, disposable
family income may be impacted by money
sent to support relatives still living in the
homeland.
Worldview
The large numbers of recent immigrants from
Central America suggest that ethnic identity
is preserved by many new residents in the
United States. For example, Salvadorans often
establish highly insular neighborhoods within
the larger Latino community, where an immi-
grant can live and conduct business exclusively
with other Salvadorans.132 Guatemalans are a
more diverse population of immigrants, and it
is the Mayan communities that are most likely
to keep traditional beliefs and practices.136 In
contrast, Nicaraguans are dispersed among
other Latinos and are adapting more to the
pan-Latino community rather than retaining
their own heritage exclusively.134
One unique Central American immi-
grant population in the United States is the
Garifuna, who are black Caribs from the
A Mayan chocolate
container.
▲
M
ex
ica
n
Sc
ho
ol
/B
rid
ge
m
an
A
rt
Lib
ra
ry
/G
et
ty
Im
ag
es
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C H A P T E R 9 2 6 3
eastern, coastal areas of Belize and Honduras.
Traditionally, men traveled great distances for
work, leaving the women to farm and raise
children. Today, their way of life is threatened
by coastal development for tourism and lack
of government support. Garifuna men often
come to the United States for employment,
sending much of their earnings home in an
effort to save their culture.137,138
Religion Most Central Americans are
Roman Catholic. Some Guatemalans observe
Catholic practices while adhering to Mayan
religious beliefs; participation in native reli-
gions declines in the United States because
they are usually dependent on sacred loca-
tions in Guatemala. Evangelical and fun-
damentalist denominations, such as the
Pentecostal Church, have attracted many
Central Americans after they arrive in the
United States. Small storefront congregations
that involve active participation and those
churches that offer traditional Central Amer-
ican social activities in addition to worship
have been especially successful.
Family Central Americans highly value family
and extended kinship. It has been noted that
some apartment buildings in Latino neighbor-
hoods are rented entirely to several families
from the same village in Central America. The
father is traditionally the undisputed head of
the household and provider for the family.
Many Costa Ricans define the term family
as having both a father and mother in the
home.139 However, some studies suggest this
dominance is changing, and shared decision
making between men and women is becom-
ing more common.140,141 Children are often
carefully controlled, especially daughters.
The roles of the men and women often
change even further in the United States,
where women are sometimes more easily
employed, and husbands must take on some
domestic responsibilities. Family disintegra-
tion has taken place in some refugee camps,
where overcrowding and unemployment led
to intergenerational conflict prior to immigra-
tion to the United States.142 In other situations,
family members were forced to immigrate
separately. Some married outside the Cen-
tral American community for immigration
benefits; others found that when their fami-
lies were reunited, children had become more
independent.134
Traditional Health Beliefs and Practices
A good diet,especially consumption of fruits
and vegetables, fresh air, and regular hours
are thought necessary to preserve health by
many Central Americans.143 Exercise is con-
sidered important by some Guatemalans and
Panamanians, though the concept of struc-
tured exercise is unfamiliar to some Central
Americans.140,141,144 Salvadorans believe
that being too thin can cause sickness, and
Americans are considered at risk for ill health
because they are so thin.
Some Central Americans view health as
a balance between the spiritual and social
worlds. For most, health is a gift of God, and
prayer is often used to restore harmony dur-
ing illness.141,145 Some Nicaraguans believe in
witchcraft, practiced by brujos or brujas who
can assume the shapes of animals and have the
power to cure illness. Guatemalans consider
outside forces to be the cause of some illnesses,
which include diseases sent by Satan to pun-
ish unbelievers and sickness due to witchcraft.
Traditional healers include curanderos and
sabadores, as well as jeberos (herbalists) and
espiritistas who treat witchcraft with prayer.
Naturalist doctors (sometimes called naturo-
paths) who work in association with natural-
ist shops that provide botanical remedies may
be used by some Guatemalans.146 Priests may
also be sought to help with prayers for health.
A balance of hot and cold is also neces-
sary to health and can be disrupted by sud-
den exposure to extremes in temperature or
strong emotions. In addition to susto and mal
de ojo, other folk conditions include bilis and
cólera, which in extreme cases are associated
with anger and general distress and precipitate
stroke. In a survey of Hispanic immigrants
(with a large sampling of Central Ameri-
cans) regarding beliefs about hypertension,
respondents reported that cólera and susto
may lead to high blood pressure, as may liv-
ing at too high an altitude or having too much
blood.142,147
In the culturally diverse region of Nica-
ragua’s east coast, more than 200 plants with
Mayan creation myths
describe how humans
were improved over time.
They were first made of
mud, then wood, and
finally perfected when
their flesh was made
from corn dough.
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2 6 4 M E X I C A N S A N D C E N T R A L A M E R I C A N S
traditional medicinal uses have been identi-
fied. One study reported rural ethnic groups
in Nicaragua were found to use traditional
healing practices more often than urban resi-
dents of mixed heritage.148 Another survey,
however, found that more than three-quarters
of respondents in an urban barrio used herbal
remedies.147
Guatemalans believe that strength is main-
tained through the quantity and quality of a
person’s blood. In urban regions of Guate-
mala, researchers have noticed the emergence
of new categories of food items, such as strong
or health-promoting foods, perhaps due to
the influence of modern health promotion
concepts.142
Over-the-counter remedies, such as anal-
gesics and cough suppressants, are commonly
used by Guatemalan Americans, although
they are considered weak by Guatemalan
standards. Medications (including antibiotics)
and herbs, such as chamomile, are sometimes
brought to immigrant families by new arrivals
from Guatemala.
Traditional Food Habits
Ingredients and Common Foods
Central American cuisine offers many of the
foods common throughout Latin America.
The native Indian dishes remain prominent
in the highland areas, Spanish influences
are found in the lowland regions, and the
cooking of the multicultural eastern coast
shares many similarities with Caribbean
Islander fare. The northern nations have
foods similar to those of southern Mexico;
the southern countries have been more
greatly influenced by European and African
cuisines.
Staples Early Mayan records indicate that
the foundation of their diet was corn and
beans, supplemented with squash, tomatoes,
chiles, tropical fruit, cocoa, and some game.
Indian foods were particularly important
in the development of Guatemalan cuisine
but gradually become less significant in the
south of Central America. Rice, introduced
by the Spanish, has become a staple in most
regions. (See the cultural food groups listed
in Table 9.3.)
Beans are eaten daily. Black beans are espe-
cially popular in Guatemala, while red beans
are common in other nations. Beans are served
simmered with spices (called frijoles sancocha-
das in El Salvador), pureed, or fried and are
often paired with rice. In Nicaragua, red beans
and rice fried with onions are called gallo pinto
(“painted rooster”) due to the colors of the dish.
Corn is eaten mostly as tortillas. Enchila-
das in Central America are open-faced sand-
wiches similar to Mexican tostadas. They
typically feature meat covered with pickled
vegetables such as cabbage, beets, and car-
rots. They are known as mixtas in Guatemala,
and here the tortilla is spread first with guaca-
mole, then topped with a sausage and pickled
cabbage. In El Salvador, a stuffed specialty is
called pupusas. A thick tortilla is filled with
chicharrónes, cheese, or black beans and then
completed with another tortilla; the edges are
sealed and the pupusa is then fried. They are
traditionally served with pickled cabbage.
Tamales are also common, often stuffed with
poultry or pork. They are called nactamal in
Nicaragua, where the dough is flavored with
sour orange juice, and the filling includes
meat, potatoes, rice, tomatoes, onions, sweet
peppers, and mint. Black tamales are served
on special occasions in Guatemala, stuffed
with a mixture of chicken, chocolate, spices,
prunes, and raisins. Empanadas, small turn-
overs made with wheat flour dough and filled
with a savory meat mixture, are popular.
French bread, introduced from Mexico, is
eaten regularly in the form of small rolls in Hon-
duras and Guatemala. In El Salvador, French
bread is used with native turkey and pickled
vegetables to make sandwiches. Coconut bread
is a specialty on the Caribbean seacoast. Rice is
often fried before boiling, cooked with coconut
milk, or, in Costa Rica, served as pancakes.
Soups and stews are popular throughout
Central America, often including fruit or fruit
juices. Beef, plantains, and cassava in coconut
milk, spicy beef stew, beef in sour orange juice,
pork and white bean stew, chicken cooked
in fruit wine; mondongo (Nicaraguan tripe
In Guatemala, refried
black beans (fríjoles vol-
teados) are fondly called
“Guatemalan caviar.”
The Mayan word for corn,
wah, also means “food.”
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C H A P T E R 9 2 6 5
Group Comments Common Foods Adaptations in the United States
Protein Foods
Milk/milk
products
Milk is not widely consumed as a
beverage, but evaporated milk
and cream are popular in some
regions.
Milk (evaporated), cream; cheese (aged
and fresh—crumbly farmer’s cheese
type)
Milk and hard cheese may be
disliked by Guatemalans,
but increased intake
reported for Salvadorans.
Meat/poultry/fish/
eggs/legumes
Legumes are important in the
cuisine and are often served with
rice. All types of meat/poultry
are eaten, but pork is popular
throughout the region. Eggs
are commonly served. Fish and
shellfish are consumed in the
coastal regions. Sea turtle eggs are
popular.
Meat: beef, iguana, lizards, pork (all
parts, including knuckles, tripe, and
skin), venison
Poultry: chicken, duck, turkey
Fish and shellfish: clams, conch,
flounder, mackerel, mussels, sea snail,
shark, shrimp, sole, tarpon, turtle
Eggs: poultry, turtle
Legumes: beans—black, chickpeas,
fava, kidney, red, white
Bean dishes remain popular.
Cereals/Grains Rice and corn are the predominant
grains of the region. Wheat flour
breads are common.
Corn (tamales, tortillas), rice, wheat
(bread, rolls)
Tortillas may be replaced by
breads.
Fruits/Vegetables Tropical fruits are abundant. Some
temperate fruits such as grapes
and apples are also available.
Salads and pickled vegetables are
popular.
Fruits: apples, bananas, breadfruit,
cherimoya, coconut, custard apple,
grapes as well as raisins, guava,
mameys, mangoes, nances, oranges
(sweet and sour types), papaya,
passion fruit, pejihaye, pineapples,
prunes, sour-sop, sweetsop, tamarind,
tangerines, zapote (sapodilla)
Vegetables: asparagus, avocados, beets,
cabbage, calabaza (green pumpkin),
carrots, cauliflower, chayote, chile
peppers, corn, cucumbers, eggplant,
green beans, hearts of palm, leeks,
lettuce, loroco flowers, onions, pacaya
buds (palm flowers), peas, plantains,
potatoes, pumpkin (ayote), spinach,
sweet peppers, tomatillos, tomatoes,
watercress, yams, yuca (cassava),
yucca flowers (izote)
Increased intake of potato
chips has been reported.
Increased consumption of
vegetable salads.
Additional Foods
Seasonings Cilantro (fresh coriander) and
epazote are important herbs. Sour
orange juice gives a tang to some
food; coconut milk flavors others.
Achiote is used to color foods
orange.
Achiote (annatto), chile peppers,
cilantro, cinnamon, cloves, cocoa,
epazote, garlic, onions, mint, nutmeg,
thyme, vanilla, Worcestershire sauce
Nuts/seeds Palm tree nuts, pepitoria (toasted
squash seeds)
Beverages Hot chocolate and coffee, grown
in the region, are favorite hot
beverages. Refrescas, cold drinks,
are made with tropical fruit flavors.
Boj, chicha, and venado are locally
made alcoholic beverages.
Coffee, chocolate, tropical fruit drinks,
alcoholic beverages (rum, beer, and
fermented or distilled fruit, sugarcane,
and grain drinks)
Increased intake of soft drinks.
TA B L E 9. 3 Cultural Food Groups: Central Americans
(Continued )
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2 6 6 M E X I C A N S A N D C E N T R A L A M E R I C A N S
soup), sopa de hombre (“a man’s soup”) made
with seafood, and plantains in coconut milk
are a few specialties. In Guatemala the stews
of meat and poultry, such as pepián and jocon,
are thickened with toasted squash seeds. Meat,
poultry, and fish are frequently roasted as well.
Fruits and vegetables are numerous.
Although bananas, coconut, plantains, yucca
(cassava), tomatoes, sweet peppers, cab-
bage, chayote squash (known as huisquil in
Guatemala), mangoes (considered an aphro-
disiac in Guatemala), oranges, and avocado
predominate, cauliflower, carrots, beets, rad-
ishes, green beans, lettuce, spinach, pump-
kin, breadfruit, passion fruit (granadilla),
pineapples, mameys, and nances (similar to
yellow cherries) are also common. Flowers
from yucca, palms (pacaya buds), and loroco
(Fernandia pandurata) are eaten as vegetables
throughout the region.165 Starchy fruit from
the peach palm (pejibaye) and spiny palm
(coyoles) are especially popular in Costa
Rica and Honduras. Onions and garlic flavor
many dishes. Salads and pickled vegetables
are common as appetizers, as side dishes, and
on sandwiches.
Coffee, grown throughout the region, is
a popular drink, usually consumed heavily
sweetened. Hot chocolate is another favorite,
and fresh milk, if consumed, may be sweet-
ened with added sugar. Refrescas, cold bever-
ages, are made in tropical fruit flavors, such
as mango and pineapple. Tiste, a Nicaraguan
favorite, is made with roasted corn, cocoa
powder, sugar, cold water, and cracked ice.
Beer is widely available. Fermented bever-
ages such as boj (from sugarcane) and chicha
(a wine made from fruit or grain, fortified
with rum) are consumed. Venado is a com-
mon distilled drink made from sugarcane.
Sweets, such as the praline-like candy called
nogada, sweetened baked plantains, ices made
with fruit syrups, custards, rice puddings, and
cakes or fritters flavored with coconut or rum,
are eaten as snacks and for dessert.
Regional Variations Although many foods of
Central America are similar, they are often fla-
vored with local ingredients for a unique taste.
Coconut milk flavors many dishes in Belize
and Honduras; seafood specialties include
conch and sea turtle. The foods of El Salvador
are often fried and feature many indigenous
flavors including corn, beans, tomatoes,
chiles, and turkey. Achiote is common in mild
seasoned Guatemalan fare. The juice of sour
oranges is mixed with sweet peppers or mint
in many Nicaraguan recipes. Costa Ricans
prefer foods simmered with herbs and season-
ings such as cilantro, thyme, oregano, onion,
garlic, and pimento; rice is also frequently
consumed. Panamanian fare is more inter-
national in flavor; one specialty is sancocho,
a stew of pork, beef, ham, sausage, tomato,
potato, squash, and plantains.
Meal Composition and Cycle
Daily Patterns As in other Latin American
regions, beans and corn are the cornerstones of
the daily diet, eaten at every meal by the poor.
Rice is also common. Queso blanco (a fresh
cheese) or meat is added whenever resources
permit. Dinner in wealthier areas usually
includes soup, meat or poultry (sometimes
fish), tortillas or bread, and substantial gar-
nishes such as avocado salad, fried plantains,
and pickled vegetables. Appetizers, such as
slivers of broiled beef, bites of meat- or cheese-
filled pastry, and soft-boiled turtle eggs, are
eaten in some urban regions before dinner;
dessert may also be served, typically including
custards, ice creams, cakes, or fritters.
Though iguana is eaten
throughout Central
America and parts of
Mexico, South America,
and the Caribbean, it is
especially popular with
Indians in Nicaragua.
Chocolate was so prized
in Mayan culture that
cacao beans were used
as currency.
TA B L E 9. 2 Cultural Food Groups: Central Americans (C on t in u e d )
Group Comments Common Foods Adaptations in the United States
Fats/oils Lard is the most commonly used fat. Butter, lard, vegetable oils, shortening Lard and shortening use may
decrease; vegetable oils and
mayonnaise may increase.
Sweeteners Honey and sugar are used as
sweeteners.
Honey, sugar, sugar syrup Increased intake of candy is
noted.
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C H A P T E R 9 2 6 7
Special Occasions Celebrations in Central
America are focused on Catholic religious
days. Christmas, Easter, and Lent, saints’
days (including All Saints’ Day), and even
Sundays may mean a change in fare. Spe-
cial dishes include the cheese-flavored bat-
ter bread called quesadilla that is served in
El Salvador on Sundays; sopa de rosquillas, a
soup made with ring-shaped corn dumplings
traditionally eaten on the Fridays of Lent in
Nicaragua; gallina rellena Navidena, a Nica-
raguan Christmas dish of chicken stuffed with
papaya, chayote squash, capers, raisins, olives,
onions, and tomatoes; and plantains served
in chocolate sauce during Semana Santa (the
Holy Week before Easter) in Guatemala.
Chicken in tomato sauce (guisado),
chicken served with cornmeal porridge, or
stews thickened with masa harina are Indian
specialties eaten at ceremonial occasions.
In some areas the stews are provided by the
village headman to serve the community. In
Guatemala All Saints’ Day is celebrated with
a unique salad called fiambre. These enor-
mous salads involve a family social event at
which as many as fifty friends and relatives
share the creation.149 They feature vegetables
(e.g., green beans, peas, carrots, cauliflower,
beets, radishes, cabbage) mixed with chicken,
beef, pork, and sausages and then artfully
garnished with salami, mortadella, cheese,
asparagus, pacaya buds, and hard-boiled eggs.
The dressing is either a vinaigrette or a sweet-
and-sour sauce.
Etiquette
Dining customs in Central America are often
similar to those of Mexico. For example, no
guest should begin eating at a meal until the
host says “¡Buen provecho!”23 Most Central
Americans eat European-style, with the fork
remaining in the left hand and the knife in
the right one. However, certain more Ameri-
canized groups, such as some Nicaraguans,
may eat in the American fashion of using
the fork in the right hand, switching to the
left when cutting food. When not eating, the
hands should remain above the table, with
the wrists resting on the edge. Bread or torti-
llas may be served (typically without butter)
and should be placed on the side of the plate.
▲ Tropical fruit from Latin
America.
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It is acceptable to scoop up small bits of food
with pieces of tortilla. Dishes are passed to
the left. Diners are expected to clean their
plates, so taking small portions is appro-
priate. Asking for seconds is considered a
compliment.
S A M P L E M E N U
A Guatemalan Dinner
Chicken Jo c on a,b or Pollo en Pipian
(Chicken in Tomato-Pumpkin Seed Sauce)b
Rice
F r ijole s V olt e ad os (Refried Black Beans)a,b
Radish Salad,a,b
Plátanos al Horno (Baked Sweet Plantains) or Coconut Candya
Hot Chocolate or Coffee
aMarks, C. 2004. False tongues and Sunday bread:
A Guatemalan and Mayan cookbook. Takoma Park, MD: Takoma Books.
bGuatemalan Cuisine & Recipes at
http://www.whats4eats.com/central-america/guatemala-cuisine
In Guatemala, eggs
poached and served with
a seasoned broth are
used to treat hangovers.
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2 6 8 M E X I C A N S A N D C E N T R A L A M E R I C A N S
Therapeutic Uses of Foods
Some Central Americans follow the hot–cold
theory of health and illness, and some also go
by the need to balance wet–dry. Guatemalan
Americans commonly believe that diarrhea is
caused by hot weather and can be alleviated
by consuming cold drinks, such as Kool-Aid
or Gatorade.142 However, ice cubes may be
avoided during hot weather. Panamanians
may avoid cold foods when sick, but in one
sample, none applied hot–cold principles to
daily meals.141,142 Guatemalans also appeared
not to balance hot and cold foods; however,
it has been suggested that the practice is so
enculturated that it is done without conscious
effort.142 Fatty foods and highly spiced dishes
may also be avoided by both Guatemalans and
Panamanians when ill.
Herbal remedies are popular through-
out Central America, especially teas. Stud-
ies of Guatemalans and Panamanians found
that the teas were consumed to maintain
health, and even more often, to cure minor
illness.141,142 Examples include teas such as
manzanilla (chamomile) for improving cir-
culation, menstrual cramps, and flu or colds;
banana leaf and hierbabuena (mint) for good
digestion and regularity; and lemon for gen-
eral health. Rosa de jamaica (hibiscus) was
used for respiratory illness, diarrhea, and
urinary tract infections, while papaya-leaf
tea was considered good for gastritis and as
a laxative. Lime, fig leaf, and grapefruit teas
were consumed for anxiety and alleviation
of stress. Notably, avocado, garlic, ginseng,
and valleriana were mentioned as remedies
for hypertension and diabetes among Pana-
manians. Coca leaves, the source of cocaine,
are also reported to be used medicinally in
some areas.148
Contemporary Food Habits
in the United States
Adaptations of Food Habits
There is scant information on the Central
American diet in the United States. Low
rates of assimilation among many Central
American immigrants are assumed to result
in preservation of traditional food hab-
its. Most Central American ingredients are
available in the Latino communities where
they settle. One study found that more than
half of Honduran women living in New
Orleans continued to consume a diet very
similar to what they ate in their homeland.150
Rice, beans, fruit juices, tortillas, cheese,
bananas or plantains, beef, and eggs were the
items eaten most often. Few new foods were
added by a small number of women, and
only kiwi fruit, plums, canned vegetables,
and olive oil were used by more than 10 per-
cent of the sample. Prepared items, especially
hamburgers (eaten by 30 percent of respon-
dents), fried chicken, pizza, and regional
dishes, such as jambalaya and Cajun foods
(13 percent for each dish), were other new
items consumed by a few of the Honduran
women. Some also reported baking more
foods, frying less, and using more vegetable
oil instead of lard or coconut oil in cook-
ing. A meal was defined as having courses,
including meat of some sort, and requiring
the diner to sit down. Though the women
reported skipping meals, this sometimes
meant that they ate a sandwich for lunch,
which was not considered a meal.
Salvadoran refugees report that, in gen-
eral, the quality of their diet has declined
since arriving in the United States. They
state that in El Salvador more foods were
made at home from fresh ingredients; they
believe that in the United States more pro-
cessed items and junk foods are eaten, and
some nutritious foods are too costly to con-
sume.144 However, findings from another
study of Salvadorans found that there were
some beneficial dietary changes after immi-
gration to the United States. Though intake
of high-sugar and high-fat foods such as
jams or jellies, soft drinks, ice cream, may-
onnaise, and vegetable oil increased, con-
sumption of lard, shortening, and fatty
meats, including chicharrones and sausage,
decreased. Bean dishes, such as frijoles san-
cochados, remain popular, although other
traditional items including pupusas, tama-
les, and plantain empanadas were eaten
significantly less often. Although milk,
fruit juice, and fresh salad intake increased,
some Salvadorans sampled consumed inad-
equate servings of dairy products, fruits,
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C H A P T E R 9 2 6 9
and vegetables.151 A recently published
study found that fruit and vegetable intake
among all subgroups of Hispanic subgroups
in the California, including Central Ameri-
cans, were higher when compared to non-
Hispanic ethnic groups.
Health workers in Florida report that
Guatemalan refugees believe that if a food is
tasty and does not cause stomach discomfort,
it must be good to eat. High intake of candy,
soft drinks, and potato chips has been noted.
Milk, which is often not well tolerated, may
be avoided. WIC (Supplemental Food Pro-
gram for Women, Infants, and Children)
nutritionists found that some food supple-
ments, including milk and cheese, are disliked
because of their taste or texture and are some-
times discarded.142
Nutritional Status
Nutritional Intake Limited data on the nutri-
tional status of Central American immigrants
have been published. Those who arrive after
spending time in refugee camps may suffer
high rates of malnutrition resulting in dis-
eases such as beriberi, pellagra, scurvy, and
vitamin A deficiency problems, especially in
children younger than the age of five. Infec-
tious diseases often follow; tuberculosis and
parasites are common.144 Endemic infec-
tions may cause problems as well. Chagas
heart disease, resulting from infections with
Trypanosoma cruzi (found in most of Cen-
tral America), presents symptoms similar
to other coronary artery conditions. U.S.
outbreaks of cyclosporiasis due to contami-
nated raspberries imported from Guatemala
in 1996 and 1997 suggest another source of
infection. Rates of sickle-cell anemia were
found to be high (5.7 percent) among mostly
Central American adolescents in Los Ange-
les, and the disease appears to be associated
with this population independent of African
heritage.152
Infant mortality rates for Central Ameri-
cans in the United States are below the aver-
age for whites.153 Low-birth-weight infants
were not found to be a problem among
Central Americans in a Chicago study. Even
those at significant personal or environmen-
tal risk (i.e., living in low income, urban
neighborhoods) showed no excessive low
birth weight.1,154 Researchers report that
Guatemalans consider breast-feeding healthy
for infants but impractical. Breast-feeding
often is used as supplementation to formula
and solid foods for the first two to three years
of a child’s life.142
A study of Salvadoran American youth
aged six to eighteen years in Washington,
DC, found a prevalence of overweight dou-
ble that of the national average and 1.7 times
higher than for Mexican American children
in national surveys. Thirty-eight percent
were overweight (BMI $95 percentile), and
another 22 percent were at risk for overweight.
Overweight in this sample was associated with
elevated blood pressure, body fat percentage
over 30 percent, and early puberty.155
An occupational hazard for many Central
Americans employed as U.S. farm-workers is
pesticide or herbicide poisoning. Exposure
occurs when labor codes are unenforced or
through worker mishandling of the danger-
ous products.
Counseling Access to biomedical health care
can be especially difficult for Central Ameri-
cans. Many are economically and linguistically
isolated within their communities; others are
unauthorized residents avoiding detection by
authorities. Failure to utilize health care is also
thought to be due to cost: a high percentage of
young adults of Central and South American
origins were uninsured in one study, with the
highest rates (73 percent) among those who
were not U.S. citizens.156
Most immigrants from Central America
are present oriented, though many are also
polychronic, viewing time more as a circle
than a straight line.24 They typically view
health from day to day, believing that they
have no control over the future. The concept
of scheduled appointments may be unfamil-
iar, and there is little interest in arriving on
time. Touching is used to communicate feel-
ings. Men usually embrace close friends, and
women are likely to hug all acquaintances.
Salvadorans, Guatemalans, and Nicaraguans
prefer a light handshake that is lingered over.
Men should wait for a woman to extend her
hand before shaking, however. Eye contact
Lactose intolerance may
be prevalent among
Central Americans.
Illness is a sign of weak-
ness among some
Guatemalans, and a
person may be stig-
matized because he or
she is unable to fulfill
responsibilities.
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2 7 0 M E X I C A N S A N D C E N T R A L A M E R I C A N S
may be direct when speaking, but it is often
downcast when listening politely. Salvadorans
use their hands expressively, but it is consid-
ered impolite to point with the fingers or the
feet. Most Central Americans have a different
sense of personal space than do Anglos and
prefer to sit and stand closer than is comfort-
able for many whites, but backing away may
be seen as an insult.
Central Americans are high-context com-
municators, using a calm, measured voice and
emotional restraint, except among family and
friends. A respectful, yet warm and caring
speaking style is most effective.24
Culturally based descriptions of symp-
toms were found among Guatemalans in
Florida.142 “Weak heart” referred to palpi-
tations or dizziness; “weak stomach” meant
indigestion; and “weak nervous system” was
applied to headaches or insomnia. Taking
blood samples was very anxiety provoking
because of the Guatemalan belief in the need
for strong, ample blood. Anemia was associ-
ated with weak blood, to be cured by “eat-
ing iron.” Guatemalans also identify susto
and nervios as illnesses (see “Traditional
Health Beliefs and Practices” in the previ-
ous Mexican section) found more often
in women than men. If not treated, these
conditions are thought to cause diabetes.14
Guatemalans believe injections are the most
effective treatment for illness—more potent
than pills. However, one study found that
some Guatemalans fear the “chemicals” used
in biomedicine.146 Treatment is successful if
symptoms are alleviated.
A study of Salvadorans found that the most
important source of emotional support came
M A R G A R E T K . W A R D , M S , R D , L D / ND / ND
Ihave worked with Hispanic clients, primarily Mexican Americans, since 1990
when I returned to the western states after
living eight years in the Midwest. In my
experience many of the clients/patients
tend to cook without recipes. The less accul-
turated client/patient tends to use many
more “basic” or less processed foods. They
may or may not have been influenced by
American food practices to the extent that
they use less lard (manteca) and more oil
(though the vegetable oils chosen are not
necessarily the “best/healthiest” choices).
I would say it’s dependent upon the length
of time the person has been in the United
States and his or her level of acculturation. If
he or she has been here awhile and is learn-
ing English, the person tends to acquire
more of the Western food culture. Also,
the number and age of children can have
an effect. Families with older, school-aged
children tend to acculturate more because
of the influences of school and interaction
with “American” children.
My advice to new health care profes-
sionals working with this community is to
acquire Spanish language skills as soon as
possible. I began my learning in the clinic;
then in desperation I took two semesters
of Spanish in the community college to
acquire the grammatical background that
the clinic wasn’t providing. Facility in the
language is critical to communication. I’m a
teacher of nutrition; if I can’t communicate
with my student, I’m not able to do my job
very well. Having good Spanish skills made
working with clients on modifying the diet
much easier, and most Mexican foods can be
modified to meet nutritional needs.
Don’t be afraid to make mistakes with
Spanish language speakers. I have found
that my Hispanic patients have almost
always been extremely forgiving of my hor-
rible Spanish. They seem to appreciate any
attempt that one makes to communicate
with them in their language. The worst that
will happen if you do make an error is that
you’ll both laugh. I have several Spanish
error stories. One took place in the Women,
Infant and Children (WIC) clinic when a
postpartum patient returned for a follow-up
hemoglobin determination, which was low
again the second time. We reviewed the
foods to include in her diet to increase her
hemoglobin, and I again encouraged her to
continue her prenatal vitamin use. At the
end of my spiel, I told her that if she took her
vitamins and ate well that she would “sen-
tarse bien.” Unfortunately, I told her that she
would sit well, rather than feel well (which is
sentirse bien).
N E W A M E R I C A N P E R S P E C T I V E S
Hispanic
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C H A P T E R 9 2 7 1
from family and friends. Single immigrant
men preferred living with other Salvadorans
when possible144 posttraumatic stress disor-
der is prevalent among refugees from El Sal-
vador and other Central American nations; it
is especially acute among those who are here
illegally and suffer continuous anxiety regard-
ing the possibility of deportation.157
Central Americans sometimes assimilate
into other Latino communities. Cross-cultural
exchanges of health beliefs and practices may
occur in some areas, and practitioners should
be aware of possible Mexican or Caribbean
Islander concepts adopted by Central
Americans. The in-depth interview is crucial
in counseling Central Americans because so
few data about food habits, health practices,
and nutritional status are available. In addi-
tion, information from family members or
community experts may be needed.
D I S C U S S I O N S T A R T E R S
Comic Books as Nutrition Education
In a story on helping migrant workers in the United States improve their diets, Evelyn Theiss, a medical writer for the Cleveland, Ohio, newspaper The
Plain Dealer (http://www.cleveland.com/healthfit/index.ssf/2010/07/comic_book_helps_families_in_m.html) tells how Jill Kilanowski, an assistant Plain Dealer (http://www.cleveland.com/healthfit/index.ssf/2010/07/comic_book_helps_families_in_m.html) tells how Jill Kilanowski, an assistant Plain Dealer
professor at Case Western Reserve University, developed a comic book for migrant worker mothers and their young children. Kilanowski explains, “The
mothers told me they wanted reading materials with primary colors to use as a teaching tool for their small children, as well as a story line and pictures.”
It turns out that comic books are very popular in Mexican and Mexican American cultures. The major focus of this comic book story is on limiting portion
sizes, because Mexican American immigrants often suffer from obesity, diabetes, and hypertension.
Imagine that you have been hired to write another comic book for Mexican American migrant workers on making some change to their dietary or
health habits to improve their health. Because limiting portion sizes has been done, what other change might you focus on? Outline the story line, if
you can. Consider a comic book for Central American immigrants. Would the same themes and story lines work for them? In small groups, share your
themes and story lines, getting feedback from your group members, and then revise your ideas for your comic books.
Review Questions
1. Compare and contrast the staple foods of
Mexico’s different regions.
2. Describe the hot–cold system of diet and
health practiced traditionally by Mexicans.
3. List two regional U.S. foods that are modifi-
cations of Mexican recipes. First, describe the
possible original dish, and then explain how it
is modified.
4. Which countries make up Central America?
Roughly, what are the demographics of immi-
grants in the United States from Central
America?
5. Compare the traditional health beliefs and
practices of Mexicans and Central Americans.
6. Describe the food staples of Central America.
7. What are the most common health problems
of Mexicans and Central Americans and their
decendants living in the United States? How
may acculturation to the American diet con-
tribute to these problems?
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tics Reports, 58(17). Hyattsville, MD: National
Center for Health Statistics.
154. Prevalence of low birth weight among Hispanic
infants with United States–born and foreign-
born mothers: The effect of urban poverty.
American Journal of Epidemiology, 139, 184–192.
155. Mirza, N.M., Kadow, K., Palmer, M., Solano, H.,
Rosche, C., & Yanovski, J.A. 2004. Prevalence of
overweight among inner city Hispanic-Ameri-
can children and adolescents. Obesity Research,
12, 1298–1310.
156. Callahan, S.T., Hickson, G.B., & Cooper, W.O.
2006. Health care access of Hispanic young
adults in the United States. Journal of Adolescent
Health, 39, 627–633.
157. Molesky, J. 1986. Pathology of Central America
refugees. Migration World, 14, 19–23.
158. Bladholm, L. 2001. Latin & Caribbean grocery
stores demystified. Los Angeles: Renaissance
Books.
159. Laudan, R. 2004. The Mexican’s kitchen’s Islamic
connection. Saudi Aramco World, 55, 32–39.
160. Looker, A.C., Loria, C.M., Carroll, M.D.,
McDowell, M.A., & Johnson, C.L. 1993. Calcium
intakes of Mexican Americans, Cubans, Puerto
Ricans, non-Hispanic whites, and non-Hispanic
blacks in the United States. Journal of the Ameri-
can Dietetic Association, 93, 1274–1279.
161. Romieu, I., Hernandez-Avila, M., Rivera, J.A.,
Ruel, M.T., & Parra, S. 1997. Dietary studies
in countries experiencing a health transition:
Mexico and Central America. American Journal
of Clinical Nutrition, 65, 1159S–1165S.
162. Basiotis, P.P., Carlson, A., Gerrior, S.A.,
Juan, W.Y., & Lino, M. 2002. The Healthy Eating
Index: 1999–2000. Washington, DC: U.S. Depart-
ment of Agriculture, Center for Nutrition Policy
and Promotion. CNPP–12.
163. Harris, K.M. 2000. The health status and risk
behaviors of adolescents in immigrant families.
In D.J. Hernandez (Ed.), Children of immigrants:
Health adjustment and public assistance. Wash-
ington, DC: National Research Council.
164. Landale, N.S., Oropesa, R.S., & Gorman, B.K.
1999. Immigration and infant health: Birth out-
comes of immigrant and native-born women. In
D.J. Hernandez (Ed.), Children of immigrants:
Health, adjustment, and public assistance. Wash-
ington, DC: National Academy Press.
165. Franzini, L., & Fernandez-Esquer, M.E. 2004.
Socioeconomic, cultural, and personal influ-
ences on health outcomes in low-income
Mexican-origin individuals in Texas. Social
Science & Medicine, 59, 1629–1646.
166. Gould, J.B., Madan, A., Qin, C., & Chavez, G.
2003. Perinatal outcomes in two dissimilar
immigrant populations in the United States.
Pediatrics, 111, e676–e682.
167. Wingate, M.S., & Alexander, G.R. 2006. The
healthy migrant theory: Variations in pregnancy
outcomes among US-born migrants. Social
Science & Medicine, 62, 491–498.
168. Guendelman, S., Thornton, D., Gould, J., &
Hosang, N. 2006. Mexican women in California:
Differentials in maternal morbidity between for-
eign and US-born populations. Paediatrics and
Perinatal Epidemiology, 20, 471–481.
169. Acevedo, M.C. 2000. The role of acculturation
in explaining ethnic differences in the prenatal
health-risk behaviors, mental health, and par-
enting beliefs of Mexican-American and Euro-
pean American at risk women. Child Abuse and
Neglect, 24, 111–127.
170. Page, R.L. 2004. Positive pregnancy outcomes in
Mexican immigrants: What can we learn? Jour-
nal of Obstetrical and Gynecological Nursing, nal of Obstetrical and Gynecological Nursing, nal of Obstetrical and Gynecological Nursing 33,
783–790.
171. Jenny, A.M., Schoendorf, K.C., & Parker, J.D.
2001. The association between community con-
text and mortality among Mexican-American
infants. Ethnicity & Disease, 11, 722–731.
172. Guendelman, S., Thornton, D., Gould, J., &
Hosang, N. 2006. Mexican women in Califor-
nia: Differentials in maternal morbidity between
foreign and US-born populations. Paediatrics
and Perinatal Epidemiology, 20, 471–481.
173. McMurray, M.P., Ceriqueira, M.T., Conner, S.L.,
& Conner, W.E. 1991. Changes in lipid and lipo-
protein levels and body weight in Tarahumara
Indians after consumption of an affluent diet. New
England Journal of Medicine, 325, 1704–1708.
174. Wright, J., Romero-Gwynn, E., Cotter, A.,
Powell, C., Garrett, C., Grajales-Hall, M., . . .
Williamson, E. 1996. Radio is effective in teach-
ing nutrition to Latino families. California Agri-
culture, 50, 14–18.
175. Centers for Disease Control and Prevention.
2013. Listeria and food. Retrieved from http://
www.CDC.gov/foodsafety/specific-foods/listeria-
and-food.html (accessed February 27, 2015).
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2 7 8
10
Caribbean Islanders
and South AmericansCH
A
P
T
E
R
Cuba, and the smallest islands are barely
more than exposed rocks. Most were claimed
at one time by Spain, Britain, France, the
Netherlands, Denmark, or the United States,
but now include the independent nations of
Antigua/Barbuda, the Bahamas, Barbados,
Cuba, Dominica, Dominican Republic,
Grenada, Haiti, Jamaica, St. Christopher/
Nevis, St. Lucia, St. Vincent/Grenadines, and
Trinidad and Tobago, as well as the U.S. terri-
tory of Puerto Rico. Many islands, such as the
Virgin Islands (U.S.) and Martinique (France),
are still under foreign control.
The islands are uniformly scenic. The
tropical warmth and torrential rains provide
the ideal climate for a lush plant cover that
includes numerous indigenous fruits and veg-
etables. Later immigrants found the region
suitable for imported crops. The Caribbean
islands share a history of domination by
foreign powers and political turmoil. Native
Indians, Europeans, blacks from Africa, and
Asians from China and India have inter-
married over the centuries to produce an
extremely diverse population.
Cultural Perspective
History of Caribbean Islanders in the
United States
Immigration Patterns It is estimated that the
Hispanic population was 17 percent of the
United States’ total population in 2010. For
Hispanics from the Caribbean, residents from
Puerto Rico constituted the largest group, fol-
lowed by those from Cuba and the Dominican
Latinos from the Caribbean islands and South America often seem more differ-ent from one another than similar. Their
homelands vary from the tropics of the islands
and northern Brazil to the highland plains of
Argentina and the snow-topped mountains
of Peru. Their ethnic backgrounds include
native Indian, Spanish, Portuguese, French,
British, Danish, Dutch, African, Asian Indian,
Chinese, Italian, German, and Japanese. And
though Roman Catholicism is practiced by a
majority, many others follow Protestant faiths,
Judaism, and numerous indigenous Afro-
European religions including voodoo, santería,
and candomblé.
One commonality between Caribbean
Islanders and South Americans is a variety
of regional fares with few national cuisines.
Dishes typically combine native ingredients
with foods introduced from Europe, Africa,
and Asia, with a broad preference for strong,
spicy flavors. This chapter reviews Caribbean
Islanders and their fare, focusing on Puerto
Ricans, Cubans, and Dominicans. A sum-
mary of South Americans is also presented
(see Figure 10.1). Other Latinos are covered
in Chapter 9.
Caribbean Islanders
More than 1,000 tropical islands in the Carib-
bean stretch from Florida to Venezuela. They
include the Bahamas, the Greater Antilles
(Jamaica, Cuba, Hispaniola, and Puerto Rico),
and the Lesser Antilles. The largest island is
When Columbus landed
in the Bahamas in 1492,
he believed he had dis-
covered a new route to
Indonesia and called the
native people “Indians.”
The Caribbean islands
later became known as
the West Indies.
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C H A P T E R 1 0 2 7 9
Republic. In addition, there were small groups
of immigrants from other Caribbean nations,
most significantly from Jamaica and Haiti.
Puerto Ricans Puerto Ricans differ from most
other people who come to the United States in
that they are technically not immigrants. They
come to the mainland as U.S. citizens and are
free to travel to and from Puerto Rico without
restriction. Over half the population of Puerto
Rico resides on the mainland of the United
States, and the number of Puerto Ricans who
live in New York City is almost double the
number living in San Juan, the largest city in
Puerto Rico.
Small numbers of political exiles from
Puerto Rico arrived in America in the 1800s,
but most returned home when Puerto Rico
Figure 10.1
Caribbean islands and South
America.
North
Atlantic
Ocean
South
Atlantic
Ocean
Caribbean
Sea
BOLIVIA
COLOMBIA
VENEZUELA
PERU
BRAZIL
FRENCH GUIANA
SURINAME
GUYANA
CHILECHILE
ECUADORDOR
PARAGURAGURAGUAY
URUGUAY
ARGENTINA
Caracas
Brasilia
AsunciónAsunción
Santiago Buenos
Aires
La Paz
Bogotá
QuitoQuitoQuito
Lima
Montevideo
FALKLAND
ISLANDS (UK)
JAMAICA HAITI
DOM.
REP.
PUERTO RICO
VIRGIN ISLANDS
ST. ST. ST KITTS AND NEVIS
DOMINICA
BARBADOS
GRENADA
TRINIDAD AND TOBAGO
CUBA
BAHAMAS
Caracas
©
C
en
ga
ge
L
ea
rn
in
g
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2 8 0 C A R I B B E A N I S L A N D E R S A N D S O U T H A M E R I C A N S
differences between the two countries, most
Cubans have not been subject to the usual
immigration quotas.
Immigration from Cuba slowed with the
end of the airlifts. In 1980, another large group
of 110,000 Cubans arrived in Florida in pri-
vate boats (the Mariel boatlift) seeking asy-
lum. Unlike earlier immigrants, these recent
arrivals, called marielitos, were mostly poor,
unskilled laborers. They were often single
and black. Today, a trickle of exiles continue
to come to the United States. Some arrive by
boat and others go through legal immigration
channels from a neutral third country.
Dominicans Information on early immi-
grants from the Dominican Republic is lim-
ited because prior to 1990, Dominicans were
counted within the broader Hispanic category
in the U.S. Census data (in 1990 “Dominican”
was a write-in category; in 2000 it became
a check-off category).1 Four immigration
groups have been identified.2 The first was
during the Trujillo era (1930–1960), when
political dissidents came to the United States
to escape the regime of President Rafael
L. Trujillo. The second group came during the
post-Trujillo era (1961–1981), when improved
social and economic conditions slowed emi-
gration to a trickle. The third is the flotilla
group (1982–1986); this comprises Domini-
cans who left the country by boat, seeking
escape from oppressive poverty, hoping for
a new start in the United States. The fourth
group includes those who have left since the
early 1980s, many of whom are urban Domin-
icans better educated than those they leave
behind, seeking employment opportunity.
Some Dominicans enter the U.S. mainland
after making Puerto Rico their home. The
numbers of unauthorized Dominicans, or
those who return to the island, are unknown.3
Current Demographics
Puerto Ricans The number of Puerto Ricans
living on the U.S. mainland reached over
5 million in the 2010 Census estimates.3 Over
25 percent of Puerto Ricans make New York
State their home, with most living in New
York City.4 In the 1930s, Puerto Ricans began
moving into East Harlem, which became
became a U.S. possession. Others arrived
when unemployment increased in the
depressed agricultural economy of the island
during the 1920s and 1930s. It was after World
War II that the largest number of Puerto
Ricans moved to the mainland. Unlike other
immigrants, the Puerto Rican population in
the United States is in continual flux. Many
Puerto Ricans live alternately between the
mainland and the island, depending on eco-
nomic conditions.
Cubans Cubans have immigrated to the
United States since the early nineteenth cen-
tury. In the early years, the majority were
those who found economic conditions dis-
advantageous or who were politically out of
favor with the current government.
The majority of Cubans came to the United
States after Fidel Castro overthrew the dicta-
torship of Fulgencio Batista in 1959. In the
three years following the revolution, more
than 150,000 Cubans arrived in America.
Most of these were families from the upper
socioeconomic group fleeing the restraints of
communism. Commercial air travel between
Cuba and the United States was suspended
after the Cuban missile crisis in 1962. Airlifts
of immigrants from 1965 to 1973 increased
the total number of Cubans in the United
States to nearly 700,000. Due to the political
Terms of identity vary for
Puerto Ricans, including
Puerto Rican American,
Borrinqueño or Boricua
(used by those who
prefer the native Taíno
Indian name for the
island), and Nuyorican
(used by second-genera-
tion Puerto Ricans living
in New York City).
Puerto Ricans living
in Puerto Rico are not
counted in the U.S.
Census totals.
▼ Cuban cafeteria, Miami,
Florida.
D
an
ie
l K
or
ze
ni
ew
sk
i/
Sh
ut
te
rs
to
ck
.c
om
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C H A P T E R 1 0 2 8 1
known both as El Barrio and as “Spanish
Harlem.” The median age of Puerto Ricans
is 27 years, compared to 37 years for the U.S.
total population.5
Cubans In 2013, the U.S. Census estimated
that the number of Americans of Cuban
descent was under 2 million.6 Most Cubans
live in urban areas, but the largest number live
in the Miami area, which is sometimes called
“Little Havana,” where the climate is similar to
that of their homeland. Economically, Cuban
Americans have a higher median income than
non-Hispanic whites.7
Dominicans Approximately 1.8 million indi-
viduals of Dominican descent are living in the
United States.6 The majority live in the urban
areas of New York, New Jersey, Massachu-
setts, and Florida. It has been estimated that
as many as 300,000 unauthorized migrants
also reside in those regions.8
Other Caribbean Islanders Steady immigra-
tion to the United States during the 1990s
had increased numbers of other Caribbean
Islanders in 2010 to over 965,000 Jamaicans
and nearly 881,000 residents from Haiti.6
Jamaicans have settled in the cities of the
Northeast and South.
Socioeconomic Status Immigrants from
the Caribbean vary in both economic and
educational attainment. Among Latinos,
Puerto Rican Americans have a high rate of
unemployment, and Cuban Americans have
the lowest. More than 28 percent of Puerto
Ricans live in poverty, which is higher than
the rate for both the general U.S. popula-
tion (16 percent) and for Hispanics overall
(26 percent). However, it should be noted that
second-generation mainland Puerto Ricans
living in regions outside New York may have a
different socioeconomic profile, with signifi-
cantly higher rates of college graduation and
white-collar employment.9 Economically, U.S.
Cubans have a higher median income than
non-Hispanic whites in the United States.10
Dominicans have the same median earnings
similar to other Hispanics, but less than the
U.S. population.11
Educational rates for first-generation
immigrants from the Caribbean are very
similar to those of other Latinos. Figures
from 2010 show that for adults, both Puerto
Ricans and Cuban Americans graduate from
high school at rates of 76 and 81 percent,
respectively, which are somewhat below that
of the general population. However, rates of
high school attendance are lower for those
who were born in Puerto Rico or Cuba. The
percentage of Puerto Ricans and Cubans who
have college degrees was 18 and 26 percent,
while total number of Americans with degrees
was 30 percent.12
Many factors influence socioeconomic
differences among Latino groups from the
Caribbean. Puerto Ricans living on the main-
land are free to travel between the United
States and their homeland, and the frequent
changes in residence may hamper socioeco-
nomic improvement. Many Puerto Ricans
have chosen to reside in New York City,
where as a new ethnic minority they took
over the lower-income neighborhoods pre-
viously occupied by African Americans. In
general, lower education levels and job skills
translate into unemployment and low-level
employment.
Furthermore, some Puerto Ricans, Domin-
icans, Jamaicans, and Haitians face biases sim-
ilar to that experienced by African Americans
because many are of African heritage. Racial
distinctions are not as significant in the Carib-
bean islands, and more overt discrimination
is a new challenge for some immigrants.13
In contrast, Cubans in the United States are
mostly political refugees who emigrated out
of necessity, not choice. There are a dispro-
portionate number of Cubans in the United
States from the upper socioeconomic levels,
and although many lost all their material
goods when they emigrated, they brought
upper-class values, including the importance
of educational and financial success. Instead
of displacing any ethnic minority in Florida,
they immigrated in such numbers that they
immediately became the dominant ethnic
group. This is not to say that there are no well-
educated, wealthy Puerto Ricans living on the
main-land or no poor Cuban Americans.
However, circumstances surrounding their
immigration have influenced the general
socioeconomic status of both groups.
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2 8 2 C A R I B B E A N I S L A N D E R S A N D S O U T H A M E R I C A N S
Worldview
Ethnic identity is strongly maintained in the
Puerto Rican, Cuban, and Dominican com-
munities in the United States. Puerto Ricans
on the mainland continue close ties with
the island, frequently returning to visit fam-
ily and friends. Cubans believe it is impor-
tant to retain their heritage because they
cannot return. Dominicans often consider
their stay in the United States temporary
and may resist acculturation to maintain
their identity. In all three groups, Spanish
may be spoken at home, but Caribbeans
were more likely to use English at home
(32 percent) than those from South America
(15 percent), Central America (7 percent), or
Mexico (3 percent).1,4,14 In contrast, Carib-
bean Islanders who are unauthorized resi-
dents, often try to blend into existing Latino
communities or assimilate into mixed ethnic
neighborhoods.15
Religion A majority of Caribbean Islanders
are Roman Catholics. The role of the Catholic
Church has been less important in the Carib-
bean than in other regions of Latin America
and is less significant to immigrants in the
United States. For example, the number of
Puerto Ricans living on the mainland who are
Catholic has declined since the 1960s, approx-
imating 70 percent today,13 and it is estimated
that only 64 percent of Cuban Americans
born in the United States are followers of the
faith.1 However, higher percentages of Catho-
lics may be found in other Caribbean Islander
groups who have been in the United States for
shorter periods of time. For instance, about
95 percent of Dominicans are adherents to
Roman Catholicism.16
A number of other religions are prac-
ticed in the islands, including Protestant-
ism and Judaism. For example, a majority of
Jamaicans, who at one time lived under Brit-
ish rule, belong to Protestant congregations,
such as the Church of God and Seventh-Day
Adventists. Folk religions are found as well.
The best known of these is voodoo, a unique
combination of West African tribal ritu-
als with Catholic beliefs and local customs.
St. Patrick is associated with the African
snake deity Damballah, for example, and St.
Christopher is identified with Bacoso, the
god responsible for infectious illness. Cer-
tain rites, such as repeating the Hail Mary,
making the sign of the cross, and baptism, are
practiced in conjunction with ancestor wor-
ship, drums, and African dancing. Worship
is family based, and there is no central lead-
ership or organization of activities. Typically
ceremonies are conducted for annual events
such as Christmas and the harvest and for
funerals.
Voodoo originated in Haiti, although very
similar Afro-Catholic cults are found on the
other islands. In Cuba and Puerto Rico, these
are called santer í a. Many followers of voodoo
or santería are also members of Christian
faiths and do not believe there is any contra-
diction in practicing both religions simultane-
ously.17 Rastafari is another Afro-Caribbean
faith indigenous to Jamaica. Rastas practice a
natural, simple lifestyle typified by bare feet,
loose clothing, dreadlocks, and sacramental
use of marijuana. It is also considered a politi-
cal movement due to Rastafari opposition to
traditional government and support for repa-
triation of blacks to Africa.
Family The Puerto Rican family is based on
the concept of c ompadr az go, which means co-
parenting. Grandparents, aunts and uncles,
cousins, and godparents are all considered
part of the immediate family, responsible
for the care of children.18 Men are the heads
of households as well as being in charge of
community matters. The oldest boys in the
family are expected to help with supervi-
sion of younger siblings, particularly daugh-
ters. Women maintain the home. Men are
expected to be aggressive; women are tradi-
tionally reserved. As in most Latino cultures,
age is respected and elders are honored.
Younger children are taught to defer even to
older children. Duty to family is extremely
important.19
Traditional Cuban families are also patriar-
chal and extend to include relatives. Godpar-
ents are significant in child rearing. Children
are deferential to elders and well chaperoned
in public.
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C H A P T E R 1 0 2 8 3
determines life and death. Prayer, the lighting
of candles to saints, and the laying on of hands
are important ways of maintaining health and
curing disease.21,22,23,24 Many Dominicans
employ the pr omesa, a promise or obligation
to be performed by a supplicant in exchange
for maintenance or restoration of health.16
In addition, some believe that all individuals
have a guardian angel who protects them from
evil. Some also believe illness can be caused by
evil spirits or the devil, particularly Domini-
cans and Haitians.
The conditions of empacho, susto, nervios,
and mal de ojo are known by many Puerto
Ricans, but not by all.21 Of special note
is nervios, which takes several forms.25,26
Someone who has experienced trauma as a
child may become a nervous person for life,
ser ner v ioso, with crying bouts, headaches,
stomach maladies, and a tendency toward
violence in men. This condition can be tem-
pered by use of herbal teas and talking with
family members, religious advisers, or mental
health professionals. P adec er de l os ner v ios is a
mental illness associated with depression that
develops in adults. It is treated with the help
of psychologists or psychiatrists. A taq ues de
ner v ios, also known as ataq ues, is a hysteri-
cal reaction to stressful events. It may include
acute breathing difficulties, frenzy, or the
sudden onset of illness. Nervios is a problem
Caribbean Islander families often change
in the United States. Women, who work in
greater numbers than men, and who may
make a higher income, often gain greater
authority within the home, and Caribbean
Islander children gain greater autonomy
in the United States. Economic pressures,
American values of individualism and equal-
ity, and intergenerational stress are often cited
as responsible for nontraditional adaptations.
Studies of early immigrants have shown that
one-third of Dominicans, for example, lived
in nuclear family groupings in the United
States even though only 1 percent did so in
the Dominican Republic. Dominican women
in the United States also had fewer children
than those on the island.18
Among the rural population of Haiti,
common-law marriage is frequent, and it
is acceptable for a man to maintain several
different households as long as he supports
each wife and their children. This pl ac aj
system is believed to be a remnant of the
polygamous societies found in parts of West
Africa.20 Gender roles are inflexible, with
men responsible for farming and providing
for the family, and women in charge of the
household budget, marketing, and child care.
Haitians have maintained more traditional
families than some other Caribbean groups
living in the United States. Typically, men
still head the family, though Haitian Ameri-
can women often insist on a greater role in
making decisions than is customary in Haiti.
Haitian children are still expected to obey
their parents, bring honor to their family,
and to reside at home until marriage. Haitian
Americans establish a close network with
other Haitian immigrants and keep in touch
with family and friends remaining in Haiti.
Those who are unable to return for political
reasons may sponsor voodoo ceremonies on
their behalf.13
Traditional Health Beliefs and Practices Many
Caribbean Islanders hold health beliefs simi-
lar to those of other Latin American cul-
tures. For example, Puerto Ricans, Cubans,
Dominicans, and Haitians often believe that
illness is a punishment from God, or that fate
M
ire
ill
e
Va
ut
ie
r/
A
la
m
y
▲ Serious conditions,
such as sickness due to
supernatural causes, may
require the cures associated
with the healing practice of
santería.
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2 8 4 C A R I B B E A N I S L A N D E R S A N D S O U T H A M E R I C A N S
found more often in women than men, and it
is associated with a weak character.27 In gen-
eral, nervios is helped by prayer, massage, sed-
atives, and herbal teas. Physicians and mental
health specialists are also useful. Other folk
conditions reported by Puerto Ricans include
pasmo, a type of paralysis due to an imbalance
of hot and cold, and f atiq ue, acute breathing
difficulties. Pasmo is cured through folk rem-
edies, whereas fatique responds to emergency
care provided by a physician.
Haitians are especially concerned with
the flow of blood, considered essential in the
balance of hot–cold categories. Many blood
irregularities are recognized, classified as hot,
cold, weak, thin, thick, dirty, and yellow.28
F ebl es occurs when there is insufficient blood
or anemia due to poor diet. The condition
is characterized by general weakness and is
cured by eating items such as liver, red meat,
pigeon meat, cow’s feet, or leafy green veg-
etables. S ez isman is a disruption of normal
blood flow, due to sudden emotional trauma
or chronic ill-treatment by others. It can cause
vision loss, headaches, high blood pressure, or
stroke. It is treated with relaxation, cold com-
presses, sipping cool water, or drinking cof-presses, sipping cool water, or drinking cof-presses, sipping cool water, or drinking cof
fee mixed with rum.29 Haitian women may
be encouraged to eat red fruits and vegetables
(such as beets or pomegranates) to strengthen
their blood.20
G az (gas) is another common condition G az (gas) is another common condition G az
for some Haitians. Gas may settle between the
ears, causing headache; in the stomach, caus-
ing indigestion; or in other parts of the body,
where it causes pain. Eating leftovers (espe-
cially beans) is one cause of gaz.29 A nursing
mother may undergo a thickening of her milk,
which causes headaches or depression in the
woman and impetigo in her baby. M ov e san is
a more serious condition in which a nursing
mother experiences fright or negative emo-
tions, causing her milk to spoil, resulting in
diarrhea and failure to thrive syndrome in her
infant.2 Some Haitians believe mal dy ok (evil
eye) can also cause illness.
The traditional healing practices common
in the Caribbean are more closely related
to African beliefs than the Arab Spanish
humoral system used in hot–cold applica-
tions. Mild conditions are treated through an
informal system of older women (mothers,
grandmothers, or neighbors) who are knowl-
edgeable about the use of teas, herbs, amu-
lets, and charms.30 A study of Dominican
healers found that the women learned their
skills from relatives or through spiritual
guidance.31 When at home in the Domini-
can Republic, they treated only clients they
knew personally from within their com-
munities. In the United States, the healers
expanded their practice to include strangers
and clients of all ethnicities. They typically
accepted a wide variety of physical and psy-
chological cases. When possible, the healers
preferred to consult with the entire family in
order to gain full support for recommended
treatment.
More serious conditions, such as those due
to supernatural causes, particularly witchcraft,
require the cures associated with voodoo and
santería. Voodoo priests ( h ougans or bok or s)
or priestesses (mambos) or spiritualist heal-
ers, known as espir itos and santer os, intervene
with the saints on behalf of a bewitched per-
son (practices related to those of the American
South; see Chapter 8). Santeros specialize in
soul possession and mental disorders. Dreams
may play an important role in health care
because they are a connection with the super-
natural world. Ancestors provide instructions
to an individual regarding health behaviors
through dreams. B r uj os (witches) and curen-
deros (healers) (see Chapter 9) may also be
sought for medical care.22
Dominicans often believe the best way to
treat illness is to use a traditional healer who
will consult with Catholic saints about which
home remedies are appropriate for the symp-
toms.16 This allows Dominicans to address
the spiritual and emotional aspects of physi-
cal problems as well as seek symptom relief.
Many Haitians recognize two types of illness.
The first is natural illness, due to a poor diet,
blood conditions, bone displacement, or cold
drafts and other environmental factors. These
can be cured by home remedies or visits to
biomedical practitioners. The second is super-
natural illness, due to angry spirits. These can
only be treated by a voodoo manger mor t
(feast for the dead) ceremony.29 Cubans often
consider santería a link to their past and may
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C H A P T E R 1 0 2 8 5
use a biomedical provider for relief of physical
symptoms but employ a santero to help them
restore balance or counteract the circum-
stances that led to their illnesses.24
Good hygiene, especially daily bathing, is
done to promote health among Puerto Ricans.
Some Puerto Ricans, Dominicans, and other
Caribbean Islanders practice a modified ver-
sion of the hot–cold classification system in
their diet, and some use it for categorizing
illness (see the “Therapeutic Uses of Food”
section in this chapter).23,31 Dominican heal-
ers may consider junk food, red meat, lack
of exercise, emotional distress, contact with
negative people, and environmental stresses
as some contributing factors in health prob-
lems.31 Haitians consider eating well, clean-
liness, and regular sleep essential to health.
Laxatives or enemas may be used to refresh
the bowel, remove impurities, and prevent
acne in children.29
Most Caribbean Islanders use herbal teas,
and over-the-counter medications are often
used to relieve symptoms—Dominicans may
also take baths with herbs or flowers. Many
Americans of Caribbean island heritage are
also likely to use home remedies or visit a
bontá nic as (herbal pharmacy) or a bodega
(small market) to purchase cures (including
antibiotics obtained without prescription) as a
first step in treating symptoms.24,32 One study
notes that some Dominicans refer to home
remedies of all types as z umos, a word that,
strictly translated, means “juices.”33
Traditional Food Habits
Ingredients and Common Foods
Caribbean food habits are remarkably simi-
lar for an area influenced by so many other
cultures. The indigenous Indians, the Spanish,
French, British, Dutch, Danes, Africans, Asian
Indians, and Chinese have all had an impact on
the cuisine. The basic diet is similar through-
out the region, with regional variations found
on each island. In recent years, tourism has
helped spread specialties from one nation to
another in order to meet visitor expectations
about what dishes are available, and the global
economy has furthered the development of a
pan-Caribbean cuisine.34,35,36
Indigenous Foods Columbus likened the
West Indies to paradise on earth. The islands
are naturally laden with fresh fruits and veg-
etables originally from Central or South
America, including the staple cassava (two
varieties of tuber, bitter and sweet, also known
as manioc and yuca; tapioca is a starch prod-
uct of manioc), acerola (Barbados cherry,
a small, sour fruit with exceptionally high
vitamin C content), avocados, bananas and
plantains, some varieties of beans, calabaza
(a type of pumpkin), cashew apples (fruit of
the cashew nut), cocoa, coconuts, corn, guavas,
malanga (a mild yam-like tuber sometimes
called cocoyam, yautia, tannier, or tannia),
mammee apples (a small green fruit with flesh
reminiscent of apricots), papayas (sometimes
called pawpaws), pineapple, sapodilla or nas-
eberry (a small fruit with aromatic flesh that
has a gritty texture similar to pears), soursop
(a fruit with a cotton-like consistency), sev-
eral types of squash (including chayote, called
chocho or christophene in the islands), sweet
potatoes, and tomatoes. Fish and small birds
are also plentiful.
As in other Latin American areas, chile
peppers grow profusely in the West Indies.
Extremely hot varieties are favored, including
Scotch bonnet and bird peppers (also called
tepins—see Chapter 9, for more information
on chiles). The native cuisine makes frequent
use of these for flavoring, especially in pepper
sauces, such as coui, a mixture of cassava juice
and chiles. Other native seasoning includes
allspice, recao (E r y ngium f oetidum, a pungent
herb also known as culantro, long cilantro, or
shandon beni), and annatto (achiote).
Because of the abundance of fresh fruits
and vegetables year-round, traditionally there
was little need for preparation or preserva-
tion of foods. Consequently, cooking tech-
niques were underdeveloped in the native
populations. Cassava was baked most often
in a kind of bread, made from pressed, dried,
grated cassava that was fried in a flat loaf. Fish
and game were either covered with mud and
baked in a pit or grilled over an open fire.
Foreign Influence The Europeans who set-
tled in the Caribbean were impressed with
the abundant supply of native fruits and
Cassava contains hydro-
cyanic acid, which is toxic
in large amounts. The
acid must be leached
out and the tuber
cooked before it can
be eaten safely.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
2 8 6 C A R I B B E A N I S L A N D E R S A N D S O U T H A M E R I C A N S
all countries are prepared similarly, flavored
with lard and salt. Onions, sweet peppers, and
tomatoes or coconut milk are added in some
variations. Other popular legumes include
pigeon peas, popularly known as gungo
(originally from Africa, often cooked with
rice, also), lentils (from India), chickpeas (also
known as garbanzo beans, introduced from
Europe), and bodi beans (another variety of
cowpea eaten as a green bean, also called Chi-
nese long beans).
Examples of other foods common
throughout the West Indies are found in the
cultural food groups list (Table 10.1). They
include native Indian foods such as cassava
bread, chile sauces, and pepper pot (a meat
stew made with the boiled juice of the cassava,
called cassarep). Tamales and pasteles are
steamed cornmeal, cassava, or plantain dough
packets with savory (such as meat, seafood, or
cheese) or sweet (including coconut or guava)
fillings. European-influenced items popular in
many Caribbean countries include escabeche
(fried, marinated fish, seafood, or poultry),
asapao (a thick rice soup with chicken, pork,
or seafood, often garnished with Parmesan
cheese in Puerto Rico and slices of avocado
or fried plantains in the Dominican Republic),
morcillas (a type of blood sausage), flaky pas-
try turnovers with meat, poultry, seafood, or
fruit fillings, and fried corn cakes (known as
surrulitos in Puerto Rico). Foods from Africa
found throughout the region include callaloo
(a dish of taro or malanga greens cooked with
okra), dried salt cod fritters (called bacalaitas
in Puerto Rico, these cakes have a different
name on nearly every island, from ar c at de
mar ue to “stamp and go”), foofoo (okra and
plantain), and coocoo (cornmeal-okra bread).
Dishes from India and Asia are also common
on many islands, although they are better
known in the areas where cheap labor was
most needed: the islands dominated by the
French, British, and Dutch (few Asians immi-
grated to Puerto Rico, Cuba, or the Domini-
can Republic). Curried dishes, called kerry on
the Dutch-influenced islands and colombo
on the French-influenced islands, and varia-
tions of pilaf are considered Caribbean foods.
Chinese cuisine is also popular and Chinese-
owned restaurants are omnipresent.
vegetables. Yet they longed for the accustomed
tastes of home. The Spanish brought cattle,
goats, hogs, and sheep to the islands, in addi-
tion to introducing rice. Plants introduced for
trade by the Europeans included breadfruit,
coffee, limes, mangoes, oranges (both sweet
and sour varieties), and spices such as gin-
ger, nutmeg, and mace. The African slaves
brought in to work the sugarcane fields cul-
tivated akee (a mild, apple-sized fruit), yams,
okra, and taro (also called eddo or dasheen;
both the roots and the leaves are eaten). The
demand for Asian ingredients by later immi-
grants resulted in the introduction of soybean
products, Asian greens, lentils, and tamarind
to the Caribbean.
Staples Legumes are eaten throughout the
Caribbean, most often in the dish “rice and
peas.” Rice with red (kidney) beans is popu-
lar in Puerto Rico and is also found in the
Dominican Republic and Jamaica (where the
dish is nicknamed “coat of arms”). In Cuba,
black beans with rice are preferred, called
Moros y Cristianos (“Moors and Christians,” a
reference to Spanish history). In Haiti, black-
eyed peas (a type of cowpea from Africa)
are combined with the rice. The legumes in
Nearly all parts of the
akee fruit contain hypo-
glycins, which can cause
fatal hypoglycemia.
Most akee products are
banned in the United
States.
S A M P L E M E N U
A Puerto Rican Lunch
E s c ab e ch e (E s c ovit ch e d Fish)E s c ovit ch e d Fish)E s c ovit ch e d a,b
S ur r ulit os c or Caribbean Johnnycakea
A r r oz c on P ollo (Peppery Chicken and Rice)a,b,c
Habich ue las G uis ad o (Stewed Beans)a,c
P lán tan os e n Alimbar (Candied Plantains/Baked Bananas) (Candied Plantains/Baked Bananas)P lán tan os e n Alimbar a,c
Fruit Juice, Beer, and Coffee with Milk
aDeMers, J. 1997. Caribbean cooking. New York: HP Books.
bCocina Criollo at http://www.ricanrecipes.com
c.The Boricua Kitchen at http://www.elboricua.com/recipes.html
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 0 2 8 7
Group Comments Common Foods Adaptations in the United States
Protein Foods
Milk/milk products Few dairy products are used;
incidence of lactose intolerance is
assumed to be high.
Infants are given whole,
evaporated, or condensed milk.
Cow’s milk (fresh, condensed,
evaporated), café con leche, café latte;
aged cheeses
More milk and cheese are
consumed.
Meat/poultry/fish/
eggs/legumes
Traditional diet is high in vegetable
protein, especially rice and
legumes; red and kidney beans
are used by Puerto Ricans, black
beans by Cubans.
Pork and beef are used more in
Spanish-influenced countries.
Dried salt cod is preferred over
fresh fish; some seafood
specialties.
Eggs are a common protein source,
especially among the poor.
Entrées are often fried in lard or
olive oil.
Meats: beef, pork (including intestines,
organs, variety cuts), goat
Poultry: chicken, turkey
Fish and shellfish: bacalao (dried salt cod),
barracuda, bonito, butterfish, crab,
dolphin fish (dorado), flying fish, gar,
grouper, grunts, land crabs, mackerel,
mullets, ostiones (tree oysters), porgie,
salmon, snapper, tarpon, turtle, tuna
Eggs: chicken
Legumes: black beans, black-eyed peas,
chick-peas (garbanzo beans), kidney
beans, lima beans, peas, red beans,
soybeans
More beef and poultry are
eaten as income increases,
though pork intake may
decline.
Less fresh fish is consumed.
Traditional entrées remain
popular.
Cereals/Grains Breads of other countries are well
accepted.
Fried breads are popular.
Cassava bread; cornmeal (fried breads,
surrulitos, puddings); oatmeal; rice
(short-grain); wheat (Asian Indian
breads, European breads, pasta)
Short-grain rice is still
preferred. More wheat
breads are eaten.
Fruits/Vegetables Starchy fruits and vegetables are
eaten daily; leafy vegetables are
consumed infrequently.
Great diversity of tropical fruits is
available, eaten mostly as snacks
or dessert.
Lime juice is used to “cook”
(a marinating method called
escabeche or ceviche) meats
and fish.
Fruits: acerola cherries, akee, avocados,
bananas and plantains, breadfruit,
caimito (star apple), cashew apple,
cherimoya, citron, coconut, cocoplum,
custard apple, gooseberries, granadilla
(passion fruit), grapefruit, guava,
guanábana (soursop), jackfruit,
kumquats, lemons, limes, mamey, mamey, mamey
mangoes, oranges, papayas, pineapple,
pomegranates, raisins, sapodilla,
sugarcane, sweetsop, tamarind
Vegetables: arracacha, arrowroot, black-
eyed peas, broccoli, cabbage, calabaza
(green pumpkin), callaloo (malanga
or taro leaves), cassava (yucaor taro leaves), cassava (yucaor taro leaves), cassava ( , manioc),
chiles, corn, cucumbers, eggplant,
green beans, lettuce, malan-gas, okra,
onions, palm hearts, peppers, potatoes,
radishes, spinach, squashes (chayote,
summer, and winter), sweet potatoes,
taro (eddo, dasheen), tomatoes, yams
Temperate fruits are
substituted for tropical
fruits when latter are
unavailable. More fresh
fruit is eaten.
Starchy fruits and vegetables
are still frequently
consumed.
Low intake of leafy
vegetables is often
continued.
Additional Foods
Seasonings Aromatic, piquant sauces are often
used to flavor foods. Very hot
chiles popular in some regions.
Anise, annatto, bay leaf, chiles, chives,
cilantro (coriander leaves), cinnamon,
coui (chiles mixed with cassava juice), coui (chiles mixed with cassava juice), coui
garlic, mace, nutmeg, onions, parsley,
pimento (allspice), recao (culantro),
scallions, thyme
TA B L E 10.1 Cultural Food Groups: Caribbean Islands
(Continued )
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2 8 8 C A R I B B E A N I S L A N D E R S A N D S O U T H A M E R I C A N S
distillation into rum, rum was shipped to
Africa and exchanged for slaves, and slaves
were shipped to the West Indies to work in
the sugarcane fields.
Juices made from tropical fruits such as
lime, otaheite apple (also called ambarella,
originally from Polynesia), pineapple, roselle
(also known as “Jamaican sorrel,” brought
from Africa), soursop, and tamarind are com-
mon. Ginger often spices the juice mixtures,
and coconut milk or condensed milk may also
be added.
Regional Variations Despite the similarities
in foods throughout the Caribbean, some
regional differences are notable. Same-
named dishes prepared on one island may
not taste the same on another island due to
variations in ingredients and seasoning. For
example, butter is the preferred cooking fat
in French-influenced countries, whereas
lard is more popular in Spanish-influenced
nations. Coconut oil is common in Jamaica.
In British-influenced countries, dishes often
include scallions, parsley or cilantro, and
thyme. On French-influenced islands roux
(flour blended with butter or oil, then cooked
until browned) is used to thicken stews and
sauces, and sauce chien (“dog sauce”) is a
popular fresh condiment served with pork,
chicken, and seafood, made with olive oil
and lime juice seasoned with ginger, gar-
lic, scallions, parsley, chiles, allspice, and
thyme. A similar preparation known as sauce
The most popular beverage in the Carib-
bean is coffee. It is often mixed with milk and
is consumed at meals, as a snack, and even
as dessert, flavored with orange rind, cin-
namon, whipped cream, coconut cream, or
rum. Some of the most expensive coffee in
the world is produced in the Blue Mountains
of Jamaica, where the cool, moderately rainy
climate is ideal for coffee cultivation. Most of
the rich beans are exported to England and
Italy, although small amounts can be found in
the United States.
The most important beverage in the Carib-
bean, at least historically, is the spirit distilled
from fermented molasses—rum. This alco-
holic drink is believed to have originated on
the island of Barbados in the early 1600s as a
by-product of sugarcane processing. Molasses
is the liquid that remains after the syrup from
the sugarcane has been crystallized to make
sugar. It is fermented, naturally or with the
addition of yeast, and then distilled to make
a clear, high-proof alcoholic beverage. Rum
can be bottled immediately or aged in oak
casks from a few months to twenty-five years.
Caramel is added to achieve the desired color.
Nearly every island produces its own variety
of rum.
The molasses produced in the West Indies
was crucial to the development of the region
during the seventeenth and eighteenth centu-
ries. The Caribbean islands were one corner
of the infamous slave triangle, formed when
molasses was shipped to New England for
Group Comments Common Foods Adaptations in the United States
Beverages Teas of all sorts are common
and are often thought to have
therapeutic value. Rum is
especially popular and is often
added for flavoring to foods and
beverages.
Beer, coffee (café con leche), teas, soft
drinks, milk, rum, Irish moss (seaweed
extract), sorrel
Fruit juice and soft drink
consumption may
increase.
Fats/oils Butter in French-influenced countries;
coconut oil; ghee (Asian Indian clarified
butter); lard in Spanish-influenced
countries; olive oil
Sweeteners Sugarcane products, such as raw and
unrefined sugar and molasses
TA B L E 10.1 Cultural Food Groups: Caribbean Islands (C on t in u e d )
©
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en
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ge
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ea
rn
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C H A P T E R 1 0 2 8 9
ti-malice is found in Haiti. Spanish-influenced
islands use more piquant seasonings with less
heat, including a greater use of tomatoes,
onions, annatto, and sweet bell peppers.
Each island is also known for its special-
ties. In addition to rice and red beans, Puerto
Rican fare is notable for its use of distinctive
flavorings, such as alcaparrado, a pickle mix
of capers, olives, and pimento, and recaito, an
aromatic blend of recao, onions, garlic, and
bell peppers. Sofrito, an all-purpose sauce
that is the foundation for many Puerto Rican
dishes, combines alcaparrado and recaito with
tomatoes. All ingredients are then fried in lard
colored with annatto seed until a thick paste is
formed. Some foods are seasoned with adobo,
a mixture of lemon, garlic, salt, pepper, and
other spices. Ajilimojili sauce is a puree of
bell peppers, garlic, olive oil, and lemon juice.
Sazón, a commercial spice blend that is pri-
marily monosodium glutamate (MSG, used
to enhance flavors), is a popular seasoning
as well.19,35
Starchy foods have a central role in Puerto
Rican cuisine, traditionally consumed at
nearly every meal as a side dish or in soups and
stews. They are known as viandas and include
bland-tasting, white or creamy colored roots,
tubers, and fruits that must be cooked, such
as cassava, malanga, potatoes, sweet potatoes
(white or yellow are preferred), yams, celery
root, breadfruit (and breadfruit seeds), under-
ripe bananas, and plantains.19,35 One espe-
cially popular preparation is mofongo, fried
and mashed plantains flavored with either
pork cracklings or bacon. Calabaza and car-
rots are considered vegetables because their
starch content is lower and they are a signifi-
cant source of vitamins; ripe bananas are con-
sidered a fruit that is eaten raw.
Pork is a favorite meat in Puerto Rico,
especially roast pork adobo. It is also used
frequently for added flavor in the form of salt
pork, ham, cracklings, or bacon. Beef and goat
are also consumed. One very popular stew is
sancocho, which includes beef short ribs, cal-
abaza, malanga, yams, and corn. Chicken is
very popular, frequently prepared with rice as
arroz con pollo, which is usually served with
stewed beans (known as habichuelas guisada),
or in asopao. Land crabs and ostiones, a type
of oyster that grows on the roots of mangrove
trees,37 are eaten, as is some seafood, includ-
ing shrimp, lobster, and conch, often prepared
as soups or stews. Fresh fish is not consumed
frequently (though a few dishes, such as esca-
beche, are popular), but dried salt cod, called
bacalao, is used in many dishes. It is soaked
and drained before use to remove some of
the salt and then added to numerous dishes
including serenata, a mixture of cod and
potatoes. Variety meats are featured in sev-
eral national dishes, such as mondongo (tripe
soup), lengua relleno (stuffed tongue), rinones
guisados (calf kidneys), and sesos empanados
(calf brains).34
Fritturas, or finger foods, are also a spe-
cialty, consumed as snacks or appetizers or
added to meals. They include simple fritters
(e.g., banana, squash, or bacalaitos); alcapur-
rias (starchy vegetable dough stuffed with
spicy beef, pork rind, poultry, or sea-food and
then fried); piñones (plantain strips wrapped
around sausage, poultry, or sea-food fillings
and fried); pastilillos (fried meat or cheese
turnovers); and cuchifritos (deep-fried chit-
terlings or variety meats). Empanadillas,
small baked turnovers typically filled with
ham, beef, lobster, conch, or cheese, are also
a favorite. Sweets including cakes, pastries,
puddings, and cookies are popular for des-
serts and snacks. One specialty is tembleque,
▲ A typical Cuban meal
often includes meat or fish,
savory picadillo (right), black
beans and rice, bread, and
flan (a Spanish style custard)
for dessert (not shown).
Ro
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.c
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Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
2 9 0 C A R I B B E A N I S L A N D E R S A N D S O U T H A M E R I C A N S
the Puerto Rican version of Spanish-style flan.
Flans are also flavored with chocolate, coco-
nut, pineapple, pumpkin, or rum. Candied
ripe plantains and baked bananas are a com-
mon fruit-based sweet in Puerto Rico, also
found throughout the Caribbean.
Nearly 70 percent of food in Puerto Rico
is imported from the mainland. Ameri-
can dishes are common, especially among
younger diners. Pizza, canned spaghetti, hot
dogs, canned soups, and cold cereals have
become favorites.19
Cuba is noted for the prominent use of
black beans in its cuisine. In addition to black
beans and rice, spicy black bean soup is very
popular. As in Puerto Rico, viandas are stan-
dard fare, especially in the more rural eastern
sections of the island where Indian heritage is
prominent. Examples include foofoo (cassava
balls) and tostones (plantain slices that have
been pressed to make them larger and thin-
ner, then fried in olive oil). Meats and viandas
are often served with mojito, a sauce of olive
oil, juice from limes or sour oranges, onions,
and garlic.
The western parts of the island are more
urban and cosmopolitan, especially around
Havana, where Spanish and Asian culinary
influences are evident. Picadillo is a type
of beef hash flavored with the traditional
Spanish ingredients featured in alcaparrado
(the same mix of olives, raisins, and capers
used in Puerto Rico), as well as Caribbean
tomatoes and chile peppers. Picadillo is
served with fried plantains or boiled rice,
or topped with fried eggs. Other Spanish-
influenced beef dishes are ropa vieja (“old
clothes”), spicy beef strips cooked until they
begin to shred, and brazo gitano, a cassava
dough pastry filled with corned beef. Roast
pork is popular, and eggs are often prepared as
Spanish-style potato omelets. In addition, the
rice and beans are usually served separately in
this region. Asian ingredients are less promi-
nent, but notable. Chicharrónes de pollo is
prepared with small pieces of chicken mari-
nated in lime juice and soy sauce, breaded,
and then fried in lard. Another example is
arroz salteado, a fried rice dish made with
eggs, shrimp, and vegetables cooked in olive
oil and seasoned with soy sauce. Fish are eaten
in western coastal areas, and one specialty is
grilled or stewed crocodile.34,35 Fruit pastes,
such as those made from guava, are typical
desserts, sometimes served with a slice of salty
cheese. Spanish-style egg desserts are also
found, especially custards, flans, and pud-
dings. Turrones, a nougat candy made with
peanuts, is a Cuban favorite.
Stews are a specialty in the Dominican
Republic. Examples include pollo guisado
(chicken with bell peppers, tomatoes, onions,
and olives, seasoned with oregano), mon-
dongo (similar to the Puerto Rican tripe
soup), and stews made with fish or sea-food,
such as shrimp, conch, or herring. Best known
is the Dominican version of sancocho, made
with several kinds of meats (including pork,
chicken, beef, and Spanish-style longaniza
pork sausage), plus numerous starchy veg-
etables cooked in sour orange juice. On spe-
cial occasions additional types of meats (e.g.,
goat, ham) are added to make sancocho pri-
eto. Stews are often served with rice and red
beans, and cassava bread.
Locrio is another Dominican favorite—a
rice dish that has its origins in Spanish paella
(see Chapter 6 for more information), but
differs in that only a single item, such as
chicken, shrimp, or sardines, distinguishes
each version. Other common dishes include
chicharrónes de pollo (prepared like the
Cuban recipe), rice with chicken and pigeon
peas, and mangu (mashed plantains topped
with olive oil-fried onions). Salads are espe-
cially popular in the Dominican Republic.
A few feature lettuce and tomatoes, but,
more often, cooked vegetables such as okra,
potatoes, chayote squash, or cabbage are
cooled and dressed with oil and vinegar.
Avocado and hearts of palm (a specialty of
the island) are featured in other versions.
Habichuelas con dulce is a unique Domini-
can dish served as a side dish or as a dessert,
combining red beans, coconut milk, evapo-
rated milk, whole milk, sugar, and butter.18
Desserts include fruit compotes, Spanish-
style flan, plantains or guavas with caramel
sauce, coconut biscuits, or sweet potato or
squash puddings.
Jamaica specialties include akee and salt
cod, curried goat, bammies, a type of cassava
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C H A P T E R 1 0 2 9 1
Asian Indian may serve typically Asian Indian
meals adapted to Caribbean ingredients, such
as a curried dish garnished with coconut,
fried plantains, and pineapple. Most menus,
however, consist of a multicultural mix, such
as European blood sausage and accra, West
African-style fritters made from the meal
of soybeans or black-eyed peas. More meats
and foreign dishes are consumed by wealthy
Caribbean Islanders and some reportedly visit
the United States weekly to shop for grocer-
ies.16,34 American fast foods have become
popular throughout the region with rich and
poor alike.
Daily Patterns Meal patterns vary somewhat
throughout the region. Three meals each day,
with lunch the largest meal, is typical in most
regions. In Haiti, however, two meals a day is
not uncommon.
In Puerto Rico, the traditionally large
lunch and smaller dinner are gradually chang-
ing to a dining schedule similar to that on the
mainland, especially in urban areas. Toast and
coffee are a common breakfast, though eggs
bread, mackerel rundown, cooked in coconut
milk with vegetables, and jerked foods (see the
Exploring Global Cuisine box for more infor-
mation). Haiti is known for its banana-stuffed
chicken dish called poulet rôti à la créole and
barbecued goat with chile peppers (kabrit
boukannen ak bon piman). Griot is another
popular dish made with pork that is first
marinated in seasoned sour orange juice, then
boiled, and then fried. Patties, a curried meat
turnover, are a Haitian specialty now served
throughout the Caribbean. Common Hai-
tian side dishes include cornmeal mush and
diri a djon djon (also called riz noir, or black
rice, this is rice cooked in a broth made by
boiling dried mushrooms native to the island
called djon djon—the mushrooms themselves
are not consumed). Curaçao is famous for its
orange-flavored liqueur of the same name,
and, in Dominica, crapaud, or “mountain
chicken,” a large, tasty frog, is considered a
delicacy. In Barbados, many more unusual
seafood dishes are popular, including those
made with flying fish, green turtles, and sea
urchins.
Meal Composition and Cycle
The most typical aspect of a Caribbean meal
is its emphasis on starchy vegetables with
some meat, poultry, or fish served with rice
and beans. Breads of all sorts are now com-
mon in many areas. Meats are frequently fried
or grilled. Sometimes before meat is added to
mixed dishes it is cooked first with sugar to
caramelize it (a technique thought to have
been brought by Africans).34,35 Soups and
stews are also popular. Soups are sometimes
served in two courses—the strained broth
first, followed by the cooked meats and veg-
etables. Leafy vegetables are sometimes ingre-
dients in soups, stews, and stuffed foods, and
only served uncooked as part of the lettuce
and tomato salads found in many regions,
including Puerto Rico, Cuba, and the Domini-
can Republic. Fruits are eaten infrequently in
many areas but are found fresh in some des-
serts and as snacks.
Ethnic heritage and social class determine
which dishes are served.34 A poor native
Indian may eat mostly cassava, tomatoes, and
chiles with a bit of salted fish at every meal. An
S A M P L E M E N U
A Caribbean Sampler
Patties (Haiti, Jamaica)a,b
Fritters-Black-Eyed Pea, Salt-Cod, or Conch (Pan-Island)a,b,c
Callaloo Soup (Pan-Island)a,b
P ue r c o As ad o (Cuban Pork Roast)a,b,c
M an gú (Dominican Republic)a,d
Black Cake/Rum Cake (Pan-Island)
aDeMers, J. 1997. Caribbean cooking. New York: HP Books.
bCaribbean Recipes at http://www.recipezaar.com/recipes/caribbean
cCuban Recipes at http://www.recipehound.com/Recipes/cuba.html
dAunt Clara’s Kitchen Dominican Cooking at
http://www.dominicancooking.com/dominican-recipes/
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2 9 2 C A R I B B E A N I S L A N D E R S A N D S O U T H A M E R I C A N S
are popular as well, often served as a Spanish-
style omelet. Lunch and dinner menus may
be similar, starting with soup (such as black
bean soup or chicken with rice soup), fol-
lowed by a stew served with rice and beans,
fried plantains, and chayote squash. Quick
lunches, such as fast food fare, may replace
the full meal. Dessert is usually eaten daily,
following whichever meal is largest, lunch or
dinner. Bread puddings with rum sauce are
favored. Soda, fruit juice, beer, or rum accom-
pany the meal. Restaurants are widely avail-
able in the cities, serving traditional Puerto
Rican cuisine, as well as international fare,
such as Spanish, Italian, and Japanese. Snack-
ing is prevalent, particularly on fried items,
such as bacalaitos, surrulitos, and cuchifritos.
Toast and coffee is a customary breakfast in
Cuba, often followed by a midmorning coffee
break with pastries or cakes. Lunch and dinner
menus are similar, with meat, poultry, or fish
(if available) served with fried plantains, rice
and black beans, and often cassava. Custards
and puddings (bread or rice) are typical des-
serts. Coffee is served after the meal. Lunch is
typically the largest meal of the day, even in
urban areas, and dinner is often leisurely, and
may include beer, rum, or wine. Snacking on
fruit, fruit juices, batidas (fruit juice blended
with milk and ice), or ice cream is frequent.
In the Dominican Republic, breakfast may
be just bread and coffee, but more often it
is larger, including eggs, cheese, and salami
or longaniza sausage (scrambled together,
or each fried separately), fried or mashed
plantains, and espresso or hot chocolate.
Lunch is usually the biggest meal of the
day. Traditionally served between noon and
2:00 p.m., it is known as La Bandera Domini-
cana (“the Dominican flag”), a plate with
rice and beans, a meat or chicken dish, and
salad—incorporating colors similar to those
found on the national banner.16 Plantains or
other starchy vegetables may also accompany
lunch. Dessert always follows, and espresso
or sweetened coffee with milk ends the meal.
The nearly half million Americans of Jamaican ancestry have had significant TJamaican ancestry have had significant T
impact on U.S. pop culture. Calypso, reggae,
the Rastafari religion, and dreadlocks Rastafari religion, and dreadlocks Rastafari
are among the many cultural additions.
In cuisine, two regional specialties have
piqued American interest: jerk and i-tal.
Jerk is believed to be related to the
dried meat called jerky. Legend is that the
technique was created by escaped African
slaves known as Maroons (from the Spanish
word for “untamed”—cimarron) who spiced
and smoked wild pig meat to preserve it.
Today, the word jerk is used to identify jerk is used to identify jerk
the wet spice mixture used as a barbecue
seasoning. It includes allspice, black pepper,
cinnamon, ginger, nutmeg, thyme, scal-
lions, and extremely hot Scotch bonnet chile
peppers—some recipes also call for garlic,
onions, ground coriander, bay leaves, brown
sugar, or other seasonings. The spices are
moistened with a little oil, lime juice, or soy
sauce to make a paste. Traditionally, the meat
is rubbed with the jerk blend and marinated
for several hours. It is then grilled in a pit over
Jamaican pimento (allspice) wood, covered
with banana leaves, typically one to four
hours, depending on the meat. Though pork
and chicken are found at every street jerk
stand in Jamaica, more recently the cooking
technique has been applied to turkey, fish,
seafood, and even vegetables. Jerk pork is
used to make jerk sausage in some parts of
Jamaica. For a complete meal, rice and peas,
cassava bread, or cornsticks accompany the
meat.116
I-tal, meaning “vital,” is the Rasta way of I-tal, meaning “vital,” is the Rasta way of I-tal
life. Applied to food it emphasizes simple,
unprocessed vegetarian fare. Fruit, veg-
etables, and grains are permitted, while pork,
red meat, salt, and artificial additives are
prohibited. Some Rastas will eat chicken or
fish (but shun bottom feeders such as shrimp
and lobster, scaleless fish such as shark, and
any fish more than twelve inches long). In
general, milk, coffee, soft drinks, and alcohol
are not consumed. I-tal foods are ideally
eaten raw or cooked over a fire (microwave
ovens are avoided by many Rastas), prepared
and served using pots, dishes, and utensils
made from natural products, such as wood or
earthenware. A woman is not allowed to pre-
pare food for others when she is menstruat-
ing. Typical i-tal dishes include rice and peas,
cassava bread, baked yams, vegetable stews,
cornmeal porridge, sautéed plantains, and
freshly squeezed juices. Thyme, cinnamon,
allspice, coconut, and reputedly marijuana
are used to flavor foods.117,118
E X P L O R I N G G L O B A L C U I S I N E
Specialty Cooking of Jamaica
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C H A P T E R 1 0 2 9 3
American meal patterns are influencing many
Dominicans, and abbreviated lunches are
becoming more common, including only a
main dish, dessert, and coffee. When lunch is
the main meal of the day, dinner is light, con-
sisting of scrambled eggs or soup, and fried
plantains or cassava bread. But when lunch is
light, dinner is more substantial, similar to the
traditional lunch.
Jamaicans often include fish at breakfast,
including sardines, mackerel, herring, or salt
cod. Other common items are eggs, fried plan-
tains, cornmeal porridge, and bammies. On
the weekends, liver with bananas is a breakfast
specialty. Lunches and dinners are similar to
those of other Caribbean Islanders, including
soups, rice, and peas with added beef, chicken,
or curried goat, pork stews, fish dishes, and
tossed salad or sweet potatoes on the side.35,38
Special Occasions The early European domi-
nance in the West Indies resulted in an
emphasis on Christian holidays. Christmas
is important, especially in the Spanish-
influenced islands that are predominantly
Catholic. In Puerto Rico pasteles are pre-
pared to celebrate Christmas. Similar to
Mexican tamales, pasteles are a savory meat
mixture surrounded by cornmeal or mashed
plantains, wrapped in plantain leaves, and
steamed. Carolers traditionally stop at houses
late at night to request hot pasteles from the
occupants. Christmas Eve, or N oc h e B uena,
includes Mass and a feast with lechón asado
(spit-roasted pig), morcillas, rice with pigeon
peas, coquito (rum and coconut milk), and
special desserts such as rice pudding and
coconut custard. In the Dominican Republic
a whole-roasted pig is also customary, served
with rice and peas, and a salad. Cubans asso-
ciate pasteles (large turnovers) or pastelitos
(smaller turnovers) with the holidays as well,
but make them with a dough that is similar to
French puff-pastry, stuffed with spicy meat or
cheese fillings, or sweet fillings, such as guava,
mango, or coconut.35
Other holidays reflect the multicultural
history of the islands. C ar niv al is celebrated C ar niv al is celebrated C ar niv al
in some Caribbean countries such as Trinidad
and Tobago and is similar to Mardi Gras in
the United States. The pre-Lenten festivities
feature parades of dancing celebrants; many
are elaborately costumed as traditional
European or African figures. Food booths that
line the parade route provide a day-and-night
supply of carnival treats. Fried Asian Indian
fritters are particularly popular.
Examples of nonreligious events include the
day-long birthday open house on Curaçao for
friends, relatives, and acquaintances. Thanks-
giving is observed in Puerto Rico. Turkey,
stuffed with a Spanish-style meat filling, is the
main course. Rum cake (also known as black
cake) is a fruitcake specialty of the Caribbean,
especially in Jamaica, where it is served at
weddings, Christmas, and other special occa-
sions. Dominican cake, a citrus-flavored cake
with a cooked pineapple filling, topped with a
caramelized sugar meringue, is popular in that
nation for all holidays and events.
Traditionally, Sunday meals emphasize
fresh meats when available, especially beef or
pork roasts. In the Dominican Republic lunch
on Sunday is very large and may last into the
early evening. On many islands Sundays are
also times when picnics are enjoyed, called dí a
del c ampo (“field day”) in Spanish-speaking
nations. One dish often served is carne fiam-
bre, a selection of cold cuts served with pick-
les, olives, and green salad.34,39
Etiquette In Puerto Rico forks and knives are
held European style—the fork in the left
hand and the knife in the right hand with no
switching hands for cutting food. This pat-
tern is also the norm in Cuba, though in the
Dominican Republic both European-style and
American-style use of utensils is accepted. In
these nations, dishes are passed to the left, and
when not eating, hands should be kept visible,
with the wrists resting on the edge of the table.
In Puerto Rico it is impolite to start eating
until a host says “ B on appetite!” whereas in
Cuba and the Dominican Republic it is rude
to eat before the host says “¡ B uen pr ov ec h o!”39
Food may be in short supply in some parts
of the Caribbean, and respectful behavior is
expected when eating. For example, in Cuba
vegetables and fruits should not be consumed
with the hands. In Puerto Rico, food should
not be wasted, and one should not take more
than one can eat.
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2 9 4 C A R I B B E A N I S L A N D E R S A N D S O U T H A M E R I C A N S
Therapeutic Uses of Food
Some Caribbean Islanders adhere to a hot–cold
classification system of diet and health simi-
lar to that found in Mexico (see Chapter 9).
In addition to the categories of hot and cold,
Puerto Ricans add cool. Imbalances in hot
and cold—for example, sitting in the shade of
a tree after being out in the sun—can cause
illness even years after the imbalance has
occurred.40 Haitians believe that women are
warmer than men and that a person cools as
he or she ages.28 Among Caribbean Islanders,
it is mostly Puerto Ricans, Dominicans, and
Haitians who follow dietary and disease hot–
cold classifications, and only small numbers
are strict adherents.35
The hot–cold theory of foods practiced in
the Caribbean sometimes includes not only
the category of cool foods, but also those con-
sidered heavy or light. A balance of hot–cold
elements is attempted at meals, and heavy
foods, such as starches, are consumed during
the day, whereas light foods, such as soup, are
eaten in the evening. Although the specific
classification of items varies from person to
person, one guideline for Puerto Ricans indi-
cates bananas, coconuts, and most vegetables
are cold; chiles, garlic, chocolate, coffee, evap-
orated milk and infant formula, and alcoholic
beverages are hot.41 Cool foods include fruit,
chicken, bacalao, whole milk, honey, onions,
peas, and wheat. Excessive intake of cool or
cold foods can make a cold condition, such as
a cough, develop into a chronic illness, such
as asthma.
Pregnancy, defined as a hot condition by
most Puerto Ricans, is a time when a hot–cold
balance is practiced carefully, and hot foods
are avoided. When infants suffer from hot
ailments, including diarrhea or rash, infant
formula may be replaced with whole milk, or
cooling ingredients such as barley water, man-
nitol, or magnesium carbonate may be added
to the formula. High-calorie tonics (eggnogs
and malts are popular types) are taken by
some Puerto Ricans to stimulate the appetite
and provide strength or energy. These are con-
sidered especially appropriate for pale chil-
dren and for pregnant or postpartum women.
Research with Dominican Americans sug-
gests the use of hot–cold classifications for
numerous conditions. Examples cited are
excessive cold causing asthma and fibroids,
whereas perimenopausal hot flashes are a
hot problem.31,33 Home remedies given to
children for asthma include warming foods,
such as oils (whale, cod liver, almond, and
castor), honey or royal jelly (bee-larva food),
onion, garlic, oregano, lemon, and aloe vera
juice. Beets combined with molasses are used
by traditional Dominican healers to treat
fibroids (and may be used by some Carib-
bean Islanders to lower blood pressure or
treat arthritis and ulcers).38,42 Research on
Dominican mothers suggests that nutritional
practices during lactation may sometimes
include avoidance of certain protein foods and
increased intake of fluids such as malt beer,
milk, orange juice, chocolate milk, and noodle
soup.43 Formula may be withheld from sick
infants and tea provided instead.
Haitians apply the hot–cold theory, includ-
ing the heavy-light categories, to a broader
number of conditions impacting health.
A person’s life cycle, a woman’s reproductive
cycle, the climate, and the time of day are cat-
egorized, and they must be balanced to main-
tain health.20 For example, heavy foods should
be eaten in the morning and light foods in the
evening. Environmental forces (such as wind,
or seeing a lightning strike) and social interac-
tions can disrupt equilibrium and result in ill-
ness. Women and their newborn infants may
spend the first month after birth in seclusion
to avoid excessive chilling.
Therapeutic use of food is not limited to
balancing hot–cold conditions. Some Haitians
believe that certain illnesses in infants can be
caused if a nursing mother’s milk is too thick
or too thin. Further, if a woman is frightened
while breast-feeding, her milk goes to her
head, causing a headache in her and diarrhea
in the baby. Gaz, another condition, causes
pain in the shoulders, back, legs, or appendix,
and headaches, stomachaches, or anemia.
Foods such as corn or a tea made from garlic,
cloves, and mint are home remedies for gaz.13
Other Caribbean Islanders, including
Cubans, do not generally subscribe to the
hot–cold theory but often use food-based
home remedies.24,38 One study of Hispanics
in the Miami area reported 75 percent had
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C H A P T E R 1 0 2 9 5
used herbal cures during the previous twelve
months. Cubans reportedly use grapefruit
and garlic for hypertension, chayote to calm
nerves, and beets to treat anemia and flu. Star
anise tea is consumed to relieve intestinal pain
and flatulence in adults and colic in infants.
Other teas used for stomach aches include
those made with aloe vera or spearmint.
Teas with cinnamon, sour orange, or honey
and lemon are used for colds and coughs.
Cinnamon tea is also believed useful for men-
strual cramps. Gastrointestinal parasites are
treated with pumpkin seed tea. Linden leaf,
also popular, is used for anxiety.24,38
Some non-Hispanic Caribbean Islanders
believe cassava helps prevent heart disease
and cancer. Plantains are also used to decrease
the risk of heart disease, as well as for treating
hypertension, ulcers, and constipation. Teas
are used for many ailments, including lemon-
grass tea for fever, and ginger tea for indiges-
tion and flatulence (ginger may also be added
to rum for diabetes). Cerasse tea, made from
Asian bitter melon (which has hypotensive
properties), may be consumed to lower blood
sugar levels, and wild sage (ma B bz ou) tea is
also used to treat diabetes.35,38,44
Contemporary Food Habits
in the United States
Adaptations of Food Habits
Traditional food habits are easily maintained
in the self-sustaining immigrant communities
of Spanish Harlem in New York City and Little
Havana in Miami. Ingredients for Caribbean
cuisine are readily available through Puerto
Rican and Cuban American markets. Cubans,
for example, may consider drinking strong
coffee a way to maintain their ethnic identity;
by comparison, Americans drink weak coffee.
Changes do occur, however, as immigrants
settle into culturally mixed communities and
children grow up as Americans.
Few current data on Caribbean Islander
food habits in the United States are available.
One older study compared the diet of three
groups of women from Puerto Rico: (1) those
living in New York (forward migrants),
(2) those who had lived on the mainland but
later returned to the island (return migrants),
and (3) those who never lived on the main-
land (nonmigrants). It was found that nonmi-
grants and return migrants ate more starchy
vegetables, sugar, and sweetened foods than
did forward migrants. Forward migrants ate a
greater variety of foods, including more beef,
eggs, bread, fresh fruit, and leafy green veg-
etables. Puerto Rican women who had lived
on the mainland quickly reverted to their tra-
ditional food habits when they returned to the
island.45
Recent research on Afro-Caribbean immi-
grants (mostly Jamaicans) in Great Britain
found that traditional items such as fish
(boiled, baked, or fried), chicken (fried, roast,
or curried), homemade soups, rice and peas,
plain rice, and boiled potatoes were consumed
by respondents several times each week. How-
ever, some foods, including patties, salt cod
fritters, akee and salt cod, callaloo, breadfruit,
and cassava were consumed infrequently.
Few Western foods were popular: 83 percent
ate hamburgers less than once a month, and
similar numbers reported rarely eating pizza,
pasta, butter, and margarine.46
Ingredients and Common Foods Research on
the food habits of Caribbean immigrants in
the United States is limited. It is thought that
rice, beans, starchy vegetables, sofrito, and
bacalao remain the basis of the daily diet of
many Puerto Ricans who live on the mainland.
Poultry is used when possible, and egg intake
decreases. Because of Cuban Americans’
greater discretionary income, their diet usu-
ally includes additional foods, such as more
pork and beef. Recent poorer immigrants
from Cuba, including the marielitos, are more
restricted in what foods they purchase, how-
ever, and may follow a diet that is closer to the
subsistence-level Puerto Rican regimen.
According to marketing studies, Caribbean
Islanders accept some American foods, espe-
cially convenience items, and purchase fro-
zen and dehydrated products when they can
afford to do so. The proportion of meat in the
diet often increases on the mainland, as does
the consumption of milk (and other dairy
foods) and soft drinks.35,47,48 Intake of leafy
vegetables continues to be low. Local fruits
often replace the tropical fruits of Puerto Rico.
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2 9 6 C A R I B B E A N I S L A N D E R S A N D S O U T H A M E R I C A N S
Data regarding Dominicans in the United
States indicate that only small changes have
occurred in consumption patterns. Protein
and fat intake has increased slightly, mostly
due to eating more meat, while carbohydrate
intake has decreased. Dominican women
reported that their diet was more varied and
abundant than in their homeland.44,48
A study of Hispanics over the age of fifty-
five in Massachusetts, including Dominicans,
Puerto Ricans, and other Latino groups, made
dietary comparisons among less-acculturated
Hispanics, more-acculturated Hispanics, and
non-Hispanic whites. It was found that rice
was the major contributor of energy for both
groups of Hispanics, compared to bread for
non-Hispanic whites. But Hispanics who had
lived in the United States for at least twenty
years had macronutrient profiles closer to
non-Hispanic whites than to less-acculturated
Hispanics, with a lower consumption of
complex carbohydrates and an increased
consumption of simple sugars.49
Meal Composition and Cycle The meals of
Puerto Ricans residing on the mainland are
similar to those of people on the island, with
a few changes. A light breakfast of bread and
coffee may be followed by a light lunch of
rice and beans or a starchy vegetable, with
or without bacalao. Often this traditional
midday meal becomes a sandwich and soft
drink, however. A late dinner consists of rice,
beans, starchy vegetable, meat if available, or
soup. Salad is included in some homes. Many
researchers have reported an increase in the
amount of snacking between meals, mostly
on high-calorie foods with little nutritional
value.35,48
Dominicans have started eating lighter
lunches.48 Interviews with Haitians living in
New York City suggest that some traditional
dietary practices are discontinued; for exam-
ple, the main meal is eaten in the evening
instead of at noon. Although some Haitians
adhere to hot–cold classifications of food,
they may differ from those used in Haiti.28
One older study reported that many low-
income Latina women living in New York did
not plan menus far in advance and that this
hampered their ability to add variety to their
diets.49 It was found that food shopping serves
as a social occasion for many of the women
and is one of the few opportunities they have
to get out of the house; thus they may go to the
grocery store more often than is really nec-
essary. The investigators reported that nearly
half of the women questioned preferred to fry
main dishes. Boiling was the second choice,
baking third. Broiling food was a distant
fourth choice. The researchers noted that in
many low-income households the oven or
broiler element may not work, restricting food
preparation methods to frying and boiling.
Special Occasions It is assumed that many
Caribbean Islander holiday food traditions
are retained after immigration to the United
States. Several events have been added to the
annual calendar, however, often featuring tra-
ditional foods and music of the region. One of
the largest is the West Indian Carnival that has
been held annually for over sixty-five years
in New York City. The carnival celebrates
the cultures of the Caribbean, featuring an
enormous parade, music competitions, and
street vendors selling items such as curried
goat and Jamaican jerk barbecue. In June, cit-
ies with large Puerto Rican populations often
host Puerto Rican Day parades. The Domini-
can Day Parade is held every August in New
York City. Major reggae music festivals with
ample Caribbean food are held throughout
the United States on February 6—reggae art-
ist Bob Marley’s birthday.
Nutritional Status
Nutritional Intake There is limited informa-
tion on the nutritional status of Caribbean
American immigrants to the United States.
The few studies available suggest several
health trends in these immigrants that have
important nutritional implications. Health
disparities for Hispanics compared to the gen-
eral population have been reported, including
lower rates of preventive care (such as inocu-
lations and screenings) health care insurance
coverage, and higher rates of risk factors.50
Differences among Puerto Ricans have been
reported between those living on the main-
land and those living in Puerto Rico, with
those living on the mainland experiencing
In Haiti protein foods
are served first to the
father in the household;
leftovers go to the wife
and children. This pattern
is believed to continue in
Haitian American homes.
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C H A P T E R 1 0 2 9 7
more physical illness and having less access to
health care.52 Low socioeconomic and educa-
tion levels are often associated with some dis-
parities.51,53,54,55 One study showed that some
chronic health conditions, such as disabil-
ity and diabetes, are more prevalent among
Puerto Rican elders than in white elders living
in the same neighborhoods.56
Mortality data suggest that although
Puerto Rican and Cuban men have lower
overall rates compared to whites, younger
men die in disproportionately higher num-
bers (often due to preventable causes). Among
Puerto Ricans, those who are born in Puerto
Rico have lower mortality rates than those
born on the mainland.57
Nearly 10 percent of Puerto Rican infants
born on the mainland are of low birth weight,
and over 13 percent are born preterm. These
factors contribute to a high infant mortal-
ity rate. Nationally, infant mortality rates for
Puerto Ricans living on the mainland are
40 percent higher than for whites, and one
earlier study of Puerto Ricans in New York
reported an infant mortality rate 40 percent
higher than that of the total population. Risk
factors including poverty, young maternal age,
low educational attainment, and inadequate
prenatal care are positively correlated with
these figures.58 The numbers for low birth
weight, preterm delivery, and infant mortality
are even higher in Puerto Rico; however, one
study found recent arrivals from the island
had lower infant mortality rates than Puerto
Ricans who had lived for an extended period
on the mainland.59 High rates (8.2 percent)
of low-birth-weight infants have also been
reported in the Haitian American community,
associated with hypertension and preeclamp-
sia.60 In contrast, the infant mortality rate of
Cuban American babies is below the national
average.
Recent data on breast-feeding practices
are limited. One anecdotal report on Puerto
Rican women states that breast-feeding is
common.19 However, earlier studies found
breast-feeding infrequent among Puerto
Rican, Cuban, and Haitian women in the
United States, and in another study, over-
weight Hispanic women in New York were
found to be less likely to initiate and more
likely to discontinue breast-feeding than
lower-weight women. This finding is sig-
nificant when obesity rates in this popula-
tion are considered (see below).61 Those few
who started breast-feeding often switched to
bottle feeding after two to four weeks. Whole
milk, condensed milk, and evaporated milk
were frequently fed to infants, as were juices.
Solid food typically was introduced at a
young age.
When the traditional Caribbean diet is
limited because of low income, it inevitably
results in low intake of many vitamins and
minerals. The emphasis on carbohydrates
and vegetable protein, with a low consump-
tion of leafy vegetables and often fruit, pro-
vides inadequate intake of calories, vitamins
A and C, iron, and calcium. An older study
indicated that the only foods consumed by
at least one-half of recent Cuban immigrants
were eggs, rice, bread, legumes, lard and oils,
sugar, and crackers.62 Newer studies of His-
panics in New York and Boston suggest higher
rates of fruit and vegetable intake, but still
below national and state norms.63 Deficien-
cies of B1, B12, folate, and sulfur amino acids
have been reported.64 One study of Puerto
Rican and Dominican elders found that the
high prevalence of B12 deficiency was due to
insufficient intake, and that supplementation
or frequent consumption of fortified cereals
reduced the risk of insufficiency.65 Low iron
intake among African Caribbean Islanders has
been reported in Great Britain.66,67
Several studies suggest rates of overweight
and obesity are higher than national or state
averages for many U.S. Hispanic popula-
tions. Data from 2008 indicate that Hispanics
have a 21 percent higher rate than whites for
overweight and obesity.68 Among Hispanic
elementary school students in New York City,
who are assumed to be primarily of Puerto
Rican and Dominican heritage, 31 percent
were obese (BMI $95 percentile) compared
to 20 percent of students overall,69 and His-
panic preschool children enrolled in Women,
Infants, and Children (WIC) programs in
New York City were twice as likely as black
children to be overweight.70 In a study of U.S.
Hispanics published in 2012, Puerto Rican
participants had the highest prevalence of
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2 9 8 C A R I B B E A N I S L A N D E R S A N D S O U T H A M E R I C A N S
obesity in men and women (31 percent and
51 percent).71 Research on Puerto Rican and
Dominican elders found that obesity (as mea-
sured by BMI and central waist circumference)
was associated with a traditional diet based
on rice and beans and poultry and oil, and
that this diet was more prevalent among less
acculturated subjects.72 In contrast, studies of
Puerto Rican women in Connecticut report
factors associated with acculturation resulted
in an approximately 54 percent increase in
obesity.73,74 Calorie and fat intake is reportedly
high in many Caribbean Islander groups.55,75
Further, larger portion size has been noted
in some research on Caribbean Islanders.55,76
Low levels of physical activity and cultural
norms regarding weight and health may be
significant factors of being overweight among
Caribbean Islanders.63 Puerto Ricans, Cubans,
and Haitians often associate well-being with
being gor dita, or a little fat. This is particu-
larly true for children, even when a thinner
body ideal is desired by mothers.77 Thinness
is thought by some Caribbean Islanders to be
indicative of poor health due to emotional or
psychological conditions.28,29
Research has established a genetic contri-
bution to the development of the clustering of
health characteristics (including obesity/waist
circumference, insulin resistance, hyperten-
sion, and dyslipidemia) known as metabolic
syndrome in Caribbean Hispanic families.78
The prevalence of hypercholesterolemia was
52 percent among men, and ranged from 48
percent (Dominican and Puerto Rican men)
to 55 percent (Central American men). In
women, the prevalence of hypercholesterol-
emia was 37 percent and ranged from 31 per-
cent (South American women) to 41 percent
(Puerto Rican women). Overall, 25 percent of
men had hypertension; hypertension preva-
lence was highest among Dominican men.
Hypertension prevalence overall among
women was 24 percent. The prevalence of
hypertension ranged from 16 percent (South
American women) to 29 percent (Puerto
Rican women). Overall, 17 percent of men
and women had diabetes; prevalence ranged
from 10 percent in South American men and
women to 19 percent in Mexican men and
women and Puerto Rican women.79,80
Persons with metabolic syndrome are at
increased risk for type 2 diabetes and car-
diovascular disease. Health statistics in 2011
estimated that 12.1 percent of Hispanics had
diagnosed diabetes.81 Studies indicate that
the prevalence of type 2 diabetes mellitus
is two to three times higher among Puerto
Ricans and Dominicans than among whites;
Cuban Americans develop the condition at
rates slightly higher than whites.82,83 African
Caribbean women also developed impaired
glucose metabolism at rates nearly double
those for white women after gestational dia-
betes in one study (50 percent and 28 per-
cent, respectively).84 A more recent study,
the Hispanic Community Health Study/
Study of Latinos (HCHS/SOL), determined
the prevalence of diabetes and rates of aware-
ness and control among adults from diverse
Hispanic or Latino backgrounds in the U.S.
Hispanic Community. The rate of type 2 dia-
betes among the participants in the study was
10.2 percent in South Americans and 13.4
percent in Cubans to 17.7 percent in Central
Americans, 18.0 percent in Dominicans and
Puerto Ricans, and 18.3 percent in Mexicans,
and prevalence increased in with length of
residence in the United States.80,85
The prevalence of hypertension is slightly
lower in Hispanics than whites.85 Rates of
mortality due to hypertension, heart disease,
and stroke, however, vary between groups.
Puerto Ricans have the highest rates of all
Latinos, approximately 13 percent above
whites. Higher rates of diabetes, which is a
risk factor for high blood pressure, may be
one reason for the discrepancy. In compari-
son, Cuban Americans have the lowest rates,
39 percent below those of whites. Deaths
from hypertension are higher for men than
for women in all Hispanics.90 It has been
noted that a high prevalence of hypertension
and cerebrovascular atherosclerosis, as well
as high rates of noncompliance regarding
medications, is a contributing factor in strokes
among black Caribbean Islanders in Miami.86
Although Hispanics experience cardiovas-
cular disease at rates lower than the national
average, there is some evidence that it may be
higher than average among some subpopula-
tions, such as in Hispanic women living in
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C H A P T E R 1 0 2 9 9
New York City. Heart disease is still the lead-
ing cause of death among Hispanics.63 Rates
of renal failure due to diabetes among Hispan-
ics are approximately 1.7 times higher than in
whites. Death rates associated with diabetes
are also 1.5 times higher in Hispanics.84
Chronic liver disease and cirrhosis are
ranked as the sixth leading cause of death
among Hispanics.87 Dental health is problem-
atic for Hispanics. Data indicate that Hispanic
preschool children have a high rate of dental
caries. Hispanic adults have a larger propor-
tion of untreated caries than whites.88
Counseling Counseling Americans of Carib-
bean descent is similar to counseling other
Latino clients and patients (see Chapter 9).
Language problems may make interviews dif-Language problems may make interviews dif-Language problems may make interviews dif
ficult, health beliefs may differ from those of
the provider, and access to medical care may
be limited. The idea that God or fate deter-
mines the outcome of illness may also inter-
fere with seeking health care. For example,
Puerto Ricans perceive diabetes as a chronic
condition and believe that complications
of the disease are unavoidable.25 One study
found Puerto Ricans in New York engaged in
preventive behaviors, such as getting vaccina-
tions or cholesterol testing, at rates below state
averages.52 Illness may be viewed as a sign of
personal weakness among Haitians, revealed
only to family members for as long as possible.
In addition, some Haitians may believe that
supernatural illness worsens if biomedical
treatment is used, and they may delay seeking
care until very ill.29,89
Caribbean Islanders use an expressive
conversational style. Respect and politeness
are practiced, but it is not considered rude
to interrupt a speaker. Periods of silence are
uncommon.39 Shaking hands in greeting and
in leaving is customary, firmly between men,
and less vigorously with women. Touching is
very common, especially between members
of the same sex, who may hug freely. Even if
touching within a group is not direct, passing
items (such as a piece of paper) from practitio-
ner to client (or to every client in a classroom
situation) increases the personal connection.19
Direct eye contact is expected throughout the
Caribbean, with some variations. Looking
away suggests disrespect or dishonesty among
Cubans; Dominicans maintain eye contact
depending on the situation, and men are more
likely to look directly at one another than are
women; Haitians may avert their eyes from
authority figures.
Puerto Ricans are open about physical and
emotional complaints, although they may
hesitate to ask questions because this might
be interpreted as disrespectful. Adequate time
and consideration of symptoms are necessary
for both diagnosis and the client–provider
relationship. High degrees of modesty are
found in both women and men, who may
prefer health providers of the same gender. In
contrast, Haitians may expect a quick physical
examination (with a stethoscope) and a fast,
accurate diagnosis. Lack of a prescription to
address a complaint may be seen as incompe-
tence. Haitians may also assume that men are
physicians and women are nurses.29
Puerto Ricans and Cubans are typically
present oriented, and may have a relativis-
tic view of time. Flexible appointments and
relaxed attitudes regarding timeliness can
help facilitate interactions with these Carib-
bean Islanders. It has been suggested that time
limitations should be explained at the outset
of the appointment so clients know what to
expect.24,25,39
A few traditional Puerto Rican hot–cold
practices may be problematic. Pregnant
women may avoid iron supplements, which
are classified as hot. Infant formula diluted
with mannitol or magnesium carbonate to
cool it (see the “Therapeutic Uses of Food” sec-
tion) may cause diarrhea in infants. A mother
may cool a hot medication, such as vitamins
or aspirin, by providing a cool beverage with
it, possibly fruit juice or milk of magnesia.41
Puerto Ricans also may interpret high blood
pressure as being too much blood or thick
blood; conversely, low blood pressure means
weak blood or anemia. Hypertension may be
treated with herbal teas.91 Some Puerto Ricans
believe that ulcers lead to cancer.
A study of Long Island Cuban Americans
showed that 20 percent acknowledged some
degree of belief in santería. Some Dominicans
believe that biomedicine is not responsive to
their spiritual and emotional needs and that
Lactose intolerance is
thought to be a problem
among many Caribbean
Islanders, although esti-
mated incidence has not
been reported.
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3 0 0 C A R I B B E A N I S L A N D E R S A N D S O U T H A M E R I C A N S
effects.31,32 In addition, sharing prescription
medications with family members or friends
is common among Americans of Cuban,
Dominican, and Haitian heritage.24,29,33 Some
Haitians reportedly have difficulty with
dietary compliance.28
Research on a diverse group of Latinos in
New York reported that physicians were the
primary source of health care information,
followed by television. Educational programs
with Puerto Ricans may be more successful
if a respected member of the community is
enlisted in support of the project, and women
often respond better if men in the family
approve of their participation.19 Caribbean
Islanders are high-context communicators,
and the relationship and process are as impor-
tant as the results.39
A Caribbean Islander client may be of
African, Asian, European, or Indian descent;
however, the island of origin is equally impor-
tant in determining ethnic identity and diet.
A black from Puerto Rico, for example, is more
likely to eat Latino foods than African dishes
or soul food. Early researchers working with
low-income Latinas and black women in New
York recommended that significant attention
be placed on the client’s socioeconomic sta-
tus, a suggestion still valid today.95 Nutrition
therapy for a poor Puerto Rican immigrant
is likely to require a different approach than
that for a wealthy Cuban immigrant within
traditional healers provide the treatments
needed to address all aspects of illness.16 Esti-
mates of espirito and santero use vary consid-
erably, from 1 to 23 percent.24,25 Many people
who use traditional folk-healing practices and
practitioners may be unwilling to admit to
these folk practices or use them only in time
of stress.92
Biomedical prescriptions may also present
difficulties. Many medications available only
by prescription in the United States are read-
ily available over the counter or through the
black market in Latin American countries.
Overuse, inappropriate use, and addiction can
occur. For example, one study found that New
York Latinos did not understand that antibi-
otics are useful only for certain infectious
conditions, and they were obtained without
prescription to treat pain. A study regarding
Metamizole (dypyrone), a toxic nonsteroidal
anti-inflammatory drug banned in the United
States, found that 28 percent of Hispanics
surveyed in Miami had purchased it in their
homelands, and 13 percent had used it in the
previous year.93,94 Another study found that
medications for chronic conditions were used
by Dominicans only during a medical crisis.
As soon as symptoms subsided, the prescrip-
tion therapies were replaced with home reme-
dies. Dominicans often express concern about
taking “chemicals” and worry that biomedical
prescriptions cause addiction and serious side
P A U L A V E L A Z Q U E Z
Iwas born and raised in Puerto Rico and came to the United States when I was
thirteen years old. In Puerto Rico I grew up
on a farm, and my diet included rice and
beans and products that we grew, such as
fresh green bananas, sweet potatoes, and
plantains. When my parents went to town
to shop, that was when we ate meat and
bread. Once a year we had pork for Christmas
and turkey for Thanksgiving because these
animals were raised by my parents for the
holidays. My sister still owns the farm, and
I try to get back for visits.
Here in the United States I live with my
aunt and uncle, and their diet is high in meat,
vegetables, and “healthy” foods. They are
in their eighties and still very healthy. The
food that made the biggest impression on
me when I came to the United States was
mashed potatoes. I had never seen or eaten
mashed potatoes, and it took me awhile
before I would even try them. The second
thing was having meat every day—that was
really a treat. However, my favorite foods are
bread and then the vegetables. I like all kinds
of seafood. I will eat seafood rather than
meat. Meat I could give up but not bread and
vegetables.
N E W A M E R I C A N P E R S P E C T I V E S
Puerto Rican
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C H A P T E R 1 0 3 0 1
the context of the basic Caribbean cuisine. An
in-depth interview should be conducted with
each client of Caribbean descent to establish
country of origin and ethnic identity. The cli-
ent’s degree of acculturation, socioeconomic
status, use of traditional heath practices, and
personal food preferences also should be
determined.
South Americans
South America is a vast land that features the
rugged ridge of the Andes Mountains stretch-
ing from north to south. Highland plains,
tropical rain forests, temperate valleys, and
desert dunes extend from where the moun-
tain peaks slope toward the coastal edges of
the continent. Extremes in terrain and climate
limit agriculture in many areas. The conti-
nent contains twelve independent nations:
Argentina, Brazil, Bolivia, Chile, Colombia,
Ecuador, Guyana, Paraguay, Peru, Suriname,
Uruguay, and Venezuela. In addition, France
retains control of the territory called French
Guyana, and Great Britain claims the Falkland
Islands.
Numerous native Indian groups popu-
lated the continent prior to settlement by the
Europeans. Although the Spanish were the
first to arrive, significant numbers of Por-
tuguese, Italians, and Germans also settled
in South America. Forced labor from West
Africa introduced blacks to the continent,
followed by Asian Indian workers after slav-
ery was outlawed. Indian and mixed Indian
European populations live in the tropical
highlands; Creoles (descendants of the Euro-
peans) have concentrated in the southern,
temperate regions of the continent; and parts
of northeastern Brazil are populated primar-
ily by blacks and mulatto black Europeans. In
more recent times, Japanese immigration to
South America has become notable.
Cultural Perspective
History of South Americans in the
United States
Immigration Patterns The first documented
South Americans in the United States were
Chileans who came to California to participate
in the gold rush. It is believed that several thou-
sand worked in the mines. Approximately half
returned to Chile, and those who remained
quickly intermarried and were absorbed into
the general population. Prior to the 1960s, all
South American immigrants were counted as
Other Hispanics in the U.S. Census. Specific
figures regarding the individual nations before
this time are uncertain but are thought to be
minimal. Most South American immigration
has occurred in the past twenty years during
periods of land reform, economic hardship,
or political repression. Jobs and educational
opportunities are the primary attractions for
the majority of immigrants, although sig-
nificant numbers of political exiles are from
Argentina and Chile.
Current Demographics Over 2.7 million
Americans of South American descent are
living in the United States.96 There are approx-
imately 1 million Americans of Colombian
ancestry; 663,000 from Ecuador; 594,000 from
Peru; 223,000 from Guyana; 326,500 from
Brazil; 249,000 from Argentina; 140,000 from
Chile; 249,000 from Venezuela; and 104,500
from Bolivia.
Most South Americans settle in the North-
east, especially New York and New Jersey. In
New York City, Colombians, Ecuadorans, and
Peruvians have established ethnic enclaves
in Queens, and “Little Brazils” are found in
both Queens and Manhattan. Miami and
Los Angeles also host large South American
populations from most nations. In addition,
Brazilians are found in Pennsylvania and
Washington, DC; Chileans have settled in
Texas; Colombians have clustered in Stam-
ford, Connecticut, the urban areas of Illinois,
and California; and Peruvian neighborhoods
have developed in Houston, Chicago, and
Washington, DC.
Most South American immigrants are
proud of their heritage and differentiate them-
selves from Americans of Mexican, Caribbean,
or Central American background. Brazilians
in particular resent being mistaken as Hispan-
ics who speak Spanish (Portuguese is their
official language). Some South Americans
suffer from discrimination directed toward
Mexican Americans or Latinos in general.
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3 0 2 C A R I B B E A N I S L A N D E R S A N D S O U T H A M E R I C A N S
Others, who are mostly of European heri-
tage, are not recognized as Latinos but may
continue the prejudices between some South
Americans. Second- and third-generation
South Americans often leave homogeneous
neighborhoods and relocate into mixed
communities.
Socioeconomic Status Few data are available
on the socioeconomic status of Americans
of South American descent who have lived
in the United States for extended periods.
Most data are related to foreign-born immi-
grants who have come in the past twenty-five
years. Regardless of arrival date, a majority
of immigrants from South America come to
the United States in search of employment
opportunities. Many are well-educated pro-
fessionals; however, they sometimes find that
their credentials are not accepted after arrival,
forcing them to accept positions in the sales,
service, trade, and labor fields, such as res-
taurant work, construction, child care, or tex-
tile and garment industry jobs. It is believed
that many second- and third-generation
Americans of South American ancestry obtain
advanced education and work in professional
occupations.
Foreign-born Colombians arrive in the
United States with overall education levels
slightly lower than the U.S. average, though
some are professionals with college degrees
who hope to find employment commensurate
with their skills.97 Most Ecuadorans are better
educated than other Hispanic Americans, but
still less than the total U.S. population.98
Peruvians have higher levels of educa-
tion than the U.S. population and Argen-
tineans have highest levels of education in
the Hispanic population overall.99,100 Of the
Brazilian population in the United States aged
twenty-five and older, 20 percent have a high
school diploma and 22 percent have a bach-
elor’s degree, which is higher than the U.S.
population.101
Worldview
Religion South Americans are mostly Roman
Catholic, a legacy of the European conquest.
In most nations approximately 64 to 89 per-
cent of the population are members of the
Catholic Church. In some regions, Christian
religion is often blended with other belief sys-
tems. In Peru, Incan gods may be included in
Catholic rites, for example, and in Venezuela
the Cult of Maria Lionza mixes indigenous,
Catholic, and African practices. Religious
syncretism is greatest in Brazil. Spiritism,
which was imported from France originally,
combines Christian precepts with scientific
principles. Popular with the upper middle
class of the country, adherents communicate
with the dead through spiritual mediums.
Umbanda is very common in rural areas and
among the urban poor, combining several
Afro-Brazilian faiths with spiritism and the
idea of Christian charity. Candomblé is prob-
ably the best known of the mixed religions,
and is an Afro-Brazilian faith founded by
blacks in the Bahia region and is now prac-
ticed nationwide by followers of all ethnici-
ties.102 African-derived beliefs dealing with
earthly matters such as health and wealth are
combined with Catholic cosmology. Yoruba
deities called or ix á or or ish a are venerated
with rites of worship that include animal
sacrifice, feasting, and dancing. Over twenty
orixás are recognized in Brazil and most are
correlated with a Catholic entity: Oxalá, god
of creation, with Jesus Christ; Exú, the mes-
senger god, with the devil; Ogun, god of war
and iron-craft, with St. Anthony or St. George;
Oxoosi, god of affluence, with St. Sebastian;
Omolu, god of plagues and illness, with St.
Lazarus; and Oxum, the fertility goddess (also
called the goddess of vanity), with the Virgin
Mary. Each orixá is associated with certain
personality traits, day of the week, color,
plants, animals, foods, and drinks; and each
person has an orixá owner of his or her head
who influences individual temperament and
behavior.
Protestant missionaries were active in
South America starting in the twentieth cen-
tury and were especially successful in Hon-
duras and Uruguay where Catholics are no
less than 50 percent of the population.103 In
Brazil, the Baptist, Pentecostal, Seventh-Day
Adventist, and Universalist denominations are
most popular. Chilean Protestants are usually
members of the Pentecostal or Seventh-Day
Adventist churches, though those of German
ancestry often follow the Lutheran or Baptist
faiths. Small numbers of Jews and Buddhists
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C H A P T E R 1 0 3 0 3
are also found in South America, in total less
than 1 percent of the population together.
Most South Americans who emigrate to
the United States are Roman Catholic and
very involved with their local parish. A major-
ity of Guyanese Americans belong to an
Episcopal church headed by a Guyanese priest
and often also send their children to church-
run schools with Guyanese teachers. In addi-
tion, some Guyanese Americans frequent
“Unity Centers,” which function as commu-
nity centers and promote spirituality but are
not affiliated with any organized religion.104
Family Family life is important in all South
American societies. In Argentina, Span-
ish and Italian traditions have shaped fam-
ily structure. The extended family usually
gathers together at least once a week and on
holidays as well. Grandparents are involved in
most family decisions, and children often stay
at home until marriage. In Brazil, extended
family members typically live close to one
another, and daily visits are common. Rela-
tives mentor children through rites of passage
such as confirmation, graduation, the start of
a career, and marriage.
The father is the head of the household
in Chilean homes, but the mother makes all
decisions regarding the family. In Colombia
the father holds all authority, and children are
taught to obey their parents. Ecuadoran fam-
ilies follow two models: Spanish-influenced
families are ruled by the father, who has few
responsibilities to the home other than finan-
cial support; in Indian-influenced families,
the father and mother share more power and
household responsibilities. In Peru, extended
families typically include godparents, who
sponsor baptisms and provide both social
and economic assistance. Families are pre-
dominantly patriarchal, though more so in the
Spanish-speaking upper and middle classes
than in poor, rural Indian homes. In contrast
to most of South America, the Venezuelan
family has changed rapidly in the past decades
due to increased national prosperity. Much of
the population has relocated to urban centers.
Many families have declined in size, and the
extended family is less common.
In many areas of South America, it is unac-
ceptable for women to work outside the home.
Even those with a profession traditionally stay
at home after marriage. Among some Indian
groups, however, women contribute to the
well-being of the family through farmwork,
and in the urban areas of Venezuela many
women have outside jobs but remain respon-
sible for household chores. In Chile, women
are usually involved in local social and politi-
cal issues.
Most South Americans prefer to immi-
grate as family groups, although financial
pressures often demand that a single family
member become established in the United
States before the rest of the family follows.
Individual immigrants commonly move to
neighborhoods where relatives, godparents,
or friends have settled. They depend on these
contacts for housing and support. This sys-
tem of mutual assistance is maintained after
the immediate family arrives, bringing more
relatives into the extended family. Colombians
and Ecuadorans often broaden their relation-
ships beyond national boundaries to form
strong bonds with other Latinos.
Many families suffer from the stresses of
American informality and freedom. Men lose
some authority over wives and children, and
women find it difficult to adjust to working
outside the home. Furthermore, many upper-
and middle-class women, who had paid help
with the housework in South America, must
learn to balance a job with responsibility for
running a home.
Traditional Health Beliefs and Practices There
are few data available on how Americans of
South American heritage maintain health or
how they approach illness. Brazilians often
attribute bad health to liver problems or an
imbalance between hot and cold, such as
drinking a glass of cold water on a hot day or
taking a cool shower after eating a hot meal.
Many South Americans self-diagnose or seek
health advice from their mothers or friends.
They then visit a pharmacist where they can
purchase many medications, such as antibiot-
ics, by the pill.
Most Brazilians associate faith with health.
Catholics may believe in fate and seek inter-
vention from patron saints when ill. Spirit-
ists employ homeopathy, exorcism, past-lives
therapy, acupuncture, yoga therapy, and
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3 0 4 C A R I B B E A N I S L A N D E R S A N D S O U T H A M E R I C A N S
chromotherapy to cure sickness.104 Followers
of candomblé believe that health is maintained
by achieving balance between the earthly and
spiritual spheres. The pai- de- santo or baba-
l or ix á (high priest) or the mä e- de- santo or
ial or ix á (high priestess) may be hired to read
the oracle of a personal orixá, for example, so
that an individual can improve his or her rela-
tionship with the deity.102 Harmonious rela-
tions with one’s orixá can maximize ax é (vital ax é (vital ax é
force). Spiritual equilibrium is maintained by
observing the preferences and prohibitions
of one’s orixá, including certain food and
beverages, colors, therapeutic herbs, beaded
necklaces, and other limitations. The priest
or priestess also serves as the local c ur endier o,
diagnosing physical and spiritual problems,
prescribing healing herbal baths or botanicals,
and manipulating occult forces. In Ecuador,
either a healer, called a c ur ander o, or a witch
doctor, called a br uj o, treats many illnesses in
small villages. In Peru, urban residents typi-
cally obtain biomedical health care, but in
rural regions home remedies and ritual magic
are often preferred.105
Herbal teas are a favorite remedy through-
out most of South America, where street
stands and small markets called y er beter í as
sell medicinal botanicals for home use.106
Numerous plants, many unfamiliar in the
United States, are used therapeutically.44
Soursop leaves are used to treat diabetes,
and the seeds of the guaraná are thought
to relieve fatigue and help with weight loss.
Retained urine is treated with avocado leaves,
and papaya leaves are considered useful in
getting rid of intestinal worms. Rue is taken
for uterine pain and as an abortive, and black
nightshade is used for coughs. P au d’ ar c o, the
bark of a tree native to Brazil, is widely used to
treat rheumatism, diabetes, venereal diseases,
yeast infections, enlarged prostate, and several
cancers.
Traditional Food Habits
Ingredients and Common Foods
Staples The cooking of South America is sim-
ilar to that of other Latin American regions
in that it combines some native ingredients
and preparation techniques with the foods
of colonial Europeans. The diet is largely
corn based and spiced with chile pepper
(see Table 10.2).Tomatoes are common, and
in tropical areas cassava (called y uc a) is a
popular tuber. Pumpkins, bananas, and plan-
tains are consumed often. Beef, rice, onions,
and olive oil, introduced by the Spanish and
the Portuguese, are eaten regularly. Tropical
fruits, such as those found in the Caribbean
(see above), are plentiful in many regions.
However, South American fare also features
a number of ingredients used infrequently
in the dishes of other Latin American areas.
Potatoes, which were first cultivated by the
Incas on mountain terraces, are particularly
important in the highlands of Peru and Ecua-
dor. Sweet potatoes (the orange-fleshed root
vegetable usually called yams in the United
States) are also native to the region. A white
r oot similar to a mild carrot, known as r oot similar to a mild carrot, known as r oot apio
or ar r ac ac h a, is found in Colombia, Peru, and
Venezuela; oca (a tuber similar to the potato
in appearance but with leaves like clover)
and y ac ó n (an elongated tuber that has the
taste and texture of a sweet turnip) are com-
monly eaten raw and cooked in Bolivia, Brazil,
Colombia, Ecuador, and Peru; and the tuber
known as ah ipa (called jicama in the United
States and Mexico) is native to the Amazon
River basin.
Beans, a foundation food in many Latin
American regions, are common in most
South American countries yet not eaten at
every meal. Other legumes and nuts, such as
peanuts and cashews, are used often in dishes.
Indigenous meats, including llama, deer, rab-
bit, wild pig, capybara, tapir, and cuy (guinea
pigs who are raised for consumption), are con-
sumed in some areas. Fish, such as anchovies
and tuna, and shellfish, particularly shrimp,
crab, spiny lobster, oysters, clams, giant sea
urchins (evisos), and giant abalone (locos),
are significant foods in the extensive coastal
regions. Iguana is consumed occasionally, and
alligator is a specialty in some areas.
A favorite way to prepare meats in South
America is grilling. Traditionally, sides of beef,
whole lambs, hogs, and kids (young goats) are
hung over smoldering wood to slowly cook
for hours in a method called asado. Today, a
grill is used more often. Steaks and marinated
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C H A P T E R 1 0 3 0 5
Group Comments Common Foods Adaptations in the United States
Protein Foods
Milk/milk products Milk is not usually consumed
as a beverage but used in
fruit-based drinks and added
to coffee. Many milk-based
desserts are enjoyed.
Cow’s, goat’s milk; evaporated milk; fresh
and aged cheeses
Available cheeses are
sometimes substituted
for unavailable traditional
cheeses.
Meat/poultry/fish/
eggs/legumes
Beef is a foundation of the diet
in parts of Argentina, Brazil,
Paraguay, and Uruguay. Some
game meats are consumed.
Fish and seafood are significant
in coastal regions, popular
as ceviche in Ecuador and
Peru. Beans are commonly
consumed.
Meat: alligator, armadillo, beef (including
variety cuts), capybara, frog, goat, guinea
pig (cuy), iguana, llama, mutton, pork, cuy), iguana, llama, mutton, pork, cuy
rabbit, tapir
Poultry: chicken, duck, turkey
Fish and shellfish: abalone, bass, catfish,
cod (including dried salt cod), crab,
eel, haddock, lobster, oysters, scallops,
shrimp, squid, trout, tuna
Eggs: chicken, quail, turtle
Legumes: beans (black, cranberry, kidney),
black-eyed peas
Less acceptable meats such
as guinea pig may no
longer be eaten.
Cereals/Grains Cuzcuz, made from cornmeal,
is prepared in parts of Brazil;
arepa, cornmeal bread, is
staple in some areas. Pasta is
popular in Argentina, Paraguay,
and Uruguay. Rice and corn
puddings are a favorite.
Amaranth, corn, rice, quinoa, wheat
Fruits/Vegetables Tropical and temperate fruits are
plentiful and popular, added
to savory and sweet dishes.
Fruit compotes and fruit pastes
are enjoyed. Potatoes are a
staple in the Andes. Cassava
flour and meal are common in
many areas; tapioca is used in
desserts.
Fruits: Abiu, acerola, apples, banana/
plantains, cashew apple (cajú), caimito,
casimiroa, cherimoya, custard apple,
feijoa, guava, grapes, jackfruit, jabitocaba,
lemons, limes, lulo (naranjillo), mammea,
mango, melon, olives, oranges (sweet
and sour), palm fruits, papaya, passion
fruit, peaches, pineapple, pitango, quince,
raisins, roseapple, sapote, soursop,
sweetsop, strawberries, sugarcane
Vegetables: abipa (jicama), arracacha (apio),
avocado, calabaza (green pumpkin),
cassava (mandioca; yuca), green peppers,
hearts of palm, kale, okra, oca, onions,
roselle, squash (chayote, winter), sweet
potatoes, tomatoes, yacón, yams
Additional Foods
Seasonings Toasted cassava meal, farinha, is
sprinkled over foods in Brazil.
Spicy hot foods are preferred in
many areas; salsas are common.
Achiote, allspice, chiles (aji, malgueta,
pimento), cilantro, cinnamon, citrus
juices (lemon, lime, and sour orange),
garlic, ginger root, oregano, paprika,
parsley, scallions, thyme, vinegar
Nuts/seeds Coconut and coconut milk are
added to numerous dishes.
Peanut sauces flavored with
chiles are common in the
Andes.
Brazil nuts, cashews, coconut, peanuts,
pumpkin seeds
TA B L E 10. 2 Cultural Food Groups: South Americans
(Continued )
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3 0 6 C A R I B B E A N I S L A N D E R S A N D S O U T H A M E R I C A N S
with indigenous ingredients such as mashed
potatoes, cassava, or corn. The turnovers
are usually baked, but sometimes they are
fried. Fillings are as many as there are cooks.
Chopped meat, olives, raisins, and onions
are popular. In Chile, the turnovers may be
filled with abalone, and in Brazil, where they
are known as empadinhas, a spicy shrimp
mixture is traditional. In Bolivia, where they
are called salteñas, the turnovers are filled
with cheese. Tamale-like steamed packets
of dough-wrapped fillings are also popular
throughout South America. In Peru, chapa-
nas are made with cassava dough, while in
Ecuador bollos are formed around cooked
chicken meat with plantain dough. In Brazil,
a freshly grated corn kernel dough is mixed
with coconut and cassava (and no filling) to
prepare pamonhas. Ground cornmeal dough
flavored with annatto and tomatoes is pre-
ferred for Venezuelan hallacas. A favorite in
Argentina, Bolivia, Brazil, Chile, and Ecua-
dor are humitas, which feature fresh kernel
or ground cornmeal dough wrapped around
a variety of savory or sweet meat, fish, or
vegetable fillings.
Regional Variations National differences
exist, although there are few clearly distinc-
tive divisions in South American fare. Several
countries share similar dishes, and only a few
nations have well-developed regional cuisines.
Peru and Ecuador The cooking of Peru and
Ecuador is divided into the highland fare
of the Andes and the lowland dishes of the
coastal regions. The cuisine of the mountain
kebobs (which often include organ meats) are
favorites. Another, even older cooking tradi-
tion is to steam foods in a pit oven. In Peru,
this method is called a pac h amanc a and typi-
cally includes a young pig or goat with guinea
pigs, chickens, tamales, potatoes, and corn
tucked around layers of hot stones and aro-
matic leaves and herbs.107 In Chile, a curanto
is closer to an elaborate coastal clambake,
including shellfish, suckling pig, sausages,
potato patties, peas, and beans layered with
seaweed.
Stuffed foods are also common, including
pastry turnovers filled with savory meat, fish,
or cheese fillings. They are called empanadas
in Argentina, which specializes in a turnover
with a flaky, Spanish-style dough enriched
▼ A market in Pisaq, Peru.
Yo
sh
io
T
om
ii/
Su
pe
rS
to
ck
Group Comments Common Foods Adaptations in the United States
Beverages Coffee is often served
concentrated, then diluted with
evaporated milk or water. Maté
is more popular than coffee or
tea in parts of Argentina, Brazil,
and Paraguay.
Batidas (tropical fruit juices, sometimes
made with alcoholic beverages), coffee,
guaraná, soft drinks, sugarcane juice,
tea, yerba maté and alcoholic beverages: yerba maté and alcoholic beverages: yerba maté
beer, cachaça (sugarcane brandy), pisco
(grape brandy), chicha (distilled corn
liquor), wine
Fats/oils Dendê oil flavors and colors
many dishes in the Bahia region
of Brazil.
Dendê (palm) oil, olive oil, butter Vegetable or peanut oil is
substituted for dendê oil.
Sweeteners Sugarcane, brown sugar, honey
TA B L E 10. 2 Cultural Food Groups: South Americans (C on t in u e d )
©
C
en
ga
ge
L
ea
rn
in
g
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 0 3 0 7
cinnamon popular along the coastal regions
of Ecuador.108 Pisco, a grape brandy that orig-
inated in Peru, is a national favorite, often
mixed with orange juice to make the refresh-
ing drink called yugeno.
Argentina, Chile, Boliv ia, Urug uay, and
Paraguay Hearty, ample fare with an empha-
sis on beef exemplifies the cooking of these
southern nations. Argentina is a major beef-
producing region, and its people eat more
beef per capita than in any other country
worldwide. The temperate weather permits
the cultivation of numerous fruits and veg-
etables, notably strawberries, grapes, and
Jerusalem artichokes (known as topinambur
in Chile). The cooking of Argentina, Chile,
Paraguay, and Uruguay has been influenced
more by their immigrant populations than by
the numerous small Indian groups native to
the area. The Spanish introduced cattle, and
the Italians brought pasta. Smaller numbers
of Germans, Hungarians, and other central
Europeans have added their foods as well.
The national dish of Argentina is matam-
br e, which means “to kill hunger.” A special
cut of flank steak is seasoned with herbs, then
traditionally rolled pinwheel fashion around
a filling of spinach, whole hard-boiled eggs,
areas is among the most unique in South
America, preserving many ingredients and
dishes of the Inca Indians. Potatoes are eaten
at nearly every meal and often for snacks.
Over one hundred varieties are cultivated.
Ocopa, boiled potatoes topped with cheese
sauce and chile peppers or peanuts, is a typi-
cal dish in Peru. In Ecuador fried potato and
cheese patties, called llapingachos, and potato
cheese soup served with slices of avocado,
known as locro, are common. Traditionally,
the tubers are preserved by freezing in the
cold night air and then drying in the hot day-
time sun. Papa seca are boiled first and then
dried until the potatoes are rocklike chunks
that must be rehydrated before consumption;
chuño are not cooked before drying and are
often ground into a fine potato starch. Corn
is also grown in the mountains. Some variet-
ies have kernels the size of small strawberries
that when prepared as hominy are known as
mote and are a popular snack item. Bananas
and plantains are cooked as savory chips and
made into flour for breads and pastries.
The foods of Peru and Ecuador are pre-
ferred picante and feature abundant use of
chile peppers in both the highlands and along
the coast. Salsa de ají, a combination of fresh
chopped chile, onion, and salt, is served as
a condiment at most meals. Orange- or yel-
low-hued dishes are favored; along the coast,
annatto colors foods, and in the Peruvian
highlands an herb known as palillo is used.
Charqui, dried strips of llama meat, is a spe-
cialty of the Andes. Anticuchos, chunks of
beef heart marinated in vinegar with chiles
and cilantro, then skewered and grilled, are a
spicy Peruvian favorite also from the Andes.
Rabbit dishes are also popular in the region.
Along the coast, seafood dominates the diet.
The region is famous for its ceviches (also
spelled c ebic h e), a method of preparing fresh
fish, shrimp, scallops, or crab by marinating
small raw chunks in citrus juice. The acidity
of the juice cooks the fish and turns it opaque.
At many beaches, cevicherias offer the dish
as a snack or light meal with beer. Chopped
onion, tomato, avocado, and cilantro are often
added. In Peru, ceviche is typically garnished
with sliced sweet potato. Chucula is a thick
plantain and milk beverage flavored with
S A M P L E M E N U
An Ecuadoran Dinner
C e bich e d e P e s c ad o (Fish C e vich e )a,b
L oc r o (Potato Soup)a,c
Humitas (Fresh Corn Tamales)a,b
Ch ucula (Plantain and Milk)a or Juice
aKijac, M.B. 2003. The South American table. Boston: Harvard Common Press.
bEcuadoran Recipes at http://thelatinkitchen.com/
slide/galapagos-island-high-end-cuisine
cEcuadoran Cuisine & Recipes at http://www.whats4eats.com/4rec_ecuad.html
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
3 0 8 C A R I B B E A N I S L A N D E R S A N D S O U T H A M E R I C A N S
and whole or sliced carrots, and then tied
with a string and poached in broth or baked.
Matambre can be served as a main course, but
it is often chilled first and offered as a cold
appetizer. Grilled steaks are particularly pop-
ular in Argentina and surrounding nations.
In Paraguay, steaks are typically served with
sopa Paraguay, a cornmeal and cheese bread.
In Uruguay, beef is eaten nearly as often as in
Argentina, although mutton and lamb are also
common.
Robust soups and stews are everyday fare.
In Bolivia, beef stew is made with carrots,
onions, hominy, and chuño. The stews of
Argentina often pair meat with fruits as well
as vegetables, such as carbonada criolla (beef
cooked with squash, corn, and peaches) or
carbonada en zapallo (veal stew cooked in a
pumpkin). In Paraguay, soups reveal European
inspiration, such as bori-bori, beef with corn-
meal and cheese dumplings, and so’ o-yosopy,
beef soup with bell peppers, tomatoes, and
vermicelli or rice, topped with Parmesan
cheese. Fish soups and stews are popular in
Chile, which has an extensive coastline and
plentiful seafood. A specialty is clam or aba-
lone chowder with beans (chupe de loco) and
congrio (an elongated, firm-fleshed fish that
looks a little like an eel) cooked with potatoes,
onions, garlic, and white wine.
National favorites include pasta (e.g., spa-
ghetti, ravioli, and lasagna), which is served
in many homes on Sundays in Argentina. It is
considered lucky to eat it on the twenty-ninth
of every month as well. In Chile, beans are
especially popular, and seafood is eaten regu-
larly. Wines from the temperate midlands of
the country are considered some of the best
on the continent. Pisco is consumed in both
Bolivia and Chile, where it is mixed with
lemon juice, sugar, and egg whites to make
a pisco sour. In Bolivia, legs from the giant
frogs found in the Andean Lake Titicaca are
a specialty, and chicha, a distilled corn liquor,
is popular.
Although coffee is consumed through-
out the area, another caffeinated beverage is
equally popular in some regions. Called maté,
it is an infusion made from the leaves of a
plant ( I l ex par aguar iensis) in the holly fam-
ily native to Paraguay. Served hot or chilled,
maté is consumed nearly every afternoon
with small snacks in Paraguay and in parts
of Argentina. The dried, powdered leaves are
called yerba and are traditionally mixed in
a gourd with boiling water. A special metal
straw is inserted to drink the brew.
Colombia and Venezuela The fare found in
Colombia and Venezuela is colonial Spanish
in character, cooked with olive oil, cream,
or cheese and flavored with ground cumin,
annatto, parsley, cilantro and chopped onions,
tomatoes, and garlic. Yet native tastes are still
evident. Guascas, or huascas (Galinsoga par-
vilora Lineo), an herb native to Colombia,
provides a flavor similar to boiled peanuts
in soups and stews. Hot chile pepper sauces
are served on the side of most dishes. Tropi-
cal fruits and vegetables, including avocados,
bananas and plantains, naranjillo (a small,
orange fruit related to tomatoes used for its
tart juice), pineapple, and coconut milk or
cream are other common regional ingredients.
In Colombia, Bogatá chicken stew (made
with chicken, two types of potatoes, and
cream) and sancocho (a boiled dinner tra-
ditionally made with beef brisket or other
roast, and ample starchy vegetables such as
potatoes, sweet potatoes, plantains, or cas-
sava) are typical Spanish-influenced dishes.
Examples in Venezuela include ropa vieja
(“old clothes”), shredded flank steak served
in a sauce made with tomatoes, onions, and
olive oil; and pabellón caraqueño, flank steak
served on rice with black beans, topped with
fried eggs, and garnished with fried plantain
chips. Dishes with more indigenous flavors
include arepa, the staple cornmeal bread of
Venezuela that is formed into one-inch-thick
patties and cooked on a griddle (it is some-
times stuffed with meat or cheese before it is
fried), cachapas, tender cornmeal crepes, and
mashed black beans, known as caviar criollo
or “native caviar.” Tropical fruits, such as gua-
vas and pineapple, are often sweetened and
dried to make favorite snacks of fruit leathers
and fruit pastes.
Guyana Guyana has a cuisine widely influ-
enced by its proximity to the Caribbean,
as well as by the many immigrants from
throughout the world who have called Latin
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 0 3 0 9
America home. For example, one national
favorite is pepper pot, a stew made with a
variety of meats and onions and flavored with
the Caribbean cassava-based sauce cassareep
(see Chapter 9). Other common dishes simi-
lar to those in the Caribbean include salt-fish
cakes, blood pudding, coocoo (cornmeal and
okra bread), cookup rice (rice with black-eyed
peas or split peas), bammies, and ginger beer.
Caribbean desserts are common, such as the
dense fruitcake known as black cake, and kon-
kee, a tamale made from sweetened cornmeal,
coconut milk, and raisins wrapped in banana
leaves, then boiled. African influence is found
in foofoo, a pounded plantain paste like
African fufu, and stews made with fish or meat,
plantains, onions, and okra (see Chapter 8).
Dumplings, called metamgee, are made from
starchy vegetables and are often added to
stews. Asian foods include Indian curries, roti
(flat bread), the use of dal (a type of legume;
see Chapter 14), and Chinese noodle dishes.
One national specialty is Portuguese garlic
pork, which is marinated in vinegar, then
fried. The country is famous for Demerara
sugar, a very rich, brown-colored, and crum-
bly raw cane sugar named for a region in
Guyana. It is the source of Demerara rum, a
Guyanese specialty.
Brazil The cooking of Brazil is very different
from that of other South American countries
due to Portuguese and African influences.
The Portuguese arrived in the sixteenth cen-
tury, looking for land on which to cultivate
sugarcane. They contributed dried salt cod
and linguiça to the diet, stews known as
cozidos made with many different meats and
vegetables (known as cocido in Portugal),
and a variety of exceptionally sweet desserts
based on sugar and egg yolks, such as cara-
mel custards and corn (canjica) or rice (pirão
de arroz) puddings flavored with coconut.
African slaves put to work on the sugar plan-
tations brought foods unknown in nearby
countries, such as dendê oil (a type of palm
oil) and okra. Spicy dishes were preferred. In
West Africa, malagueta peppercorn, a small,
hot grain, was used to season foods; in Brazil,
Africans adopted a very small, mouth-searing
chile pepper indigenous to the area and also
called it malagueta. It is typically minced and
added to dendê oil, often with dried shrimp
and grated ginger root, to make a hot sauce.
Although Indian, Portuguese, and African
tastes and textures have influenced cooking
throughout Brazil, nowhere are they more
prominent than in the state of Bahia. Known
as Afro-Brazilian fare, or cozinha baiana, this
cuisine is famous for fritters made from dried
shrimp, dried salt cod, yams, black-eyed peas,
mashed beans, peanuts, and ripe plantains
fried in dendê oil. Vatapá, another specialty,
is a paste made with smoked dried shrimp,
peanuts, cashews, coconut milk, and malagu-
eta chiles. It is used as a filling for black-bean
fritters called aracanjá and sometimes served
with rice as an entree.
The national dish of Brazil is feijoda com-
pleta, which originated in Rio. Black beans
cooked with smoked meats and sausages are
served with rice, sliced oranges, boiled greens,
and a hot sauce mixed with lemon or lime
juice. Toasted cassava meal, called farinha, is
sprinkled over the top like Parmesan cheese.
Farinha is served with most dishes and is often
S A M P L E M E N U
A Brazilian Celebration
F e ijoad a C om ple t a (Black Beans with Meats)a,b,c
F ar of a (Toasted Manioc Meal)a,b,c
Braised Collard Greensa,b,c
Brazilian Ricea,b
Coconut Bread Puddinga
or T or t e d e Ban an a (Banana Pie)b
C apir in h as ,a,b,c Beer or Juice
aKijac, M.B. 2003. The South American table. Boston: Harvard Common Press.
bMaria’s Cookbook at http://www.maria-brazil.orgMaria’s Cookbook at http://www.maria-brazil.orgMaria’s Cookbook
cCook Brazil at http://cookingbrasil.com/Cook Brazil at http://cookingbrasil.com/Cook Brazil
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
3 1 0 C A R I B B E A N I S L A N D E R S A N D S O U T H A M E R I C A N S
mixed with butter and other ingredients, such
as bits of meat, pumpkin, plantains, or coco-
nut milk to create crunchy side dishes called
farofa. Rice or cornmeal porridge, called pirão,
is another type of side dish. Middle Eastern-
ers who immigrated to the southeastern areas
of Brazil brought the concept of couscous to
the country and adapted the dish to native
ingredients. Cuzcuz paulista is prepared with
cornmeal in a cuzcuzeiro, which looks like a
colander on legs that is inserted over a pot of
boiling water to steam. The basket of the cuz-
cuzeiro is first lined with seafood or poultry
and vegetables, which flavors the cornmeal as
it cooks and looks decorative when the cuzcuz
cake is inverted.
In the far south, the cuisine has been
influenced by the foods of Argentina. Grilled
meats are a favorite in Brazil, especially in the
south, home of the frontiersmen known as
gauchos, who herded cattle on the grassland
plains. Sides of beef were traditionally staked
at the edges of a bonfire for slow cooking in
a method called c h ur r asc o. The popularity
of the outdoor barbecue led to c h ur r asc ar ia
r odiz io, restaurants located in cities through-
out the nation that specialize in spit-roasted
beef, pork, lamb, and sausages brought to the
table on large skewers and carved to taste.
Specialties include picanha (rump roast) and
beef heart. Assorted side dishes such as salads,
potatoes, condiments, and desserts round out
the meal. Brazilians in the South also drink
maté, which they call chimmarão. Coffee,
rum, and beer are common beverages in
Brazil, but several other drinks are also popu-
lar. Guaraná is a delicious, stimulating car-
bonated soft drink made from the seeds of the
native guaraná fruit, which contain caffeine.
Cachaça (called aguardiente in other South
American nations) is an alcoholic beverage,
often compared to brandy, distilled from sug-
arcane. It is used to make batidas, a refreshing
punch with fruit juice, or caipirinhas, mixed
with a little lime juice, sugar and mint, then
consumed over ice.
Meal Composition and Cycle
Daily Pattern Three meals a day are tradi-
tional among middle-class and affluent South
Americans, with an afternoon snack often
added. The poor, especially those in rural
areas, are often limited to an early breakfast
with a large dinner around 6:00 p.m.106
For those who can afford more than two
meals daily, breakfast is typically light, often
bread or a roll with jam and a cup of coffee,
served black or with milk. A more complete
meal features fresh fruit or pastries and occa-
sionally ham or cheese. Lunch is usually the
main meal, consumed in a leisurely manner
with family or friends. Appetizers such as
fritters, humitas, or empanadas may start the
meal, followed by a meat or seafood stew or
a grilled meat dish. Side dishes may include
rice, beans, farofa, fried potatoes, and greens
such as kale. Salads, typically featuring cooked
vegetables, are popular in some areas, includ-
ing Brazil, and are served with the meal. Des-
sert, most often flan or another sweet custard
or pudding, is usually served. In Argentina,
the time spent relaxing and socializing after
lunch is called l a sombr emes and sometimes
includes a nap. Dinner is traditionally lighter,
sometimes just cold cuts, a seafood salad, or
a serving of soup or stew, and usually eaten
around 9:00 each evening, often continuing
past midnight. Beer, wine, fruit juice, and soft
drinks are beverages commonly consumed
at meals.
An afternoon break is typical in much of
South America: coffee is typically consumed
in Argentina, Colombia, Ecuador, and Brazil;
tea is served in the late afternoon in Chile
and Uruguay; and maté is popular in parts
of Argentina, Paraguay, Uruguay, and Brazil.
Snacks eaten with the beverage are often fruit,
cachapas or arepa, sandwiches, or a pastry.
Street vendors offering coffee, fruit juice, and
snacks throughout the day are common in
urban areas. Unlike wealthier South Ameri-
cans, the poor often skip lunch and eat a large
dinner. The meal may consist of soup or a
serving of stew with a side dish of potatoes,
plantains, cassava, corn, or rice and beans,
depending on the region.
Special Occasions Catholic traditions have
influenced many South American holidays.
A rich Christmas Eve dinner is traditional
in most nations, often with a roast, such as
lechón (suckling pig) in Brazil and cuy or
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C H A P T E R 1 0 3 1 1
lechón in Ecuador. Italian specialties includ-
ing torrone and panettone are Christmas
items in Argentina, where Epiphany is another
significant religious holiday (see Chapter 6).
Easter is important in many homes, and
Carnival (C ar nav al ) festivities featuring danc-
ing, parties, and traditional fare are popu-
lar in Brazil, Ecuador, Peru, and Uruguay.
Americans from these countries sometimes
celebrate with parties during the three days
before Lent. During the time of Lent, animals
associated with water habits, such as alligators,
armadillos, capybaras, iguanas, and turtles,
were traditionally classified as fish; thus the
Catholic Church permitted their consumption
on meatless days.106 These game meats are still
considered Lent specialties in some regions.
St. John’s Day is a favorite in Brazil, featur-
ing foods made with corn and pumpkin, and
it is also celebrated by the citizens of Otavalo,
Ecuador with all-night feasting and danc-
ing. In Peru, All Soul’s Day on November 2
includes gifts of food and family picnics at
the gravesites of deceased kin. Also signifi-
cant for many Americans of South American
descent are the independence days observed
in various nations. Brazilian Americans com-
memorate their independence on September 7
with day-long festivities in Boston, New
York, and Newark, New Jersey. Americans
from Chile sponsor traditional food and craft
booths for fairs to celebrate their Indepen-
dence on September 18. Colombian Ameri-
cans consume tamales, empanadas, arepas,
and other specialties on their independence
day, July 20. In Ecuador, the pr imer gr ito (“first
cry” of independence) is held on August 10
and is officially marked as Ecuador Day in
New York City. Independence Day in Peru
is July 28. The Day of Tradition is popular in
the Argentinian American community, with
customary foods, folk music, and equestrian
displays by men dressed as gauchos.
Etiquette Traditionally, women prepared
meals and served them to men, who con-
sumed their food first. Women would eat after
the men finished. This custom is continued in
many rural, and even some urban, homes in
South America today, especially among fami-
lies of Indian ancestry.106
European-style dining is common in
most of South America. The fork is kept in
the left hand, and the knife in the right, with
no switching for cutting food. Bread is often
served without butter and placed on the side
of the plate. It is the only food that should be
eaten with the hands. All other items, includ-
ing fruit, require cutlery. Salads, however,
should not be cut. Instead the lettuce should
be folded into bite-size packets with the fork.
In Brazil, even sandwiches are eaten with
a knife and fork. All items are passed to the
left. The hands should remain above the table
when a person is not eating, with wrists rest-
ing on the table edge. In Colombia, it is impo-
lite to start a meal until the host says “¡ B uen
pr ov ec h o!” In Bolivia, it is an insult to pour
wine with your left hand or to hold the bottle
at the base when pouring, which is interpreted
to mean you dislike the person for whom the
glass is intended.39
Therapeutic Uses of Foods Candomblé orixás
are associated with certain foods, and fol-
lowers honor their deity by eating those
items. Examples include white corn, white
beans, rice, porridge, yams, and water with
Oxalá; rice, black beans, black-eyed peas,
and roasted corn with Omolu; black beans
with Ogun; farofa made with dendê oil,
black beans, honey, steak with onions, and
chachaça with Exú; tapioca, pudding, cooked
corn, and a ginger-flavored drink called aluá
with Oxoosi; and pudding, banana, ximxim
(chicken stew), and champagne with Oxum.
A hot–cold system of medicine, most likely
introduced by European immigrants, has also
been adapted by candomblé healers, treat-
ing hot conditions associated with hot orixás
with cool prescriptions associated with cool
orixás. Classification is inconsistent, however,
and cold conditions are rarely treated with hot
remedies.102
Some South Americans may adhere to
more general hot–cold classifications not asso-
ciated with candomblé.112 Foods that are hot
in temperature, or irritating to the stomach,
may be avoided during fevers, for example.
Conditions such as menstruation, pregnancy,
and lactation also require specific foods. In
addition, some people believe that certain
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3 1 2 C A R I B B E A N I S L A N D E R S A N D S O U T H A M E R I C A N S
foods should be eaten at specific times of day,
such as fruit, which is considered wholesome
in the morning but harmful in the evening.
Some South Americans avoid combinations of
some foods, such as eating acidic fruits at the
same time as drinking milk.
Contemporary Food Habits
in the United States
Adaptations of Food Habits
Very little has been reported on the adapted
food habits of South Americans living in the
United States. Many continue cooking their
favorites from home, although recipes are
often adapted to accommodate U.S. ingredi-
ents or to improve acceptability (e.g., cuy is
not often prepared). Substitutions for unavail-
able ingredients, such as feta cheese for fresh
farmer’s cheese or peanut oil for dênde oil, are
common. Sometimes the fact that certain cus-
tomary ingredients are unobtainable makes
other dishes that can be prepared traditionally
more popular in the United States than these
dishes are in their countries of origin. For
instance, llapingachos is probably eaten more
often by Peruvian Americans than by Peruvi-
ans.109 Among Chileans, many find it difficult
to adapt to typical American schedules with a
work day that begins earlier than in Chile (dif-work day that begins earlier than in Chile (dif-work day that begins earlier than in Chile (dif
ficult after a late dinner) and has a short lunch
period precluding a leisurely meal.
Nutritional Status
Nutritional Intake There are minimal data on
the nutritional status of Americans of South
American descent. Parasitic infection, iron-
deficiency anemia, and protein-calorie mal-
nutrition are common in many rural areas of
South America and in some crowded urban
neighborhoods as well. Chronic Chagas dis-
ease involving the esophagus and colon is
endemic in some regions and may be a risk
factor in cardiovascular disease.
Studies in South America reveal trends that
may be applicable to the population in the
United States, particularly recent immigrants.
Overweight and obesity is prevalent in some
regions, with reported rates for BMI $25
in 48 percent of one Colombian adult sam-
ple, 64 percent in Chilean, 55 percent in
Ecuadoran, and 52 percent in Brazilian stud-
ies. Reports on obesity show rates of BMI .30
in 19 percent of a study of Brazilians, 30 per-
cent in Argentinans, and 30 percent of Chil-
eans. The prevalence for high blood pressure
in South American Countries ranges from 23
to 46 percent.110
Among Brazilians, traditional diets low
in calorie density and high in fiber were
associated with lower BMI, whereas more
Westernized diets with foods high in added
fats (especially butter, margarine, and fried
snacks) and sugars (particularly soft drinks)
were associated with a higher BMI.111
Type 2 diabetes rates are in the 6 to 12 per-
cent range in South American countries.110
A study in Ecuador reported 41 percent of
postmenopausal women had metabolic syn-
drome.112 Research in Venezuela estimated
that one-third of the adult population in
the region had metabolic syndrome associ-
ated with dyslipidemia. Among men, rates
varied widely by ethnicity and were highest
in those of mixed heritage (37 percent), fol-
lowed by whites and blacks. The lowest rates
(17 percent) were found in the Native Indian
group.113,114
Counseling In many South American coun-
tries, universal health care is available. How-
ever, preventive health practices may or may
not be provided, and care may not be sought
except in emergency situations. Unauthorized
South Americans living in the United States
illegally typically have no medical insurance
and may avoid contact with any government
agency.
South Americans tend toward formality
in their interactions with others. Conversa-
tions are often reserved, with little emotional
expression. However, Venezuelans are note-
worthy for their directness, and Brazilians are
typically restrained with strangers but very
animated with family and friends.39 Most
South Americans prefer to sit and stand closer
than is usual in the United States. Direct
eye contact is common throughout South
America, except in Colombia, where eye con-
tact may be avoided with authority figures or
elders, or in embarrassing situations as a sign
of subordination. Most South Americans are
Chileans commonly use
both their paternal and
maternal surnames.
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C H A P T E R 1 0 3 1 3
present oriented and polychronic, which may
result in relaxed attitudes toward appointment
and treatment schedules. Generally speaking,
immediate interventions are valued more than
either preventive or long-term care. In Argen-
tina, a patient is often protected from a nega-
tive prognosis.
When counseling Argentinians, the
eldest of the group will be introduced first.
Maintaining eye contact is a sign of interest
and will help build trust. With Venezuelans
punctuality is valued and respected. Use
only their first name if you are given per-
mission. Family is important to Peruvians
and be can be used in conversation to build
a relationship. Peruvians consider it rude to
use your index finger to point at an object
or person. Dominicans expect direct eye
contact and may interrupt you while you’re
talking.115
The role of traditional health beliefs and
practices is largely undocumented, though it
D I S C U S S I O N S T A R T E R S
Understanding Cultural Differences
This chapter covers many cultures. Some share traits; others do not. Cultural differences can be subtle. It’s easy to stereotype people from unfamiliar
cultures, but doing so can cause poor outcomes for U.S. health care professionals trying to counsel immigrant patients. Below are examples of two
matrixes, intended to help us differentiate among immigrants from various Caribbean island and South American cultures. Your task is to create two
tables using the following models, each with two rows: Caribbean islands and South America. The first table lists health issues, and the second lists
cultural issues for the two groups. Place a plus sign in the squares where the features are present for the immigrants in each row.
In the first matrix, identify which of the immigrant groups have been generally recognized as suffering from which diseases. This is an example of
how you can organize your information:
Counseling patients from different cultures is complicated not only by the fact that immigrants from different cultures may tend to suffer from different
diseases, but also by the fact that different cultures tend to behave differently. In the second matrix, identify which problematic features are associated
with which immigrant groups.
In small groups, share your completed matrixes. Within your group, come to a consensus on your identifications and discuss the implications this infor-
mation might have for training health professionals. Are there categories shared by several immigrant groups? Do the matrixes suggest some general
guidelines for addressing the dietary needs of immigrants from the Caribbean islands and South America?
Obesity Hypertension DiabetesHypertension Diabetes Liver Disease
Parasitic
Disease
List the country in
this column
Language Problems FatalismLanguage Problems Fatalism1
Modest
Reserved
Behavior
Direct Eye
Contact
List the country in this
column
1By fatalism, we mean the idea that God or fate determines a person’s health.
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3 1 4 C A R I B B E A N I S L A N D E R S A N D S O U T H A M E R I C A N S
Review Questions
1. Choose one Caribbean country and summa-
rize the worldview of its immigrants living in
the United States. Include an example of the
use of the hot–cold system for cause or treat-
ment of an illness. Describe the types of tradi-
tional healers used in this region.
2. Select one indigenous food found in the
Caribbean. Describe its taste and use in recipes
from the region. Next, select a foreign food that
was brought to the region and still commonly
consumed—provide a recipe. Which foods are
now the staples of the diet? Describe a holiday
meal in one Caribbean country plus the spe-
cialties of the island.
3. What health problems have become common
for people from the Caribbean living in the
United States? If you were a nutritionist, how
would you modify the diet in the treatment of
these disorders?
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One study of women with type 2 diabetes
living in southeastern Brazil reported that
many found dietary restrictions burdensome.
Some were concerned with loss of autonomy,
and others mentioned cravings for sweets.
Some felt sadness when following the diet.
Many mentioned that they had no symptoms
of diabetes, and therefore believed dietary
restrictions were unnecessary. Compliance
was poor in this group.
An in-depth client interview should be
used to determine South American country of
origin, preferred language, and length of stay
in the United States. Client’s socioeconomic
status, degree of acculturation, and use of
traditional health practices will be significant
factors in care.36
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
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81. Centers for Disease Control and Prevention. 2012.
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82. Cleghorn, G.D., Nguyen, M., Roberts, B., Duran,
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83. Ho, G.Y., Qian, H., Kim, M.Y., Melnik, T.A.,
Tucker, K.L., Jimenez-Velazquez, I.Z., . . . Rohan,
T.E. 2006. Health disparities between island and
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P ubl ic H eal th , 1 9 , 331–339.
84. Kousta, E., Efstathiadou, Z., Lawrence, N.J., Jeffs,
J.A., Godsland, I.H., Barrett, S.C., . . . Johnston,
D.G. 2006. The impact of ethnicity on glucose
regulation and the metabolic syndrome follow-
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hart, J., Carnethon, M., Gallo, L.C., . . . Avilés-
Santa, M.L. 2014. Prevalence of diabetes among
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spec if ic or al h eal th data 2 0 1 0 . Retrieved from
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barriers to health care for Haitian immigrants in
Miami-Dade County, Florida. J our nal of H eal th
C ar e f or th e P oor and U nder ser v ed, 1 6 , 29–41.
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pr of il e. Retrieved from http://minorityhealth.
hhs.gov/templates/browse.aspx?lvl52&lvlid554
(accessed March 5, 2011).
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itz, S. 2004. Awareness about factors that affect
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N ur sing, N ur sing, N ur sing 1 2 , 380–390
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93. Garcia, S., Canoniero, M., Lopez, G., & Soriano,
A.O. 2006. Metamizole use among Hispanics in
Miami: Report of a survey conducted in a pri-
mary care setting. S outh er n M edic al J our nal , 9 9 ,
924–926.
94. Larson, E.L., Dilone, J., Garcia, M., & Smolowitz,
J. 2006. Factors which influence Latino commu-
nity members to self-prescribe antibiotics. N ur s-
ing R esear c h , 5 5 , 94–102.
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intake of black and Hispanic mothers in a Brook-
lyn ghetto. J our nal of th e A mer ic an Dietetic A sso-
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of the foreign-born population by region of birth.
2 0 0 9 – 2 0 1 3 A mer ic an C ommunity S ur v ey 5 - Y ear
E stimates Table S0506. Retrieved from http://
factfinder.census.gov/faces/tableservices/jsf/
pages/productview.xhtml?pid=ACS_13_5YR_
S0506&prodType=table (accessed March 5, 2015).
97. Motel, S., & Patten, E. June 27, 2012. H ispanic s
of C ol ombian or igin in th e U nited S tates, 2 0 1 0 ,
statistic al pr of il e. Retrieved from http://www.
pewhispanic.org/2012/06/27/hispanics-of-
colombian-origin-in-the-united-states-2010/
(accessed March 5, 2015).
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ic s of E c uador ian or igin in th e U nited S tates,
2 0 1 1 . Retrieved from http://www.pewhispanic
.org/2013/06/19/hispanics-of-ecuadorian-
origin-in-the-united-states-2011/ (accessed
March 5, 2015).
99. Brown. A., & Patten, E. June 19, 2011. H is-
panic s of P er uv ian or igin in th e U nited S tates,
2 0 1 1 . Retrieved from http://www.pewhispanic
.org/2013/06/19/hispanics-of-peruvian-origin-
in-the-united-states-2011/ (accessed March 5,
2015).
100. Brown. A., & Patten, E. June 19, 2011. H ispan-
ic s of A r gentinean or igin in th e U nited S tates,
2 0 1 1 . Retrieved from http://www.pewhispanic
.org/2013/06/19/hispanics-of-argentinean-
origin-in-the-united-states-2011/ (accessed
March 5, 2015).
101. U.S. Census Bureau. n.d. Selected population pro-
file in the U.S. 2 0 1 2 A mer ic an C ommunity S ur v ey
1 - Y ear E stimates, Table S0201. Retrieved from
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jsf/pages/productview.xhtml?pid5ACS_12_1YR_
S0201&prodType5table (accessed March 5,
2011).
102. Voeks, R.A. 1997. S ac r ed l eav es of C andombl é :
A f r ic an magic , medic ine, and r el igion in B r az il .
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latin-america/ (accessed March 5, 2015).
104. Jefferson, A.W. 2000. Brazilian Americans. In
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ton Hills, MI: Gale Group.
105. Packel, J. 2000. Peruvian Americans. In
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enc y c l opedia of mul tic ul tur al A mer ic a. Farming-
ton Hills, MI: Gale Group.
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3 1 9
Korea. Southeast Asians are discussed in
Chapter 12 and South Asians are considered
in Chapter 14.
Chinese
Chinese civilization is more than 4,000 years
old and has made numerous significant con-
tributions in agriculture, the arts, religion and
philosophy, and warfare. Silk and embroi-
dered brocade cloth, intricate jade sculpture,
Chinese porcelain and lacquerware, book
printing, Confucianism, Taoism, and gun-
powder are just a few examples. The name
China, meaning “middle kingdom,” or center
of the world, is probably derived from a ruling
dynasty of the third century bce.
China’s landscape is dominated by
the valleys of two great rivers, the Huang
(Yellow) River in the north and the Chang
Jiang (Yangtze) in the south. The climate
is monsoonal, with most of China’s rainfall
occurring in the spring and summer months.
The northern plain through which the
Huang River flows is agriculturally very fer-
tile. The area is cold, and sometimes the severe
winter results in a growing season of only four
to six months. In the south the Chang Jiang
River starts in Tibet, traverses the southern
provinces, and eventually empties into the
China Sea near the city of Shanghai. South of
the mouth of the Chang Jiang delta is a rug-
ged and mountainous coastline off which are
located the islands of Hong Kong and Taiwan.
Marco Polo, the famous
European traveler who
went to China in the late
thirteenth century, is said
to have brought Chinese
noodles to Italy. The
Italians, however, were
undoubtedly making
pasta long before the
times of Marco Polo—
noodles are thought to
have been developed
independently in each
region.
East Asians
Asia is one of the world’s largest conti-nents, stretching from the Ural Moun-tains and Suez Canal in the east and
the Arctic Circle in the north, to the tropical
peninsulas of India and Southeast Asia. It
encompasses almost one-third of the world
landmass and nearly two-thirds of the global
population. Asia is divided into the regions
of East Asia, Southeast Asia, and South Asia.
Though the continent has historically included
parts of Russia and several nations of the for-
mer Soviet Union (sometimes known as Cen-
tral Asia) and the Middle East (sometimes
called West Asia, or Asia Minor), the people
of these countries are culturally distinct from
the rest of Asia and are covered in Chapters 7
and 13, respectively.
East Asia is defined as China (the Peo-
ple’s Republic of China), Taiwan (Republic
of China), Japan, the Democratic People’s
Republic of Korea (North Korea), the Repub-
lic of Korea (South Korea), and the Mon-
golian People’s Republic (see Figure 11.1).
Immigrants from these nations, particularly
China and Japan, have been coming to the
United States since the 1800s. Many settled
on the West Coast, where the majority of
their descendants still live. In recent years,
large numbers from throughout the region
have arrived in the United States; many are
refugees from political oppression, whereas
others seek education and employment
opportunities. This chapter introduces the
peoples and cuisines of China, Japan, and
11CHA
P
T
E
R
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3 2 0 E A S T A S I A N S
The southern provinces are warmer and wet-
ter and have a longer growing season (six to
nine months) than in the north.
The population of China is estimated to
exceed 1.36 billion people, more than four
and a half times as large as the population of
the United States. The Chinese have a hetero-
geneous society with numerous ethnic and
racial groups. The Chinese language is equally
diverse, with many dialects, some of which are
incomprehensible to people of other Chinese
regions.
Cultural Perspective
History of Chinese in the United States
Immigration Patterns The first major surge
in Chinese immigration to the United States
occurred in the early 1850s when the Chinese
joined in the gold rush to California; many
Chinese still refer to America as the “Land of
the Golden Mountain.” As mining became less
lucrative, the Chinese opened their own busi-
nesses, such as laundries and restaurants, but
also found employment in other occupations.
Figure 11.1
China, Japan, and Korea.
PAPUA
NEW GUINEA
SRI LANKA
CHINA
INDIA
THAILAND
MALAYSIA
PHILIPPINES
Hong Kong
TAIWAN
JAPAN
MONGOLIA
South
China
Sea
Bay of Bengal
Philippine Sea
Sea of
Japan
Pacific
Ocean
East
China
Sea
BRUNEI
SINGAPORESINGAPORE
MYANMAR
NEPALLLLLL
BHUTAN
BANGLADESH
VIETNAM
LAOS
SOUTH
KOREA
NORTH KOREA
Beijing
Tokyo
SeoulSeoul
PyongyangPyongyangPyongyangPyongyang
Bangkok
Manila
CAMBODIA
INDONESIAAAA ©
C
en
ga
ge
L
ea
rn
in
g
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C H A P T E R 11 3 2 1
The Central Pacific Railroad, which joined the
Union Pacific as the first cross-country line,
was built primarily by 10,000 Chinese workers.
By 1870, there were 63,000 Chinese, mostly
male, in the United States, nearly all on the
West Coast. Another 120,000 Chinese are esti-
mated to have entered the United States during
the following decade. Racial discrimination
against Asians increased as their numbers
swelled. By 1880 Chinese immigration slowed
to a trickle due to exclusion laws directed
against Asians. The Chinese also immigrated
to Hawaii, and when the islands were annexed
by the United States in 1898, approximately
25,000 Chinese were living there.
Most early Chinese immigrants were from
the southeastern Guangdong province of
China, formerly referred to as Canton. Most
were young men with no intention of stay-
ing—they came to make their fortune and
then return to China and their families. Many
married before coming to the United States,
and more than half returned to China. By the
1920s the Chinese population in the United
States had dropped to 1870 levels.
In each city where the Chinese settled, they
usually lived within a small geographic area
known as “Chinatown.” Large Chinatowns
evolved in San Francisco, New York, Boston,
Chicago, Philadelphia, Los Angeles, and
Oakland, California. These neighborhoods
offered protection against a sometimes hostile
social and economic environment; assimila-
tion was not an option. Conditions were often
crowded and unusual in the predominance of
men, but were tolerated with the expectation
of eventual return to China. It was not until
1943 that Chinese could become naturalized
U.S. citizens.
Current Demographics and Socioeconomic
Status When the exclusion laws were repealed
in 1943, people from many Asian countries
once again entered the United States. Chinese
immigrants who have arrived since World War
II are usually not from Guangdong. They are
urban dwellers from other regions and are gen-
erally better educated than earlier immigrants.
Political instability in the People’s Republic
of China has led to a recent exodus of Chinese.
Following the pro-democracy uprising in
Tiananmen Square in 1989, U.S. immigration
laws were changed with the Chinese Student
Protection Act of 1992. More than 41,000 Chi-
nese residents were granted visas and are eli-
gible for citizenship under the provision.
Furthermore, the return of Hong Kong to
mainland China and the uncertainty of Tai-
wan’s future have led to increased immigra-
tion from these islands.
In 2013, the U.S. Census estimated that
4.5 million Chinese (including Taiwanese)
are living in the United States, representing
nearly a quarter of all Asians in the nation.1
Within the Chinese American population,
close to 3 million individuals were not born
in the United States, and 14.5 percent of those
born outside the United States have come here
since 2010. More than half reside in Califor-
nia and New York.1 Large numbers of Chinese
Americans also reside in the cities of Houston,
Boston, Chicago, Seattle, and Philadelphia,
and parts of Hawaii.
As of 2010, it is estimated that there are
over 230,000 Taiwanese living in the United
States.2 Sizable populations are found in Cali-
fornia, New York, and Texas.
Four types of Chinese American house-
holds have been identified.3 First are the
sojourners, mostly men born in the early
twentieth century, who came to the United
States with the intent of returning after accu-
mulating some wealth. Political changes in
China have stranded this group in urban
Chinatowns throughout America. The sec-
ond type are sojourners who were successful
in bringing their wives to the United States.
These elderly first-generation couples still live
in Chinatown neighborhoods, although their
children have often moved from the area. The
third type of household is established by new
immigrant families. Often one member will
arrive to establish residency, and then family
members will follow. These immigrants usu-
ally settle with other Asians, often in China-
towns, where the parents speak Chinese and
children learn English in school. Although
many families include two wage earners or
combine the incomes of extended members,
they may remain poor due to low salaries,
large families, and supporting relatives in the
homeland. Chinese American households of
The first Chinese
restaurants in the
United States opened in
San Francisco in 1849.
Over 40,000 Chinese
restaurants are in
operation today.190
The number of Chinese
American women in
the United States did
not equal men until the
1970s.
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3 2 2 E A S T A S I A N S
the fourth type include acculturated subur-
ban families. These families include both new
immigrants who are white-collar profession-
als and those Americans of Chinese descent
who have lived in the United States for several
generations. Both parents may be college edu-
cated, often with specialization in engineering
and the sciences.
Chinese Americans value education, and
there are disproportionately large numbers
of them (over 50 percent according to 2010
Census figures) holding college and graduate
degrees.4 Fewer than 18 percent of foreign-
born Chinese in the United States do not
have a high school diploma.4 High levels of
educational attainment often translate into
well-compensated professional employment.
Americans of Chinese descent are so well
known for their successful transition in the
United States that a stereotype has developed,
obscuring what is in reality a divided popula-
tion.5 Though many Chinese Americans are
in the upper and middle classes, immigrants
who came before the 1950s were often poorly
educated, and many found work in sweat-
shops. Even those who had college degrees
were sometimes unable to find jobs suitable
to their skills due to discrimination.
Worldview
Religion Most Americans of Chinese descent
are not affiliated with a specific church. Reli-
gious practices are often eclectic, a combi-
nation of ancestor worship, Confucianism,
Taoism, and Buddhism. Many early Chinese
immigrants were not formally schooled in any
religion; instead, beliefs and practices were
passed orally from generation to generation.
Spirituality is integrated into family and com-
munity life. Daily living includes avoiding any
actions that might offend the gods, nature, or
ancestors.
Early Religion The ancient faith of China was
probably a mixture of ancestor worship and
respect for the forces of nature and the heav-
enly bodies. The supreme power was either
Tien (heaven) or Shang Ti (the Supreme Ruler
or the Ruler Above). One gained favor with
the spirits by the correct performance of cer-
emonies. These beliefs and practices were
later incorporated into subsequent Chinese
religions.
Ceremonies for the dead are a prominent
Chinese religious practice. The dead are sup-
posed to depend on the living for the condi-
tions of their existence after death. In turn, the
dead can influence the lives of the living.
Confucianism Confucius was a sage, one of
many who gave order to Chinese society by
defining the ways in which people should live
and work together. Confucianism incorpo-
rated the ceremonies of earlier religions, with
the following cornerstones:
1. Fatherly love and filial piety in the son
(i.e., children are expected to obey their
parents and adults are expected to take
care of their children)
2. Tolerance in the eldest brother and
humility in the younger
3. Proper behavior by the husband and
submission by the wife
4. Respect for one’s elders and compassion
in adults
5. Allegiance to rulers and benevolence by
leaders
Inherent in these relationships is the ideal
of social reciprocity, which means that one
should treat others as one would like to be
treated. To enhance harmony in the family
and in society as a whole, one must exercise
self-restraint. An individual must never lose
face—meaning a person’s favorable name
and position in society—because that would
defame the whole family. Many of these values
influence Chinese behavior today.
Taoism The Taoist, like the Confucianist,
believes that heaven and humanity function
in unison and can achieve harmony, but under
Taoism people are subordinate to nature’s way.
There is a fundamental duality within the
universe of interacting, opposite principles
or forces—the yang (masculine, positive, yang (masculine, positive, yang
bright, steadfast, warm, hard, and dry; some-
times referred to as shen) and the yin (femi-
nine, negative, dark, cold, wet, mysterious,
and secret; also called kwei) (Figure 11.2).
Everything in nature contains both yin and
yang, and a balanced unity between them is
Early immigrants and
their descendants, as
well as many current
immigrants from Hong
Kong, speak Cantonese,
a dialect that typically is
difficult to understand by
Chinese immigrants who
speak Mandarin.
2011 Census data report
1.49 million Canadians of
Chinese heritage.
Confucius also
developed protocols for
cooking and eating that
were practiced in China
until the nineteenth
century.17
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C H A P T E R 11 3 2 3
necessary for harmony. This balance occurs
when Tao, the way of nature, is allowed to take
its course unimpeded by human willfulness.
Taoism advocates a simple life, communion
with nature, and the avoidance of extremes.
Buddhism Buddhism grew during the T’ang
Dynasty but then suffered a slow decline.
The Mahayana sect dominated in China,
blending with traditional Chinese beliefs and
resulting in a unique Chinese form of Bud-
dhism. Ten schools of Buddhism flourished
in China at one time, but only four were left
by the twentieth century. The two dominant
schools in China are Ch’an (Zen Buddhism in
Japan) and Pure Land (see Chapter 2 for more
information).
Chinese American Spirituality Both Catholic
and Protestant churches were established in
the early Chinatown neighborhoods, usually
organized by the Chinese dialect spoken in the
area. Few first-generation Chinese Americans
joined Christian religions, but converts were
found in subsequent generations. Others
maintain aspects of Buddhism, Taoism, or
spirit and ancestor worship in their daily lives,
keeping small altars at home in which to offer
respect and perform the rites that will pre-
serve good relations with the gods and bring
good fortune.
Only a minority of Taiwanese belong to
Protestant faiths in their homeland; however,
Baptist, Presbyterian, and several smaller
evangelical churches have found Taiwanese
followers in the United States. Services are
conducted in Mandarin or Taiwanese dialects,
and the church serves as a social network for
the immigrant community. Buddhism has
also gained adherents in recent years.6
Family Confucian teachings about correct
relationships are still important for many
Chinese American families, even if they have
become Christians. Chinese American fami-
lies are usually patriarchal. Women are tradi-
tionally taught to be unassuming and yielding.
They live by the formula of “thrice obeying”:
Young girls are submissive to their fathers,
wives are subordinate to their husbands,
and mothers obey their sons. Children are
expected to be quiet, acquiescent, and defer-
ential to their elders.
Harmony in the family is the ideal, so chil-
dren are taught not to fight or cry. Showing
emotion is discouraged. Chinese parents may
be very strict, and children are commanded to
honor the family. Many of these ideas conflict
with American ideals of equal rights and free-
dom of speech and may lead to intergenera-
tional conflict in the Chinese American home.
Traditional Health Beliefs and Practices
Chinese medicine includes a complex hum-
oral system of professional practice by
physicians, known as Traditional Chinese
Medicine (TCM), as well as correlated folk
remedies used by laypersons at home. Health
beliefs and practices have developed over
generations, incorporating Confucian, Tao-
ist, and Buddhist concepts regarding the
interdependencies of humans and nature and
the need for balance and moderation in life
(Figure 11.3).
Professional TCM follows texts prepared
between approximately 2500 bce and the
third century bce, outlining the dynamic
equilibrium of forces necessary for health.
These include the five elements, or five evolv-
ing phases, of fire, earth, metal, water, and
wood, each of which may become unbalanced,
much as fire consumes wood or wood (as a
tree) absorbs the earth. These elements cor-
respond with five organs: the heart, spleen,
lungs, kidneys, and gallbladder, respectively.
Associations with secretions (perspiration,
saliva, mucous, spit, and tears); the seasons
(summer, late summer, autumn, winter, and
spring); colors (red, yellow, white, blue, and
green); tastes (bitter, sweet, pungent, salty, and
sour); and directions (south, center, west,
north, and east); as well as times of day, odors,
sounds, and emotions may also occur.7,8,9
This system was further elaborated some-
where between the third and sixth centuries
by the adoption of Buddhist principles of
hot and cold humoral medicine, which were
congruent with the Taoist system of yin and
yang.10,11 The concept of harmony was refined
to include a balance of these opposites; illness
develops when disequilibrium occurs. Organs
such as the liver, heart, spleen, kidneys, and
lungs are yin, as is the outside and the front
of the body. The gallbladder, stomach, intes-
tines, and bladder are yang, as well as the body
Most Chinese believe
in feng shui, the way in
which a home should be
situated and its furnish-
ings arranged to promote
optimal flow of energy
and personal well-being.
Chinese physicians were
traditionally paid for their
services when the client
was healthy. Payment
stopped if the client
became ill.
Jade charms are worn to
keep children safe, and
to bestow health, fertility,
long life, power, and
wisdom on adults.
Figure 11.2
Yin–yang symbol. This
symbol represents the
fundamental duality of the
universe and the balance
between the forces of yang
(light) and yin (dark). Each
force has a little of the other
in it (indicated by the dot of
the opposite color).
©
C
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3 2 4 E A S T A S I A N S
surface and the back. Outside forces, such as
the seasons, are also defined as yin (winter/
spring) and yang (summer/fall) and illnesses
associated with these times may fall into cor-
responding categories.
Symptoms of disease usually reflect an
imbalance between yin and yang. When there
is an excess of yang, acne, rashes, conjunc-
tivitis, hemorrhoids, constipation, diarrhea,
coughing, sore throat, ear infections, fever,
or hypertension may occur. Anemia, colds,
flu, frequent urination, nausea, shortness of
breath, weakness, and weight loss suggest that
an excess of yin is the problem. Also associ-
ated with yin and yang is the condition of the
blood. Weak blood (yin) may develop dur-
ing growth or pregnancy, postpartum, and in
old age. Treatment includes yang therapies,
particularly the intake of herbs and certain
foods.
The vital force of life is qi and is equated
with energy, air, and breath. Qi flows along
twelve defined meridians in the body, and
some conditions are related to the disruption
of qi or to excessive qi. Other types of energy
that must be balanced for health include jing, jing, jing
sexual or primordial energy, and sheng, spirisheng, spirisheng -
tual energy or the essence of consciousness.7,11
Other lesser forces that may influence
health include wind (including natural drafts
and those resulting from fans, air condition-
ers, exposure, or a symptom that rhymes with
the Chinese word for wind); poison, which is
somewhat related to the Western concept of
allergies; and fright, a condition in children
that includes listlessness, anorexia, low fever,
and crying. Fright is believed to occur when
the soul becomes scattered and is mostly lim-
ited to Chinese from Taiwan and Hong Kong.3
▼ Botanical remedies are ▼ Botanical remedies are ▼
usually combined in formu-
lary mixtures in traditional
Chinese medicine.
A
fr
ic
a
St
ud
io
/S
hu
tt
er
st
oc
k.
co
m
A major difference between Chinese medi-
cine and U.S. biomedicine is the idea that the
body and mind are unified, governed by the
heart. There is no English word to describe
the concept. Emotions are often somaticized,
meaning that feelings are related to specific
conditions. More than 500 symptoms corre-
sponding to emotions have been identified,
each characteristic of one or more organs. For
example, tou yun (or tou hun) is vertigo, the
most common complaint made by Chinese
patients worldwide. Dizziness or a confused
state of mind indicates significant imbal-
ance and serious illness. It is a nonspecific
condition thought to originate from anger or
anxiety manifested in liver, heart, or kidney
dysfunction (if the patient is a young man,
too much sexual intercourse or masturba-
tion may be believed to be the cause). Liver
disorders develop from suppressed hostil-
ity. Anger is discouraged in Chinese culture
and may accumulate in the liver, causing it to
expand and attack other organs. This diag-
nosis is common for many gastrointestinal
complaints. Generalized stomachaches are
believed to be due to eating bitterness in life,
often including an inadequate diet when one
is young. Anxiety, nervousness, or the stron-
ger emotion of fear results in heart palpita-
tions.12 Most Chinese prefer this integrated
approach to health.13
Many Chinese maintain health through a
properly balanced diet, moderation in activi-
ties and sleep, and avoidance of sudden imbal-
ance caused by forces such as wind. Qi must
flow freely and blood must be strengthened
through nourishment. For instance, if an indi-
vidual is imprudent and celebrates too much
by eating excessive yang foods (see the section
“Therapeutic Uses of Food”), indigestion or a
hangover may occur. Eating yin foods, which
are often bland, is the remedy.10 One study
of Chinese Americans found that almost all
the participants had used TCM in the previ-
ous year.13 When home cures are ineffective,
advice from a TCM physician may be sought.
Diagnosis is made through taking an exten-
sive history, and examination of the client,
particularly palpitation of pulses and evalu-
ation of the tongue. Through this process a
medical pattern is detected, in contrast to
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C H A P T E R 11 3 2 5
determining a specific disease or condition
based on symptoms or laboratory testing. It
is the medical pattern that determines the
appropriate intervention, not the illness.
Treatment for nearly all illness involves the
restoration of harmony. Therapy may empha-
size dietary and lifestyle changes, or attempt
to balance the organs so that emotional bal-
ance results. Nearly every visit to the doc-
tor results in a botanical remedy, and most
medicinal herbs are only available through
prescription. For instance, ginseng may be
used to fortify qi, and antelope horn can help
cool too much yang in the liver.11 Formulary
mixtures of five to ten substances are com-
mon. Most TCM remedies are prepared as
decoctions, taken in a single dose. The client
owns the prescription and can reuse it when
symptoms occur or share it with family and
friends.
Acupuncture is another traditional Chinese
treatment. It involves the use of nine types
of exceptionally thin metal needles inserted
at various points on the body where the qi
meridians surface. Meridians are considered
yin or yang and correspond with specific
organs. The needles are placed to facilitate a
balanced flow of qi, restoring harmony to the
afflicted organ, mostly for symptoms of excess
yang. Acupuncture may be performed by a
TCM physician or by a specialist. Another,
less common, therapy is moxibustion. Small
bundles of dried wormwood are heated and
carefully applied to certain meridians, usu-
ally to balance a yin condition. Moxibustion
is particularly used during labor and delivery.
Massage or therapeutic exercise is another tra-
ditional therapy, found more often in China
and rarely in the United States.
National board certification for TCM
practitioners, which requires three to four
years of full-time, postgraduate study at an
accredited educational institution, is required
in most states. Word-of-mouth recommen-
dations are common within the Chinese
community. TCM practitioners may use first
aid on injuries or broken bones, prescribe
herbs, perform acupuncture or moxibustion,
or they may diagnose the condition and pro-
vide a recommended course of therapy by a
specialist in one of these practices. Asians
Figure 11.3
Traditional Chinese
Medicine (TCM) is a humoral
system that incorporates
Confucian, Taoist, and Bud-
dhist concepts regarding
the interdependencies of
humans and nature and the
need for balance and mod-
eration in life.
Source: New Yorker Cartoon Bank,
www.cartoonbank.com; image ID
121130, originally published in The
New Yorker on July 25, 2005.
concerned with humoral conditions use
TCM (often concurrently with biomedical
therapies), and in recent years these practi-
tioners have attracted a growing multiethnic
clientele.
Traditional Food Habits
The Chinese eat a wide variety of foods and
avoid very few. This may have developed out
of necessity, as China has long been plagued
with recurrent famine caused by too much
or too little rainfall. Chinese cuisine largely
reflects the food habits and preferences of
the Han people, the largest ethnic group in
China, but not to the exclusion of other eth-
nic groups’ cuisines. For example, Beijing has
a large Muslim population whose restaurants
serve lamb, kid, horse meat, and donkey, but
no pork. Foreigners have also introduced
ingredients that have been incorporated into
local cuisines. Some foods now common
in China, but not indigenous, are water-
melon, tomatoes, bananas, peanuts, and chile
peppers.
Ingredients and Common Foods
Staples Traditional Chinese foods are listed
in Table 11.1. In China, numerous fruits,
vegetables, and protein items are consumed
but few dairy products, whether fresh or fer-
mented, are eaten. Grains are the foundation
of the diet.
Th
e
N
ew
Y
or
ke
r C
ol
le
ct
io
n
20
05
, A
le
x
G
re
go
ry
fr
om
c
ar
to
on
ba
nk
.c
om
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3 2 6 E A S T A S I A N S
Group Comments Common Foods Adaptations in the United States
Protein Foods
Milk/milk products Dairy products are not routinely used
in China. Many Chinese are lactose
intolerant.
Traditional alternative sources of
calcium are tofu, calcium-fortified
soy milk, small bones in fish and
poultry, and dishes in which bones
have been dissolved.
Cow’s milk, buffalo milk Many Chinese consume
dairy products, especially
milk and ice cream, some
cheese. Some alternative
sources of calcium may no
longer be used.
Meat/poultry/
fish/eggs/
legumes
Mostly protein-rich foods are eaten.
Beef and pork are usually cut into
bite-size pieces before cooking.
Fish is preferred fresh and is often
prepared whole and divided into
portions at the table.
Preservation by salting and drying is
common.
Shrimp and legumes are made into
pastes.
Meat: beef and lamb (brains, heart, kidneys,
liver, tongue, tripe, oxtails); pork (bacon,
ham, roasts, pig’s feet, sausage, ears);
game meats (e.g., bear, moose)
Poultry: chicken, duck, quail, rice birds,
squab
Fish: bluegill, carp, catfish, cod, dace, fish
tripe, herring, king fish, mandarin fish,
minnow, mullet, perch, red snapper,
river bass, salmon, sea bass, sea
bream, sea perch, shad, sole, sturgeon,
tuna
Eggs: chicken, duck, quail, fresh and
preserved
Shellfish and other seafood: abalone,
clams, conch, crab, jellyfish, lobster,
mussels, oysters, periwinkles, prawns,
sea cucumbers (sea slugs), shark’s
fin, shrimp, squid, turtle, wawa fish
(salamander)
Legumes: broad beans, cowpeas, horse
beans, mung beans, red beans, red
kidney beans, split peas, soybeans,
white beans, bean paste
More meat and poultry are
consumed, though some
traditional protein sources
are still popular
Cereals/Grains Wheat is the staple grain in the north,
long-grain rice in the south.
Fan (cereal or grain) is the primary item
of the meal; ts’ai (vegetables and
meat or seafood) makes it tastier.
Rice is washed before cooking.
Buckwheat, corn, millet, rice, sorghum,
wheat
Chinese Americans eat less
fan and more ts’ai. The
primary staple remains rice,
but more wheat bread is
eaten.
Fruits/Vegetables Many non-Asian fruits and vegetables
are popular. Potatoes, however, are
not well accepted.
Vegetables are usually cut into bite-
size pieces before cooking.
Slightly unripe fruit is often served as
a dessert.
Fruits: apples, bananas, custard apples,
coconut, dates, dragon eyes (longan),
figs, grapes, kumquats, lily seed, lime,
litchi, mango, muskmelon, oranges,
papaya, passion fruit, peaches,
persimmons, pineapples, plums
(fresh and preserved), pomegranates,
pomelos, tangerines, watermelon
More temperate fruits are
consumed.
Both fresh fruits and vegetables
preferred; seasonal variation
dictates the type of produce used.
Many vegetables are pickled or
preserved. Fruits are often dried or
preserved.
Vegetables: amaranth, asparagus,
bamboo shoots, banana squash, bean
sprouts, bitter melon, cassava (tapioca),
cauliflower, celery, cabbage (bok choy
and napa), chile peppers, Chinese
broccoli (gai lan), Chinese long beans,
More raw vegetables and
salads are eaten. Data
on overall consumption
trends are contradictory.
TA B L E 11.1 Cultural Food Groups: Chinese
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C H A P T E R 11 3 2 7
Group Comments Common Foods Adaptations in the United States
Chinese mustard (gai choy), gai choy), gai choy
chrysanthemum greens, cucumbers,
eggplant, flat beans, fuzzy melon, garlic,
ginger root, green peppers, kohlrabi,
leeks, lettuce, lily blossoms, lily root, lotus
root and stems, luffa, dried and fresh
mushrooms (black, button, cloud ear,
wood ear, enoki, straw, oyster, monkey’s
head), mustard root, okra, olives, onions
(yellow, scallions, shallots), parsnip, peas,
potato, pumpkin, seaweed (agar), snow
peas, spinach, taro, tea
melon, tomatoes, turnips, water
chestnuts, watercress, wax beans, water
convolvus, winter melon, yams, yam
beans
Additional Foods
Seasonings Complex, sophisticated seasoning
combinations common. Various
tastes appreciated, such as the
moldy flavor of lily flower buds.
Spice and herb preferences
distinguish regional cuisines.
Anise, bird’s nest, chile sauce, Chinese
parsley (cilantro), cinnamon, cloves,
cumin, curry powder, five-spice
powder (anise, star anise, clove,
cinnamon or cassia, Sichuan pepper),
fennel, fish sauce, garlic, ginger, golden
needles (lily flowers), green onions,
hot mustard, mace, monosodium
glutamate (MSG), mustard seed,
nutmeg, oyster sauce, parsley, pastes
(hoisin, sweet flour, brown bean,
Sichuan hot beans, sesame seed,
shrimp), pepper (black, chile, red, and
Sichuan), red dates, sesame seeds
(black and white), soy sauce (light
and dark), star anise, tangerine skin,
turmeric, vinegar
Many Chinese restaurants
use MSG, but it is not
usually used in the home.
Nuts/seeds Nuts and seeds are popular snacks
and may be colored or flavored.
Almonds, apricot kernels, areca nuts,
cashews, chestnuts, ginkgo nuts,
peanuts, walnuts; sesame seeds,
watermelon seeds
Beverages In northern China the beverage
accompanying the meal often is
soup. In the south, it is tea.
Alcoholic drinks, usually called
wines, are rarely made from
grapes. They are either beers or
distilled spirits made from starches
or fruit.
Beer, distilled alcoholic spirits, soup broth,
tea
Fats/oils Traditionally lard was used if affordable.
In recent years, soy, peanut, or corn
oil is more common.
Bacon fat, butter, lard, corn oil, peanut oil,
sesame oil, soybean oil, suet
Fat intake increases with
consumption of fast foods
and snacks
Sweeteners Sugar not used in large quantities;
many desserts made with bean
pastes.
Honey, maltose syrup, table sugar (brown
and white)
Sugar consumption has
increased due to increased
intake of soft drinks, candy,
cakes, and pastries.
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3 2 8 E A S T A S I A N S
Rice is essential in the cuisine of southern
China, believed to have been introduced to
the region from India in the first century bce.
It is so common that people in southern China
greet each other by asking, “Have you had rice
today?” There are approximately 2,500 differ-
ent forms of rice, but the Chinese prefer a
polished, white, long-grain variety that is not
sticky and remains firm after cooking. Short,
sticky, glutinous rice is used occasionally,
mainly in sweet dishes. Although it is usually
steamed, rice can also be made into a por-
ridge called congee, eaten for breakfast or as a
late-night snack, with vegetables, meat, or fish
added for flavor. Congee is also fed to people
who are ill. Rice flour is used to make rice
sticks, which can be boiled or fried in hot oil.
Wheat is also common throughout China,
although it is used more often in the north
than the south. It is popular as noodles, thin
wrappers, dumplings, pancakes, and steamed
bread. Noodles are popular in soups, or pan-
fried, then topped with meats and vegetables
that have been stir-fried separately. Thin,
square wheat-flour wrappers are used to
make steamed or fried egg rolls with a meat,
vegetable, or mixed filling and wontons (in
which the wrapper is folded over the filling),
served either fried or in soup. Spring rolls,
similar to egg rolls, are made with very thin,
The custom of throw-
ing rice at newlyweds is
believed to come from
China, where rice is a
symbol of fertility.
Congee may be eaten at
any meal in Hong Kong,
where a family version
topped with lobster is
popular. In Taiwan, con-
gee is also consumed
throughout the day. One
variety served in Chinese
American restaurants is
“sizzling rice soup.”
▼ Traditional foods of
China. Some typical foods
include bitter melon, bok
choy, Chinese eggplant,
ginger root, long beans, lotus
root, mushrooms, oyster
sauce, pork, long-grain rice,
shrimp, soy sauce, and water
chestnuts.
M
ar
tin
J
ac
ob
s/
G
et
ty
Im
ag
es
round, wheat-flour wrappers. Dumplings can
be small steamed bundles made with wontons
filled with bits of shrimp, crab, and vegetables
(called sui mai) or more substantial, breadlike
versions, filled with spiced pork, minced beef,
or sweetened bean paste, then baked, steamed,
or panfried. Buckwheat is grown in the north
and commonly made into noodles.
The Chinese eat a variety of animal pro-
tein foods. Pork, mutton, chicken, and duck
are common in many regions (see “Regional
Variations” below). Fish and seafood of all
kinds are specialties. Eggs are frequently con-
sumed. They are sometimes cooked as thin
omelets in which to wrap foods or to add to
mixed dishes. However, eggs are most often
prepared cooked, then salted and brined, and
are particularly popular in southern China.14
Thousand-year-old eggs (also called hundred-
year-old, century, and pine flower eggs) are
duck or chicken eggs cured for three months
in a lime, ash, and salt mixture. The whites
become black and gelatinous; the yolks turn
greenish. In Taiwan a similar specialty called
iron eggs is common. Chicken, pigeon, or
quail eggs are cooked repeatedly in soy sauce,
tea, or other flavored liquids until they shrink
and become very chewy. They are eaten for
breakfast and snacks.15 More unusual items
include snakes, frogs, turtles, sea cucumbers
(also known as sea slugs, shell-less echino-
derms related to starfish and sea urchins), and
seahorses. The Chinese also raise many kinds
of insects for consumption, such as scorpions,
which are prepared fried or in soups.16
In China soybeans are known as the poor
man’s cow, as they are made into products
resembling milk and cheese. Soybeans are
transformed into an amazing array of food
products that are indispensable in Chinese
cooking (see Table 11.2). Other beans are also
popular, made into pastes, flour, or even thin,
transparent noodles known in the United
States as cellophane noodles or bean threads.
Chinese cuisine makes extensive use of
vegetables. Many are those known in other
regions of the world such as asparagus, broc-
coli, cabbage, cauliflower, eggplant, green
beans, mushrooms, onions, peas, potatoes,
radish, and squash. Chinese varieties may
differ, however. For instance, leafy bok choy
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C H A P T E R 11 3 2 9
and wrinkled napa cabbage are preferred over
European types; long beans, small purple egg-
plant, gai lan (Chinese broccoli, also called
Chinese kale), gai choi (Chinese mustard),
and the large white icicle radish are featured
in many dishes. One popular squash variety
is called a winter melon (when immature it is
called fuzzy melon); it is pale green and mild
in flavor. Mushrooms of all types, including
black mushrooms (a Japanese native also
called shiitake), the tiny enoki, grayish oyster
mushrooms, straw mushrooms, and dried
kinds such as cloud (or wood) ears flavor
numerous dishes. Lily buds, snow peas (pea
pods), bamboo shoots, chrysanthemum
greens, water chestnuts, bitter melon, water
convolvulus, and lotus root are other, more
distinctively Asian, vegetables found in Chi-
nese cuisine.
The Chinese eat fresh fruit infrequently,
occasionally for a snack or for dessert, and
it is preferred slightly unripe or even salted.
Chinese dates (jujubes), persimmons, pome-
granates, and tangerines are favorites. A few
fruits are typically preserved in syrups, such
as pungent kumquats, yellow-orange loquats,
longans (dragon eyes), and litchis, a tropical
fruit with creamy, jelly-like flesh.
Traditionally people cooked with lard
if they could afford it. In recent years, soy,
peanut, or corn oil is more common. Until
recently sugar was not used in large quanti-
ties; many desserts were made with sweetened
bean pastes.
Hot soup or tea is the usual beverage
accompanying a meal. Tea, used in China for
more than 2,000 years, was first cultivated in
the Chang Jiang valley and later introduced
to western Europe in the seventeenth century.
There are three general types of tea: green,
black (red), and oolong (black dragon). Green
tea is the dried, tender leaves of the tea plant.
It brews a yellow, slightly astringent drink.
Black tea is toasted, fermented black-colored
leaves; it makes a reddish drink. Black tea is
commonly drunk in Europe and America.
Oolong tea is made from partially fermented
leaves and is a Taiwanese specialty. Some teas
Bird’s nest soup is often
served at special occa-
sions. It is made from the
cleansed nests of swifts
from the South China
Sea. The flavor is bland,
but the dish is very
expensive and is reputed
to be an aphrodisiac.
TA B L E 11. 2 Common Chinese Soy Bean Products
Soy sauce Cooked soybeans that are first fermented and then processed into sauce. The
southern Chinese prefer light-colored soy sauce in some dishes over the darker,
more opaque kind used in Japanese and some regional Chinese cooking.
Soy milk Prepared with soaked soybeans that are first pureed, then filtered, and then boiled
to produce a white, milk-like drink.
Doufu (tofu) Made by boiling soy milk and then adding gypsum, which causes it to curdle.
The excess liquid is pressed from the bean curd, producing a soft or firm, bland,
custard-like product. Doufu can be purchased fresh, frozen, smoked, dried,
sweetened, or in sheets to make wrapped dishes.
Fuyu (sufu) Sometimes called Chinese cheese—bean curd is fermented in brine and 100-
proof liquor. The aroma is tangy but the flavor is mild, except when chile peppers
are added to the process.
Black bean sauce Cooked fermented soybeans preserved with salt and ginger. Black beans are
usually added as a flavoring in dishes.
Brown bean sauce Similar to black bean sauce, but made with yellow soy beans.
Sweet bean sauce Similar to soy sauce but with reduced spicing and added sugar. It is common in
northern Chinese cooking.
Hoisin sauce Thick, brownish-red sweet-and-sour sauce that combines fermented soybeans,
flour, sugar, water, spices, and garlic with chiles—often used in southern Chinese
cuisine.
Oyster sauce Thick brown sauce prepared from oysters, soybeans, and brine that is also used in
southern Chinese fare.
Chile bean paste Very hot, thick paste made from brown bean sauce spiced with mashed chile
peppers and vinegar. A favorite in Sichuan cuisine.
©
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3 3 0 E A S T A S I A N S
in China are flavored with fruits or flow-
ers, such as black tea with litchis, or orange
blossoms, or oolong with jasmine. Other
infusions of fruits or flowers are called tea,
including longan and chrysanthemum. Pearl
tea, or bubble tea, made with chewy, pea-size
balls of tapioca that are sucked up through
large straws, was also created in Taiwan and
has become popular with Chinese youth
worldwide.
Chinese alcoholic drinks are often called
wines, but they are not usually made from
grapes.17 They are typically distilled alco-
hols made from grains or from fruit, such as
plums. A few examples are bamboo leaf-green
(95 proof ), fen (made from rice, 130 proof ),
hua diao (yellow rice wine), mou tai (made
from sorghum, 110 proof ), and red rice wine.
Beer is also very popular.
Most Chinese food is cooked, and very
little raw food, except fruit, is eaten. Cooked
foods may be eaten cold. Common cooking
methods maximize the limited fuel available
and include stir-frying, steaming, deep-fat fry-
ing, simmering, and roasting. In stir-frying,
foods are cut into uniform, bite-size pieces
and quickly cooked in a wok (a hemispheri-
cal shell of iron or steel) in which oil has been
heated. The wok is placed over a gas burner or
in a metal ring placed over an electric burner.
Food can also be steamed in the wok. Bam-
boo containers, perforated on the bottom,
are stacked in a wok containing boiling water
and fitted with a domed cover. Roasted food
is usually bought from a commercial shop, not
prepared in the home.
The Chinese usually strive to obtain the
freshest ingredients for their meals, and in
most American Chinatowns it is common to
find markets that sell live animals and fish.
However, because of seasonal availability and
geographic distances, many Chinese foods are
preserved by drying or pickling.
Regional Variations China is usually divided
into five culinary regions characterized by
flavor or into two areas (northern and south-
ern) based on climate and the availability of
foodstuffs. In recent years, however, regional
differences have diminished due to increased
global influences, particularly television.18
Northern This area includes the Shandong
and Honan regions of Chinese cooking. The
Shandong area (Beijing is sometimes included
in this area, sometimes considered a third
division of northern cooking) is famous for
Peking duck and mu shu pork, both of which
are eaten wrapped in Mandarin wheat pan-
cakes topped with hoisin sauce. Honan, south
of Beijing, is known for its sweet-and-sour
freshwater fish, made from whole carp caught
in the Huang River. Much of the north is bor-
dered by Mongolia, whose people eat mainly
mutton.
Grilling or barbecuing is a common way of
preparing meat in this area. One specialty is
the Mongolian hot pot, featuring sliced meats
and vegetables cooked at the table in a pot of
broth simmering over a charcoal brazier. The
food is eaten first, and the broth is consumed
as a beverage afterward. (See also Exploring
Global Cuisine—Mongolian Fare.)
Northern China has a cool climate, limiting
the amount and type of food produced. Tra-
ditionally, foods were often preserved, result-
ing in a preference for salty flavors. In general,
its staples are millet, sorghum, and soybeans.
Winter vegetables such as cabbage, turnips,
and onions are common. A delicacy from this
area is braised bear paw. Hot, clear soup is the
beverage that usually accompanies a meal.
Southern Southern China is divided into three
culinary areas: Sichuan-Hunan, Yunnan, and
Cantonese (with Fukien and Hakka regional
specialties). Sichuan-Hunan (some English
translations still use the term Szechuan or
Szechwan), which is an inland region, features
fare distinguished by the use of chiles, garlic,
and the Sichuan pepper fagara. Typical dishes
include hot and sour soup, camphor and tea-
smoked duck, and an oily walnut paste and
sugar dessert that may be related to the nut
halvah of the Middle East. Yunnan cooking
is distinctive in its use of dairy products, such
as yogurt, fried milk curd, and cheese. Dishes
are often hot and spicy, and some of the best
ham and head cheese in China are found in
this area.
Cantonese cooking is probably the most
familiar to Americans, because the majority of
Chinese restaurants in the United States serve
In some regions, two lon-
gans or litchis are placed
under the pillows of
newlyweds because their
names sound like the
words “to have children
quickly.”18
In China, a marriage is
consummated when the
new in-laws officially
accept a cup of tea from
the bride. If the groom
dies before the wedding,
the bride-to-be is said to
have “spilled her tea.”
Unlike northern or south-
ern Chinese cooking,
Taiwanese fare makes
ample use of herbs
such as basil and pars-
ley. Vodka is a popular
alcoholic beverage; the
most popular brand is
named for the infamous
Mongolian ruler, Ghengis
Khan.10
Dumplings shaped like
animals, such as birds
or frogs, are specialties
in Xian. A dim sum ban-
quet may feature several
dozen varieties.
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C H A P T E R 11 3 3 1
Cantonese-style food. It is characterized by
stir-fried dishes, seafood (fresh and dried or
salted), delicate thickened sauces, and the use
of vegetable oil instead of lard. The Cantonese
are known for dim sum (“small bites,” such as
sui mai, pork ribs, meatballs, and other tid-
bits) served with tea. The staple foods of the
south are rice and soybeans. As in the north, a
variety of vegetables from the cabbage family
are used, as well as garlic, melon, onions, peas,
green beans, squashes, and a range of rootlike
crops, such as taro, water chestnuts, and lotus
root. Southern cooking uses mushrooms of
many types to enhance the flavor of the foods
and takes advantage of an abundance of fruits
and nuts. Fish, both fresh and saltwater, are
popular. Also important are poultry and eggs.
Pork is the preferred meat. Tea is the beverage
served with meals.
Along the coast, Fukien provincial fare
includes numerous seafood dishes and clear
broths. Paper-wrapped foods and egg rolls are
thought to have originated there. In the city
of Shanghai, chefs specialize in new food cre-
ations and elaborate garnishes. Red foods are
also a specialty due to the use of red wine paste
(a sediment remaining after the fermentation
of rice wine) on pork, on poultry, in soups,
and even in dumpling dough.19
A southern regional specialty is Hakka
cuisine, sometimes called the soul food of
southern China. The Hakkas fled to the south
in the fourth century bce when the Mongols
invaded the north. They remained an insular
ethnic group, preserving their traditional lan-
guage, dress, and foods. Their fare is hearty
and robust, featuring dishes made with red
rice wine and pungent seasonings, cooked for
a lengthy time, often in clay pots. Salt-baked
chicken, greens simmered with pork fat, and
meat-stuffed doufu are examples.
Meal Composition and Cycle
Daily Patterns The Chinese customarily eat
three meals per day, plus numerous snacks.
Breakfast often includes the hot rice or millet
porridge, congee, which in southern China
may be seasoned with small amounts of meat
or fish. In northern China hot steamed bread,
deep-fried crullers, dumplings, or noodles are
served for breakfast. In Taiwan both south-
ern- and northern-style breakfasts are popu-
lar. In urban areas lunch is a smaller version
of dinner, including soup, a rice or wheat dish,
The Mongolians once ruled an empire that stretched from China to Europe. Tthat stretched from China to Europe. T
In more recent times, it has been colonized
by Russia and China. Today, it is an inde-
pendent nation reestablishing its cultural
identity through shared language, customs,
and cuisine.
Historically, Mongolians consumed red
foods (meat) and white foods (dairy), and this
tradition continues today with the addition of
some grain products. Meats, especially mut-
ton, goat, and beef, are favorites (camel meat
is eaten when available, though it is banned
in some areas). Meat is enjoyed barbecued on
a grill or over charcoal in a specially designed
hot pot that sits on the table. It is also added
to soups, stuffed into pancakes, and served on
sesame seed buns.191
Dairy foods are numerous, prepared from
cow, sheep, goat, or camel’s milk. There are
three types of butter (liquid, yellow, and
white), a type of milk doufu, sour milk (simi-
lar to yogurt), milk leather (made from the
film skimmed off boiled milk and air-dried),
and fresh cheese. Milk is added to tea, called
Mongolian tea, sometimes with a little salt
or fried millet.192 Cheese is mixed with sugar
and flour and then baked, to make a dessert
known as milk pie. Kumys, a wine distilled
from fermented milk (traditionally mare’s
milk), is a Mongolian specialty and consumed
at many occasions.
Millet is the staple grain in Mongolia. It is
cooked like a porridge or roasted until it pops
like popcorn. Flour is made from millet, buck-
wheat, or wheat and cooked as fried pancakes
or steamed flat breads. Tea is consumed at
every meal and with snacks. Three meals a
day are typical, consumed with the fingers.
Special occasions include Lunar New Years
and the Naadam festival, a three-day event
featuring wrestling, archery, and horse races.
E X P L O R I N G G L O B A L C U I S I N E
Mongolian Fare
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3 3 2 E A S T A S I A N S
vegetables, and fish or meat. Sliced fruit may
be offered at the end of the meal.
Although the Chinese are receptive to
all types of food, the composition of a meal
is governed by specific rules—a balance
between yin and yang foods and the proper
amounts of fan and cai. Fan includes all foods
made from grains, such as steamed rice,
noodles, porridge, pancakes, or dumplings,
which are served in a separate bowl to each
diner. Cai includes cooked meats and vegeta-
bles, which are shared from bowls set in the
center of the table. Fan is the primary item in
a meal; cai helps people eat the grain only by
making the meal tastier. A meal is not com-
plete unless it contains fan, but it does not
have to contain cai. At a banquet the opposite
is true. An elaborate meal must contain cai,
but the fan is usually an afterthought and may
not be eaten.
Street stalls and tea houses provide snacks
and small meals when away from home.
Although restaurants were traditionally
uncommon in rural areas, today they are
found throughout the nation. The Chinese
all-you-can-eat buffet, which originated in the
United States, is now found in some regions.
Other American restaurant ideas that have
made their way to China include fast-food
franchises and food courts.14
Etiquette The traditional eating utensils
are chopsticks and a porcelain spoon used
for soup. Teacups are always made out of
porcelain, as are rice bowls. Few foods are
eaten with the fingers, though that is chang-
ing somewhat in China today, where it is
sometimes acceptable to pick up wrapped
or stuffed items, such as dumplings.20 All
courses of a meal are traditionally served at
once. Each place setting includes a bowl of
rice or noodles, and each diner then takes
what is desired from the communal serving
plates. At the meal all diners should take equal
amounts of the cai dishes, and younger din-
ers wait to eat until their elders have started;
it is rude to reject food. It is also considered
bad manners to eat rice or noodles with the
bowl resting on the table; instead, it should
be raised to the mouth. It is rude to pick at
your food or to lick your chopsticks. Laying
your chopsticks across the top of the rice bowl
or dropping them brings bad luck. It is also
improper to stick chopsticks straight up in
a rice bowl because in some areas this sym-
bolizes an offering to the dead. Any bones or
other debris should be placed on the small
plate at each place setting, or on the table next
to the rice bowl.
Proper Chinese behavior at the table was
first outlined over 4,000 years ago, and many
practices remain unchanged.14 Rules include
not making noises while eating (except when
consuming soup, when slurping facilitates
cooling the soup and expresses pleasure), not
grabbing food, not eating quickly, not putting
food back on the communal plate after tast-
ing it, and not picking one’s teeth. Beverages,
such as tea, should be served to others at the
table before pouring for one’s self, and the
cups should not be filled to the brim. Both
hands are used to offer a cup of tea, and the
cup should be taken with both hands as well.
Wine and other alcoholic drinks should not
be consumed alone, and when the toast gam-
bei (“bottoms up”) is made, everyone at the
table drains his or her glass.
Chopsticks were
likely invented as an
extension of the fingers.
They are made from
bamboo, ivory, or plastic.
Chopsticks are used in
most countries that have
been influenced by China,
including Japan (where
the chopsticks are shorter
and have rounded rather
than squared sides and
more pointed tips) and
Korea (where the chop-
sticks are typically made
of metal, the same length
as the Japanese type, but
flatter). Chopsticks are
found frequently in Viet-
nam (the Chinese type),
though forks, spoons, and
fingers are also commonly
used. Other Southeast
Asian cultures use chop-
sticks only occasionally,
mostly for rice or noodles.
S A M P L E M E N U
Cantonese Dim Sum
S pr in g R olls a,b or F r ie d W on t on s a,b
Har gau (S h r imp D umplin gs ) a,b
Sui mai (P or k D umplin gs ) a,b
Ch ar s iu bao (S t e ame d BBQ Bun s ) a,b
E g g C us tar d T ar tle ts a,b
Jas min e T e a or Ch r y s an th e m um T e a
aSimonds, N. 1994. Classic Chinese cuisine. Boston: Houghton Mifflin.
bAbout: Chinese Cuisine at
http://chinesefood.about.com/od/diningout/p/dim_sum.htm
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C H A P T E R 11 3 3 3
Though strict rules regarding dining
behavior are observed in China, it is not
uncommon to play games at the table during
a meal.14 This is especially true at banquets,
with guests joining and leaving the game as
they please. Multiple conversations may take
place at once, and interruptions are frequent.
It is considered polite to compliment the host
throughout the meal on the deliciousness of
the food and on his or her good taste and
wisdom.21
Special Occasions Traditionally, the Chinese
week did not include a day of rest. Conse-
quently, there were numerous feasts to break
up the continuous workdays. Chinese festival
days do not fall on the same day each year
because their calendar is lunar. Celebrations
are traditionally yang occasions because heat
symbolizes activity, noise, and excitement
in China.10 Yang foods, such as meats, fried
dishes, and alcoholic beverages, are featured
at festive banquets (see the “Therapeutic Uses
of Food” section). Most Chinese homes are
small and unsuited to entertaining, so spe-
cial meals with guests are generally held at
restaurants.14
The most important festival is New Year’s,
which can fall anytime from the end of Janu-
ary to the end of February. Traditionally the
New Year was a time to settle old debts and
to honor ancestors, parents, and elders. The
New Year holiday season begins on the eve-
ning of the twenty-third day of the last lunar
month of the year. At that time the Kitchen
God, whose picture hangs in the kitchen and
who sees and hears everything in the house,
flies upward to make his annual report on the
family to the Jade Emperor. To ensure that his
report will be good, the family smears his lips
with honey or sweet rice before they burn his
picture. A new picture of the Kitchen God is
placed in the kitchen on New Year’s Eve. Food
preparation must be completed on New Year’s
Eve, as knives cannot be used on the first day
of the year because they might “cut” luck.
Deep-fried dumplings, made from glutinous
rice and filled with sweetmeats, and steamed
turnip and rice flour puddings, are usually
included in the New Year’s Day meal.
During the New Year festivities, only good
omens are permitted and unlucky-sounding
words are not uttered. Foods that sound like
lucky words, such as tangerine (good fortune),
fish (surplus), chicken (good fortune), chest-
nuts (profit), and doufu (fu (fu ( means “riches”),
are eaten. Friends and relatives visit each
other during the first ten days of the new
year, and good wishes, presents, and food are
exchanged. Children receive money in small
red envelopes. Traditionally the Feast of Lan-
terns, the fifteenth day of the first month, ends
the New Year’s season and is marked by the
dragon dancing in the streets and exploding
firecrackers to scare away evil spirits.
Ch’ing Ming, the chief spring festival, falls Ch’ing Ming, the chief spring festival, falls Ch’ing Ming
106 days after the winter solstice. Families
The Chinese-controlled province of Tibet has a unique fare due to the isolation
provided by its locale in the Himalayan
Mountains. The foundation of the diet is
zampa, a toasted flour produced from bar-
ley or buckwheat. It is traditionally mixed
with the butter obtained from yak, cow, or
sheep milk (called “crispy oil”), sugar, milk
or cream, and sometimes tea to make flat-
tened balls consumed with tea or soup. The
zampa can also be used to make momos, a
Tibetan dumpling filled with meat. Yak and
mutton are common, but most Tibetans
who are Buddhist do not eat pork, poultry,
or fish.25 Dairy products are also prevalent.
Butter-tea, made by churning crispy oil,
milk, and salt with brewed tea, is consumed
throughout the day. Sour milk, milk solids
preserved from the crispy oil process, and
the milk film skimmed from boiled milk
and then dried are all consumed. Cabbage,
radishes, onions, garlic, leeks, and potatoes
are available. Wine, made from barley or
buckwheat, is served at special occasions.
E X P L O R I N G G L O B A L C U I S I N E
Tibetan Fare
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3 3 4 E A S T A S I A N S
customarily go to the cemetery and tend the
graves of their relatives. Food is symbolically
fed to the dead and then later eaten by the
family. Sweets and alcoholic beverages are
popular offerings. Duan wu, the Dragon Boat
Festival, is held on the fifteenth day of the fifth
month to commemorate the drowning death
of a famous third-century bce poet. A boat
race and special dumplings are traditional.
The Moon Festival occurs at the end of Sep-
tember on a full moon (the fifteenth day of
the eighth lunar month). Because the moon
is a yin symbol, this festival was traditionally
for women, but today it also symbolizes the
togetherness of the family. It is sometimes
called the harvest festival or moon’s birthday.
Large round cakes filled with spices, nuts,
fruit, or red bean paste, called moon cakes,
are typically eaten during this event.
Therapeutic Uses of Food
Most Chinese believe eating the proper bal-
ance of yin and yang foods is necessary to
assure physical and emotional harmony and
to strengthen the body against disease (see
Chapter 1). Extra care should be taken with
children’s diets because they are more suscep-
tible to imbalance.
Hot foods generally include those high in
calories, cooked in oil, and irritating to the
mouth and those that are red, orange, or yel-
low in color. Examples include most meats,
eggs, chile peppers, tomatoes, eggplant, per-
simmons, pomegranates, onions, leeks, garlic,
ginger, and alcoholic beverages. Cold foods are
often low in calories, raw or boiled/steamed,
soothing, and green or white in color. Many
vegetables and fruits are considered cold
items, as are some legumes. Pork, duck, crab,
clams, shrimp, snake meat, and honey also
are classified as cold in some regions. Staples,
such as boiled rice and noodles, and other
commonly eaten foods, such as soy sauce
and red or black tea, are typically placed in
a third, neutral category.10,14,22 Some food
preparations can make foods hotter or colder
by the infusion or removal of heat. Foods
classified as yin or yang vary from region to
region. Acculturated Chinese Americans may
be uncertain about some categorizations and
thus identify many foods as neutral.
Typically, hot foods are eaten in the win-
ter by menstruating women and for fatigue.
Pregnancy is considered a cold condition,
and birth is a dangerously cooling expe-
rience. Postpartum women often remain
indoors and eat hot foods, such as chicken
fried in sesame oil and pig’s feet simmered in
vinegar, for four to six weeks after delivery.23
This period is known as tso yueh-tzu, “doing
the month.” In addition to eating warming
items, raw and cooling foods are avoided,
as is contact with cold air, wind, and water
(bathing in hot water with ginger in it is per-
mitted after a few days). Other conditions
caused by too much yin and that respond to
eating more yang foods include colds, flu,
nausea, anemia, frequent urination, shortness
of breath, weakness, and unexplained weight
loss. It is also believed that as a person grows
older, the body cools off and more hot foods
should be eaten.
Conditions due to excessive yang that
improve with an increase in yin food intake
include constipation, diarrhea, hemorrhoids,
coughing, sore throat, fever, skin problems,
conjunctivitis, earaches, and hypertension.
Cool foods are consumed in the summer, for
dry lips, and to relieve irritability.
In addition to yin and yang, some foods
are believed to affect the blood or promote
wound healing and are labeled pu, or bo,
meaning “strengthening.” This classification
is separate from the concept of yin and yang
but often used in conjunction with it; most
strengthening foods are also categorized as
hot. The yin condition of weak blood (most
associated with pregnancy, postpartum, and
surgery) is treated with specific hot items such
as protein-rich soups made with chicken, pork
liver, eggs, pig’s feet, or oxtail. Other health-
promoting foods identified by Chinese Amer-
icans include royal jelly (made from honey),
bee pollen, lin chih (edible fungus), rattlesnake
meat, dog meat, roasted beetles, barley juice,
garlic, dong gwai (angelica, a celery-like herb),
fruit juice, and milk. However, it is believed
that too many of certain yang items can cause
the blood to thin, and these foods are avoided
for conditions such as hypertension.9,10,22,24
Ginseng is one of the better known
health-promoting Chinese foods. It is made
The New Year’s dragon
dance and firecrackers
are thought to inhibit the
yin element and promote
the yang forces. Red, the
color of yang, is used
throughout the New
Year’s season.
Eating crab and persim-
mons together is one
food taboo maintained
by some Chinese Ameri-
cans elders because
these foods represent
extreme hot and extreme
cold and are considered
to be poisonous if mixed.
In 1718, a Jesuit mission-
ary in Quebec discovered
an American species of
ginseng that is nearly
identical to the Chinese
variety. Growing demand
in China led many Ameri-
cans, including Daniel
Boone, to hunt the root
for export.
According to the Chi-
nese, a child is one year
old at birth and becomes
two years old after the
New Year.
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C H A P T E R 11 3 3 5
from an herb (genus Panax) found in Asia
and the Americas. The root is boiled until
only a sediment remains, then powdered
for use in teas and broths. Ginseng reput-
edly cures cancer, rheumatism, diabetes,
sexual dysfunctions, and complaints asso-
ciated with aging. It is most often used as a
restorative tonic. Taro root is also thought
to have therapeutic properties, such as
improving eyesight, curing vaginal dis-
charge, reducing weakness, and promoting
multiple births; it will also bring good luck
if eaten on the fourth day of the first lunar
month.25 Bitter orange is used to alleviate
bloating and constipation. Guava, which
has some hypoglycemic properties, is used
for diabetes.26 Other popular remedies
include deer antlers, rhinoceros horns, and
pulverized sea horses.27 The concept “like
cures like” (sympathy healing) is seen in
many food cures for specific illnesses.28
Walnuts (which resemble brains) are eaten
as a remedy for headaches in Hong Kong
and to increase intelligence in China.14 Red
jujubes may be consumed for strengthen-
ing blood, soups made with bones are used
for treating broken bones, and male genital
organs from sea otters, deer, or other ani-
mals are eaten to cure impotence. Chinese
foods and herbs, such as such as “bird nest”
and “glucose drink”29 are also used in the
infant weaning diet. The weaning diet is
considered the semisolid food that is added
to a child’s diet of formula or breast milk
to increase appetite, balance the yin and
yang system, restore qi, or treat diarrhea.30
Based on some traditional beliefs, orange
skin is believed to enhance the taste and
flavor of the soups and contributes to the
ying–yang balance. Pork bone is believed to
add calcium into the soup and is needed for
growth. Moreover, some Chinese believes
that alligator meats will benefit the respira-
tory system.31
Some food taboos have been noted during
pregnancy. Soy sauce may be avoided to pre-
vent dark skin, and iron supplements may not
be taken because they are thought to harden
the baby’s bones and make birth difficult.
Shellfish may also be shunned for the same
reason.32
Contemporary Food Habits
in the United States
Adaptations of Food Habits
Generally speaking, changes in the eating
habits of Chinese Americans correlate with
increased length of stay in the United States,
particularly in subsequent generations. Din-
ner often remains the most traditionally
Chinese meal, whereas breakfast, lunch, and
snacks tend to become more Americanized.
Younger persons are also more likely than
their elders to accept U.S. fare.33
Ingredients and Common Foods Most Amer-
icans of Chinese descent regularly consume
several Chinese foods, such as rice, pork, sea-
food, soup broth, soybean products, cooked
vegetables, tea, and fruit.34,35 One preliminary
study suggests that the majority (88 percent)
of foreign-born immigrants prefer Chinese
fare at home, although younger respondents
(aged twenty to thirty-four) expressed prefer-
ence for American foods.24 Meat and poultry
intake increases, while some traditional pro-
tein items like pig’s liver and bone marrow
soup often remain popular. Greater consump-
tion of protein foods, in addition to increased
intake of fast foods, soft drinks, candy, and
pastries, results in higher fat and sugar intake
among more acculturated Chinese Americans.
The impact of acculturation on fruit and
vegetable intake is less clear. Traditional
fruits and vegetables may be replaced by
more commonly available American items,
such as potatoes, lettuce, apples, peaches, and
watermelon.24,36 Some studies have found that
greater fruit and vegetable intake is associ-
ated with acculturation, education level, and
income.37,38 Among families, however, data
indicate that pressure to maintain a tradi-
tional diet by elders living at home results in a
higher intake of fruits and vegetables among
all members.39
Even though milk is not a familiar item
in the typical Chinese diet, several studies
suggest that milk is consumed by nearly half
to three-quarters of Chinese Americans in
the United States.24,38,40 Cheese, yogurt, and
ice cream have also been found to be well
accepted.41
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3 3 6 E A S T A S I A N S
One study found that dietary variety
increased after immigration to the United
States, and another noted that U.S.-born Chi-
nese women have a more varied diet than
Chinese American women who were foreign
born.37,42 Respondents ate more breads, cere-
als, dairy foods, meats, vegetables, and ethnic
items, such as Italian and Mexican foods. In
another study acculturation was significantly
associated with improved dietary variety but
with lower dietary moderation.43
Meal Composition Skipping meals and
increased snacking have been reported in
Asian students and in Chinese American and
Chinese Canadian women.36,37,44 Surveys of
Chinese in North America suggest that tra-
ditional foods are the choice of older, less
acculturated adults, and their preferences
sometimes influence household meals.35,39,45
Lunches and dinners may consist mainly of
Chinese-style foods, while breakfasts are
more variable. Many Chinese Americans
attempt to balance hot and cold items in their
diets. Other studies suggest that the use of
yin and yang in the diet may diminish over
time and that Chinese Americans may prac-
tice some aspects of it but without knowl-
edge as to why certain food combinations
are preferred.8,9,14,43,45 Stir-frying, simmering,
and steaming remain the favored cooking
methods.24,46 In one study, more acculturated
respondents found cooking Chinese meals
was inconvenient.39
Americans of Chinese descent usually
celebrate the major Chinese holidays of New
Year’s and the Moon Festival with traditional
foods. Chinese American Christians some-
times combine the spring festival of Ch’ing
Ming with Easter festivities. In addition, some Ming with Easter festivities. In addition, some Ming
Chinese Americans recognize the founding
of the People’s Republic of China (mainland
China) on October 1 (on the solar calendar)
or the establishment of the Republic of China
(Taiwan) on October 10 with cultural perfor-
mances and banquets.
Nutritional Status
Nutritional Intake The traditional Chinese
diet is low in fat and dairy products and
high in complex carbohydrates and sodium.
As length of stay and the number of genera-
tions living in the United States increase, the
diet becomes more like the majority Ameri-
can diet—higher in fat, protein, sugar, and
cholesterol, and lower in complex carbohy-
drates. Research on women in the United
States and Canada reported even less accultur-
ated respondents consumed milk, ate cheese,
ate fast foods, and snacked regularly,38 and
another study of women including foreign-
born Chinese Americans, U.S.-born Chinese
Americans, and white Americans revealed
that all three groups consumed more than
recommended levels of fat in their diets, sug-
gesting that some changes in food consump-
tion may occur very quickly.40 The U.S.-born
cohort also demonstrated high levels of nutri-
tion knowledge, and their diet contained a
higher concentration of nutrients than either
the foreign-born Chinese Americans or the
white Americans.42,43
Some Americans of Chinese descent con-
tinue to avoid fresh dairy products because of
lactose intolerance, which may be found in as
many as 75 percent of Asians. Low calcium
intake has been reported in some samples.40,47
Alternative calcium sources are bean curd, soy
milk—if fortified with calcium—and soups
or condiments made with vinegar in which
bones have been partially dissolved. However,
as noted previously, many Chinese Americans
do consume milk, cheese, and yogurt, as well
as leafy green vegetables, and calcium defi-
ciency should not be presumed. Low vitamin
A and C intake has been observed in some
Americans of Chinese descent, but iron intake
is satisfactory, perhaps due in part to the use
of iron-containing cooking tools, such as
woks.46
Obesity and overweight are found to be
low among Chinese Americans.48,49,50,51 In
one national survey Chinese were found to
have very low median body mass indexes
(BMIs) when compared to the general U.S.
population. However, median BMI and pro-
portion obese went up significantly for U.S.-
born subjects when compared to foreign-born
subjects and with acculturation.48,52 Some
Chinese Americans feel pressured to overeat
due to traditional Chinese eating behavior.53
In a study of Chinese American children,
A study of Asian college
students found fast
foods and sweet and
salty snacks very popular.
Intake of fats, sweets,
dairy products, and fruit
increased, while intake
of meats and vegetables
decreased.44
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C H A P T E R 11 3 3 7
33 percent were reported overweight (BMI
$85th percentile); however, the mother’s
degree of acculturation was found inversely
associated with risk.54,55
Concerns that overweight and obesity
may become problematic in this popula-
tion as demographics change over time are
as yet unconfirmed. Research on anthro-
pometric measures indicates that BMI and
waste circumferences underestimate obesity
in Chinese Americans.56,57 Chinese heritage
was found to modify waist circumference
measurements and metabolic risk factors.58
Calculated energy requirements may differ as
well. Predictive equations for basal metabolic
rate (BMR) and for resting energy expendi-
ture (REE) are found to overestimate BMR
and REE in adult Chinese Americans. There
is concern in some Asian nations about the
increasing incidence of eating disorders in
young women.59,60,61
The percentage of type 2 diabetes in U.S
Asians is 20 percent higher than in whites,
but the percentage of overweight or obese
was lower than all other Asians and non-
Hispanic whites, although Asians are more
likely than whites to develop the condition at
a lower BMI.49,62,63,64,85 Further, data suggest
that weight gain associated with incidence of
type 2 diabetes was particularly detrimental
in Asians—each 5-kilogram gain increased
risk by 84 percent, nearly double the increase
found in any other ethnic group in the
study. Data on diabetes specific to Chinese
Americans are sparse, but these pan-Asian
studies suggest type 2 diabetes may become
a significant health issue if overweight and
obesity rates grow.
It is generally assumed that many Chinese
eat a diet high in sodium, which may contrib-
ute to high blood pressure. Hypertension rates
among Chinese Americans are lower than
for whites, but 19 percent of adult Chinese
Americans have hypertension.65 One study
found Chinese subjects are 30 percent more
likely than whites to have high blood pressure
when adjusted for age, BMI, prevalence of dia-
betes, and smoking.66 Asians are 20 percent
more likely to suffer a stroke than whites.65
Another study found that when compared to
whites, Chinese Americans who suffered from
stroke had higher risk profiles, including his-
tory of hypertension, history of diabetes, and
higher levels of blood lipids and glucose.67,68
Hypertension is considered a yang condition
and is often treated by the consumption of yin
foods.69
Asian American adults are less likely than
white adults to have heart disease and they are
less likely to die from heart disease.65 How-
ever, cardiovascular disease rates in China
increased 60 percent between 1993 and 2003,
paralleling increased rates of overweight and
obesity, diabetes, and hypertension.70,87 Preva-
lence in the United States may also increase
with these changes in first-generation immi-
grants, as well as with possible changes in sub-
sequent generations.
Cancer risk is higher in Asians than non-
Hispanic whites for stomach, liver, and intra-
hepatic bile duct and prostate cancer.71,72 Liver
cancer is the result of contracting the hepatitis
B virus, and Asians are 5.5 times more likely
to develop chronic hepatitis B, as compared to
whites.73 Risk of liver cancer should decrease
with inoculation of the vaccine now available
to prevent hepatitis B infection. The number
of colorectal and breast cancer incidences has
increased with length of stay in the United
States, but is still less than for non-Hispanic
white population.72,74 Inadequate preventive
screenings and dietary changes, including
lower intake of protective foods (e.g., soybean
products) and higher intake of saturated fats,
are thought to be factors for these increased
cancer risks.54,75,76,77
Infant mortality rates for Asians are lower
than for non-Hispanic whites, and Chinese
were the least likely among Asians to have low-
birth-weight children.78,79 Breast-feeding is
reportedly common in China, and 65 percent
of Chinese women in Australia breast-fed
their infants in one study.27,80,81
Asians accounted for 28 percent of
reported tuberculosis cases in the United
States in 2010, while Asians born outside
the United States represented 44 percent of
the tuberculosis cases in foreign-born per-
sons.82 Also noted are higher rates of certain
inherited conditions, including thalassemia
and glucose-6-phosphate dehydrogenase
deficiency.84
Asian American women
have the highest life
expectancy (85.8 years)
of any other ethnic group
in the United States. Life
expectancy varies among
Asian subgroups: Filipino
(81.5 years), Japanese
(84.5 years), and Chinese
women (86.1 years).202
A study of accultura-
tion and diet in Chinese
American women found
that Chinese-language
newspapers and friends
were primary sources of
nutrition information.36
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3 3 8 E A S T A S I A N S
Counseling Americans of Chinese descent
accept personal responsibility for their health;
keeping healthy is considered an obligation to
family and society. However, biomedical health
care is underutilized. Language barriers are
thought to be one issue. Over half of Chinese
Americans speak English at home, and nearly
50 percent report that they speak English less
than “very well.”1 Low income, long work
hours, and inconvenient locations are other
reasons believed to limit access. Lack of health
care insurance is another factor, which may be
due to expense, or because purchasing insur-
ance is sometimes seen as inviting death.12,83,88
Mistrust of biomedicine, especially its possible
side effects, is also found.12,86 The concept of
preventive checkups is unfamiliar to many
Chinese Americans.89,90
Perhaps because Chinese Americans fre-
quently believe that hospitals are where a
person goes to die, hospitalization rates of
Chinese Americans are lower than for any
other ethnic group in America. Blood tests,
thought to permanently diminish the blood
supply, are of particular concern to some Chi-
nese clients, who may avoid all biomedical
health care for this reason.
Some Chinese Americans favor biomedi-
cal providers of Chinese heritage, citing
common language, mutual sympathy, and
flexible appointments (many Chinese are
polychronic).12 Effective treatment is the
primary concern for most clients, however.
Preferred communication style is formal and
includes unrushed dialogue (focusing on time
is considered offensive), detailed explanation
of the origins and symptoms of any condition
in understandable terms, simple treatment,
and a positive outlook. Chinese patients con-
sider it important to maintain hope. When
possible, terminal illness should be discussed
first with family members to determine how
and when a client is informed. Medical confi-
dentiality is not widely practiced.2
The Chinese have a quiet conversational
approach, especially with strangers and
acquaintances. Some speakers may pause
during conversation as a sign of thoughtful-
ness. Interruptions should always be avoided.
Many Chinese avoid confrontation and may
initially say yes to questions that require a
positive or negative response. Asking ques-
tions can be interpreted as disrespect, a sign
that the person speaking is being unclear.
Surprise or discomfort may be expressed by
quickly and noisily sucking in air.91 If a person
is offended, he or she may become very direct
and even loud in expressing anger. Conversa-
tions between friends or family members are
often animated.21 Eye contact is made briefly
during introductions, but indirect eye contact
is standard. Direct eye contact may be inter-
preted as confrontational.
Elder or less acculturated Americans
of Chinese descent may show deference to
authority by means of acceptance and sub-
mission. In the hospital setting, patients are
often silent rather than voicing complaints;
providers should not necessarily accept this
as compliance but should actively seek infor-
mation about patient satisfaction. Emotional
displays are considered immature, but most
Chinese patients are willing to discuss feelings
in conjunction with somatic symptoms (see
the section “Traditional Health Beliefs and
Practices”).83
The traditional Chinese greeting is a nod
or a slight bow from the waist while holding
palms together near the chest, often with-
out a smile. Traditionally, surnames come
first, followed by given names, and women
do not customarily take their husband’s last
name when married, so surnames may differ
within the same family. Use of any titles dem-
onstrates respect. Touching between strang-
ers and acquaintances is uncommon.87 Even
handshaking may be inappropriate (wait for
the extended hand, especially with women),
except for Westernized Chinese Americans
and people from Hong Kong. Hugging, kiss-
ing, and back patting should be avoided.
Good posture is expected, and slouching or
putting one’s feet on a desk is considered rude.
Personal space is typically farther apart than
in Western cultures.21
Chinese American women may be very
modest, especially regarding touching. Tradi-
tionally, Chinese women were never touched
by male health care providers (today, more
than 90 percent of obstetricians and gyne-
cologists in China are women). Symptoms
would be discussed by pointing to an alabaster
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 11 3 3 9
figurine.44 If a male must do an examination,
a formal, polite attitude, explanations of all
procedures, and avoidance of tension-reliev-
ing jokes or comments will help the client feel
more at ease.2 Furthermore, within the family,
sons receive more concern and attention over
minor symptoms than daughters. Women,
consequently, may believe that their com-
plaints do not warrant care.
Researchers are unsure how many Chinese
Americans use Traditional Chinese Medi-
cine.92,93,94 The majority are believed to first
self-diagnose and self-prescribe at home
before seeking outside care, although the
reasons why certain foods or medications
are consumed for an illness (particularly the
complementary use of yin and yang) are often
lost through acculturation.8,45 Biomedicine is
completely accepted by many Chinese Amer-
icans; one unpublished study found that 88
percent of foreign-born Chinese American
subjects preferred biomedical care for the
treatment of illness.24 Others consider bio-
medicine best in the treatment of acute symp-
toms, and TCM best for chronic conditions.12
For example, a client with type 2 diabetes
may consult a biomedical physician regard-
ing symptoms but, when he or she finds that
no immediate cure is offered, may seek a TCM
doctor to restore balance to the body and treat
the actual cause of the disease.95
Practitioners of TCM are often con-
sulted concurrently with biomedical care in
an effort to maximize the chances of a cure.
Few conflicts in therapies have been identi-
fied, although the active agents in most herbal
medicines remain unidentified in biomedical
terms. It is possible that a formulary prepara-
tion might be additive with a prescribed medi-
cation, producing excessive response, such as
taking guava juice with hypoglycemics. Con-
versely, a TCM product taken for a different
condition might counteract a drug therapy. For
example, bitter orange peel (which contains
synephrine, a chemical similar to stimulant
ephedrine) may be taken for constipation, thus
reducing the effectiveness of a client’s hypoten-
sive prescription. Providers should encourage
traditional practices if desired by a client, but
ask for information regarding herbal medi-
cines consumed. A prescription from a TCM
In Asia, family members
stay at the hospital to
provide feeding, bathing,
and general care for the
patient.
In 2004 the U.S. Food
and Drug Administration
banned the Chinese herb
ma huang (ephedra), a
methamphetamine-like
stimulant with serious
side effects such as heart
attack, stroke, seizures,
and psychosis. In a subse-
quent lawsuit, a court rul-
ing partially overturned
the ban, permitting small
amounts to be included
in diet preparations.
doctor remains in possession of the client, who
may reuse it if symptoms reoccur or who may
share it with family and friends. Some pre-
scriptions are passed along from generation to
generation; others are obtained directly from
China. Occasionally, a client may present mul-
tiple burn marks from moxibustion, and the
client’s use of this treatment should be deter-
mined before presumption of abuse.
A Chinese client expects that the provider
will perform few tests and ask a limited num-
ber of questions during an examination. Rec-
ommendations on diet, relaxation, and sleep
are desired as an integral part of treatment.
Long-term therapy intended to cure a disease
is preferred over short-term surgical solutions
or invasive treatment, even at the expense of
pain or discomfort from symptoms. Most
Chinese clients are resolved to die at home
(many actually return to China), and their
wishes should be accommodated.
Few compliance problems have been
noted. One difficulty that sometimes arises
is the issue of lengthy or continuous medica-
tion. Many Chinese are accustomed to single-
dose Chinese remedies and may discontinue
a prescription if directions are not thoroughly
explained. Many researchers have remarked
on the difficulty of eliminating high-salt items
(e.g., soy sauce) from Chinese fare and rec-
ommend reduction as a goal in cases where a
low-sodium diet is required.96 Dairy products
may be accepted when clients become familiar
with the foods.40 One study of nursing home
residents found a significant dislike of West-
ern foods among Chinese elders.97
An in-depth interview should tactfully
be conducted to identify which traditional
practices, if any, are followed by a client. Even
▲ Traditionally, Chinese women were never touched by their
male health care providers. Symptoms would be discussed by
pointing to an alabaster figurine, like the one shown.
SS
PL
/W
el
lc
om
e
Tr
us
t/
Th
e
Im
ag
e
W
or
ks
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3 4 0 E A S T A S I A N S
when concepts such as yin and yang are con-
sidered primitive or rustic by some Chinese
Americans, they may still adhere to certain
food combinations learned at home without
knowing why. Birthplace and acculturation
may significantly impact dietary intake of
Chinese Americans, and individual prefer-
ences should be determined.
Japanese
The multi-island nation of Japan is off the
coast of East Asia and has approximately
the same latitude and range of climate as the
East Coast of the United States. The capital of
Japan is Tokyo, located on the island of Hon-
shu. Today, Japan is a prosperous country of
over 127 million people that has overcome
the limitations of a mountainous geography,
a rugged coastline, and few mineral resources.
Perhaps Japan’s greatest natural resource is the
sea, which provides one of the richest fishing
grounds in the world.
Cultural Perspective
History of Japanese in the United States
Immigration Patterns Significant Japanese
immigration to the United States occurred
after 1890 during the Meiji era. The immi-
grants were mostly young men with four to
six years of education from the rural southern
provinces of Japan. Most came for economic
opportunities and many eventually returned
to Japan. They settled primarily in Hawaii and
on the West Coast of the United States and
often worked in agriculture, on the railroads,
and in canneries. Like the Chinese before
them, Japanese immigrants opened small
businesses, such as hotels and restaurants.
In contrast to the Chinese, many Japanese
became farmers, ran plant nurseries, and were
employed as gardeners. The Japanese pros-
pered within their ethnic communities. Most
Japanese women came to the United States as
picture brides: Their marriages were arranged
by professional matchmakers, and they were
married by proxy in Japan. They did not usu-
ally meet their husbands until they disem-
barked from the ship in the United States.
Among Japanese Americans, first-generation
immigrants born in Japan are called Issei,
second-generation Japanese Americans born
in the United States are known as Nisei, and
the third and fourth generations are known as
Sansei and Yonsei, respectively.
Discrimination against the Japanese was
commonplace. The Issei were classified as
aliens who were ineligible to become natural-
ized U.S. citizens, and in 1913 land owner-
ship became illegal in California. Although
Japanese bought land in the names of their
children, who were Americans by birth, the
amount of land owned and leased by Japanese
was reduced by half in the 1920s. In 1907 the
Japanese government had informally agreed
to limit the number of emigrants, and in 1924
the Japanese Exclusion Act halted Japanese
immigration completely.
World War II heightened the prejudice
against the Japanese on the West Coast. After
Japan attacked Pearl Harbor, all West Coast
Japanese, even if they were U.S. citizens, were
evacuated to war relocation camps, and many
remained there for the duration of the war.
Most lost or sold their businesses as a result of
internment. Nevertheless, many Nisei volun-
teered for combat duty and fought in Europe.
Current Demographics and Socioeconomic
Status After the war, most Japanese Ameri-
cans resettled on the West Coast, and the most
discriminatory laws were repealed or ruled
unconstitutional. The successful postwar
recovery of Japan resulted in reduced emigra-
tion to the United States, usually far below
the quota allotted under current immigration
laws. According to 2010 U.S. Census esti-
mates, 1.3 million Japanese Americans live in
the United States, a majority of whom reside
in California or Hawaii.98 Many West Coast
cities have a section of town called “Little
Tokyo” or “Japantown,” and a small number of
older Japanese still live in these homogeneous
neighborhoods. Most Japantowns contain
Japanese American–owned restaurants, mar-
kets, and other small businesses, as well as
Chinese churches or Buddhist temples.
More than 95 percent of Japanese
Americans live in culturally mixed urban and
suburban areas. Americans of Japanese descent
are unique for a nonwhite ethnic group in the
high rate of citizenship, degree of assimilation,
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C H A P T E R 11 3 4 1
and economic mobility they have experienced.1
Over 95 percent of all Japanese Americans
have graduated from high school, and of the
third-generation Sansei, many of whom were
born in the relocation camps, 46 percent have
attended college and most hold professional
jobs. In 2010, median family income was
$65,390, and only 8 percent of adults lived in
poverty. Some Japanese Americans have noted
that few Asians are found in top private- and
public-sector positions, however, and believe
that they suffer from the stereotype of being
too unassertive for upper management.98
Worldview
Religion Early Japanese immigrants usually
joined a Buddhist temple (Pure Land sect) or
a Christian church after arriving in America.
The church frequently provided employment
and an opportunity to learn English. Today,
it is thought that there are more Japanese
Americans who belong to Protestant faiths
than who follow Buddhism.1
Shintoism, the indigenous religion of Japan,
does not have a formal organization, but its
beliefs are a fundamental part of Japanese
culture. The Shinto view is that humans are
inherently good. Evil is caused by pollution
or filthiness—physical as well as spiritual;
goodness is associated with purity. Evil can be
removed through ritual purification. Shinto
deities, called kami, represent any form of
existence (human, animal, plant, or geologic)
that evokes a sense of awe. Kami are wor-
shiped at their shrines as ritual expression of
veneration and thankfulness. Prayers are also
said for divine favors and blessings, as well as
for avoidance of misfortunes and accidents.
Family Until World War II the structure of
the Japanese American family had its roots in
Japan and was similar to that of the Chinese
due to the strong influence of Confucianism.
In addition, the rigid pattern of conduct that
evolved in Japan during the sixteenth century
resulted in the following practices among the
Issei and their descendants:
1. Koko. Filial piety defines the relation-
ship between parents and children,
between siblings, and between individu-
als and their community and rulers. (See
the Chinese religion section on Confu-
cianism in the first part of this chapter
for further explanation.) One outcome
is that the Issei expect their children to
care for them in their old age.
2. Gaman. Most Japanese believe it is vir-
tuous to suppress emotions. The prac-
tice of self-control is paramount.
3. Haji. Individuals should not bring
shame on themselves, their families,
or their communities. This Japanese
cultural concept exerts strong social
control.
4. Enryo. There is no equivalent word in
English, but many Japanese believe it
is important to be polite and to show
respect, deference, self-effacement,
humility, and hesitation. Thus, some
older or less acculturated Americans of
Japanese descent are neither aggressive
nor assertive.
Japanese clan or village affiliation has tra-
ditionally been much weaker than in China,
and Japanese immigrants arrived in the
United States prepared to raise nuclear fami-
lies similar to those in white America. Even
when picture brides were trapped in unhappy
More than 110,000
residents of Japanese
ancestry were living in
Canada in 2011.
Heikegani crabs
are believed to be
reincarnations of
drowned warriors due to
the facelike markings on
their shells.
Japanese physicians were
polled to discover why
they began prescribing
traditional herbal
remedies; a majority said
they were influenced
by pharmaceutical
company salespeople
and advertising.
▲ Japantown, San Francisco.
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3 4 2 E A S T A S I A N S
marriages, they persevered on behalf of their
children. Most Issei women worked along-
side their husbands to support the family
financially.
The internment of Japanese Americans
during World War II brought further changes
in family structure and accelerated accultura-
tion into mainstream society after the war. In
the camps very low wages were paid and the
pay was the same for everyone; thus the father
could no longer be the primary wage earner.
The camps were run democratically, but posi-
tions of authority could be held only by Amer-
ican citizens, so the younger generation held
these more prestigious jobs. The camps also
allowed the Japanese to work in a wider range
of fields than those available to them on the
outside. After their internment, the Nisei no
longer had to follow the few occupations of
their parents, and many chose to follow dif-their parents, and many chose to follow dif-their parents, and many chose to follow dif
ferent paths.
Sansei couples generally form dual-career
households. Nearly 50 percent marry outside
their ethnic group. The societal problems
prevalent in majority American homes, such
as spousal abuse, have surfaced among Japa-
nese Americans as well,99 and it is not known
if the family values that have thrust Ameri-
cans of Japanese descent into educational and
financial success will continue in the fully
assimilated fourth-generation of Yonsei.
Traditional Health Beliefs and Practices Early
Japanese health beliefs involved Shinto con-
cepts of purity and pollution. Health was
maintained through cleanliness and avoidance
of contaminating substances such as blood,
skin infections, and corpses.100 Botanical rem-
edies were used, particularly purgatives, in the
prevention and treatment of disease.
When Buddhism was introduced in the
sixth century, the concept of harmony was
applied within the context of Japanese culture
to mean a person’s relationship with nature,
family, and society. Imbalance resulting from
poor diet, insufficient sleep, lack of exercise,
or conflict with family or society disrupts the
proper flow of energy within the body, leading
to illness. Chinese practices such as acupunc-
ture, moxibustion, and massage were accepted
as ways to restore the energy flow along
the meridians of the body (see the section
“Traditional Health Beliefs and Practices”).
The application of yin and yang in health and
diet was limited in Japan.
The more complex herbal medications
of China were brought to Japan as kanpo.
However, the numerous plants, animals,
and minerals necessary for kanpo were not
widely available on the islands, so its use was
confined to the elite, urban aristocracy until
recent times. Practitioners of the profession
were called kanpo-i and underwent rigorous
training.
Kanpo-i approached each case individually,
reviewing symptoms carefully and in detail
before determining the best combination of
therapies and medications for the specific
patient. Diagnosis was an art that recognized
that symptoms may present differently in
every consultation.101 Western biomedicine
was introduced to Japan in the sixteenth
century with the arrival of the Portuguese. It
was widely embraced; Japanese kanpo-i were
required to retrain if they wished to continue
working as doctors. The majority of Japanese
Americans migrated to the United States dur-
ing the time when kanpo was rarely prac-
ticed, and they were often unfamiliar with its
therapies.
Since 1960 Japan has been in the middle
of a kanpo boom and is now approved reim-
bursement under the Japanese health insur-
ance policy.102 Concerns about the side effects
of biomedical therapeutics and a growing
interest in holistic and herbal healing have
prompted the resurgence.
Kanpo-i take a generalized approach,
using natural medications with broad effects
to stimulate the immune system. Some herbs
also have known bacteriostatic action or anti-
inflammatory properties. Small doses of the
medications are taken for lengthy periods of
time to promote gradual improvement. Physi-
cians trained in biomedicine are also prescrib-
ing kanpo for many clients (though without
the extensive education of kanpo-i); mass pro-
duction of herbal medications by pharmaceu-
tical companies began in the 1970s.
Stress-induced illness is of particular
concern in Japan. Work-related fatigue and
symptoms of anxiety and depression have
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C H A P T E R 11 3 4 3
risen dramatically in the past decade.103 An
estimated 10,000 men die annually from
karoshi (literally “death from overwork,” but
referring to suicide). The healing industry
in Japan is an estimated $30 billion-a-year
business.104 Stress-reducing therapies, called
iyashi, include herbs, teas, and ten-minute
massage parlors. One aquarium provides
overnight accommodations in its tank rooms,
where visitors can sleep to relaxing music in
the company of swaying jellyfish. Spas offer
specialized soaking alternatives, such as bath-
ing in coffee, green tea, red wine, or sake, to
rejuvenate and energize clients. Researchers
report such activities result in reduced lev-
els of stress hormones as measured in saliva
tests.105 Napping on the job and at school
has also gained some acceptance follow-
ing studies on how short rests can improve
productivity.106,107
Traditional Food Habits
Japanese ingredients, as well as cooking and
eating utensils, are very similar to those of the
Chinese, due to China’s strong influence on
Japan. Yet Japanese food preparation and pre-
sentation are unique. The Japanese reverence
for harmony within the body and community
and with nature has resulted in a cuisine offer-
ing numerous preparation methods for a lim-
ited number of foods. Each item is to be seen,
tasted, and relished. The Japanese also place
an emphasis on the appearance of the meal so
that the visual appeal reflects balance among
the foods and the environment. For example,
a summer meal may be served on glass dishes
so that the meal looks cooler, while a Septem-
ber meal may include the autumn colors of
reds and golds.
Ingredients and Common Foods
Japan’s mountainous terrain and limited ara-
ble land have contributed historically to a less-
than-abundant food supply. Even today much
of Japan’s food supply is imported.
Staples and Regional Variations The basic
foods of the Japanese diet are found in the cul-
tural food groups list (Table 11.3). Several key
ingredients were adopted from China, includ-
ing rice, soybeans, and tea. Rice or gohan (the
word for “cooked rice,” and also for “meal”) is
the main staple eaten with almost every meal.
In contrast to the Chinese, the Japanese prefer
a short-grain rice that contains more starch
and is stickier after cooking.
Rice mixed with rice vinegar, called su, is
used in sushi, one of the most popular Japa-
nese specialties in both Japan and abroad.
Sushi rice is formed with fish and seafood
to make decorative, bite-size mounds served
with soy sauce for dipping. Types of sushi
include Nigirisushi, which features rice
topped with items such as sliced raw fish or
squid (called sashimi), cooked octopus, crab
or shrimp, omelet strips, or roe of salmon
(ikura), sea urchin (uni), or flying fish (tobi-
kko), sometimes wrapped in a strip of seaweed;
Makisushi, a roll of sushi rice, often including
cucumber (kappamaki), tuna, mushrooms,
or other fillings, then wrapped in a sheet of
seaweed and sliced into individual pieces; and
Chirashisushi, with the topping ingredients lit-
erally scattered over a large mound of rice and
eaten with chopsticks.
Rice is also made into noodles, although
those made from wheat (known as udon,
somen, and ramen) or buckwheat (soba) are
more commonly consumed. Other noodles
made from less familiar starches, such as
kudzu, are also eaten.
Soybean products are an important com-
ponent of Japanese cuisine. Tofu (bean curd),
soy sauce (shoyu), and fermented bean paste
Sea urchin roe, called
uni, is thought to
enhance male sexual
potency in Japan, where
wholesalers pay up to
$100 per pound for it.
California imposed strict
urchin harvesting laws to
prevent extinction along
the coast.
▲ Traditional foods of
Japan. Some typical foods
include daikon, dried
sardines, Japanese egg-
plant, Japanese pickles,
nori (seaweed), red beans, nori (seaweed), red beans, nori (
shiitake mushrooms, short-
grain rice, shrimp, soy sauce,
and wheat noodles.
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3 4 4 E A S T A S I A N S
Group Comments Common Foods Adaptations in the United States
Protein Foods
Milk/milk
products
Japanese cooking does not
utilize significant amounts
of dairy products. Many
Japanese are lactose
intolerant. Soybean
products, seaweed,
and small bony fish are
alternative calcium sources.
Milk, butter, ice cream First-generation Japanese
Americans drink little milk
and eat few dairy products.
Subsequent generations
eat more dairy foods.
Meat/poultry/
fish/eggs/
legumes
Soybean products and a
wide variety of fish and
shellfish (fresh, frozen,
dried, smoked) are the
primary protein sources in
the Japanese diet. Fish and
shellfish often eaten raw.
Chicken is used more often
than beef; price is the
limiting factor in meat
consumption.
Meat: beef, deer, lamb, pork, rabbit, veal
Poultry: capon, chicken, duck, goose, partridge,
pheasant, quail, thrush, turkey
Fish: blowfish, bonito, bream, carp, cod, cuttlefish,
eel, flounder, herring, mackerel, porgy, octopus,
red snapper, salmon, sardines, shark, sillago,
snipefish, squid, swordfish, trout, tuna, turbot,
yellowtail, whale
Shellfish: abalone, ayu, clams, crab, earshell, lobster,
mussels, oysters, sea urchin roe (uni), scallops,
shrimp, snails
Legumes: adzuki, black beans, lima beans, red
beans, soybeans
Dried fish and fish cakes are
available in the United
States, but some varieties
of fresh fish are not.
Japanese Americans eat
more poultry and meat
than fish.
Cereals/Grains Short-grain rice is the primary
staple of the diet and is
eaten with every meal.
Wheat is often eaten in the
form of noodles, such as
ramen, somen, and udon.
Wheat, rice, buckwheat, millet Rice is still an important
staple in the diet and
usually eaten at dinner.
Fruits/Vegetables Fresh fruits and vegetables
are the most desirable;
usually eaten only in
season.
Many fruits and vegetables
are preserved, dried, or
pickled.
Fruits: apples, apricots, bananas, cherries, dates,
figs, grapes, grapefruits (yuzufigs, grapes, grapefruits (yuzufigs, grapes, grapefruits ( ), kumquats,
lemons, limes, loquats, melons, oranges,
peaches, pears, pear apples, persimmons, plums
(fresh and pickled), pineapples, strawberries,
mikan (tangerine)
Vegetables: artichokes, asparagus, bamboo shoots,
beans, bean sprouts, broccoli, brussels sprouts,
beets, burdock root (gobo), cabbage (several
varieties), carrots, chickweed, chrysanthemum
greens, eggplant (long, slender variety), ferns,
ginger, ginger sprouts and flowers (myoga),
and pickled ginger (beni shoga), green onions,
green peppers, gourd (kanpyo, dried gourd
shavings), kudzu, leeks, lettuce, lotus root,
mizuna, mushrooms (shiitake, matsutake,
nameko), okra, onions, peas, potatoes, pumpkins,
radishes, rhubarb, seaweed, snow peas, shiso,
sorrel, spinach, squash (including kabocha),
sweet potatoes, taro, tomatoes, turnips,
watercress, yams
Fewer fruits and vegetables
are eaten; freshness is less
critical.
Additional Foods
Seasonings Sugar, shoyu, and vinegar are
a basic seasoning mixture.
Shoyu and mirin can vary in
strength; amounts used will
vary according to taste.
Alum, anise, bean paste (miso), caraway, chives,
dashi, fish paste, garlic, ginger, mint, mirin, MSG,
mustard, red pepper, sake, seaweed, sesame
seeds, shiso, shoyu, sugar, thyme, vinegar (rice),
wasabi (green, horseradish-like condiment)
TA B L E 11. 3 Cultural Food Groups: Japanese
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C H A P T E R 11 3 4 5
(miso) are just a few. Miso comes in numerous
varieties. Those made with the addition of rice
are most popular; however, miso mixed with
barley is found in western regions, and plain
miso with just soybeans and salt is favored in a
few central areas.108 Red miso (akamiso) is very
salty and is used most often. White miso (shi-
romiso) is sweeter, often used in cooked salads.
Specialty misos, with added vegetables such as
kombu or daikon, or seasoned with shiso, are
also available. Sugar, shoyu, and vinegar are
a basic seasoning mixture for foods. Teriyaki
sauce (“shining broil”) made from soy sauce
and mirin, a sweet rice wine, is another com-
mon flavoring for foods. Shoyu and mirin can
vary in strength, and the amounts used depend
on personal taste. In addition to soy beans,
small, red adzuki beans are significant in Japa-
nese cuisine, most often made into sweetened
red bean paste and a popular red bean jelly
dessert (similar to gelatin) called yo-kan.
Green tea is served with most meals. Tea
was originally used in a devotional ceremony
in Zen Buddhism. The ritual was raised to
a fine art by Japanese tea masters, and as a
result, they also set the standards for behavior
in Japanese society. Today, the tea ceremony
and the accompanying food (kaiseki ryori)
remain a cultural ideal that reflects the search
for harmony with nature and within one’s self.
The meal features six small courses balanc-
ing the tastes of sweet, sour, pungent, bitter,
and salty. The tea used for the ceremony is not
the common leaf tea usually used for meals,
but rather a blend of ground, dry tea or a tea
powder. Hot water is added to the tea, and the
mixture is whipped together using a hand-
made whisk, resulting in a frothy green drink.
Diners demonstrate their sophistication and
sensitivity through deliberate eating of each
course after expressions of appreciation for
the presentation.
Soybean products and a wide variety of
fish and shellfish (fresh, dried, or smoked) are
the primary protein sources. Fresh fish and
shellfish are often eaten raw. Beef, pork, and
poultry are also popular but very expensive.
One specialty is Kobe (or Tajima) beef, from a
Japanese breed of cattle that is fed beer as an
appetite stimulant and regularly massaged to
relieve stress. It often costs more than $100 per
pound. Pork is a favorite as cutlets. Chicken,
which is often served as teriyaki sauce–
glazed skewers, may also be very thinly sliced
and served raw like sashimi.109 Only small
amounts of meat, poultry, or fish are added to
the vegetables in traditional Japanese recipes.
Japanese fare does not use many dairy foods.
Fresh fruits and vegetables are the most
desirable and are eaten only when in sea-
son. As in China, many Asian and European
varieties are consumed (see the subsection
“Staples” in the Chinese part of the chapter).
A few favorites include herbs and greens such
as chrysanthemum greens, mizuna (pot-
herb), and shiso (perillaherb), and shiso (perillaherb), and shiso ( , a member of the
When a family moves
to a new home, they
give soba noodles to the
neighbors on either side
and across the street as a
gesture of friendship.
kaiseki ryori meals have
recently become trendy
in both Japan and the
United States, costing
up to $100 per person at
restaurants featuring the
ceremonial menu.
Group Comments Common Foods Adaptations in the United States
Nuts/seeds Chestnut, gingko nuts, peanuts, walnuts; poppy
(black and white), sesame seeds
Beverages Green tea is the preferred
beverage with meals;
coffee or black tea is drunk
with Western-style foods.
Sake or beer is often served
with dinner.
Carbonated beverages, beer, coffee, gin, tea (black
and green), sake, scotch
Japanese Americans drink
less tea and more milk,
coffee, and carbonated
beverages.
Fats/oils The traditional Japanese diet
is low in fat and cholesterol.
Butter, cottonseed oil, olive oil, peanut oil, sesame
seed oil, vegetable oil
Japanese Americans
consume more fats and oils
because of increased use of
Western foods and cooking
methods.
Sweeteners Honey, sugar Increased use of sugar; sweet
desserts are noted.
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3 4 6 E A S T A S I A N S
mint family—the red variety is used to color
pickled foods); many tubers, including gobo
(burdock root, which is shaved and leached
in water to remove bitterness), sweet pota-
toes, a small variety of taro, and yams; and
others such as daikon (a white radish similar
to the Chinese radish, but longer, up to twelve
inches in length), edamame (young soybean
pods boiled in saltwater, then popped open
for a snack, often with beer), kabocha (winter
squash), shiitake mushrooms, and the winter
tangerine known as mikan. Pickled vegetables
are available year round and are eaten exten-
sively. Fresh fruit is a traditional dessert.
The Japanese use large amounts of seaweed
and algae in their cooking for seasoning, as
a wrapping, or in salads and soups. There
are many types. Nori is a paper-thin sheet of
algae that is rolled around sushi. Kombu is an
essential ingredient in dashi, or soup stock
made from dried bonito fish and seaweed.
Misoshiru is a popular soup made with dashi
and miso (either red or white miso can be
used). Wakame and hijiki are used primarily
in soups and salads. Aonoriko is powdered
green seaweed used as a seasoning agent.
Japanese dishes are classified by the way the
food is prepared (see Table 11.4). Tempura is an Tempura is an Tempura
example of an agemono dish. Adapted from a
dish introduced in the sixteenth century by the
Catholic Portuguese for religious fast days, it
consists of shrimp and sliced vegetables—such
as eggplant, carrots, sweet potato, lotus root,
and green beans—lightly battered and deep-
fried. Katsu is another agemono dish of
deep-fried breaded pork cutlets or fish filets.
Sukiyaki is a simmered beef dish usually pre-
pared at the table. The name means “broiled
on the blade of the plow” and probably dates
back to ancient times.110 The current version
of sukiyaki is mislabeled, however, because
it is a nimono-style, not a yakimono-style
food. Shabu shabu, a nabemono dish of small
pieces of beef and vegetables cooked in broth
at the table, is similar to a Mongolian hot pot
(see “Chinese Regional Specialties” above).
After the meat and vegetables are cooked and
eaten, the broth is ladled into bowls and con-
sumed. Teriyaki is one type of grilled yakimono
dish, as is yakitori (grilled, marinated chicken
skewers). Teppanyaki is a Japanese term for
stovetop grilling. The style familiar to U.S. din-
ers was invented to take advantage of the tour-
ist trade. Beef, chicken, shrimp, and vegetables
are cooked on a hot grill in the center of a large
table, then served with ponzu, a soy sauce and
citrus juice mixture. Chawanmushi, a savory
egg custard in which meats and vegetables are
cooked, is a typical steamed mushimono dish.
Seafood, fish, fruits, and vegetables that
are pickled in a mixture of miso, soy sauce,
vinegar, and the residue from sake production
are known as tsukemono, and they are served
at nearly every meal.
Suimono Clear soups, such as dashi or dashi or dashi misoshiru
Yakimono Broiled or grilled food (often marinated), such as teriyaki or teriyaki or teriyaki yakitori
Nimono Foods (usually a single item) simmered in seasoned water or broth, such as fish in sake-
flavored broth, served hot or at room temperature
Mushimono Steamed foods, such as chawanmushi
Agemono Deep-fried foods, such as deep-fried tofu or katsu, usually served with a dipping sauce
Aemono Fresh or cooked mixed foods tossed with thick sauces, such as salad with miso dressing
Sunomono Mixed salads with vinegared dressing, such as crab and cucumber with rice vinegar and
soy sauce dipping sauce
Chameshi Rice cooked with other ingredients, such as chicken, fish, vegetables (especially
mushrooms)—one specialty is rice with red adzuki beans, served for celebrations
Men rui Noodle dishes, served hot or cold (plain or topped with fish or vegetables) with dipping
sauce, or in a broth with items such as meats, seafood, tofu, and vegetables
Nabemono Foods that are cooked at the table and one-pot dishes (usually a type of nimono dish),
usually hearty combinations, such as sukiyaki and sukiyaki and sukiyaki shabu shabu
TA B L E 11. 4 Selected Japanese Cooking Styles
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C H A P T E R 11 3 4 7
Japanese foods are usually cut into small
pieces if the item is not naturally easy to eat
with chopsticks, and dishes are frequently
modified for children, as it is believed that
adult recipes are too spicy for them. Cooking
style varies from region to region in Japan.
Kyoto is known for its vegetarian specialties,
Osaka and Tokyo are known for their seafood,
and Nagasaki’s cooking has been greatly influ-
enced by the Chinese.
Meal Composition and Cycle
Daily Pattern Traditionally the Japanese eat
three meals a day, plus a snack called oyatsu.
Simple meals, such as breakfast and lunch, are
often ichiju—issei, meaning “soup with one
side.” For example, breakfast usually starts
with a salty sour plum (umeboshi), followed
by rice garnished with nori, soup, and pickled
vegetables. A side dish such as an egg or fried
fish is served with the rice. A nabemono can
replace the side dish, which often happens at
lunchtime. The meal is typically simple and
often consists only of rice topped with left-
overs from the previous night. Sometimes hot
tea or dashi is added to the rice mixture. A
bowl of noodles cooked or served with meats,
poultry, or fish and vegetables is a popu-
lar alternative to leftovers. One such dish is
oyakodon, which means “parent and child on
rice,” a mixture of boiled chicken and scram-
bled eggs on a bed of rice.
Dinner is usually ichiju sansei, meaning
“soup and three sides,” including rice, soup,
and tsukemono, and three dishes: a raw or
vinegared fish, a simmered dish, and a grilled
or fried dish.108 Pink pickled ginger (beni
shoga) garnishes many meals, and soy sauce is
usually available. The pungent, green, horse-
radish-like condiment called wasabi may also
be offered, and it is mixed in small individual
bowls with soy sauce to taste.
The Japanese tend not to serve meals by
courses. Instead, all the dishes are presented
at the same time in individual portions, each
food in its own bowl or plate. The soup, how-
ever, is sometimes served last or near the end
of the meal, and tsukemono may be placed on
a communal plate for diners to add accord-
ing to their personal preference. Traditionally,
desserts were not common in Japan; meals
usually ended with fruit.
A small grill in Japan is
called a hibachi, meaning
“fire bowl.”
Sansai ryori is a style of
cooking with fresh wild
herbs and vegetables
such as goosefoot, mug-
wort, nettles, ferns, and
bracken. It is considered
the essence of spring.
Kombu sounds like the
word for “happiness,” and
it is often presented as a
hostess gift by guests.
Myoga ginger is prized
in Japan for its tender
shoots in the spring and
its flower buds in the fall.
The Japanese use
21 billion sets of dispos-
able wood chopsticks in
restaurants annually.
In addition, the Japanese often eat a boxed
meal called bento. A pleasing assortment of at
least ten items is packaged attractively for con-
sumption at school, picnics, or even between
acts at the theater. Some restaurants specialize
in bento meals.
Snacks include several kinds of sweets, rice
crackers, or fruit. Traditional Japanese confec-
tions include mochi gashi (rice cakes with sweet mochi gashi (rice cakes with sweet mochi gashi
red bean paste), manju (dumplings), and yo-
kan. Green tea is served after all meals except
when Western-style food is eaten; then coffee or
black tea is served. Beer or sake (rice wine, usu-
ally served warm) may be served with dinner.
Eating out is common. Numerous small
restaurants specialize in certain preparations,
such as sushi, yakitori, or noodle dishes. Res-
taurant windows often display their menu
items with plastic replicas of their dishes.
Etiquette The Japanese, like the Chinese, eat
with chopsticks and follow many of the same
customs regarding their use (see the “Etiquette”
subsection in the Chinese part of the chap-
ter); the rice bowl is not held as closely to the
mouth, however. Soups are consumed directly
from the bowl; the only dish eaten with a spoon
is chawanmushi. Slurping soups and noodles is
permitted and may be seen as a sign of appre-
ciation. Tea should always be silently sipped.21
Traditionally the Japanese eat their meals
at low tables, in a kneeling position with the
heels tucked under the buttocks. In less for-
mal situations men may sit cross-legged and
women with their legs tucked to the side.
▼ The o sonae mochi is
traditional in Japanese Bud-
dhist homes at New Year’s,
symbolizing prosperity and
happiness in the future.
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3 4 8 E A S T A S I A N S
Shoes are removed first. Dishes on the left
are picked up with the right hand, and dishes
to the right are lifted with the left hand. It is
impolite to serve sake, beer, or tea to oneself.
Each diner is obliged to fill his or her neigh-
bor’s glass whenever it is half-empty.
Guests are usually entertained at restau-
rants, where the host chooses the menu in
advance. The meal may include frequent
toasts, particularly kampai (“bottoms up”).
Games may be played at the table after the
meal. Karaoke singing is common, and guests
are expected to good-naturedly participate.21
Special Occasions In Japan there are numer-
ous festivals associated with the harvesting of
specific crops or with local Shinto shrines or
Buddhist temples. The most important and
largest celebration in Japan is the New Year
celebration. The Japanese share many holi-
day traditions with the Chinese. Homes are
cleaned thoroughly, and all debts are settled
before the New Year; food is also prepared
ahead so that no knives or cooking will inter-
fere with the seven-day event. The Japanese
celebrate New Year’s Day on January 1. The
New Year’s foods consist of ten to twenty
meticulously prepared dishes served in a spe-
cial set of nesting boxes. Each dish symbolizes
a specific value, such as happiness, prosperity,
wealth, long life, wisdom, and diligence. For
example, fish eggs represent fertility, mashed
sweet potatoes and chestnuts protect against
bad spirits, and black beans represent a will-
ingness to keep healthy through hard work
and sweat.
An important New Year’s food is mochi,
a rice cake made by pounding hot, steamed
rice into a sticky dough. Traditionally a Bud-
dhist o sonae mochi is set up in many homes.
A large rice cake represents the foundation
of the older generation and is placed on the
bottom, and a smaller rice cake symbolizing
the younger generation is placed atop it, fol-
lowed by a tangerine indicating generations to
come. The o sonae mochi is as meaningful to
the Japanese as a Christmas tree is to Ameri-
cans, preserving good fortune and happiness
for future generations. Another special food is
ozoni, a soup cooked with mochi, vegetables,
fish cakes, and chicken or eggs. A special rice
wine called otoso is consumed to preserve
health in the coming year. Japanese Bud-
dhist temples usually hold an Obon festival in
the second or third week of July to appreci-
ate the living, honor the dead, and comfort
the bereaved. Food and dancing are a tradi-
tional part of the holiday. Certain birthdays
are considered either hazardous or auspicious
in Japanese culture. When a man turns forty-
two or a woman becomes thirty-three, spe-
cial festivities are held to prevent misfortune.
Age sixty-one marks the beginning of second
childhood, and a person dons a red cap for
this honor. At age seventy-seven a person puts
on a long red overcoat, and at the most pro-
pitious birthday of all, age eighty-eight, the
celebrant may begin wearing both the hat and
the coat.
Therapeutic Uses of Food
Although the use of yin and yang is not as
prevalent among the Japanese as it is among
the Chinese, there are many beliefs about the
harmful or beneficial effects of specific foods
and food combinations. Traditionally certain
food pairs, such as eel and pickled plums,
watermelon and crab, or cherries and milk,
are thought to cause illness.
Pickled plums and hot tea, which are cus-
tomarily eaten for breakfast, are believed to
prevent constipation. Both pickled plums
and rice porridge, called okayu, are thought
to be easily digested and well tolerated during
recovery from sickness.
Contemporary Food Habits
in the United States
Adaptations of Food Habits
Little recent information on the food habits
of Japanese Americans has been reported, but
available data suggest the adoption of a West-
ernized diet continues with each subsequent
generation in the United States. It is thought
that when acculturated Japanese Americans
eat a typical American diet, they may eat more
rice and use more soy sauce than non-Asians.
Traditional foods are still prepared for special
occasions. A Westernized diet is increasingly
followed even in Japan. Bread and butter are
becoming staples, and consumption of meat,
milk, and eggs is increasing.
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C H A P T E R 11 3 4 9
A detailed study of Nisei and Sansei
(mothers of Japanese immigrants and their
daughters) reported several trends in dietary
acculturation.111,112 Compared to the predom-
inantly Japanese diet consumed by the Issei
who immigrated to the United States, Nisei
women in the study continued to eat rice daily
but added other starches, such as breads and
cereals. Traditional protein sources, including
seafood, tofu, and eggs, were often replaced
with more meats and dairy items. Condi-
ments such as soy sauce and miso were con-
sumed less often, while butter and margarine
intake increased substantially. When com-
pared to their mothers, the Sansei daughters
consumed less rice and more pasta, ate less
dried fish and more cheese, consumed fewer
traditional preserved or pickled foods and
more fresh fruits and vegetables (particularly
potatoes), and used less butter and margarine.
The Sansei women also ate fewer Japanese-
style sweets and more salty snacks. Green tea
consumption declined with the Sansei daugh-
ters, and soft drink consumption increased.
Notably, meal consumption became more
irregular with the Sansei, and eating out and
use of takeout foods were significantly more
common.
Nutritional Status
Nutritional Intake The traditional Japanese
diet is high in carbohydrates and very low
in fat and cholesterol. Most cooking fats are
polyunsaturated, and butter is rarely used.
Japanese Americans, however, consume a
more typically American diet, and this change
may contribute to increased incidence of
several diseases. The leading cause of death
for Japanese Americans is cancer and heart
disease, but it is still lower than death rates
for other Americans.113 According to classic
epidemiological studies, mainland Japanese
Americans have a higher risk of developing
colorectal cancer and heart disease than the
Japanese in Hawaii, and those in Hawaii have
a higher risk than the Japanese in Japan.114,115
More detailed evaluation has shown Japa-
nese Americans have more rapid athero-
sclerosis progression than do Japanese men
and women.116 It has been postulated that
the increase is caused by diet because it is
Historically, rice was
often in short supply
in Japan, so eating
the round rice cakes,
mochi, at New Year’s
represented wealth and
prosperity.
correlated to a higher intake of cholesterol
and animal fat and a lower intake of dietary
fiber and a lower intake of fish oil (omega-3
fatty acids).117 Other cancers, such as those of
the breast and prostate, have also increased in
Japanese Americans as their stay in the United
States lengthens.
Changes in diet have also been implicated
in the high rates of type 2 diabetes found
among Japanese American men.118,119,120
Among Nisei men in one study, the rates for
diabetes were twice that for similarly aged
white men living in the same region of the
United States and four times that for simi-
larly aged men in Japan.121 Data showed that
the Japanese American men were consum-
ing carbohydrate, protein, and fat propor-
tions similar to the overall American diet,
but with fewer total calories. (A third of
Japanese Americans are overweight and
obesity has been found to be higher in
U.S.-born Japanese Americans than in
foreign-born Japanese Americans, total
rates are low.)122 However, insulin resistance
and metabolic syndrome was greater in the
Japanese American men when compared
to Japanese subjects, and increased intra-
abdominal fat deposits were found.123,124
S A M P L E M E N U
A Japanese Family Dinner
Misoshiru (M is o S oup) a,b
Sashimia,b
Tempuraa or Y e llo w t ail T e r iy ak ib
P ick le d C ucumb e r a,bP ick le d C ucumb e r a,bP ick le d C ucumb e r
S t e ame d R ic e , P ick le d G in ge r , Wasabi , an d S oy S au c e
S ak e (R ic e W in e ) or G r e e n T e a
aFukushima, S. 2001. Japanese home cooking. Boston: Periplus.
bYasuko-san’s Home Cooking
at http://www.nsknet.or.jp/~tomi-yasu/index_e.html
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
3 5 0 E A S T A S I A N S
Among women, intra-abdominal fat
increased with menopause.118 Intra-abdom-
inal fat deposition was found predictive of
type 2 diabetes in Japanese Americans inde-
pendent of total adiposity, family history, and
other risk factors.125,126,127 A genetic predispo-
sition for diabetes combined with increased
fat consumption, especially animal fats, may
account for the disproportionately high rates.
Earlier studies suggest Japanese American
elders may have a low intake of calcium
because of limited consumption of dairy prod-
ucts.47 The Japanese have a high incidence of
lactose intolerance. Although seaweed, tofu,
and small bony fish contain calcium, they may
not be eaten in adequate amounts to provide
sufficient intake. Prevalence of osteoporosis
may be higher than among whites (see
Cultural Controversy—Dairy Foods, BMD,
and Osteoporosis). Calorie consumption and
meat intake have also been found to decline
with age in Japanese Americans.
The traditional Japanese diet tends to
be high in salt from soy sauce, dashi, miso,
monosodium glutamate (MSG), dried pre-
served fish, and pickled vegetables. Rates of
conditions sometimes linked to high-sodium
diets, such as hypertension, stroke, and stom-
ach cancer, are extremely high in Japan but
have been dropping as the Japanese adopt
Western fare.128
Infant mortality rates for Japanese Americans
are lower than those for the general popula-
tion.78 However, a study comparing pregnancy
outcomes in Japanese Americans noted that
U.S.-born mothers are significantly more
likely to have low-birth-weight infants than are
foreign-born mothers.129,130
A comparison of Asian (Chinese, Japa-
nese, and Korean) alcohol consumption habits
found that Americans of Japanese heritage had
the most permissive attitude toward drinking,
particularly among women. Japanese Ameri-
can men had high rates of heavy drinking
(nearly 30 percent) and the fewest abstain-
ers (16 percent). Japanese American women
showed similar trends, with the highest rates
of heavy drinking (almost 12 percent) and
the lowest number of abstainers (27 percent).
Although the number of women engaged in
chronic heavy drinking is lower than for white
American women, the rates for men were
comparable. Friends who drink and social
occasions where drinking was expected were
significant influences on consumption among
men.131 These studies confirms previous work
indicating that alcohol consumption may
be more frequent than previously assumed
among Japanese Americans, although behav-
ior problems related to drinking have not been
widely reported.120,132,133
Counseling Japanese American values such as
placing the family before the individual, pre-
serving harmony with society, and respect-
ing and caring for elders may have a positive
impact on health.99 Illness may be regarded
as both a symptom of an unbalanced life as
well as an impediment to fulfilling personal
obligations. Japanese Americans were found
less accepting of pain behaviors than whites
in one study.134
Formality and politeness are essential con-
versational elements in Japan. Addressing Jap-
anese elders or Japanese American Issei, and
some Nisei, by their first names is insulting.
Sansei and Yonsei are often more informal.100
Emotional displays are avoided, especially of
anger. The Japanese are nonconfrontational
and may be reluctant to say no even when
the answer to a question is negative. Waving
a hand in front of the face with the palm out-
ward indicates “I’m unsure” or “I don’t know.”
Conversational style is typically indirect, and
frequent pauses, up to several minutes, are
common. It is usually best to remain silent
during such pauses. Direct eye contact is dis-
respectful—glancing around or downcast eyes
are expected. Smiling can indicate pleasure
but is also used to hide displeasure. Sucking
in air through the teeth can also be a sign of
discomfort or anger.
The Japanese are a nontouching culture,
and they often stand or sit farther apart
than do most Americans. Their commu-
nication style is extremely high context,
and the slightest gesture may have meaning
(see Chapter 3 for more details). Broad hand
or body gestures may be misconstrued.
Though touching between strangers or
acquaintances is infrequent, most Japanese
Americans are comfortable with a light
A small percentage of
Asians lack the ability to
metabolize alcohol well.
This inherited condition
causes immediate skin
flushing (reddening)
and may even result in
heart palpitations when
alcohol is consumed. This
reaction may contribute
to the number of abstain-
ers in the population.
Korea is called Choson by
Koreans, meaning “Land
of Morning Calm.”
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C H A P T E R 11 3 5 1
handshake. The traditional greeting is a bow
from the waist with palms against thighs. The
lower the bow and the longer it is held, the
more respect is shown for the status of the
other person.21 Slouching and putting one’s
feet on a desk are signs of disinterest.
Japanese Americans often believe that
the health care provider is a knowledge-
able authority figure who will meet their
needs without assistance. Most Americans
of Japanese descent expect to be directed in
their health care, yet are insulted if they are
ordered to do anything that they feel requires
only an explanation. Criticism of a client’s
health habits can lead to embarrassment and
loss of effective communication. Concrete,
structured approaches based on information
gathered through an unhurried, in-depth
interview that determines degree of accul-
turation and personal preferences are most
effective.
Koreans
The mountainous peninsula that forms Korea
is suspended geographically and culturally
between China and Japan. Korea has his-
torically been caught in the middle of both
Chinese and Japanese expansionism yet has
maintained a homogeneous population with
an independent, distinctive character. Lit-
tle land is arable, and the climate fluctuates
between cold, snowy winters and hot, mon-
soonal summers that limit agriculture signifi-
cantly. The peninsula is currently divided into
two nations. The Democratic People’s Repub-
lic of Korea (North Korea), with the capital
city of Pyongyang, has a communist govern-
ment. The Republic of Korea (South Korea) is
a democracy supported by the United States.
Seoul is the country’s capital. Both nations
desire the reunification of Korea through
political and military domination of the other.
There were approxi-
mately 169,000 Canadi-
ans of Korean ancestry in
the 2011 Census.
The status of Koreans
in the United States
during World War II was
unique. Many remained
technically Japanese
citizens and as such
were declared enemy
aliens (although none
were interred). Yet
many Koreans had been
involved for years in
anti-Japanese activities.
They wore “I am Korean”
buttons to distinguish
themselves from
Japanese residents.
Dairy Foods, BMD, and Osteoporosis
Osteoporosis, which means “porous bone,” affects 10 million women
and 2 million men in the United States.
Another 16 million have low bone mineral
density (BMD), which may put them at risk
of developing the disease. Osteoporosis is
characterized by reduced height, a stooped
spinal deformity, and over 1.5 million
bone fractures annually, most often of the
spine, the hip, and the wrist. The causes of
osteoporosis are not completely understood.
Contributing factors include ethnicity,
family history, low calcium intake, insuf-family history, low calcium intake, insuf-family history, low calcium intake, insuf
ficient weight-bearing exercise, smoking,
high alcohol consumption, and low levels
of estrogen in women and testosterone
in men.192,193
White women have long been considered
at highest risk for osteoporosis. In particular,
thin white women have been thought most
vulnerable because higher body mass is
related to better BMD. Asian women have a
lower incidence of hip fracture than white
women, but the prevalence of vertebral
fractures among Asians seems to be as high
as that in white individuals. Protective factors
that lower the risk for fracture in Asians may
be diminishing, however. Hip fracture rates
are rising dramatically in Japan, Hong Kong,
and among the Chinese in Singapore.194,195,
196,197
Dietary recommendations regarding
osteoporosis have traditionally emphasized
a high intake of calcium-rich foods. Dairy
foods are considered good sources because
in addition to calcium they also contain
vitamin D, which enhances absorption of the
mineral. Although many Asians do not eat
dairy foods, it has been thought that they
obtained adequate calcium from eating small
fish with bones (e.g., sardines), mineral-rich
fish sauces, and ample dark green leafy
vegetables. Some scientists also suggest that
soybean intake may be protective, slowing
bone mineral loss after menopause.198,199,201
Yet, if prevalence for low BMD and osteopo-
rosis among Asians is higher than previously
calculated, and if fractures are increasing, do
nondairy foods provide adequate calcium
intake? Or, if the intake of traditional calcium-
rich foods declines with acculturation in the
United States (and Westernization world-
wide), are dairy foods needed to provide the
calcium no longer being consumed?200
More research on the bioavailability of
calcium in different foods and the role of diet
in the development of BMD, osteoporosis,
and fractures is needed to determine whether
dairy food recommendations are sensible for
all Americans or simply ethnocentric.
C U L T U R A L C O N T R O V E R S Y
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3 5 2 E A S T A S I A N S
Cultural Perspective
History of Koreans in the United States
Immigration Patterns Early Korean immi-
gration to the United States was severely
restricted by the isolationist policies of Korea.
A small number of Koreans arrived before
1900, most of whom were Protestants seek-
ing to escape discrimination and further their
education in America.
Between 1903 and 1905 Christian mis-
sionaries recruited more than 7,000 Korean
men, women, and children to work in
Hawaiian sugarcane fields. In 1905, when
Korea was under Japanese rule, overseas
emigration of Koreans was barred, and in
1907 the United States entered a gentlemen’s
agreement with Japan limiting both Japanese
and Korean immigration. During the next
seventeen years, only picture brides and
oppressed political activists were permitted
entry. In 1924 the Japanese Exclusion Act
was applied to Koreans as well, preventing
all immigration. Most early Korean immi-
grants worked as field hands or in domestic
service; many first- and second-generation
Koreans living in urban areas were barred
from professional jobs and established small
businesses such as vegetable stands and
restaurants.135
Between 1959 and 1971, nearly all Korean
immigrants were the wives and children of
U.S. soldiers who fought in the Korean War.
Following relaxation of U.S. immigration laws
in 1965, the numbers of Korean immigrants
increased, including many college-educated,
middle-class professionals and their families.
Current Demographics The Korean immi-
grant population has increased dramatically
in recent years. According to 2008 Census
estimates, over 1.7 million Koreans are living
in the United States, over half of whom have
arrived since 1980. More than 78 percent of
Koreans in America were born in Korea, and
67 percent of those have become citizens.4
Large numbers of immigrants to the United
States relocated first from North Korea to
South Korea, seeking greater freedom. Kore-
ans coming to America hope to find economic
opportunity and to avoid any North Korean–
South Korean conflict that may arise in the
future. Large numbers of Koreans have settled
in California, particularly Los Angeles and the
New York metropolitan area.
Socioeconomic Status Families working
together toward the success of a small busi-
ness and the purchase of a home are common.
Contributing factors include high achieve-
ment in education and professionalism; quick
mastery of English; over 50 percent of individ-
uals have college degrees; and large numbers
work in management and professional posi-
tions. Family median incomes were slightly
above the U.S. average, and poverty rates were
15 percent.1,4
Worldview
Religion In South Korea, Buddhism and Con-
fucianism are the majority religions. Approx-
imately 28.4 percent of South Koreans are
Christian, and smaller numbers adhere to sha-
manism (belief in natural and ancestral spir-
its) and the national Korean religion Chundo
Kyo, formerly known as Tonghak (a mixture of
Confucian, Taoist, and Buddhist concepts).136
In North Korea, all religious beliefs other than
the national ideology of Marxism and self-
reliance are suppressed.
The first Korean immigrants at the turn of
the century were Christians attracted to the
United States as a religious homeland. Today,
71 percent identify themselves as Christian,
and there are 4,000 Korean Christian churches
in the United States. Only 6 percent of Korean
Americans identify themselves as Buddhists.137
Family Hundreds of years of Confucianism
in Korea have significantly influenced family
structure regardless of current religious affili-
ation. Family is highly valued, and loyalty to
one’s immediate and extended family is more
important than individual wants or needs.
Generational ties are more important than
those of marriage, and parents are especially
close to children. Korean Americans often
invite family members in Korea to join them
in the United States, and extended families are
not uncommon.
In Korea, a male is always the head of the
family; if a father is unable to fulfill that role,
the eldest son (even if still a child) takes on
that responsibility. Birth sequence orders
The economic success
of South Korea has lured
thousands of second-
generation Korean Amer-
icans to immigrate there,
where they have taken
positions in marketing,
public relations, and the
entertainment industry.
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C H A P T E R 11 3 5 3
life’s events within the family, and older male
children are traditionally awarded privileges,
such as advanced education, that younger
children and daughters are denied. The
role of women is to take care of the house
and care for children. Parenting tends to be
authoritative, and any child over the age of
five years exhibiting inappropriate behav-
ior brings disrespect on the entire family.139
Elders are esteemed and cared for in Korea.
The two major birthday celebrations in
Korean culture occur at age one and when
an individual reaches age sixty, meaning that
the person has survived a full five repeats of
the twelve-year cycle of life and attained old
age. The opinions of elders are respected, and
after age sixty a person is allowed to relax and
enjoy life.
Many changes occur in the Korean fam-
ily after immigration to the United States. For
example, the marriage bond often becomes
more important than obligations to one’s par-
ents. Few elders maintain traditional arrange-
ments of living with an eldest son’s family.
Some live with unmarried children or with
married daughters, or live alone.138 Male dom-
inance has declined with increased participa-
tion of women in the workplace, yet most
married women assume total responsibility
for home and their job and often are not paid
for their work if employed in a family-owned
business.
Traditional Health Beliefs and Practices
Traditional Korean concepts related health
to happiness, to the ability to live life fully, to
function without impairment, and to not be a
burden on one’s children.138 A good appetite
is a significant indicator of health.
The Korean system of health and illness
is closely related to Chinese precepts
(see the section “Traditional Health Beliefs
and Practices” in the Chinese part of the
chapter). The proper balance of um (yin) and
yang must occur to maintain health, influ-
enced by the relationships of the five evolu-
tive elements (fire, water, wood, metal, and
earth) and ki (vital energy). Too much or
too little of these forces results in illness. For
example, cold, damp, heat, or wind can enter
a body through the pores and then interfere
with ki and weaken yang. Symptoms of the
imbalance include indigestion, arthritis, and
asthma. Other disruptive causes such as phys-
ical exhaustion, eating too much or too little
food, and spiritual intervention (by ancestors
or supernatural deities) may also result in
disease.140
MICHAEL HAN, Foodservice Management
I am a Korean American born in South
Korea, and my parents moved to the United
States in 1979 when I was eight months old.
Members of my father’s family came over first
and then we followed.
We pretty much ate Korean meals at
home. Most meals consisted of short-grain
(sticky) rice, kimchi, with a soup/stew. The
soup contains meat (including Spam) and
vegetables. My father really likes meat, so
we probably had more than other Korean
families, and really unusual is that he added
butter as well. Now he adds olive oil instead
because his cholesterol is too high. Once in a
while we would have Korean barbecue, but
that was for special occasions or as a treat.
Dessert was mostly fruit.
When I was young I wanted to eat
more American food. For a while my mom
would make pancakes for breakfast on the
weekend, and when she stopped, I was
really upset. Now I eat American food for
breakfast and lunch but not dinner, and I
usually have rice once a day. My aunt has
taken over making kimchi for the family,
but I don’t live that close to her, so I only get
it once in a while. When I do have it—I eat
it all the time, so my supply lasts only a
week.
In general, it would be hard to get
Koreans in the United States to modify the
amount and type of rice they eat, and I don’t
think they would ever give up pickled, spicy
vegetables like kimchi.
N E W A M E R I C A N P E R S P E C T I V E S
Korean
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3 5 4 E A S T A S I A N S
Both digestion and circulation are promi-
nent in the maintenance of health, because
energy is absorbed into the body through
the stomach when food is mixed with air
or one of the forces, and the blood distrib-
utes this vital energy. Good-quality food is
restorative, but too much food can block ki,
resulting in cold hands and feet, cold sweats,
or even fainting.138 A few Koreans attribute
diabetes to eating too much rich food, such
as meat, sugar, or honey, and getting too lit-
tle exercise. Blood conditions that interfere
with the distribution of vital energy include
a lack of blood; a drying or hardening of the
blood (typical in old age, causing indigestion,
neuralgia, and body aches); and bad blood,
caused by a sudden fright, which can result
in chronic pain.
Korean-specific folk illnesses often include
somatic complaints that are an expression of
psychological distress.141 Excessive emotions
such as joy, sadness, depression, worry, anger,
fright, and fear are believed to result in certain
physical conditions. Hwabyung, attributed
most often to anger, victimization, or stress,
is associated with poor appetite, indigestion,
stomach pain, chest pain, shortness of breath,
weight gain, and high blood pressure among
other symptoms. A study of middle-aged
Korean women found that nearly 5 percent
suffered from hwabyung, with rates higher in
women of lower socioeconomic status, those
who lived in rural areas, those who were sepa-
rated or divorced, and those who smoked or
drank alcohol.142,143 Han, which causes a pain-
ful lump in the throat, occurs when a person
suffers disappointments and regrets, such as
guilt over the neglect of one’s children, par-
ents, or spouse. Shinggyongshaeyak, resulting
from stress (especially from oversensitivity
and lack of happy interactions with fam-
ily and friends), can cause insomnia, weight
loss, and nervous collapse. Traditional cures
include use of a shaman or spiritual mediator
(mansin or mudang) to determine whether the mudang) to determine whether the mudang
cause of an illness is due to disharmony with
one’s ancestors or natural and supernatural
forces.140 Sacred therapeutic rituals to rectify
such spiritual disruptions are conducted with
the patient, the family, and sometimes the
community.
Hanyak is the traditional approach to natu-
ral cures in Korea. It is typically practiced by
a hanui. When a client visits a hanui, he or
she obtains a medical history, observes how
the patient looks, listens to the quality of the
voice, and takes the patient’s pulse. More than
twenty-four pulse conditions are defined, from
floating to sunken, and smooth, vacant, or
accelerated.144 Hanyak medications are classi-
fied according to their plant, animal, or min-
eral source, and mixed in ways to balance um
(yin), yang, and ki. Other physical therapies to
restore harmony and vital energy, such as acu-
puncture, moxibustion, cupping, and sweating
(see Chapter 2), may also be applied. In the
United States, the hanui may use some bio-
medical procedures in conjunction with tradi-
tional practices. It has been reported that some
hanui take blood pressures and body tempera-
tures. Some even offer the convenience of tak-
ing hanyak prescriptions in pill form so that
bitter-tasting broths or teas are avoided.144
Many professional Korean health practices
have been popularized and may be used as
home remedies. In the United States, where
access to traditional healers may be limited
in some regions, the mother or grandmother
in the home often takes responsibility for
administering these cures.145 Some Koreans
believe that a person’s fate is determined by
the forces of um and yang at the moment of
birth. Christian Koreans may believe strongly
in faith healing and in fate as determined by
God. However, it does not appear to influ-
ence their desire for health care or practicing
health-promoting lifestyles.146
Traditional Food Habits
Ingredients and Common Foods
Korean cuisine is neither Chinese nor Japa-
nese, although it has been influenced by both
styles of cooking. It is a distinctly hearty Asian
fare that is highly seasoned and instanta-
neously recognizable as Korean by its flavors
and colors. Sweet, sour, bitter, hot, and salty
tastes are combined in all meals, and foods
are often seasoned before and after cooking.
Five colors—white, red, black, green, and yel-
low—are also important considerations in the
preparation and presentation of dishes.
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C H A P T E R 11 3 5 5
Staples Korean cooking is based on grains
flavored with spicy vegetable and meat, poul-
try, or fish side dishes. Korean staples are
listed in Table 11.5. Rice is the foundation of
the Korean diet. Rice cooking is an important
skill in Korea; the rice must be neither under-
done nor overcooked and mushy. Short-grain
varieties are usually preferred, both a regular
and glutinous (sticky) type, the latter most
often in sweets. Long-grain rice, called Viet-
namese rice in Korea, is available but not com-
mon. Millet and barley are used, most often as
extenders for rice.
Noodles are also an important staple and
are made from wheat, buckwheat, mung
beans, and from the starch of sweet potatoes
and the kudzu plant (a pervasive vine).147 The
buckwheat variety is often used in cold dishes.
Fritters, dumplings, and pancakes flavored
with scallions, chile pepper, and sometimes
fish or meat placed directly in the batter before
cooking are other popular grain dishes.148
Vegetables are served at every meal. Chi-
nese cabbage (both bok choy and napa), Euro-
pean cabbage, and a long white radish (similar
but not identical to the Japanese daikon rad-
ish) are eaten most often. Eggplant, cucum-
bers, perilla (a mint-family green also called
shiso), chrysanthemum greens, bean sprouts,
sweet potatoes, and winter melon are also very
popular. Vegetables are added to soups and
braised dishes and are often served individu-
ally as hot or cold side dishes. Pickled, fer-
mented vegetables are included at every meal,
usually in the form of kimchi, which comes
in many types, based on seasonal availability
of produce. A common version of kimchi is
made with shredded Chinese cabbage and
white radish, heavily seasoned with garlic,
onions, and chile peppers, then fermented.
Cucumber, eggplant, turnip, and even fruits
or fish are sometimes added. Some recipes
are mild, but most are very hot. Seaweed is
eaten as a vegetable, including kelp and laver
(called kim). Kim is brushed with sesame oil,
salted, and toasted to make a condiment. The
seaweed called wakame in Japan is used in
Korean soups.149
Fruits are eaten mostly fresh. Crisp, juicy
Asian pears (known as apple pears in the
United States) are very popular; apples,
cherries, jujubes (red dates), plums, melons,
grapes, tangerines, and persimmons are also
common.
Fish and shellfish are eaten throughout
Korea. Fresh fish dishes are preferred near
the coast or in river regions, but dried or
salted fish is more common in the inland
areas. Saewujeot, a Korean fermented fish
sauce, is made from tiny shrimplike crusta-
ceans. Saewujeot flavors many dishes. Beef
and beef variety cuts are especially popular
in Korea.109 Cubes, thin slices, or small ribs
of marinated beef are barbecued or grilled at
the table over a small charcoal brazier or gas
grill. Bulgogi, grilled strips of beef flavored
with garlic, onions, soy sauce, and sesame oil,
is best known. Another Korean specialty is
the fire pot (sinsullo), similar to the Mongo-
lian hot pot, featuring beef or liver, cooked egg
strips, sliced vegetables (e.g., mushrooms, car-
rots, bamboo shoots, onions), and nuts that
are cooked in a seasoned broth heated over
charcoal. After the morsels of food have been
eaten, the broth is served as a soup. Chicken
and poultry are not especially popular in
Korea. Soybean products, however, are com-
mon, including soy sauce and soy paste. Bean
curd, made from soybeans (tobu) or mung
beans (cheong-po), is a favorite. Mung beans,
adzuki beans, and other legumes are steamed
and added to many savory and sweet dishes.
Nuts, such as pine nuts, chestnuts, and pea-
nuts, and toasted, crushed sesame seeds are
frequent additions as ingredients or garnish.
Seasonings are the soul of Korean cooking.
Garlic, ginger root, black pepper, chile pep-
pers, scallions, and toasted sesame in the form
of oil or crushed seeds flavor nearly all dishes.
Ginseng is added to some soups.149 Prepared
condiments, such as soy sauce, toenjang (fertoenjang (fertoenjang -
mented soy bean paste), fish sauce (saewu-
jeot), and hot mustard are also frequently
added to foods. Kochujang, a fermented jamKochujang, a fermented jamKochujang -
like chile paste, is prepared by each family on
March 3 and then traditionally stored for use
throughout the year in black pottery crocks.
Marinades and dipping sauces are common.
Soup or a thin barley water is used as a bev-
erage. Herbal teas are very popular; ginseng tea
flavored with cinnamon is a favorite. Ginger,
cinnamon, or citron can also be used separately
To make an accurate
diagnosis, a hanui must
determine a client’s
character through
questions such as
“Do you like meats or
vegetables?,” “What
season is your favorite?,”
“Do you worry much?,” or
“Are you stubborn?”144
The preparation of
kimchi every autumn is
a special family event. In
the past a family’s wealth
was demonstrated by
the ingredients in their
kimchi, with rare veg-
etables and fruits used
by the most affluent.
Koreans consume over
2 tons annually.
South Korea is the largest
consumer of Spam out-
side the United States.
It is believed that a Por-
tuguese Catholic priest
introduced chile pep-
pers into Korea in the
sixteenth century. They
were quickly adopted
and have become ubiq-
uitous in the cuisine.
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3 5 6 E A S T A S I A N S
TA B L E 11. 5 Cultural Food Groups: Koreans
Group Comments Common Foods Adaptations in the United States
Protein Foods
Milk/milk
products
Milk and milk products are
generally not consumed or used
in cooking.
Milk, yogurt, and cheese product
consumption increases.
Meat/poultry/
fish/eggs/
legumes
Beef and beef variety cuts are
especially popular. Barbecuing
is a popular method for cooking
meat.
Fish and shellfish, either fresh,
dried, or salted, are eaten
throughout Korea.
Soybean products are added to
many dishes.
Meat: beef, variety meats (heart, kidney,
liver), oxtail, pork
Fish and shellfish: abalone, clams,
codfish, crab, cuttlefish, jellyfish,
lobster, mackerel, mullet, octopus,
oysters, perch, scallops, sea cucumber,
shad, shrimp, squid, whiting
Poultry and small birds: chicken, pheasant
Eggs: hen
Legumes: adzuki, lima beans, mung
beans, red beans, soybeans
Beef, pork, and poultry
consumption rises. Fish is eaten
frequently. Many still consume
tofu several times a week.
Younger Korean Americans may
consume more pork products.
Cereals/Grains Rice is the most important
component of the Korean diet.
Noodles made from wheat, mung
bean, or buckwheat flours are an
important staple.
Barley, buckwheat, millet, rice (short-
grain glutinous), wheat
Rice consumption declines, but
it is still eaten every day. Breads,
cereals, and pasta popular
with well-acculturated Korean
Americans.
Fruits/Vegetables A wide variety of fruits are
consumed.
Vegetables are often pickled and
are eaten at every meal.
Fruits: apples, Asian pears, cherries,
dates (jujubes, red date), grapes,
melons, oranges, pears, persimmons,
plums, pumpkin, tangerines
Vegetables: bamboo shoots,
bean sprouts, beets, cabbage
(Chinese, European), celery, chives,
chrysanthemum leaves, cucumber,
eggplant, fern, green beans, green
onion, green pepper, leaf lettuce, leeks,
lotus root, mushrooms, onion, peas,
perilla (shiso), potato, seaweed (kim),
spinach, sweet potato, turnips, water
chestnut, watercress, white radish
Increased intake of fruits and
vegetables is noted. The
majority eat kimchi daily.kimchi daily.kimchi
Additional Foods
Seasonings Sweet, sour, bitter, hot, and salty
tastes are combined in all meals.
Dishes are often seasoned during
and after cooking.
Chile peppers (kochujang—fermented
chile paste), Chinese parsley (cilantro),
chrysanthemum greens, cinnamon,
garlic, ginger root, green onions, MSG,
hot mustard, red pepper sauce, pine
nuts, rice wine, saewujeot (fermented saewujeot (fermented saewujeot
fish sauce), sesame seed oil, sesame
seeds, soy sauce, sugar, vinegar, sea salt
Nuts/seeds Chestnuts, gingko nuts, hazelnuts,
peanuts, pine nuts, pistachios, sesame
seeds, walnuts
Beverages Herbal teas are popular, as well
as rice tea. They are commonly
served after the meal.
Soup or barley water is used as a
beverage with the meal.
Barley water, beer, coffee, fruit drinks, green
tea, honey water, jasmine tea, magnolia
flower drink, rice tea, rice water, rice
wine, soju (sweet potato vodka), spiced
teas (ginseng, cinnamon, ginger), wines
made from other ingredients
Hot barley water is still the
preferred beverage and is
served after the meal. Increased
consumption of soft drinks.
Fats/oils Animal fat is rarely used. Sesame oil, vegetable oils
Sweeteners Sweets are made for snacks and
special occasions.
Honey, sugar Cookies and other sweets popular
with Korean American youth.
©
C
en
ga
ge
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ea
rn
in
g
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C H A P T E R 11 3 5 7
to make a spice tea. A common drink is rice
tea, made by pouring warm water over toasted,
ground rice or by simmering water in the pot in
which rice was cooked. On special occasions,
wine might be served. Wines are made from
rice and other grains; some include various
flower blossoms or ginseng as flavorings. Beer
is also well liked. Milk and other dairy products
are generally not consumed or used in cooking.
Meal Composition and Cycle
Daily Patterns Three small meals, with fre-
quent snacking throughout the day, are
typical in Korea. Breakfast was traditionally
the main meal in Korea, but today is more
likely to be something light, caught on the
run. Soup is almost always served at break-
fast, along with rice (usually as gruel). Eggs,
meat or fish, or vegetables may top the meal.
Kimchi and dipping sauces are the usual
accompaniments.
Lunch is typically noodles served with
broth of beef, chicken, or fish and garnished
with shellfish, meat, or vegetables. Supper is
more similar to breakfast, but with steamed
rice. In many modern homes, it has become
the main meal of the day. Snacks are widely
available from street vendors, including grilled
and steamed tidbits of all types. Sweets, such
as rice cookies and cakes, or dried fruit (espe-
cially persimmons) are also popular snacks.
Rice is considered the main dish of each
meal. Everything else is served as an accom-
paniment to the rice and is called panch’an.
For dinner, at least one meat or fish dish is
included, if affordable, and two or three veg-
etables are usually served. Kimchi is always
offered. Soup is very popular and is served at
most meals. Individual bowls of rice and soup
are served to each diner, and panch’an dishes
are served on trays in the center of the table for
communal eating. Wine may be served before
the meal with appetizers such as batter-fried
vegetables, seasoned tobu, pickled seafood,
meatballs, or steamed dumplings. Dessert is
seldom eaten, although fresh fruit sometimes
concludes the meal. Hot barley water or rice
tea is served with the meal.
Drinking is a social ritual, practiced mostly
by men. Distilled beverages like soju, a sweet
potato vodka, are consumed with snacks like
spicy squid or chile peppers stuffed with beef.
A special category of foods, called anju,
are considered an alternative to a full meal.
Analogous to tapas in Spain (see Chapter
6), they are small dishes especially well
suited to eating while socializing and drink-
ing.109 Examples include scallion-flavored
pancakes usually accompanied by Korean
rice wine, mukhuli, Japanese-style sashimi,
quail eggs, bits of pork, raw crab in chile
paste, or dumplings. These items are often
served as appetizers in Korean American
restaurants.
Etiquette Chopsticks and soup spoons are the
only eating utensils used in Korea. In the past,
seating was around a low, rectangular table on
the floor, and young women were assigned
the awkward corner seats (today most tables
are set with chairs). Traditionally, elders are
served first, and children are served last at
the meal. It is considered polite to fill the soy
sauce dish of the people one is sitting beside.
Food is always passed with the right hand, and
a communal beverage may be passed for all
to share.
Special Occasions Korean cooking was histor-
ically divided into everyday fare and cuisine
for royalty. The traditions of palace cooking
and food presentation, including the use of
numerous ingredients in elaborate dishes, are
At Korean weddings,
sweetened dates rolled
in sesame seeds are
tossed at the bride by her
in-laws to ensure health,
prosperity, and numer-
ous children.
Dog meat soup is eaten
by some men to enhance
their strength and physi-
cal prowess.
Boyak is often given as a
gift, particularly to one’s
parents, to promote
long life.
▲ Korean street vendors shredding
daikon for the preparation of the
spicy vegetable pickle kimchi.
M
ic
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F
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em
an
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yc
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is
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3 5 8 E A S T A S I A N S
seen today in meals for special occasions. At a
meal celebrating a birthday or holiday, or one
shared with guests, more dishes are served
and both wine and dessert are offered. For
special occasions, Koreans offer a thick drink
of persimmons or dates, nuts, and spices, or a
beverage made with molasses and magnolia
served with small, edible flowers floating on
top.
Both Koreans and Korean Americans cel-
ebrate several holidays throughout the year.
The first is New Year’s, called Sol, a three-day
event at which traditional dress is worn and
the elders in the family are honored. Festivi-
ties include feasts, games, and flying kites. On
the first full moon, in a tradition reflecting
ancient religious rites, torches are lighted, and
firecrackers are set off to frighten evil spirits
away. Shampoo Day (Yadu Nal) on June 15
is when families bathe in streams to ward off
fevers. Thanksgiving (Chusok) is a fall harvest
festival; duk, steamed rice cakes filled with
chestnuts, dates, red beans, or other items, are
associated with the holiday.
A special ceremony is observed on a child’s
first birthday. He or she is dressed in tradi-
tional clothing and placed among stacks of
rice cakes, cookies, and fruit. Family and
friends offer the child objects symbolizing
various professions, such as a pen for writ-
ing or a coin for finance, and the first one
accepted is thought to predict his or her future
career.135
Therapeutic Uses of Food
Many Koreans follow the um and yang food
classification system. Little has been reported
about specific foods, although Koreans are
believed to adhere to categorizations simi-
lar to other Asians: um (cold) foods include
mung beans, winter melon, cucumber, and
most other vegetables and fruits; meats
(e.g., beef, mutton, goat, dog), chile peppers, gar-
lic, and ginger are considered yang (hot) foods.
Preparation of healthy, tasty food is an
important way that Korean women show
affection for family and friends.138,148 Good
appetite is considered a sign of good health.
Foods that are believed to be health promot-
ing include bean paste soup, beef turnip soup,
rice with grains and beans, broiled seaweed,
kimchi, and ginseng tea. Ginseng products are
often used to promote health and stamina and
to alleviate tiredness. One very popular tonic,
called boyak, combines ginseng and deer horn
or bear gallbladder.144
More than one-half of Korean American
respondents in one survey reported using
ginseng, with older women more likely to
use such products than men or younger
women.150 Other home remedies commonly
used include ginger tea, yoojacha (hot cit-
rus beverage), bean sprout soup, and lemon
with honey in hot water. Restorative herbal
medicines, vitamin supplements, meat soups,
bone marrow soup, and samgyetang (game-
hen soup) also were mentioned by subjects as
useful when feeling weak.
A study of pregnant Korean American
women suggests that certain foods, such as
seaweed soup, beef, and rice, are thought to
build strength during this difficult time.151
Food taboos during pregnancy often involve
the concept of “like causes like.” For instance,
eating blemished fruit may result in a baby
with skin problems. Other such items men-
tioned are chicken, duck, rabbit, goat, crab,
sparrow, pork, twin chestnuts, and spicy foods.
Although most food avoidance was attributed
to personal preference and availability, many
of the women acknowledged familiarity with
the traditional beliefs. Korean women tradi-
tionally consumed seaweed soup, miyuk kook,
three times a day for seven weeks after the
birth of a child to restore their strength.
▲ Korean Americans cel-
ebrate Sol, or the New Year,
on the first full moon.
G
ar
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Co
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C H A P T E R 11 3 5 9
Contemporary Food Habits
in the United States
Adaptations of Food Habits
Ingredients and Common Foods A survey
of Korean Americans in the San Francisco
area showed that many traditional Korean
food habits continue after immigration to
the United States. Nearly all respondents ate
rice at one meal every day, and two-thirds ate
kimchi daily. Beef and beef variety cuts were
consumed regularly, and fish was eaten at least
once a week. Sesame oil/seeds and vegetable
oils were used more often than butter or may-
onnaise. Soy sauce, soybean paste, kochujang,
and garlic were the most popular condiments.
More than 40 percent of Korean Americans
surveyed consumed tobu several times a week.
Pork and pork products were not commonly
eaten, although younger respondents reported
more frequent use of these foods than older
subjects. Length of stay in the United States
had little impact on diet.152 Among Korean
American adults in Chicago, only one-third
reported increased intake of beef, dairy prod-
ucts, bread, coffee, and soda (combined with
decreased consumption of fish and rice), and
a majority continued to follow Korean dietary
patterns.153
A national study of mostly first-genera-
tion Korean Americans found similar trends.
Regular consumption continued of some tra-
ditional dishes and ingredients, such as rice,
kimchi, garlic, scallions, Korean soup, sesame
oil, Korean stew, soybean paste, and kochu-
jang. Frequently consumed American foods
included oranges, low-fat milk, bagels, toma-
toes, and bread. Regularly eaten foods com-
mon to both cultures included onions, coffee,
apples, eggs, beef, carrots, lettuce, fish, and tea.
The researchers found that most respondents
had access to Korean items, but as participa-
tion in American social life increased, accep-
tance of American foods increased. Persons
who had someone familiar with Korean fare
to cook for them were more likely to continue
eating traditional dishes than were those who
cooked for themselves.154
In contrast, one study of Korean Ameri-
cans, in New York found that while less
acculturated adults consumed a relatively
traditional Korean diet, well-acculturated
adults consumed significantly more bread,
cereals, spaghetti, ham, green salad, corn,
chocolate, candies, and diet soft drinks.155
Another study reported that well-acculturated
Korean American mothers were less likely to
prepare Korean dishes at home and were more
likely to dine out.156 Research on Korean,
Korean American, and American adolescents
found that Korean American teens adopted a
diet in-between that of traditional Korean and
American food patterns, eating less rice and
kimchi, but more cookies and other sweets
and soft drinks.157
Although milk and dairy products are
not consumed in Korea, these foods are
often well accepted in the United States. One
study indicated that more than one-half of
the subjects reported drinking milk or eat-
ing yogurt or cheese one or more times each
week.152 Another study of pregnant Korean
American women reported a similar finding
that 56 percent of respondents drank milk
daily.151 Korean American adolescent boys
were found to consume milk at 22 percent of
meals, and teen girls drank it at 17 percent
of meals.157
S A M P L E M E N U
Dinner in Korea
S oy b e an S pr out S oup a,b
Bulgogi (K or e an B ar b e cue Be e f ) a,b
S e as on e d Tobu S e as on e d Tobu S e as on e d ( B e an C u r d ) , a C h r y s an t h e m u m L e af S al ad aC h r y s an t h e m u m L e af S al ad aC h r y s an t h e m u m L e af S al ad
S e as on e d E g gplan t a
S t e ame d R ic e , Kimchi
A pple P e ar
Bar le y W at e r or G in s e n g T e a
aKwak, J. 1998. Dok Suni: Recipes from my mother’s Korean kitchen.
New York: St. Martin’s Press.
bKorean Recipes at http://koreanrecipes.org/
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
3 6 0 E A S T A S I A N S
It should be noted that many changes
in the traditional diet have been observed
in Korea. A study of adolescents found only
30 percent consumed a diet dependent on rice
and kimchi, while 70 percent ate a modified
diet with added bread, noodles, cookies, pizza,
and hamburgers.158 Recent immigrants from
Korea may prefer a more Westernized diet
than earlier immigrants, even when length of
stay is shorter.
Korean American Cuisine Koreans have
blended their traditional flavoring and cook-
ing techniques to American foods. One of
the better-known dishes is the Korean taco,
a Mexican corn tortilla with Korean style fill-
ings, such as bulgogi (grilled beef ) and kim-
chi. It started in a food truck in Los Angeles
and rapidly spread across the country, espe-
cially in metropolitan areas. Other examples
of Korean fusion dishes are kimchi que-
sadillas, short rib sliders, and Korean fried
chicken.
Meal Composition and Cycle Little has been
reported regarding Korean American meal
composition and cycle. It is assumed that
because Korean meal and snacking patterns
are similar to those in the United States, three
meals a day remain common. One study
found American foods were most popular at
breakfast and lunch, but traditional Korean
dishes were favored for dinner.159 Elderly
Korean Americans are more likely to con-
sume a Korean meal pattern for most of their
meals.160 Survey data suggest that hot barley
water served after meals is still the preferred
beverage of Korean Americans.152 Accul-
turation and/or length stay has been found
to increase the frequency of eating out for
Korean Americans.161,162
Korean Americans observe traditional
Korean holidays (see “Special Occasions” in
this section) as well as other events, such as
Buddha’s birthday (April 8), Korean Memo-
rial Day (June 6), South Korean Constitution
Day (July 17), and Korean National Founda-
tion Day (October 3). Fathers are honored on
June 15. In addition, Christian Americans of
Korean descent celebrate the major religious
holidays.
Nutritional Status
Nutritional Intake Few health studies focusing
on Korean Americans have been published.
Most research on Asian Americans combines
heterogeneous Asian and sometimes Pacific
Islander populations. One study found that
Korean Americans maintained a relatively
traditional diet and that even with the addi-
tion of some American foods, 60 percent of
calories came from carbohydrates and only
16 percent from fat.153 Higher intakes of vita-
mins A and C, beta-carotene, niacin, and
fiber are associated with a more traditional
diet. High sodium intake is also common
when Korean foods are preferred.153,155,157,163
Korean Americans who adopt more American
foods are reported to consume more calories
and have higher intakes of total fat, saturated
fat, cholesterol, B1, vitamin E, folate, iron, and
zinc. Calcium, which is often deficient in the
Korean diet, is increased with the use of dairy
products. A survey of Korean Americans con-
ducted in a midwestern city found that those
with the worst eating habits were younger, not
married, less educated, and more acculturated
to mainstream American culture.164
Self-reported health behaviors and
medical disorders indicate that 22 percent
of Korean Americans smoke cigarettes,
less than 10 percent drink moderately or
heavily, 40 percent are physically inactive,
and 30 percent overweight or obese. Their
reported medical disorders were: 4.4 percent
heart disease and 17 percent hypertension,
4 percent type 2 diabetes, 11 percent ulcers,
cancer was less than 2 percent, and hepatitis B
was 6 percent.65,158,159,172,173
Age-adjusted mortality rates for Korean
Americans are lower than for the general
population, although infant mortality rates
are somewhat higher than those for whi
tes.76,77,165,166 The more common causes of
death among Koreans is stomach cancer;
higher incidence of stomach, liver, and esoph-
ageal cancers have been found among Korean
Americans as compared to whites.73,167,168,169
However, self-reported incidence of digestive
diseases decreased with increase length of res-
idence in the United States but increased with
more servings of rice or rice dishes.169 The rate
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C H A P T E R 11 3 6 1
of hepatitis B (responsible for most liver can-
cer) is very high in Korean Americans.
Self-reported health behaviors and medi-
cal disorders showed that 22 percent of Kore-
ans smoke cigarettes, less than 10 percent
drink moderately or heavily, 40 percent were
physically inactive and 30 percent overweight
or obese. Reported medical disorders were
heart disease (4.4 percent), hypertension
(17 percent), type 2 diabetes (4 percent), ulcers
(11 percent), cancer (less than 2 percent), and
hepatitis B (6 percent).65,171,172,173,184,186
Other research also reported high blood
pressure rates in Korean Americans, but were
not consistent in being higher or lower than
the U.S. average.170,175,176,177,178 In Korea, hyper-
tension affects 42 percent of the population.174
No correlation with diet (including alcohol,
spicy food, or salt intake) was noted.179 Korean
Americans diagnosed with high blood pres-
sure are less likely to take hypertension medi-
cations or to follow their physician’s advice on
losing weight or lowering sodium intake.177,180
Incidence of death from heart disease also has
been found to be very low.
Information on obesity in Korean Ameri-
cans is limited. One study found that 46 per-
cent of Korean Americans living in California
were overweight or obese.181 More recently, a
literature review determined that first-gener-
ation, foreign-born Koreans had significantly
higher five-year increases in BMI, which was
not associated with length of U.S. residence
that is normally seen in other foreign-born
Americans.182
Koreans have higher alcohol consump-
tion rates compared to other Asian groups.183
However, for 77 percent of Korean Americans,
drinking occurred at social occasions.132
Counseling Korean American clients are
similar to many Asians in that language bar-
riers may interfere with counseling. Proficient
translators and cultural interpreters are often
crucial to effective communication. Cultural
attitudes may also interfere with health care.
A client may be ashamed of needing help and
fear being a burden to other family mem-
bers during illness. Many Korean Americans
avoid screening exams.139,185 The stresses of
acculturation may be especially severe in the
Korean American community due to the large
number of recent immigrants.
Koreans use a quiet, nonassertive approach
to conversation. Emotional expression over
pleasant topics may be animated, but dur-
ing confrontation, emotional displays are
avoided.21 Loud talking or laughing is con-
sidered impolite (although some Koreans may
laugh excessively when embarrassed). A mea-
sured, indirect approach to topics is appreci-
ated. Koreans may be hesitant to say no or to
disagree with a statement. Instead, tipping the
head back and sucking air through the teeth
are often used to signal dissension. Direct eye
contact is expected, and it is used to demon-
strate attentiveness and sincerity. Koreans use
few hand gestures when talking. Touching is
uncommon, except for a light, introductory
handshake between men. Hugging, kissing,
and back patting should be avoided, as should
crossing one’s legs or putting feet on the fur-
niture. Rising whenever an elder enters the
room and touching the palm of the left hand
to the elbow of the right arm when shaking
hands or passing an item to an elder is con-
sidered respectful.91,187
The family is responsible for all its members
and is usually involved in health care. In one
study it was found that most Korean Americans
believed a patient should not be told of a ter-
minal illness, and the family should make any
life support decisions, although younger, bet-
ter educated, and wealthier Korean Americans
were more open to patient autonomy.186,188,189 It
also is helpful to determine who is head of the
household (often the father, eldest son, or other
male member). Some Koreans find biomedi-
cal health systems very unsatisfactory. They
become frustrated when a physician relies on
lab tests to determine illness, especially if they
are told there is no reason for a specific com-
plaint, or conversely, that some problem exists
even though they have no symptoms. They also
may disagree with the cause of a complaint;
some somatic symptoms may result from
emotional distress, yet mental illness is highly
stigmatized. Furthermore, they may expect
physical treatments (e.g., acupuncture or cup-
ping) from the provider and are likely to want a
As with other Asians
who use moxibustion or
cupping, it is important
for health care providers
to determine the cause
of burns and bruises on
clients before assuming
abuse has occurred.
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3 6 2 E A S T A S I A N S
permanent cure.138 Inconvenient hours and the
need for an appointment may also discourage
the use of biomedical health care.
In the United States, clients often administer
home remedies and consult shamans or hanui
before (or while) they seek advice from biomedi-
cal health care providers.176 There is concern
regarding the safety of some traditional products
and overmedication due to herbal remedies used
simultaneously with prescriptive medications.140
For example, clamshell powder (haigefen) may
cause stomach and muscle pain or fatigue from
lead toxicity.139 Korean Americans must some-
times choose between treatments when tradi-
tional and biomedical health practitioners work
at cross purposes; professionals of both systems
have been known to advise clients against using
the services of the other.141,189
Religious affiliation varies in Korean Ameri-
can clients and may have a significant impact on
health and nutritional care. One study found that
the influence of messages from religious leaders
and congregants that discouraged excessive eat-
ing or encouraged exercise was associated with
fewer overweight or obese in Korean American
congregants.190 An in-depth interview should
be used to ascertain religious beliefs, degree of
acculturation, traditional health practices used,
and personal dietary preferences.
Review Questions
1. List the countries for each region of Asia: East
Asia, Southeast Asia, and South Asia.
2. Visit a Chinese restaurant or just look at the
menu. Can you tell which region of China
the recipes represent? How? Why do so many
Chinese restaurants in the United States cook
Cantonese style (Guangdong)?
3. What are the basic tenets of Confucianism,
Taoism, and Buddhism? How might these reli-
gions influence Asian food culture?
4. Describe what is meant by Traditional Chinese
Medicines, Kanpo, and Hanyak. How might
these be integrated into the Chinese, Japanese,
and Korean meaning of a balanced diet and life?
5. What are the staples of the Asian diet? Describe
some common foods derived from soybeans.
What are different types of tea from Asia—
describe how they differ, including their tastes.
6. How did the Chinese influence the cuisine and
worldview of the Koreans and the Japanese?
Provide two example of their influence, one
each in Korea and Japan.
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D I S C U S S I O N S T A R T E R S
Examining the Diet of Asian Americans
In small groups of three or four, compare and contrast the diet and culture of Chinese
Americans, Japanese Americans, and Korean Americans, with each group focusing on a
different aspect of the diet and culture of these groups:
Within your group, try to come to a consensus on what findings to report to the rest
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findings of your previous group, and, as a group, discuss the relationship of traditional
attitudes toward diet and health and changes in diet and health due to immigration
to the United States.
Group A: The food habits and the typical eating etiquette and meal composition
of these three immigrant groups
Group B: Issues involved in counseling these immigrant groups on diet and health
Group C: Attitudes within each immigrant group toward diet, health, and
medical treatment, notably attitudes toward traditional home culture
medical treatment and U.S. biomedicine
Group D: Amount of obesity, diabetes, hypertension, and other diseases within
each immigrant group
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3 7 0
The Philippines Substantial immigration from
the Philippines to the United States started in
1898 after the country became a U.S. territory.
Approximately 113,000 young male Filipinos
traveled to the Hawaiian Islands between
1909 and 1930 to work in the sugarcane
fields. Many of these immigrants later moved
to the U.S. mainland. These early immigrants
were considered U.S. nationals and carried
U.S. passports, yet they were not allowed
to become citizens or own land. Most were
uneducated peasant laborers from the island
of Illocos. Because they were not permitted to
bring their wives or families, social and politi-
cal clubs replaced the family as the primary
social structure.
In 1924 the immigration of Filipinos
slowed as a result of Asian exclusion laws
(see Chapter 11, for more information). After
World War II, it became legal for Filipinos
to become U.S. citizens, and the number of
immigrants increased. Significant numbers
of Filipinos arrived in the United States after
1965 when the U.S. immigration laws were
changed, and by 1980 more than 350,000 had
emigrated to mostly urban areas. Two-thirds
of the Filipinos who arrived after World War II
qualified for entrance as professional or tech-
nical workers. Yet discrimination against
Asians often forced Filipinos into low-
paying jobs. “Little Manilas” formed in many
California cities, and similar homogeneous
neighborhoods were found in Chicago, New
York City, and Washington, DC, where some
Filipinos opened small service businesses to
meet the needs of their community.
Southeast Asians
and Pacific Islanders
Southeast Asians and Pacific Islanders live in similar tropical regions and may share some common ancestors, yet
their cultures have diverged markedly over
the centuries. The countries of Southeast Asia
have developed under hundreds of years of
Chinese domination. Spanish expansionism
in the Philippines and French occupation in
Vietnam were also significant. In contrast,
Asian and European contact in the Pacific
Islands was limited until the eighteenth cen-
tury, and subsequent foreign influence almost
completely overwhelmed the traditional
indigenous societies. This section discusses
the cultures and cuisines of the Southeast
Asians who have immigrated in substantial
numbers to the United States—Filipinos,
Vietnamese, Cambodians, and Laotians—as
well as those Pacific Islander groups with
significant American populations—Native
Hawaiians, Samoans, Guamanians, and
Tongans.
Southeast Asians
Cultural Perspective
History of Southeast Asians in the
United States
Immigration Patterns Most Filipinos immi-
grate to the United States for educational
and economic opportunities. In contrast, the
majority of mainland Southeast Asians who
have come to the United States have arrived
since the 1970s as refugees from the political
conflicts of the region.
12 CHA
P
T
E
R
The only Filipinos allowed
to apply for U.S. citizen-
ship prior to 1946 were
those who had enlisted
in the U.S. Navy, Naval
Auxiliary, or Marine Corps
during World War II;
had served at least three
years; and had an honor-
able discharge.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 2 3 7 1
Figure 12.1
Southeast Asia and the
Pacific Islands.
Vietnam Vietnamese immigration to the
United States is characterized by three dis-
tinct waves. The first occurred when South
Vietnam fell to the North in 1975, and
60,000 Vietnamese left the country with
the assistance of the United States. Another
70,000 managed to flee on their own. Most
of these refugees had been employed by the
United States or were members of the upper
classes. They immigrated in intact family
AUSTRALIA
PHILIPPINES
M A L A Y S I AM A L A Y S I AM A L A Y S I AM A L A Y S I AM A L A Y S I AM A L A Y S I AM A L A Y S I AM A L A Y S I AM A L A Y S I AM A L A Y S I AM A L A Y S I AM A L A Y S I AM A L A Y S I A
I
N D O N E S I A
CAMBODIA
LAOS
THAILAND
NEW GUINEANEW GUINEANEW GUINEANEW GUINEA
VIETNAM
NEW
CALEDONIA
S O L O M O N
I S L A N D
S
M I C
R
O
N
E
S
I
A
M E L
A
N
E
S
I
A
South
China
Sea
Indian Ocean
©
C
en
ga
ge
L
ea
rn
in
g
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
3 7 2 S O U T H E A S T A S I A N S A N D P A C I F I C I S L A N D E R S
Figure 12.1
Southeast Asia and the
Pacific Islands (continued).
groups and were able to bring their property
with them. From 1975 to 1977 another wave
of Vietnamese left for political or economic
reasons, often escaping by sea. Many of these
boat people left their families and what little
money they had to find freedom. The third
phase of immigration started in 1978, when
increasing numbers of ethnic Chinese living
in Vietnam fled the country, again by boat.
This wave of immigration was accelerated by
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C H A P T E R 1 2 3 7 3
the Chinese invasion of northern Vietnam in
1979. This second group of boat people left
with no financial resources, and many lost
family members escaping in unseaworthy
vessels that were easy prey for pirates. After
being rescued, the boat people often lived for
several months, even years, in refugee camps
in various Southeast Asian countries before
coming to the United States. In addition, the
United States and Vietnam developed the
Orderly Departure Program (ODP) in 1979
to bring imprisoned former South Vietnamese
soldiers and the approximately 8,000 Amera-
sians, children of U.S. fathers and Vietnamese
mothers, to the United States.
Cambodia and Laos Cambodian and Lao-
tian immigration to the United States did not
begin until the United States granted asylum
to the residents of the refugee camps along the
border with Thailand in 1976 to 1979. Inter-
national concern about the large numbers
of refugees and the conditions in the camps
prompted accelerated admittance of Southeast
Asian immigrants worldwide. Many of the
refugees were members of tribal populations
who lived in the isolated mountainous regions
of Southeast Asia, including the Hmong
and Mien (ethnic Chinese populations who
migrated south to escape persecution in the
eighteenth century).
Current Demographics and Socioeconomic Status
Filipino The Filipino American population
has more than doubled since 1980. Over
3.6 million Filipinos live in the United States,
according to 2013 Census estimates. Almost
half reside in California, with significant pop-
ulations of more than 30,000 Filipinos found
also in Hawaii, Florida, Illinois, New York,
New Jersey, Texas, and Washington.1 It should
be noted that Filipino Americans are a very
heterogeneous group who come from differ-
ent cultural groups within the Philippines and
often speak a variety of native languages.1,2
Over 50 percent of Filipino Americans
are foreign born; citizenship rates are higher
than in other Asian groups. Educational
attainment is also high. Nearly 46 percent
of Filipino Americans hold college degrees.2
Family median incomes are 50 percent above
the national average, combined with poverty
rates approximately half that of the general
U.S. population, both due to higher earnings
and, sometimes, to pooled income of several
adults living in each household.4
Some Filipinos find that their education or
professional experience is not recognized in
the United States, forcing them to accept blue-
collar jobs when they first arrive. Over time,
many professionals do obtain licensing or
accreditation and work as physicians, nurses,
or lawyers. Nearly 40 percent are employed in
professional or management careers.2 Others
are employed in the sales and service indus-
tries, or in construction, and this group is
economically better off than previous immi-
grants, many of whom are now poor, elderly
single men.
Vietnamese More than 700,000 Vietnamese
have entered the United States since 1975, and
the total Vietnamese population, including
those born in America, was estimated at over
1.9 million in 2013 by the U.S. Census, indi-
cating it has more than doubled since 1990,
with roughly 60 percent foreign born.2,3 Some
were initially sponsored by American agen-
cies or organizations, which provided food,
clothing, and shelter in cities throughout
the United States until the Vietnamese could
become self-supporting. Many Vietnamese
Americans have since relocated to the western
and Gulf states, probably because the climate
is similar to that of Vietnam.
Vietnamese Americans live primarily
in urban areas. Many are young and live in
large households with grandparents and other
relatives. The first wave of Vietnamese immi-
grants was well educated, could speak English,
and had held white-collar jobs in Vietnam.
Many of them had to accept blue-collar jobs
initially and had difficulties supporting their
extended families. The boat people were even
less prepared for life in the United States
because they often had no English language
skills, were illiterate, had less job training, and
did not have support from an extended family.
Language acquisition has been important
in the Vietnamese community,5 and many
immigrants have made the decision to assim-
ilate as quickly as possible. However, over
80 percent do not speak English at home. Edu-
cation is highly valued, and a child’s academic
There were over 662,600
Canadians of Filipino
heritage in the 2011
Canadian Census.
During the 1920s and
1930s, Filipinos were
often barred from restau-
rants, swimming pools
(and other recreational
facilities), and movie
theaters because of their
dark skin and heavy
accents.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
3 7 4 S O U T H E A S T A S I A N S A N D P A C I F I C I S L A N D E R S
achievement is considered a reflection on the
whole family. High school dropout rates are
very low among Vietnamese Americans, and
23 percent over the age of twenty-five had a
college degree.5 Vietnamese have high rates of
employment, and more than 50 percent have
professional or service-related employment.
Those who obtain college degrees often pre-
fer technical professions, such as engineering.
Median family income is slightly higher than
the U.S. average, and their poverty rate is at
the national average of 15 percent.5
Cambodian The 2013 U.S. Census identified
approximately 323,000 Americans of Cambo-
dian descent. Approximately 79 percent are
foreign born, and 71 percent are American cit-
izens.1 Nearly half of Cambodian Americans
reside in California, with the greatest popu-
lations found in Long Beach and Stockton.
Another large Cambodian community has
developed in Lowell, Massachusetts. Texas,
Pennsylvania, Virginia, New York, Minnesota,
and Illinois also have significant numbers of
immigrants.
Adjustment to America has been slower
for Cambodians, most of whom came from
rural regions where they worked as farmers.
They have a high unemployment rate, and
those who work have found employment in
professional and service jobs, manufacturing,
transportation, and manual labor. Median
family income is slightly above the national
average, but 19 percent of Cambodians live
below the poverty level. Low levels of educa-
tion have limited economic success for many
Cambodian Americans. Thirty-eight percent
of adult men and women have less than a high
school education and only 15 percent have a
college degree.1,2,6
Laotian Over 261,000 nontribal Laotians live
in the United States, according to 2013 U.S.
Census figures.2 Refugee resettlement ser-
vices dispersed the Hmong, irrespective of
family clan associations, in 53 American cit-
ies. Secondary migration of Hmong Ameri-
cans has reunited clan groups, mostly in the
suburban and rural communities primarily
in the southern and western states. Most Lao-
tians have settled in the California cities with
larger populations in the San Francisco Bay
Area and Sacramento. Outside of California,
Seattle, Dallas, Fort Worth, and Minneapo-
lis–Saint Paul also have significant number of
Laotians.1,2
Poor fluency in English and low education
levels have hindered economic achievement
for Laotian Americans. Only 70 percent of
adults have a high school degree and 15 per-
cent have a bachelor’s degree or higher.2 Many
Laotians hold lower-paying jobs in transpor-
tation and as machine operators, fabricators,
and laborers, yet it is estimated that only 14
percent live in poverty. However, their median
income is over $55,000, which is higher than
the national median.2
More than 81 percent of American Hmong
over twenty-five years old have a high school
degree, and over 13 percent have a college
degree. Median family income has improved
in the last ten years, but it is still below the
national average ($47,200, compared to
$51,200), and the poverty rate (25 percent) is
more than the national average (15 percent)
in the United States for the same time period.6
Worldview
Religion Many Southeast Asians hold beliefs
dating back to the ancient religions prevalent
before the introduction of Buddhism, Catholi-
cism, and Islam. Most believe in spirits and
ghosts, especially of ancestors, who have the
ability to act as guardians against misfortune
or cause harm and suffering. Ideas about spirit
intervention have often been incorporated
into Eastern and Western religious practices
or survive as significant superstitions.
Filipino The majority of Americans of Filipino
descent are Roman Catholics, although it is
estimated that as many as 5.5 percent are Mus-
lim. Religion significantly affects the world-
view of Filipinos, especially elders. Many hold
that those who lead a good life on earth will be
rewarded with life after death. Human misfor-
tunes come from violating the will of God. One
should accept one’s fate because supernatural
forces control the world. Time and providence
will ultimately solve all problems.
Vietnamese Forty-three percent of Vietnam-
ese Americans are Buddhists, and 30 percent
are Roman Catholic. Small numbers of
In 2011 the Canadian
Census reported over
230,000 residents of
Southeast Asian heritage,
221,000 of whom were
Vietnamese.
There are five major
tribes among the
Hmong—the White
Hmong, the Black
Hmong, the Blue Hmong,
the Red Hmong, and the
Flowery Hmong—named
according to legend by
the colors of clothing
they were forced to wear
by the ancient Chinese
for identification pur-
poses. Most Hmong refu-
gees in the United States
come from the White and
Blue tribes.
The U.S. Census reported
that in 2013, 179,925
Thais were living in the
United States; most have
settled in Los Angeles,
New York, and Texas.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 2 3 7 5
Protestants also are found. Those who are
Buddhists follow the Mahayana sect, influ-
enced particularly by the Chinese school of
Ch’an Buddhism (Zen Buddhism in Japan)
called Tien in Vietnam. Buddhists believe that
their present life reflects their past lives and
also predetermines their and their descen-
dants’ future lives. They consider themselves
as part of a greater force in the universe
(see Chapter 4 for more information about
Buddhism).
Cambodian The predominant religion in
Cambodia is Theravada Buddhism, which
places greater emphasis on a person’s efforts
to reach spiritual perfection than does the
Mahayana sect, which employs the help of
deities. Merit through good deeds, the par-
ticipation in religious ritual, and the support
of monks and temples is critical to one’s prog-
ress through reincarnation. Although some
Cambodian Americans have converted to
Christian faiths, most still practice Buddhism,
often in temples established in apartments or
homes.
Laotian Almost all Laotians are also Thera-
vada Buddhists. Making merit for Laotians
includes the expectation that every man will
devote some time in his life to living as a
practicing monk, either before marriage or in
his old age. In the United States, men find it
difficult to fulfill their obligation to the faith.
Women may become nuns for periods in their
lives as well, especially if widowed. Most Lao-
tians in the United States worship at Buddhist
temples alongside Cambodians or Thais who
share their religious practices.
About half the Hmong population in the
United States is now Christian as a result of
French and American missionary work in
Laos and conversions after arrival. Baptists,
Presbyterians, Mormons, Jehovah’s Wit-
nesses, and members of the Church of Christ
have actively recruited the Hmong. The other
half of Hmong Americans practice animism,
shamanism, and ancestor worship (Ua Dab).
They believe that the world is divided into
two spheres—that which is visible, contain-
ing humans, nature, and material objects, and
that which is invisible, containing spirits. The
shaman acts as an intermediary between the
two; some spirits, such as those of ancestors,
are available to those who aren’t shamans.
Women are generally responsible for making
contact with these more accessible spirits.
It has been suggested that many Hmong
became Protestants because they believed
it was necessary to gain entry to the United
States or in deference to their church sponsors.
Some try to combine ancestor worship with
their new faiths so as not to offend the spir-
its.7 Small numbers of other Hmong belong
to a modern Hmong religion called Chao Fa
(“Lord of the Sky”), started by a prophet in the
1960s who encouraged the Hmong to break
with both Laotian and Western ways.
Family Southeast Asians share a high esteem
for the family, respect for elders, and interde-
pendence among family members. Behavior
that would bring shame to the family’s honor
is avoided, as is direct expression of conflict.
Social acceptance and smooth interpersonal
relationships are emphasized.
Filipino The Filipino family is highly struc-
tured. At the center is the extended family,
containing all paternal and maternal relatives.
Kinship is extended to friends, neighbors, and
fellow workers through the system of compa-
drazgo. Lifelong relationships are initiated
through shared Roman Catholic rituals, par-
ticularly the selection of godparents and bap-
tism of new babies. Community obligations
created through this system include shared
food, labor, and financial resources.
The first Filipino immigrants were single
men hoping to make their fortune and return
to the Philippines. They developed surrogate
family systems of fellow workers who lived
together, with the eldest man serving as patri-
arch. More recent immigrants have come as
whole families and have been able to maintain
much of their social organization.
Filipino children are adored by the fam-
ily and are typically indulged until the age
of six. At that time, socialization through
negative feedback (e.g., shame) begins. Chil-
dren are taught to be obedient and respect-
ful, to contain their emotions and avoid all
conflict, and to be quiet and shy. Politeness
is emphasized.10,11 People must avoid sham-
ing themselves or their families; discord is
Hmong ancestors are fed
at every festive occasion
with a little pork and rice
placed in the center of
the feast table.
In Thailand, miniature
Thai temples are built
and posted on pedestals
next to a home to shelter
the family ancestors.
Such spirit houses are
believed to prevent the
ghosts from moving
in with the family and
causing trouble.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
3 7 6 S O U T H E A S T A S I A N S A N D P A C I F I C I S L A N D E R S
minimized by the use of euphemisms and by
sending go-betweens in sensitive situations.
The prestige of a family may be measured by
how well children adhere to traditional values.
Though Filipino parents often support their
children in advanced education and profes-
sional careers, women may be discouraged
from attending schools where they would be
beyond family supervision.11
Vietnamese The extended Vietnamese fam-
ily has been modified in the United States to
adapt to American norms. Close relatives are
encouraged to move into homes next door or
in the same neighborhood.
Family values are in transition. The father
is traditionally the undisputed head of the
household, but patriarchy is diminishing as
women attain higher levels of education and
professional achievement. American-style
dating has become common. Although most
Vietnamese marry within their ethnic group,
women are more likely than men to wed non-
Vietnamese mates. Divorce is uncommon.12
The level of intergenerational conflict is
reportedly high.12 Children are often the first to
learn English and acculturate more easily than
their parents, causing value conflicts and loss
of respect for elders. The role of elders is also
changing. Old age is valued in Southeast Asia,
but in the United States older relatives are often
physically isolated from their peers and even
younger family members and may be linguisti-
cally isolated within the larger community.
▼ The traditional
Vietnamese extended family
home is less common in the
United States, but relatives
often live near each other.
A Cambodian proverb
states “If you don’t take
your wife’s advice, you’ll
have no rice the next
year.”
When Cambodians wed,
a Buddhist monk cuts a
lock of hair from both the
bride and groom to mix
together symbolically in
a bowl.
Cambodian Large extended families are com-
mon in Cambodia; children are considered
treasures. Cambodians are notable in that
their traditional kinship system was bilateral,
emphasizing both the paternal and maternal
lines. The family was primarily a matriar-
chy until the 1930s, when French influence
strengthened the authority of the father.
Today, men are responsible for providing for
their families, while women make all deci-
sions regarding the family budget.
It has been difficult for Cambodian Ameri-
cans to retain their traditional family struc-
ture in the United States. A large percentage
of Cambodian homes are headed by single
women, due most likely to the large numbers
of men killed in recent years during conflicts
in Cambodia. Furthermore, Cambodian
American women are permitted formal edu-
cation, and their financial contributions are
needed to help support the whole family. Dif-needed to help support the whole family. Dif-needed to help support the whole family. Dif
ferences between immigrants who have lived
most of their lives in Cambodia and the chil-
dren of these immigrants raised in the United
States (with no memory of Cambodia) can be
enormous in terms of language, acculturation,
and values.7
Laotian Most families are agriculturally
based in Laos. Extended members live and
work together in the fields to support the
whole family. In Laos men represent the fam-
ily in village affairs, and women run the home.
Great significance is given to the site of the
family’s house; it is believed that as long as the
site exists, the family will exist.
Extended families are still important to
Laotian Americans due to dependency on
relatives for social and economic support.
Although nuclear families have become the
norm, extended members tend to live nearby
each other. Women have attained nearly equal
status with men in the United States, and it is
not unusual for Laotian men to share respon-
sibility for household chores.8
Hmong American families are among the
youngest and largest in the United States:
Less than half of all Hmong are under the
age of eighteen. Typical family size is about
6 members; the Asian average is 3.7, and the
white American average is less than 2.13 These Mi
ch
ae
l N
ew
m
an
/P
ho
to
Ed
it
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C H A P T E R 1 2 3 7 7
large families are usually nuclear, reflecting
numbers of children rather than relatives.
Extended family members are often located
nearby, and families frequently congregate
with other families from the same tradi-
tional clan from Laos, sometimes pooling
resources.9
Men remain the heads of households in the
United States. Women are traditionally held
in high regard in their roles as mothers, yet
it has been noted that fathers are assuming a
much larger role in child care in the United
States.14 Children are the heart of the home,
and much of family life revolves around them.
At age five, however, children are expected to
behave as adults.
As in some other Southeast Asian groups,
a generation gap has developed between
recently arrived immigrants and their West-
ernized children. Some Hmong customs
have come in direct conflict with U.S. laws.
Polygyny, marriage to more than one wife, is
unusual but not illegal in Laos The practice
that has received the most press in the United
States, however, is the kidnapping of young
women and enforced marriage. Tradition-
ally, girls married between the ages of four-
teen and eighteen after a bridal price (paid by
the groom) was agreed to by both families. If
no agreement was reached, the couple could
elope, and a mediator would help settle the
differences. If the bride was unwilling, the
groom could kidnap the girl, and the mar-
riage would be recognized after some pay-
ment to the bride’s family was arranged. Men
who have attempted this in the United States
have been charged with abduction and sexual
assault, often by the young women involved.
Many Americans of Hmong descent believe
that it is best to wait until a woman is in her
late teens or early twenties to wed; arranged
marriages are still common.
Traditional Health Beliefs and Practices South-
east Asian health concepts typically combine
facets of multiple belief systems. Indigenous
ideas about the origins of illness center on the
supernatural world, particularly the inter-
vention of malevolent spirits or the ghosts of
angry ancestors. Chinese medical practices
involving yin and yang or the five evolutive
elements (see Chapter 11) are considerations
in some areas of mainland Southeast Asia,
while the Mexican hot–cold theory is more
prevalent in the Philippines (see Chapter 9).
Religious precepts regarding rewards for
making merit, or performing good deeds, and
punishment for violating God’s will are also
involved in health maintenance. In the most
general terms, keeping healthy requires per-
sonal harmony with the supernatural world,
nature, society, and family fulfilled through
one’s obligations to one’s ancestors, one’s reli-
gion, and one’s kin and community. Illness is
usually defined by its cause, not its symptoms.
Most Filipinos adhere to the concept of
bahala na, meaning that life is controlled by
the will of God and by supernatural forces. If a
person behaves properly, shows consideration
of others and sensitivity in relationships, ful-
fills debts and obligations, shows gratitude,
and avoids shame, he or she is rewarded with
health in this life and eternal life after death.10
Many Filipinos believe that illness is a punish-
ment for transgressions against God. Religious
medals are worn for protection from evil.
Spanish control of the islands administered
through Mexico led to the adoption of some
aspects of humoral medicine in the Philip-
pines, including not only the hot–cold theory,
but also the condition commonly known as
wind or air (mal aire in Mexico; see the sec-
tion titled “Traditional Health Beliefs and
Practices” in Chapter 9).
Supernatural illnesses in the Philippines
are most often due to the unhappy ghosts of
one’s ancestors, although witchcraft, or the
powers of animal spirits, may also be involved.
Usog or Usog or Usog tuyaw occurs when a person transmits tuyaw occurs when a person transmits tuyaw
illness through the power of the evil eye or the
use of hands, fingers, words, or even physi-
cal proximity.15 Undesirable traits or condi-
tions can be transferred magically through
contact with a person or object. A pregnant
woman will try to gaze upon beautiful objects
or people and avoid looking at a person with
a deformity to prevent a similar occurrence in
her fetus. Some believe if a pregnant woman
craves dark-skinned fruit, her infant will have
a dark complexion.11,18 Some Filipino Ameri-
cans who believe in supernatural causes of
disease do not think that these forces apply in
Hmong marriages are
traditionally formalized at
a two-day feast featuring
a roasted pig.
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3 7 8 S O U T H E A S T A S I A N S A N D P A C I F I C I S L A N D E R S
the United States, because ghosts and spirits
cannot cross the ocean, nor can they sur-
vive in the noisy cities where many Filipinos
now live.
In the Philippines health is maintained
through the balance (timbering) of natural
and supernatural elements.10,15,16,18 A person is
thought to be predisposed to certain illnesses,
and the timing of external events contributes
to the development of disease. Unbalanced
conditions, such as working too much, over-
eating, excessive drinking, inadequate diet or
sleep, unhygienic conditions, infections, acci-
dents, emotional stress (especially fright or
anxiety), or loss of self-esteem, may increase
a person’s vulnerability, as do factors such as
the season and the weather.
Three practices are used to produce bal-
ance: heating, protection, and flushing. It is
widely believed that a warm body is needed
to prevent illness. Heating means that a per-
son balances hot and cold—whether through
exposure to the elements or through eating
the right proportions of foods classified as
hot or cold—so that warmth is maintained
and overheating is avoided. For example, cold
or cooling foods, such as orange juice, are not
consumed first thing in the morning. Bathing,
often twice per day, is also used to maintain
warmth in the body. Any imbalance, whether
too hot or too cold, is believed to cause illness
by reducing blood flow, causing loss of appe-
tite, and lowering of the body’s ability to fight
off sickness. For example, a nursing mother
who becomes overheated by too much sun
or from exposure to a hot kitchen may find
that her milk has become rancid, producing
colic or diarrhea in the baby.19 Specifics on the
application of hot and cold classifications and
treatment vary tremendously from person to
person.
Protection safeguards the body from natu-
ral and supernatural forces. For instance, a
layer of fat is needed to protect the body from
external cooling. Wind is of special con-
cern. It may cause disease directly through
drafts or be absorbed through the pores or
any wounds. Wind that is too cold or too
hot affects the blood, causing increased or
decreased circulation, resulting in a general
malaise and increased susceptibility to illness.
A postpartum woman avoids bathing for nine
to forty days after birth of the baby to pre-
vent wind from entering her vagina; a new-
born’s umbilicus is bound to keep wind from
entering that opening; and coconut oil may
be rubbed into the skin to block the pores.
Whooping cough and mental illnesses are
two of the more serious conditions that can
be caused by wind.
Balance is also important in other areas
as well. Any rapid change is avoided, such
as going from the activity of heavy exercise
to the inactivity of showering (thus a short
rest period is needed in between). Emotional
restraint is maintained when possible, because
strong emotion may cause certain symptoms
of illness.16 For instance, some Filipinos feel
that excessive anger or envy is a hot condi-
tion and great fright or joy is a cold condition.
Somaticized complaints are common.11,20
Flushing is used to cleanse the body of
impurities or evil forces through perspiration,
flatulence, vomiting, or menstrual blood.19
Vinegar mixed with water, salt, and chile pep-
pers is one example of a flushing treatment,
taken to stimulate sweating.
Several types of traditional healers are
common in the Philippines: midwives, mas-
seurs, curers (who diagnoses through evalua-
tion of the pulse), arbularyos (herbalists), and
shamans, who cure supernaturally caused ill-
ness through use of folk remedies. In urban
regions, where belief in ghosts and spirits
is not as prevalent, faith healers are gaining
in popularity. Faith healers do not diagnose
illness but cure it through prayer, anointing
with oil, and the laying on of hands, which
transmits a sacred healing energy to the
patient.11,15,18
For the Vietnamese, health is related to
personal destiny. How one behaved in past
lives and the number of good deeds per-
formed by one’s ancestors determine one’s
experiences in this life. Current behavior,
such as pleasing good spirits and avoiding
evil spirits, can also impact health. Similar to
the Filipinos, pregnant Vietnamese women
may avoid funerals or ugly objects or leaving
their homes at the times malevolent spirits
are active (noon and 5:00 p.m.). The use of
divination, through fortune-telling, astrology,
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C H A P T E R 1 2 3 7 9
or physiognomy (the shape of the body, espe-
cially the head, as it correlates to the mind),
is popular for predicting how a person might
expect his or her life to proceed and what
interventions might be needed to prevent
certain negative experiences.21,22
Traditionally, the Vietnamese believe that
the human body is sustained by three sepa-
rate souls: one that encompasses the life force,
one that represents intelligence, and one that
embodies emotions. In addition, nine vital
spirits provide assistance to the souls. Soul
loss can be an important and life-threatening
reason for illness. Typically, strong feelings,
especially fright, can cause the soul to leave
the body.23
The Chinese medical system is commonly
used by ethnic Chinese Vietnamese and by
some other Vietnamese as well. Maintaining
a balance of yin and yang, especially through
diet and the treatment of disease, is a primary
consideration in health. Like the Filipinos,
wind (or air) is sometimes seen as a cause of
illness. Some Hmong are also concerned with
hot, cold, and wind as well. Hmong women
are reportedly thought to be in a cold condi-
tion immediately following birth (having lost
hot blood) and must avoid cold drinks, cold
drafts and wind, and sexual intercourse to
reestablish balance.24
Cambodians, Laotians, and Hmong are
also concerned with spiritual intervention
in health. Laotians identify thirty-two spir-
its that oversee the thirty-two organs of the
body.8 The Hmong recognize the world of
the invisible, where the spirit of every animal,
tree, and rock resides, amid the souls of the
living, ancestor spirits, caretaker spirits, and
evil spirits. Ancestor spirits require special
consideration because if they become angry,
they may leave their progenies or fail to pro-
tect them from evil. The Laotians have elabo-
rate rituals called baci, mostly performed at
all special occasions by older men who have
been monks, that bind the spirits to their
possessor. Among the Hmong, the loss of
one’s soul, usually due to strong emotional
distress, is the single most important cause
of illness. It generally results in malaise and
weight loss, leading to more serious disease.
Related to soul loss is the condition called
ceeb, or fright illness. Ceeb typically occurs in
children (although it can happen to adults as
well) if they are in an accident, chased by a
dog, startled by a noise, or plunged into cold
water. The soul becomes disconnected; the
blood cools down and slows, resulting in a
chilling effect that begins in the extremities
and can progress to the vital organs.25
Unique to Southeast Asians in the United
States is the unexplained condition known
as sudden unexpected nocturnal death syn-
drome (SUNDS), when a seemingly healthy
person dies in his or her sleep. It is especially
prevalent among Cambodians, Laotians,
and Hmong, although it may occur in other
immigrants from the mainland as well. It was
a leading cause of death among Hmong men
aged twenty-five to forty who were the earliest
immigrants to the United States.17 Although
biomedical hypotheses have been proposed to
account for the fatal syndrome, such as heart
irregularities or sleep apnea, none has been
proven. It is now believed the phenomenon
known as sleep paralysis is involved.26,27 Some
researchers believe that death is caused within
the cultural context of the nightmare experi-
ence. Specifically, the nightmare spirit, dab
tsog, enters the room at night and the victim tsog, enters the room at night and the victim tsog
“wakes” to the sensation of the spirit sitting on
his or her chest; he or she is unable to move
and is terrified. Although many immigrants
report having experienced nightmares in
Southeast Asia, the attack by the spirit does
not usually result in death. Cultural disrup-
tions are believed to have intensified the epi-
sodes. Guilt and depression create increased
vulnerability to fatal nightmare experiences.
Posttraumatic stress disorder, panic attacks,
exposure to chemical warfare agents, or
blood electrolyte imbalances may be other
risk factors.23,27
Traditional healers are typically special-
ized practitioners among mainland Southeast
Asians. They may provide services for broken
bones, skin infections, or objects stuck in the
throat. Hmong herbalists (kws tshuaj) treat
natural disorders, such as menstrual problems,
impotence, infertility, stomach disorders, and
diarrhea, with teas and poultices.24 Hmong
shamans treat patients for spiritual disorders
at great personal risk due to interaction with
In parts of Southeast
Asia, opium is
traditionally grown in
home herb gardens for
use as a pain killer.14
Among the ethnic
Chinese-Vietnamese
immigrants, many are
Traditional Chinese
Medicine practitioners.
Laotians often wear
copper or silver bracelets
or colored strings around
their wrists, necks, and
ankles to keep their
souls from leaving. White
string is used by families;
red or black strings are
tied on by shamans
during ritual ceremonies.
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3 8 0 S O U T H E A S T A S I A N S A N D P A C I F I C I S L A N D E R S
the spirit world.28 They heal conditions such
as mental illness, hypertension, diabetes,
breathing difficulties, and fainting. In many
cases, they often deal with lost souls. Magic
healers are not spiritually chosen for their pro-
fession but may interface with the spirit world
to treat injuries and stones (such as those
found in kidneys, or those placed in bodies
by evil spirits). Monks may lead religious
rituals. Among most Southeast Asians, minor
illnesses may be treated by anyone with heal-
ing experience, typically a grandmother or
mother in the home. The family takes respon-
sibility for the illness of an individual and will
usually exhaust all remedies available within
the house before seeking outside help.14
Botanical remedies are very popular with
many mainland Southeast Asians living in
the United States. Cambodians, Laotians, and
Hmong sometimes maintain herb gardens for
easy access to therapeutic ingredients. Some
immigrants frequent Chinese herbalists or
will buy imported products from Asia.29 Kws
tshuaj (herbal medicine experts) sell tshuaj
ntsuab (fresh herbs), tshuaj qhuav (dried roots tshuaj qhuav (dried roots tshuaj qhuav
or bark), as well as other organic substances
(e.g., rhinoceros bones/skin/dried blood,
dried bear, and snake gall bladders, etc).
Herbs and other substances are prepared as
teas, broths, steam inhalants, or balms.14,30
Physical therapies may include massage;
cupping (a heated cup or a cup with a small
amount of burning paper is placed over a cer-
tain spot on the body until the fire goes out,
leaving a round red spot on the skin); moxi-
bustion (burning a small bundle of herbs on
the skin or using a lit cigarette); and coining
(rubbing a coin or spoon dipped in tiger balm
or eucalyptus ointment across the skin with
pressure), scratching, or pinching affected
areas. In most cases the therapy is used to
release any bad wind or excess heat and to
restore balance to the body.14,31
Religious rituals are also used to intervene
on behalf of an ill person. Hmong soul call-
ers perform the “Mandate of Life” ceremony
to return a lost soul to its host body, and the
Mien appeal to ancestor spirits to protect
family members and assist in healing. These
rituals sometimes include animal offerings.
A butchered animal, typically a chicken, pig,
or occasionally a cow, is purchased from a
packinghouse prior to the ceremony; then it is
cooked and consumed after the rite as part of a
feast. Its soul is offered in exchange for the vic-
tim’s missing soul.14,24 In Vietnam small shrines
are sometimes constructed to appease ancestor
spirits or the souls of premature infants who
have died and still wander the earth. Offerings
may also be made to the Goddess Quang Am
for good health. Among Catholic Vietnamese
and Filipinos, appeals are made to the Virgin
Mary; group prayer has assumed significance
for many Protestant Southeast Asians.
It has been noted that Christian Hmong
often avoid the use of shamans, soul callers,
and other traditional practitioners, depend-
ing on the clergy and the power of prayer to
promote physical and spiritual healing. Herbs,
however, may still be used at home.24,28
Traditional Food Habits
The cuisines of Southeast Asia have many
ingredients in common, but food preparation
methods and meal patterns reflect the foreign
cultures that have influenced each nation. For
example, the Vietnamese often serve cream-
filled French pastries for dessert, whereas
Filipinos frequently have Spanish-style cus-
tard flan. As in China and Japan, the staple
foods are rice (primarily long grain), soybean
products, and tea. A meal is not considered
complete unless rice is included. Instead of
soy sauce, however, Southeast Asians often
season their food with strongly flavored fer-
mented fish sauces and fish pastes.
Ingredients and Common Foods: Staples
and Regional Variations
Filipino Filipino fare has blended Malaysian,
Polynesian, Spanish, and Chinese influences
into a distinctive cuisine. There are three prin-
ciples in Filipino cooking: First, never cook
any food by itself; second, fry with garlic in
olive oil or lard; and third, foods should have
a sour–cool–salty taste.32 For example, adobo,
one of the most popular Filipino preparations,
combines marinated chicken, pork, and some-
times fish or shellfish, that is then fried with
garlic in lard and then braised in soy sauce,
vinegar, garlic, chile peppers, bay leaf, and
Mien rituals involving
ancestor spirits require
a genealogical record of
the family going back ten
generations.
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C H A P T E R 1 2 3 8 1
peppercorn with whatever vegetables are on
hand, such as plantains, potatoes, greens, or
bamboo shoots.33 Filipinos traditionally used
a clay pot for cooking but now use a large wok
called a kawali, especially for frying. They
tend to leave the food in longer than the Chi-
nese do, to allow it to absorb more fat. The
common foods of the Philippines are listed in
Table 12.1.
Rice is the foundation of the diet, and the
long-grain variety accompanies the meal. It
is typically steamed or fried (the preferred
method of serving leftover rice). Garlic fried
rice is a favorite, topped with bits of meat,
sausages, and a fried egg. Vinegar, additional
garlic, and a spicy vegetable/fruit pickle called
atchara are added to taste. A common bread,
pan de sal, is made from rice flour. Noodles
are also used extensively. Pancit is a popular
dish made with rice, wheat, or mung bean
noodles mixed with cooked chicken, ham,
shrimp, or pork in a soy and garlic-flavored
sauce. Short-grain, glutinous rice is used for
sweet desserts such as puto, a fluffy cake made
from rice, sugar, and sometimes coconut milk.
The amount of meat, poultry, or fish a
family eats depends on economic status.
Pork, chicken, and fish are popular, added
as available to mixed dishes such as sinigang,
a soup of fish or meat cooked in water with
sour fruits, tomatoes, and vegetables; puchero,
a beef, chicken, sweet potato, tomato, and
garbanzo bean stew with an eggplant sauce;
Group Comments Common Foods Adaptations in the United States
Protein Foods
Milk/milk
products
Filipinos make one of the few native
cheeses in Asia, from carabao
(water buffalo) milk.
U.S. influence has resulted in the
availability of many Western dairy
products.
Many Filipinos may be lactose intolerant.
In desserts, coconut milk is frequently
used in place of cow’s milk.
Evaporated milk (cow, goat), white cheese
(carabao)
Consumption of milk and
other dairy products has
increased.
Meat/poultry/
fish/eggs/
legumes
Protein intake is often dependent on
income.
Meat: beef, carabao, goat, pork, monkey,
variety meats (liver, kidney, stomach,
tripe), rabbits
Poultry and small birds: chicken, duck,
pigeon, sparrow
Consumption of fish has
decreased; intake of meat,
poultry, and eggs has
increased.
TA B L E 12 .1 Cultural Food Groups: Filipino
▼ Traditional foods of
Southeast Asia and the
Pacific Islands. Some typical
foods include coconut, dried
anchovies, dried mango,
French bread, lemon grass,
lime, nuoc mam, pineapple,
pork, rice, rice paper, rice
sticks, taro root, and water
chestnuts.
Kr
is
tia
n
Ca
ba
ni
s/
A
G
E
Fo
to
st
oc
k
gulay, fried fish with vegetables; and lumpia,
the Filipino version of egg rolls, stuffed with
pork, chile peppers, and vegetables like hearts
of palm. Other traditional dishes popular for
special occasions include chicken relleno, a
whole chicken stuffed with boiled eggs, pork,
sausage, and spices; paella, a Spanish recipe
for saffron-flavored rice typically topped with
chicken, sausage, pork, seafood, tomatoes,
and peas; and lechon, a whole roasted pig.
Filipinos use all parts of the animal in
their cooking; in addition to the pork meat,
for example, the pig variety cuts might show
up in various soups or mixed stews, such as
dinuguan, consisting of diced pork, chicken,
(Continued)Continued)Continued
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3 8 2 S O U T H E A S T A S I A N S A N D P A C I F I C I S L A N D E R S
Group Comments Common Foods Adaptations in the United States
Fish and shellfish: anchovies, bonita, carp,
catfish, crab, crawfish, cuttlefish, dilis,
mackerel, milkfish, mussels, prawns, rock
oyster, salt cod, salmon, sardines, sea
bass, sea urchins, shrimp, sole, squid,
swordfish, tilapia, tuna
Eggs: chicken, fish
Legumes: black beans, black-eyed peas,
chickpeas, lentils, lima beans, mung
beans, red beans, soybeans, white
kidney beans, winged beans
Cereals/Grains Rice is the main staple and is usually
eaten at every meal.
Corn, oatmeal, rice (long- and short-grain,
flour, noodles), wheat flour (bread and
noodles)
Rice is not usually eaten at
breakfast but is eaten at
least once per day.
Fruits/Vegetables Vegetables are often consumed
in mixed stews, stir-fries, and
soups. Braised vegetables may be
consumed as entrée or side dish.
Pickled fruits and vegetables are very
popular.
Fruits: apples, avocados, banana blossoms,
bananas (100 varieties), breadfruit,
calamansi (lime), citrus fruit, coconut, calamansi (lime), citrus fruit, coconut, calamansi
durian, grapes, guava, jackfruit,
Java plum, litchi, mangoes, melons,
papaya, pears, persimmons (chicos),
pineapples, plums, pomegranates,
pomelo, rambutan, rhubarb, star fruit,
strawberries, sugar cane, tamarind,
watermelon
Vegetables: amaranth, bamboo shoots, bean Vegetables: amaranth, bamboo shoots, bean Vegetables:
sprouts, beets, bitter melon, burdock
root, cabbage, carrots, cashew nut leaves,
cassava, cauliflower, celery, Chinese celery,
drumstick plant (sili leaves), eggplant,
endive, garlic, green beans, green papaya,
green peppers, hearts of palm, hyacinth
bean, kamis, leaf fern, leeks, lettuce, long
green beans, mushrooms, nettles, okra,
onions, parsley, pigeon peas, potatoes,
pumpkins, purslane, radish, safflower,
snow peas, spinach, sponge gourd,
squash blossoms, winter and summer
squashes, sugar palm shoot, swamp
cabbage, sweet potatoes, taro leaves and
roots, tomatoes, turnips, water chestnuts,
watercress, yams
More green vegetables
are consumed. More raw
vegetables and salads are
eaten.
Additional Foods
Seasonings Food is spicy, but the variety of spices
used is limited. Regional cooking is
differentiated in part by seasoning
preferences.
Atchuete (annatto), bagoong, baggong-
alamang, chile peppers, garlic, lemon
grass, patis, seaweed, soy sauce,
turmeric, vinegar
Nuts/seeds Betel nuts, cashews, kaong (palm seeds),
peanuts, pili nuts
Beverages Soy milk, cocoa, coconut juice, coffee with
milk, tea
Chocolate milk is substituted
for soy milk. Soft drinks are
popular.
Fats/oils Traditional diet is considerably higher
in fat than are other Asian cultures.
Coconut oil, lard, vegetable oil
Sweeteners Brown and white sugar, coconut, honey
TA B L E 12 .1 Cultural Food Groups: Filipino (C on tin u e d )
©
C
en
ga
ge
L
ea
rn
in
g
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C H A P T E R 1 2 3 8 3
or entrails cooked in pig’s blood and seasoned
with vinegar and hot green chile peppers or
sausage such as garlicky longaniza. The skin is
commonly fried to make sitsaron (similar to
the Mexican chicharrónes or U.S. cracklings),
which are eaten as snacks or pulverized to top
noodle dishes.
Due to the U.S. influence in the Philippines,
many Western dairy products are available,
but cow’s milk is used infrequently. Evapo-
rated milk is a common ingredient in leche
flan, a custard, and in halo-halo, a parfait-
like dessert consisting of shaved ice, coconut
milk, mung beans, purple yam pudding (ube),
boiled palm seeds (kaong), corn kernels, pine-
apple jelly, and other ingredients. Halo-halo
can be bought premixed with just the shaved
ice needed for completion. Rural Filipinos use
carabao (water buffalo) milk to make one of
the few native cheeses in Asia, kesong puti.
Carabao milk is also popular in desserts, such
as ice cream, flan, and pastille candies.
A common seasoning, used instead of
salt and found throughout Southeast Asia, is
fermented fish paste or sauce. In the Philip-
pines, the powerful paste is called bagoong
and tastes somewhat like anchovies, although
it can be made from a variety of fish. A similar
paste made of shrimp is known as bagoong-
alamang. Patis is a translucent amber fish
sauce. To obtain the popular sour–cool taste,
palm vinegar, or a paste made from either the
cucumber-like vegetable called kamis or the
pulp of the tamarind pod, may be used. Kini-
law, a Filipino specialty, uses sour ingredients
to marinate and pickle raw foods, including
fruits and vegetables, but also meats, organs,
and seafood. Bagoong, patis, lime (calamansi)
wedges, and vinegar flavored with chilies are
frequently placed on the table so that each
diner may add saltiness or sourness to taste.
A principal food in many Pacific Islands is
the coconut, and it is widely used in Filipino
cooking. In addition, copra (dried coconut
kernels used for oil extraction) is an impor-
tant export crop. It takes approximately one
year for a coconut to mature, but if picked at
six months, the soft, jellylike coconut meat
can be eaten with a spoon and is a popular
delicacy. The coconut plant provides several
food products, including beverages, cooking
▼ Two traditional Filipino
dishes—lumpia (similar
to an egg roll) and pancit
(noodles cooked with meat or
shrimp in a soy- and garlic-
flavored sauce).
In Filipino culture,
sticky, glutinous rice
cakes symbolize
the cohesiveness of
the family.
Among the more
unusual Filipino special-
ties is balut, eaten occa-
sionally as snacks. These
partially developed duck
eggs are soft-boiled
and sold warm by street
vendors. Salt and a little
vinegar are added to the
embryonic birds before
they are popped whole
into the mouth.
Durian is an acquired
taste. Its odor, which
has been likened to rot-
ting onions mixed with
gasoline, is so strong that
some apartment build-
ings in Asia ban the fruit.
liquids, and even a vegetable. The sweet, clear
liquid found in young coconuts is the juice or
water. It is consumed fresh but is not used in
cooking. Coconut cream, which is used for
cooking along with coconut milk, is the first
liquid extracted from grated, mature coconut
meat. After the cream is removed, coconut
milk is made by adding water to the meat and
then squeezing the mixture. Coconut milk
is used primarily in special dishes. Coconut
palm blossom sap can be fermented to pro-
duce a strong alcoholic drink called tuba,
which, when distilled, is known as lambanog.
Hearts of palm, sometimes called palmetto
cabbage, is the firm, greenish inner core of the
tree; it is used as a vegetable. Bananas, durian
(a large, strong-smelling, sweet fruit with a
creamy texture), jackfruit, mango, papaya,
and pineapples are also popular.
Regional cooking styles are divided into
four regions: Luzon (the largest group of
islands, also home to the nation’s capital,
Manila), Bicolandia, the Viscayan Islands, and
Mindanao.34 Luzon is made up of various eth-
nic groups, and the cuisine has been strongly
influenced by the Spanish. Ocean fish, such
as prawns, milkfish (bangus), and halibut, as
well as the ample use of anchovy sauce and
shrimp paste, are preferred in the northern
areas. Foods are typically boiled or steamed.
Saluyot (“okra leaves”—not related to okra),
a spinach-like green with a slippery texture
when cooked, and drumstick plant leaves,
called sili, are especially popular in the north.
M
ic
ha
el
C
oc
ita
/S
hu
tt
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oc
k.
co
m
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3 8 4 S O U T H E A S T A S I A N S A N D P A C I F I C I S L A N D E R S
Rice is grown in the central region of Luzon,
known for its freshwater fish and richly sauced
dishes flavored with onions and garlic. One
delicacy is rellenong manok, a deboned chicken
stuffed with sausage, vegetables, and ground
pork mixed with raisins and spices, topped
with a tangy red sauce. Stir-frying is the most
common cooking technique. Coconut products
and tropical fruits predominate. Sweetened rice
dishes such as suman, a snack made from rice
(cassava or plantains can be used) steamed in
banana leaves or corn husks, are a specialty.
Bicolandia is an ethnically homogeneous
region that came in contact with both Malay-
sian and Polynesian cooking. Foods are spicy
hot with chile peppers, balanced by copious use
of coconut milk and cream. Taro leaves cooked
in coconut milk with ginger and chiles are one
example of the unique blend of foods found
in this area. Viscayan Islands fare also reflects
its heritage—abundant use of seafood (includ-
ing a distinctive fermented shrimp paste called
guinamos) and seaweed, as well as many des-
sert specialties, such as candies and pastries
developed due to the sugarcane plantations
in the area. The Mindanao region was heavily
In rural regions, raw
pork is heavily salted
and then stored in jars
for many months until it
ripens. Called itog, small
amounts are added to
other dishes to enhance
their flavor.
influenced by the Indonesians and Malaysians.
The many ethnic groups living there are pre-
dominantly Muslim, so little pork is consumed
(see Chapter 4). Sauces made from peanuts
and chiles are popular, as are curries and other
spicy dishes, such as piarun (fish spiced with
chiles) and tiola sapi (boiled beef curry).
Vietnamese, Cambodian, and Laotian Ingre-
dients are similar in all the mainland South-
east Asian countries, but recipes and meal
patterns vary. Indigenous fish and seafood,
tropical fruits and vegetables, and glutinous
rice were the foundation of the native diets.
The Chinese introduced long-grain rice, soy
products, stir-frying, hot pots, fried pastries,
and chopsticks to areas they ruled. French
regional occupation popularized such items
as French bread, meat pâtés, asparagus, pota-
toes, pastries, and strong coffee. Indian and
Malaysian influence is seen in the curries and
coconut milk–flavored dishes of eastern and
southern Southeast Asia. The common foods
of mainland Southeast Asians are listed in
Table 12.2.
Rice, both long and short grain, is the sta-
ple of the diet. Rice products, such as noodles,
paper, and flour, are used extensively. In Viet-
nam, rice paper is used as egg roll or wonton
wrappers. In the dish cha gio, the moistened
paper is wrapped around a variety of meats,
fish, vegetables, and herbs and then deep-
fried. Often the rice paper is filled with meat,
fresh herbs, and vegetables at the table. Dried
rice noodles (sticks) are called pho, which is
also the name of the popular noodle-based
soup in Vietnam. In Laos, the sticky, gluti-
nous short-grain rice is more prevalent than
long-grain types (traditionally formed into
small balls to use as scoops for other foods),
and the very thin Chinese-style rice noodles
are common. Wheat is used to make French
bread, noodles, and some pastries.
Fried noodles topped with meats and veg-
etables are a favorite. Fish and shellfish are the
predominant protein food on the mainland.
Even landlocked Laos depends on freshwater
varieties. Fish, shrimp, and squid are often
preserved through salting and drying. Poultry
is widely available, and pork or goat is eaten
in wealthier areas. Beef is used occasionally.
S A M P L E M E N U
A Filipino Lunch
L umpia (Egg Rolls)a,b,c
S in igan g (Pork in Sour Broth)a,c
Chicken A d ob oa,b,c
Steamed Rice Pan s it C an t on (Sautéed Rice Noodles)a,c
Halo - h alo (Shaved Ice Dessert)a,b or P u t o
(Steamed Rice Cakes)a,b
aGelle, G.G. 1997. Filipino cuisine: Recipes from the islands. Santa Fe: Red Crane Books.
bFilipino Recipe at http://www.filipino-recipe.com/
cFilipino Recipes at http://www.filipinofoodrecipes.net/
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 2 3 8 5
Religious prohibitions often influence which
meats are consumed. Like other Asians, the
people of mainland Southeast Asia do not
use appreciable amounts of dairy products.
However, soy milk is a common beverage.
Soy products, particularly a chewier version
of tofu (soybean curd) called tempeh, are
common.
Mainland Southeast Asians frequently
consume vegetables, cooked in stir-fries and
stews or uncooked in salads and pickles.
Especially noteworthy are the many shred-
ded vegetables and unripe fruits, such as
cabbage, papaya, carrots, cucumber, rad-
ishes, jicama, and bean sprouts topped with
fish, poultry, meat, or peanuts and spicy hot
Malaysia, which includes a western section contiguous with Thailand
and an eastern section on the island
of Borneo, extends south into the gap
between Southeast Asia, the Philippines,
and Australia (see Figure 12.1). At its tip is
the independent city-nation of Singapore.
Indonesia, comprised of over 10,000 islands
(mostly uninhabited), arches eastward
from Malaysia and includes Bali, Borneo
(now known as Kalimantan), Java, New
Guinea, and Sumatra. The region lies along
the equator and contains a majority of the
world’s tropical rainforests. The fertile land
is conducive to the cultivation of the herbs
and spices brought by Asian, Middle East-
ern, and European traders, including chile
peppers, cinnamon, cloves, cumin, ginger,
nutmeg, and pepper. Parts of Indonesia are
still known as the Spice Islands.
The cuisines of Malaysia, Singapore, and
Indonesia have been greatly influenced by
the diversity of their populations: native
Malays, Chinese, Asian Indians, Pakistanis,
Arabs, Thais, Eurasians, Melaka Portuguese
(Malaysian Portuguese), and Peranakan
(southern Chinese and Malaysian or
Indonesian—the women are called Nyonya
and men are known as Baba).153 Further, the
numerous religious practices of the region—
Islam, Hinduism, Buddhism, Christianity,
and Judaism—have played a role in the
fare. Today, Malaysia and Indonesia are
predominantly Muslim nations (with the
exception of Bali, which is mostly Hindu),
while Singapore is primarily Christian.
Rice, both long-grain and glutinous,
is the foundation of the diet. It is often
steamed, but it is also popular fried, prepared
as sticky rice balls, and especially as noodles.
Noodles are typically stir-fried, added to
soups, or topped with mixed vegetables, fish,
or meat. They are eaten at nearly all meals,
and often for snacks. One Indonesian favorite
is nasi goring, Chinese fried rice topped with
a European-introduced fried egg. Steamed
rice in Malaysia is often served with both
an Indian-influenced curried meat or fish
and a Chinese stir-fried vegetable. Fish is
very common (often fried) and eaten by all
groups except some vegetarian Buddhists
(who prefer tofu- or tempeh-based dishes).
Beef and poultry are popular but costly in
much of Malaysia and Indonesia, while pork
is uncommon in majority Muslim areas. The
exception is Singapore, a wealthier nation,
which includes abundant meat and egg
dishes in its fare. Temperate vegetables
introduced from the Middle East and Europe,
such as tomatoes, eggplants, and potatoes,
are usually added to soups and rice dishes
instead of being served separately. Salads are
popular, however; an example is Indonesian
gado gado, a mixture of cooked vegetables
(including cabbage, green beans, and carrots)
dressed with a peanut sauce. Tropical fruits
are eaten at nearly every meal, fresh, pre-
served, in baked goods and puddings, and
deep-fried as fritters.
Coconut flavors many foods, and season-
ings are used liberally, including chiles, fresh
coriander, ginger, lemongrass, pandanus leaf,
pepper, and turmeric. Lemons, limes, unripe
mangoes, tamarind, or vinegar is usually
added for a sour taste. The most distinctive
cooking in the region is Nyonya fare, found
especially in Singapore, which combines
Chinese preparations (often pork -based)
with Malaysian seasonings, particularly
coconut, turmeric, and lemongrass.
All courses are served at once in Malaysian,
Singaporean, and Indonesian meals, and the
dishes are categorized by preparation technique,
not ingredients. For example, sambals are fried
dishes seasoned with chiles (or the name for
just a chile dipping sauce); satays are delicate,
grilled kebabs (of Middle Eastern origin) served
with spicy dipping sauces; croquettes (from the
Dutch influence) are fried rice, meat, vegetable;
or fruit fritters; and sayur are soupy dishes with
ample sauce for dipping rice balls. In most areas
forks and spoons are used (knives are rarely
available). The Chinese often use chopsticks,
and Asian Indians frequently employ their
right hand to scoop up food.153 One tradition is
universal in the region: street vendors. Meals
and snacks are usually available around the
clock at food stalls and small eateries, and al
fresco dining is a daily event.
E X P L O R I N G G L O B A L C U I S I N E
The Cooking of Malaysia, Singapore, and Indonesia
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3 8 6 S O U T H E A S T A S I A N S A N D P A C I F I C I S L A N D E R S
Group Comments Common Foods Adaptations in the United States
Protein Foods
Milk/milk products Most Southeast Asians do
not drink milk and may be
lactose intolerant.
Sweetened condensed milk
is used in coffee; whipping
cream is used in pastries.
Sweetened condensed milk, whipping
cream
It is expected that younger
Southeast Asians will increase
their use of dairy products.
Ice cream is popular; milk and
cheese are often disliked.
Meat/poultry/fish/
eggs/legumes
The traditional Southeast
Asian diet is low in protein.
Fish, poultry, and pork are
common; most parts of
the animal are used (brains,
heart, lungs, spleen).
Meat: beef, lamb, pork, goat, venison; variety
meats of all types
Poultry and small birds: chicken, duck, quail,
pigeon, sparrow, doves
Eggs: chicken, duck (both embryonic and
unfertilized), fish
Fish and shellfish: almost all varieties of
freshwater and saltwater seafood, fresh
and dried
Legumes: chickpeas, lentils, mung beans (black Legumes: chickpeas, lentils, mung beans (black Legumes:
and red), soybeans and soybean products
(tempeh, tofu, soy milk), winged beans
Meat, lamb, and eggs are eaten
more; fish, shellfish, and duck
are eaten less because of
price.
Cereals/Grains Rice is the staple grain and
is usually eaten with every
meal.
French bread is commonly
eaten.
Rice (long- and short-grain, sticks, noodles),
wheat (French bread, cakes, pastries)
Intake of baked goods
increases.
Fruits/Vegetables Hearty garnishes of fresh
vegetables are commonly
added to dishes. The
Vietnamese eat a
considerable amount of
fruit and vegetables, fresh
and cooked.
Fruit is often eaten for dessert
or as a snack.
Fruits: apples, bananas, cantaloupe,
coconut, custard apple, dates, durian,
figs, grapefruit, guava, jackfruit, jujube,
lemon, lime, litchi, longans, mandarin
orange, mango, orange, papaya,
peach, pear, persimmon, pineapple,
plum, pomegranates, pomelo, raisins,
rambutan, roselle, sapodilla, star
fruit, soursop, strawberries, tamarind,
watermelon
Vegetables: amaranth, arrowroot, artichokes,
asparagus, bamboo shoots, banana leaves
and flowers, betel leaves, beans (yard
long and string), bitter melon, breadfruit,
broccoli (Chinese and domestic), cabbage
(domestic, Chinese, savoy, napa), calabash,
carrot, cassava (tapioca), cauliflower,
celery (domestic and Chinese), chayote
squash, Chinese chard, Chinese radish
(daikon), chrysanthemum, corn, cucumber,
eggplant (domestic and Thai), leeks, lotus
root, luffa, matrimony vine, mushrooms
(many varieties), mustard (Chinese greens),
okra (domestic, lady finger), peas, peppers,
potato, pumpkin (flowers, leaves), spinach,
squash, sweet potatoes (tubers, leaves),
taro (root, stalk, leaf, shoots), tomatoes,
turnips, water lily greens, water chestnuts,
water convolvulus, was gourd, yams
Use of fruits and vegetables
is dependent on availability
and price. It is expected that
use of fruits and vegetables
will decline.
Fresh vegetables and herbs
are sometimes grown in
backyard gardens.
TA B L E 12 . 2 Cultural Food Groups: Mainland Southeast Asian
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C H A P T E R 1 2 3 8 7
dressing. One example is goi go, a Vietnam-
ese specialty featuring cabbage and chicken.
Greens and leaves are often used to wrap
foods, such as collard greens for Cambo-
dian steamed fish and la lot (betel leaves)
used for Vietnamese spring rolls stuffed with
minced beef. Further, fresh herbs and spices,
including basil, coriander leaves, chile pep-
pers, galangal (similar to young ginger root),
garlic, ginger, kaffir lime leaves, lemon grass,
and mint, are often added to foods as they
are served, providing distinctive flavors and
color to many dishes. Both Laotian laap, a
spicy ground meat or fish dish (tradition-
ally prepared uncooked), and Vietnamese
grilled lemon grass beef, bo nuong xa, are
served with a substantial garnish of basil,
mint, and coriander leaves. Due to the strong
influence of the French, the Vietnamese also
frequently eat asparagus, green beans (hari-
cots), and potatoes; though the French had
less impact on the cuisine of surrounding
nations, subsequent Vietnamese rule has
popularized these vegetables in other regions
as well.
Tropical fruits are available, although in
some areas bananas and plantains are the
only fruit widely consumed. Banana leaves
are used to wrap rice, vegetables, and meats
for steaming in both Cambodia and Laos.
Pineapple, papaya, limes, mangoes, and man-
gosteens are common, as are soursop, star
fruit, guavas, custard apples, durian, jackfruit,
and tamarind (a pod with very tart pulp).
Oranges, lemons, melon, and sugarcane are
also popular.
In Vietnam, foods are customarily sea-
soned with a salty sauce made from fermented
fish called nuoc mam. It can be transformed
into a hot sauce, nuoc cham, with the addi-
tion of chiles, vinegar, sugar, garlic, and citrus
fruit juice. In Cambodia the fermented fish
sauce is called tuk-trey; a stronger fish paste
is also used, known as prahoc. The Laotian
version of fish sauce is nam pa; pa dek is the
fermented fish paste.
In Vietnam, com,
meaning “cooked rice,” is
the same word used for
“food.”
Vietnamese Buddhists
eat soybean products
on the first, fifteenth,
and last day of the lunar
month, when meat is
prohibited.
Furr, a soup containing
pork, noodles, garlic, and
hemp (marijuana) leaves,
is a Laotian specialty.
“Without fish sauce
or salt, life is nothing,”
according to a
Vietnamese saying.
©
C
en
ga
ge
L
ea
rn
in
g
Group Comments Common Foods Adaptations in the United States
Additional Foods
Seasonings Fermented fish sauce, as well
as soy sauce, is often used.
Fresh herbs are very popular
garnishes in Vietnamese
dishes; typical Cambodian
fare is delicately seasoned;
Thai dishes are frequently
very hot and spicy, with
several types of curry and
chile peppers especially
popular.
Allspice, alum, basil, black pepper, borax,
cayenne pepper, chile pepper, chives,
cinnamon, coconut milk, fresh coriander,
curry powder, fennel, galanga, garlic,
ginger, kaffir lime leaves, lemon grass,
lemon juice, lily flowers, lotus seed, mint,
MSG, nuoc mam (and other fermented fish
sauces and pastes), paprika, saffron, star
anise, tamarind juice, vinegar
Nuts/seeds Almonds, betel nuts, cashews, chestnuts,
macadamia nuts, peanuts, pili nuts,
walnuts; locust seeds, lotus seeds,
pumpkin seeds, sesame seeds,
watermelon seeds
Peanut butter is often disliked.
Beverages Beverages are usually drunk
after the meal or with
snacks or desserts.
Coffee, tea, sweetened soybean milk, a wide
variety of fruit and bean drinks, hot water,
hot soup, beer
Carbonated drinks have
increased in use.
Fats/oils Bacon, butter, lard, margarine, peanut oil,
vegetable oil
The Vietnamese have increased
their use of butter and
margarine.
Sweeteners Sweets are luxury foods. Cane sugar, candy The use of sweetened
products has risen in the
United States.
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3 8 8 S O U T H E A S T A S I A N S A N D P A C I F I C I S L A N D E R S
Tea is the preferred beverage throughout
mainland Southeast Asia. In Vietnam, it is
served before and after meals but not during
the meal. Tea is often blended with flowers
such as rose petals, jasmine blossoms, chry-
santhemums, and lotus blossoms (which
are especially popular). Coffee is popular in
French-influenced areas, usually served with
large amounts of sweetened condensed milk
added to it. Broth is traditionally consumed
at meals, and in poorer, rural regions, such as
where the Hmong live, it is the only bever-
age besides water that is commonly available.
In wealthier areas, men may drink beer, and
women and children consume soft drinks
during meals. Soybean drinks and fruit drinks
are common; rice wine or whiskey is served
on special occasions.
Regional variations are prominent, espe-
cially in Vietnam.35 The Chinese influence is
stronger in the north than in other regions.
Hot pots, stir-fried foods, and chao (rice
gruel similar to congee) are especially popu-
lar. Soups are a specialty, particularly pho bo
ha noi, a delicate broth to which rice noodles,
sliced beef, bean sprouts, herbs, and other
Numerous small wild
animals are consumed in
Southeast Asia. In 2005
a new species of rodent,
related to the porcu-
pine, was discovered
by scientists for sale in
a Laos market. Called
kha-nyou, it is roasted
whole, then eaten by
crunching up the small
bones, and spitting out
the larger ones.154
▲
Shoppers choose from
a wide selection of tropical
fruits and vegetables in
a Southeast Asian street
market.
M
ea
of
ot
o/
Sh
ut
te
rs
to
ck
.c
om
seasonings are added immediately before
serving. Mein go is a chicken noodle soup
served in a similar manner. Other favorites
include stuffed tofu, bun cha (grilled pork
over noodles), and snails (stir-fried, sim-
mered in beer, or minced with garlic). The
central region is known for sophisticated
gastronomy. Presentation is emphasized and
seasonal cooking reigns. Specialties include a
sauce similar to nuoc mam made from shrimp
called mam tom, shrimp pâté grilled on sugar
cane, spicy pork sausages, sweet soups, ver-
micelli soups, and both sweet and salty rice
cakes. The climate of the South is tropical.
Cooking is simpler and seasoning is stronger;
curries and spicy Indonesian-style peanut
sauces are favorites. Coconut milk and cara-
mel flavor many dishes. Clay pot cooking is
common. One specialty is tidbits of grilled
meats, fresh vegetables, and fruits such as
guava, mango, green papaya, pineapple, or
starfruit wrapped in a lettuce leaf, according
to personal preference, that can be dipped in
salty or spicy sauces. Sweets are more popular
in the south than in other areas.
Khmer cooking of Cambodia features
northern Indian, Malaysian, and Chinese
elements. Although French cooking is much
admired, it has never been integrated into
the Khmer kitchen.36 Aromatic seasonings
are preferred, particularly the paste known
as kroeung, made fresh for each dish from
pulverized herbs and spices such as galangal,
garlic, kaffir lime leaves, lemon grass, shallots,
and turmeric. A touch of spice is achieved with
chile peppers, particularly in curried dishes,
though it is usually moderated by the use of
coconut milk. Sweet ingredients, such as ripe
fruit or sugar, are often included as a contrast
to the sour flavor provided by vinegar, lime
juice, or tamarind. Salty fish sauce or soy sauce
is always added, as are bitter herbs for bal-
ance. Amok, fish in coconut milk steamed in
a banana or collard leaf, is a national favorite as
is num banh choc, a rice noodle and fish soup.
In some areas, dishes featuring wild foods such
as land crabs, snakes, and locusts are found.
Laotians prefer glutinous rice over long-
grain types. Added vegetables and fish make
up the basic diet, with eggs, poultry, and beef
included as affordable. In rural areas game
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C H A P T E R 1 2 3 8 9
such as deer, squirrels, ducks, quail, lizards,
frogs, snakes, and grasshoppers are common.
Meats are frequently stewed or grilled, though
a salty beef jerky prepared with nam pa is a
specialty. Coconut cream or milk, nam pa
and pa dek, lime juice, fresh coriander leaves,
garlic, lemon grass, and mint are typical sea-
sonings. Hot chile peppers add heat to most
foods, though the extent of their use varies
regionally. Spicy salads consisting of fresh veg-
etables or shredded immature papaya topped
with lime juice, palm sugar, and chile pepper
dressing are popular. Chinese and French
influence via Vietnam is seen in some areas
where French bread, croissants, spring rolls,
and a soup similar to pho are popular foods.
Hmong fare traditionally differs from Lao-
tian cooking and shares some similarities with
Vietnamese cuisine. Long-grain rice is favored
and stir-frying, steaming, and roasting are
common preparation methods. Although
rice and vegetables are the foundation of
the diet, families sometimes raise chickens,
ducks, pigeons, and pigs. These foods are
supplemented with wild game and fish, crabs,
and snails. Seasonings, however, are similar
to Laotian, though the Hmong use soy sauce
in addition to fish sauces. Hmong who were
forced from the mountains to the lowlands
during Southeast Asian conflicts have added
many Laotian foods to their meals.
Meal Composition and Cycle
Daily Pattern
Filipino The traditional meal pattern in the
Philippines is three meals a day. Breakfast
is garlic fried rice with eggs or broiled fish,
sausage, or meat, plus coffee or hot chocolate;
bread may be substituted for rice. Especially
popular are sweet, cheesy rolls called ensay-
mada. Lunch and dinner are similar in size
and composition. Both are often large meals,
characteristically including soup, rice, a crispy
or chewy dish (such as fried fish), a salty dish
(meat or poultry cooked in fish sauce or soy
sauce), a sour dish (flavored predominantly
with vinegar or tamarind), a noodle dish,
and often, an adobo dish. Fresh fruit or des-
sert concludes the meal. If the meal features
mostly Spanish-style items, the courses are
served consecutively. If the meal features
more Filipino-style dishes, all courses are
served together, including dessert.33
In addition to meals, two snacks, called
meriendas, are consumed in the midmorning
and late afternoon. Meriendas may be small
or may consist of substantial amounts of food,
such as fritters, pastries, fruits, ensaymadas,
lumpia, or almost anything else except rice,
which is served only at meals.
Vietnamese and Other Mainland Southeast
Asians Mainland Southeast Asians eat two or
three meals a day with the number of meals
and the amount of food consumed often
based on income. Snacking is uncommon.
Southeast Asians do not usually associate par-
ticular foods with breakfast, lunch, or dinner.
For example, soups are especially popular and
are often consumed with every meal.
In Vietnam, a traditional breakfast is large
and may consist of soup with rice noodles
topped with meat or poultry; a boiled egg with
meat and pickled vegetables on French bread;
chao with bits of leftover meat and vegetables;
steamed rice cakes or Chinese-style crullers;
or glutinous rice or boiled sweet potatoes with
sugar, coconut, and chopped roasted peanuts.
A strong cup of coffee may accompany the
meal. Lunch and dinner typically include
S A M P L E M E N U
A Vietnamese Dinner
Asparagus and Crabmeat Soupa,b
Braised Bean Curda,b or Grilled Beef with Lemongrassa,b
Stir-Fried Vegetables
Steamed Rice
Fruit Juice or Iced Coffee with Evaporated Milk
aRouthier, N. 1999. The foods of Vietnam. New York: Stewart, Tabori & Chang.
bVietnamese Recipes & Cuisines at http://www.vietnamese-recipes.com
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3 9 0 S O U T H E A S T A S I A N S A N D P A C I F I C I S L A N D E R S
rice, fish or meat, a vegetable dish, and a broth
with vegetables or meat. Fresh vegetables and
pickled garnishes are served with the meal. All
items are served at once, and individual diners
place whatever foods they wish over their por-
tion of rice and flavor it as desired with nuoc
mam and other condiments. French bread
with meat or shrimp pâté may be substituted
for a lunch or dinner meal. In late afternoon,
tea or coffee may be enjoyed with a sweet cus-
tard, pastry, candy, or piece of fruit.
Cambodians also eat family style. Soups
are often served for breakfast and accompany
the main course at nearly every other meal.
Steamed or fried rice or rice noodles are the
centerpiece of lunch and dinner, accompa-
nied by grilled or steamed freshwater fish and
seafood, and less frequently poultry, pork, or
beef. Fresh salads are common. Fruit is often
eaten as dessert, though very sweet rice or
corn dishes are also popular. Tea and coffee
with condensed milk are usually consumed
with the meal, and fruit juices, soft drinks,
and beer may be available. In Laos gluti-
nous rice, fish, poultry or meat, soup, and a
cooked vegetable dish or fresh salads make
up most meals. Chile pepper paste is the stan-
dard condiment. Tea, coffee with condensed
milk, and rice wine or rice whiskey round out
the menu.
Etiquette Filipinos generally dine at tables
equipped with lazy Susan turntables so that
dishes are accessible to everyone. Tradition-
ally, no one starts eating until the eldest male
at the table begins. Many Filipinos use a West-
ern style of dining with forks, knives, and
spoons. Others employ just forks and spoons.
The spoon is used to hold the food down
while the fork is used to pull bits away. The
food is then pushed onto the spoon with the
fork and eaten. Chopsticks may be used for
Chinese dishes. In some rural areas, fingers
are still more commonly used.33 In such cases,
only the right hand is used for dining. Small
mounds of rice are rolled between the index
finger, middle finger, and thumb to form a ball
that is dipped into a sauce, then pressed into
a bit of meat or poultry and popped whole
into the mouth. It is considered rude to take
the last bits of food from the central platter.37
In Vietnam it is polite to wait for the eldest
person to be served and then, after everyone
else is served, to ask him or her if it is okay to
eat. It is a breach of good manners to refuse
any offer of food, yet when served, only small
amounts of any single dish should be taken.
If sufficient amounts remain, seconds will be
offered.37 Throughout mainland Southeast
Asia, an empty plate or cup indicates that the
diner is still hungry or thirsty. Leaving a small
amount of food or beverage signals satiety.
Traditional dining in Vietnam is done on a
low table with family gathered round, sitting
cross-legged on mats. Both hands customarily
rest on the table while dining, and conversa-
tion is limited. In contrast, dinner is a time
for socializing in Laos. The food is served on
a low rattan tray, and women gather on one
side, the men on the other side. Each diner
eats from the dishes as desired.
A variety of utensils are used to eat in
Southeast Asia mainland nations. Chopsticks
are used for most dishes in most of Vietnam,
though spoons and fingers are considered
appropriate for certain foods and in some
areas. Rural Laotians often eat with their fin-
gers, using balls of sticky rice to scoop up fish
and meats and vegetables and sauce; however,
spoons are used as needed. In urban areas
forks are now common. Hmong typically
employ forks and spoons, and Cambodians
use spoons, chopsticks, or fingers dependent
on the food.
Special Occasions
Filipino In the predominantly Catholic Phil-
ippines, religious festivals and saints’ days are
numerous (see Chapter 4). On all special occa-
sions, it is customary to serve plenty of food
buffet-style with a roasted pig (lechon) as the
centerpiece. The Filipinos claim to have the
longest Christmas season in the world, from
the first Sunday of Advent in late November
or early December to January 6. The midnight
Mass celebrated on Christmas Eve is usually
followed by the traditional media noche, a
midnight supper of fiesta foods such as roast
ham, sweet potatoes, banana flower salad,
niaga—a dish made of boiled meat, onions,
and vegetables whose name means “good
life”—and hot chocolate. Other specialties
Turo-turo are fast-food
stands in the Philip-
pines, specializing in
rice bowls topped with
foods according to the
customer’s preference.
Other hot items are also
available.
It is said that you can
trace the penetration of
Chinese rule in Vietnam
by the areas in which
chopsticks are common,
compared to those
where hands are still
most frequently used to
dine.32
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C H A P T E R 1 2 3 9 1
eaten during the Christmas season are puto
bumbong, a rice flour delicacy cooked in a
whistling bamboo kettle, and bibingka, a glu-
tinous rice cake cooked in a clay pan topped
with salted egg slices, kesong puti cheese, and
a bit of coconut.
A midnight Mass is also held on New Year’s
Eve, but many Filipinos attend parties to cel-
ebrate the holiday instead. Again, a midnight
supper consisting of fiesta foods is traditional.
There is also a superstition that eating seven
grapes in succession as the clock strikes mid-
night will bring good luck in the coming
year. For birthdays, pancit is eaten to ensure
a long life.
There are numerous Filipino practices and
customs associated with Easter, beginning
with observances on Ash Wednesday. Late on
Easter Eve, young children are awakened to
partake of special meat dishes, such as adobo
and dinuguan, in the belief that if they do not
do so, they will become deaf. In May, fiestas
honoring the Virgin Mary often include fam-
ily feasts.
Vietnamese and Other Mainland Southeast
Asians Of all Vietnamese holidays, Tet, the
New Year’s celebration, is the most important.
Tet is observed at the end of the lunar year
(end of January or beginning of February) just
after the rice harvest. In Vietnam, the first Tet
ritual is an observance at the family gravesites.
Offerings of cake, chicken, tea, rice, and alco-
hol, as well as money, are made at the graves,
and then the family picnics on the offerings.
The second ritual, held on the twenty-third
day of the twelfth lunar month, is to celebrate
the departure of the Spirit of the Hearth, Ong
Tao. He is represented by three stones on
which the cooking pots are placed and is hon-
ored by a small altar. Like the Chinese Kitchen
God, Ong Tao returns to the celestial realm
each year and reports on the family’s behavior.
After the family makes an offering to symbol-
ize his departure, they share a feast including
glutinous rice cakes and a very sweet soybean
soup. One week later the family celebrates
Ong Tao’s return to their hearth. The follow-
ing day is the first day of Tet. Guests (espe-
cially those with favorable names, such as
Tho, meaning “longevity”) are entertained
with tea, rice alcohol, red-dyed watermelon
seeds, candied fruits, and vegetables.
Special dishes prepared for the week-long
celebration include banh chung, glutinous rice
cakes filled with meat and beans and boiled
in banana leaves, squid soup, stir-fried young
seasonal vegetables, pork with lotus root, and
sometimes a special shark fin soup.
Many Vietnamese, including those in the
United States, celebrate the Buddhist holiday
called Trung Nguyen, or Wandering Souls
Day. It occurs in the middle of the seventh
lunar month and is celebrated with a large
banquet prepared in honor of the lost souls
of ancestors.12 Traditionally, the Vietnamese
did not commemorate birthdays but rather
honored their ancestors on the anniversary
of their death with a special celebration and
meal. In the United States, it is now more
common to celebrate birthdays.
The largest holiday of the year in Cam-
bodia is also the New Year’s Day celebration,
Chaul Chnam, which begins on April 13 and
lasts for three days. Prayers and special foods
like fried coconut and fried bananas rolled in
coconut are offered to the New Year Angel,
who descends with either blessings or ill will.
The Water Festival, held in November after
the seasonal rains have ended, features color-
ful floats in local rivers.
Most Laotian holidays are religious in ori-
gin and are celebrated at local temples. Pha
Vet, which occurs in the fourth lunar month,
commemorates the life of Buddha. Boon Bang
Fay, held in the sixth lunar month, also honors
the Buddha with a fireworks display. Among
the Hmong and other Laotians, the New Year’s
celebration is a major event. It begins with the
first crow of a rooster on the first day of the
new moon in the twelfth lunar month, usually
in December. The highlight of the festivities
is the world renewal ritual, which involves an
elder who chants while holding a live chicken.
He circles a tree three times clockwise to
remove the accumulated evil of the previous
year and then circles the tree three more times
counterclockwise to invoke good fortune in
the upcoming year. The bad luck collects in
the blood of the chicken, which is traditionally
taken to a remote location and slaughtered.
Customarily considered a good time to meet
Hospitality is very impor-
tant to the Filipinos, and
food gifts to express
love or appreciation are
common.
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3 9 2 S O U T H E A S T A S I A N S A N D P A C I F I C I S L A N D E R S
future wives and husbands, New Year’s was the
one time each year when Hmong from differ-
ent clans celebrated together.
Therapeutic Uses of Food
Filipino When the Spanish came to the
Philippines, they introduced the Mexican hot–
cold theory of health and diet (see Chapter 9).
Foods are classified as being hot or cold based
on their innate qualities or their effect on the
body, not on their spiciness or temperature.
Although the classification of certain foods
varies regionally, avocados, alcoholic bever-
ages, coconuts, nuts, legumes, spices, chile
peppers, and fatty meats are generally con-
sidered hot items; tropical fruits, vegetables,
milk and dairy foods, eggs, fish, and lean or
inexpensive meats are regarded as cold.20,38
A balance is attempted at meals between hot
and cold elements. The reason Filipino dishes
contain so many ingredients may be to ensure
this balance.
Some illnesses are characterized as hot or
cold and are treated with foods of the opposite
category. Diarrhea and fevers are hot; colds
and chills are cold. Other food beliefs are
based on sympathetic qualities (“like causes
like”); for instance, pregnant women may
avoid dark foods to prevent their babies’ skin
from being too dark. Sometimes the meaning
behind a therapeutic food use is more obscure;
horseradish leaves and broth seasoned with
ginger are believed to promote milk produc-
tion in nursing mothers, and fish heads and
onions are considered brain food by some
Filipinos. Honey, as well as certain herbs such
as thyme, marjoram, and chamomile, is used
to treat diabetes. Licorice root is considered
a general tonic, especially beneficial during
times of stress. Some elderly Filipinos have
adopted the Asian Indian practice of chew-
ing areca nuts (also called betel nuts), which
is believed to prevent tooth decay, although it
leaves permanent stains.
The Department of Health in the Philip-
pines has approved several herbal remedies as
safe and effective, including ampalaya (bitter
melon, prepared as a side dish or as a juice)
for diabetes, bawang (garlic) to lower blood bawang (garlic) to lower blood bawang
cholesterol levels and reduce blood pressure,
ulasaming bato (pepperomia, which is eaten
as a salad or brewed into tea) for arthritis and
gout, and sambong (an indigenous herb) as a sambong (an indigenous herb) as a sambong
diuretic.39
Vietnamese and Other Mainland Southeast
Asians Many Vietnamese follow the Chinese
yin–yang theory of health and diet (see the
section titled “Therapeutic Uses of Food” in
Chapter 11). Yin is known as âm and yang is
called duong. As in the hot–cold system, clas-
sification is based on intrinsic characteristics
rather than temperature or spiciness. Exam-
ples of duong (hot) foods are red meat, unripe
fruit, ginger, garlic, coffee, and alcoholic bev-
erages. Âm (cold) items include noodles,
bananas, oranges, gelatin, and ice cream.22,40
Some foods, such as rice, pork, eggs, chicken
broth, teas, and sweets, are classified as neu-
tral.41,42 Not only must a balance be main-
tained within a meal, but extremes are also
avoided during certain conditions, such as
pregnancy. As with Filipinos and other Asians,
illnesses are defined as âm and duong and are
sometimes caused by eating too many âm or
too many duong foods. During pregnancy,
which is duong, hot foods are avoided, and
equilibrium is restored by eating foods of the
opposite type; during the postpartum period,
which is âm, cold foods are avoided. Yin and
yang concepts are less prevalent among Cam-
bodians and Laotians, although some hot and
cold beliefs exist regarding specific foods and
certain conditions.
The Chinese medical system details other
influential elements in health, including the
five flavors of sour, bitter, sweet, pungent, and
salty; these tastes are harmonized in many
Vietnamese dishes. Vietnamese believe that
ingestion of specific organ meats will benefit
the like internal organs. For example, con-
sumption of liver will produce a stronger liver.
Some Vietnamese believe that eating gelati-
nous tiger bones (produced by prolonged
cooking) will make them strong. Concur-
rently, some foods may be injurious because
they resemble certain disorders. Pregnant
women may refuse to eat ginger because the
multilobed root is thought to cause polydac-
tyly (too many digits) in babies.
A feast is held by the
Hmong following the
birth of a child. Included
are two chickens
representing the parents,
a boiled egg signifying
the child, and a small lit
candle symbolic of the
ancestor spirits whose
blessing and protection
are sought.
Licorice root, which
contains glycyrrhizin, can
cause fluid retention and
increase blood pressure
if consumed in large
amounts.
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C H A P T E R 1 2 3 9 3
The therapeutic value of some foods is
unrelated to yin or yang or how they look.
Some Vietnamese eat chile peppers to get
rid of worms, or noodles with roasted rice
paper and shrimp sauce for curing the flu.
Cambodians may drink water with bitter
melon for fevers. Vietnamese women may
consume large amounts of salty foods during
pregnancy,43 and mothers may avoid feeding
chicken or duck to their babies to prevent
them from becoming deaf or mute.44 Hmong
women eat a diet of rice, chicken broth, black
pepper, and herbs for a month after giving
birth,45 and some clans have specific taboos
against eating certain foods, such as heart.46
Contemporary Food Habits
in the United States
Adaptations of Food Habits
Filipino Little current information on the
food habits of Filipino Americans has been
reported. Most are able to obtain traditional
foodstuffs without much difficulty, although
some of the familiar tropical fresh fruits and
vegetables are not available. Research shows
that most Filipinos still eat rice every day but
not with every meal, and their diets tend to
contain a greater variety of foods, especially
more milk, green vegetables, meat, and sweets
than they did in the Philippines.47,48,49,50
Meriendas are not eaten as often as in the
Philippines.
Filipinos born in the United States fre-
quently consume a typically American diet.
Breakfast consists of cereal, toast, eggs or
meat, juice, and coffee; sandwiches, salads,
and sodas are common at lunch; and dinner
is usually a meat or fish dish served with rice
or potatoes, followed by dessert. Traditional
Filipino items may appear at some meals, such
as eating longaniza sausage at breakfast or eat-
ing halo-halo (sometimes topped with vanilla
ice cream) for dessert.51
Vietnamese and Other Mainland Southeast
Asians A study conducted in Washington,
DC, found that 30 percent of the Vietnamese
households surveyed had changed their eat-
ing habits since coming to the United States.53
Although most continued to eat rice at least
once a day, they ate more bread or instant
noodles at lunch and more cereal at breakfast.
Respondents also reported consuming more
meat and poultry and less fish and shellfish
than in Vietnam, mainly because of cost.
Pork and pork products were still preferred
to beef. They also reported consuming fewer
bananas but more oranges, fruit juices, and
soft drinks. More recent research indicates
that Vietnamese Americans decreased their
vegetable intake as their household income
increased.52
More than 90 percent of Vietnamese Amer-
ican adolescents in another study were found
to prefer their native diet, although a major-
ity listed items such as steak and ice cream as
being among their favorite foods. Soft drinks
and milk were well liked; cheese and peanut
butter were strongly disliked. Only a small
percentage of the teens snacked regularly.54
A more recent study on the same population
reported that Vietnamese American high
school students in Massachusetts consumed
more fruits and vegetables than did other eth-
nic groups, and fewer dairy products. Over
28 percent ate at least five fruits or vegetables
each day; however, only 8.5 percent consumed
the recommended number of dairy servings.
Notably, fruit and vegetable consumption
increased with degree of acculturation, but
decreased with age.55
A sur vey of Cambodian and Hmong
families indicated some similar trends.
Although traditional items were preferred
by the adults, both American and native
foods were acceptable to the children. Most-
liked items among the adults included steak,
oranges, candy, and soft drinks, all of which
are prestige foods in Cambodia and Laos.56
Least-liked items included cheese, chocolate
milk, and milk.57 A detailed study of poor
Hmong immigrants in California revealed
that the majority of adults (52 percent) con-
sumed two meals each day of rice, greens,
and meats. Pork was the preferred meat,
although chicken, turkey, fish, and eggs were
also eaten. The adults were mostly unfamil-
iar with baked products, such as bread or
cookies, and most strongly disliked both
milk and cheese. It was found that many
Though overall con-
sumption of fish by
Vietnamese Americans is
thought to be lower than
in Vietnam, data show
they have the highest
intakes of recent Asian
immigrants, particularly
of shellfish.58
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3 9 4 S O U T H E A S T A S I A N S A N D P A C I F I C I S L A N D E R S
Hmong grow their own vegetables and
seasonings (especially varieties difficult to
obtain from grocery stores) in backyard
gardens. In a study limited to fish consump-
tion, it was reported that Laotians and Mien
were most likely to harvest fish and seafood
locally, and that Mien (23 percent) and
Hmong (90 percent) frequently consumed
the entire fish, including head, bones, eggs,
and organs.58
Food purchasing and preparation as well
as meal patterns are also changing. South-
east Asian American women report that men
frequently help with shopping or cooking.
Vietnamese, Cambodian, and Laotian ado-
lescents often are involved in food purchases,
and surveys indicate as many as 60 percent of
girls and 35 percent of boys have total respon-
sibility for fixing dinner each evening. South-
east Asian women living in the United States
are more likely to have a job or to attend adult
education classes than in their homeland,
relinquishing some household responsibili-
ties to other family members. Further, many
families report a significant decline in eating
meals together.56,59,60
Some young Hmong
women avoid eating
gizzards because they
are believed to toughen
the placenta and make
birth difficult.
There are approximately sixteen times more Filipino Americans and ten times
more Vietnamese Americans than there are
Thai Americans in the United States. Yet Thai
cooking is more familiar to the general pop-
ulation than either Filipino or Vietnamese
fare. Thai restaurants which are 16 percent
of total U.S. market share in the restaurant
industry have introduced the distinctive
cuisine in many parts of the United States,
even where few Thai Americans live, and
dozens of cookbooks have further popular-
ized the cuisine.152
The country of Thailand is located on
the southern end of the archipelago that is
Southeast Asia. The hot, monsoonal climate
is ideal for rice cultivation. Long-grain rice
is the foundation of the diet, though short-
grain glutinous rice is used for snacks and
desserts and is preferred in the regional Issan
cuisine of the northeast (similar to Cambo-
dian fare, also known for its culinary use of
insects).155 Noodles made of rice, wheat, or
mung beans are also common. Both tropi-
cal and temperate fruits and vegetables are
prominent in the cuisine. Seafood from the
lengthy coast, especially shrimp, is popular.
Dried herring-like fish (which are sometimes
smoked as well) are often flaked into rice
for added flavor. Beef, chicken, and pork are
common. Duck is a favorite.
Thai food differs from that of its South-
east Asian neighbors because of its flavors.
It is one of the hottest cuisines in the world,
with lavish use of chile peppers. Several
varieties of basil, fresh coriander leaves and
root, galangal, garlic, ginger root, kaffir lime
leaves, lemon grass, mint, and tamarind are
typical seasonings. In addition, curried dishes
are eaten daily. There are three types of curry
sauces: yellow, which are smooth, mild,
Indian-like sauces that include spices such
as cardamom and turmeric; red, which are
chunkier, hotter, and typically include ample
fresh red chiles and coconut milk; and green,
which are prepared with fresh green chiles
whose heat is excruciating for all but the most
experienced palates. Fermented fish products,
such as nam pla (similar to the Vietnamese
sauce called nuoc mam) and kapi (a paste
made from fish or shrimp), are added to most
dishes. Nam prik, a sauce that combines nam
pla or kapi with other ingredients like garlic,
peppers, shallots, lime juice, tamarind, palm
sugar, and peanuts, complements dishes such
as yam (fresh vegetables rolled up into a leafy
package and dipped into the nam prik), salads
(nam prik is the dressing), noodle dishes,
dumplings, fried or grilled foods, and highly
spiced raw pork called nam. Noodle dishes are
usually eaten for breakfast and lunch. Phad
Thai—stir-fried noodles cooked with bits of
meat, seafood, and vegetables bound with
eggs, then topped with peanuts and nam
prik—is an example. Sweets such as coconut
custards and fruit jellies are preferred snacks.
Thai cooking began as a court cuisine,
and this heritage is most obvious in the
evening meal.32,156 Dinner often includes
appetizers, such as deep-fried chicken wings
stuffed with ground pork and shrimp or pas-
tries shaped like delicate flowers. The main
meal traditionally features steamed rice,
soup, a curried dish, a fried dish, and a salad
of raw vegetables and grilled poultry, beef, or
seafood. Mee krob, a volcanic-looking mound
of stir-fried noodles and meats or seafood
cooked with sugar until caramelized, is a
favorite addition. Various nam prik accom-
pany the dishes. All dishes are served at the
same time. Fingers and spoons are the usual
implements, and forks are available for push-
ing food into the spoon. The meal usually
concludes with elaborately carved fruits.
E X P L O R I N G G L O B A L C U I S I N E
T h a i Fa r e
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C H A P T E R 1 2 3 9 5
Nutritional Status
Nutritional Intake
Filipino Life expectancy rates for Filipino
Americans are higher than for the general
U.S. population.63 The traditional Filipino
diet is higher in total fat, saturated fat,
and cholesterol than most Asian diets, and
urban Filipinos living in the United States
tend to have an even higher intake of these
dietary components.61,62 Median body mass
indexes (BMIs) in men and women are close
to those of whites in the United States, while
rates of overweight and obesity are higher
than in most other Asian groups.64 Filipino
Americans have high rates of hypertension
and serum cholesterol levels, equal to those
of white Americans. Twenty-seven percent
of Filipinos have reported being told that
they had hypertension.64,65,66 Heart dis-
ease is the leading cause of death in mor-
tality statistics for Filipinos, and strokes
are third. Filipinos develop type 2 diabetes
mellitus (9 percent) more often than most
other Asians.64,65 Filipina women are at an
increased risk for developing gestational
diabetes during pregnancy.67,68,69,73 Filipina
women in the United States have been found
to have larger waist circumferences and a
higher percentage of visceral adipose tis-
sue than white women despite lower rates
of overweight and obesity, suggesting more
research is needed on metabolic syndrome
(which is also higher in Filipinas) in non-
obese populations.70,71,72,74,75
Many are lactose intolerant and calcium
intake may therefore be limited.11 Dried fish,
fish sauce, and fish paste may provide cal-
cium, but amounts vary depending on the
source and quality of the product. Some Fili-
pinos may be at risk for calcium deficiency,
particularly newer immigrant women during
pregnancy and postpartum.11
Infant mortality rates are slightly below
those for the general population.76 When
compared to other Asian groups, Filipino
neonates are also at increased risk for death
from infection, and postneonatal infants from
respiratory distress syndrome.68
In addition, Filipino rates for hyper-
uricemia (resulting in gouty arthritis) and
Certain Filipino dishes
are very high in purines,
a concern for patients
with gout; dinu-guan, for
example, often includes
pork liver, kidney, heart,
and small intestine.
glucose-6-phosphate dehydrogenase defi-
ciency (causing anemia unrelated to iron
intake) are also higher than for white Ameri-
cans. It should also be noted that alpha
thalassemia (hemoglobin H disease) is also
prevalent and results in a hypochromic micro-
cytic anemia, especially during an infection or
when oxidant drugs are taken.
Vietnamese and Othe r Mainland S outh-
east Asians Food intake data suggest that
the calcium intake of mainland Southeast
Asians is low, although this observation
does not account for fish sauces and other
traditional foods that may contain sufficient
calcium.77 An analysis of broth made with
acidified bones reported that one table-
spoon provided nearly as much calcium as
one-half cup of milk.78 Vietnamese have
been reported to have high rates of lactose
intolerance.
Very little health and nutrition research
has investigated the children and grandchil-
dren of Southeast Asian immigrants from spe-
cific countries, but other studies have shown
that diet and health risk factors are correlated
to the adoption of American culture and
lifestyle.59,77 As previously mentioned, Asian
American women have the highest life expec-
tancy (85.8 years) of any other ethnic group
in the United States. The following health
conditions are more common for these eth-
nic groups: cancer, heart disease, stroke,
unintentional injuries (accidents), and type
2 diabetes (at a lower BMI).78 Asian Ameri-
cans also have a high prevalence for the fol-
lowing conditions and risk factors: chronic
▲ Vietnamese restaurants,
especially those featuring
the noodle soups called pho,
have become popular in
many communities where
Vietnamese immigrants have
settled.
Ro
be
rt
F
rie
d/
A
la
m
y
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3 9 6 S O U T H E A S T A S I A N S A N D P A C I F I C I S L A N D E R S
obstructive pulmonary disease, hepatitis B,
HIV/AIDS, smoking, tuberculosis, and liver
disease.64,77,79,80,81,83,84,85 Thalassemia, a genetic
form of anemia, is more common in Southeast
Asians and is not due to an iron deficiency.82
In a study of California Asian groups, Cambo-
dian and Laotian women had adverse mater-
nal risk profiles and higher death rates than
whites for neonates, postnatal infants, and
infants.69
Numerous studies have noted that the now
older refugees from mainland Southeast Asia
are at special risk for mental health prob-
lems, due to the horrors of war, difficulties in
escape, lengthy camp confinement, and the
extreme cultural differences between their
homeland and the United States. Posttrau-
matic stress disorder is common. One study
of the Hmong suggests, however, that levels of
depression, anxiety, hostility, and other symp-
toms of adjustment problems may gradually
resolve with length of stay.92,95,96
Southeast Asians typically calculate age on
a lunar calendar, often starting with being one
year old at birth. Reported age may differ as
much as two years from Western chronologi-
cal age, which can distort the use of standard-
ized growth curves. Some Vietnamese parents
may claim, however, that their children are
younger than they are to enroll them in lower
school grades; this allows the children to catch
up in their schooling.
Counseling
Filipino Americans of Filipino descent may
accept illness as fate, tolerating symptoms
until the severity forces them to seek care.
Relatives, neighbors, and traditional healers
may be consulted before obtaining biomedi-
cal service. Language barriers may be signifi-
cant. For example, some Filipino languages
do not recognize gender, and there may be
some confusion with pronouns. In 2010, over
22 percent of Filipinos reported they did not
speak English well; nevertheless, the assump-
tion that an interpreter is needed may offend
those who have mastered the language.97
The communication style of many Fili-
pino Americans is very high context, and
expression is formal and polite.11 Confronta-
tion is avoided, and all attempts to maintain
harmony will be made, including the use of
silent pauses and laughter to hide embarrass-
ment.37 Raising one’s voice or losing emotional
control is considered rude and immature.
Positive expression, no matter the situation,
is expected.
Filipino elders should not be addressed
by their first names, as this is disrespectful.
Health care practitioners are often consid-
ered to be authority figures, so responses to
questions may be deferential; Filipinos will
avoid voicing disagreement. Many Filipinos
avoid situations in which self-esteem may be
lost, and thus health care providers should be
sensitive in discussing certain subjects, such
as socioeconomic background. Modesty may
make other topics uncomfortable to discuss
as well, including sexuality (handled best by a
provider of the same gender as the client) and
“shameful” conditions such as tuberculosis or
mental illness.
Soft handshaking is the common greeting,
although an eyebrow flash (quick lifting of
the eyebrows) may be used between acquain-
tances.86 Avoid any other touching, and keep
hands exposed at the side of the body, not in
pockets. Direct eye contact between peers of
the same gender may occur, but in general
quick contact and aversion is more common,
particularly when addressing someone in a
position of higher authority. Further, direct
eye contact between men and women may be
interpreted as an expression of sexual inter-
est or aggression. Filipinos may expect quick
results from their health providers and will
switch to other healers if they feel that prog-
ress is too slow.15
Unknown numbers of traditional heal-
ers are used by some Filipino Americans. An
older study in Los Angeles reported that most
respondents, independent of education level,
still adhered to many traditional beliefs about
the cause of illness, including unbalanced
conditions such as eating too much or eating
the wrong combination of foods, working too
hard, or being punished for one’s sins against
God. Immigrants from rural regions were
more familiar with traditional medical prac-
tices than immigrants from urban areas, who
were more likely to rely on over-the-counter
therapeutics.15
The Mien in California
have been found to be
at high risk for trichinosis
infection due to the use
of raw pork in dishes
such as laap.
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C H A P T E R 1 2 3 9 7
Due to the strong family orientation, rela-
tives play a significant role in a Filipino client’s
treatment and recovery. For most effective
treatment, the provider should discuss diet
modifications with family members as well
as with the patient. Compliance may be moti-
vated by desire to fulfill familial obligations
and participate in social life.87 The in-depth
interview should be used to determine the
patient’s degree of acculturation, use of tra-
ditional medical practices, and personal food
habits.
Vietnamese and Other Mainland Southeast
Asians Cultural factors that are potential bar-
riers to treatment are believing in the spiri-
tual etiology of diseases, patriarchal values,
modesty, and mistrust of the Western medi-
cal system.60,85 Language barriers may also
exist. Large numbers of Southeast Asians do
not speak English well: Vietnamese (59 per-
cent), Hmong (48 percent), Cambodians
(53 percent), and Laotians (51 percent).97 In
one study, Vietnamese Americans with lim-
ited English proficiency considered quality
translation services essential to care, express-
ing a preference for professional, gender-
concordant interpreters instead of the use of
family members.89
Similar to Filipinos, some Southeast Asians
believe that illness is in the hands of God, spir-
its, or fate. For example, a study of college stu-
dents found that over 38 percent of Hmong
participants believe developing osteoporosis
is due to chance or luck (though Vietnam-
ese students were more likely to attribute
the condition to diet).90 Furthermore, some
Southeast Asian Americans may deny dis-
comfort and pain until it becomes intolerable,
or until all home remedies prove ineffective.
Many Southeast Asians also philosophically
regard quality of life to be more important
than length of life, believing that personal
illness or suffering will diminish in the next
reincarnation. As a result, a client may be
very ill before deciding to go to a clinic or
hospital. Traditionally, prevention of disease
occurs primarily through harmonious living;
most Southeast Asians have little experience
with medical checkups or treating a condition
when no symptoms are present.24,91
Trust is a significant issue in Southeast
Asian health care. Experiences with medical
personnel in refugee camps have left many
immigrants suspicious of biomedicine in
general. Many Americans of Southeast Asian
descent believe that Western practitioners do
not understand their medical needs and are
disrespectful of their traditional practices;
many are fearful of invasive laboratory tests,
especially the taking of blood because this
may upset the body’s balance. Surgery may be
avoided and even autopsies denied due to fears
about the relationship between the body and
soul. Privacy issues may also be of concern.
For example, the need to completely undress
or the use of hospital gowns, breast and pelvic
exams, and discussions about family planning
should be postponed until a client–provider
relationship has been established, preferably
between a provider of the same gender as the
client.24
Southeast Asian clients desire a full
description of their disorders and therapies,
and interpreter fluent in a client’s dialect and
culture may be essential to communication.
For example, one study found that the con-
cept of chronic illness did not exist in Hmong
healing practices, and there were no words or
explanations for conditions such as hyper-
tension and diabetes. There was confusion
among respondents between curing and con-
trolling an illness.93 Differences in medical
concepts and technologies require
A very polite, unhurried, and reserved con-
versational style is appreciated by most South-
east Asians. Excited, informal, or frank speech
may be considered rude.46 Many Hmong pre-
fer an attitude of caring and respect, showing
warmth through smiling and using a positive
approach—negative statements and outcomes
should be avoided.24,94 The Vietnamese place
a high value on social harmony; both Con-
fucian and Buddhist belief systems encour-
age modesty. The clinician should be aware
that, in general, Southeast Asian clients will
be agreeable to avoid disharmony or to please
the questioner. When angry or embarrassed,
Southeast Asian Americans may laugh to
mask their emotion. Proper posture and
appearance are important. In addition, certain
non-verbal forms of communication should
Some Filipinos believe
that fat is a protection
against becoming too
cold and losing vital
energy; thus, being
overweight is preferred
to being too thin.
Some Filipino elders
prefer their food soft
and warm and will reject
beverages with ice.157
Traditional therapies
such as coining or
moxibustion may leave
marks on the skin; abuse
should not necessarily be
presumed.
Hmong may prefer
unseasoned foods when
hospitalized and may
desire water that is
boiled before drinking.46
Some Southeast Asians
may not distinguish
between fruit juices and
fruit-flavored beverages
in food recalls.
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3 9 8 S O U T H E A S T A S I A N S A N D P A C I F I C I S L A N D E R S
be carefully observed. The head is considered
sacred, and it is extremely offensive to pat or
even touch the head of an adult or child with-
out permission. The feet are the lowest part of
the body, and thus it is impolite to point with
the foot or show the bottoms of one’s shoes. It
is also rude to snap one’s fingers or signal by
using an upturned index finger, as this is how
dogs are called. Respect is shown by giving a
small bow of the head when greeting elders
and by using both hands to present any item
to the client.
Numerous studies have noted that the now
older refugees from mainland Southeast Asia
are at special risk for mental health prob-
lems, due to the horrors of war, difficulties in
escape, lengthy camp confinement, and the
extreme cultural differences between their
homeland and the United States. Posttrau-
matic stress disorder is common. One study
of the Hmong suggests, however, that levels of
depression, anxiety, hostility, and other symp-
toms of adjustment problems may gradually
resolve with length of stay.114 Adherence to
traditional health beliefs varies, often accord-
ing to whether new religious faiths have been
adopted; Christian churches strongly discour-
age ancestor and spirit worship.22 Some stud-
ies suggest that the majority of immigrants
continue certain practices, such as the use of
botanical home remedies and coining (see the
section “Traditional Health Beliefs and Prac-
tices”), for many years after arrival although
the costs and inconvenience of some tradi-
tional cures, including difficulties in obtain-
ing animals and herbs, the disintegration of
clan ties, and the scarcity of shamans pres-
ent barriers in some communities.17,27,33,95,115
Southeast Asians frequently develop a medical
pluralism, accepting those theories and thera-
peutics most congruent with their accultura-
tion experiences.
Adherence to traditional health beliefs and
practices, such as hot and cold theories and
the use of herbal remedies, is reportedly high
among many Southeast Asians.24,31,88 It is not
unusual for Southeast Asians to consult both
biomedical practitioners and healers for relief
Iwas born in Vietnam but came to the United States when I was about a year
old. My parents left Vietnam in 1976. My
grandparents got us and about thirty-five
other people out on a boat. We first went to
a refugee camp in Malaysia, and after a few
months we were able to settle in Southern
California.
At home we ate a traditional diet, and
I still do. Rice and noodles are staple foods.
Breakfast is a French baguette with pâté and
ham (there is a lot of pork in the diet). Lunch
is soup or a bowl of rice with one entrée, usu-
ally a leftover from dinner. There are always
three things for dinner: (1) always soup, (2) a
stewed meat entrée, and (3) vegetable stir-
fry. Fruit is usually served for dessert. Snacks
are commonly fruit or sticky rice. Western
foods that I eat now are dairy products
such as milk, cheese, and yogurt; cereal for
breakfast; and more sweets for dessert. Viet-
namese have always eaten a lot of sugar but
not as desserts. I lost all my baby teeth due to
cavities because I was given so much candy.
In Vietnam, only children from wealthy fami-
lies got candy, so it was a real treat here.
When we first came over, our neighbors
gave my parents cereal to try, and they liked
it. At that time my parents hardly spoke or
read English, and there were very few Viet-
namese markets. Because the cereal box had
pictures of cats and dogs on it, when they
went to the grocery store they bought a box
of something with pictures of cats or dogs on
it, but it turned out to be pet food. They ate
the whole box, but they did put sugar on it
because it wasn’t sweet enough. This was not
an uncommon problem when the Vietnamese
first immigrated to the United States. A friend
was enrolled in WIC (Women, Infants, and
Children) while she was pregnant and had
vouchers to buy WIC food at the market. She
recognized the word cheese and she bought
cream cheese and ate one package every day
during her pregnancy.
When counseling Vietnamese, it is
important to remember that our meal is not
complete unless it contains rice or noodles.
Therefore you should not recommend
eliminating these elements of the diet but
rather just decrease their amount.
N E W A M E R I C A N P E R S P E C T I V E S
HAN LE, Student
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C H A P T E R 1 2 3 9 9
of symptoms. The Vietnamese usually char-
acterize U.S. biomedicine as yang (hot) and
traditional Vietnamese medicine as yin (cold).
Biomedicine is seen as fast-acting, temporary,
and likely to have side effects. It is useful for
emergency situations. Vietnamese medicine is
considered slow-acting, gentle, without side
effects, a permanent cure, or useful in preven-
tion. Some immigrants believe it is important
to counteract the yang impact of biomedical
therapies with yin herbal remedies.23 Little is
known about the active agents in Southeast
Asian herbal remedies, and some may be of
concern. High levels of lead have been found
in paylooh, an orange powder ingested for
rashes or fever. A case study found that the use
of slang nut (the source of strychnine) was not
toxic as applied in Cambodia, but is poisonous
when used in the United States without the
leaves it is traditionally wrapped in.24,98
Because the postpartum period is defined
as yin (cold), women avoid exposure to cold
and wind (see the section “Traditional Health
Beliefs and Practices”). Clients may refuse
to get out of bed soon after giving birth and
refuse to take a shower or wash their hair. Âm
foods, such as cold beverages and vegetables,
may be refused even if prepared in a cultur-
ally sensitive manner. Women may consume
alcoholic beverages because they are duong,
and alcohol is also thought to cleanse the
reproductive system and promote milk pro-
duction.40 Hmong women also consider the
postpartum period a cold condition.
An in-depth interview is critical to deter-
mine the patient’s country of origin (a patient
may be offended if grouped with all other
Southeast Asians), length of time in the United
States, and any immediate health problems.
Degree of acculturation and personal food
preferences should also be noted.
Native Hawaiians and
Pacific Islanders
Native Hawaiians and Pacific Islanders
(NHPIs) are the peoples inhabiting some
of the 10,000 islands of Oceania. Polynesia,
Micronesia, and Melanesia are the three areas
that make up the Pacific region. Polynesia
includes the major islands and island groups
of Hawaii, American Samoa, Western Samoa,
Tonga, Easter Island, and Tahiti and the
Society Islands. The 2,000 small islands of
Micronesia include Guam, Kiribati, Nauru,
the Marshall and Northern Mariana Islands,
Palau, and the Federated States of Microne-
sia. Although the boundaries of Melanesia are
not exact, it includes the nations of Fiji, Papua
New Guinea, Vanuatu, the Solomon Islands,
and the French dependency of New Caledonia.
Although the area is geographically simi-
lar, consisting of mostly small, tropical coral
or volcanic islands, NHPI are a racially and
culturally diverse population. European,
American, and Japanese influences have been
extensive. Today there are greater numbers of
some NHPI groups living in the United States
than in their native homelands.
Cultural Perspective
History of Native Hawaiians and Pacific
Islanders in the United States
Immigration Patterns Since the first settle-
ment of the island Oceania, the migration of
population groups has been very fluid among
Polynesia, Micronesia, and Melanesia. As
conditions on one island grew too crowded,
colonization of surrounding islands occurred.
That trend continues, with economic oppor-
tunity the primary motivation for NHPI
immigration to the United States and other
nations.
Hawaiians When British explorer James
Cook first arrived in Hawaii, approximately
300,000 Native Hawaiians were living on the
islands. European diseases introduced by the
explorers and missionaries decimated the
population, and by 1910 only a little more
than 38,500 persons of Hawaiian ancestry
remained. A high rate of intermarriage has
resulted in a population with few Hawaiians of
full native heritage. A large number of Hawai-
ians have migrated to the mainland United
States, but the census figures do not reflect
such interstate relocations.
Samoans In 1951 the Pago Pago naval base
that employed many Samoans moved to
Hawaii, and many Samoans followed. Increas-
ing population pressures and a deteriorating
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4 0 0 S O U T H E A S T A S I A N S A N D P A C I F I C I S L A N D E R S
economy encouraged further immigration.
Once in Hawaii, Samoans sometimes move
to the mainland United States in search of
broader job availability and for wider edu-
cational opportunities for their children. A
chain of immigration between Hawaii and the
West Coast has been created, with Samoans
established in the mainland helping extended
family members settle nearby.
Guamanians Following attainment of citizen-
ship in 1950, many Guamanians enlisted in the
U.S. armed forces seeking better employment.
Some moved to Hawaii and the West Coast of
the U.S. mainland. By the early 1970s, approxi-
mately 12,000 Guamanians had immigrated,
mostly Chamorros (native Micronesians). Major
populations have settled in San Diego, Los Ange-
les, San Francisco, the Seattle area, and Hawaii.
Tongans The immigration of Tongans to the
United States did not begin until population
pressures in the 1960s decreased economic
opportunities in Tonga. Under the strict
hereditary social structure, only the eldest son
in a family may inherit land, leaving younger
men with little economic mobility. Unlike
most other NHPIs, Tongans usually immi-
grate directly to the U.S. mainland rather than
settling first in Hawaii.
Current Demographics and Socioeconomic Status
Hawaiians More than 1.2 million U.S. citi-
zens were self-identified as Native Hawaiians
and Pacific Islander (NHPI) in the 2010 U.S.
Census estimate. Over half a million are Native
Hawaiians, and Samoans are the next largest
group with under 200,000. More than half
of NHPI peoples live in Hawaii and Califor-
nia.97 Scant socioeconomic data are available,
but reports indicate that some Hawaiians
occupy the lowest economic strata in the state
of Hawaii, along with other Pacific Islander
immigrants, living mostly in rural and semiru-
ral regions.99 Hawaiian heritage is less of a
handicap on the mainland, where Hawaiians
have a cultural advantage over other Pacific
Islanders (through extensive exposure to U.S.
society) and often enter the middle class.
Overall, median family income is higher than
the national average, and poverty rates are
higher than the total U.S. figure. Over 90 per-
cent have a high school degree and 19 percent
have a college degree.97
Samoans Probably more Samoans are living
outside Samoa than in American and Western
Samoa combined. Over 184,000 Samoans total
(alone and in combination with other eth-
nicity) are U.S. residents. The largest groups
are found in Honolulu, Los Angeles, the San
Francisco Bay Area, and Salt Lake City.97
Though nearly one-third of Samoans in the
United States work in office and sales jobs, and
18 percent hold management and professional
positions, another 30 percent of Samoans in
the United States are employed in unskilled or
semiskilled labor such as assembly line jobs,
construction, janitorial or maintenance jobs,
or as security guards.99 Median family income
is lower than the national average. Approxi-
mately 17 percent of Samoans live in pov-
erty. Over ninety percent of Samoan adults
have a high school education and just under
15 percent have a college degree.97
Guamanians The 2010 U.S. Census statistics
indicate over 63,000 Guamanians are residing
in the United States. Many are Chamorros,
although self-identification figures are unclear
on the exact percentage. The Chamorros often
become part of Pacific Islander communi-
ties (with Samoan and Tongan immigrants).
Large populations of Guamanians are found
in Hawaii, California, Washington State, and
Washington, DC.97
▲ A rendering of the
Resolution, the ship used
by James Cook to explore
Polynesia. Many Pacific
Islander cultural traditions
disappeared after European
discovery of the islands in the
eighteenth century.
Be
tt
m
an
n/
Co
rb
is
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C H A P T E R 1 2 4 0 1
Over one-quarter of Guamanians work in
professional or management positions, and
nearly one-third are employed in office and
sales jobs.100 Their median family income is
above the U.S. average.. Nearly 50 percent
of Guamanian adults have attended college,
though graduation rates are well below the
national average. Additionally, 22 percent of
adults have not graduated from high school.97
Tongans Over 27,000 Tongans live in the
United States according to U.S. 2010 Census
figures.97 Many are Mormons and are aided in
their immigration by their church, and most
move to communities of other NHPIs in San
Francisco, Los Angeles, Dallas, Fort Worth,
and Salt Lake City.
In regard to educational attainment in the
U.S. Tongan community, 81 percent of adults
have graduated from high school. Median
family income is higher than the national
average.97
Worldview
Religion Native Hawaiians and Pacific Island-
ers follow a wide variety of religions, often
according to which missionary groups were
active in their homeland. Hawaiians practice
mostly Protestantism, Buddhism, or Shinto-
ism. Samoans are largely Methodist, Catholic,
Mormon, and Anglican. Chomorros are pri-
marily Catholic, and Tongans in the United
States are mostly Mormon. Religion is often
prominent in the lives of NHPIs, and minis-
ters usually are held in high esteem. In Samoa,
nightly readings from the Bible are common
in most homes, and prayers are offered at
every meal.101,102,103,104
Family Although most native religions were
abandoned, many concepts central to Pacific
Islander culture remained within the struc-
ture of families. For example, on many islands
social rank and power were established by
birth order within the extended kinship sys-
tem or clan, and even within families, younger
siblings deferred to their older brothers and
sisters. Elders were respected. The senior
male in the group, whether in the village or
in a family, managed all group matters. In
Hawaii women and men were segregated
under the kapu system, each with specific
roles and responsibilities. Extended families
were the foundation of society, and children
were raised usually by grandparents, aunts
and uncles, and even remote kin rather than
by just the parents. Household composition
was flexible, and all members were obligated
to support the extended family, resulting in
substantial redistribution of resources. Gen-
erosity and sharing were highly valued. Any
social transgressions committed by the indi-
vidual were the responsibility of the whole
family. In Samoa, if the violation was severe,
the family could be disinherited from their
land and stripped of any social title.
Some of these same practices are contin-
ued by NHPIs today. Unlike many immigrant
groups, they typically maintain extended
families in the United States. Responsibil-
ity for child rearing is shared among family
members (children may move freely between
homes), and household chores are assigned
according to age and gender. The oldest man
(or occasionally the oldest woman) in the
home assumes control, collecting everyone’s
paycheck (or weekly contribution) and pro-
viding for the household needs. The good
of the whole family is considered before the
benefit to the individual, and most NHPIs are
guided by their desire to avoid bringing shame
on their family. In Guam this interdependence
is known as inafa’maolek and extends not only
to family and community, but to national affil-
iation as well.101,102,103,104
The stresses of acculturation in the United
States usually occur due to moving from a
society in which there is little anonymity (with
individual behavior reflecting on the whole
family or village) to a society in which NHPIs
are often marginalized or even invisible if mis-
identified as Asians or Filipinos. Most NHPIs
maintain close contact with their homeland
and fulfill their obligation to family by send-
ing financial support. Trips back to the islands
for political and social events are common.
Traditional Health Beliefs and Practices
Religion and medicine were closely linked
in Pacific Islander culture, and the loss of
many traditional health beliefs and practices
occurred with the adoption of nonnative
faiths. Although folk healers specializing in
Nearly 40,000 Fijians
live in the United States,
according to 2013 U.S.
Census data, primarily
in California. Most
are of Asian-Indian
descent, were originally
indentured laborers in
Fiji, and follow the Islamic
or Hindu faith. Though
overall educational
attainment is low,
median family income
approaches the national
average, and poverty
rates are significantly
lower than the norm.158
In Samoa, a serious
offense by an individual
can be ameliorated
by an ifoga (literally “a
lowering”). The extended
family positions
themselves in front of
the victim’s home and
remains there until
invited in and forgiven.
They formally apologize
through the presentation
of gifts and cash.
Certain fish in Hawaii
were reserved for royalty,
and women rarely
consumed fish, although
they were permitted to
eat shellfish.
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4 0 2 S O U T H E A S T A S I A N S A N D P A C I F I C I S L A N D E R S
herbs, massage, or religious and/or spiritual
intervention work in Pacific Islander com-
munities both in Hawaii and on the U.S.
mainland, their current use is not well docu-
mented. Traditional practitioners are iden-
tified with a broad range of Eastern and
Western religious affiliations and offer a wide
spectrum of services. Their clientele are also
extremely diverse, often crossing ethnic or
religious lines to seek effective care.105
Many Native Hawaiians believe lokahi,
harmony between individuals, nature, and
the gods, is essential to good health. Hawai-
ian healers typically practice massage
(ho’olomilomi—used for conditions such as
childbirth, asthma, congestion, bronchitis,
inflammation, and rheumatism), herbal med-
icine (la’au lapa’au), and/or conflict resolution
(ho’ononpono, meaning “make things right”—
used to remove emotional obstacles to heal-
ing). Meditation, deep breathing, and Chinese
Traditional Medicine may also be employed.
Healing is initiated at the end of each session
with spiritual blessings.106,107,108
It is reported that more than 300 Hawai-
ian botanicals and animal- or mineral-based
cures were available traditionally, with over
fifty-eight remedies for respiratory prob-
lems alone.101,110,111Today, only thirty plants
are estimated to be used regularly. Examples
include aloe vera for burns, hypertension, dia-
betes, and cancer; plantain leaves to reduce
blood sugar levels in diabetes; polokai (black
nightshade) for asthma, coughs, and colds;
and wild ginger for gastrointestinal prob-
lems, ulcers, and asthma. Native Hawaiians
also practice home remedies. For example,
drinking seawater followed by freshwater is
believed to be a general tonic.
Samoans believe that health is maintained
through a good diet, cleanliness, and harmony
in interpersonal relationships. An individual is
at high risk of illness if he or she does not fulfill
family obligations or support village life. The
concept of balance is essential: disruptions in
interpersonal relationships, working too hard,
sleeping too little, or eating the wrong foods
can cause dislocation of the to’ala (the center
of one’s being, located just beneath the navel)
to another part of the body, where it induces
pain, poor appetite, or other symptoms.112,113
Treatment typically requires the restoration of
balance. A family may get together to openly
air disputes so that harmony can be reestab-
lished, or massage by an elder may be used to
gently coax the to’ala back into position. A tra-
ditional Samoan healer may be consulted to
cure certain folk illnesses, particularly those
due to supernatural causes, such as spirit pos-
session by malevolent ghosts or the actions of
ancestor spirits angered by a person’s conduct.
One such condition is musu, a mental illness
in young men and women typified by extreme
withdrawal. Healers may be herbalists, mas-
seuses, bone setters, midwives, taulasea (a
general practitioner familiar with Samoan
sicknesses), power healers (who provide
spiritual interventions), or diviners (special-
izing in the determination of why an illness
has occurred). Massage, herbal remedies, and
communication with the supernatural ele-
ments are the usual therapies.102,113
Traditional Food Habits
The cooking of the Pacific Islands developed
without benefit of metal pots, pans, and uten-
sils, and many foods were eaten raw. The
indigenous cuisine was probably based on
breadfruit, taro, cassava, yams, and perhaps
pigs and poultry. Fruits were also widely avail-
able, although those often associated with the
Pacific region, such as coconuts and bananas,
▼ Taro root, staple of the
Native Hawaiians and Pacific
Islanders, is served boiled
or pounded into a paste
called poi. The leaves are also
consumed.
Is
ab
el
le
R
oz
en
ba
um
/P
ho
to
A
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A
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nc
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RF
C
ol
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io
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/G
et
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Im
ag
es
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C H A P T E R 1 2 4 0 3
were not introduced from Indonesia until
approximately 1000 c.e. Other items, includ-
ing sugar cane and pineapple, were brought by
European plantation owners.
Ingredients and Common Foods: Staples
Starchy vegetables are the mainstay of the
traditional Pacific Islander diet (Table 12.3).
These include the root vegetable taro, which
is a little denser and more glutinous than the
white potato; breadfruit, with a fluffy, bread-
like interior; cassava; and yams. These foods
were often cooked and then pounded into a
paste. In Hawaii, taro root paste eaten fresh, or
partially fermented, is called poi (a word that
originally referred to the pounding method).
When food was scarce, the Native Hawaiians
survived on the purplish-colored poi, some-
times with a little seaweed or fish added to it.
Although taro root is also a staple in Samoa, it
is usually boiled but not pounded. Arrowroot
is used to thicken puddings and other dishes.
The Europeans introduced wheat, and bread is
eaten in some areas; for instance, Portuguese
sweet bread is known as Hawaiian bread in
Hawaii. Asian settlers popularized both short-
and long-grain rice, as well as noodles.151
More than forty varieties of seaweed are
consumed. Cooked greens, including the
leaves of the taro root, yam, ti plant, and sweet
potatoes, are very popular. One specialty is to
wrap foods in ti or taro leaves, then steam the
packets for several hours. The musky flavor
of the leaves permeates the entire dish, called
laulau in Hawaii.32 Another specialty known
as lu’au combines chopped taro leaves with
chicken or octopus and coconut milk.114
Fish and seafood are abundant in the
Pacific Islands, and in some regions they
were eaten at every meal. Mullet is one of the
most popular fishes, but many others, includ-
ing mahimahi (“dolphin fish,” not related
to the mammal), salmon, shark, tuna, and
sardines are also consumed. A tremendous
variety of shellfish is available, such as clams,
crabs, lobster, scallops, shrimp, crawfish, and
sea urchins, as well as many local species.
Eel, octopus, squid, and sea cucumbers are
also eaten. Although some fish and seafood
was stewed or roasted, some was also eaten
uncooked, marinated in lemon or lime juice,
which turns the fish opaque much the same
as cooking it. A popular Hawaiian specialty
is lomi-lomi, made with marinated chunks of
salmon, tomatoes, and onions, served with or
without poi as an appetizer. A similar Samoan
dish, called oka, is also made with chunks of
raw fish marinated in a mixture of lemon juice
and coconut cream.
Pork is the most commonly eaten meat,
especially for ceremonial occasions. Tradi-
tionally it was cooked in a pit called an imu
in Hawaii, a hima’a in Samoa, and an umu in
Tonga. A fire was built over the stones lining
the pit, and when the coals were hot, layers of
banana leaves or palm fronds were added. The
pig and other foods, such as breadfruit and
yams, were placed on the leaves, then covered
with more leaves and sealed with dirt. In some
cases water was poured over the rocks just
before the pit was closed, steaming the foods
instead of baking them. The pit was left sealed
for hours until the food was completely cooked.
Chicken is widely available, as are eggs.
Limited grazing land kept beef from becom-
ing a frequently eaten item. Milk and other
dairy products are also uncommon. Soybean
products are used by Asian residents, and
winged beans are a popular legume on some
islands.
Fruits and nuts are important ingredients in
Pacific Islander cuisine. Bananas, candlenuts
(kukui nuts), citrus fruits, coconuts, pineap-
ples, guavas, litchis, jackfruit, mangoes, mel-
ons, papayas, passion fruit, and vi (ambarella)
are a few of the widely available varieties.
Fruits are eaten fresh or added to dishes such
as Samoan papaya and coconut cream soup
(supo ’esi) and deep-fried dumplings filled
with pineapple or bananas (pani keki). Coco-
nuts provide juice for drinking, sap for fermen-
tation, and milk or cream used in numerous
stewed dishes (coconut milk can also be made
into foods resembling cheese and buttermilk).
Immature coconuts are considered a delicacy
throughout the Pacific. Haupia, a traditional
gelatin-like Hawaiian dessert, is made from
coconut milk sweetened with sugar.
Traditional Pacific Islander fare was not
highly seasoned. The flavors of lime or lemon
juice, coconut milk or cream, and salt pre-
dominate, with occasional use of ginger, garlic,
Hysterical behavior,
especially by women, was
called “ghost sickness”
by the Tongans and
attributed to possession
by the spirit of a deceased
female ancestor. Another
traditional illness occurs
in infants when the
fontanel does not close
(mavae ua).
Traditionally, Samoan
men obtained full-body
tattoos, in part to help
them empathize with
the prolonged pain of
childbirth suffered by
Samoan women.
Fish hooks are symbolic
of good luck in Hawaii.
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4 0 4 S O U T H E A S T A S I A N S A N D P A C I F I C I S L A N D E R S
©
C
en
ga
ge
L
ea
rn
in
g
Group Comments Common Foods Adaptations in the United States
Protein Foods
Milk/milk products Milk and other dairy products are
uncommon. Many Pacific Islanders
are lactose intolerant.
Increased intake of milk has
occurred.
Meat/poultry/fish/
eggs/legumes
Pork is the most commonly eaten
meat.
Soybean products are used by Asian
residents. Winged beans are a
popular legume on some islands.
Meat: beef, pork
Poultry and small birds: chicken, duck,
squab, turkey
Eggs: chicken, duck
Fish and shellfish: ahi, clams, crabs,
crawfish, eel, lobster, mahimahi,
mullet, octopus, salmon, sardines,
scallops, sea cucumber, sea urchin,
shark, shrimp, swordfish, tuna,
turtle, whale
Legumes: beans (long, navy, soy,
sword, winged), cowpeas, lentils,
pigeon peas
Dietary changes often
occur before immigration.
Many are dependent on
imported foods such as
canned meats and fish.
Cereals/Grains Europeans introduced wheat
bread, and Asians brought rice
and noodles.
Rice, wheat Increased intake of bread
and rice is noted.
Fruits/Vegetables Starchy vegetables are the mainstay
of the diet. They were often cooked
and pounded into a paste.
More than 40 varieties of seaweed are
eaten. Cooked greens are popular.
Fruits are an important ingredient.
Immature coconuts are considered
a delicacy.
Arrowroot is used to thicken
puddings and other dishes.
Fruits: acerola cherry, apples, apricot,
avocado, banana, breadfruit, citrus
fruits, coconut, guava, jackfruit,
kumquat, litchis, loquat, mango,
melons, papaya, passion fruit,
peach, pear, pineapple, plum,
prune, soursop, strawberry,
tamarind
Vegetables: arrowroot, bitter melon,
burdock root, cabbage, carrot,
cassava, cauliflower, daikon,
eggplant, ferns, green beans, green
pepper, horseradish, jute, kohlrabi,
leeks, lettuce, lotus root, mustard
greens, green onions, parsley, peas,
seaweed, spinach, squashes, sweet
potato, taro, ti plant, tomato, water ti plant, tomato, water ti
chestnuts, yams
The traditional starchy
vegetables have decreased
in use and may only be
consumed at special
occasions.
Additional Foods
Seasonings Food is not highly seasoned but often
flavored with lime or lemon juice
and coconut milk or cream.
Curry powder, garlic, ginger, mint,
paprika, pepper, salt, scallions or
green onions, seaweed, soy sauce,
tamarind
Nuts/seeds Nuts are a core ingredient. Candlenuts (kukui), litchi, macadamia
nuts, peanuts
Beverages Coconuts provide juice for drinking
and sap for fermentation.
Cocoa, coconut drinks, coffee, fruit
juice, kava (alcoholic beverage made
from pepper plant), tea
Increased consumption of
sweetened fruit beverages
and soft drinks has
occurred.
Fats/oils Coconut oil and lard are the preferred
fats.
Butter, coconut oil or cream, lard,
vegetable oil and shortening,
sesame oil
Use of vegetable oils and
mayonnaise has increased.
Sweeteners Sugar
TA B L E 12 . 3 Cultural Food Groups: Pacific Islanders
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C H A P T E R 1 2 4 0 5
tamarind, and scallions or onions. Coconut oil
and lard are the preferred fats, providing a dis-
tinctive taste to many dishes. Foreign spices,
such as Asian Indian curry blends, and sauces,
such as soy sauce, have been incorporated into
some dishes.
Meal Composition and Cycle
Daily Patterns Traditional meals included
poi or boiled taro root, breadfruit, or green
bananas; fish or pork; and greens or seaweed.
In Samoa, Guam, and Tonga, most dishes are
cooked in coconut milk or cream. Although
the evening supper was generally the largest
meal, little distinction was made between the
foods served at the two or three daily meals.
When food was pit-cooked, amounts suitable
for two or three days at a time were prepared.
Fresh fruit was eaten as snacks. Beverages
made from coconut juice or sap were com-
mon. The Asians introduced various teas,
including those made from lemon grass and
orange leaves. In Samoa a drink made from
ground cacao beans mixed with water, called
koko samoa, is traditional. Kava, a bland,
mildly intoxicating beverage, remains a pop-
ular drink in many regions. It is made from
the chewed or ground root of the native pep-
per plant, mixed with water in a stone bowl.
It reputedly tastes a little like dirt or licorice.
Etiquette Most NHPIs consider hospitality an
honor, and outsiders are usually exempt from
traditional manners. In Samoa, for example, it
is considered rude to eat in front of someone
without sharing. When eating a meal, respect
should be shown for the food because it rep-
resents the host’s generosity; this includes not
talking during the meal.102 Most hosts will not
eat until a guest is satisfied. As in many societ-
ies, it is impolite to refuse food, although a guest
is not obligated to eat every morsel served. At
some Samoan celebrations, for example, a large
box of food may be placed on the table for each
guest. The diner samples items from the box
until full, then brings the remaining food home
to share with his or her extended family.116
Special Occasions Throughout the NHPI spe-
cial events were commemorated with feasting,
often including pit-roasted foods. In Hawaii
weddings, childbirth, completion of a canoe
or house, or a prolific harvest or abundant
catch was celebrated with a luau, featuring a
whole pig, poultry, fish, and vegetables cooked
in the imu. In Samoa the feast is sometimes
preceded by a kava ceremony, in which the
beverage is distributed ritualistically to guests
who are expected to drain the cup in one gulp.
Traditionally kava was offered as a gesture of
hospitality and for occasions such as the ordi-
nation of a new chief. In Tonga, where umu-
cooked food accompanies celebrations such
as the commemoration of a royal birthday,
special coconut frond stretchers are woven
for transporting the massive amounts of food
prepared for the occasion.
Holidays celebrated in the NHPI are usu-
ally those associated with religious affiliation.
In addition, Hawaiians also honor Prince
Kuhio on March 26 and the Kamehameha
Dynasty on June 11. Samoans feast nearly
every Sunday, and almost all denominations
celebrate White Sunday on the third Sunday
of October, venerating children. After a spe-
cial service featuring religious recitations by
children, a festive meal is served, and children
are waited on by the adults in their extended
family.102 Guamanians celebrate their Libera-
tion Day on July 21 with parades, fireworks,
and feasting.103 King Tuafa’ahau Tuopu IV’s
birthday is a national holiday in Tonga.104
Role of Food
Food holds particular importance within
most Pacific Island cultures. Sharing food
is a way of demonstrating generosity and
Hawaii is a leader in
aquaculture. As early
as 1778, Captain Cook
reported 360 fish farms
on the island of Kauai,
producing an estimated
2 million pounds of fish
annually.
The enzyme papain,
extracted from papayas,
is used in some meat ten-
derizers. In Hawaii, papaya
juice is applied to jellyfish
stings to reduce the pain.
Red salt, made from salt
mixed with iron-rich earth,
is a Hawaiian specialty,
traditionally reserved for
important feasts.114
When drinking kava, it is
considered polite to drip
a few drops onto the
ground and say “manuia”
as a blessing before
quaffing.
▼ Pork was traditionally the
most commonly eaten meat,
particularly for ceremonial
occasions. The pig and other
foods were cooked in a stone-
lined pit over coals.
Po
rt
er
fie
ld
-
Ch
ic
ke
rin
g/
Sc
ie
nc
e
So
ur
ce
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4 0 6 S O U T H E A S T A S I A N S A N D P A C I F I C I S L A N D E R S
support for family and village. It is also a way
of expressing prosperity or social standing.
Many events are celebrated with feasting,
and food is eaten to excess as part of the cer-
emony in some regions. Traditionally, gender
roles were defined by food interactions. Boys
and girls were often raised similarly until the
age of eight or nine, at which time they were
separated for training in food procurement
(farming and fishing) or food preparation
(cooking and food storage). Throughout the
NHPI, gifts of food are given often. Because
the gifts are given without expectation of reci-
procity, it is a serious affront to reject any item
presented.
Therapeutic Uses of Foods
Numerous botanicals are used by Native
Hawaiians as cures. Most notable is the pep-
per plant (Piper methusticum—related to the
betel vine), which is used to make kava or awa.
It is sometimes used medicinally as an analge-
sic or narcotic.116 In diluted form, it is used as
a sedative and given to teething infants. Noni
(Indian Mulberry) is consumed as a juice for
anorexia, renal problems, urinary tract infec-
tions, hypertension, diabetes, musculoskel-
etal pain, to boost the immune system, and
to prevent cancer.108 Turmeric is consumed as
a blood cleanser, and breadfruit is made into
a tea to treat high blood sugar and elevated
blood pressure.
Contemporary Food Habits
in the United States
Adaptations of Food Habits
Ingredients and Common Foods In Hawaii,
today’s population often eats fare that com-
bines elements of Eastern and Western foods,
typified by the plate lunch: rice heaped with
one or two types of meat, poultry, or fish
(such as teriyaki beef, spaghetti and meat
sauce, fried mahi-mahi, pit-cooked pork,
curry, or Spam) covered with gravy, served
with a scoop of macaroni or potato salad, and
eaten with chopsticks. Soy sauce is the most
common condiment.114 Ethnic cuisines and
typical American dishes are also widely con-
sumed. Snacking is prevalent and may include
noodles topped with meat (saimin), steamed
pork rolls (manapua) or a large ball of glu-
tinous rice with a bit of pickled daikon or
teriyaki tuna tucked in the middle (musubi).
Crack seed is especially popular, consisting of
dried, salted, and sugared fruits (e.g., guava,
sliced ginger, lemon peel, mango, plum) that
provide a sweet-and-sour flavor experience.
Some are also seasoned with spices, such as
anise. The seed kernels (in whole preserved
fruit) are traditionally cracked open with
the teeth, adding extra flavor and giving the
descriptive name to the treats.114
The dietary changes made by other Pacific
Islanders often begin before immigration
to the mainland United States. Most Pacific
Islanders in their homelands are highly reli-
ant on imported foods, particularly pro-
cessed items such as canned meats and fish,
cooking oil, mayonnaise, cookies, breakfast
cereals, and soft drinks. One study of Samoa
indicated that 80 percent of all foods found
in one market were from the United States,
New Zealand, or Australia.117 Consumption
of native foods, such as taro and coconut,
increases on Sundays.118 In Guam, a high
intake of meats, fried foods, foods cooked in
coconut milk, white rice, and sweetened bev-
erages and a low intake of produce have been
S A M P L E M E N U
A Native Hawaiian Dinner
L omi- L omi (Marinated Salmon) (Marinated Salmon)L omi- L omi a,b,c
Chicken L u ’ au (Chicken with Taro/Spinach Leaves)a,c
P oi (Fermented Taro Root)P oi (Fermented Taro Root)P oi a or Sweet Potatoesc
Haup ia (Coconut Dessert)a,b,c or Guava Cakea,b,c
Fruit Juice or Coffee
aLaudan, R. 1996. The food of paradise: Exploring Hawaii’s culinary heritage. Honolulu:
University of Hawai’i Press.
bLocal Kine Recipes at http://www.hawaii.edu/recipes
cLuau Foods and Recipes at http://alohaworld.com/ono/
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 2 4 0 7
noted.119 Nutrient-rich native foods, such as
fish, yams, papayas, and mangoes, were rarely
consumed by Guamanian children in another
study.119 Traditional starches, such as taro root
and cassava, are often reserved for special-
occasion feasts.120
Little has been reported on Pacific Islander
food habits in the United States. A study com-
paring the intakes of Western Samoans (living
in a poorer, less Westernized culture) to those
of American Samoans (living in a wealthier,
more Westernized culture) found that the
Western Samoans ate a diet higher in total fat
due to a reliance on coconut cream compared
to a diet higher in protein, cholesterol, and salt
due to higher consumption of processed foods
eaten by American Samoans.121
Older studies on Samoans who have
moved to Hawaii show diets with greater vari-
ety of foods; traditional foods contribute only
minimally to daily intake, and items such as
rice, bread, sugar, beef, canned fish, milk, soft
drinks, and sweetened fruit beverages make
up most of the diet.118 Available health statis-
tics indicate that a diet substantially higher
in fat and simple carbohydrates and lower in
fruits, vegetables, and fiber has been adopted
by many immigrants.
Meal Composition and Cycle Three meals each
day are common for most Pacific Islanders.
Breakfast is most often cereal with coffee.
More traditional meals may be eaten for lunch
and dinner; a few Hawaiians still eat poi once
or twice a day. Fruit appears more often as
part of the meal rather than as a snack. It is
believed that Sunday feasting among Samoans
is still prevalent.
Nutritional Status
Nutritional Intake Serious nutritional defi-
ciencies are uncommon in most Pacific
Islander diets. A high calorie intake gener-
ally guarantees nutritional sufficiency. How-
ever, research in the last decade (2000–2007)
indicated that 10 percent (6 to 27 percent) of
NHPI elders reported food security issues
as a result of inadequate income. California
NHPI adults ate fast food meals 1.5 times a
week, and teens were even higher at 2.4 times
per week.122
A study of children in Guam found that
three-quarters consumed fruits and vegeta-
bles less than once daily, and Native Hawaiian
and Pacific Islander adults consume approxi-
mately one fruit or vegetable daily on aver-
age.123,124 Rice, meat, powdered fruit drinks,
milk, and fortified cereals were the primary
sources of vitamins and minerals in the diets
of Guamanian children in other research. Low
intakes of calcium, vitamin E, and folate were
identified.119
NHPIs have high rates of smoking, alco-
hol consumption, and obesity. In 2011, they
were almost four times more obese than the
Asian American population and 30 percent
more obese than non-Hispanic, and were
twice as likely to be diagnosed with diabetes.
Obesity may be caused by overeating (within
the context of family and church activities)
combined with inadequate physical exercise,
and traditionally, being overweight was an
aesthetic preference in the cultures. Hered-
ity may also be a factor, and/or it may be due
to the change in the types and amount of
foods consumed plus lower levels of physical
activity.103,125,126,127 Additionally, researchers
have found that when Pacific Islanders are
compared to whites with the same percentage
of body fat, the Pacific Islanders have higher
BMIs, suggesting greater nonfat density. Body
mass index cutoffs for overweight and obesity
that are standardized for whites may need to
be modified.128
Many NHPIs value a larger body size.
One study in Hawaii found that they believe
whites and Europeans should be slim, but that
NHPIs should be over-weight or obese.129
Though Samoans living in Westernized New
Zealand identified a slim body as ideal, those
who were above normal weight did not con-
sider themselves to be obese and were positive
about their body size and health.130 Research
in Micronesia reported that many mothers of
overweight children associate thinness with
illness.131
Risk for type 2 diabetes mellitus is also high
for the NHPI population.124,132,133 Prevalence
estimates are the highest for Native Hawaiians
(two to six times the 5 to 7 percent prevalence
among whites) and from 9 to 16 percent for
Samoans.109,134 It is postulated that Samoans
Areca nuts are used
throughout the Pacific
Islands, and in Hawaii
they are considered a
stimulant. Guamanians
are especially fond of
chewing them. The
practice is traditionally
passed from grandparent
to grandchild and
is common at social
occasions. Chomorrans
chew them after meals.103
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
4 0 8 S O U T H E A S T A S I A N S A N D P A C I F I C I S L A N D E R S
may be especially susceptible to the kidney
damage associated with hypertension because
end-stage renal failure is a common cause of
death in American Samoan diabetes patients.
Leading causes of death among NHPIs are
cancer, heart disease, unintentional injuries
(accidents), stroke, and diabetes. In Hawaii,
Native Hawaiians were 1.7 times more likely
to die from heart disease compared to His-
panic whites, three times more likely to be
diagnosed with coronary heart disease as
compared to non-Hispanic whites. and four
times more likely than non-Hispanic white
adults to die from a stroke.135,136,137 Interest-
ingly NHPIs have a lower rate of hypertension
compared to non–Hispanic whites.138
Native Hawaiians and Pacific Islanders are
30 percent more likely to be diagnosed with
cancer, as compared to non-Hispanic whites.
American Samoan women are twice as likely
to be diagnosed with, and to die from, cervical
cancer, as compared to non-Hispanic whites.
American Samoan men are eight times more
likely to develop liver cancer, and Native
Hawaiian men are 2.4 times more likely to be
diagnosed with the same disease, as compared
to non-Hispanic whites. In Hawaii, Native
Hawaiian men have the highest mortality rate
(220) for all types of cancer, as compared to
other ethnic groups in Hawaii, and Native
Hawaiian women have the highest incidence
rate (463.6) for all types of cancer, as compared
to other ethnic groups in the state.139,140,141 In
the U.S. territory of Guam, the incidence rate
for liver cancer was 6.7 times higher in the
Micronesian population, as compared to the
national U.S. population (38.2 and 5.8, respec-
tively), from 2003 to 2007.142
Infant mortality data suggest that Native
Hawaiians have rates above the national aver-
age.76 California data also report significantly
higher rates of infant deaths among Samoans
and Pacific Islanders, though for Native Hawai-
ians and Guamanians, infant deaths were nearly
half those of the total population despite higher
rates of low-birth-weight neonates.143,144,145
Native Hawaiian mothers were twice as likely
not to begin prenatal care until the third tri-
mester of pregnancy.146 Native Hawaiians
and Pacific Islanders are at increased risk for
gestational diabetes, and 25 percent of births
exceeded 4,000 grams (high birth weights are
also reported in American Samoa).68
Counseling Concepts regarding the role of the
individual in health care may be an issue for
Pacific Islander American clients. Biomedi-
cine presumes that better health depends on
behavior changes made by a client. Pacific
Islanders view the role of the individual as
interdependent on the group and may not
take responsibility for personal health.120
Family members may expect to be involved in
the care of sick relatives, and decisions regard-
ing treatment are often made through consul-
tation with the entire family.147 Because health
is defined as a harmonious balance of the
physical, social, natural, and spiritual worlds,
many Pacific Islanders prefer a comprehensive
approach to care, which may involve religious
rituals, including prayer.
Samoan Americans generally seek care for
symptomatic relief and are typically unin-
terested in long-term approaches to disease
prevention or management.113 Low compli-
ance rates in the treatment of hypertension
and diabetes in Pacific Islanders have been
noted.124 A study on Native Hawaiian health
needs found that cultural differences were a
primary reason for underuse of services.148
Young adults defined health in terms of par-
ticipating in their responsibilities, which
include working and caring for their fami-
lies.149 Further, some Pacific Islanders believe
that illness is the will of God and may delay
obtaining care until symptoms are advanced.
Samoans expect exceptional politeness
in interactions; showing irritation, anger, or
other hostile emotion is considered rude and a
sign of weakness.102 A reserved conversational
style and the desire to maintain harmony may
result in some Pacific Islanders enduring pain
rather than expressing it.147 Judgmental or
accusatory attitudes regarding lifestyle (espe-
cially weight gain) may cause Pacific Islanders
to avoid further counseling.
When entering a room, Samoans walk
around to greet each person with a smile and
handshake. Eye contact is expected. Both Samo-
ans and Tongans are concerned that all partici-
pants in a conversation be at an equal level; for
example, everyone should be sitting on mats or
Research on Asian,
mixed ethnicity, and
white adolescent girls
in Hawaii found that all
groups could benefit
from increased intake of
fruits, vegetables, and
calcium-rich foods.159
Many Pacific Islanders
are lactose intolerant; it is
estimated that 50 percent
of Samoan adults do not
tolerate milk.160
In Guam, an extremely
high prevalence of
both amyothrophic
lateral sclerosis (called
letigo) and Parkinsonism
dementia (known
as bodig) has been
reported. Incidence has
decreased significantly
in recent years,
however, suggesting
environmental causes
may be to blame.161
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 2 4 0 9
in chairs. It is offensive to stand while speaking
to someone who is sitting. When seated, legs
should be crossed or kept close to the body;
extended legs or pointing one’s feet at a person
is considered poor manners.102
One study reported that weight-loss inter-
ventions based on traditional Hawaiian foods
were well accepted by Native Hawaiians, par-
ticularly those who emphasized cultural val-
ues and provided group support. However,
most participants found it difficult to adhere
to the diet long-term, citing difficulties in
obtaining fresh produce and the pressures
of an obesogenic environment.150 A study in
Micronesia found significant cultural conflict
in homes where mothers attempted to restrict
the food intake of their overweight children.
Food is associated with love, and grandpar-
ents who perceive grandchildren as too thin
often accuse mothers of inadequate care.131
An in-depth interview should be used to
determine if a client has any traditional health
beliefs or practices regarding a specific con-
dition and if religious affiliation is a factor.
Due to the paucity of research, coworkers or
a client’s family members may provide signifi-
cant information regarding particular Pacific
Islander groups.
Samoan women are
traditionally treated to a
rich coconut drink called
vaisalo after childbirth.
The large island continent of Australia and the two-island nation of New Tand the two-island nation of New T
Zealand are thought to have been initially
populated by peoples from Southeast Asia.
Centuries later, Polynesians traveled to New
Zealand, intermingling with the existing
native peoples to become the Maoris.
Despite a shared heritage, there are only
a few similarities between the cooking of
Southeast Asia and the Pacific Islands and
the fare of Australia and New Zealand.
British colonization of the countries in the
eighteenth and nineteenth centuries over-
whelmed the original inhabitants and their
culinary traditions.
Meat is the mainstay of the Austra-
lian and New Zealand diets. Beef is most
popular in Australia, especially steak, served
with fried eggs or stuffed with oysters
(carpetbagger steak). Lamb is favored in New
Zealand (and also well liked in Australia),
typically roasted and served with mint sauce
or barbecued. Other meats and poultry are
uncommon in both nations, though some
wild game, particularly venison, boar, duck,
and pheasant, is found in New Zealand.
Fish and seafood, however, are eaten often,
including shrimp, oysters, scallops, spiny
lobster, and crawfish (called yabbies in
Australia). Most meats and fish are simply
prepared, by roasting, pan-frying, braising
or poaching, and grilling. Traditionally,
seasoning was very limited, but today, an
international array of herbs and spices are
used. For example, in New Zealand, Asian
Indian lamb curries and Greek gyros are
popular. Minced and ground meats appear in
numerous dishes. In Australia, shepherd’s pie
(ground lamb topped with mashed potatoes)
and hamburgers topped with fried eggs
and beet slices are common. Battered, fried
sausages are a favorite snack in New Zealand.
In both nations individual steak, sausage,
bacon, and egg, or fish pies (consumed with
tomato sauce or ketchup) are popular.
Numerous fruits and vegetables are
grown in the mild climate. Potatoes, beets,
peas, carrots, and corn are typical accompani-
ments to meals, though more exotic produce,
such as eggplants, feijoas, kiwifruit (Chinese
gooseberries), pineapple, and tamarillos are
also available. Bread rounds out the meal.
Sweets are eaten daily. Scones are common,
as are biscuits (cookies) such as lamingtons
(chocolate coconut) and ANZAC biscuits (oat-
meal cookies provided to the Australian and
New Zealand Army Corps during the world
wars). Puddings and custards are especially
popular. Both countries claim pavlova, a
meringue and fruit dish topped with whipped
cream, as a national dessert. Three meals each
day are the norm. In Australia, an afternoon
break for tea or beer is customary, and in New
Zealand many people break for morning and
afternoon tea. Australia is noteworthy for its
beers and hearty wines, beverages that New
Zealand is also successfully producing.
The Aboriginal foods of Australia, called
bush tucker, include kangaroo, wombat,
emu, duck, fish, shrimp, snakes, and lizards,
witchetty grubs, and wild plants such as
yams, onions, wattle seeds, and quandong
(a peach-like fruit). Most foods were prepared
simply over a fire, in the ashes, or boiled.
Foods introduced by Polynesians formed
the foundation of the Maori diet in New
Zealand, such as kumara (sweet potatoes),
taro, and ti plants. Native greens and fruits
were also available. Fish, seafood, birds, and
sea mammals provided protein (there were
no indigenous land mammals in the islands).
The Polynesian influence is also seen in the
use of the hangi, a pit-roasting method
similar to imu used for ceremonial occasions.
E X P L O R I N G G L O B A L C U I S I N E
Australian and New Zealand Fare
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4 1 0 S O U T H E A S T A S I A N S A N D P A C I F I C I S L A N D E R S
Review Questions
1. Choose one typical Filipino dish and describe
it. Explain how it conforms to the principles of
Filipino cooking. Select one or two ingredients
and discuss whether they are due to an influ-
ence from another culture and why that might
have happened.
2. Describe the traditional health and dietary beliefs
for the prevention and treatment of disease in
one Southeast Asian immigrant group. How
does the concept of “balance” for maintenance of
health fit within Southeast Asian health beliefs?
3. Pick one type of traditional healer used in
Southeast Asian countries. Describe this type
of healer’s practice and research whether he or
she currently practices in the United States.
4. List the indigenous foods of the Pacific Islands.
Pick two from your list, describe how they
might be prepared today, and discuss whether
they are considered to have any special dietary
or health properties.
5. Processed meat products, such as Spam, are com-
mon in the Filipino and Native Hawaiian and
Pacific Islander diet. What is Spam, where does
it come from, and how did it become prevalent
in the NHPI diet? Include a recipe using Spam.
References
1. Hoeffel, E.M., Rastog, S., Kim, M.O., & Shahid,
H. March 2012. The Asian Population: 2010.
2010 Census Briefs. United States Census Bureau.
Retrieved from http://www.census.gov/prod/
cen2010/briefs/c2010br-11
2. U.S. Census Bureau. n.d. Selected population pro-
file in the U.S. 2013 American Community Survey 1
Year Estimates, Table S0201. Retrieved from http://
factfinder.census.gov/faces/tableser vices/jsf/
pages/productview.xhtml?pid5ACS_13_1YR_
S0201&prodType5table
3. Gryn, T., & Cambino, C. October 2012. The
foreign born from Asia: 2011. American
Community Survey Briefs. United States Census
Bureau. Retrieved from http://www.census.gov/
prod/2012pubs/acsbr11-06
4. U.S. Department of Health and Human Services,
Office of Minority Health. n.d. Profile: Native
Hawaiians/Other Pacific Islanders. Retrieved
from http://minorityhealth.hhs.gov/omh/browse.
aspx?lvl54&lvlid588
5. Rkasnuam, H., & Batalova, J. August 25, 2014.
Vietnamese immigrants in the U.S. Migration
Policy Institute. Retrieved from http://www.migra-
tionpolicy.org/print/14793#.VQ3T49FARFo
6. Pfeifer, M.E., & Thao, B.K. (Eds.). 2013. State of
the Hmong American community. Washington,
DC: Hmong National Development.
7. Bankston, C.L. 2000. Cambodian Americans. In
R.V. Dassanowsky & J. Lehman (Eds.), Gale ency-
clopedia of multicultural America, Farmington
Hills, MI: Gale Group.
8. Bankston, C.L. 2000. Laotian Americans. In R.V.
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pedia of multicultural America, Farmington Hills,
MI: Gale Group.
D I S C U S S I O N S T A R T E R S
Working with Differences in Diet and Culture
In small groups of three or four, compare and contrast the diet and culture of Filipino, Vietnamese, Cambodian, and Laotian Americans, with each group
focusing on a different aspect of the diet and culture of these groups:
Within your group, try to come to a consensus on what findings to report to the rest of the class. Before breaking up, assign a number to each group
member: A1, A2, A3, A4; B1, B2, and so forth. Form new groups with all the 1’s in a group, all the 2’s in another group, all the 3’s another group, and
so on. In your new group, report the findings of your previous group, and, as a group, discuss the relationship of traditional attitudes toward diet and
health and changes in diet and health due to immigration to the United States.
Group A: The food habits and the typical eating etiquette and meal composition of these four immigrant groups
Group B: Issues involved in counseling these immigrant groups on diet and health
Group C: Attitudes within each immigrant group toward diet, health, and medical treatment, notably attitudes toward traditional home
culture medical treatment and U.S. biomedicine
Group D: Amount of obesity, diabetes, hypertension, and other diseases within each immigrant group
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 2 4 1 1
9. Bankston, C.L. 2000. Hmong Americans. In R.V.
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MI: Gale Group.
10. Anderson, J.N. 1983. Health and illness in Filipino
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811–819.
11. Pacquiao, D.F. 2003. People of Filipino heritage.
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cultural health care (2nd ed.). Philadelphia: F.A.
Davis.
12. Bankston, C. L. 2000. Vietnamese Americans. In
R.V. Dassanowsky & J. Lehman (Eds.), Gale ency-
clopedia of multicultural America, Farmington
Hills, MI: Gale Group.
13. Pfeifer, M.E., & Thao, B.K. (Eds.). 2013. State of
the Hmong American community. Washington,
DC: Hmong National Development.
14. Nuttall, P., & Flores, F.C. 1997. Hmong healing
practices used for common childhood illnesses.
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15. Montepio, S.N. 1986–1987. Folk medicine in the
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16. Becker, G. 2003. Cultural expressions of bodily
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17. Adler, S.R. 1995. Refuge stress and folk belief:
Hmong sudden deaths. Social Science and
Medicine, 40, 1623–1629.
18. Vance, A.R., & Davidhizar, R. 1999, December.
Developing cultural sensitivity when your client
is Filipino American. Journal of Practical Nursing, Journal of Practical Nursing, Journal of Practical Nursing
16–20.
19. Hart, D.V. 1981. Bisayan Filipino and Malayan
folk medicine. In G. Henderson & M. Primeaux
(Eds.), Transcultural health care. Menlo Park, CA:
Addison-Wesley.
20. Orque, M.S. 1983. Nursing care of Filipino
American patients. In M.S. Orque, B. Bloch,
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health care. In N.W.S. Zane, D.T. Takeuchi, &
K.N.J. Young (Eds.), Confronting critical health
issues of Asian and Pacific Islander Americans.
Thousand Oaks, CA: Sage.
150. Boyd, J.K., & Braun, K.L. 2007. Supports for and
barriers to healthy living for Native Hawaiian
young adults enrolled in community colleges.
Preventing Chronic Disease, 4(4), 1–12. Retrieved
from http://www.cdc.gov/pcd/issues/2007/
oct/07_0012.htm (accessed March 14, 2011).
151. Fujita, R., Braun, K.L., & Hughes, C.K. 2004.
The traditional Hawaiian diet: A review of the
literature. Pacific Health Dialog, Pacific Health Dialog, Pacific Health Dialog 11, 250–259.
152. 2008 Restaurant Industry Pocket FactBook.
National Restaurant Association. (2008). 2055 L
St. NW, Suite 700, Washington, DC 20036.
153. Uhl, S. 2001, January–February. Exploring the
culinary mysteries of Malaysia. Restaurants USA.
Retrieved from http://www.restaurant.org/busi-
ness/magarticle.cfm?ArticleID513
154. Owen, J. 2005. New rodent discovered at Asian
food market. National Geographic News, May 16.
Retrieved from http://news.nationalgeographic.
com/news/2005/05/0516_050516_new_rodent.html
155. Gampell, J. 2006. Letter from Ubon: In northeast
Thailand, a cuisine based on bugs. The New York
Times, June 22. Retrieved from http://travel2.
nytimes.com/2006/06/22/travel/22webletter.html
156. Sukalakamala, S., & Brittin, H.C. 2006. Food
practices, changes, preferences, and accultura-
tion of Thais in the United States. Journal of the
American Dietetic Association, 106, 103–108.
157. Storz, D. 1998. Filipino culture. News and Views:
The Newsletter of the San Jose Peninsula Dietetic
Association, 29, 7.
158. U.S. Census. n.d. Fijian selected population pro-
file in the United States 2011–2013. American
Community Survey 3-Year Estimates.
159. Daida, Y., Novotny, R., Grove, J.S., Acharya, S., &
Vogt, T.M. 2006. Ethnicity and nutrition of ado-
lescent girls in Hawaii. Journal of the American
Dietetic Association, 106, 221–226.
160. Seakins, J.M., Elliott, R.B., Quested, C.M., &
Mataumua, A. 1987. Lactose malabsorption in
Polynesian and white children in the southwest
Pacific studied by breath hydrogen technique.
British Medical Journal, 295, 876–878.
161. Steele, J.C. 2005. Parkinsonism-dementia complex
of Guam. Movement Disorders, 12, S99–S107.
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4 1 6
The southeast European nations of the The southeast European nations of the TBalkan Peninsula and the countries of TBalkan Peninsula and the countries of Tthe Middle East are in close proximity Tthe Middle East are in close proximity T
to central Europe, Africa, and Asia. The region
has traditionally been a cultural crossroads of
ideas, values, and material goods and is often
considered the cradle of Western civilization.
Many immigrants from the Balkans and the
Middle East have come to the United States in
search of economic opportunity and political
stability. They frequently retain a strong eth-
nic identity, exhibited in their strong religious
faith and in their maintenance of traditional
food culture. This chapter examines the cui-
sine of the Balkans and the Middle East, its
role in the U.S. diet, and the changes that have
occurred in the United States.
Cultural Perspective
The Balkan nations include Greece, Albania,
Bosnia-Herzegovina, Montenegro, Serbia
(including the two autonomous provinces
Kosovo and Vojvodina), the Republic of
Macedonia, Croatia, Slovenia, Bulgaria, and
Romania. Countries of the Middle East include
Bahrain, Egypt, Iran, Iraq, Israel, Jordan,
Kuwait, Lebanon, Oman, Saudi Arabia, Syria,
Turkey, United Arab Emirates, and Yemen
(see Figure 13.1). In addition, there are several
notable groups who do not have a homeland in
the region, including the Palestinians (an Arab
ethnic group), the Kurds (an Indo-European
ethnic group), and the Chaldeans and Assyr-
ians (Semitic ethnic groups).
Geographically, much of the Balkans is con-
sidered temperate in climate and is suited to
agriculture. In Greece, however, and in most of
the Middle East, aridity limits cultivation. Even
in the desert regions, distinct areas of arable
land exist along the seacoasts and in some
plains and valleys, such as the Fertile Crescent
(a plain in Iraq fed by the Euphrates and Tigris
Rivers) and the Nile River valley of Egypt.
Greece dominated or greatly influenced
its Balkan and Middle Eastern neighbors in
ancient times, and, in turn, it was conquered
and ruled by the Turkish Ottoman Empire for
four centuries in the modern era. These hun-
dreds of years of Greek and Turkish hegemony
facilitated the spread of products, especially
foods, throughout the region and stretched
cultural influence to both the southern states
of the former Soviet Union (see Chapter 7)
and to North Africa. Despite such commonal-
ities, however, populations within the nations
of the Balkans and the Middle East are very
diverse in religious affiliation. Judaism, Chris-
tianity (particularly Eastern Orthodox), and
Islam all have substantial numbers of follow-
ers in the region. Faith is fundamental to daily
life in both the Balkans and the Middle East.
History of People of the
Balkans and Middle East in
the United States
Balkans
Immigration from Greece has occurred pri-
marily in two waves. The first lasted from the
late 1800s to the 1920s, when the restrictive
People of the Balkans
and the Middle East13 CHA
P
T
E
R
An Arab is commonly
defined as a person
who speaks Arabic—the
term does not refer to a
particular religious belief.
Iranians speak Farsi and
call themselves Persians.
The Turks, whose nation
is geographically divided
between Europe and
Asia, speak modern
Turkish, a language that
is traced to the Altay
region in the Eurasian
steppes and now written
with the Latin alphabet.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 3 4 1 7
Immigration Act of 1924 was imposed; the
second wave started after World War II and
has not yet ended. The early Greek immi-
grants were mostly young men from rural
agricultural areas who came to America pri-
marily for economic opportunities. Many
came to make their fortune and go back to
their homeland—approximately 30 percent of
early Greek immigrants returned to Greece.
A bitter civil war from 1946 to 1949 and a
military coup in 1967 resulted in numerous
Greek refugees who sought asylum in the
United States. While most settled in New
York, Detroit, Chicago, and other cities of the
Midwest, a large community developed in
Tarpon Springs, Florida, supported by diving
for sponges. Some Greeks were attracted to
mining and railroad work in the West.
During the 1850s and 1860s, numerous
Croatian immigrants from the area of Dalma-
tia arrived in the United States. Most migrated
to the southern and western regions where
they had a substantial impact on the oyster
fisheries of Mississippi and the fig, apple,
Until 1992, the nations of
Serbia, Croatia, Slovenia,
Bosnia-Herzegovina,
Montenegro, and
Macedonia were the
states of a single country
known as Yugoslavia.
Figure 13.1
The Balkans and the Middle
East.
Mediterranean Sea
IRAN
BOSNIABOSNIABOSNIABOSNIABOSNIA
AND HER-AND HER-AND HER-AND HER-
ZEGOVINAZEGOVINAZEGOVINAZEGOVINA
Caspian Sea
GREECEGREECEGREECEGREECE
REPUBLIC
OF MACEDONIA
MONTENEGROMONTENEGROMONTENEGROMONTENEGROMONTENEGRO
S
E
R
B
IA
CROATIACROATIACROATIACROATIACROATIACROATIACROATIACROATIACROATIACROATIACROATIA
ALBANIAALBANIAALBANIAALBANIA
BULGARIA
ROMANIA
EGYPT
JORDAN
ISRAEL
LEBANON
SYRIA
IRAQ
SAUDI
ARABIA
BAHRAIN
OMAN
YEMEN
UNITED ARAB
EMIRATES
TURKEY
HUNGARYHUNGARYHUNGARYHUNGARYHUNGARY
KUWAIT
SLOVENIASLOVENIA
©
C
en
ga
ge
L
ea
rn
in
g
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4 1 8 P E O P L E O F T H E B A L K A N S A N D T H E M I D D L E E A S T
grape, and plum horticulture of northern
California. The many Serbs who immigrated to
the United States in this period were unskilled
laborers who obtained industrial jobs in the
Northeast. Croatian and Serbian immigration
increased following World War II, including
professionals, such as engineers and physi-
cians, seeking better job opportunities.
The largest number of Slovenian immi-
grants arrived between 1880 and World War I,
though exact figures are not available because
many were listed as Austrians. Most were
farmers seeking economic opportunity. They
settled initially in the rural Midwest, form-
ing self-sustaining ethnic communities with
Slovenian churches, schools, businesses, and
social organizations.
Middle East
Statistics on immigration from the Middle
East are inexact. Until 1900, all immigrants
from the area were called “Egyptians.” Later
arrivals were typically termed “Syrians” or
“Turks from Asia.” More specific nationalities
have been recognized since the 1930s, yet it
has only been in recent years that Palestinian
has been defined as an immigration category,
and it is standard practice to combine Chal-
deans with Assyrians.
Early Arab immigrants arrived at the turn
of the twentieth century seeking economic
opportunity. Most were Christians from the
area that is today Lebanon and Syria, although
small numbers of Turkish Muslims also came
during this period. Most settled in New Eng-
land and the Midwest and were employed in
the textile, shoe, and wire factories.
The major influx of Middle Easterners
began in the years following World War II.
A high percentage of immigrants from Jordan,
Egypt, Lebanon, Iraq, and Syria were Chris-
tian Palestinians who initially fled Israel when
it was declared a state. After first settling in
refugee camps, many later immigrated to the
United States when Israel won the 1967 war
against neighboring Arab countries. Political
unrest and Islamic revolution in Iran led to a
large exodus of Persians beginning in 1976.
Many were members of the wealthy Iranian
elite; others were Jewish and Christian minor-
ities, including Chaldeans and Assyrians. In
addition, many Turks and Arabs who came
to the United States for their college educa-
tion elected to stay in the country to establish
their careers. A similar situation is reported for
Israelis, who immigrated in small but steady
numbers to America for advanced education
and professional, managerial, or technical jobs.
▼ A large Greek community ▼ A large Greek community ▼
developed in Tarpon Springs,
Florida, based on diving for
sponges.
Va
n
Bu
ch
er
/S
ci
en
ce
S
ou
rc
e
Though large numbers
of Kurds have been
displaced due to conflicts
in the Middle East,
most refugees—over
500,000—have gone to
Europe. Much smaller
numbers have come
to the United States,
particularly Nashville, Salt
Lake City, and San Diego.
Around the turn of
the twentieth century,
an elite group of Arab
artists, writers, and poets
settled in New York City.
They called their literary
circle the Pen League; the
best-known member was
Kahlil Gibran, author of
The Prophet.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 3 4 1 9
Current Demographics and
Socioeconomic Status
People of the Balkans
Nearly 1.27 million people claimed Greek
ancestry in the 2013 U.S. Census estimates.
New York City has the largest concentration
of Greek Americans, followed by California,
Illinois, Massachusetts, and Florida. In recent
years, Greek Americans have moved progres-
sively south and west in the United States.
Early Greek immigrants preferred to live in
urban areas. The Greeks sought economic
independence by opening small businesses,
especially in candy production and restau-
rants. Greek Americans can be found in all
occupations, particularly managerial, profes-
sional, technical, and service jobs.1
Over 400,000 Croatian Americans and
189,000 Americans of Serbian descent lived
in the United States in 2007.1 Most origi-
nally settled in the mining regions of Penn-
sylvania, Ohio, and other midwestern states;
mining also attracted sizable populations to
Colorado, Nevada, Arizona, and California.1,2
More than 160,000 Slovenian Americans
were identified in the 2013 U.S. Census data.1
Although many Slovenian immigrants also
became involved in mining, others moved
to industrial urban areas in search of jobs.
Forty percent live in Ohio; Cleveland has the
largest Slovenian community in the nation.
Other states with notable Slovenian popu-
lations include Pennsylvania, Minnesota,
Wisconsin, California, Colorado, Michigan,
Florida, and New York. Many Croatians, Ser-
bians, and Slovenians who first arrived in the
United States were unskilled laborers in agri-
culture or industry.3 Education was valued
and second-generation immigrants obtained
the training needed to secure white-collar
employment. Over time, most Americans of
Croatian, Serbian, and Slovenian descent have
assimilated into the U.S. mainstream, working
in all sectors of the economy. All have incomes
at or over the U.S. average.1
Beginning in the early 1990s, nearly
200,000 Bosnian refugees seeking refuge
from ethnic cleansing in that region were
resettled in the United States. Many left their
homeland suddenly, with little time to pack
or prepare for life in a new country. Nearly all
are Muslim, and most were not comfortable in
the small number of Bosnian Serbian or Bos-
nian Croatian communities already scattered
throughout the United States. A majority
have chosen to live in homogeneous Bos-
nian Muslim neighborhoods in New York, St.
Louis, Chicago, Salt Lake City, St. Petersburg,
Florida, and Waynesboro, Pennsylvania.5 Sig-
nificant populations are found in California as
well.4 Though approximately half of Bosnian
refugees arrived unskilled in any profession,
today 68 percent of their young adults are
attending institutions of higher education.1
Middle Easterners
Demographic figures for Middle Easterners
are more problematic. Some older immi-
grants may deny their Arab ancestry due to
a history of discrimination in the West, and
more recent arrivals may refuse cooperation
with government-sponsored surveys due to
negative experiences in their homelands and
fear of mistreatment following the September
11, 2001, attacks on the United States. Immi-
gration figures suggest, however, that Arabs
are one of the fastest-growing ethnic groups
in the nation, increasing from approximately
200,000 in 1970 to over 1.6 million in 2007.
This growth is even more dramatic if a poll
on Arab ancestry is correct in estimating that
the Arab population is actually closer to 3.5
million.5
In 2013, the Census estimated 491,000
self-declared Americans from Lebanon,
157,000 from Syria, 214,000 from Egypt of
Palestinian heritage, 91,000 from Morocco,
10,000 from Jordan, and 98,000 from Iraq.1
A movement toward pan-Arab American-
ism is seen in the number of U.S.-born Arabs
who are selecting “Arab” or “Arabic” as their
background instead of a national affiliation.7
Approximately 66,000 Arabs are now listed in
this category, 25,000 in 2013.1 Two-thirds of
Arabs have settled in California, New York,
and Michigan. The largest concentration of
Muslims, (including those from areas other
than the Middle East) is in the Detroit met-
ropolitan area.6,9 Most Arabs choose urban
areas of residence, and ethnic neighborhoods
have developed in cities with substantial Arab
The 2011 Canadian
census lists over
252,960 residents of
Greek ancestry, 114,880
Croatians, and much
smaller populations of
Serbians and Slovenians.
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4 2 0 P E O P L E O F T H E B A L K A N S A N D T H E M I D D L E E A S T
populations. These communities help pre-
serve Arab culture within what is often viewed
as an alien American society. Many Arabs suf-as an alien American society. Many Arabs suf-as an alien American society. Many Arabs suf
fer discrimination and accept marginaliza-
tion as a necessary part of living in the United
States.7 Despite these experiences by some,
foreign-born Arabs become U.S. citizens at
rates 25 percent higher than the average for
all foreign-born residents.8
Early Arab immigrants found it easy to
assimilate into American society, in part
because a majority of them were Christian.9
Many survived as peddlers and then later
opened family businesses, usually dry goods
or grocery stores. A tradition of entrepreneur-
ship among Arabs continues today, and nearly
one in five owns his or her own business. Even
families that started with unskilled employ-
ment or small businesses have made substan-
tial economic progress through schooling.
Nearly every Arab American group in the
2013 Census reported that 50 percent had a
college degree or higher, and median family
income was above the U.S average.1
Over 460,000 Americans of Iranian heri-
tage were living in the United States accord-
ing to 2013 Census figures.1 Nearly half reside
in Southern California, and another large
population is found in New York City. Many
who immigrated following the 1979 Iranian
revolution were among the well-educated
elite who spoke English fluently and were
skilled in the professions, such as engineer-
ing, medicine, pharmacy, dentistry, and law.
Others arrived in the United States with sub-
stantial savings from their livelihood in Iran.
This group has been economically successful
in the United States. It is also reported that
many Iranian immigrants are self-employed.9
Data on foreign-born Iranians show that over
half hold college degrees, and median house-
hold income far exceeds that of the average
U.S. family.1 Turkish Americans numbered
194,000 in the census estimates of 2013.1
Immigration prior to 1965 was severely lim-
ited by quotas, yet included a disproportion-
ate number of engineers and physicians. Since
that time, the numbers of Turkish immigrants
have increased, most seeking educational
and occupational opportunity. Homoge-
neous neighborhoods, supported by Turkish
American organizations, have been estab-
lished in many cities, including New York City,
Boston, Chicago, Detroit, Los Angeles, San
Francisco, and Rochester, New York. Smaller
populations are found in New England, the
Midwest, and parts of the South, including
Maryland, Virginia, Texas, and Georgia.10,15
Census statistics on foreign-born Turk-
ish Americans indicate higher rates of high
school and college graduation than the U.S.
norm, and median household income above
the U.S. family average.1 Turkish Americans
are found in most employment sectors and are
solidly middle class in socioeconomic status.1
Most Israelis today come to the United
States for educational and professional oppor-
tunities; most are of European heritage, typi-
cally middle or upper class, and a significant
number are single men and women.11 Some
arrivals are also seeking security and escape
from the political unrest in the region. Most
possess the job skills that ensure an easy
transition in the United States, and over half
hold professional, managerial, or technical
positions. They are prominent in the fields
of medicine, technology, architecture, enter-
tainment, and education. Approximately
one-third are self-employed in the garment
industry, electronic industry, or in small
businesses catering to the Israeli community,
including restaurants, nightclubs, and retail
shops.12 Average earnings are believed to be
higher than the U.S. norm.
Worldview
Religion
Religion is often the defining factor in Bal-
kan and Middle Eastern life. Though affilia-
tion varies, strong devotion is common. Many
congregations remain insular in the United
States, serving the needs of a specific ethnic
group, and there is little interest in proselytiz-
ing to outsiders.
People of the Balkans The ethnicity of Greek
immigrants was affirmed mostly by religion;
it was said that a person was not Greek by
birth but through the active affiliation with
the Greek Eastern Orthodox Church. The
first Greek Orthodox Church in America
was founded in New Orleans in 1864. Most
McDonald’s and Walmart
sell halal foods, such as
Chicken McNuggets, at
certain U.S. locations.
Persia was the
conventional European
name for Iran, used
until the early twentieth
century; many Iranian
immigrants prefer the
designation Persian
American.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 3 4 2 1
Greek Americans today still belong to the
church, which continues to be the center of
Greek community life. The word orthodox
comes from the Greek for “correct” (orthos)
and “worship” (doxa). A fundamental belief
of the Greek Orthodox faith is that an indi-
vidual attains complete identification with
God through participation in the numerous
religious services and activities sponsored by
the church. Although the Greek Orthodox
Church is conservative and traditionally resis-
tant to change, some accommodations have
been made in the United States; for instance,
the service typically is conducted both in
Greek and English, and modern organ music
accompanies the liturgy (see Chapter 4 for
more information about Greek Orthodoxy).
Most Serbs also belong to the Eastern
Orthodox faith, as members of the Serbian
Orthodox Autonomous Church. A major-
ity of Croatians and Slovenians are devout
Roman Catholics, worshiping primarily in
multiethnic congregations. A small number
of Slovenians are Protestants known as Wind-
ish. Windish churches have helped maintain
Slovenian ethnic identity through services
conducted in a Slovenian dialect. Small pop-
ulations of Croatian Muslims are found in
Cleveland and Chicago.
Early Bosnian Croat immigrants were
mostly members of the Catholic Church, and
Bosnian Serb immigrants followed the East-
ern Orthodox religion. An estimated sixty-
eight Serbian Orthodox churches exist in the
United States, serving both the worship and
social needs of each community. The majority
of recent Bosnian refugees are Sunni Muslims.
Regardless of faith, many Bosnians are more
secular than observant, attending services on
major holidays only, or not at all. Intermar-
riage between Bosnians of different religious
beliefs is not uncommon.5,6
Middle Easterners Early Arab immigrants
were primarily Christians belonging to the
Eastern Orthodox (particularly the Egyptian
Coptic Church) or the Latin rite Maronite,
Melkite, or Chaldean churches. Although
Christian Arabs are still a majority in Amer-
ica, more recent immigrants follow Islam, and
the number of Arab Muslims in the United
States is growing rapidly. Most belong to
the Sunni sect. Many Arab Muslims in the
United States have made several adaptations
to accommodate their religious practices to
American society. Most significantly, the Fri-
day Sabbath prayer has been moved to Sun-
day, and many Muslims cannot fulfill their
obligation to pray five times daily due to work
or school limitations (see Chapter 4 for more
information about Islam).
Though the vast majority of Iranians in
the United States are members of the Muslim
Shiite sect, small numbers of Iranian religious
minorities have come to the United States
seeking freedom from persecution, including
Jews, Catholics, Anglicans, Protestants, and
members of the Baha’i faith (a Muslim off-members of the Baha’i faith (a Muslim off-members of the Baha’i faith (a Muslim off
shoot that has renounced its ties to Islam and
preaches gender equality, world brotherhood,
and pacifism). Most Turkish Americans are
Sunni Muslims, and many worship at Arab or
Pakistani mosques.12
Presumably, most Israeli Americans are
followers of Judaism. However, unlike other
Middle Eastern groups, Israelis who immi-
grate may be among the least orthodox of Jews
in Israel. Many, upon arrival, choose to join
Reform congregations or are unaffiliated with
a synagogue.
Family
People of the Balkans The traditional Greek
home is strongly patriarchal. The head of the
household is the unquestioned authority, with
responsibility for supporting the immediate
family and elder parents. In addition, he is
accountable for the family reputation within
the community. The Greek term for this pride
and obligation to family is philotomo, mean-
ing “love of honor.” Each family member is
expected to behave in ways that maintain fam-
ily dignity and status.
Obligation to family and community has
lessened somewhat in the Greek American
community. Extended families have become
less common due to assimilation pressures
and secondary migration to other areas of the
country. Children are doted on, and parents
often put their welfare first. Yet obedience
and respect for elders are expected, and inter-
generational conflict is less common among
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
4 2 2 P E O P L E O F T H E B A L K A N S A N D T H E M I D D L E E A S T
Greek Americans than in many other immi-
grant groups.
Greek women had traditionally focused on
family, home, and church. Even after coming
to the United States, many Greek American
women continued in this role. today they bal-
ance their duty to family and community with
personal interests in education or pursuing a
career. Education is valued for Greek men and
women.
Croatian and Serbian families are also tra-
ditionally patriarchal. Extended families are
the norm, often including friends as well as
relatives. Among Croatians, communal living
may involve taking in boarders. Both Croa-
tians and Serbians have become well accul-
turated in the United States. The tradition
of older generations caring for children has
allowed many Croatian and Serbian women
to take advantage of educational and career
opportunities, and the authority of the father
has lessened. Slovenian Americans are also
assimilated. The extended family structure
typical in Slovenia is rarely found among
Slovenians in the United States, who prefer
nuclear families. American women of Slove-
nian descent are active in the home, church,
and Slovenian schools and are increasingly
involved in politics.
B osni ans t radit iona l ly maint aine d
extended family homes, but conflict in the
region and migration to urban areas has
resulted in more nuclear families living
apart from relatives.5 In the United States
the extended family structure is important
to newer arrivals but difficult for some refu-
gees who had no family members already
established in the country. While strong fam-
ily bonds support new immigrants, Bosnian
women (who are not employed outside the
home) and elders are often dependent on
extended family and may become isolated
within the larger community.6 Traditionally,
Bosnian husbands and wives both work, but
responsibility for the home remains with the
woman. Bosnian children assimilate quickly
to American culture, and some parents are
frustrated by their inability to instill Bosnian
cultural values and to maintain the Bosnian
language within the home. Some refugees
believe kinship ties and the integrity of the
family are weakened with continuing expo-
sure to American society.6
Middle Easterners Traditionally, Arab cul-
tures center on a strong patriarchal family
whose honor must be maintained. The fam-
ily demands conformity and subordination
of individual will and interest, but in return
the members of the family are protected and
can identify with the family’s status. Families
often live with extended members in a single
home or, for well-to-do Arabs, in a family
compound. An exception is Egyptians, who
traditionally live in nuclear family groups,
often far from other relatives.13
The teachings of the Qur’an state that men
and women are considered equal but with
different roles and responsibilities. Children
are valued in Arab families, and sacrifice for
the good of the children is common. Men
are obligated to provide economic security
for children, while women are expected to
socialize them, including the preservation of
religious and cultural values. Due to the strict
patriarchy, it is the role of women to provide
the love and comfort in a home as well. The
relationship between mothers and daughters
is very intimate. There is also a strong bond
between mothers and sons, especially the
firstborn son.14
Marriage contracts in the Middle East are
often arranged between children to establish
political and business alliances through kin-
ship. Also among Arabs there is a preference
for marriage between cousins, with the excep-
tion of Egyptians and some Arab Christians.9
Only after an engagement announcement is
made are young men and women allowed to
date, and then only when chaperoned. A fam-
ily’s honor is related to the modesty and chas-
tity of the women in the home: A woman is
chaste before her wedding and faithful after.
Actual or alleged violations of moral codes
by a young woman are considered evidence
that her mother has failed in her responsi-
bilities; inappropriate sexual conduct also
brings shame on her male relatives. Inter-
ethnic marriages are strongly discouraged
by both Muslims and Christians, especially
for women. It is preferable to marry some-
one of a different ethnic group and the same
The tall white hats worn
by professional chefs
are thought to have
originated with the
tall black hats worn by
Eastern Orthodox priests.
Of the 90,000 Jews
living in Iran in 1987,
55,000 have since left,
including 35,000 who
have immigrated to the
United States.
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C H A P T E R 1 3 4 2 3
religious affiliation than to marry outside the
religion. Most Iranians and Turks establish
homes similar to those of Arabs, headed by
the father or eldest sons, and centered on an
extended family network for support. Tra-
ditionally, Iranian families worked to place
members in all significant sectors of the
society (through marriage and employment)
to ensure family status and security.11 Immi-
gration to the United States often results in
difficulties maintaining an extended fam-
ily household for many Middle Easterners.
Family ties remain strong among Arabs, Ira-
nians, and Turks; however, nuclear families
are the norm for most immigrants. It is still
common for grandparents to live with their
children and grandchildren, yet in some more
acculturated families (such as in many Leba-
nese homes) daughters are no longer solely
responsible for the care of elders, a duty they
now share with their brothers.15
The role of women of Middle Eastern
heritage in the United States is changing for
those who are engaged in American soci-
ety, and the customarily strict separation of
private and public spheres has blurred with
increased numbers of women seeking college
degrees and professional careers.11 For exam-
ple, dating is becoming more accepted as seg-
regation of the sexes cannot be maintained in
most schools, nor in the U.S. workplace. Yet,
more traditional Middle Eastern women are
sometimes isolated in their home life. Some
Iranian women, for instance, feel that their
limited authority has decreased since arriv-
ing in the United States, that they spend more
time on household chores, and that they
are less involved in family decisions and in
mosque activities.11 More acculturated Arab
women may also experience serious setbacks
in acceptance of their Americanized conduct
every time a large influx of new and conserva-
tively minded Middle Eastern women settles
in their area.
Many second-and third-generation Mid-
dle Easterners in the United States think
that their parents are old-fashioned. Adop-
tion of American practices, such as personal
autonomy and self-determination, contradicts
the Middle Eastern emphasis on doing what
is best for the good of the family, increasing
intergenerational conflict between parents
and children. Acculturation also may result in
the reduction of a father’s authority in some
Middle Eastern homes, though filial respect
is usually retained. Pressures for children to
adhere to family expectations—from partici-
pation in arranged marriages to denial of col-
lege attendance—can be substantial, however,
and not all children reject the values of their
parents. Researchers note that among Iranian
Americans, the stresses of living in the United
States lead some children of immigrants to
embrace their heritage.11 Although some
Arab groups, such as Egyptians and Syrians,
are especially well acculturated, and some
subgroups within each population are fully
integrated within the U.S. society, resistance
to American culture can be strong among a
small number of Middle Eastern immigrants.
The attempt to retain ethnic identity takes
many forms, and it cannot be assumed that
assimilation is automatic, especially for new
immigrants who may arrive with the intention
of returning to their homeland when conflicts
subside, or are fearful of discrimination in the
United States. For example, some Arab immi-
grants seek to insulate their families from the
influences of American society by isolating
them within homogeneous enclaves, and eth-
nic identity is so important to most Turkish
Americans that unlike most Arabs and Irani-
ans (who have very high rates of citizenship),
Turks who seek naturalization are often ostra-
cized within their communities.9,12
A majority of Israelis live in nuclear fami-
lies. After arrival in the United States, the
nuclear family structure continues with sup-
port from Jewish organizations and a network
of Israeli American groups. Israeli American
women are typically well educated and over
half are employed, often in professional posi-
tions. Israeli immigrants are often concerned
that their cultural values will be lost if their
children become acculturated, and that their
children may become too competitive or
too materialistic.14 Many Israeli parents, like
American Jewish parents, strive to preserve
ethnic identity by enrolling their children in
religious training and Jewish summer camps,
and by sending them to Israel to learn about
their heritage.
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4 2 4 P E O P L E O F T H E B A L K A N S A N D T H E M I D D L E E A S T
Traditional Health Beliefs and Practices
People of the Balkans In many parts of the
Balkans, physical fitness is thought essential
to good health and is also considered neces-
sary in the development of good character.
Team sports, water activities, gymnastics, ski-
ing, hiking, and bicycling are common forms
of exercise.4,16,21 Among some Greeks, eating
a good diet, relaxation, adequate sleep, and
keeping a positive mental attitude are equally
important to maintaining health.17,18
Traditionally, most health care was pro-
vided by grandmothers or mothers at home.
Many people kept an herbal pharmacy avail-
able for preparation of therapeutic teas. In
Greece, castor oil is taken to clean the bowels,
quinine is used to relieve pain, chamomile tea
is sipped to get rid of cramps, and a sore throat
is treated with honey and lemon. Examples of
Bosnian cures also include chamomile, as well
as elder, rose hips, and mint.4,18,20 Cupping (see
Chapter 2 for more information) in a manner
similar to the Asian method, except that the
skin is cut with a razor first to allow the blood
out, is done by a few Greeks to treat colds and
chest ailments. More severe conditions and
serious injuries were treated by neighborhood
experts, for instance, the midwives and bone-
setters used in Croatia.2,20 Some people in the
Balkans believe that the evil eye of one who
envies a person can cause accidents or illness.
Greeks may use ritual prayer or, the sign of
the cross, or wear blue amulets with an eye in
the center or garlic as a precaution against a
jealous gaze. When receiving a compliment (a
form of envy), it is also customary to spit two
or three times to keep harm away.19,20
Middle Easterners Cleanliness, diet, and keep-
ing warm and dry are all Middle Eastern fac-
tors important to maintaining health. Some
Middle Easterners believe that illness is due
to wind or air in certain situations. Lebanese
Muslims believe that following childbirth,
a woman is especially susceptible to wind;
showers and baths are avoided for ten days
to prevent wind from entering the veins and
causing sickness. An infant is vulnerable to
wind through the umbilicus, so the baby’s
stomach is wrapped at all times with a band
called a zunaad.16
Traditional humoral medicine is impor-
tant in the health practices of Iranians.
Though traditional humoral theories iden-
tify four bodily humors, in practice Iranians
are concerned primarily with hot and cold.
Each person is born with a physiological tem-
perament dependent on the ratio of humors,
which varies by gender, age, and race—
women, for instance, are considered colder
than men, and younger persons are hotter
than older people—and can be influenced
by diet, climate, geographic location and cer-
tain conditions, such as childbirth.20 Sickness
can be caused by consuming too many hot
items or too many cold foods (see “Thera-
peutic Uses of Food” section), but individual
conditions and symptoms are not classified
as being hot or cold. Iranians are also con-
cerned with the amount of blood they have,
which in turn is associated with numerous
ailments, including thinness (due to lack of
proper nourishment), weakness, irritability,
lethargy, and headaches. Kam Kuhn—blood
deficiency due to excessive bleeding from
injuries, menstruation, or a poor diet that
prevents the making of blood—is the source
of these symptoms.
Iranians use the term narahati for undif- for undif- for undif
ferentiated feelings of physical and emo-
tional discomfort. Most often it is expressed
privately and in a nonverbal form through
sullenness, anorexia, and, among women,
bouts of crying. Expressions of anger are
considered the public expressions of the con-
dition and are usually discouraged because
anger is a lack of control that can upset the
social order and cause others to become
narahat. Sorrow or grief is another public
expression, but in contrast to anger, sadness
is considered the poetic manifestation of
fully experiencing the tragedy of the human
condition. Naharati qalb (heart distress) is
a folk condition typified by fluttering of the
heart due to the strong expression of anger
or sadness.21,22
A long-standing tradition of home health
care exists among Middle Easterners. Folk
remedies are common, such as rubbing
ko’hl (a dark powder made mainly from the
chemical element antimony and used mostly
as a cosmetic) on the umbilical cord of an
The Sufis, members
of an ascetic and
mystical Islamic sect,
define health as an
existential state of
abstinence, patience,
and self- examination,
resulting in harmony
with the universe.
Zamzam water from the
Mecca Valley is collected
by Muslim pilgrims who
complete the Hadj to be
shared with family and
friends at home—it is
thought to have curative
powers.
Muslims often have
serious concerns
about raising their
children in America.
Permissive attitudes
about dating and
drinking and pressure
to practice independent
thought prompt some
immigrants to send their
children, especially their
daughters, to the Middle
East for schooling.
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C H A P T E R 1 3 4 2 5
infant to help it dry. Herbal therapies are
especially prevalent, and it is believed that
approximately 200 plant species are used in
Arab traditional medicine today.22 Exam-
ples include yarrow for diabetes and khella
(a member of the parsley family) for kidney
disorders. Palestinians use most traditional
remedies as both food and medicine; for
instance, caraway is used for digestive dis-
orders and to increase milk flow in nursing
mothers; mallow is used as a laxative; and
olive oil to treat urinary tract infections,
prostate conditions, and cancer.23 Other
cures include snakeroot as a diuretic, laven-
der for kidney stones, and rue as an analgesic
and sedative. In Iran foxglove blossoms are
used especially for nervous conditions, some
digestive problems, to strengthen blood,
relieve fear, and for pains of unknown etiol-
ogy; arugula seeds are taken to clean dirty
blood and for fever, constipation, and nau-
sea; and mint tea with coriander seeds is
used to promote sleep.22 In Turkey, nettle,
oleander, and thyme are used therapeutically
for cancer. Other commonly used herbal
remedies include St. John’s wort, rosemary,
sage, and hawthorne.24
Cupping (see Chapter 2) is used by some
Middle Easterners to cure chronic leg pain,
paralysis, headaches, and obesity. Another
therapy that is sometimes applied is called
wasm, or cauterization. A heated iron rod is
used to place symbolic burn marks on the
patient, for example, below the anus to treat
diarrhea and under the ear lope to cure a
toothache. The burns are then treated with
special herbal poultices.25 Though supersti-
tion is discouraged in Islam, many Arabs
retain some beliefs in magic and supernatu-
ral causes of illness. As in the Balkans, the evil
eye is feared by some Arabs, who may place
blue beads on infants to protect them, or wear
amulets.16 In Iran, some believe the evil eye is
the cause of cheshm-i-bad, the occurrence of a
sudden or unexplained illness.22 Some Arabs
attribute mental illness to possession by the
devil, or by jinn (spirits who can be good or
evil).26
Iranians often put their health into the
hands of God. Tagdir, meaning “God’s will,”
is thought to determine all aspects of life and,
ultimately, death. Throughout the Middle
East, illness is sometimes seen as a punish-
ment from God. However, biomedical prac-
tice is well established in the Middle East, and
for the most part, Western therapies are con-
sidered strong and effective.28
Traditional Food Habits
The origins of most Balkan and Middle
Eastern dishes may never be known because
the geographic, political, and economic
history of the region has resulted in simi-
lar food cultures. Many ingredients in the
Balkans and the Middle East, including
wheat, olives, and dates, are indigenous.
Sheep were first domesticated in the region
over 10,000 years ago. Other foods, such as
rice, chickpeas, and lemons, gained wide-
spread acceptance after introduction. Yet
most countries in the area claim one dish or
another prepared by all ethnic groups to be
their own invention.
Culinary commonalities extend beyond
the arbitrary designation of the Balkan
and Middle Eastern nations. As previously
mentioned, North Africa is sometimes con-
sidered part of the Middle East and shares
numerous dishes of the region. In addi-
tion, the southern nations of the former
Soviet Union, the southern regions of cen-
tral Europe, and parts of South Asia exhibit
influences as well.
The most significant differences in Balkan
and Middle Eastern foods are due to various
religious dietary restrictions and proximity to
other global cuisines. For example, the Chris-
tian populations of Croatia, Serbia, and Slo-
venia frequently consume pork, a favorite of
neighboring central Europeans. Yet Christian
Greeks, who have no pork prohibitions, eat it
only occasionally, preferring lamb and goat,
similar to adjacent Middle Easterners. Alco-
holic beverages are banned for Muslims and
are avoided in most Middle Eastern nations,
though widely consumed in Turkey, perhaps
due to historical associations with nearby
Russia (beet soup is also popular). But despite
these distinctions, foods are far more similar
than different.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
4 2 6 P E O P L E O F T H E B A L K A N S A N D T H E M I D D L E E A S T
Ingredients and Common
Foods
Staples
The common ingredients used in Balkan and
Middle Eastern cooking are listed in Table 13.1.
Wheat, thought to have been cultivated first in
this region, is consumed at every meal as bread.
Leavened loaves are typical in Greece and the
other Balkan nations, and leavened flat breads
are more common in the Middle Eastern coun-
tries. However, both loaves and flat breads are
found throughout the region. Pita or pida, a
thin, round Arabic bread with a hollow center
(known as pocket bread in the United States),
is a common type, as is lavash, a larger, crisp
flatbread (also called cracker bread).
Besides bread, wheat doughs are also used
to make pies and turnovers prepared in a vari-
ety of sizes and shapes. Bread dough, short
crust, or paper-thin pastry sheets called filo
or phyllo are all used. Savory pies may con-
tain meat, cheese, eggs, or vegetables. Desserts
are usually filled with nuts or dried fruits. An
example of a fried meat or cheese-filled pas-
try that can be served hot or cold is sanbusak.
Traditionally half-moon shaped, it is popular
in Syria, Lebanon, and Egypt. A similar turn-
over is called burek in Slovenia and boereg
in Bulgaria and Romania. Fatayeh is another
specialty served as a snack, featuring bread
At ancient Greek
weddings the bride and
groom were showered
with wheat kernels.
dough topped with cheese, meat, or spinach
and baked like a pizza. Tiropetas are Greek
flaky turnovers stuffed with cheese. In Serbia a
cheese and egg pie called gibanjica is popular.
A dessert made with filo dough, baklava or
paklava, can be purchased at every bakery and
café throughout the Balkans and Middle East.
The sheets of dough are layered with a walnut,
almond, or pistachio filling and then soaked
in a syrup flavored with honey, brandy, rose
water, or orange-blossom water. It is often cut
into diamond shapes.
Raw kernels of cracked whole wheat are
used in a number of Balkan and Middle
Eastern dishes. When the kernels are first
steamed and then dried and crushed to dif-steamed and then dried and crushed to dif-steamed and then dried and crushed to dif
ferent degrees of fineness, the cracked wheat
is called burghul or burghul or burghul bulgur. Unripened dried
but not cracked wheat kernels are known in
Arabic markets as fireek. All varieties of wheat
kernels are typically cooked as side dishes or
made into tabouli, a popular salad contain-
ing onions, parsley, mint, and various fresh
vegetables. Another Arab specialty is kish’ka,
made by blending bulgur with yogurt, dry-
ing the mixture in the sun, then grinding it
into a powder that can later be reconstituted
with water to make a filling for pita or thinned
enough for soup. In Serbia wheat kernels are
cooked with sugar, dried fruits, and ground
nuts to make koljivo.
Dumplings filled with meat are called
cmoki in Slovenia and are stuffed with fruit
for dessert. In Turkey, cheese or meat dump-
lings are known as manti. A few pasta dishes
are found in the Balkans, such as the Greek
pasta with baked lamb or goat and toma-
toes called yiouvetsi and macaroni baked
with cheese, ground meat, tomato sauce, and
bechamel sauce called pastitsio. A dish similar
to Italian pasta with beans is prepared. In the
Middle East vermicelli is often added to rice,
and noodles are found in a few dishes, such as
Syrian chicken with macaroni.
In addition to wheat, rice is also a staple
item in Middle Eastern cuisine and found in
some Balkan regions. The long-grain vari-
ety is used to make pilaf or pilav, a dish that
commonly accompanies meat or poultry. The
rice is first sautéed in butter or oil in which
chopped onions have been browned. It is then
▼ Traditional foods of the
Balkans and the Middle East.
Some foods include almonds,
chickpeas (garbanzo beans),
couscous, cracked wheat,
dates, eggplant, feta cheese,
figs, filo dough, garlic, lamb,
lemon, olives, pita bread,
and yogurt.
En
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yc
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di
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is
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C H A P T E R 1 3 4 2 7
Group Comments Common Foods Adaptations in the United States
Protein Foods
Milk/milk
products
Most dairy products are
consumed in fermented form
(yogurt, cheese). Whole milk
is used in desserts, especially
puddings. Sour cream and
whipped cream are common
in northern Balkan nations.
High incidence of lactose
intolerance is reported.
Cheese (goat’s, sheep’s, cow’s, and camel’s),
milk (goat’s, sheep’s, camel’s, and cow’s),
yogurt; buttermilk, cream
More cow’s milk and less
sheep’s, camel’s, and
goat’s milk are drunk. Ice
cream is popular.
Feta is the most common
Middle Eastern cheese
available in the United
States.
Meat/poultry/
fish/eggs/
legumes
Lamb is the most popular meat.
Pork is eaten only by Christians,
not by Muslims or Jews.
Jews do not eat shellfish. In
Egypt, fish is generally not
eaten with dairy products.
Legumes are commonly
consumed.
Meat: beef, kid, lamb, pork, rabbit, veal, many
variety cuts
Poultry: chicken, duck, pigeon, turkey
Fish and shellfish: anchovies, bass, bream, clams,
cod, crab, crawfish, eels, flounder, frog legs,
halibut, lobster, mackerel, mullet, mussels,
oysters, redfish, salmon, sardines, shrimp
Eggs: poultry, fish
Legumes: black beans, chickpeas (garbanzo Legumes: black beans, chickpeas (garbanzo Legumes:
beans), fava (broad) beans, lentils, navy beans,
red beans; peanuts
Lamb is still very popular.
More beef and fewer
legumes are eaten.
Cereals/Grains Some form of wheat or rice
usually accompanies the meal
in the Balkans and Middle East.
Bread (wheat, barley, corn, millet), barley,
buckwheat, corn, farina, millet, oatmeal,
pasta, rice (long-grain and basmati), wheat
(bulgur, couscous)
Bread and grains are eaten
at most meals. Pita bread
is commonly available.
Fruits/Vegetables Fruits are eaten for dessert
or as snacks. Fresh fruit and
vegetables are preferred, but if
they are not available, fruits are
served as jams and compotes
and vegetables as pickles.
Eggplant is very popular.
Vegetables are consumed often;
sometimes stuffed with rice or
a meat mixture.
Fruits: apples, apricots, avocado, barberries,
bergamots, cherries, currants, dates, figs,
grapes, lemons, limes, melons (most
varieties), oranges, peaches, pears, plums,
pomegranates, quinces, raisins, strawberries,
tangerines
Vegetables: artichokes, asparagus, beets,
broccoli, brussels sprouts, cabbage, carrots,
cauliflower, celeriac, celery, corn, cucumbers,
eggplant, grape leaves, green beans, green
peppers, greens, Jerusalem artichokes, leeks,
lettuce, mushrooms, okra, olives, onions,
peas, pimientos, potatoes, spinach, squashes,
tomatoes, turnips, zucchini
Fewer fruits and vegetables
are consumed. Olives are
still popular.
Additional Foods
Seasonings Numerous spices and herbs
are used.
Lemons are often used for
flavoring.
Ajowan, allspice, anise, basil, bay leaf, caraway
seed, cardamom, cayenne, chervil, chives,
chocolate, cinnamon, cloves, coriander,
cumin, dill, fennel, fenugreek seeds, garlic,
ginger, gum arabic and mastic, lavender,
linden blossoms, mace, mahleh, marjoram,
mint, mustard, nasturtium flowers, nutmeg,
orange blossoms or water, oregano, paprika,
parsley, pepper (red and black), rose petals
and water, rosemary, saffron, sage, savory,
sorrel, sumac, tamarind, tarragon, thyme,
turmeric, verjuice, verbena, vinegar
Nuts/seeds Ground nuts are often used to
thicken soups and stews.
Almonds, cashews, hazelnuts, peanuts, pine
nuts, pistachios, walnuts; poppy, pumpkin,
sunflower, sesame seeds
TA B L E 13.1 Cultural Food Groups: Balkan and Middle Eastern
(Continued)Continued)Continued
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4 2 8 P E O P L E O F T H E B A L K A N S A N D T H E M I D D L E E A S T
steamed in chicken or beef broth. Saffron or
turmeric may be added to give the dish a deep
yellow color.
Polo is the Iranian version of pilaf, but a
final step in its preparation produces rice with
a crunchy brown crust known as the tah dig.
A more fragrant variety of rice, basmati, is used
in Iran for khoresh, rice topped with stewed
meat, poultry, or legumes. Rice is frequently
added to soups and stuffings for poultry and
vegetables in both the Balkans and Middle East.
A large variety of legumes are another
important ingredient in both Balkan and Mid-
dle Eastern cooking. Cooked, pureed chick-
peas are the base for hummus, often served as
an appetizer or as a dip. Ground chickpeas or
fava beans are sometimes formed into small
balls and then fried and served as a main
course (ta’amia) or in pita bread with raw
vegetables (falafel). A common breakfast food
is foul, slowly simmered fava or black beans
topped with chopped tomato, garlic, lemon
juice, olive oil, and cilantro (fresh coriander
leaves). Lentils are especially popular in the
soups of some areas.
Many vegetables are used, although egg-
plant is the most popular in the Middle
East, Greece, and southern Balkan regions.
A common cooking method for Middle East-
ern vegetables (the Greek term is yiachni; the
Arabic word is yakhini) is to combine them
with tomatoes or tomato paste and sautéed
onions together with a small amount of water,
then cook until the vegetables are soft and very
little liquid remains. Vegetable salads (freshly
sliced tomatoes or cucumbers are common)
and cold, cooked vegetable salads are eaten.
Vegetables are frequently stuffed with a meat
or rice mixture. Moussaka or musaka is a Bal-
kan specialty made with minced lamb, egg-
plant, onions, and tomato sauce baked in a dish
lined with eggplant slices. The Turks prefer
imam bayildi (meaning “the priest fainted”),
eggplant filled with tomatoes, onions, and gar-
lic, stewed in olive oil and served cold.27 Grape
or cabbage leaves are stuffed to make the spe-
cialties known as dolma or sarma. Potatoes,
particularly enjoyed in the northern Balkan
nations, are also found in some Middle East-
ern stews and side dishes. Vegetables are fre-
quently enjoyed raw, mixed together in a salad,
or preserved as pickles. Sauerkraut is eaten in
Croatia, Serbia, and Slovenia.
The olive tree contributes in many ways,
particularly to Greek and Middle Eastern
cooking. Olives prepared in the Middle
In Bosnia-Herzegovina,
Croatia, Serbia, and
Slovenia, pida usually
refers to filo dough, not
pocket bread.
TA B L E 13.1 Cultural Food Groups: Balkan and Middle Eastern (C on t in u e d )
Group Comments Common Foods Adaptations in the United States
Beverages Coffee and tea are often flavored
with cardamom or mint,
respectively.
Aperitifs are often anise flavored.
Alcoholic beverages are
prohibited for Muslims, but
consumed in most of the
Balkans, Turkey, and Israel.
Coffee, date palm juice, fruit juices, tea and
herbal infusions, yogurt drinks; beer, wine,
brandy
Fats/oils Olive oil is generally used in
dishes that are to be eaten
cold. For most deep-frying,
corn or nut oil is used; olive
oil is preferred for deep-frying
fish. Clarified butter (samana)
is also popular. Sheep’s tail fat
is a delicacy.
Butter, olive oil, sesame oil, various nut and
vegetable oils, rendered lamb fat
Olive oil is still popular.
Sweeteners Coffee and tea are heavily
sweetened.
Dessert syrups are flavored with
honey, rose water, or orange-
flower water.
Honey, sugar
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C H A P T E R 1 3 4 2 9
Eastern way have a much stronger flavor
than European or American olives; they
often accompany the meal or are served as an
appetizer (see Table 13.2). The olive is also a
source of oil, which is frequently used in food
preparation, although butter, clarified butter
(samana), and most vegetable oils, as well as
rendered lamb fat and margarine, are found in
the Balkans and Middle East. Olive oil is gen-
erally used in dishes that are to be eaten cold.
For most deep-frying, corn or nut oil is used,
but olive oil is preferred for deep-frying fish.
Fruits are preferred fresh, eaten for dessert or
as snacks. Apricots, cherries, figs, dates, grapes,
melons, pomegranates, and quince are favor-
ites. Pears, plums, and pumpkins are well liked
in the more temperate climates of the northern
Balkan nations. A distinctive characteristic of
Middle Eastern fare is the addition of fruits to
savory dishes; apricot sauce tops meatballs in
Egypt and chicken in Syria. Fruits are also often
served dried or as jams and compotes. Slatko is
a Balkan specialty featuring fruits simmered in
thick syrup. Fruit juices (especially lemon) and
syrups flavor many foods.
Fresh milk is not widely consumed in the
Balkans or Middle East, though it is used in
puddings and custards. Dairy products are
usually fermented into yogurt or processed
into cheese. Yogurt is eaten as a side dish and
served plain (unsweetened) or mixed with
cucumbers or other vegetables. It is diluted
to make a refreshing drink. Cheese is usually
made from goat’s, sheep’s, or (in the Middle
East) camel’s milk. The most widely used
cheese is feta, a salty, white, moist cheese that
crumbles easily. Myzithra, a soft pot cheese,
is a by-product of the feta process. Lebneh or
labni is a fresh cheese made by draining the
whey from salted yogurt overnight. Haloumi
is a springy, semisoft cheese that is sometimes
flavored with mint. It holds its shape when
cooked, and pieces can be grilled quickly on
both sides for a hot treat. Kaseri is a firm,
white, aged cheese, mild in flavor and simi-
lar to Italian provolone. Kashkaval is a hard, Kashkaval is a hard, Kashkaval
tangy ewe’s milk cheese, sometimes called the
cheddar of the Balkans.
Almost all meats and seafood are eaten in
the Balkans and Middle East, with the excep-
tion of pork in Muslim countries and pork
and shellfish among observant Jews in Israel.
Lamb is the most widely used meat, though
pork is very popular in the northern Balkan
areas. Grilling, frying, grinding, and stewing
are the common ways of preparing meat in
the region. A popular dish is kabobs, mari-
nated pieces of meat threaded onto skewers
then grilled over a fire. Vegetables, such as
onions or tomatoes, are sometimes added
to the skewers. Souvlaki or shawarma is very
thin slices of lamb (or chicken) layered onto
a rotisserie with slices of fat (resulting in a
single roast), grilled, then carved and served.
In Greece, thin slices of souvlaki are folded
into pita bread with tomatoes, cucumber, and
yogurt to make the sandwich-like treat gyros.
Meatballs, called kofta, are favorites, eaten
as snacks or served with stewed vegetables.
A whole roasted lamb or sheep is a festive
dish prepared for parties, festivals, and family
gatherings.
Numerous spices and herbs are used in
the Balkans and Middle Eastern seasoning
as a result of a once-thriving spice trade with
India, Africa, and Asia. Common spices and
herbs are dill, garlic, mint, cardamom, cin-
namon, oregano, parsley, and pepper. Sumac,
ground red berries from a nontoxic variety
of the plant, is sprinkled over salads to give
a slightly astringent flavor; it is mixed with
thyme to make the Arabic seasoning mix
called za’atar. Other typical Middle Eastern
spices include mahleb, made from the ground
▲ Assorted Egyptian
pastries made with filo
dough, couscous, and nuts.
D
av
e
Ba
rt
ru
ff
/E
nc
yc
lo
pe
di
a/
Co
rb
is
The term yogurt is
Turkish. In Syria and
Lebanon the fermented
milk product is called
laban; in Egypt, laban
zabadi; and in Iran, mast.
Camel’s milk, unlike other
commonly consumed
animal milks, is high in
vitamin C.
Eggplant “caviar,” which
is a cooked salad, and
baba ganouj, an unusual
smoked eggplant
puree, are very popular
appetizer dishes served
throughout the Middle
East.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
4 3 0 P E O P L E O F T H E B A L K A N S A N D T H E M I D D L E E A S T
pits of a cherry-like fruit, and ajowan, small,
black carom seeds with a thymelike flavor.
The juice of unripe lemons, verjuice, is used
to provide a sour taste to dishes. Ground nuts
are often used to thicken soups and stews.
Sesame seeds are crushed to make a thick
sauce, tahini, which is used as an ingredient
in Arabic cooking and in a sweet dessert paste
known as halvah.
Fruit juice is popular as a beverage through-
out the Balkans and Middle East, and some-
times fruit syrups or flower extracts are mixed
with ice (or in the past, snow) to make the
refreshing beverage known as sharbat in Arasharbat in Arasharbat -
bic or şerbet in Turkish (origin of the şerbet in Turkish (origin of the şerbet English
word “sherbet”). Coffee is a favorite (see “Is
Coffee Beneficial for Health?” later in this
chapter) across the entire region, consumed
throughout the day at home and in cafés. It is
frequently flavored with cardamom and copi-
ous amounts of sugar. Traditionally, the drink
is made in a long-handled metal briki, produc-
ing a strong, very thick, and often sweet brew
served in small cylindrical cups. It is called
“Turkish coffee” in Turkey and “Serbian coffee”
in Serbia. Tea is equally popular in many
nations and is served sweetened and flavored
with mint, or fruit such as dates or raisins.
The Balkan countries are well known for
their wines and distilled spirits. Civek is a rosé
served throughout Slovenia, and a high-proof
brandy made from plums called sljivovica is
available in both Serbia and Slovenia. Best
known in the United States are the Greek
specialties retsina (white wine with a resinous
flavor), ouzo and arak (anise-flavored aperi-
tifs), and metaxia (orange-flavored brandy).
Although observant Muslims do not drink
alcohol, several Middle Eastern nations (e.g.,
Iraq, Israel, and Turkey) produce wines and
spirits. Raki, a Turkish version of arak, is tra-
ditionally consumed with appetizers.
Regional Variations
Balkan All Balkan nations combine both
European and Middle Eastern elements in
their cooking. The noteworthy division is
between the more European-influenced fare
TA B L E 13. 2 Glossary of Selected Olives
Olives originated in the Middle East and spread throughout the Mediterranean. They are picked unripe (green, with dry, firm flesh and
a bitter taste) or when fully ripened (black, oilier, soft textured, and milder in flavor). Raw olives are inedible and must be cured in salt
(also called dry-cured) or in a brine, oil, wine, or lye solution before they can be consumed. Both the stage at which they are harvested
and the type of curing process affect the flavor of the final product.
Aleppo (Middle East) Small, dry-cured black olive (with wrinkled, chewy texture) named after a Syrian city
Amphissa (Greek) Dark purple olives with nutty flavor
Gaeta (Italy) Medium black olives, dry-cured (with wrinkled texture) or brine-cured (with smooth purplish flesh)
Kalamata (Greece/Middle East) Large, deep-purple with crunchy texture—salt-cured, packed in vinegar (sometimes with preserved
lemon in Morocco)
Kura (Middle East) Large green olive with hard flesh cracked to allow penetration of brine, bitter flavored, also called
Middle Eastern cracked green
Manzanilla (Spain) Small to large green olive usually pitted and stuffed with other ingredients (e.g., pimento, garlic, almonds)
Middle Eastern Green Small, brine-cured olives packed with olive oil, herbs, and often chile peppers
Moroccan Dry-Cured Medium black, dry-cured with wrinkled flesh and bitter flavor, used mostly in cooking
Nabali (Middle East)Nabali (Middle East)Nabali Dark green olive with soft texture, brine-cured, and often packed with lemon, garlic, and vinegar—
grown in Israel (including the Palestinian territories) and Jordan; also called mushhan, baladi, or
Roman olives
Naphlion (Greece) Dark green, brine-cured, packed in olive oil
Niçoise (France) Small, sour, salt-cured purplish black olives
Picholine (France) Small, mild, salt-cured light green olives
Sicilian (Italy) Very large, green olive, brine-cured, somewhat sour
Thassos (Greece) Small, dry-cured black olives (with wrinkled texture), intense tart flavor
©
C
en
ga
ge
L
ea
rn
in
g
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C H A P T E R 1 3 4 3 1
of Bosnia-Herzegovina, Croatia, Romania
(see Exploring Global Cuisine: Romanian
Fare), Serbia, Slovenia, and the other north-
ern nations and the foods of the southern
countries, including Albania (see Exploring
Global Cuisine: Albanian Fare) and Greece,
with a decidedly more Middle Eastern flavor
(Greek cooking is considered in the discus-
sion of Turkish fare in the following section).
The use of pork and veal, the selection of
fruits and vegetables, and the popularity of
fresh dairy products are all characteristics of
central European cooking in the northern Bal-
kans. German-style sausages, pork roasts, and
hams are frequently consumed. Veal is popu-
lar for stew and is sometimes seasoned with
paprika. One popular dish found in most of the
Balkan countries is ćevapi (or ćevapčići), grilled
elongated kebobs of spicy minced meat that are
often eaten on somun (a thick pita bread) or
lepinja (a small, flat roll). In Bosnia they are
usually made with beef, or a beef and lamb
mixture, served with chopped onions, cottage
cheese, and an extra-rich sour cream called
kajmak. Large, thin meat patties made from
lamb and beef, known as pljeskavica, are con-
sidered the national dish of Serbia but are also
a favorite with Bosnians and Croatians. Middle
Eastern–style grilled meats are also found in
some areas, especially in Bosnia-Herzegovina.
Potatoes, cabbage, and cucumbers are
typical vegetables, and many families gather
wild mushrooms. Ajyar, made with roasted
red bell peppers and eggplant, seasoned
with garlic and vinegar, is popular through-
out the Balkans. It comes in many versions,
from sweet to hot (flavored with chile pep-
pers), and is served as a condiment with
grilled meats, as a salad on a mezze plate
(typically with a selection of sliced sausages
or smoked meats, cheeses, hard-boiled eggs,
and sliced tomatoes) or spread on bread. Veg-
etables are sometimes stuffed with meat and
rice mixtures similar to those in the Middle
East, but with a Balkan flavor due to the use
of bell peppers, onions, potatoes, or cabbage
leaves. In Bosnia-Herzegovina these stuffed
items are called sarma or dolma and may be
served in the tureen in which they have been
heated.5 Cooler-weather fruits such as apples,
berries, peaches, pears, and plums are more
M
ar
k
D
af
fe
y/
Lo
ne
ly
P
la
ne
t I
m
ag
es
/G
et
ty
Im
ag
es
▼
Preparing Middle Eastern
coffee. The coffee of the
Balkans and the Middle East
is made in a long-handled
briki. It is preferred strong,
thick, and sweet and is often
flavoured with cardamom.
common. They are found in desserts, such as
sweet dumplings and strudels, and preserved
as compotes. Fruit juices are favorites and an
important industry in the region.
Buttermilk is frequently consumed and
fresh cheeses are well liked, often combined
with herbs for mezze or mixed with eggs and
honey or sugar for cheese-filled dessert pas-
tries. Cream enriches soups, stews, casseroles,
and sauces. Sour cream or whipped cream
tops many dishes. A specialty dairy prod-
uct found throughout the region is a heavy,
crème fraiche–like product called smetana (in
Slovenia), vrhnje (in Croatia), or pavlaka (in
Bosnia-Herzegovina). In Croatia it is added to
cottage cheese and seasoned with onions, gar-
lic, radish or horseradish, and paprika, then
eaten with cornbread.
The definitive northern Balkan treat is a
sweet yeast bread rolled with a rich walnut,
butter, cream, and egg filling. It is widely
known as potica and in some areas as povitica
or kolachki. Some versions are more savory,
flavored with tarragon—others are sweeter,
with dried fruits. Variations include cream
cheese, poppy seed, and pumpkin fillings.
Whipped cream tops many sweet versions.
In the Middle East coffee
is consumed highly
sweetened at happy
occasions; it is drunk
black and bitter at
funerals.
The Arabs were the
first to mix gum arabic
with sugar to produce
chewing gum.
The Greeks prefer
to chew on the
licorice-flavored resin
mastic (source of the
verb masticate).
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
4 3 2 P E O P L E O F T H E B A L K A N S A N D T H E M I D D L E E A S T
Middle Eastern There are two schools of thought
about the number of regional cooking areas in
the Middle East. One identifies three culinary
areas: Greek/Turkish, Iranian, and Arabic, and
the other defines five divisions: Greek/Turkish,
Arabic, Iranian, Israeli, and North African (see
Exploring Global Cuisine: Moroccan Cooking).
Certainly every region has some unique recipes
and cooking methods, but the similarity in fare
throughout the region is striking.
The cooking of Greece and Turkey has
evolved through an extensive exchange of
ingredients and preparation techniques.
Both cuisines feature more meat (especially
grilled), fish and seafood, cheese, butter,
and olive oil than in the fare of neighboring
Middle Eastern countries. Both the Greeks
and Turks prefer using flatware to fingers
when eating. Similar distinguishing dishes
include filo dough layered with spinach and
Is Coffee Beneficial for Health?
Despite the importance of wheat in the diet of Western nations, it can
be argued that the most important Middle
Eastern product consumed worldwide is
coffee. Over 500 billion cups are consumed
annually. Coffee is currently grown in
over fifty countries and is second only to
petroleum in global trade activity and
value. The International Coffee Organization
reports that exports increased 17 percent
in 2006, and it is becoming increasingly
common in tea-drinking nations such as
Japan, China, and India.
Coffee is indigenous to Ethiopia, but
it was the Arabs who first brewed and
popularized the beverage after it was
introduced to the region sometime around
the tenth century.87 It is said that a Sufi
sheikh was first to note the ability of coffee to
promote wakefulness, and it became widely
used by worshippers to increase stamina and
to produce a mystical euphoria.35 The Sufis
called it qahwah (thought to be the origin
of the term coffee), a word originally used
for wine. By the early 1500s it had become a
secular beverage consumed in Middle Eastern
social settings, especially coffee houses,
where men could drink and discuss the
matters of the day. The coffeehouses attracted
philosophers and poets, and in Istanbul they
were known in jest as schools of knowledge.35
Some Islamic leaders became concerned
that men were spending more time drinking
coffee than attending mosque services, and
that politically subversive activities were
being planned in the coffeehouses. This led
to their closure in some areas, but efforts to
enforce a permanent ban among Muslims
failed due to coffee’s broad popularity.
During this period, coffee was
successfully grown in the Arabian Peninsula
nations, and the product was improved
by dark-roasting the beans. The beverage
spread with the expansion of the Turkish
Ottoman Empire, especially in southern
Europe, where the social tradition of
coffeehouses was well accepted. The
Middle East became the first major exporter
of beans through the Yemenese port of
Moccha. However, some sixteenth-century
Catholics believed that coffee was the
beverage of Satan, due to its association
with infidels. Popular legend is that plans
to prohibit coffee were foiled when Pope
Clement VIII asked to taste the brew and
immediately claimed it so good that
Christians should make it their own.
Historical controversies aside, the most
significant issue regarding coffee in modern
times has been its impact on health. Coffee
contains numerous active ingredients,
most notably caffeine and chlorogenic acid.
Caffeine is an alkaloid that is classified with
cocaine and amphetamines as a central
nervous system stimulant. Chlorogenic
acid is a phenolic compound that works
as an antioxidant. Over the years, coffee
has developed a bad reputation, related to
studies on the development of ulcers, heart
disease, cancer, and birth defects. Beginning
in the 1980s, many health-conscious people
began to cut consumption or switch to
decaffeinated coffee.
Recent research, however, is leading
to redemption of the beverage. Coffee has
been exonerated as a causative agent in
many gastrointestinal disorders, in most
cardiovascular conditions, and in almost
all cancers.88,89,90,91 Even the association
with birth defects has been disproved.92
Instead, research suggests that moderate
consumption of three to four cups each day
may actually offer health benefits, reducing
the risk of metabolic syndrome,93 coronary
heart disease,94,95 type 2 diabetes,96,97 several
cancers,98,99,100 rheumatoid arthritis,101 and
possibly Alzheimer’s disease.102 Studies on
the effect of coffee on hypertension are
contradictory.91,103 Coffee is still suspect in
bladder cancer, spontaneous abortion, and
impaired fetal growth, and may aggravate
some gastrointestinal disorders.91,104
Researchers caution that coffee is not for
everyone and that people with hypertension,
children, elders, and pregnant women are
most susceptible to adverse effects.
C U L T U R A L C O N T R O V E R S Y
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C H A P T E R 1 3 4 3 3
feta filling (spanakopita in Greece, ispanakli
borek in Turkey); fish roe (caviar) dip made
with olive oil and bread (taramasalata in
Greece and tarama in Turkey); salads with
fresh greens, tomato, cucumbers, olives, and
lemon juice–olive oil vinaigrette (the Greek
version adds feta cheese; the Turkish recipe
includes more vegetables, such as green pep-
pers); the lemony, egg-enriched sauce used
to thicken soups and top meat and vegetable
dishes (avgolemono in Greece, tebiye in Tur-
key); yogurt cake; and anise-flavored alco-
holic beverages. Yet many differences exist.
Greeks prefer small pastries, such as the spe-
cialty butter cookie, kourabiedes, for snacking
and dessert, while the Turkish sweet tooth is
more often satisfied with fruit compotes, rich
custards, and candy, including lokum, also
known as Turkish delight. More significantly,
consumption due to religious affiliation var-
ies. Feasting and fasting rules for the Eastern
Orthodox of Greece and the Muslims of Tur-
key differ tremendously (see Chapter 4).
Arab fare, based originally on the cook-
ing of nomadic tribes and later influenced
by the foods of surrounding nations, features
more grains, legumes, and vegetables than the
Greek, Turkish, Israeli, or Iranian diet. In Syria
and Lebanon, the national dish is kibbeh, a
mixture of fine cracked wheat, grated onion,
and ground lamb pounded into a paste. This
mixture can be eaten raw or grilled, and with
a great deal of dexterity it can be made into a
hollow shell, then filled with a meat mixture,
and deep-fried. In Jordan, a specialty is man-
saf—flat breads layered with yogurt are placed
on a communal platter and then topped with
a mound of rice pilaf and shredded lamb or
chicken. A broth mixed with whey or yogurt is
poured over the top, then the dish is garnished
with nuts. The national dish of Egypt is ful
medames, cooked fava beans seasoned with
oil, lemon, and garlic, sprinkled with parsley,
and served with baladi, a whole-wheat type
of pita bread. Many soups and stews include
legumes, and some salads include grains, such
as tabouli. Pieces of pita bread are added to
many dishes as well. Tharid is a casserole
of layered flatbread with meat stew found
in many Arab nations. Fatout is a popular
preparation in Yemen, combining toasted
bread with honey, with scrambled eggs, or
any other food; fattoush is a Lebanese favorite
with greens, tomatoes, radishes, cucumbers,
onions, and pieces of pita bread. Another
feature of Arab cooking is the use of variety
meats. Lamb, goat, and beef are costly; thus,
all parts of the animal are used, with brains,
chitterlings, heads, and feet considered deli-
cacies. Pacha is an Iraqi soup of sheep heads,
stomach, and trotters served with ample bread
and pickled vegetables.
Iran is the most eastern of Middle East-
ern nations. It spans a region between the
warm Persian Gulf and the cold Caspian Sea,
encompassing several agricultural climates
suited to a wide variety of fruits and vegeta-
bles. Its dominance of the Middle East, parts
of the Balkans, and areas of India during the
Persian Empire dispersed indigenous prod-
ucts such as spinach, pomegranates, and saf-ucts such as spinach, pomegranates, and saf-ucts such as spinach, pomegranates, and saf
fron throughout the region.
Later trade routes between China and Syria
(the Silk Road) and between India and Africa
crossed through Iran, introducing rice, tea,
eggplants, citrus fruits, tamarind, and garam
masala (the spice blend used in curried dishes)
from these eastern cuisines. Though the cook-
ing of Iran, usually called Persian cuisine, is
very similar to other Middle Eastern foods, it
is famous for its sophisticated rice dishes and
its use of fruits for flavoring. The national dish
is chelo kebab, which is thinly sliced pieces
of marinated, charcoal-grilled lamb served
over rice seasoned with butter, egg yolks, saf-over rice seasoned with butter, egg yolks, saf-over rice seasoned with butter, egg yolks, saf
fron, and sumac. Soups and sauces are given
a sweet and sour taste by combining different
ripe and unripe fruits, such as oranges, bar-
berries, cherries, dates, grapes, plums, pome-
granates, quinces, and raisins with astringent
seasonings, including lemon juice, vinegar,
tamarind, and sumac.
Israel probably has the most varied foods
and food culture because its cuisine blends
indigenous Middle Eastern cooking with that
of the many Jewish immigrant groups who
have settled in the area since nationhood.
Hummus and pita bread may appear at the
same meal as German schnitzel, Hungarian-
style goulash, or Italian pasta.28 American
immigrants introduced bagels; Russians
brought kasha and borscht. Chocolate mousse
One specialty of North
African cooking is mirqaz
(or merguez) sausage—
which is also popular
in France—made from
lamb or other meats,
seasoned with chiles,
cinnamon, dried rose
petals, and other spices,
then typically sun-dried
and packed in olive oil.
Syrian food is often
spicier than that of
other Arab nations.
They are known for their
small baked lamb pies
seasoned with cayenne
called sfeehas.
Tharid was reputedly
Mohammed’s favorite
dish.
The Iranians call their
breads nan and bake
many of them, such as
nan-e lavash and nan-e
barbari, in a clay bread
oven known as a tanoor.
Both the name and
oven were brought by
the Persians to northern
India, where naan
flat-breads are baked in
tandoor ovens.
Israelis born in Israel are
nicknamed sabra after
the cactus of the same
name because the fruit is
tough and prickly on the
outside but sweet inside.
A U.S. native known as
the prickly pear cactus
was first exported to
the Middle East in the
nineteenth century.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
4 3 4 P E O P L E O F T H E B A L K A N S A N D T H E M I D D L E E A S T
cake, linzertorte, and coconut macaroons are
as popular as baklava. Furthermore, observant
Israel’s citizens adhere to the kosher laws of
the Jewish religion (see Chapter 4 for more
information on Jewish dietary practices).
Meal Composition and Cycle
Daily Patterns
The Balkans People in Balkan countries eat
three meals a day. The main meal is at midday,
and in the hotter climates a short nap follows.
Dinner is lighter and is served in the cooler
evening hours. Snacking is prevalent.
In the northern regions a light breakfast
of bread with preserves or honey and tea
or coffee is most common. Lunch usually
includes soup, a casserole of meats and veg-
etables, or a fish dish, bread and cheese, and
a fruit compote or pastry for dessert. Dinner
is often leftovers or another soup or stew;
sweet dumplings may also be served. Wine
is the typical beverage for both lunch and
dinner, though buttermilk, fruit juices, and
soft drinks are consumed in some areas. In
urban regions street vendors ply pastries and
ice cream throughout the day. Late evening
visits to cafés or coffee houses often include
small kebabs, meatballs, vegetable salads and
pickles, and other tidbits to accompany coffee,
wine, or plum brandy.
In Greece and the southern Balkan nations,
the traditional breakfast typically consists of
bread with cheese, olives, or jam plus coffee or
tea. The main meal, eaten in early afternoon,
usually begins with mezze or appetizers, such
as hummus, baba ganouj, tiropetes, and dol-
mas, often consumed with a small glass of
ouzo: the actual selection of included items
varies by the inclination of the homemaker
and affordability. Next a meat stew, meatballs,
kebabs, vegetables stuffed with chopped meat,
or a bean dish is served with a salad of raw sea-
sonal vegetables, yogurt or cheese, and fruit
for dessert. Roasted or baked whole meats are
served on weekends, accompanied by cooked
vegetables, salad, and dessert. Late afternoon
and early evening are times when neighbors
and friends may drop by for some sweets and
a cup of coffee or glass of ouzo. A light sup-
per is served in the late evening. Throughout
the day, mezze are widely available from street
vendors and cafés for snacking.
Middle East In most Arabic countries coffee
or tea is often served first for breakfast around
7:00 or 8:00 a.m., followed by a light meal
that might include bread, cheeses, beans,
Romania is a nation poised between the West and the East. Some describe
Romanian food as “pastoral” with Turkish
and Hungarian overtones. However, there
are also many Italian and central European
influences. Beef, veal, mutton, lamb, pork,
chicken, geese, and duck are popular.
Freshwater fish such as pike and catfish
are harvested from the Danube and other
rivers. Cabbage, red and green peppers,
leeks, tomatoes, onions, radishes, and let-
tuce are common vegetables. Temperate
fruits, particularly grapes, plums, and
berries, are eaten. Other common foods
include walnuts, filberts, olives, sour cream,
and sheep and goat cheeses. The national
bread is mamaliga, which is like the Italian
polenta. It is sliced and spread with but-
ter or topped with cheese, meats, or fruit
for dessert. Another specialty is pastrama
(from the Turkish meaning “to keep”), which
is lamb, beef, pork, or goose cured (spic-
ing varies, from garlic and black pepper
to allspice, nutmeg, and hot red pepper)
and then smoked. Ground meats are also
popular, made into patties, stuffed into cab-
bage leaves, or as sausages. One-dish meals
such as stews and soups are eaten with
whole-grain bread; one example is ciorba,
a soup made with vegetables (e.g., peppers,
onions, sauerkraut, tomatoes) and meat
(usually ground) or fish and then flavored
with sour ingredients (e.g., sauerkraut juice,
pickle juice, or vinegar). Cake is a traditional
dessert, but custards (including one similar
to Italian zabaglione) and soufflés are also
eaten. Romanian beverages include wine
(red, white, sweet, dry) and tuica, a plum
and wheat brandy. Most Romanians belong
to the Eastern Orthodox Church and adhere
to the numerous feasting and fasting days
of the church calendar.
E X P L O R I N G G L O B A L C U I S I N E
Romanian Fare
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C H A P T E R 1 3 4 3 5
eggs, olives, jam and bread, and plain yogurt.
Lunch is the main meal of the day, eaten in the
early afternoon. It is customarily bread, rice or
bulgur, and a vegetable or legume casserole,
a meat or poultry stew, or, where available, a
fish or seafood dish. Fresh or cooked vegetable
salad or onions and olives are common side
dishes. Additional items, depending on region
and affordability, may include a selection of
mezze (such as hummus, tabouli, vegetables
in yogurt, and bowls of nuts), a soup, and
cheeses. Dessert is usually included, typically
a piece of fresh fruit, a pastry, or a custard or
pudding. Diluted yogurt drinks or water is
served while eating, followed by sweetened
tea or coffee. Dinner in the early evening is
light, consisting of foods similar to those eaten
at breakfast, soup, or leftovers from lunch. All
the dishes in a meal are customarily served
at once in Egypt, Iraq, and Yeman, and in
courses in Jordan, Lebanon, and Syria.29
Turkish meals vary slightly from the Mid-
dle Eastern pattern. Breakfast (often served
a little later than in Arabic nations) varies
regionally, but is often substantial, with leav-
ened bread or simit (a chewy or crunchy ring-simit (a chewy or crunchy ring-simit
shaped roll resembling a bagel in shape, but
richer in flavor—also found in Greece where
they are called koulouri), cheese, butter, toma-
toes, olives, and jam served with sweetened
tea. Eggs, soups or sausages are common
additions in some areas. Lunch, eaten around
noon, and dinner, served between 6:00 and
8:00 p.m., are also plentiful meals, especially
dinner, which is the main meal of the day. It
begins with a selection of mezze (mezeler in mezeler in mezeler
Turkish) served with raki. Items may include
lamb meatballs, dolma, stuffed mussels, fried
squids, baba ganouj, hummus, and vegetable
salads. These appetizers are followed by the
olive oil course, featuring vegetables such as
eggplant, tomatoes, or leeks stewed in olive
oil. Kebabs, casseroles, or stews are the cen-
terpiece of the meal, served with pilaf and
bread. Fresh fruit such as melon, baklava,
or rice pudding follows, and the sweets are
consumed with coffee. In some regions, tripe
soup with vinegar and garlic may be eaten
Albania was not of interest to most Americans until the 1998 civil war
in the Serbian province of Kosova focused
attention on the plight of the Kosovar
Albanians. Albanians, living in a country
bordered by Greece, Macedonia, Serbia,
and Montenegro, have often been involved
in regional discord and shifting national
boundaries.105 Years of foreign rule have left
their mark on Albanian cuisine: pastitsio
and feta cheese from Greece, versions of
imam bayaldi and imam bayaldi and imam bayaldi halvah from Turkey,
omelets and tomato sauces from Italy,
boereg from Armenia, and borscht from borscht from borscht
Russia. Other dishes including dolma, kofta,
shish kebabs, moussaka, and baklava are
popular throughout the region.
In the poorest rural regions of Albania,
farmers and shepherds are often limited to a
diet of cornmeal bread, cheese, and yogurt,
with added lamb or mutton when afford-
able. In wealthier areas, three meals a day
are typical with a mid-afternoon snack of
thick Turkish-style coffee or tea consumed
with pastries, nuts, or fresh fruit, called sille.
A complete lunch or dinner begins with
mezze (appetizers), such as salads, pickles,
fish and seafood, omelets, spit-roasted
lamb or entrails, and baked variety meats.
Examples include liptao, a feta cheese salad
garnished with bell pepper, deli meats,
sardines, and hard-boiled egg; and soup-
like tarator, yogurt flavored with garlic and
olive oil and mixed with vegetables, such
as cucumber. These are usually consumed
with a glass of the distilled Turkish specialty,
raki, or a beverage made from fermented raki, or a beverage made from fermented raki
cabbage called orme. The meal follows with
soups, meat, or cheese-stuffed vegetables or
casseroles; pilaf-like dishes or pies filled with
vegetables, cheese, and/or ground meats
called byrek; and an assortment of vegetable
side dishes and pickles. Dessert may include
pastries but is typically a fruit compote. Few
legumes are consumed, but nuts (especially
walnuts) are added to numerous sweet and
savory dishes.
One of the most distinctive characteristics
of Albanian fare is the differentiation made
between vegetables and fruit. Only vegetables
are pickled and served as side dishes, and
fruits are only eaten fresh, as desserts or as
preserves. There are no crossover items, such
as a fruit pickle or a vegetable-sweetened
filling for a pie. Vegetables and fruits are also
prepared separately and not mixed together
in dishes.106
E X P L O R I N G G L O B A L C U I S I N E
Albanian Fare
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4 3 6 P E O P L E O F T H E B A L K A N S A N D T H E M I D D L E E A S T
after dinner, served with alcoholic beverages.
Turkish meals are typically served in courses.
In Iran, breakfast is usually a selection of
flat breads served with feta or other cheeses,
sweetened whipped cream, and jam. In some
regions, offal soup or halim (a savory wheat
porridge with meats and vegetables) is pre-
ferred.30 Lunch and dinner are similar, usually
with rice, a meat or poultry dish (roasted, or
as kebabs or ground meat), often a vegetable
salad, flat breads, some feta cheese or yogurt,
and a selection of chopped herbs (such as
mint, basil, and dill). A meat or vegetable
stew is frequently substituted for the meat
or poultry course, served over the rice. Fruit,
especially melon or grapes, is a typical dessert,
and tea or a yogurt drink accompanies the
meal. Traditionally, the dishes are all served
at one time and eaten communally.
Weekday breakfasts in Israel are customar-
ily light: coffee with some pita and olive oil
and za’atar, European-style breads with jam
or other spread, or a selection of cheeses,
yogurt, and chopped vegetables and fruit.
Sabbath breakfasts, however, are somewhat
heartier. European Jews may choose coffee-
cakes or pancakes, and Middle Eastern Jews
may select bureks, kataif (a sweet, stuffed pan-
cake), or sabikh (an Iraqi dish of pita bread
topped with fried eggplant, hard-boiled egg,
Morocco is one of five nations that make up the Maghreb, a region
of North Africa differentiated from the
Middle East by its substantial populations
of nomadic Berbers, also including the
countries of Algeria, Tunisia, Mauritania,
and Libya. Although there are very few
immigrants to the United States from the
Maghreb, many Moroccan restaurants have
opened, advertising an exotic dining experi-
ence at low tables amid pillowed opulence,
often with belly-dancing entertainment.
The cooking of Morocco is predominantly
Berber in origin, strongly influenced by
neighboring Arabic fare and, to a much lesser
degree, through interchange with sub-Saha-
ran Africa and the southern European coun-
tries of the Mediterranean. It is noteworthy
for its exquisite seasonings. Spices, such as
allspice, anise, cardamom, cayenne, cumin,
cinnamon, cloves, mace, malagueta pep-
per (see Chapter 8), nutmeg, turmeric, and
saffron, are combined with herbs, including
basil, fresh coriander, lavender, marjoram,
mint, verbena, and za’atar. One mixture, ras
el hanout, includes between ten and twenty-el hanout, includes between ten and twenty-el hanout
five ingredients, depending on the chef and
its intended purpose; medicinal herbs such
as belladonna or reputed aphrodisiacs (such
as the pulverized beetle known as “Spanish
fly”) may also be added.107 Garlic, onions,
lemons (some preserved through brining),
almonds, and sweet peppers also flavor
many dishes, and some are heated with the
chile pepper and garlic paste condiment
called harissa (from Tunisia, where foods
are preferred very spicy). Rose water and
orange-blossom water are also commonly
used. Foods are also flavored by the preferred
cooking fats of the region, zebeda (a sour
fresh butter) and smen (a preserved clarified
butter often seasoned with herbs; it is tradi-
tionally stored for months underground until
cheese like).
Couscous is a staple eaten throughout
the Mahgreb, where it is known by many
names. It is made from a dough of hulled,
crushed (not ground) grains of semolina
wheat (other grains prepared the same way,
such as barley and millet, are also called
couscous) mixed with water and processed
into very small pellets and dried. It is tra-
ditionally cooked in a specialized steamer
known as a couscousière. The word couscous
is also used to describe the finished dish:
the steamed grain topped with a mixture
of lamb with chickpeas and vegetables,
fish with fennel, dates with cinnamon (for
dessert), or other popular versions. Moroccan
stews, tagines, are slow-cooked in ceramic
pots and feature any combination of meats,
poultry, fish, organ meats, vegetables, and
fruits. Mechoui is spit-roasted lamb or kid.
The meat is first rubbed with cumin and
garlic, and then cooked until it can be pulled
off with the fingers. Bastilla or b’stila (from
the Spanish word for pastry or pie, pastel) pastel) pastel
is the quintessential Moroccan dish: sheets
of warqa (a dough similar to filo, though
thinner) enclose layers of ground almonds
mixed with sugar and cinnamon alternating
with pigeon or chicken meat. The layers are
bound with a lemony egg sauce, and the pie
is baked until golden. The crispy crust is often
sprinkled with sugar and cinnamon before
serving. Cooked or marinated vegetable
salads usually start a meal, and fresh fruit
and nuts add the finishing touch. All foods
are eaten with the first three fingers of the
right hand, and bread is used to sop up
sauces.
E X P L O R I N G G L O B A L C U I S I N E
Moroccan Cooking
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C H A P T E R 1 3 4 3 7
tahini, and a mango pickle). The traditional
Israeli breakfast buffet associated with kib-
butz life is offered at some restaurants, featur-
ing a more typically Middle Eastern selection
of flat breads, cheeses, vegetables, and olives,
often with added eggs, baked goods, and
other selections. The midday meal is the
largest in most homes, beginning with hum-
mus or tahini served with pita bread, then
a salad—often cucumbers, tomatoes, and
onions—followed by items appropriate to a
meat or dairy meal (see Chapter 4 for more
information on Kosher rules). The evening
meal, typically eaten around 8:00 or 9:00 p.m.,
is usually light with cheeses, yogurt, salads,
and eggs. Some families serve all the dishes of
the meal at once, while others serve them in
courses, often depending on heritage. Street
stands offer falafel, kebabs, shawarma, and
other snacks, and fast-food restaurants, espe-
cially those serving hamburgers or pizza, are
popular with many Israelis. Fruit juices, soft
drinks, and beer are common meal beverages.
Etiquette
Throughout the Balkans and the Middle East,
hospitality is a duty and a family’s status is
measured by how guests are treated. Guests,
even uninvited ones, are made to feel welcome
and are automatically offered food and drink.
In the Balkans it is likely to be fruit compotes,
candies, and buttermilk, coffee, plum brandy,
or, in Greece, ouzo or arak. In the Middle East
it may be a few dates and water or an exten-
sive choice of mezze served with coffee, tea, or
raki. Even if food is initially refused, it will be
offered again, and a guest must accept because
refusal is considered an insult. Invited guests
bring a gift, often candy or other sweets,
which the host must open immediately and
serve. Hospitality is even offered to clients in
the office setting, and failure to make guests
or clients comfortable may create extreme
embarrassment for all parties.22
In the Middle East, a guest’s status is indi-
cated by which pieces of food are offered, and
the order in which the items are served. Status
is based on sex, age, family, and social rank.
For example, a dignitary or head of the family
is served the best portion first. In Saudi Arabia
and other nations of the Arabian peninsula,
S A M P L E M E N U
A Greek Mezze
Olives and Cheeses (such as K as e r i or K as e r i or K as e r i M y z it h r a)
T ar amos alata (Caviar Dip)a,b or Hummus
(Chickpea Dip)
T z atz ik i (Cucumber Yogurt Dip)T z atz ik i (Cucumber Yogurt Dip)T z atz ik i a,b
Pita Bread
S pan ak opita (Spinach and Cheese Triangles)a,b
D olmas (Stuffed Grape Leaves)a,b with A v gole m on o
(Egg and Lemon Sauce)a,b
Ouzo or Wine
aHarris, A. 2002. Modern Greek: 170 contemporary recipes
from the Mediterranean. San Francisco: Chronicle Books.
bbbEat Greek TonightEat Greek TonightEat Greek Tonight at http://www.greek-recipe.com at http://www.greek-recipe.com at http://www.greek-recipe.comEat Greek Tonight at http://www.greek-recipe.comEat Greek TonightEat Greek Tonight at http://www.greek-recipe.comEat Greek TonightEat Greek Tonight at http://www.greek-recipe.comEat Greek Tonight
S A M P L E M E N U
An Arab Sampler
Baba G an ou s h a,b with Pita Bread
K of t a (Kebabs) in Yogurt Saucea,b
Tabouli (Bulgur Salad)a,b
Olive and Orange Salada,
Bak lav aa,b or Stuffed Datesa (or Apricots)b
Arabic Coffee or Mint Tea
aSalloum, H., & Peters, J. 2001. From the land of figs and olives.
New York: Inter-link Books.
bMiddle Eastern Recipes at http://middleeastkitchen.com/
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
4 3 8 P E O P L E O F T H E B A L K A N S A N D T H E M I D D L E E A S T
to end it.33 Three fingers of the right hand are
used if forks or spoons are not offered. The left
hand should not be used in any food-related
manner (including passing food), and women
should not touch any food that is to be eaten
by a Muslim man who is not her immediate
family member. Rice should be taken from the
communal bowl and rolled into a small ball
with the fingers before dipping it into stews
or sauces. Licking the fingers after eating is
expected, and appreciation is shown in some
areas by making eating noises.32 It is rude to
fill one’s own cup, and it is expected that a
diner will refresh his or her neighbor’s cup as
soon as it is half empty. It is also considered
polite to continue eating until everyone else is
finished because if one person stops the others
feel compelled to stop, too. One should leave
a little food on one’s plate to indicate satisfac-
tion with the abundance of the meal. Most
conversation takes place before and after the
meal, and limited discussion of pleasant and
joyful things takes place while dining. It is
important to compliment the host and host-
ess on their hospitality.
Special Occasions
In Balkan and Middle Eastern countries, food
plays an important role in the celebration of
religious occasions and in the observance of
certain events such as weddings and births.
In the Eastern Orthodox Church, there are
numerous feast and fast days (see Chapter 4).
The most important religious holiday for the
Greeks is Easter. Immediately after midnight
Mass on Holy Saturday, the family shares the
first post-Lenten meal. It traditionally begins
with red-dyed Easter eggs and continues with
mayeritsa, a soup made of the lamb’s internal
organs, sometimes flavored with avgolemono,
a tart egg, and lemon. The Easter Sunday
meal usually consists of roast lamb, rice pilaf,
accompanying vegetables, cheese, yogurt,
and a special Easter bread called lambrop-
somo that is decorated with whole dyed eggs.
Dessert usually includes sweet pastries made
with filo dough and koulourakia, a traditional
Greek sweet bread cookie, sometimes shaped
into a hairpin twist or wreath or coiled in the
shape of a snake (a creature that the pagan
Greeks worshiped for its healing powers).
“Spoon sweets” (seasonal
fruits, vegetables, nuts,
or rose petals preserved
in a heavy, sweet syrup)
are a Greek specialty
specifically reserved for
guests, offered by the
spoonful on arrival as a
sweet welcome.
the honored seat at the table is in the middle
of the table, whereas in Egypt, it is at the head
of the table.31 In some areas, such as some
parts of Yemen, it is customary for women to
eat separately from men.31 Guests are tradi-
tionally entertained in a separate room before
the meal, at which time scented water is pro-
vided so they may wash their hands. The din-
ing table might be a large, round metal tray,
resting on a low stool or platform, and the
diners sit around it on cushions. Western-
style dining is found occasionally, especially
in Middle Eastern restaurants. In Iran, food is
traditionally served on a rug. The meal is set
out in several bowls placed on the table or rug
and then shared by the diners. After the meal,
the guests leave the table, wash their hands,
and then have coffee or tea.
Several rules of etiquette apply to eating
in the Middle East. One should always wash
one’s hands before eating. In Muslim regions
the guests thank Allah before and after the
meal. Other Middle Easterners may say
“Sahain!” (“good appetite!”) to start the meal, “Sahain!” (“good appetite!”) to start the meal, “Sahain!”
and “Daimah” (“may there always be plenty”) “Daimah” (“may there always be plenty”) “Daimah”
S A M P L E M E N U
A Persian Lunch
Olives and Pistachios
K h or e s h - e F e s e n jan (Chicken Stew with Walnuts and
Pomegranate over Rice)a,b
Cucumber, Tomato, and Onion Salada,b
Feta Cheese and Lav as h
Fresh fruit or Sholeh Zard (Saffron Pudding)a,b
Tea
aBatmanglij, N.K. 2000. New food of life: Ancient Persian and modern
Iranian cooking and ceremonies. Washington, DC: Mage Publishers.
bIranian/Persian Recipes at
http://www.iranchamber.com/recipes/recipes.php
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 3 4 3 9
Easter is preceded by the pre-Lenten holiday
of Apokreas, which is similar to Carnival or
Mardi Gras and features costumed events and
parties with ample merrymaking, food, and
music. In addition to religious holidays, Greek
Americans typically celebrate Greek Indepen-
dence Day on March 25. It is commemorated
with parades in traditional dress, folk dancing,
songs, and poetry readings.
The Easter meal in Croatia is typically
lamb or ham and pogaca, an Easter bread
with painted eggs on top that is similar to
the Greek lambropsomo. Christmas Eve fea-
tures a meal of cod, and a stuffed cabbage and
sauerkraut dish is customary on Christmas.
Among Serbians, the most auspicious day of
the year is Krsna Slava, Patron Saint’s Day.
This holiday dates back to the worship of
protective spirits in pagan times; today each
family honors its self-chosen patron saint with
a sumptuous feast and dancing that may last
for two to three days. The family customar-
ily announces the annual open house with a
small advertisement in the local newspaper.
Krsni kolac is a ritual bread prepared for the
occasion, decorated with the religious Serbian
emblem “Samo sloga Srbina spašava” (“Only “Samo sloga Srbina spašava” (“Only “Samo sloga Srbina spašava”
unity will save the Serbs”) as well as grapes,
wheat, birds, flowers, barrels of wine, or other
representations made in dough. Slovenians
celebrate St. Nick’s Feast. Gifts are distributed
to children by St. Nick, dressed as a bishop,
who admonishes the youngsters to be good.
The grape harvest and winemaking are tradi-
tionally commemorated with numerous festi-
vals and St. Martin’s Feast.
There are also feasts and fasts connected
with Islamic religious observances. Tradi-
tional festive foods vary from country to
country and may also vary seasonally since
the Muslim calendar is lunar, and holidays
fall at different times each year. Iftar is the Iftar is the Iftar
meal that breaks the fast during Ramadan,
the month in which Muslims fast from sunrise
to sunset; it is common to dine with relatives
and neighbors. The meal usually starts with
a beverage, preferably water, followed by an
odd number of dates and coffee or tea. A large
meal, served after prayers, includes moist and
hearty dishes. Regular items eaten during
Ramadan include soups, fruit juices, cheeses,
and fresh or dried fruit. Traditional sweets
include kataif, which refers to a pancake or
a shredded wheat dough dessert and, in Tur-
key and Iran, rose-flavored rice puddings. In
some Muslim homes, the post-fast meal is
considered a feast with elaborate dishes that
emphasizes the Muslim virtues of hospitality
and community, while in other homes a more
moderate meal is thought to be in keeping
with the purposes of the fast.33 The dawn meal
is usually light, and salty foods are avoided
because water is not allowed during the fast.
The holiday Eid al-Fitr follows the end of Eid al-Fitr follows the end of Eid al-Fitr
Ramadan and is described as a cross between
the feasting of Thanksgiving and the festivity of
Christmas. Typically family, friends, and neigh-
bors gather to celebrate; in areas with large Mus-
lim populations, Eid al-Fitr may be held at the
local fairgrounds with games, rides, and many
food vendors. The other major holiday observed
by Arab Muslims is Eid al-Adha, the Feast of
Sacrifice held in conjunction with the annual
pilgrimage (Hadj) to Mecca (see Chapter 4).
In Turkey, Eid al-Fitr is known as Seker
Bayram, meaning “sugar festival.” It is tradi-
tional to exchange small gifts with friends,
and for four days children are given sweet
treats, such as lokums or chocolates. On the
tenth day of the first lunar month of the
Islamic calendar, Turks celebrate the martyr-
dom of Mohammed’s grandson and the day
Noah was able to leave the ark. They pre-
pare asure, or Noah’s pudding, made from
the ingredients remaining after the receding
of the flood waters: fresh and dried fruits,
nuts, and legumes. Kurban Bayram is a day of
remembrance for when the prophet Abraham
nearly sacrificed his son Ishmael. Families
customarily sacrifice a sheep or a goat and
distribute it to family, friends, and community
charities. Another special occasion in Turkey
is National Sovereignty and Children’s Day on
April 23. It commemorates the establishment
of the Grand National Assembly in 1923 and
specifically honors all children. The following
day has become Turkish American Day in the
United States, featuring parades in traditional
dress and other festivities.
In Iran the most significant holiday of the
year is Muharram, which commemorates the
martyrdom of the grandson of Mohammed
Yemen qat (the herb
with amphetamine-like
properties called khat in
Ethiopia—see Chapter
8) is frequently chewed
in social and business
settings.
In Greek Orthodox
tradition, the egg
represents life, and
red is the color of the
blood Christ shed. The
breaking of the red-dyed
egg symbolizes the
resurrection.
For New Year’s Day
the Greeks prepare
a sweet spicy bread
called vasilopitta with a
coin baked into it—the
person who gets the
piece with the money
has good luck in the
upcoming year (the Serbs
have the same tradition
for Christmas Day).
Kahk is a sweet Egyptian
bread made with ample
butter and nuts that
is served at all special
occasions.
Some non-Christian Arab
Americans celebrate
the birth of Jesus on
Christmas; Jesus is
considered a prophet
in Islam.
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4 4 0 P E O P L E O F T H E B A L K A N S A N D T H E M I D D L E E A S T
in the seventh century. It is a time of com-
munal mourning and penitence for Shiites,
and often features sholeh zard, a sweet rice
pudding flavored with saffron. Another cel-
ebration marking the spring equinox is Nau
Roz, which features a meal, called haft-sinn,
including a ceremonial table setting where
the Qur’an, a mirror to reflect life, sweets,
bread, cheese, and seven items starting with
the letter s representing rebirth, good fortune,
love, happiness, health, and other wishes for
the new year are displayed. Foods and other
goods starting with s may include serke (vine-
gar), seeb (apple), sanjed (dried fruit or olives), sanjed (dried fruit or olives), sanjed
sumagh (sumac), samanu (a sweet sprouted
wheat kernel pudding), seer (garlic), sonbul seer (garlic), sonbul seer
(hyacinth), sabzi (sprouted seeds), or sekeh
(coins). Readings from the Qur’an are fol-
lowed with a traditional meal of herbed rice
(sabzu polo) and an herbed omelet (kukuye
sabzi) served with fish. The number seven
probably relates to the seven days of the week
or the seven planets of the ancient solar sys-
tem. On the thirteenth day of Nau Roz, it is
customary to have a picnic.
The traditional holidays of the Jewish cal-
endar are observed in Israel (see Chapter 4
for Jewish food practices). The Shabbat, or
Sabbath, occurs from sunset Friday to sun-
set on Saturday evening. The Friday meal is
served on a table set with white linen and
includes the symbolic Kiddush cup of wine
that is shared by all diners. In Ashkenazi
homes a representative menu would include
gefilte fish, a leavened, braided loaf of egg-rich
challah bread, a roast chicken, a noodle pud-
ding called kugel, and fruit or cake and tea
for dessert. In Sephardic households a more
Middle Eastern meal would be typical, such
as pilaf, roast lamb, cooked eggplant or stuffed
dolma, pita bread, and honey-soaked filo pas-
tries with coffee for dessert. Jews from other
regions have favorite Sabbath menus as well.
For example, an Ethiopian family might serve
chicken doro wat and caraway-flavored dabo
bread. Because all work, including cooking, is
prohibited on the Sabbath, the more obser-
vant prepare food during the day on Friday
or left cooking overnight, which can be con-
sumed on Saturday. Stews that can simmer
overnight on the stovetop are popular dishes
for the midday meal following morning ser-
vices, such as cholent, also known as hamim
in Israel. Every family has its own version,
though most include beans and potatoes. The
Lebanese and Syrians use white beans, the
Brazilians use black beans, and the Moroc-
cans add rice. Most Ashkenazi recipes use
beef brisket, and some Sephardic versions
include sausages. In most homes whole eggs
cooked in their shells are buried in the stew.
Other religious holidays offer a similar vari-
ety of food traditions based on nationality of
origin. Israelis also observe the secular Yom
Ha-Atzma’ut, Independence Day, on the fifth
day of Iyar (a spring month in the Jewish lunar
calendar). Celebrants view parades, hold bar-
becues, and watch fireworks. Street vendors
sell falafel, ears of corn, and numerous sweets,
including candied fruits and nuts, sesame seed
candy, and European cakes and tortes with
whipped cream.
Therapeutic Uses of Food
Fresh foods are considered best, and canned
or frozen foods are often avoided by Middle
Easterners to preserve health. The amount of
food eaten is of special concern in the diet.
Ample meals are needed to prevent illness,
and poor appetite is regarded as a disease in
itself or as a generalized complaint signify-
ing that one’s life is not as it should be. Food
deprivation is believed to cause illness.22,34,35
Some Middle Easterners also believe that
illness can be triggered by hot cold shifts in
food, especially in people with weak or sus-
ceptible constitutions. In Iran, eating too
many hot foods may result in headaches,
sweating, itching, and rashes. Excessive
amounts of cold foods can cause dizziness,
nausea, and vomiting.22,23 Foods and drinks
of the opposite category can ameliorate
these conditions. For example, citrus fruits
or a sour lemonade called ablimu is used for
headaches and acne. Nausea is treated with
tea or a sweet similar to rock candy. Classi-
fications can vary, but examples of hot foods
include lamb, eggs, onions, garlic, carrots,
bell peppers, apples, dates, quinces, chick-
peas, wheat, almonds, walnuts, pistachios,
honey, and tea. Cold foods can include beef,
cucumbers, tomatoes, eggplant, grape leaves,
In Greece and the Middle
East, sugared almonds
(Jordan almonds) are
served at weddings to
ensure sweetness in
married life.
The name of the Jewish
Sabbath stew cholent
may come from the
French for “warm,” chaud,
and “slow,” lent,30 or from
cholent (or sholen) from
the Hebrew she’lan,
which means “that rested
[overnight].”84
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 3 4 4 1
grapes, lemons, sour cherries, apricots, mul-
berries, pomegranates, rice, yogurt, coffee,
and beer. The temperature (not spiciness) can
cause a shift in the body from hot to cold and
vice versa, and it is believed the digestive sys-
tem must have time to adjust to one extreme
before a food of the opposite temperature
can be introduced. In addition, though ill-
ness may be related to hot-cold imbalances,
Iranians do not consider certain conditions
as being hot or cold. Thus, a symptom such
as coughing requires specific treatment unre-
lated to classification: consuming cold turnips
is considered beneficial, whereas cold pickles
are deemed harmful.22
Some Middle Easterners also believe cer-
tain combinations of incompatible foods are
damaging to health. For example, Egyptians
do not consume fish at the same time as dairy
products. Other Middle Easterners avoid eat-
ing sour foods with milk and legumes with
cheese. Iranians believe consumption of
melon with yogurt causes wind in the stom-
ach and gastrointestinal disorders.
Many special foods are associated with
childbirth. Eggs cooked in garlic and chicken
soup are frequently consumed by Lebanese
women after childbirth. When a woman gives
birth to a girl in Iran, coldness is neutralized
with a diet high in hot foods to ensure a male
child in the next pregnancy. Saffron custard
garnished with nuts is thought to help Iranian
women regain strength postpartum, while
Palestinian women consume oats, coriander,
or fennel.
The division between food and medicine
is somewhat blurred in the Middle East,
especially in Arabic nations.25 Turnips are
considered good for the kidneys and urinary
tract, whereas cauliflower is beneficial for the
respiratory system. Red onion bulbs and their
leaves (which are added to salads) are con-
sumed to help with diabetes and cancer. They
are also eaten to ease liver disease, which is
treated with asparagus and artichokes, too.24
Many foods have a multiplicity of therapeutic
uses. Some Palestinians, for example, consider
garlic to be good for colic, nausea, kidney
infections, intestinal worms, ulcers, genito-
urinary infections, prostate conditions, and
tumors, and as an aphrodisiac.25
Contemporary Food
Habits in the United
States
Adaptations of Food Habits
There is scant information on the adaptation of
Balkan or Middle Eastern diets in the United
States. It is assumed that, as in other immi-
grant groups, increasing length of stay is cor-
related with Americanization of the diet, with
traditional dishes prepared and eaten only for
the main meal or for special occasions. It is
less likely that religious dietary practices, such
as adherence to halal or kosher law, change
significantly after arrival in the United States.
Ingredients and Common Foods
Greek Americans still use olive oil extensively,
although they use less of it than their immigrant
relatives.41 Salads still accompany the meal,
and fruit is often served for dessert. Vegetables
are prepared in the traditional manner. Lamb
is still very popular; for special occasions,
roasted leg of lamb is substituted for the whole
animal. Consumption of beef and pork has
increased, whereas consumption of legumes
has decreased. Cereal and grain consump-
tion among Greek Americans remains high,
and bread, rice, or cereal products are usu-
ally included in every meal. Greek Americans
consume more milk than their immigrant par-
ents, and ice cream is very popular.
▼ Middle Eastern market.
A
le
xe
y
St
io
p/
Sh
ut
te
rs
to
ck
.c
om
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4 4 2 P E O P L E O F T H E B A L K A N S A N D T H E M I D D L E E A S T
One small study of first-generation Egyp-
tians found that traditional wheat bread
remained commonly consumed, though
intake of legumes, especially fava beans, was
somewhat lower than when the immigrants
had lived in Egypt. Snacking and eating out
had become much more prevalent, and soft
drinks were more popular.36
Meal Composition and Cycle
Greek Americans maintain traditional meal
patterns, but the main meal of the day is
now dinner.37 They prefer an American-type
breakfast and lunch, but dinner is more tra-
ditional. However, they have adapted Greek
recipes to make them less time-consuming to
prepare and to include fewer fats and spices.
It is assumed that the meal pattern for most
Americans of Croatian, Serbian, and Slove-
nian heritage is much acculturated.
After immigration to Canada and the
United States, Arab Americans may have a
substantial midday meal, but the main meal
of the day has become dinner.38 Members of
the extended family may dine together daily,
with the women who stay at home cooking for
employed female relatives.37
Nutritional Status
Nutritional Intake
Very little has been reported on the nutritional
composition of the Balkan American or Middle
Eastern American diet. However, research on
the diets of nations bordering the Mediterra-
nean (particularly Greece) often report that the
traditional diet there, one that is low in satu-
rated fats and high in monounsaturated fats
and omega-3 fatty acids (due to a low intake
of meats combined with high consumption
of olive oil, fruits, and vegetables), lowers the
risk of cardiovascular disease and cancer.38,39,40
Studies on the impact of the Mediterranean diet
on the development of metabolic syndrome
conditions (including obesity, hypertension,
and type 2 diabetes) have been contradictory,
but supports improvement in risk factors asso-
ciated with heart disease.41,42,43,44,45 What is
known is that the number of people consum-
ing this traditional diet is declining with the
Westernization of the region. Since the 1960s,
the Greeks have been consuming significantly
less olive oil and more alcohol.46 Rates of
overweight and obesity in Greece are nearly
50 percent for women and almost 75 percent
for men.47 A recent study in Lebanon found
younger adults were eating fewer fruits, veg-
etables, and legumes, while consuming more
meat and sugar and drinking more soft drinks
and alcoholic beverages, than older adults.48
Similar results were found among male college
students in Saudi Arabia.49
Sparse data on Bosnian immigrants has
shown that 8 percent of first-time patients
seeking care at a refugee medical clinic were
diagnosed with hypertension, and another 4
percent presented with type 2 diabetes. Thirty-
six percent of those in a smaller surveyed
subset desired care for chronic disease manage-
ment. Providers report a need for diet and exer-
cise counseling due to diets high in sugar, fat,
and meat, and low in salads, fruits, and grains.
Some refugees have stated they have little time
for exercise beyond work-related physical
activity. Dental problems were significant, and
alcohol abuse may be seen in some refugees.6,18
Research suggests that Arab men living
in the Arabian Peninsula region may be as
susceptible to the clustering of risk factors in
metabolic syndrome as are some other ethnic
groups, such as Asian Indians (see Chapter 14
for more information). High prevalence of
undiagnosed type 2 diabetes and hyperten-
sion, and high rates of insulin resistance, low
levels of high-density lipoprotein (HDL) cho-
lesterol, and a tendency toward abdominal
obesity were found. Coronary heart disease,
diabetes, hypertension, and cancer are the
primary health concerns in Arab countries.50
Studies of men and women in Turkey, where
cardiovascular disease is the most common
cause of death, have also reported strikingly
low serum levels of HDL cholesterol unrelated
to diet, obesity, or lifestyle.51,52,53 Worldwide,
one of the greatest relative increases in type
2 diabetes is expected to occur in the eastern
Mediterranean region.54
Limited research on Arabs living in the
United States has reported similar health
trends. One study of Arab American adults
found that 29 percent of men and 37 percent
of women were obese (body mass index [BMI]
≥30), with central obesity (as measured by
waist-to-hip ratio) found in over 50 percent of
both men and women. High blood pressures
The demand for properly
slaughtered (halal) meat
among Muslims in the
United States has led to
increased numbers of
Arab halal markets.
Greek weddings in the
United States offer a
blend of Greek and
American foods; for
example, the wedding
cake is served along with
baklava.
Life expectancy for
adult Albanians is very
high despite very low
socioeconomic status,
and some researchers
hypothesize that this
is due to a diet high in
mono-unsaturated fats
from olive oil and low
intake of animal products
due to privation.85
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C H A P T E R 1 3 4 4 3
were noted in about 20 percent of the adults.55
A more recent study reported higher rates of
hypertension (37 percent), and 40 percent
of Arab Americans had pre-hypertension.56
Rates of type 2 diabetes in Arab/Chaldean
Americans in Michigan aged twenty to sev-
enty-five years were found to be very high:
over 15 percent for women and 20 percent for
men, with rates of impaired fasting glucose
and glucose intolerance above 32 percent in
women, and almost 50 percent in men.57,58
When analyzed further, the data suggest that
lack of acculturation was associated with
diabetes risk, as was consumption of Arabic
foods, being an older age at time of immigra-
tion, unemployment, and reduced activity
in Arab organizations.59 The age-adjusted
prevalence of metabolic syndrome was found
to be between 23 and 28 percent of Arab
American adults in one study, and the most
common component was low levels of HDL
cholesterol.60 Low HDL cholesterol levels in
Arab American women were accompanied
by high triglyceride levels in another study.61
Data on cancer incidence in Arab/Chal-
dean adults indicate that, when compared to
the non-Arab white population, the men have
disproportionately high rates of leukemia, mul-
tiple myeloma, and liver, kidney, and urinary
bladder cancers, while women have greater
proportions of leukemia and thyroid and brain
cancers.62 However, the leading causes of can-
cer-related deaths in Arab Americans are lung,
colorectal, and breast cancers.63,64
The effects of Ramadan fasting have been
explored among Muslims. Although hunger
increases in some fasters, there were no sig-
nificant changes in body weight noted in one
study.65 Increases in uric acid blood levels have
been noted when weight loss occurs in non-
obese men, however, which may be related to
high rates of kidney stones and angina pecto-
ris reported in some epidemiological surveys
conducted during the month long fast.66,67
A majority of pregnant women go through
Ramadan, and one study suggested that with
certain precautions, such as excluding women
with medical risk factors (including diabetes
and history of preterm deliveries or renal
stones), increased prenatal visits, avoiding
strenuous exercise, staying cool, and con-
sumption of extra fluids before dawn, fasting
was safe for many of the women. It was also
noted that immigrant Muslim women fasted
on average more days than did women born
in the United States.24 Individuals with type
2 diabetes who fasted during Ramadan were
able to maintain normal blood sugar levels,
but fasting is not recommend for those with
type 1 diabetes.68
Cross-cultural research on breast-feeding
reported that 82 percent of Iranian American
mothers in the study exclusively breast-fed
their infants. This high rate was attributed
to a strong social network of support for the
practice. In Turkey, mothers sometimes nurse
their sons longer than daughters because
breast milk is believed to increase strength.69,70
Though rates of celiac disease in the Middle
East are estimated to be below those in north-
ern Europeans (see Chapter 6), it is consid-
ered the primary cause of chronic diarrhea in
Iran and may contribute to iron deficiency,
malnutrition, rickets, and short stature in
children.71,72,73,74 Thalassemia syndromes may
also be prevalent in Middle Easterners.75
Counseling
Considerable discomfort has been noted
between health care practitioners and their
Middle Eastern American clients, much of it
due to cultural differences. Most difficulties
evolve from misunderstandings in the provider
patient relationship.76 There are considerable
similarities in culture between people of the
Balkans and the Middle East, even among those
immigrants who share Arabic as a language
there can be notable differences in dialect, eth-
nic background, and socioeconomic status.77
Religious affiliation and degree of orthodoxy
are equally important. Language and commu-
nication problems can cause significant health
care access issues.78 Many refugees, especially
elders who are homebound, have poor English
skills, and lack of interpreter services is one
barrier to health care services.7
Interactions are highly contextual through-
out the Balkans and the Middle East, meaning
that body language and general atmosphere
are as important to communication as words,
if not more so (see Chapter 3). People in the
Middle East spend time getting to know one
another before any business is discussed.
Offering coffee or tea at the beginning of any
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4 4 4 P E O P L E O F T H E B A L K A N S A N D T H E M I D D L E E A S T
interaction helps to establish a warm and
hospitable atmosphere with many Balkan or
Middle Eastern clients.33,80
Direct eye contact is expected and neces-
sary to interpret meaning, so Middle East-
erners usually sit or stand quite close when
conversing with intimates but may retain a
larger distance with strangers.79 Greeks may
smile when angry. Nodding one’s head up and
down or back and forth can be very confusing.
Traditionally, moving the chin up and down
meant “no” and back and forth meant “yes”
or “I don’t understand.” But many Greeks and
Middle Easterners use the American protocol,
so it is difficult to know whether the gesture is
affirmative or negative.
Touching between members of the same
sex is frequent, including handshaking, pat-
ting, shoulder slapping, hugging, and kissing.
Contact between members of the opposite sex
is prohibited in some Middle Eastern Mus-
lim cultures and avoided in most. Extended
eye contact between men and women can be
considered a sexual overture (staring between
members of the same sex is acceptable). The
left hand is not used for any social purposes,
nor to pass documents or administer medica-
tions.33,80 In general, it is best to wait for Mid-
dle Easterners to extend their hand in greeting
before making any unwanted contact. Proper
posture is a sign of respect, and crossing one’s
legs, pointing with the foot, or showing the
sole of the shoe is considered impolite. In Tur-
key, one should stand when an elder enters a
room.
Good manners are important; if not an
emergency situation, inquire first about over-
all well-being of the patient and exchange
pleasantries, such as a few minutes for gen-
eral questions about the well-being of other
family members or personal interests of the
client.19,80,82 It is important to speak kindly,
softly, and respectfully.22,81,82 Privacy is val-
ued and clients may resist disclosure of per-
sonal information to strangers, especially
when it relates to familial disease conditions.
Individual clients may be inexperienced with
making independent decisions, thus options
should be kept to a minimum to avoid over-
whelming the client with too many choices.81
Family members, especially an elder male
relative, may insist on participating in all
conversations, even those that customar-
ily take place in the office between only the
practitioner and the patient. Because these
family members may make the final deci-
sions regarding care, their presence should
be valued and their opinions fully solicited.
However, if the client is a woman, she may
ask to have her husband or father sign medi-
cal forms, presenting liability issues regarding
consent.81 There may be suspicion regarding
questions about religious affiliation or socio-
economic data. Fear of racial profiling may
occur.79
Balkan and Middle Eastern Americans
value biomedicine and have considerable
respect for authority figures.80,81 When pro-
viding information to the clients, verbal deliv-
ery may be more receptively received than
written information. They may be hesitant
to ask questions when confused, however, or
they may provide answers that are designed to
please the provider. The health provider may
have to assess and give advice about a medical
or dietary problem without the client explain-
ing his or her needs. If the provider does not
repeat the offer to help, the client may believe
that the provider is indifferent. Further, shame
about certain conditions may cause noncom-
pliance when a client is in public situations.
Diabetes, for example, may be associated with
male impotence and female infertility. Strate-
gies for adhering to diet modifications without
disclosure of the cause can increase efficacy.83
Culturally, Arab immigrants tend to view
good health as a state of balance and poor
health as a state of imbalance.82 Complaints
by clients of Balkan or Middle Eastern heri-
tage are frequently generalized or nonspecific,
sometimes indicating anxiety or depression in
a patient who does not distinguish culturally
between physical and mental health. This may
be particularly true with Bosnian refugees,
who sometimes present with ill-defined symp-
toms and may suffer from anxiety, depression,
and post-traumatic stress disorder.6,81
Middle Eastern Americans may expect the
health care provider to make decisions for
them and be responsible for the consequences.
They may also demand the services of the top
expert or the department head because the
expectation is that they will receive the best
care from the most senior, most powerful
Some researchers note
that Muslim women who,
for religious reasons,
completely cover their
bodies and heads with
clothing when outdoors
may be at risk for vitamin
D deficiency.86
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C H A P T E R 1 3 4 4 5
person in the system. Female health care
providers may face added difficulties in
gaining the trust and respect of Balkan and
Middle Eastern clients due to cultural norms
regarding gender. Clients may believe that
the more intrusive the medical procedure, the
more effective the treatment.80 Among Irani-
ans, the disclosure of bad news too quickly
can cause a patient to become narahati.22 It
is considered sacrilegious to presume death
because only God can make that final deci-
sion, and hope must always be maintained.
Muslim clients usually feel most comfort-
able with providers of the same gender.81,82
Less acculturated Greek Americans preferred
seeing counselors (for psychological services)
of the same ethnic background.83 Consistent
care from a single provider is most success-
ful and may eliminate many communication
difficulties.
Practitioners report that many Bosnian
clients did not understand the importance of
taking prescribed medications, and some did
not follow instructions on how they should
be taken or discontinued their use when side
effects occurred.18 Though few studies have
been conducted to assess the continuing use
of traditional health practices in the United
States, it is believed that Bosnians frequently
take herbal cures and alcohol-based tinctures
simultaneously with biomedical therapies.81
There are few data about the therapeutic
ingredients in Balkan and Middle Eastern
home remedies. Ko’hl, for example, used on
the umbilical cords of newborns, is high in
lead content and may present a danger, and
the active ingredient in foxglove (used by
some Iranians) is digitalis. Support for use
of traditional remedies encourages clients to
report their use, allowing the provider to pre-
vent possible adverse interactions.
The need to pray during a medical care
visit is a problem for some Muslims. Provid-
ers who have Muslim clients should consider
setting up private areas with prayer rugs as a
sign of respect. No talking can occur during
prayers, and it is disrespectful to walk in front
of someone who is praying.82
Practitioners who work with Balkan and
Middle Eastern clients should recognize that
a high-context relationship is often intensive
and time-consuming.18 The in-depth inter-
view should be used to determine country of
origin, degree of acculturation, and religious
faith. Information on traditional health care
beliefs still being practiced should be elicited.
Traditional healers in
Saudi Arabia sometimes
recommend drinking
sheep bile to treat
diabetes, a practice
that can result in acute
toxicity.
Many pregnant Muslim
American women in one
study reported that they
did not discuss Ramadan
fasting with their
prenatal care provider
for fear of being treated
disrespectfully or being
told to stop outright.24
D I S C U S S I O N S T A R T E R S
Diet and Culture of Balkan and Middle Eastern Americans
In small groups of three to four, compare and contrast the diet and culture of Balkan Americans and Middle Eastern Americans, with each group focusing
on a different aspect of the diet and culture of these groups:
Given the scarcity of data in some cases, you may have to draw hypotheses about the diet, food habits, and so on of these groups from what we know
about diet, food habits, and the like of nonimmigrants.
Within your group, try to come to a consensus on what findings to report to the rest of the class. Before breaking up, assign a number to each group
member: A1, A2, A3, A4; B1, B2, and so forth. Form new groups with all the 1’s in a group, all the 2’s in another group, all the 3’s another group, and so
on. In your new group, report the findings of your previous group, and as a group, discuss the relationship of traditional attitudes toward diet and health
and changes in diet and health due to immigration to the United States.
Group A: The food habits and the typical eating etiquette and meal composition of these two immigrant groups
Group B: Issues involved in counseling these immigrant groups on diet and health
Group C: Attitudes within each immigrant group toward diet, health, and medical treatment, notably attitudes toward traditional home
culture medical treatment and U.S. biomedicine
Group D: Amount of obesity, diabetes, hypertension, and other diseases within each immigrant group
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
4 4 6 P E O P L E O F T H E B A L K A N S A N D T H E M I D D L E E A S T
Review Questions
1. What food flavors and food ingredients are
associated with the Balkan and Middle East-
ern countries? Why might they be similar?
Describe two recipes, one from the Balkans
and one from the Middle East, that contain
filo (phyllo) dough.
2. What is meant by the “evil eye”? How might
you protect yourself from it?
3. What countries make up the Balkans and the
Middle East? Pick either the Balkans or Mid-
dle East and map the religions found in that
region. Pick one religion, describe a recipe
eaten for a holiday of that religion, and explain
how the recipe reflects the ingredients of the
region.
4. What are common health problems associated
with peoples from the Balkans or the Middle
East? Select one group and a health disor-
der, and describe that group’s cultural beliefs
regarding the cause and appropriate treatment
of that disorder.
5. In several countries from these two regions,
food and illness may be classified as “hot”
or “cold.” What does this mean? Provide
examples.
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4 5 0
South Asia is the geographic region com-prising the nations of India, Pakistan, Bangladesh, Sri Lanka, Nepal, and
Bhutan (see Figure 14.1). Immigrants from
South Asia, mostly India and Pakistan, com-
prise one of the fastest-growing populations in
the United States.
India is a culturally complex country with
a population of more than 1.28 billion—over
four times that of the United States. The
sophisticated civilization began approximately
4,000 years ago and is the source of some of
the most influential religions, art, architec-
ture, and foods in the world. The South Asian
subcontinent contains the fertile Indus and
Ganges river basins, as well as parts of the
Himalayan mountain range; it varies in cli-
mate from extensive desert regions to jungle
forests to the world’s largest mountain gla-
ciers. The people of India are as diverse as its
geography and climate. People from virtually
every racial and religious group have migrated
to or invaded India at some time in history,
and each group has brought its own language
and customs. As the different races and reli-
gions intermingled, other cultures were cre-
ated. One result is that there are currently
fifteen separate languages recognized by the
Indian government. Nearly 300 languages
are actually spoken in India, and there are
approximately 700 dialects.
The Islamic Republic of Pakistan, located
to the northwest of India, encompasses some
of the most rugged territory in the world. The
Himalayas stretch across the north, includ-
ing the second-highest peak in the world, K2.
The Hindukush range defines the northwest-
ern region. From these mountains spills the
Indus River, supplying the plains of the south
before emptying into the Arabian Sea. Paki-
stan received its independence from India in
1947 to provide a homeland for the Muslim
minority of that nation. It was a bitter split.
Two wars between the countries have been
fought since independence, and tensions con-
tinue over the province of Kashmir. Though
Pakistan is an Islamic state, it is divided
into four regions, each with its own cultural
groups and languages: Punjab, Sindh, Baluch-
istan, and the North-West Frontier Province
(NWFP).
Although India and Pakistan share a past,
Asian Indians and Pakistanis each bring dis-
tinctive contributions when they move to the
United States, particularly in their traditional
foods and food habits. This chapter examines
the customary diets of India and Pakistan and
the changes that occur when immigrants from
these countries move to America.
Cultural Perspective
History of Asian Indians and
Pakistanis in the United States
Given the complexity of South Asian cul-
ture, it is not surprising that the immigrants
to the United States from India and Pakistan
differ from other immigrant groups in sev-
eral ways. Most significantly, the majority
arriving in the United States are not escap-
ing political or economic pressures in their
South Asians
14 CHA
P
T
E
R
Fewer than 55,000 Sri
Lankans, Nepalese, and
Bhutanese combined
have immigrated to the
United States. The 2013
Census reported that
163,000 Bangladeshis are
estimated to live in the
nation (over half of them
in New York City), most of
whom have arrived since
1990.1
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C H A P T E R 1 4 4 5 1
homelands. Since 1965, when the national
quota system was temporarily dropped from
U.S. immigration laws, the majority of South
Asian immigrants have been from the upper
socioeconomic classes. They were somewhat
acculturated at the time of arrival, often fluent
in English, and acquainted with many Ameri-
can customs.
Immigration Patterns
Asian Indians The first immigrants to the
United States from India were members of
the Sikh religion, who arrived on the West
Coast in the early twentieth century. Many
were employed by the railroads, and oth-
ers established large farms. They faced overt
discrimination and persecution. Newspapers
warned of the “Hindoo invasion”; anti–Asian
Figure 14.1
India and Pakistan.
Arabian Sea
AFGHANISTAN
PAKISTAN
INDIA
CHINA
NEPAL
BHUBHUTAN
BANGLADESH
SRI LANKA
Bay of Bengal
©
C
en
ga
ge
L
ea
rn
in
g
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4 5 2 S O U T H A S I A N S
Indian feelings brought about the expulsion
of Asian Indians from Washington logging
communities and in 1907 sparked violent
riots in California. Although such extreme
bigotry lessened in time, the Asian Indian
immigrant population remained small until
after World War II.
Relaxed immigration laws encouraged
Asian Indians, especially well-educated urban
professionals, to come to the United States in
starting in the 1960s. Economic and social
adjustment was a priority for this group,
although many Asian Indian traditions con-
tinue within the privacy of the home. These
immigrants formed a self-reliant community
and discouraged comparison or identification
with other ethnic groups.
Pakistanis Though Muslims from northern
India certainly came to the United States prior
to the founding of Pakistan, immigration
from the nation technically began in 1947.
However, prior to 1965, only 2,500 Pakistanis
moved to the United States. Beginning in
1965, when certain immigration quotas were
lifted, thousands have been arriving from
Pakistan each year.
Current Demographics and
Socioeconomic Status
Asian Indians According to U.S. Census esti-
mates for 2013, the Asian Indian population
has increased 800 percent during the previous
33 years, from 400,000 to an estimated 3.19
million. Over 71 percent of Indian Ameri-
cans are foreign born, and most of them have
arrived since 1970.1 Asian Indians have settled
throughout the United States, but especially
in the metropolitan areas of California, New
York, and New Jersey, as well as in Illinois,
Maryland, Massachusetts, Michigan, Ohio,
Pennsylvania, and Texas. There are also sev-
eral Asian Indian settlements in the agricul-
tural regions of California.1
Some Asian Indians coming to the United
States in recent years are exiles from regions
where Indian immigration in the past has
been substantial, such as East Africa, Fiji, and
Guyana. These immigrants often feel unwel-
come in Indian American communities, and
form separate enclaves.2
The relative affluence of Americans of Asian
Indian heritage is due mostly to a well-educated
population: nearly 56 percent held a college or
graduate degree in 2000.1 Many were employed
in professional or white-collar occupations in
India, such as college professors, engineers,
physicians, and scientists, and most continue
their careers in the United States. Nearly 69
percent of Indian Americans hold management
or professional jobs.1 Newer immigrants have
found success in small-business and franchise
ownership involving many members of their
extended family. Motel and hotel ownership
is especially common, and it is estimated that
over 50 percent of these businesses nationwide
are run by Indian Americans.1 Median family
income is 150 percent above the national norm,
and family poverty rates are below average.3
Many Asian Indians come to the United
States to complete their college or post-
graduate education. They are often unmar-
ried or have left their spouses and children in
India. It is not uncommon for the families to
join the student in America after he or she has
become financially established.
Pakistanis As of 2013, Census figures sug-
gest the number of Pakistani Americans is
less than 450,000, more than 50 percent of
whom are foreign-born immigrants, and
nearly all of whom have arrived since 1980.1
A majority have come from large cities and
the largest population is in the New York City
metropolitan area and Chicago.1
The immigrants who first arrived after
1965 were typically well-educated profession-
als seeking employment in professions such
as law, medicine, computer technology, and
teaching. Many students obtaining advanced
degrees also chose to stay in the United States.
Over 56 percent of Pakistani Americans hold
a college degree.1 However, Pakistanis are
often grouped with Asian Indians and Arabs
in data collection, so little is known specifi-
cally regarding their socioeconomic status.
It is believed that most Pakistani Americans
are solidly middle class or upper middle class.
Home ownership is valued and may be higher
than average compared to other recent immi-
grant groups. Family income for all Pakistani
Americans is similar to the U.S. median.5
In the early 1900s it was
not unusual for single
Sikh men living in the
United States to marry
Mexican American
women and start
families.
In the 2011 Canadian
census, 1,567,400
individuals identified
themselves as
South Asian.
Confusion over the term
Indian (does it mean a
Native American or an
Asian Indian?) has made
it difficult to find consen-
sus on a designation for
Asian Indians living in the
United States. South Asian
or Indian American have
emerged as terms used
by many Asian Indians.
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C H A P T E R 1 4 4 5 3
However, 15.9 percent of Pakistani families
were living in poverty as of 2013.1
Worldview
The Caste System in India
The traditional Indian caste system, which
influences the social structure of many Asian
Indian groups, is the Hindu method of order-
ing an individual’s role in society. A more
encompassing term is j ati, which is the orga-
nization of all aspects of Hindu life, including
actions, places, things, and symbols, not just
people. Caste categories are hereditary. There
are four main castes associated with certain
professions (although members are not neces-
sarily employed in these jobs): the Brahmans
(priests), Kshatriyas (soldiers), Vaisyas (mer-
chants or farmers), and the Sudras (serfs).
These castes are divided into more than 1,000
subcastes, usually according to occupation.
Existing outside the caste system are individu-
als considered so impure that they are called
“untouchables.” Although the laws discrimi-
nating against untouchables were repealed in
1949, this group of the desperately poor con-
tinues to occupy the lowest stratum in Indian
society.
The caste system has permeated Indian
society despite the fact that it is an exclusively
Hindu classification. Americans of Asian
Indian descent often continue to identify
proudly with their caste. Most come from
the upper castes of Brahmans and Kshatriyas.
As with all cultural practices, it is important
to remember that even within a group there
is great diversity of individual beliefs and
customs.
Religion
Asian Indians The influence of religion on
Indian culture is ubiquitous. Every aspect of
life and death is affected not only by individ-
ual religious affiliation, but also by the Hindu
ideology that pervades Indian society.
Hinduism Nearly 85 percent of Indians are
Hindus. Hinduism is an ancient faith, believed
to have developed in India between 2000 and
1500 bce. from the Aryan hymns and prayers
known as the Vedas mixed with elements from
traditional Dravidian religion (see Chapter 4,
for more information about Hinduism and
other major Indian religions).
The Hindu Society of India established
community organizations to serve the reli-
gious needs of early Asian Indian immigrants
to the United States. Many Hindu temples
now exist in regions where Asian Indians have
settled, with services and religious ceremonies
conducted by Brahman priests (who are often
employed part-time in other occupations).
However, temple attendance may be limited
to significant religious events. Small shrines
are often created in Asian Indian apartments
or houses so that prayer and meditation may
take place at home.
Islam Today the Islamic religion in India is
second only to Hinduism in number of fol-
lowers; one in every nine Asian Indians is a
Muslim. Islam was brought to India by traders
from Persia, and it expanded with the Muslim
invasions of the northern regions beginning
about 1000. The Islamic Moghul Empire
dominated the country for nearly 800 years.
The influence of Islam is seen today mostly in
northern India.
Buddhism Buddhism developed as a prot-
estant revolt against Hinduism. Its founder,
known as Gautama Buddha, lived in India
during the fifth century bce. Although it
is a popular religion in other parts of Asia,
Buddhism is followed by less than 1 percent
of Asian Indians today.
Jainism This branch of Hinduism devel-
oped at about the time Buddhism emerged.
The Jains believed that all living things have
souls. Some wear masks to prevent breathing
in insects and sweep a path in front of them
to prevent stepping on any creatures. Ortho-
dox Jains are strict vegetarians. Approximately
2 percent of Indians are Jains; in the United
States, Jains have established their own tem-
ples for worship.
Sikhism The Sikh religion differs from Hin-
duism in its belief in a single God. It is best
known for its military fraternity, although
most Sikhs in India are farmers. Male Sikhs
wear a turban and follow the “five Ks”: uncut
hair ( k es), a comb worn in the hair ( k anga),
short pants ( k ac c h a), a steel bracelet worn on
A reverence for all life,
called ahimsa, is funda-
mental to Asian Indian
ideology. It is reflected
in the religions native
to India, as well as in
the vegetarian diet that
many Indians follow.
The Moghul culture
combined Persian and
Indian influences, as
seen in the architectural
masterpiece of the
period, the Taj Mahal.
The untouchables were
considered impure
because of their contact
with cattle carcasses
and their consumption
of beef.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
4 5 4 S O U T H A S I A N S
the right wrist ( k ada), and use of a special
saber ( k ir pan). Each has a spiritual mean-
ing; for example, the short pants symbolize
self-restraint; the bracelet, obedience; and the
comb, purity of mind. In the United States
many Sikhs continue these traditions, though
some men forgo uncut hair to better fit into
American society.4 Although Sikhs are only
2 percent of the population in India, it is
reported that they make up nearly one-third
of Asian Indians living in California.
Christians It is estimated that Christians
make up 2.3 percent of the Indian popula-
tion. One form of Christianity emerged when
the Syrians, who migrated to the Malabar
Coast of southwest India in 345 ce, intermar-
ried with native people. Syrian Christians do
not observe Hindu dietary laws, but they do
participate in the caste system. Their agricul-
tural community is operated with farm labor-
ers who can be described as serfs. Another
Christian community developed at the former
Portuguese colony of Goa, farther north on
the southwest coast. Approximately half of cit-
izens are Catholic, known as Goan Christians,
and the city is dedicated to St. Catherine.
Zoroastrianism More than 1,200 years ago
the Parsis fled from religious persecution in
Persia to northern India. The religion they
brought is known as Zoroastrianism, an
ancient faith that venerates Ahur Mazda, the
wise god of fire. The sacred fires of Zoroastri-
anism are tended in temples protected from
the sun and from the eyes of unbelievers. The
Parsis have adapted many of their practices to
blend into Indian society but have maintained
their faith through private schooling of their
children. Parsis are considered the most West-
ernized of all Asian Indians, and significant
Parsi communities are found in New York and
Los Angeles.
Judaism Four small Jewish communities were
established in India when Jews fled persecution
in Greece, Palestine (under Roman domina-
tion), Iraq, and Germany. The largest popula-
tions are found in Bombay and Calcutta.
Animism The oldest religions in India are
those practiced by the small tribal populations
that live in isolated regions of the Himalayas.
They worship spirits associated with natural
phenomena, a religious practice known as
animism. In the past they have practiced such
varied social customs as polyandry (having
more than one husband) and head hunting.
Pakistanis Nearly 98 percent of Pakistanis
are Muslim (approximately three-quarters
are Sunni and one-quarter are Shiite). Small
numbers of Pakistanis are Hindus, Christians,
Sikhs, and Zoroastrians. In the United States,
families attend a local mosque at least once a
week, and men often attend daily. Religious
education for children is expected, often
occurring on weekends, and may include
instruction in Arabic (so that the Qur’an can
be read in its original language). There are few
strictly Pakistani congregations, and some fol-
lowers may attend only on special holidays if
there is no local mosque and they must travel
long distances for services.
Family
Asian Indians The husband is the head of
the household in the traditional Indian fam-
ily. Traditionally the wife does not work out-
side the home and is expected to perform
all duties related to housekeeping and child
care. She obtains help in these responsibili-
ties from the extended family and, in some
homes, from servants. If the wife does hold
a job, she can depend on the help of relatives.
Children are expected to show respect for
their elders; parents may choose what career
a child should pursue. Dating is uncommon
in India, and many marriages are arranged by
families based on similarities in caste, educa-
tion, religion, and upbringing between pro-
spective husbands and wives.
In the United States most Indian Ameri-
cans live in nuclear families, and strains in the
traditional structure often occur. Asian Indian
women are more likely to work in America than
in their homeland, yet they lack the support
system of an extended family. Elders may also
find themselves cut off from their traditional
role of advisers and may not have opportunities
for involvement in certain religious activities
that would fill their lives in India. Some Asian
Indians, especially women raised in India, find
it difficult to adjust to these changes.
The kirpan has become
a civil rights issue in
some U.S. public schools,
pitting religious freedom
against provisions
restricting weapons on
campus.
In India, marriage is con-
sidered the beginning of
a relationship from which
love develops over time.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 4 4 5 5
Children who grow up in the United States
usually insist on making their own career
choices. Dating has become more acceptable,
but some parents strongly discourage rela-
tionships with persons of other ethnic or reli-
gious backgrounds.4 Though most parents do
not choose their child’s spouse, many Asian
Indian children still defer to their parents’
opinions; young male students in the United
States sometimes ask their families in India to
find suitable wives for them.
Elders are well respected in Indian cul-
ture, and it is considered auspicious to have
a senior at any social function.5 Older women
are considered experts in family matters. Tra-
ditionally, the oldest sons are expected to care
for their parents, who in turn often help out
with caring for children in the family. Some
Indian Americans continue the practice of
having elder parents in the home, and others
(with parents who still live in India) host their
mothers or fathers for months at a time.
The family is seen as the way to preserve
Indian values and beliefs while living in the
United States. They consider themselves as
bicultural—Indians at home but Americans
at work.6 There is also strong interest in
sponsoring the immigration of relatives to the
United States. Most Asian Indians have found
successful adjustment in the United States
through educational and economic achieve-
ment in American public life, while main-
taining an emphasis on Asian Indian culture
within the privacy of their home life.
Pakistanis The traditional Pakistani home
is strongly patriarchal. The husband is often
the only wage earner in the family, and the
wife is expected to stay inside the house to
raise the children.7 She is allowed out to do
essential chores such as shopping, but other
activities require that she be accompanied by
her husband. Faith is the centerpiece of fam-
ily life for Muslims, and modesty for women
is prized.
Women are not allowed to have con-
tact with unrelated men after puberty, and
inappropriate touching could bring shame
on the entire family and make a young girl
unsuitable for marriage. In the United States
most households include the immediate
members, though close relatives such as
grandparents or aunts and uncles may live
in the home for extended periods. Some
women prefer a traditional role. They may
remain at home throughout the day and may
never acquire English language skills. Oth-
ers straddle a middle ground, working dur-
ing the day, interacting with non-Pakistanis,
and returning at night to don traditional
garb and perform customary religious and
family chores.
Many young Pakistani Americans are not
allowed to date, and marriages are still fre-
quently arranged. In the more conservative
homes, girls may be withdrawn from public
schools in the seventh grade to prevent mix-
ing with boys. If private segregated schools
are unavailable or unacceptable, girls may be
schooled at home or not at all. Other Pakistani
teens are well integrated into American life
and education, continuing on to college and
often attaining advanced degrees.
Traditional Health Beliefs and Practices
Asian Indians Traditional medicine in India
has a long and distinguished history. Sev-
eral systems have developed over several
thousand years, the most important of which
is Ayurvedic medicine, which established the
humoral concepts of the body that were later
adopted in Greece and eventually evolved into
biomedicine as it is practiced today.
Ayurvedic medicine developed into its
current form between 500 bce and 500 ce;
it is based on Sanskrit texts and the writ-
ings of practitioners. A y ur means “longevity” A y ur means “longevity” A y ur
and v eda means “science or knowledge.” The
purpose of the Ayurvedic system is to ensure
a long and active life so that the wisdom of
elders may be passed down to future genera-
tions. Ayurvedic physicians, called vaidyas,
are trained at government-supported schools
that grant degrees based on an established
curriculum. Their diagnosis focuses on who
the person is that has the illness: their tastes,
their work habits, their character, and their
life history. Evaluation of the pulse, the face,
the eyes, and the nails provides further data.
A person’s constitution, including tempera-
ment and preferences in food, is believed to
be determined at birth.
Deepak Chopra, an
Indian-born physician,
popularized Ayurvedic
medicine in the United
States through his best-
selling books and videos.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
4 5 6 S O U T H A S I A N S
Ayur vedic therapy uses diet, herbal
remedies, and meditation to reestablish equi-
librium between the sick person and the
universe, including the social, natural, and
spiritual worlds. Diet is considered most
significant.
Foods are classified as hot or cold depend-
ing on their effect on the body and must be
balanced for each condition (see the “Ther-
apeutic Uses of Food” section later in this
chapter). In addition, more than 700 plants
and animal substances are listed in the
Ayurvedic texts for prescriptive use. Because
the mind, body, and soul are all considered to
be interconnected parts of the whole system,
meditation is used to address imbalance in the
spirit of a person.
Ayurvedic medicine has declined some-
what in popularity in India as Westernized
medicine has become more established and
is frequently perceived as a paraprofessional
practice. Folk beliefs about health and ill-
ness are found in some regions. For example,
Yunani or Unani-Tibb medicine is common
in the northern areas of India. It is an Ara-
bic system that has been modified by Indian
practitioners known as hakim. It is a humoral
system that identifies four humors—yellow
bile, black bile, phlegm, and blood—and four
qualities—heat, cold, moisture, and dryness.
Health is sustained through balance of these
humors and qualities. Illness is treated by
complementary remedies; for example, dis-
ease due to too much cold is cured with a hot
therapy. Diet is an important therapeutic tool,
and advanced conditions are often treated first
with a fast, or limitation of intake, to allow
the digestive system to rest.8 Siddha medicine,
another humoral system, is developed within
Tamil culture and is found mostly in southern
India. Older practices, such as the use of sha-
mans, bonesetters, and snakebite healers, are
found in some rural regions.
Home remedies such as herbal infusions
and poultices are prevalent in India, often
derived from Ayurvedic prescriptions or
other traditional practices, but administered
by home diagnosis. Many are known to have
pharmacological activity, and several are con-
traindicated in certain medical conditions or
toxic in some preparations. Examples include
aloe vera for obesity, liver problems, and both
high and low blood sugar levels. Licorice root
is used for indigestion and stomach aches, uri-
nary tract problems, constipation, colds, and
coughs. Black nightshade is considered help-
ful in heart disease and liver problems. Diabe-
tes is treated with numerous cures, including
pellitory, neem, gudmar, and puncture vine.9
Recent surveys of more remote areas of the
country have identified numerous previously
unknown plants used by local inhabitants,
many with demonstrated therapeutic proper-
ties.10,11,12 Medications available only through
prescription in the United States can be pur-
chased over the counter in India. Widespread
use of antibiotics and mixing of therapeutics
have been reported.13
Pakistanis Little has been reported on the
traditional health beliefs and practices of
Pakistanis, though it has been noted that
complementary care may be sought concur-
rently with biomedicine.14 A recent study
found 23 percent of a sample of young, well-
educated residents of Karachi sought the help
of healers, known as hakims.15 Similar to the
same-named practitioners in India, hakims
use Islami-Tibb, a humoral form of medi-
cine adapted from traditional Arab systems
and related to Indian Unani-Tibb. Therapeu-
tic herbs or botanicals are used to maintain
balance in the body and to cure a variety of
ailments, such as common colds, coughs,
cancer, leprosy, and reproductive disorders.
Respondents who used such services reported
that they believed hakims were reliable and
inexpensive; those who did not visit hakims
questioned their effectiveness and safety.
Ayurvedic medicine is also available. Pro-
phetic healing, prayer, and home remedies
such as honey are often used to treat minor
conditions or to seek protection from malign
influence.15,16
Traditional Food Habits
It is difficult to generalize about Indian cui-
sine because of the diverse geography and het-
erogeneous population of the country. Foods
vary north to south, east to west, region to
region, and among religious and caste groups.
Meditation is the
quiet consideration of
religious teachings to
understand faith and
to achieve spiritual
enlightenment. It is
practiced by Hindus and
Buddhists, and by some
Christians and Muslims
as well. Transcendental
meditation (TM) is associ-
ated with yoga and has
no affiliation with any
specific religion.
Homeopathy is well
accepted throughout
India and Pakistan.
Pakistani hakims
sometimes use exotic
preparations, such as
those made from opium
poppies or monitor lizard
oil, in their treatment
programs.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 4 4 5 7
The cooking of Pakistan is considered similar
to aromatic northern Indian fare, though with
Persian and Afghani influences, including a
greater emphasis on meat dishes and a prefer-
ence for onions, ginger, and garlic.
Ingredients and Common
Foods
Staples
India Few foods are eaten throughout all
of India. Grains and legumes predominate
in the frequently vegetarian cooking, with
added vegetables and fruits. Dairy items often
supplement the diet. The types of ingredients
and preparation methods vary by locality and,
often, according to religious practices.
Rice is the grain most commonly con-
sumed, and the average Indian eats half a
pound of it each day. This amount, however,
varies considerably by region, and it is most
popular in the southern and eastern areas of
the nation. Wherever it is consumed, long-
grained rice is preferred. Wheat, used pri-
marily in breads, is another staple. Legumes
are consumed daily by nearly all Asian Indi-
ans. Dal (or Dal (or Dal dh al ) is the Hindi term for dried
beans, peas, and lentils, which come hulled,
skinned, whole, and split (in some literature
the English word pul se is used instead). Dal is
also the name for the dish made when they are
boiled and seasoned. They are also commonly
added to rice or soups, prepared as seasoned
purees, or ground into flour to make distinc-
tive breads (see Table 14.1).
Dairy foods are significant in most regions.
Fermented milk products such as yogurt are
found throughout most of the country, as is
the cooking fat gh ee, which is pure, clarified
butter (this butter, known as usl i gh ee, is
too expensive for daily use in many homes,
so vegetable shortening, also called ghee, is
often used instead). Seasonings are distinc-
tive. Masalas are mixtures of spices and herbs
that can be either fresh and “wet” or dried
and powdered. Coriander, cumin, fenugreek,
turmeric, black and cayenne pepper, cloves,
cardamom, cinnamon, and chile peppers are a
common blend that is called curry in Western
countries. Other typical spices and herbs
include aj w ain (carom or loveage seeds),
▼ Traditional foods of
India. Some foods typical of
the traditional Indian diet
include amchoor (mango
powder), basmati rice,
broccoli, coconut, cucumber,
eggplant, ghee, herbs
and spices (black pepper,
cardamom, chiles, fresh
coriander, cloves, coriander
seeds, cumin, garlic, ginger
root, mint, mustard seeds,
nutmeg, tamarind, and
turmeric), lentils, peas,
plantains, and yogurt.
amc h oor (unripe mango powder), asafetida amc h oor (unripe mango powder), asafetida amc h oor
(a pungent powdered resin), coconut, fresh
coriander, garlic, mint, saffron, and tamarind
(the sour pulp of a bean pod).17 Beyond these
generalities, the staples of the Indian diet are
best classified by region.
The greatest division in diet is seen
between northern and southern India.
Northern cuisine is characterized by the use
of wheat, tea, a large number of eggs, garlic,
dried or pickled fruits and vegetables, and
use of dry masalas that are aromatic rather
than hot. These foods are typical of a cooler
climate, where wheat grows better than rice
and where fruits, vegetables, herbs, and spices
are available only seasonally. Boiling, stew-
ing, and frying are the most common forms
of cooking. In the south steaming is the pre-
ferred method of food preparation. Rice, cof-ferred method of food preparation. Rice, cof-ferred method of food preparation. Rice, cof
fee, fresh pickles (some known as chutney),
pachadi (seasoned yogurt side dishes called
raytas in northern India), “wet,” spicy-hot
masalas, and fresh fruits, vegetables, herbs,
and spices are fundamental to the cuisine.
Again, these foods reflect the regional agri-
cultural conditions.
Many Asian Indians are vegetarians, and
most use some milk products but avoid eggs
(see Exploring Global Cuisine: Vegetarianism
in India). Pork is eaten in some communities in
the west, lamb and beef are eaten in many areas
of the north, and fish and poultry are eaten
in several coastal regions. The cultural food
groups list is found in Table 14.2.
J.
Y.
L
ok
e/
Sh
ut
te
rs
to
ck
.c
om
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
4 5 8 S O U T H A S I A N S
The ancient Indian diet featured a variety of meats, such as cows, bulls, buffalos, Tof meats, such as cows, bulls, buffalos, T
horses, rams, goats, and pigs, in addition
to wild game including deer, alligator, and
tortoise. The vegetarian ethic entered India
slowly, probably beginning with the bulls
and barren cows used for sacrifice by the
Aryans. Later, prohibitions were extended
to the milk cow and the draft bull, as well
as the village pig (a useful scavenger) and
the village cock. Over time, a more general
concern for animal life developed, though
meat eating (especially in the upper classes)
was difficult for many Indians to forgo.
Buddhist and, later, Jain doctrines reinforced
the concept of ahimsa, and vegetarianism
became more widely practiced. It is
often suggested that only in India, with
its enormous variety of available fruits,
vegetables, and grains, could such a broad
acceptance of a vegetarian diet prevail.21
Yet the definition of vegetarianism
in India is elusive. It is usually considered
a symbol of piety in the Brahman castes
and may be a necessity among the poor.
Abstinence from meat and poultry is
most common; however, nearly all Indian
vegetarians consume milk products, and
some eat eggs. Fish is problematic because it
is an inexpensive food where available. Except
in the state of Gujerat (where the influence of
Jainism has been especially strong), a large
percentage of people living in coastal regions
eat fish, sometimes justifying it as fruit of
the sea. Other Indians practice vegetarianism
only on days of religious observance or as
they age and become more devout. Some
sources suggest that vegetarianism is most
prevalent in southern India due to the Muslim
influence found in the North. Indian census
data show this is not the case. Overall, it
is believed that 30 percent of Indians are
strict vegetarians, abstaining from all meat,
poultry, fish, and eggs but consuming milk,
yogurt, and other dairy products.
E X P L O R I N G G L O B A L C U I S I N E
Vegetarianism in India
English Hindi Common Preparations
Black lentils
(black gram)
Urad dal Black skins with creamy insides—boiled, added to rice or
vegetables, seasoned with mustard oil (Bengal); often ground
for flatbreads (e.g., pappadams) or fermented and combined
with rice flour to make flatbreads (e.g., idli, dosas).
Black-eyed peas Lobhia Boiled, seasoned with onions, ginger, garlic (in the north),
ginger, asafetida, mustard oil (in the west), or coconut
(in the south).
Chickpeas
(Bengal gram)
Channa dal Most commonly used dal in India—boiled, added to curries,
chutneys, rice (pulao); pureed (sambar); roasted whole for
snacks; ground into flour (besan) and added to curries, used
for deep-fried fritters; made into thick, sweet puddings for
dessert.
Green peas Mutter dal Boiled, added to curries, rice (pulao) or pureed.
Hyacinth beans Valor Boiled, often seasoned with coconut, ginger, and jaggery;
sprouted in soups, salads.
Lima beans Pavti Boiled, mixed with vegetables (especially potatoes, eggplant),
added to curries; made into fritters or patties.
Madras beans
(horse gram)
Kulith Assertive earthy flavor—boiled, added to curries; powdered for
soup.
Mung beans
(green gram)
Moong dal Brownish green—boiled with spices, added to rice (khichri),
made into dumplings; sprouted for salads.
Red lentils Masur dal Salmon colored—boiled, often mashed and added to meat for
kebabs or curries (most common in the north).
Yellow lentils
(yellow split peas)
Toor (Arhar) dal Pale yellow—boiled, often pureed with seasonings, or added to
rice (khichri); mashed with other dals or rice to make pancakes
(adai).
TA B L E 14 .1 Selected South Asian Dals
©
C
en
ga
ge
L
ea
rn
in
g
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C H A P T E R 1 4 4 5 9
Pakistan Pakistani fare combines the spices
of India, such as cumin, turmeric, and chile
peppers, with the more typically Arab flavors
of cinnamon, cloves, and cardamom. It is dis-
tinctive for its ample use of garlic, ginger, and
onions in many savory and even some sweet
dishes. Wheat is the staple of Pakistan, and
flatbreads, similar to those in northern India,
accompany every meal. Dal ia, the Pakistani
version of Middle Eastern bulgur, is cooked
with water or milk to make a porridge. Other
commonly consumed grains include rice, usu-
ally the nutty-flavored basmati rice cooked as
pulao (cooked in a manner similar to Turkish
pilau) and khichri (mildly spiced mixture of
rice and legumes). Corn is popular in some
areas, typically ground into meal and made
into bread flavored with mustard greens and
served with butter. Barley, sorghum, and mil-
let are available but consumed less frequently.
Legumes, especially chickpeas and lentils, are
served daily, usually as one of several side
dishes. One favorite is cholay, chickpeas or
whole dried peas cooked with ginger, garlic,
onions, tomatoes, chile peppers, cumin, and
turmeric. Besan (chickpea flour) is used for
breads and batters for fried foods.
Dairy foods from cows and water buffaloes
are another staple in the diet. Whole-milk
yogurt (dah i) is used to prepare raytas (yogurt
and vegetable side dishes) that are eaten with
every meal. Lassi (the diluted yogurt bever-
age found in India), paneer (Indian-style pot
cheese), fresh milk, cream, and ice cream are
other common dairy foods, consumed regu-
larly or added to other dishes.
Lamb, mutton, goat, beef, and chicken are
Pakistani favorites. Pork is rarely eaten due
to the Muslim majority, and nearly all meats
are processed according to Islamic h al al
guidelines (see Chapter 4). Meat or poultry is
served at lunch and dinner if affordable. Beef
stew, called nihari, is an example of pot roast-
ing (dum), a popular preparation technique.
Braising ( k or ma or q or ma) is also common,
as is the Indian charcoal tandoor i style of
cooking. B h una is a method of slowly frying
wet seasonings (such as onions, ginger, and
garlic), then adding dry spices to make a thick
paste, then vegetables, and finally bits of meat
to make a curried dish. Biryani rice is another
specialty, a highly seasoned pilau (including
saffron) with added meat. Yogurt or amc h oor
is used to marinate both meats and poultry.
Minced and ground meat dishes are especially
popular, and meats are sometimes extended
with ground legumes. Kabobs can be grilled
or pan-fried patties; koftay are fried meat-
balls (sometimes dipped in besan batter first)
served with a curry sauce. G h ee is the pre-
ferred cooking fat, although some Pakistanis
must use less costly vegetable oils.
Both tropical and temperate vegetables and
fruits are available, though not consumed in
large amounts. Apples, apricots, cabbage, car-
rots, cauliflower, cucumbers, dates, grapes,
guavas, mangos, onions, oranges, papayas,
peas, plums, pomegranates, potatoes, pump-
kin, spinach, tamarind, and watermelon are
common. Vegetables are typically added to
raytas, chutneys, curried dishes, and stews.
Desserts are popular, especially ice cream
and puddings made from rice, besan, carrots,
bread, or vermicelli noodles. Cardamom,
cloves, ginger, poppy seeds, aniseed, saffron,
almonds, or pistachios flavor many sweets.
One unique pudding dating from the Moghul
period includes both ginger and garlic. Fried
fritters are consumed, as are ladoos, balls
made from sweetened besan and garnished
with nuts. A Pakistani dessert specialty is ras
malai, which may be best described as a rich
cheesecake without a crust. Special-occasion
desserts may be garnished with silver leaf. Tea
is consumed throughout the day. It is usually
heavily sweetened and boiled with milk, fla-
vored with cinnamon or cardamom. Other
popular beverages include lassi, sharbat (fruit
juice), and sugarcane juice. Carbonated drinks
are less common, and alcohol is prohibited for
Muslims.
Regional Variations
Nor thern India The inf luences of the
Moghul period are still found in the cooking
of northern India, where Muslim influence
was most prominent. The royal court fare of
that time featured lavish meat and rice dishes
flavored with expensive aromatic seasonings,
nuts, dried fruits such as raisins, and yogurt
or cream. Ample use of ghee and sugar
was also characteristic. Many similarities
The word curry is
believed to be the English
adaptation of a southern
Indian term for “sauce,”
kari. Curry powder is
not a single spice but
a complex blend of
seasonings that varies
according to the cook
and the dish. The closest
Indian equivalent is
garam masala.
In Bombay, it is legal for
a vegetarian to refuse to
sell his or her property to
a nonvegetarian.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
4 6 0 S O U T H A S I A N S
Group Comments Common Foods Adaptations in the United States
Protein Foods
Milk/milk
products
In general, milk is considered a
beverage for children in India;
consumed by some adults
in Pakistan. Fermented dairy
products are popular.
Fresh cow’s, buffalo’s, ass’s milk; evaporated
milk; cream used in Pakistan; fermented
milk products (yogurt, lassi); fresh curds very
popular; fresh cheese (paneer); milk-based
desserts, such as kheer, khir, kulfi, barfi, and
Pakistani puddings.
Much cheese is consumed by
Asian Indians; ice cream is
popular with Asian Indians
and Pakistanis.
Meat/poultry/
fish/eggs/
legumes
A sophisticated vegetarian
cuisine exists in India; legumes
are a primary protein source;
meat and poultry are very
popular in Pakistan.
Hulled, split legumes, grains,
and seeds, such as lentils, are
known as dals.
Legumes are typically prepared
whole or pureed, or used
as flour to prepare baked,
steamed, or fried breads and
pastries.
Beef avoided by Hindus; pork
prohibited for Muslims.
Meats: beef, goat, mutton, pork
Poultry: chicken, duck
Fish and seafood: Bombay duck, carp, clams,
crab, herring, lobster, mackerel, mullet,
pomfret, sardines, shrimp, sole, turtle
Eggs: chicken
Legumes: beans (kidney, mung, etc.),
chickpeas, lentils (many varieties and colors),
peas (black-eyed, green)
Consumption of legumes
decreases; meat intake
increases.
Meat may be added to
traditional Indian vegetarian
dishes.
Fast foods are popular.
Cereals/Grains More than 1,000 varieties of
Indian rice are cultivated.
Basmati is preferred in
Pakistan.
Wheat used mostly in northern
India and Pakistan; rice in
southern India.
Most breads (roti) are
unleavened.
Rice (steamed, boiled, fried, puffed), wheat,
buckwheat, corn, millet, sorghum
Use of American-style breads
occurs in place of roti;
breakfast cereals are popular
Fruits/Vegetables More than 100 types of fruit and
200 types of vegetables are
commonly used in India.
Fruits and vegetables may be
used in fresh or preserved
pickles, called rayta (northern
India/Pakistan), pachadi
(southern), or chutney.
Fruits often costly in Pakistan.
Fruit: apples, apricots, avocados, bananas
(several types), coconut, dates, figs, grapes,
guava, jackfruit, limes, litchis, loquats,
mangoes, melon, nongus, oranges, papaya,
peaches, pears, persimmons (chicos),
pineapple, plums, pomegranate, pomelos,
raisins, starfruit, strawberries, sugarcane,
tangerines, watermelon
Vegetables: agathi flowers, amaranth,
artichokes, bamboo shoots, banana
flower, beets (leaves and root), bitter
melon, Brussels sprouts, cabbage, carrots,
cauliflower, collard greens (haak), corn, haak), corn, haak
cucumbers, drumstick plant, eggplant,
lettuce, lotus root, manioc (tapioca),
mushrooms, mustard greens, okra, onions,
pandanus, parsnips, plantain flowers,
potatoes, pumpkin, radishes (four types,
leaves and roots), rhubarb, sago palm,
scallions, spinach, squash, sweet potatoes
(leaves and roots), tomatoes, turnips, yams,
water chestnuts, water convolvulus, water
lilies
Decreased variety of fruits
and vegetables is available;
decreased vegetable intake
results for Asian Indians.
More fruit juice is consumed
by Asian Indians.
Salad is well accepted by
Asian Indians.
Use of canned and frozen
produce increases.
TA B L E 14 . 2 Cultural Food Groups: South Asian
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 4 4 6 1
between the foods of this region, Pakistan,
and modern-day Iran are still evident due to
this shared history.
Basmati rice is commonly served as a
pilaf in northern India, and biriyani rice with
seasoned chicken, lamb, or beef is popular.
Meatballs (kofta) made with ground meats
or with meat and dal mixtures are a specialty,
as are skewered pieces of broiled or grilled
meats (kabobs). Northern specialties include
korma—a curried lamb dish with a nut and
yogurt-thickened sauce—and masala chicken.
Peanut and sesame oils are used in many prep-
arations.8 The dishes of the north, particularly
in Kashmir (which boarders Pakistan and has
a significant Muslim population), are often
seasoned with saffron.2,18
Bread, which is called ro ti in northern
India, is eaten daily. Examples include whole-
wheat flatbreads, such as chapatis, which are
cooked on a griddle without oil until they puff
up, and puris, which are deep-fried, usually in
ghee. Paratha, a griddle-fried roti, is used as a
wrapping for spiced vegetable fillings. A rich,
leavened bread of the region, called sh eer mal ,
is flavored with rose water. Fresh cheese made
from buffalo milk (similar to cottage cheese),
called paneer , is added to many dishes, or
skewered and grilled. Milk desserts are
favored, such as carrot pudding (gajar halva)
and rice pudding with cardamom (kheer).
In northern and northwestern India a spe-
cial cylindrical clay oven heated with charcoal
and called a tandoor is used. Tandoori cook-
ing is identified particularly with lamb and
chicken dishes (the meat is often marinated in
a spicy yogurt sauce before cooking), although
the leavened bread known as naan is also typi-
cally baked in a tandoor. This method of cook-
ing is associated with the state of Punjab, and
Group Comments Common Foods Adaptations in the United States
Additional Foods
Seasonings Aromatic (northern) and hot
(southern) combinations of
fresh or dried spices and herbs
accentuate or complement
food flavors. Pakistani fare
similar to northern Indian
but with ample use of ginger,
garlic, and onions.
Ajwain, amchoor, asafetida, bay leaf, amchoor, asafetida, bay leaf, amchoor
cardamom (two types), chiles, cinnamon,
cloves, coconut, fresh coriander, coriander
seeds, cumin, dill, fennel, fenugreek, garlic,
kewra, lemon, limes, mace, mint, mustard,
nutmeg, pepper (black and red), poppy
seeds, rose water, saffron, tamarind, turmeric
Spice use depends on
availability.
Nuts/seeds Nuts and seeds of all types
are popular; used to thicken
korma sauces in India and
garnish desserts in Pakistan.
Almonds, betel nuts and leaves, cashews,
peanuts, pistachios, sunflower seeds,
walnuts
Paan tray may be limited to
betel nuts and spices.
Beverages Tea is common in northern
India/Pakistan, coffee in
southern India. Coffeehouses
are favored meeting places.
Coffee, tea, water flavored with fruit syrups,
sugarcane, spices, or herbs; alcoholic
beverages such as fermented fruit syrups,
rice wines, beer
Increased consumption of
soft drinks and coffee is
noted for Asian Indians.
Alcoholic beverages are
widely accepted by Asian
Indians (women may
abstain); consumed by very
few Pakistanis.
Fats/oils Coconut oil, ghee (clarified butter), mustard
oil, peanut oil, sesame seed oil, sunflower oil
Purchased ghee is often made
from vegetable oil instead
of butter.
Sweeteners Sugarcane, jaggery (unrefined palm sugar), jaggery (unrefined palm sugar), jaggery
molasses
Candy and sweets are
enjoyed by Asian Indians
but not overconsumed;
cookies may replace
flatbreads as snacks for
Pakistanis.
©
C
en
ga
ge
L
ea
rn
in
g
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
4 6 2 S O U T H A S I A N S
though few homes have tandoor ovens, it has
been popularized throughout the nation (and
with many visitors) by specialty restaurants.
The northwestern region is characterized
by the large percentage of Hindus and Jains
and high numbers of vegetarians. In the state
of Punjab, where the national capital Delhi
is situated, many cooler weather vegetables
associated more with temperate climates than
tropical ones, such as cabbage, carrots, cau-
liflower, potatoes, tomatoes, and turnips, are
used. Onions and garlic, infrequently used in
most of India, are common seasonings. Dairy
products, including milk and buttermilk in
addition to yogurt and paneer, are consumed
more often in this area than in any other
Indian region.9 In the state of Rajasthan, bar-
ley, millet, and, later, corn were the primary
grains grown in the region and are featured
in many breads. Today, wheat is becoming
much more prominent. Aromatic spices such
as cumin and cardamom are found in many
dishes, and red chiles add zing. A little farther
south is the state of Gujarat, which special-
izes in vegetarian dishes flavored with green
chiles and ginger.8 Sweet-and-sour dishes
are also featured, usually achieved by pair-
ing sugar with a sour fruit indigenous to the
region called kokum (related to mangosteen
S A M P L E M E N U
Pakistani Midday Meal
Lamb K or ma ( Q or ma) a,b or Beef K of t aa
S ambals : Imli (Tamarind) Chutney, (Tamarind) Chutney,S ambals : Imli a
R ay ta (Yogurt Condiment),a C h ola y aC h ola y aC h ola y
N aan *
Tea
*Store bought
aDesi Cookbook at http://www.desicookbook.com/Desi Cookbook at http://www.desicookbook.com/Desi Cookbook
bPakiRecipes at http://www.pakirecipes.com
and tamarind). The combination is found in
savory dishes as well as in desserts, and espe-
cially in the drink k ok um sh ar bat.
Coastal India The coastal region offers a num-
ber of seafood specialties and fish prepared in
a variety of ways, including fried, steamed,
boiled, curried, and stuffed with herbs. For
example, in the northeastern state of Bengal
(which includes the city of Kolkata—formerly
known as Calcutta), prawns are a specialty
even in the more inland areas. Freshwater
fish, mostly those from numerous rivers and
estuaries, are consumed by most Bengalis
every day. A favorite along the coast is bhapa,
steamed packets of fish (or vegetables) sea-
soned with mustard seed and spices, such as
cumin, asafetida, and nigella (a small black
seed with subtle bitterness called k al onj i in
Hindi). A dessert version features sweetened
yogurt. The inland dishes of Bengal are note-
worthy for their use of poppy seeds. Mumbai
(formerly known as Bombay), located on the
west coast in the state of Maharashtra, boasts
a dried, salted fish—which is thin, bony, and
strongly flavored—known as Bombay duck. It
is usually prepared fried. Other coastal foods
eaten by the people of the Marathis region
include numerous curried fish dishes as well
as shrimp, crab, and lobster. In inland areas,
Marathis are known for adding peanuts to
their dishes, and for bhakris, a crispy, tradi-
tional flatbread made from rice flour (sor-
ghum flour is used in some rural areas) and
cooked on an ungreased griddle. The tiny
state of Goa, which is south of Mumbai, is
home to many Christians. Fish is eaten daily,
but pork is also popular. The most famous
dish of the region is vindaloo, a hot-and-sour
pork curry seasoned with coconut, vinegar,
tomatoes, and ample chile peppers.
Southern India The menus of the south fea-
ture numerous steamed and fried rice dishes.
A coarse red rice with a smoky flavor called
rosematta is favored in some parts of south-
eastern India, including the state of Tamil
Nadu (home of the Tamils), and may be mixed
with other grains.19 Rice is even served puffed,
as in a snack called bhelpuri. Other grains,
such as semolina wheat, are also popular
cooked as a cereal known as uppama, which
Samosas—angular,
deep-fried turnovers
with spicy potato, veg-
etable, cheese or meat
stuffings and served with
chutney—are thought to
be variations of Middle
Eastern sanbusak.110
Green tea is made in a
samovar in the Indian
state of Kashmir, a
method that may have
been introduced to the
region from Russia via
central Asia.8
A comfort food in many
parts of India is khichri,
a combination of veg-
etables sautéed with
rice and dal in an ample
amount of ghee. Khichri
is usually served with
kadhi, a curry made with
yogurt and besan.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 4 4 6 3
may include vegetables. Dal s, particularly
chickpeas and lentils, accompany nearly every
meal in the form of a spiced purée known as
sambar or as a thin, crisply fried roti called
pappadams. Fermented black lentil flour
mixed with rice flour is used at breakfast for
steamed cakes called idli and for spicy, fried
pancakes called dosas. A mixture of different
dals (and sometimes rice) is cooked, seasoned
with chile peppers, and mashed into a thick,
unfermented puree that is fried for the savory
pancakes known as adai, traditionally served
with jaggery or coconut chutney. Fresh milk
curds are also served for breakfast.
Highly spiced vegetable curries, such as
aviyal, include such southern ingredients as
bananas, banana flowers, bittermelons, coco-
nut, drumstick plant, green mango, and jack-
fruit seeds, in addition to potatoes, cauliflower,
and eggplant. Pandanus leaves, with a flavor
reminiscent of mown hay, are used to season
some dishes. Coconut milk is often used in cur-
ries and sauces, and coconut oil is commonly
used for frying.9 Refreshing yogurt-based
pachadi and spicy, pickled fruits or vegetables,
such as chutney, accompany the main course.
In the state of Kerala (in the southwest), where
there is the smallest percentage of vegetarians
in the nation, fish or seafood is eaten often,
as is chicken. Black pepper is a favorite sea-
soning, often combined with coconut, green
chiles, and karhi (curry leaves), an herb with a
citrus-like, tangerine flavor). A large Muslim
population prepares traditional biryanis and
cooks lamb with garlic, anise, and ground chile
peppers. In the large state of Andhra Pradesh,
dishes are typically seasoned with tamarind
(which is also used for beverages), gongura
(the leaves of roselle, a type of hibiscus also
used in African cooking), and red chile pep-
pers. Andhran fare is reputedly the hottest in
all of India. Throughout the South, deep-fried
salty foods and sweets are favored snacks, such
as the syrup-soaked, orange-colored pretzels
called jalebis.
Pakistan Pakistani fare consists of many
regional variations. In Punjab, the royal cook-
ing style of the Moghul period still influences
a preference for elaborate, rich dishes. Tan-
doori fare is popular, and the k ar ah i—a deep,
A French Christian
colony on the east coast
of India at Pondicherry
introduced baguettes,
croissants, pâté, and
French-style desserts into
the regional fare.
▲ Samosas, spicy deep-fried
turnovers.
H
ig
hv
ie
w
s/
Sh
ut
te
rs
to
ck
.c
om
cast-iron pot shaped something like a wok—
is used to deep-fry foods. Fish is a common
food in Sindh, which has a lengthy coastline,
and is prepared as fritters, kabobs, steamed,
or curried. Spit-roasted meats are a specialty
in Baluchistan. Called sajji, the whole lamb or
chicken is skewered on a small pole, then the
poles are inserted into the dirt around a large
fire. The poles are rotated by hand as the meat
cooks, assuring even roasting. The North-
West Frontier Province, which is populated by
eight different tribes, has a simple cuisine that
emphasizes rice, dal, and lamb. More locally,
in the valley of Hunza, a distinctive fare devel-
oped due in part to the limitations of its high
altitude. Wheat predominates, traditionally
baked as a flatbread (phitta) in hot ashes.
M al tash , a strongly flavored aged butter, is
prized, and k ur utz , a salty dry cheese, flavors
soups. Wild thyme and turmeric are common
seasonings. Apricots and apricot kernels are
eaten as snacks, while oil extracted from the
kernels is used in cooking.20
Religious Variations
In addition to region, religious affiliation may
greatly influence food habits, especially in
India. Religious groups have varying dietary
practices, yet their cooking is Indian in flavor.
The relationship between food and spiritu-
ality is very complex in Hinduism. Eating is an
integral part of each person’s spiritual journey
and defines one’s role within society (see the
The English words
pepper, sugar, and orange
are all derived from Asian
Indian terms for those
foods.
Balti cooking, from the
Kashmir region (claimed
by both Pakistan and
India), uses a woklike
karahi pan to stir-fry
aromatic curries
seasoned with fresh
coriander, mint, and
fenugreek served with
flatbreads instead of rice.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
4 6 4 S O U T H A S I A N S
sections “Special Occasions” and “Role of
Food in Indian Society and Etiquette”). For
example, each caste traditionally was associ-
ated with different food habits.8 Brahmans
were generally vegetarians. Kashatriyas con-
sumed meat, and vaishyas consumed meat
depending on their locale and whether it was
available—farmers often had more access than
merchants. Sudras ate meat, but typically only
when it was provided for them as leftovers.
Muslims avoid all pork and pork products
but are not vegetarians. Orthodox Jains may
eat only innocent foods that avoid injury to
any life and are therefore strict vegetarians.
In addition, there are twenty-two prohibited
foods (e.g., fruit with small seeds or tender
new greens) and thirty-two other items that
may have the potential for life to exist, includ-
ing root vegetables, because insects might
be killed when the tubers are harvested and
honey, because bees might be killed when it is
gathered from the hive. They also refuse to eat
Chai, a north Indian
specialty, was created
as a way of using
lower-grade tea leaves by
boiling them with spices,
sugar, and milk.8
S A M P L E M E N U
A Southern-Indian Vegetarian
Dinner
A viy al (Spicy South Indian Vegetable Curry)A viy al (Spicy South Indian Vegetable Curry)A viy al a,b
S ambar (Seasoned Dal) (Seasoned Dal)S ambar a,b,c
Steamed Rice
Pineapple P ach ad ia,c
P appad ams * (Spicy Fried Flatbread)P appad ams * (Spicy Fried Flatbread)P appad ams *
Water (with the meal)
Mango Las s ib,c or Ch aia,c (following the meal)
*Store-purchased, fried before serving
aKaimal, M. 2000. Kaimal, M. 2000. Savoring the spice coast of India: Fresh flavors from KeralaSavoring the spice coast of India: Fresh flavors from Kerala.
New York: HarperCollins.
bIndian and Pakistani Recipes at http://www.recipesource.com
cSouth Indian Recipes at http://www.south-indian-recipes.com
any foods made with eggs, or blood-colored
foods such as tomatoes and watermelon.
Water must be boiled (and re-boiled after six
hours)—if boiled water is unavailable, dis-
tilled water may be permitted.8,21
Sikh cuisine is noted for its use of wheat,
corn, and sugar and the complete abstinence
from alcohol and beef (pork is permitted).
Sikhs are also prohibited from consuming
halal meat. Some Sikhs are vegetarians and
may avoid eggs. Many Sikh dishes are pre-
pared in pure usli ghee, which gives them a
richness not found in some other religious
fare.8,22,23 The Syrian Christians are renowned
for their beef (tenderized by mincing or mar-
inating), duck, and wild boar dishes. Goan
Christians are unique in Indian cooking for
their use of pork. They make Western-style
sausages and have such specialties as a vine-
gar-basted hog’s head stuffed with vegetables
and herbs.23 Most Jews in India keep kosher.
The Parsis blend Indian and Persian elements
in their cuisine, exemplified by dishes such
as dhansak, an entrée combining lamb, tripe,
lentils, and vegetables. Eggs, such as ekuri—
spicy scrambled eggs—are especially popular.
Dietary variations due to religious prac-
tice are limited in Pakistan because of a large
Muslim majority. The small number of Hindu,
Christian, Sikh, and Zoroastrian Pakistanis
are assumed to adapt their food habits in ways
appropriate to their faith (see Chapter 4).
Meal Composition and Cycle
Daily Patterns
Asian Indians Meal patterns in India, though
not consistent across regions and classes, vary
less than the foods served. Two full meals with
substantial snacks are typical. Early risers enjoy
a rich coffee or tea boiled with milk and sugar.
Breakfast, usually eaten between 9:00 and
11:00 a.m., consists of rice or roti, a pickled
fruit or vegetable, and a sambar or other dal
dish, which may be left over from the previous
evening. At 4:00 or 5:00 p.m., similar foods
or snack items are eaten with coffee or tea.
The main meal of the day follows between
7:00 and 9:00 p.m.23 Texture, color, and bal-
ance of seasoning are all important factors in
an Indian meal. A menu customarily includes
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 4 4 6 5
at least one rice dish; a curried vegetable,
legume, or meat dish; a vegetable legume side
dish; a baked or fried roti; a fruit or vegetable
pickle; and a yogurt rayta or pachadi. Some-
times a dessert is served, usually fruit.
Water is the most common drink con-
sumed with meals, though milk and butter-
milk are also prevalent, especially in the north
and west. Sugarcane juice, fruit juice, and
sodas are popular in urban areas. Alcoholic
beverages are not widely consumed, though
rice beer, home-brewed rum made from
molasses, toddy (a brandy-like drink made
from palm sap), and melon wine are a few tra-
ditional beverages still popular in some rural
regions. Many Westernized Asian Indians,
particularly men, drink beer or scotch.
Courses are not presented sequentially in
an Indian meal. They are placed on the table
all at once, with savory dishes eaten at the same
time as sweets. Typically, an individual serv-
ing of rice or breads is served surrounded by a
selection of other foods, such as curried dishes,
dals, rayta, or pachadi, and pickled fruits or
vegetables. Diners may combine tastes and
textures according to personal preference. The
meal concludes with the passing of the paan
tray. Paan is a combination of betel (areca)
nuts and spices, such as anise seed, cardamom,
and fennel, wrapped in large, heart-shaped
betel leaves secured with a clove. It is chewed
to freshen the breath and to aid digestion.
Snacking is very popular in India. In cities
and small towns snacks are sold in numerous
small shops and by street vendors. In villages
they are prepared at home. A clear distinc-
tion is made between meals and snacks. Many
Indian languages have specific words to define
each form of eating. In southern India the
word tif f in is used to distinguish a snack from
a meal. The coffee or tea drunk before break-
fast or in the late afternoon is considered tiffin.
A meal is not a meal unless the traditional sta-
ple prepared in the traditional manner, such as
boiled rice in southern India (or roti in north-
ern India), is served. This means that no matter
how substantial the snack—and some include
more food than a meal—it is still called tiffin.
Spicy snacks served with chutney often
consist of batter-fried vegetables, pancakes
with or without a filling, or fried seasoned
▼ Fast-food street vendor
sells his food in Karachi,
Pakistan.
dough made from wheat or lentils. Savory
saladlike mixtures of diced fruit and vegeta-
bles (sometimes with added meat or shrimp)
and flavored with amc h oor or tamarind, called amc h oor or tamarind, called amc h oor
chaat, are popular. Snacks sweetened with
sugarcane, molasses, or jaggery are usually
milk-based, as are the saffron-spiced khir, the
Indian ice cream called kulfi, and the candy
barfi, although nuts, coconut, sesame seeds,
or lentils are also used. Bengalis are noted for
their sweetshops, which prepare numerous
specialties, such as sandesh, a delicate curd
candy, and singhara (a sweet version of the
samosa filled with coconut and jaggery).18
A snack may also include a cooling beverage,
such as the sweetened, diluted yogurt drink
called l assi or the fruit juice known as sh ur but.
Restaurants are becoming increasingly
popular in India, and Western fast-food fran-
chises are found in many regions. Chinese
and Thai establishments are also common,
particularly in urban areas.
Pakistanis Breakfast, if consumed, is a light
meal in Pakistan, consisting of fried flat-
breads such as puris, a sweetened porridge,
or a legume dish. Traditionally, however, only
two meals a day are eaten. Lunch and dinner
are large meals and if affordable, include a
meat, poultry, or fish dish, and sambals: side
dishes such as curries, cholay, raytas and other
fresh vegetable or fruit saladlike mixtures,
chutneys, and pickles selected for a balance
of flavors and textures. Flatbreads and tea are
served with the meal.
St
af
fa
n
W
id
st
ra
nd
/E
nc
yc
lo
pe
di
a/
Co
rb
is
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
4 6 6 S O U T H A S I A N S
Dessert often follows, and paan may be
chewed afterward. K h at, a plant with mild
amphetamine-like properties, is often added
to the betel-leaf roll (see Chapter 8). Snacking
is common and hearty, including fried items
such as meat, poultry, or fish fritters and pat-
ties, stuffed pastries and flatbreads, kabobs,
sandwiches, spicy saladlike mixtures, roast
beef or chicken, and, in urban areas, Western
fast food.
Traditionally, meals were served on large
trays and eaten with the hands while sitting
on the floor. Many Pakistanis today have
been influenced by European customs and
consume their meals at tables using flatware
and cutlery.24
Special Occasions
Asian Indians Another aspect of Indian cul-
ture affecting daily diet is the concept of feast-
ing and fasting. As with other Indian food
habits, feasting and fasting activities are com-
plex and vary greatly from person to person
and group to group. No occasion passes in
India without some special food observance:
regional holidays, community celebrations,
and personal events such as births, weddings,
funerals, and illness. A devout Hindu may
feast or fast nearly every day of the year (see
Chapter 4).
Feasting Feasts serve as a method of food
distribution throughout the community.
They are generally observed by presenting
large amounts of everyday foods and sweets
of all kinds to the appropriate holy figure; all
members of the community then eat the food.
Feasts may be the only time that the poor get
enough to eat.
Some foods are associated with certain
concepts. Rice and bananas both symbolize
fertility, for example. Betel leaves represent
auspiciousness; ghee, purity; salt, hospital-
ity and pleasantness; mango, hospitality and
auspiciousness; and betel nuts and coconuts,
hospitality, sacredness, and auspiciousness.
Most festivals are Hindu in origin, and
although many are observed nationwide,
each is celebrated differently according to the
region. H ol i is a spectacular holiday in the
north, featuring reenactments of Krishna’s
life, fireworks, and colored powders tossed
everywhere. Celebrants snack at bazaar
booths. Dusseh r a is a ten-day holiday observed
in both the north and the south. A special
dish is prepared each day, and every day that
dish is added to those prepared the previous
days, culminating in an enormous feast on
the last evening after a torchlight parade of
ornamented elephants. Div al i, the festival of
lights, is the New Year’s holiday celebrated
everywhere with gifts of sweets. Another
holiday, J anmash tami, commemorates the
birth of Krishna. As a boy, Krishna and his
friends would steal butter or curds hung high
in earthen containers. This story is recreated
during the celebration as young boys attempt
to break elevated clay pots full of curds.
Non-Hindu harvest festivals also feature
feasts. They are dedicated to wheat in the
North and rice in the South. At the three-day
rice festival in Pongal, dishes made from the
newly harvested rice are ceremonially fed to
the local cows. The ten-day festival of Onam
in Kerali culminates with a feast served by the
local women, including thirty to forty dishes
ranging from fiery curries to foods sweet-
ened with a combination of molasses, milk,
and sugar.
Asian Indian Muslims may dine with
friends on Eid al-Fitr at the end of Ramadan
and Eid al-Azha (see Chapter 13). Christians
celebrate Christmas and Easter in India.
Fasting Fasting is also associated with special
occasions in India. It accompanies both reli-
gious and personal events. An orthodox
Hindu may fast more days a week than not.
However, the term f ast includes many differf ast includes many differf ast -
ent food restrictions in India, from avoidance
of a single food item to complete abstinence
from all food. A person might adopt a com-
pletely vegetarian diet for the day or eat foods
believed to be spiritually purer, such as those
cooked in milk (see the section “Purity and
Pollution” in this chapter). Individuals rarely
suffer from hunger because of fasting in India.
In fact, more food may be consumed on fast
days than on a nonfast day.
Muslims in India also fast, notably during
the month of Ramadan. No food or drink is
consumed between sunrise and sunset (see
Chapter 4 for more information). Sikhs may
fast on the days of the full moon.22
It is illegal to bring betel
leaves into the United
States. There is a black
market for paan obtained
in Canada and other
countries.
Traditionally, six tastes
(sweet, sour, salty, bitter,
pungent, and astringent)
and five textures (foods
that need to be chewed,
those that need no
chewing, those that are
licked, those that are
sucked, and those that
are drunk) were balanced
in an Indian meal.
McDonald’s restaurants
in India do not serve beef
hamburgers but offer
instead selections such
as paneer wraps and
spicy potato burgers—all
items are made with
egg-free mayonnaise.111
The decorative red or
yellow dot that Hindu
Asian Indian women
apply to their foreheads
represents joy or
prosperity. It is omitted
during fast days.
Sweets represent
prosperity because they
often include costly
ingredients and may be
decorated with silver or
gold leaf.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 4 4 6 7
Pakistanis Most Pakistanis follow the Islamic
calendar, fasting for the month of Ramadan
and celebrating the feast days of Eid al-Fitr
and Eid al-Azha (see Chapter 4). Several
secular holidays are also observed, including
Pakistan Day (March 23), Independence Day
(August 14), and the birthday of the national
founder, Jinnah (December 25). Special occa-
sions are marked by dishes that use costly
ingredients, such as silver leaf and nuts, and
feature numerous sweets.
Role of Food in Indian Society
and Etiquette
The importance of food in Indian culture goes
far beyond mere sustenance. Sanskrit texts
describe its importance:
From earth sprang herbs, from herbs food,
from food seed, from seed man. Man thus
consists of the essence of food. . . . From
food are all creatures produced, by food do
they grow. . . . The self consists of food, of
breath, of mind, of understanding, of bliss.
(Achaya, 1994, p. 61)
In a society that traditionally experienced
frequent famines and chronic malnutrition,
food is venerated. Complex traditions have
developed around when, how, and why foods
are prepared, served, and eaten.
Purity and Pollution
Many Hindu dietary customs are meant to
lead to purity of mind and spirit. Pollution
is the opposite of purity, and polluted foods
should be avoided or ameliorated. To be pure
is to be free of pollution.
The Hindu classification system of j ati is
used to evaluate the relative spiritual purity of
all foods. Purity is determined by the ingre-
dients, how they are prepared, who prepares
them, and how they are served. Some foods,
such as milk, are inherently pure. Raw foods
that are naturally protected by a husk or a
peel are less susceptible to pollution. P ak k a
(meaning “cooked”) foods are those that are
fried or fat-basted during preparation, prefer-
ably in ghee. Pakka foods are relatively unre-
stricted due to their high degree of purity and
often include fried breads and many sweets.
Pakka foods are considered appropriate for
serving at temples and at community feasts
because they are pure enough for anyone to
consume.8 K ac c h a (meaning “undercooked”)
foods are those that are boiled in water, baked,
or roasted. Kaccha foods are more susceptible
to pollution than pakka foods and must there-
fore be treated carefully during serving and
consumption. They include many of the foods
that are central to the daily diet, such as rice
and dal , and are typically only served within
the home.
Some foods, such as alcohol and meat, are
j h uta, meaning that they are innately polluted.
Jhuta foods are those that are by their very
nature impure. All leftovers, unless completely
untouched by the consumer or by other foods
that have been eaten, are jhuta. Those foods
that are identified as jhuta vary by religious
sect. The term j h uta is also used for garbage
and offal.
Asian Indian Women and Food
The role of women in food preparation is
extremely important throughout Indian cul-
ture. Feeding the family is an Indian woman’s
primary household duty. She is responsible
for overseeing the procurement, storage,
preparation, and serving of all meals. Because
arranged marriages are common, training
in kitchen management is considered essen-
tial for a Hindu woman in obtaining good
marriage offers. It is generally believed that a
woman cannot be completely substituted for in
the kitchen, for she imparts a special sweetness
to food. If the wife is unable to perform food-
related duties, a daughter or daughter-in-law
may substitute, and in multi-family homes, the
mother-in-law assumes control of the kitchen.
If servants help in meal preparation, it is still
important for the woman of the house to serve
the food directly from the c h ul a (stove) to the
table. This often requires many trips.
Etiquette
Traditionally, only foods cooked and served
by a member of an equal or superior caste
could be consumed by any Hindu. The cus-
toms were such that a Brahman would not eat
food if the shadow from a member of another
caste fell on it.8 Only members of the same
caste ate together. Untouched leftovers can be
Food served in brass
dishes is less vulnerable
to “pollution” than is food
in clay dishes.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
4 6 8 S O U T H A S I A N S
given to a member of a lower caste, such as
servants, but polluted leftovers are eaten only
by scavengers of the lowest caste. Today, Asian
Indians adhere to these commensal rules
to various degrees, however. An orthodox
Hindu attempts to follow them at all times.
A more modern Hindu might adhere to them
only during holy services and holidays. Most
Westernized Indians eat in restaurants and use
convenience products in cooking, ignoring
how and by whom the food was prepared.
The consumption of jhuta foods also var-
ies among Hindus. Historically, laborers and
warriors were allowed to eat meat to help
keep up their strength. Some Brahman sub-
castes, though primarily vegetarian, permit
consumption of impure foods that are plenti-
ful in their region, such as fish in the coastal
areas and lamb in the north. Other sects are
so rigid that even inadvertent intake of pol-
luted food results in spiritual disaster. Mem-
bers of the International Society for Krishna
Consciousness (see Chapter 4) believe that if
they accidentally eat a prohibited animal food,
they will lose human form in their next life
and assume the form of an animal that is the
prey of the animal they ate.
Hospitality is highly valued in Hindu
homes, where serving a guest is considered
equivalent to serving God.8 Traditionally, the
male head of the household was responsible
for seeing that any guests, pregnant women, or
elderly persons were well fed before he could
sit down to eat. The order of serving today is
more likely to be guests, oldest men, remain-
ing male diners, children, and then women.
In some situations men and women may be
separated while eating.25 However, more
Westernized Asian Indians are often relaxed
about these customs, and in some homes each
diner goes his or her own way at meals.8
Food is served in small individual bowls
from serving trays called th al is. The thalis may
be silver or brass, with matching bowls. Origi-
nally, the thalis were simply banana leaves and
the bowls were earthenware, and these are still
used today in some rural areas or when dis-
posable trays and bowls are desired.
Only the right hand is used in dining,
which may be done with spoons (the most
common utensil), forks, and knives, or with
just the fingers. When eating with the hand
in the north, only the fingertips are used to
delicately scoop up food with bits of bread,
whereas in the south, the bread and food are
dexterously rolled into the palm, then popped
into the mouth.26 Food being served to oth-
ers should never be directly touched with
the hand, nor should a diner refill his or her
glass, waiting instead for neighboring diners
to do so, and carefully tending to their drinks
whenever their glass is half empty. If alcohol
is served, a guest is expected to make a toast
to the health of the host (after the host toasts
the guests). However, any verbal thanks for
the meal are considered very rude, and only
a quick nod with the head while holding the
hands palm to palm and saying “namaste” (see
“Counseling”) is appropriate.25
Therapeutic Uses of Food
Asian Indians
Ayurvedic medicine is based on the premise
that each human is a microcosm of the uni-
verse. As such, the body experiences the three
inevitable laws of nature (also called universal
tendencies) of creation (sattw a), maintenance
(r aj us), and dissolution (tamas).9 The funda-
mental elements of fire, water, and wind also
have their counterparts in the humors of the
body—bile (pittabody—bile (pittabody—bile ( ), phlegm ( k aph a), and wind
(v ata). Pitta regulates metabolic activities and
resulting heat. Kapha provides structure and
support through bone and flesh, and vata
represents movement of muscle and semen.
Health is maintained through a careful bal-
ance of humors and substances in the body
according to each person’s internal constitu-
tion and external experiences.
When pitta is in balance, digestion is com-
fortable and a person is content; balanced
kapha produces physical and emotional
stability, strength, and stamina; vitality and
creativity are the results of balanced vata.27
Good digestion is critical because food is
transformed into the body humors and sub-
stances when it is cooked by the digestive
agnis (“fires”), producing food juices and
wastes. Food that is indigestible is harmful
because it is believed to accumulate in the
intestines and decompose, sending toxins
A Hindu woman is
traditionally considered
impure during her
menses and is prohibited
from cooking or touching
any food that is to be
consumed by others.
Many Brahmans were
historically employed as
cooks, because everyone
could eat food prepared
by this caste.
Cow’s milk is thought
to increase intelligence;
buffalo’s milk is believed
to strengthen the body.
Garlic is found in many
Ayurvedic remedies, and
an old Indian proverb
states: “Garlic is as good
as ten mothers.”
Curcumin, a chemical
found in turmeric
(used in many curry
spice blends), has
anti- inflammatory and
immunomodulatory
properties, and has been
reported to be beneficial
in arthritis, asthma,
cardiovascular disease,
diabetes, Alzheimer’s
disease, and some
cancers.112
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 4 4 6 9
into the bloodstream; excessive waste or
too little waste is an imbalance that causes
illness.13
Foods are classified according to which
humors they enhance or inhibit. For exam-
ple, pomegranate increases vata and reduces
pitta and kapha. Molasses does the opposite:
it increases pitta and kapha and reduces vata.
Some foods are also grouped according to
their universal tendencies. Mung beans, for
instance, are considered sattaw ic , chile pep-
pers are r aj asic , and nutmeg is tamasic . Fur-
thermore, the hot–cold classification system is
used for foods, depending on how they affect
the body. The specific identification of an item
as hot or cold varies regionally; for example,
lentils and peas are considered hot in western
India, but cold in northern India. Generally
wheat, spices, and seasonings (except mustard
and sesame seeds), chicken, and oils are classi-
fied as hot; rice, leafy vegetables, fruits (except
mango, papaya, and jackfruit), dairy products,
honey, sugar, pickles, and condiments are
considered cold.21 The hot or cold nature of
a food can be altered through the method of
preparation. The use of hot spices or roasting
may make a cold food hot; conversely, soaking
a hot food in water or blending it with yogurt
can change it into a cold food.13 Many foods
are considered incompatible in Ayurvedic
medicine, such as honey with ghee, rice with
vinegar, and honeydew melon with yogurt,
because of conflicting properties which over-
whelm the agnis and diminish digestion.
Although a balance of foods according to
humoral effect, universal tendencies, and hot–
cold is essential to health, the exact proportions
of each change with age, gender, physical con-
dition, and the weather. Traditionally, six sea-
sons are recognized, each with certain dietary
recommendations. During winter, when diges-
tion is thought to be strongest, roasted or sour
and salty dishes are preferred as well as sweets;
in summer and during the monsoons, when
digestion is thought to be weak, salty, sour,
and fatty foods are avoided.21 The way foods
are eaten is as important as which foods are
consumed. To maximize digestion of foods, a
person should eat in a quiet atmosphere, sip
warm water throughout the meal, and sit for a
short while after dining.27
▲ Traditional Indian thali
(individual silver serving
tray), featuring a selection
of roti (flat breads), fruit and
vegetable pickles, such as
chutneys, and yogurt-based
pachadi or rayta.
M
uk
es
h
Ku
m
ar
/S
hu
tt
er
st
oc
k.
co
m
Pregnancy is considered to be a normal
and healthy condition; however, certain food
taboos are sometimes followed. Women espe-
cially avoid extremes in foods that are too hot
or too cold. Lime juice with honey is a general
tonic, believed to prevent excessive bleeding
at birth, while cow’s milk (particularly with
almonds and saffron) and rice porridge are
thought to ensure proper development of the
fetus. Fenugreek seeds in buttermilk are given
for nausea, and butter or ghee is believed to
make the body supple and ease delivery of the
baby.
Food taboos for infants and young chil-
dren may also be practiced. A survey of
Indian mothers found that many believed
spicy foods and mangoes were too hot and
caused diarrhea, bananas caused colds, and
fried foods were considered difficult to digest
and the source of coughs. A small percentage
also reported that sweets and salty foods were
avoided to prevent diabetes and hypertension,
respectively.28
Numerous dietary remedies are listed for
minor illness. Barley water is consumed for a
fever; vomiting is treated with milk. Coconut
water, buttermilk, anise seed oil, and pome-
granate flowers are all considered helpful
for diarrhea. A powder called ashtachooran
(a mixture of asafetida, salt, ginger, pepper,
cumin, and ajwain) is added to honey for indi-
gestion. Ginger tea or garlic soup is used to
treat colds. Gooseberries and hibiscus flower
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
4 7 0 S O U T H A S I A N S
tea are considered general tonics.21,29 Bitter-
melon and fenugreek seeds—used to treat
diabetes—have been found to work clinically
as hypoglycemic agents.30
It is widely believed that a highly spiced
diet is necessary in the tropical Indian climate
to stimulate the liver. One food habit that may
result in ill health is the common practice of
disguising otherwise undrinkable water with
flavorful herbs and spices. Cholera, dysentery,
and typhoid are endemic in many regions.
Pakistanis
Limited data suggest that a hot–cold system of
classification is used by some Pakistanis. Items
considered hot and therefore avoided during
summer include beef and potatoes. Cold foods
avoided during winter include chicken, fish,
and fruit.31 Folk remedies are very common
in Pakistan, for everything from colds and flu
to asthma and jaundice.15 Eggs, curds, ginger,
honey, and poppy seeds are just a few of the
foods used therapeutically. For infant care
Pakistanis may believe that colostrum is like
stale milk and until the breast milk comes in
the baby is given cow’s milk and a mixture of
food called gh utti (honey, butter mixed with
sugar and other liquids). In addition, some
believe that certain foods should be restricted
during children’s illness. Breast milk should
not be given if the child has diarrhea, and the
child has a fever milk and rice are withheld.32,33
Contemporary Food
Habits in the United
States
Adaptations of Food Habits
Asian Indians
Americans of Asian Indian descent have usu-
ally been exposed to American or European
lifestyles in India and may be familiar with a
Westernized diet before immigration to the
United States. Yet even the most accultur-
ated Indian Americans continue some tra-
ditional food habits. Most accept American
foods when eating out, but many prefer Asian
Indian foods when at home.34,35
Ingredients and Common Foods Very little
research has been conducted on the food
habits of Asian Indians in the United States.
Two study of Asian Indians college students
in Pennsylvania suggested that acculturation
takes place in two phases.36 Typically,35 the
first lasts for two to three years, often while
the immigrant is a student. Interaction with
mainstream American society may be limited
during this period. The recent immigrant pre-
fers to associate with members of the same
caste, regional, or linguistic group; experi-
ence with American foods often includes
only fast foods. Male Asian Indian students
are often unable to cook and may rely heav-
ily on purchased meals. Many Asian Indian
immigrants will eat hamburgers because of
their availability and low cost. Sometime dur-
ing the next ten years, Asian Indians who stay
in the United States longer than four years
enter the second phase of acculturation. They
are usually employed by American businesses
and are raising families. They keep their social
interactions with Americans separate from
those with other Indian Americans. They
might serve meat and alcohol to American
guests, for example, and vegetarian dishes to
Indian guests.
Early research on Asian Indian immigrants
reported some vegetarians become meat eat-
ers when living in America. In one early study,
one-third of those who were vegetarians in
India became nonvegetarians in the United
States.37 One survey on acculturation pat-
terns revealed that nearly 75 percent of Indian
Americans believe it is acceptable for nonveg-
etarians to eat beef; 44 percent indicated that
it is acceptable for vegetarians to eat beef.34
A recent study of software engineers living in
northern California also found that accultura-
tion resulted in increased acculturation and
consumption of meat.38
As yet, the reasons vegetarians become
nonvegetarians have not been stated con-
clusively. It has been suggested that veg-
etarianism may lose its social and cultural
significance in the United States. Data regard-
ing the influence of factors such as gender,
income, region of origin in India, and length
of stay in America have been contradictory.
Variables that affect acculturation include
Asian Indians who are
practicing Muslims rarely
begin eating pork in the
United States. They may
drive long distances to
purchase halal or kosher
meats to fulfill traditional
Muslim dietary laws.
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C H A P T E R 1 4 4 7 1
gender (men tend to change their food hab-
its more readily than women because women
are the traditional food preparers in Indian
society), age (children raised in the United
States prefer American foods), marital status
(single unmarried men are the most accultur-
ated, married men with families in India next,
and married men with families in the United
States are least acculturated), caste (depend-
ing on whether caste members used meat or
alcohol in India), and region (Asian Indians
from rural areas are often stricter vegetarians
than those from the cities).
A study of Asian Indians living in Cincinnati
found several changes in the types of foods
they ate.39 Foods that subjects used fre-
quently in India but that were in only low to
moderate use in the United States were ghee,
yogurt, dal, roti, rice dishes, and tea. Foods
that were in low to moderate use in India but
in frequent use in the United States were fruit
juice, canned or frozen vegetables, American
bread, dry cereals, cheese and cheese dishes,
and soft drinks. Coffee consumption also
increased.
A small study of Asian Indians living in
New York City and Washington, DC, com-
pared the diets of residents who lived in
the United States for more than ten years
to those who had lived in the United States
for less than ten years. Few significant dif-for less than ten years. Few significant dif-for less than ten years. Few significant dif
ferences were identified, though longtime
residents reported a greater preference for
traditional meals at dinner and on weekends
than did more recent immigrants. Regard-
less of length of residence, consumption of
roots/tubers, vegetables oils, legumes, white
bread, and tea remained about the same as
in India. Ghee intake decreased for both
groups; cheese, fruit juice, and whole-wheat
bread intake increased. Cola beverages, low-
fat milk, pizza, mayonnaise, and cookies
were popular American items. Nontradi-
tional foods that were never or rarely con-
sumed included egg substitutes, nondairy
creamer, nonfat milk, peanut butter, hot
dogs, and hamburgers. The authors note
that many American processed foods and
baked goods are now available in India and
that recent immigrants have incorporated
these items into their diets before coming to
the United States.40 Research that compared
dietary intake of Asian Indian immigrants
originally from different regions of India
found some differences in food use. Those
from the north were more likely to use fat
spreads, such as butter or margarine, while
those from the southern areas of India were
more likely to eat starchy foods and fried
chicken. Immigrants who came from western
India ate significantly less fruit and eggs than
those from the north and south.41 A majority
of Americans of Asian Indian descent make
an effort to obtain traditional food products.
Many markets in the United States special-
ize in Indian canned and packaged food
products, including spices, and many stores
provide mail orders. Fresh foods are more
difficult to find. Some fruits and vegetables
can be bought at Asian specialty markets,
and Indian bakeries featuring sweets and tif-and Indian bakeries featuring sweets and tif-and Indian bakeries featuring sweets and tif
fin items have opened in some areas. Even
in an older study done in the Midwest, 100
percent of Indians interviewed reported that
their traditional foods were available.39
Meal Composition and Cycle Asian Indian
eating patterns may become more irregular
in the United States, possibly because of the
pressures of a faster-paced lifestyle. Breakfast
is the meal most commonly omitted; snacking
occurs between one and three times per day
and may be more common in women than in
men.42,43 Many Americans of Asian Indian
descent eat American foods for breakfast and
lunch. Traditional Indian evening meals are
preferred if native foods and spices are avail-
able. Yet dinners at home may also be influ-
enced by U.S. food habits in that more meat,
poultry, or fish may be eaten, and American
breads may be served in place of roti.
Recent research on Bengali Americans
illustrates many of these changes. Dinner is
now the main meal of the day, and breakfast
is a little larger than is traditional, usually
consisting of toast or cereal and milk, with
tea.44 Lunch, unless brought from home, was
typically pizza, a salad or a sandwich. Rice
remains the core of the evening meal, and
60 percent of households reported serving
it daily. Fish consumption, which is closely
associated with Bengali ethnic identity,
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
4 7 2 S O U T H A S I A N S
actually increases in American homes com-
pared to those in India. Fish is served with
rice and dal, seasoned with cumin, fennel,
fenugreek, nigella seed, and mustard seed.
The portion size of fish has doubled to
about eight ounces, and this meal is eaten at
approximately half of all dinners. Rice with
other items, for example, roast chicken, is
consumed at other main meals. Dishes are
usually prepared Bengali-style by sautéing,
stewing, or braising.
Pakistanis
Many Pakistani Americans are believed
to consume at least one traditional meal
each day, usually dinner, when the fam-
ily can gather and discuss the day’s events.7
American-style convenience foods are popu-
lar for breakfast and lunch; cereals, pizza,
hamburgers, sandwiches, fried fish, and cook-
ies replace the flatbreads, stews, and curries
typically consumed for these meals. Research
on Pakistani immigrants in Norway found
that dinner had become the main meal of
the day and that meals on weekends included
more traditional foods than did meals during
the week.45 Restaurant meals may be avoided
by some Pakistani Americans if halal meats
are unavailable.46
Nutritional Status
Nutritional Intake
Recent research on Asian Indians is notewor-
thy for the dramatic health changes that have
occurred among urban Indians in India and
immigrants to Western nations, suggesting
adverse effects of dietary differences and a
sedentary lifestyle.47 In comparison, there are
few data on Pakistani and other South Asian
immigrants, especially those in the United
States.
Asian Indians Data on the nutritional status
of Indian Americans suggest that in gen-
eral, many meet recommended intakes for
grains and vegetables but do not meet those
for fruits, dairy products, or meats, poultry,
and fish.4,48 Intake of dietary fat approxi-
mates that of the U.S. population but is often
higher than fat intake in India. Energy, car-
bohydrate, and protein intakes may increase
with length of stay.49 Figures on fiber intake
are less conclusive. Although one study found
older immigrants consumed ample amounts,
others suggest fiber intake is low, even among
vegetarians.49,50
Micronutrient intake is less studied. A
study on older Gujarti Americans found
that intakes of vitamins D and B6 were low
and that intakes of calcium, magnesium,
potassium, manganese, copper, zinc, and
selenium were marginal. The research-
ers questioned dietary sufficiency in this
group given the possible reduced bioavail-
ability of some micronutrients due to a rela-
tively high intake of fiber, especially among
vegetarians.49
Obesity rates in Indian Americans are
lower than among African Americans and
whites in the United States, and average
body mass index (BMI) is less than that
found in blacks, Mexican Americans, and
whites.51,52 However, BMI tends to increase
with urbanization and migration, and Asian
Indians have a higher percentage of body fat
in relation to BMI than other groups.53,54
In addition, Asian Indians have increased
amounts of visceral fat, even in non-obese
persons.55,56,57 Since a higher percentage
of body fat, fat patterning, and abdominal
adiposity are associated with increased rates
of insulin resistance and dyslipidemia, this
suggests that some Asian Indians who are
not overweight by national standards are,
nonetheless, metabolically obese.55,56,58,59
In 2002, the World Health Organization
(WHO) recommended establishing new
BMI standards for Asian populations:
normal weight (18.5 to 23.0 kg/0 kg/0 k m2, ),
a moderate-risk public health action point
(23.0 kg/0 kg/0 k m )m )2m ), and a high-risk public health
action point (27.5 kg/5 kg/5 k m )m )2m ). In 2009, India’s
health ministry enacted even lower BMI
ranges for overweight (23.0 to <25.0) and
obesity (≥25.0).60,61
High rates of insulin resistance and
dylipidemia, especially high triglyceride
levels and low high-density lipoprotein
(HDL) cholesterol levels, are associated with
increased risk for type 2 diabetes and car-
diovascular disease in Asian Indians.60,62,63
Data show that Asian Indians develop
Chaat houses,
specializing in the small,
usually cold dishes of
mixed fruits, vegetables,
legumes, and meats
topped with tangy
dressing, are trendy
gathering spots for Asian
Indian Americans.
Iron intake may be low
among some Indian
American vegetarians;
however, substantial
amounts of iron are
obtained through the
use of traditional iron
cookware.113
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C H A P T E R 1 4 4 7 3
diabetes at an earlier age and at higher
prevalence rates than whites and most other
ethnic groups.64,65,66,67 Overall prevalence
of diabetes in Indian Americans has been
estimated to average 13 percent in adults,64
compared to 9.3 percent for the general U.S.
population, and is higher than rates for other
Asians, blacks, Hispanics, whites, and many
Native American groups. Rates of cardio-
vascular disease for Indian Americans are
higher than for whites, and data show that it
has earlier onset and higher mortality rates
when compared to deaths from all other
causes.68 Cardiovascular risk was found to
increase in Asian Indian immigrants with
length of stay in one study.69 Hypertension
rates in Indian Americans are variable—
slightly below the prevalence in whites in
some studies and above the average in oth-
ers.70,71,72,73 This clustering of conditions—a
high waist-to-hip ratio indicative of abdomi-
nal fat, insulin resistance or glucose intol-
erance, high triglyceride levels, low HDL
cholesterol levels, and hypertension—is
considered the hallmark of metabolic syn-
drome. It is especially associated with Asian
Indians, and they may have the highest rates
of all ethnic groups.74,75,76,77,78 Researchers
are studying numerous other factors related
to these issues in an attempt to fully under-
stand the role of genetic predisposition and
environmental influence (such as diet, inac-
tivity, and stress) in the condition.79,80
It should be noted that a vegetarian diet
does not necessarily provide protection
from these health problems seen in many
Asian Indians. Research outcomes that have
studied South Asians’ dietary intake and its
effect on health have been inconsistent. Veg-
etarian diets can be higher in carbohydrates
than higher-protein Western diets, but both
diets may be hypercaloric, resulting in weight
gain.81,82,83 The most prevalent cancers in
Asian Indian men are of the lung and prostate.
Colorectal cancers, leukemias, and liver can-
cers are also common. Asian Indian women
suffer from breast cancer most often, fol-
lowed by lung and colorectal cancer. Women
also have high rates of ovarian and uterine
cancers, as well as cancers of the pancreas.84
Oral cancers are also common in South
Asians, due in some subgroups to chewing of
paan with betel nuts.85
Despite high socioeconomic status, few
births to teen mothers, and good prena-
tal care, Asian Indian women in one study
were more likely to have adverse birth out-
comes than blacks, Hispanics, and whites.86,87
These included high levels of low birth
weight, mental retardation, and fetal mortal-
ity. Other research comparing perinatal out-
comes among Asians and Pacific Islanders
reported Asian Indian/Pakistani women
had the highest risk for preterm delivery,
gestational diabetes, and low birth weight at
term.85,88 Studies in Canada and Britain have
found that South Asian women were more
likely than whites to become insulin resistant
during late pregnancy, and nearly half of all
Asian Indian women who developed gesta-
tional diabetes had metabolic syndrome fol-
lowing birth.89,90,91 Scientists are uncertain as
to why this paradox of poor birth outcomes
in a population with few environmental risk
factors exists.
A study comparing neonatal feeding prac-
tices of whites and Indian Americans in the
United States and Asian Indians in India
found that whites relied on health profession-
als for advice, while Indian Americans sought
information from family and friends during
the first six months and from health profes-
sionals thereafter.92 It is common practice
in India to avoid breast-feeding colostrum
to newborns due to various concerns such
as causing indigestion or diarrhea, or that it
is bad for the infant’s health. The research-
ers report that all white, 76 percent of Indian
American, and 32 percent of Indian moth-
ers initiated breast-feeding within an hour
of birth. Twenty-four percent of Indian
American women and 68 percent of Indian
mothers delayed breast-feeding for several
days, in part to find an auspicious time to
start based on astrological conditions.93 Foods
such as ghee and fenugreek are believed to
increase milk production.94 Prelacteal feeds
were prepared for the infants during this
period, including honey (which is thought
by some Asian Indians to help rid the infant
of meconium) and water with sugar, glucose,
or jaggery and seasonings such as asafetida,
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4 7 4 S O U T H A S I A N S
cumin, and aniseed. Another study noted that
the longer an Indian American woman has
lived in the United States, the less likely she
is to use traditional feeding practices.93 These
same researchers found Asian Indian Ameri-
can women breast-fed for shorter durations
and introduced formula and solids earlier
than did white women.95
Pakistanis Little has been reported on
the consumption patterns of Pakistani
Americans. Malnutrition has been noted in
some regions of Pakistan where droughts
limit the food supply, and some studies esti-
mate stunting occurs in 40 to 50 percent of
all Pakistani children, with stunting in female
children three times more likely than in male
children.96 Rural children have been found
at potential risk for underconsumption of
micronutrients even when ample food is
available. Vitamin D and iron deficien-
cies have been found in pregnant Pakistani
women living in Norway, in part due to low
intake of supplements; low levels of plasma
vitamin D are also a concern in South Asian
children living in England. Low bone min-
eral density and a risk for early osteoporotic
fractures in both men and women from South
Asia have been noted.97
In contrast, overconsumption is more of a
concern for Pakistanis living in urban areas
and in Westernized nations. Children living
in Pakistan cities were found to have a high
intake of calories, sugar, total fats, and cho-
lesterol.98 Overweight and obesity in adults is
estimated at 25 percent in the nation, associ-
ated with increased age, being female, urban
residence, being literate, higher socioeco-
nomic status, and higher intake of meat.99,100
Adults living in wealthier neighborhoods of
Karachi reported higher rates of type 2 dia-
betes and cardiovascular disease when com-
pared to those living in impoverished Karachi
households. 100 Of particular concern is a fat
distribution pattern that favors abdominal fat,
even at normal weight levels.101
Pakistanis in Britain had a higher aver-
age BMI and higher intake of calories from
fat than Europeans or Afro-Caribbean immi-
grants in one study.102 When compared to
other South Asians, Pakistani men were found
to have higher rates of diabetes than Asian
Indian men (22 and 15 percent, respectively).
The prevalence of metabolic syndrome in
adults aged twenty-five years and older from
an urban population of Karachi, Pakistan, was
over 35 percent.103
Counseling
Asian Indians The majority of Indian
Americans are very familiar with biomedi-
cine, and health care access is considered
good. English fluency is prevalent, and only
7 percent of Indian Americans report they
speak English “less than well”—a small num-
ber given the high percentage of first-genera-
tion immigrants in the population. The largest
dialects spoken in the United States are Hindi,
Gujerati, and Bengali. Many Asian Indians
whose native tongue is another dialect also
speak Hindi.104
Traditional expectations regarding social
interactions may present problems in the
provider–client relationship.105 A client may
not disagree with or correct a provider in
situations where the client believes that the
provider is superior in status, and compli-
ance may be assumed because the client does
not indicate otherwise. If the client does not
feel that treatment is satisfactory, he or she
will typically change providers rather than
confront the problem. Conversely, if a cli-
ent believes that she or he is an equal with
the provider, the client may desire a social
rather than professional relationship with the
provider. The client may also feel entitled to
special privileges, such as immediate access to
the provider and longer appointments. Some
Americans of Asian Indian descent may feel
cheated if exhaustive testing procedures or
invasive therapies are not provided for their
condition.105
A polite, respectful, direct yet leisurely
style of communication is preferred by most
South Asians.5 Loudness is discouraged,
whereas self-control and occasional periods
of silence are valued. Small talk is significant,
and rushing is considered rude. A direct “no”
is considered impolite, so an evasive negative
response is the norm. Feelings and faith may
be more important than objective facts in
making decisions.25
Asian Indians may have
difficulty digesting fresh
milk; estimates also
indicate that 60 percent
of adults in Pakistan are
lactose intolerant.114
Conditions that may be
of concern in some Asian
Indians and Pakistanis
include beta-thalassemia,
which is a commonly
inherited disorder, and a
high prevalence of glu-
cose-6-phosphate dehy-
drogenase deficiency in
some tribal groups from
the North-West Frontier
Province of Pakistan.
Iodine deficiency and
goiter are endemic in the
Kashmir region.
One Ayurvedic remedy
for diabetes uses ginger
and rock candy.
Mental illness is highly
stigmatized in India.
Complaints of headache,
leg tingling, or burn-
ing on the soles of the
feet may be related to
psychological distress in
recent immigrants.
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C H A P T E R 1 4 4 7 5
Though India is a relatively low-context
culture,25 several nonverbal communication
customs among Asian Indians are significant.
Most Indian Hindu, Sikh, and Christian men
and women avoid contact with the opposite
sex in public, and contact between men and
women in public is completely prohibited
by Muslims. Direct eye contact between
men and women who are not related may be
interpreted by some less acculturated South
Asians as suggestive.5 The traditional greet-
ing is to nod with the head while holding
the hands palm to palm beneath the chin
and saying “namaste” (“I honor God within
you”), but Westernized Indians will use a
handshake (it is best to wait and follow the
client’s lead). Some Asian Indians (especially
those from South India) indicate agreement
by head wobbling, which resembles the way
Americans shake their heads back and forth
to indicate the negative.25 Informal smiles
are used between equals only—superiors do
not generally smile at subordinates or vice
versa.
In both India and Pakistan the left
hand is never used for any social purposes,
including handshakes, giving an item to
another person, or pointing. The head is
considered the seat of the soul; patting or
touching another person’s head should
always be avoided. Conversely, the feet and
shoe soles are considered the dirtiest parts
of the body, and it is impolite to point with
the foot or show the bottom of one’s shoe.25
All that said, it should be noted that most
Indian Americans are highly acculturated
and can converse in a style comfortable for
Americans.
Asian Indian women are often less vocal
than men and may be very uncomfortable
with a male health care provider. Men do
not touch women in either informal or for-
mal situations; physical exams of women are
unusual. Female gynecologists and obstetri-
cians may be preferred. Family members may
accompany a patient, especially a woman, as a
chaperone during an appointment. The chap-
erone expects to participate in any discussion
of the client and to oversee the exam (privacy
among spouses and siblings is limited). Family
members may also assume responsibility for
all but the most technical care of a patient
during hospitalization; it is their obligation to
feed, bathe, and support a relative. If cost is an
issue in obtaining health care, the male head
of the household may receive priority over
women, girls, or elders in a traditional Asian
Indian home.
Americans of Asian Indian descent may
provide more information regarding their
condition than the practitioner may feel is
warranted. Ayurvedic medicine focuses on
a person’s role within the cosmos, so details
about what a client is eating, sleep patterns,
and changes in the weather may be impor-
tant to a client. Most clients expect lifestyle
advice, particularly regarding diet, as part of
their therapy.13,27 Some clients may expect
a complete history and physical exam to be
undertaken at each appointment, while oth-
ers assume that the practitioner can diag-
nose simply by taking a pulse and without
prying into what may be perceived as per-
sonal issues. The practitioner should pro-
ceed cautiously with questioning until the
client’s expectations have been determined.
Indian Americans have strong opinions
about the therapeutic value of medications.
Injections are believed most potent, and
in India a patient might receive between
one and four shots each visit. Capsules
are thought to be more effective than tab-
lets, and colorful tablets more potent than
white tablets. Furthermore, the medication
becomes more effective through the skill of
the provider; thus, it is imperative that the
provider personally hand the prescription to
the client.
Little information has been reported
regarding the use of Ayurvedic medicine
or folk remedies by Asian Indians living in
the United States. Research suggests that
home remedies, Ayurvedic medicines, and
homeopathic prescriptions are used fre-
quently, most often for minor ailments or
when biomedical therapies were ineffective.
Traditional cures are often used concur-
rently with biomedicine.106 Although most
herbal preparations are compatible with
biomedical therapies, some have potent
therapeutic effects (see the earlier section
“Traditional Health Beliefs and Practices”),
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4 7 6 S O U T H A S I A N S
thus it is important to ascertain which rem-
edies are in use. Further, a study of herbal
medicines purchased in South Asian grocery
stores found that one in every five contained
potentially harmful levels of lead, mercury,
or arsenic.107 An in-depth interview should
be used to establish the client’s religious
affiliation and degree of adherence, length
of residency in the United States, and degree
of acculturation, as well as vegetarian or
nonvegetarian preferences. Clients should
also be asked about Ayurvedic practices,
particularly those regarding diet and home
remedies.
Pakistanis There has been little reported spe-
cifically on counseling Pakistani American
clients. Most are familiar with biomedicine.
Few data are available on health insurance
coverage for Pakistanis. Though fewer than
10 percent of Pakistanis speak only English
at home, another 90 percent reported speak-
ing it well.104 The remaining 10 percent
speak English less than “well,” which pres-
ents potential language difficulties in some
clinical situations. It should be noted that
although Urdu is the official language of Pak-
istan, only 8 percent of Pakistanis speak it as
their native tongue. Nearly half of Pakistanis
speak Punjabi, and the remainder are divided
between six or seven other languages or
dialects.
In contrast to Asian Indians, Pakistanis
tend to prefer indirect, restrained commu-
nication and avoid confrontation. They are
more high-context than Asian Indians, and
meaning is interpreted through the specifics
of the social situation and the use of sym-
bolic language.25 In general, loud expression
and body motions are avoided, and many
gestures, including winking and whistling,
are considered vulgar. Pakistan is essentially
a nontouching culture, but hugs and other
expressions of warmth are found between
intimates of the same gender. A very soft
shake of the right hand, then touching the
heart, is known as the salaam and is the
traditional greeting between men. Hand-
shaking may be used with Westerners,
though it tends to be an adaptation of the
salaam and is light. Men and women do
not use the salaam or shake hands in the
American style unless the woman is west-
ernized. Many Pakistanis maintain an
expression of serious attention in interac-
tions with acquaintances.
Pakistanis are similar to Asian Indians
regarding certain nonverbal communica-
tion styles. No eye contact or only periph-
eral glances may be preferred between
men and women, for example. A Pakistani
should never be touched on the head with-
out requesting and receiving permission to
do so, the foot should never be used to point,
and the soles of shoes should not be shown
when seated. Only the right hand should be
used to touch people and pass objects, includ-
ing papers and money. Slouching and leaning
are inappropriate in most circumstances.
Pakistanis may stand closer than is comfort-
able for Americans, and it is considered rude
to back away.25
Islamic rules regarding modesty may
require women to seek care only from other
women. Exposure of clients, even when men
are examining men, should be limited.14 In
Pakistan, families may be responsible for pro-
viding food or medicine for ill members who
are hospitalized. Pakistanis in Great Britain
report that family care often includes prayer
and massage.108 Women may be discouraged
from decision making, which is traditionally
the responsibility of a husband or older male
relative.
Many South Asians in Scotland (Pakistanis
and Asian Indians) believe American medica-
tions are superior to those from their home-
land. A study on use of oral hypoglycemic
agents found that some patients assumed
they should take the medication only if they
had symptoms, while others worried about
long-term use or adverse effects if taken with
other drugs or certain traditional foods.109
Clients sometimes reduce intake without
supervision.
An in-depth interview, including assess-
ment of education level and acculturation
status, is necessary to determine appropri-
ate therapeutic approaches for Pakistani
American clients. Accommodation of Muslim
dietary laws and individual preferences in
nutritional counseling is most effective.
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C H A P T E R 1 4 4 7 7
D I S C U S S I O N S T A R T E R S
Comparing Native Diet and Culture to That of Immigrants in the
United States
In small groups of three to four, compare and contrast the diet and culture of Asian Indian and Pakistani immigrants to the United States with the
diet and culture of immigrants to the United States from the Balkans and the Middle East (see Discussion Starter from Chapter 13) and from Vietnam,
Cambodia, and Laos (see Discussion Starter from Chapter 12). Again, each group of students is to focus on a different aspect of the diet and culture of
these groups:
Within your group, decide on what findings to report to the rest of the class. Before breaking up, assign a number to each group member: A1, A2, A3,
A4; B1, B2, and so on. Form new groups with all the 1’s in a group; all the 2’s in another group; all the 3’s another group; and so on. In your new group,
report the findings of your previous group, and as a group, discuss the how traditional attitudes toward diet and health in these immigrant groups relate
to the changes in diet and health due to immigration to the United States.
Group A: The food habits and the typical eating etiquette and meal composition of these three immigrant groups
Group B: Issues involved in counseling these immigrant groups on diet and health
Group C: Attitudes within each immigrant group toward diet, health, and medical treatment, notably attitudes toward traditional home
culture medical treatment and U.S. biomedicine
Group D: Amount of obesity, diabetes, hypertension, and other diseases within each immigrant group
I am from India and have been a practitioner in the United States for close
to thirty years, and many of my clients are South Asians. I would describe
the typical South Asian meal as containing a lot of variety on the plate—
grains (rice and bread), beans (lentils), salad ingredients in the raytas,
along with vegetables. The meal also contains several condiments, such
as pappadams and pickled mangos—all these ingredients help balance
the meal, which is important because many South Asians from India are
vegetarians. For South Asians living in the United States, the typical fast
foods that have crept into the diet tend to be those that can be vegetarian,
such as pizza. Inexpensive convenience foods are bagels, pasta, and ramen
noodles. Many South Asians will go out to eat in Mexican and most Asian
restaurants.
Preparation of South Asian food is labor intensive, and back home there are
often servants to help in the kitchen. Here, especially for younger South Asian
men who are not married, the ingredients may be hard to find, and they will
have to prepare their own food. So it is not uncommon that they will go out to
eat and, even though they are vegetarian, will sometimes even eat hamburgers.
South Asians have a very high rate of type 2 diabetes and heart disease, so my
advice to many of my clients is to eat smaller portions of rice and bread, increase
their intake of vegetables and lentils, and be aware of the sodium content in food,
especially pickles. I always ask about desserts and sweets in their diet since they
are common in the diet. I never tell my clients to eliminate bread and rice in their
diet because I know they won’t do it. Instead, I tell them how much they can eat.
Same with fruit, but I tell them to eat whole fruit and not consume it as juice.
P R A C T I T I O N E R P E R S P E C T I V E S
Asian Indian
Gita Patel, MS, RD, CDE, LD
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4 7 8 S O U T H A S I A N S
Review Questions
1. List the countries that comprise South Asia.
List and briefly describe at least four religions
practiced in this region. What are the simi-
larities and differences in regard to religion
between Pakistan and India?
2. Describe the vegetarian diet of Hindus. Which
animal foods are allowed and which are not
consumed? What are the staples of the diet?
How would the Hindu diet differ from that of
the Sikhs and Muslims? What would make a
food pure or polluted? Are there regional dif-food pure or polluted? Are there regional dif-food pure or polluted? Are there regional dif
ferences in staples used in India and Pakistan?
Describe at least three types of bread con-
sumed in India.
3. What are masalas, and when are they used in
South Asian cooking? Describe regional varia-
tions in South Asian cuisine. What is curry?
4. Briefly explain Ayurvedic medicine. How does
food fit into the Ayurvedic system?
5. What is metabolic syndrome? How does it
affect Asian Indians, and how may their diet
contribute to its development?
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4 8 3
associations with place and food suggest the
importance placed on the superior quality of
local items. Even today, with a global assort-
ment available, there is a certain cachet to
Maine lobsters, Vermont maple syrup, Geor-
gia peaches, Florida oranges, Idaho potatoes,
and Washington apples (see Figure 15.1).
Ethnic and religious practices also affect
the development of regional fare, particu-
larly specialty foods. Jewish bagels in New
York, German doughnuts called f astnac h ts in
Pennsylvania, Cajun French–style sausages in
Louisiana, West African–influenced hoppin’
John in South Carolina, southern Italian–
flavored pizza in Chicago, Cornish pasties
in Michigan, and Mexican-inspired chili con
carne in Texas are just a few examples. Most
regional cuisine is a blend of several ethnic
elements, such as the British–Native American
dishes of New England, the African–French–
Spanish–British–Native American mélange
that is southern fare, and the northern Ital-
ian–Mexican–Asian mix found in California
cuisine. Religious food habits are a factor in
areas where large numbers of a specific faith
have congregated. For instance, the majority
of Mormons live in Utah, and Mormons typi-
cally do not drink alcohol, tea, coffee, or other
stimulating beverages. Alcohol purchases in
Utah are more strictly controlled with more
restrictions as to what and where they can be
sold. Sweets are allowed, however, and are well
integrated into family activities. A third fac-
tor in regional foods is local history, which is
often associated with certain dishes. A good
example is the Kentucky stew called burgoo.
Regional Americans
In Boston, they eat beans. In Philadelphia, they eat cheesesteak. In Kansas City, they eat barbecue. And in Seattle, they drink
café lattes. A person from Montana is no more
likely to eat grits (ground hominy) than a
person from Mississippi is likely to eat Rocky
Mountain oysters (deep-fried beef testicles).
Just as certain fare is associated with ethnicity
and religious affiliation, local food preferences
are central to American regional identity. This
chapter profiles the Northeast, South, Midwest,
and West regions and examines traditional
fare, noting significant culinary variations and
trends in U.S. regional food habits.
American Regional
Food Habits
What Is Regional Fare?
Regional fare has traditionally been home-
style food prepared with local ingredients,
dependent on agricultural conditions and
seasonal availability. Most families made do
with what they could grow, gather, or barter.
Local foods are the most significant of several
factors that influence the development of a
particular regional cuisine. The spicy cooking
of the Southwest with its emphasis on corn,
beans, and chiles could not have been created
in the upper Great Lakes area, which pro-
duces wheat, fish, and dairy foods. Before the
advent of food preservation and refrigerated
shipping, local items were not only freshest
and tastiest, but also most economical. Strong
15CHA
P
T
E
R
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4 8 4 R E G I O N A L A M E R I C A N S
Legend has it that the mixture of poultry and
red meat with vegetables dates back to the
Civil War when a chef for the Confederate
cavalry at Lexington created the stew from
native blackbirds, game, and greens. There
is no single recipe for the dish, but today it
typically includes chicken, pork, beef, or lamb;
and cabbage, potatoes, tomatoes, lima beans,
corn, and okra. It is seasoned with cayenne.
Burgoo is traditionally served at picnics,
political rallies, and sporting events, includ-
ing Derby Day. Current trends can be an
influence as well. Some dishes sweep through
one region but never gain national accep-
tance, such as caviar pie (layered hard-boiled
eggs, scallions, caviar, and sour cream) in the
Southeast, or loco moco (a bowl with rice
topped with a ground beef patty, then an egg
over easy, and gravy) in Hawaii. Other trends
start out regionally and then catch on coun-
trywide, such as the salsas of the Southwest.
Economics contribute to the popularity
of certain foods. One study found that some
of the best markets for beer in the country
are in the poorest areas. Wine is popular
in upper-income regions,1 although more
recently brewpubs are also popular. The
number of brewpubs in the United States
increased sevenfold from 1994 to 2012.2,5
Households with incomes below $20,000
a year spend about $1,400 per capita on
food, buying more white bread, bacon, pork
chops, luncheon meats, and eggs per person
than the U.S. average. On the other end of
the socioeconomic spectrum, households
with incomes more than $100,000 annu-
ally spend over $4,725 on food, with above-
average purchases in almost every category,
especially expensive cuts of beef, lamb, fresh
fish and seafood, dairy products, biscuits/
rolls, fruits, prepared salads, nuts, and snack
foods.3 Upscale consumers are more likely to
be exposed to unique culinary ideas when
dining out in trendy full-service restaurants
and to be willing to pay for new or unusual
food items.
Figure 15.1
Foods associated with
places.
Source: de Wit, C. W. Food-place
associations on American product
labels. Geographical Review, 83,
323–330. Copyright 1992. Reprinted
with permission by American
Geographical Society.
Rolls
Bread
Sugar
THE SOUTH
Hush puppies
Hush puppy mix
Taco sauce
NEW
ENGLAND
ClamClamClamClam
chowderchowderchowderchowder
NEW YORK
CITY
Cheesecake
Seltzer water
Hot dog buns
Flavored mustards
Salad dressings
Apple sauce
Apple butter
Cheddar cheese
Maple syrup
Key lime mangroveKey lime mangroveKey lime mangroveKey lime mangrove
honey dressing honey dressing honey dressing honey dressing
Mango dressingMango dressingMango dressingMango dressing
Lime fruit juiceLime fruit juiceLime fruit juiceLime fruit juice
cooler cooler cooler cooler
BerBerBerBerry conserves conserves conserves conserves
Organic fruitOrganic fruitOrganic fruitOrganic fruit
sweetener
Beer
Berries1
Grapes
Kadota figs
Plums
Cherries
Berry juiceBerry juiceBerry juiceBerry juice
Honey
Cheddar cheeseCheddar cheeseCheddar cheeseCheddar cheese
ProcessedProcessed
potatoes5
Whole potatoesWhole potatoes
KANSAS
CITY
Pork roast
Sarsaparilla
Cheese
Wild rice
Bread
Chili mix
Popcorn
Cheese
Corned beef
brisket
BBQ
sauce
Sirloin
MILMILWAWAMILWAMILMILWAMIL UKEEUKEE
Butter
Margarine
Sparkling
mineral
water
Taco shells
Chili spices
Mexican foods
Chili seasoning
Hot sauce
Salsa
BBQ sauce
BiscuitsBiscuitsBiscuitsBiscuits
Spiced peanutsSpiced peanutsSpiced peanutsSpiced peanuts
Grapefruit juiceGrapefruit juiceGrapefruit juiceGrapefruit juice
Orange JuiceOrange JuiceOrange JuiceOrange Juice
Okra picklesOkra picklesOkra picklesOkra pickles
Bloody Mary mixBloody Mary mixBloody Mary mixBloody Mary mix
Basmati rice
Jalapeno slices
Dried fruitsDried fruitsDried fruitsDried fruits2
Flavored mustardsFlavored mustardsFlavored mustardsFlavored mustardsFlavored mustardsFlavored mustards
OlivesOlivesOlivesOlives
CarrotsCarrotsCarrotsCarrots
Misc. freshMisc. freshMisc. freshMisc. fresh
vegetables vegetables vegetables vegetables
Canned tomatoesCanned tomatoesCanned tomatoesCanned tomatoes
Herb vinegarsHerb vinegarsHerb vinegarsHerb vinegars
Vegetable oilsVegetable oilsVegetable oilsVegetable oils3
MarinatedMarinatedMarinatedMarinated
vegetables vegetables vegetables vegetables
Fruit jams4
Cheese
Tomato juice
Apple butter
Organic apple sauces
Carrot juice
Catsup
Burritos
Peach
juice
CCCCCCCAPE CODAPE COD
Cranberry
juice
BOSBOSBOSBOSTON
BostonBostonBostonBostonBostonBostonBostonBoston
cr cr cr cream pieeam pieeam pieeam pie
Hot pepper
sauce
Sweet potatoesSweet potatoesSweet potatoesSweet potatoes
Cream cheeseCream cheeseCream cheeseCream cheese
Neufchâtel cheeseNeufchâtel cheeseNeufchâtel cheeseNeufchâtel cheese
Sharp cheddarSharp cheddarSharp cheddarSharp cheddar
Cheese
Pickles
Beer
ChocolateChocolateChocolateChocolateChocolateChocolate
Cocoa powderCocoa powder
Choc. syrupChoc. syrup
1Gooseberries, boysenberries, blackberries, strawberries, blueberries, red raspberries. 2Apples, peaches, figs, prunes, raisins. 3 Walnut, olive, pecan. 4Black raspberry, strawberry,
apricot, kiwi. 5Hash browns, tater tots, golden fries, potatoes O’Brien, crinkle cuts, homestyle potatoes, cottage fries, shoestrings, potatoes au gratin, scalloped potatoes,
instamash potatoes.
Cajun coatingCajun coatingCajun coatingCajun coatingCajun coatingCajun coatingCajun coating
mixes
Hot sauce
Cajun seasoning
Steak sauce
Gumbo mix
Crab & Shrimp
boil mix
*Listed in order from most to least frequent occurrence.
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C H A P T E R 1 5 4 8 5
This blending of physical, cultural, his-
toric, current, and economic conditions in a
region produces what researchers call a “taste
of place,” from the French gout de ter r oir .4 Ele-
mentally, the taste of place is the identification
of certain ingredients or dishes with an area.
At a deeper level, it is the emotional connec-
tion between people and a local heritage, an
appreciation for the regional characteristics
that create flavors unlike those found any-
where else in the nation, or the world.
Regional Divisions
The United States has been divided numer-
ous ways. Sometimes regions are delineated
by terrain, as in the Great Plains, or marked
by major rivers or mountain ranges, as in the
Mississippi River Valley or the Appalachians.
Sometimes areas are defined by similarities in
climate, as in the Sun Belt; by economic affili-
ation, as in the Steel Belt and Silicon Valley;
or by the characteristics of the population, as
in Indian Lands and the Bible Belt. Histori-
cal divisions, such as the Mason-Dixon Line,
or political divisions, including state bound-
aries, can also be used. Geographers suggest
that traditional regions contain elements of
all these variables, characterized as a syner-
gistic relationship between a people and the
land that develops over time and is specific to
the locality. Such regional identity is dynamic,
more of a process than a delineation, subject
to changes in population, economy, ecology,
and other factors.5,6 However, geographic
considerations are used to set arbitrary
regional divisions independent of cultural
relationships.
The U.S. Census Bureau and the U.S.
Department of Commerce list four regions
with nine subdivisions for data collec-
tion purposes: Northeast, Midwest, South,
and West. Although these categories group
together states with distinctively different
cuisines, such as Florida and Texas, or Alaska
and Hawaii, most demographic and food
consumption data are presented in this four-
region format (see Figure 15.2). It is useful
for detecting broad trends, as long as results
are not overgeneralized to smaller popula-
tions that may observe alternate regional
boundaries.
The Northeast
Regional Profile
The states of the U.S. Northeast include those
of New England (Connecticut, Maine, Mas-
sachusetts, New Hampshire, Rhode Island,
and Vermont) and those of the Mid-Atlantic
region (New Jersey, New York, and Penn-
sylvania). The New England area features
a rugged, irregular Atlantic coastline with
many protected bays. Rolling hills and val-
leys that gradually become densely forested
mountains extend west. The region is noted
for its spectacular autumn weather and col-
orful fall foliage, followed by harsh winters.
The Mid-Atlantic states are farther south and
more temperate in climate. Sandy beaches and
estuaries line the long coast. The ridges, river
valleys, and fertile plateaus of the Adirondack,
Appalachian, Blue, Catskill, and other moun-
tain ranges crisscross much of the three states.
Freshwater lakes dot the region and provide
the northern boundary along Lake Ontario
and Lake Erie.
Despite differences in climate and geog-
raphy, the entire Northeast shares a common
early history of sophisticated Native American
societies supplanted by European settlements.
The colonial immigrants from England, Ger-
many, the Netherlands, and France were
followed by newcomers from Ireland, Italy,
Portugal, Poland, and other central and east-
ern European countries, particularly in the
Mid-Atlantic states. African Americans from
the South and more recent immigrants from
the Caribbean, Central America, Africa, and
Asia have added to the diversity of some parts
of the Northeast (see each chapter on ethnic
food habits for more immigration details and
Table 15.1).
Eighteen percent of the total U.S. popula-
tion is found in the Northeast.7 Over eight
million individuals (10 percent) living in the
Northeast region are born in another coun-
try.7 Over two-thirds of Puerto Ricans living
on the mainland reside there, and more than
one-third of all Asian Indians in the United
States have settled in the region. Dispropor-
tionately large populations of blacks and Lati-
nos reside in New York and New Jersey. Yet
the rest of the Northeast is still predominantly
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4 8 6 R E G I O N A L A M E R I C A N S
white, including large percentages of Italians,
Ukrainians, Portuguese, French Canadians,
Russians, Lithuanians, Slovaks, and Poles.
Nearly half of all American Jews also live in
the Northeast, primarily in New York, New
Jersey, and Massachusetts.
Compared to national figures, the North-
east has a lower percentage (13 percent) of
persons under the age of 15, and a higher
proportion of persons over the age of 65.
The Northeast region had a total population
of 55.6 million in 2013. The median age was
38.6 years, with 16.2 percent of the population
being under 18 years and 14.5 percent 65 years
and older. Data from the 2009 American Fam-
ily Survey also show that the Northeast has
United States Northeast Region
Estimate Estimate
Total: 311,536,594 55,564,549
White alone 238,007,238 42,498,388
Black or African American alone 42,496,977 7,223,003
American Indian and Alaska Native alone 5,142,542 446,737
Asian alone 17,845,862 3,538,059
Native Hawaiian and Other Pacific Islander alone 1,177,092 62,544
Some other race alone 16,399,187 3,231,056
Hispanic or Latino (of any race) 51,786,591 7,199,979
SOURCE: U.S. Census Bureau, 2013 American Community Survey.
TA B L E 15.1 Estimates of Ethnicity in the Northeast Region
Figure 15-2
Regional divisions in the
United States.
West
Midwest
South
Northeast
DEDEDEDE
MDMDMDMD
OK
NE
SD
NDMT
KY
ME
PA
MI
MAMAMAMA
RIRIRIRICTCTCTCTCTCTCT
VA
WV
OH
IN
NC
TN
SC
AL
MS
AR
LA
MO
IA
MN
WI
NJ
GA
VT
NH
TX
FL
CO
NM
UT
AZ
NV
ID
WY
OR
WA
CA KS
IL
NY
HI
AK
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C H A P T E R 1 5 4 8 7
the highest population density of all regions
and the highest number of people living in
metropolitan areas (nearly 90 percent). The
average household income was $59,822 per
year. An estimated 13 percent of the North-
east population live in poverty. Fifteen percent
of related children under 18 were below the
poverty level.7
Traditional Fare
The cooking of the Northeast features the
abundance of the Atlantic, the plenty of
native and introduced produce, and the
freshwater wealth of the many rivers and
lakes (see Table 15.2). In New England, sea-
food—such as clams, lobster, scallops, and
fish, especially cod—has been prominent.
Indigenous game, including wild turkey and
venison, supplemented the poultry, pork, and
beef brought by early immigrants. The foun-
dation of the diet was traditionally corn, and
many dishes of the region reflect its impor-
tance. Beans have also made a substantial
contribution. Root vegetables (potatoes,
onions, beets, turnips, rutabagas, carrots,
etc.) quickly added to the vegetable selection.
Wild berries, including blueberries, cranber-
ries, gooseberries, and cloudberries (which
look like bleached blackberries), grapes,
and beach plums were the main fruits con-
sumed until the apple orchards planted by
immigrants became productive. Maple sugar
sweetened many foods in New England.
Even when molasses and cane sugar became
widely available, maple syrup was preferred
for many dishes.
The warmer weather and fertile lands of
the Mid-Atlantic states have provided more
native foods than New England. The coastal
waters offer clams, oysters, mussels, scal-
lops, and crabs, while the estuaries shelter
ducks, geese, and turtles. Passenger pigeons
once darkened the skies with their massive
numbers, and bison roamed the area around
Lake Erie. Freshwater fish such as catfish,
eels, pickerel, salmon, shad, smelt, trout, and
whitefish were plentiful; at one time, shad,
a flavorful relative of the herring, was the
most numerous of all freshwater fish in the
United States. Both the flesh and roe were
commonly eaten.
Introduced foods also flourished in the
region. Cabbage, potatoes, yams, carrots, peas,
apples, pears, cherries, peaches, and strawber-
ries were easily grown. Tomatoes thrived in
the hot summers. Although New Jersey is
now one of the most industrialized states in
the nation, it is still known as the Garden State
due to the success of these early agricultural
Figure 15-3
Estimates of obesity and
diabetes mellitus in the
United States, 2013, by
state.
Source: CDC, http://www.cdc.gov/
diabetes
Age–adjusted Percentage of U.S. Adults Who
Were Obese or Who Had Diagnosed Diabetes
2013
Obesity (BMI≥30 kg/m2) Diabetes
<4.5%Missing data
4.5%–5.9% 6.0%–7.4%
7.5%–8.9% ≥9.0%
18.0%–21.9%
<14.0%Missing Data
14.0%–17.9%
22.0%–25.9% ≥26.0%
Shad migrate from the
ocean up freshwater
rivers to spawn in early
summer. Shadberries
(also known as
juneberries) are a
popular treat that ripen
at the same time the fish
arrive each year.
Salmon served with fresh
peas is a Fourth of July
tradition for many New
Englanders.
Fudge was originally
a maple sugar candy
popular in New England
in the 1800s. When cocoa
became widely available,
the chocolate version
was developed.
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4 8 8 R E G I O N A L A M E R I C A N S
efforts. Wheat, which was difficult to grow in
New England, did well in the Mid-Atlantic.
At one time, New York provided all the wheat
consumed in the Northeast and much of the
South.
New England
The cuisine of New England has been shaped
predominantly by Native American prepa-
ration techniques combined with British
homestyle cooking. Roasting, boiling, and
stewing are preferred. Dishes are often
made with cream, and strong seasonings are
avoided. People of the region take pride in
simple fare.
The immigrants of the early seventeenth
century were mostly tradespeople, inexpe-
rienced in farming and husbandry. History
abounds with tales of how the first settlers
were dependent on the skills and generosity
TA B L E 15. 2 Northeastern Specialties
Group Foods Preparations
Protein Foods
Milk/milk products Cream; cheddar and cream cheese Cream soups, sauces, puddings; ice
cream
Meats/poultry/fish/
eggs
Native game, particularly venison
and turkey
Preserved meats, such as corned
beef, pastrami, salt pork, ham,
bacon, sausages
Seafood prevalent, especially clams,
lobster, oysters, scallops
Salt and freshwater fish, such as salt
cod and shad
Numerous beans (e.g., cranberry,
kidney, lima)
New England boiled dinner; scrapple;
red-flannel hash
Fish stews, soups; clam chowder; clam
bakes; oyster or lobster loafs
Cod cakes; shad bakes; gefilte fish
Baked beans; succotash
Cereals/Grains Corn, wheat, rye Cornmeal porridges, puddings, and
breads
Dumplings
Baked goods—savory and sweet pies,
cakes, doughnuts, waffles, pretzels,
bagels
Fruits/Vegetables Apples, blueberries, cranberries,
grapes
Cabbage, fiddlehead fern fronds,
potatoes
Applesauce, apple butter; fruit
puddings, pies
Coleslaw; sauerkraut; ferns on toast;
potatoes—mashed, fried, creamed,
baked, scalloped, hashed, as
croquettes, salad
Additional Foods
Seasonings Salt, pepper, onions, saffron
Nuts/seeds Black walnuts, butternuts
Beverages Apple cider, hard cider, applejack;
ale, beer; rum, whiskey; wine
New York State white, red, sparkling
wines; sherry, port
Fats/oils Lard, butter
Sweeteners Maple sugar; molasses Maple sugar candies, maple syrup pie;
chocolates
©
C
en
ga
ge
L
ea
rn
in
g
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C H A P T E R 1 5 4 8 9
of local Indians in preventing starvation
(see Chapter 5). Corn dishes were especially
significant. Cornmeal porridge cooked into a
mush like consistency was a Native American
food called samp by the early colonists. It was
often prepared with another cornerstone of
the Indian diet, beans. New Englanders used
cornmeal to make an adaptation of the tradi-
tional English dish known as hasty pudding.
The settlers would pour cornmeal porridge
into a loaf pan to firm up overnight, then
slice it and serve it topped with cream. This
new dish, often flavored with maple syrup or
molasses, was named Indian pudding.
Steamed, baked, and boiled puddings were
eaten daily in New England homes. They
were known as grunts (steamed dough and
berries), slumps (baked puddings), and flum-
meries (a British molded oatmeal or custard
pudding). As in England, a pudding could be
savory or sweet and was generally served at
the beginning of the meal. Breads were also
a mainstay. Many were dense, baked with-
out any leavening (reliable leavenings such
as baking powder and baking soda were not
available until the mid-1900s). Homegrown
yeast from potatoes, hops, or the dregs of beer
barrels was used in some recipes. Cornbread
cooked in a skillet over the fire was most
common. Rye, which grows well in cooler cli-
mates, was often combined with cornmeal to
make a popular bread called ryaninjun (from
“Rye ‘n’ Indian”). Stewed pumpkin was some-
times added for a moister loaf. Boston brown
bread is a traditional recipe of the region—a
steamed loaf made with whole-wheat and rye
flours (sometimes with cornmeal as well) and
flavored with molasses.
Pork, cod, or beef flavored most main
dishes. Long winters required that most meats
and fish be preserved, and few recipes called
for fresh cuts. Salt pork, bacon, smoked pork,
dried salt cod, corned beef, and dried beef
were common, usually braised or stewed with
vegetables. The New England boiled dinner
is typical. This one-pot meal is still popular
throughout the region and usually includes
corned beef brisket simmered for hours with
potatoes, onions, carrots, turnips, and, tradi-
tionally, beets. Cabbage is added toward the
end of the cooking time. Seasoning is mild,
often just a little black pepper. Leftovers are
often chopped up the next day and heated in a
skillet with a little cream and sometimes some
bacon and more onions to make another New
England specialty known as red-flannel hash,
so called because the cooked beets would
bleed into the other ingredients during fry-
ing. A dried salt cod and potato version of
the New England boiled dinner is prepared in
Massachusetts, called Cape Cod turkey. Plym-
outh succotash is another example. Although
this Native American dish (see Chapter 5) is
often associated with southern fare today, it
was popular in the Northeast during colonial
times. It combined corned beef, turkey or
chicken, beans, corn, potatoes, and turnips.
Other variations featured just vegetables or
combinations of meats, poultry, and fish.
Other popular dishes included dried beef
rehydrated in boiling water and served with
cream sauce over bread or potatoes (precur-
sor to what is called chipped beef today), and
fried salt pork topped with cream gravy. New
England states without access to the coast
were more dependent on meat, poultry, and
dairy products. Today, New Hampshire is
acknowledged for the quality of its butter,
and Vermont is famous for its cheeses, such
as cheddar and the similar but milder Colby.
Beans were eaten regularly in early New
England. Best known are baked beans fla-
vored with molasses or maple syrup and salt
pork, a recipe adapted from the Native Ameri-
can dish. Traditionally the Puritans prepared
a large pot of beans on Saturday morning,
simmered them over the fire all day, and then
ate them with Boston brown bread for dinner
to start the Sabbath (observed from sundown
to sundown). Leftovers were kept warm on
the hearth for Sunday breakfast with codfish
cakes and for Sunday lunch.8 Boston is still
known as Bean Town due to its long associa-
tion with baked beans. In Maine, a version
of baked beans called bean pot is made with
indigenous yellow-eye, cranberry, or kidney
beans.
Pies made with suet pastry were served
at most meals. Savory kinds included an
American version of the British steak and
kidney pie, chicken pot pie (later topped
with biscuits instead of pie crust), a ground
The oldest continually
operating cheese fac-
tory in the United States
was founded in 1822 in
Healdville, Vermont.
During the colonial
period, dried salt cod
was exchanged for fruit
in the Mediterranean
and for molasses in the
Caribbean (the molasses
was then used to make
rum). Cod traders in
Massachusetts became
wealthy and were
nicknamed the “codfish
aristocracy.”
The Maine bean pot
is based on the Indian
method of placing the
ingredients in a pot that
is then buried in a pit
over embers, a so-called
bean hole.
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4 9 0 R E G I O N A L A M E R I C A N S
pork and onion pie seasoned with allspice
called tourtière introduced by French Cana-
dians in the region (served traditionally at
Christmas or on New Year’s Day), clam pie,
lobster and oyster pie, and a salt-cod pie cov-
ered with mashed potatoes. Sweet pies were
also popular, especially apple pies, made with
fresh apple slices, dried rings, or even apple-
sauce. Mincemeat, a traditional English treat
combining savory and sweet ingredients, was
featured at many meals because the filling
of meat, dried fruits, nuts, and rum or other
alcoholic preservative aged well, becoming
tastier over time. Today, Vermont fried pies
(fried applesauce turnovers flavored with
cinnamon) and apple pie topped with sliced
cheddar cheese are Vermont favorites, while
in New Hampshire, apple pie is sometimes
drenched in maple syrup. Blueberry pie is a
specialty in Maine.
No discussion of New England fare is
complete without further detailing the use
of fish and shellfish in coastal areas. In Mas-
sachusetts, for example, cod helped sustain
the earliest populations, and Cape Cod, the
peninsula that curls out into the Atlantic, was
so named in 1602 for an abundance of the
fish. The Puritans used it in boiled and baked
dishes, soups, stews, hash, and, most notably,
codfish cakes. These cakes, which are also
called codfish balls, are still a sign of regional
affiliation for some residents of the Boston
area. In Connecticut shad was enjoyed by the
Native Americans of the region but disdained
by the earliest Europeans in the area due to its
multitude of tiny, difficult-to-remove bones.
By the mid-eighteenth century Connecticut
residents had changed their opinion of shad,
especially the roe, which they fried quickly in
butter. Traditionally, American Indians would
plank the fish and slowly cook it at the edge
of hot coals, a method still practiced today at
shad bakes where the fillets are placed on an
oak board with strips of bacon, then grilled
or smoked.
Lobster is a specialty, especially in Maine. The
Indians of the area consumed the meat, used the
discarded shells for fertilizer, and formed the
claws into pipes. British settlers mostly added the
meat to mixed fish dishes, and later colonialists
added it to salads, sauces, soups, and fried cro-
quettes. Commercial trapping began in the late
1800s with the advent of shipping by train and
the development of the canning industry. The
lobster supply diminished rapidly, increasing its
prestige and popularity—today trapping regula-
tions are strict. In addition to steamed or grilled
lobster tail, a specialty in Maine and other coastal
areas is lobster rolls, which take two forms (both
served on toasted, fluffy white bread buns): plain
meat drenched in butter, or meat mixed with
mayonnaise, celery, onions, and lemon juice.
Clams, oysters, and scallops are also New
England favorites. The clambake, in which
clams, corn, and other items such as onions,
potatoes, or lobster are steamed in a pit on the
beach, shares some similarities with American
Indian seafood feasts, and was enjoyed as a
way of connecting with what New Englanders
in the early nineteenth century believed was
their Puritan past.9 Clams are also featured in
the cream-based soup known as clam chow-
der. One version, the cream-based Boston
clam chowder, is known nationally. It is typi-
cally garnished with Boston crackers or oyster
crackers, the slightly sweet, small, dry biscuits
invented by Massachusetts sea captains for use
on long journeys aboard ship. In Rhode Island
tomato-based red clam chowder, a soup inac-
curately attributed to Manhattan, is popular.
Clams called steamers are just that—steamed
and served with the broth and melted butter
▼ Lobster is a specialty
of Maine, though it is also
trapped in other New
England coastal states.
Ri
ch
ar
d
Sc
hu
ltz
/C
ra
ve
/C
or
bi
s
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C H A P T E R 1 5 4 9 1
(a bucket of steamers is often the first course
of a lobster dinner). Oysters were typically
prepared with cream and breadcrumbs in
a dish called scalloped oysters, or served in
oyster stew. In Rhode Island they were espe-
cially popular among the nineteenth-century
elite, who served them in pies (raw oysters
in cream sauce topped with biscuit dough),
as patties, creamed, curried, and, for New
Year’s Eve, pickled, with eggnog to wash them
down. Today they are commonly broiled with
bacon or breaded and deep-fried. Bay, sea,
and Digby scallops are prepared similarly to
oysters. In Maine two less common shellfish
specialties are found. The first is mussels (the
state provides nearly two-thirds of those shell-
fish consumed nationally), and the second is
sea urchin roe (uni), served at local restau-
rants and sushi bars, or exported to Japan.10
There are two fruits particularly associ-
ated with the New England area. The first is
cranberries, known as sassamanesh and ibimi
(meaning bitter or sour) by some Native
Americans, who ate them fresh with maple
syrup, or dried and added to pemmican.
It was the Dutch who introduced the term
K r anbeer e, meaning “crane berry,” because the
flower resembles the head of a crane. Cran-
berries grow exceptionally well in the sandy
peat bogs of eastern Massachusetts, where
they were first cultivated in the early 1800s.
They are used primarily in juices and sauces,
though in recent years, dried cranberries have
become popular as snacks or added to baked
goods. The second fruit is wild or low-bush
blueberries, which are used mostly in baked
goods. Maine grows nearly 100 percent of this
variety in the United States.
New England desserts are mostly fruit
based. In addition to the puddings and pies
already discussed, pandowdies (baked fruit
layered with bread), shortbreads (fruit pre-
serves, biscuits, and cream), and roly-polys
(fruit rolled up in biscuit dough, then baked)
were other favorites. Pound cakes and fruit-
cakes were enjoyed but were difficult to make
before commercial leavening and reliable
ovens were available.
No sweet is as associated with New Eng-
land, particularly Vermont, as is maple syrup.
One New England des-
sert popular throughout
the nation is chocolate
chip cookies, which
were created by Ruth
Wakefield in 1930 at the
Toll House Inn in Whit-
man, Massachusetts.
Boston cream pie, a
favorite in New England,
is not a pie but a custard-
filled white cake covered
with chocolate icing. It
probably derives from a
popular colonial dessert
called “pudding cake”
that included cake,
custard, and usually fruit
or jam.
S a m p l e M e n u
A New England Supper
New England Boiled Dinnera,b,c
Boston Brown Breada,c
Blueberry Pieb,c or Apple Pandowdy with Maple Syrupa
aJamison, C.A., & Jamison, B. 1999. American home cooking.
New York: Broadway Books.
bOliver, S.L. 1995. Saltwater foodways. Mystic, CT: Mystic Seaport Museum.
cNew England Recipes at http://www.newenglandrecipes.com
The sweet sap of the sugar maple tree had long
been used by Indians of the Northeast to cook
beans and meats and to flavor other items
(see Chapter 5). The syrup was an everyday
sweetener in colonial kitchens throughout
the region until cane sugar became more
affordable. Maple syrup production peaked
in the 1880s, and the sweet has since become
a costly item. Vermont specialties include
sugar-on-snow (hot syrup poured over fresh
snow to make a chewy taffy eaten with pickles
or doughnuts), maple syrup pie (with a filling
of cream, eggs, and syrup), and maple-sugar
candies.
Tea and apple cider were consumed daily
in colonial times. Hard cider, an alcoholic
beverage caused by the fermentation of sug-
ars in apple cider, was also favored. Many New
Englanders would start their day with a pint of
beer or ale made from barley, corn, pumpkins,
persimmons, or spruce bark. Rum, as well as
whiskey made from rye, was available. Wine
from dandelions or gooseberries was a spe-
cialty, and an American version of the Eng-
lish drink called syllabub, containing apple
cider, sherry or wine, and whipped cream,
was served at special occasions. Today, apple
cider remains a regional specialty, particularly
in New Hampshire.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
4 9 2 R E G I O N A L A M E R I C A N S
Mid-Atlantic
Many of the influences on New England fare
are seen in the foods of the Mid-Atlantic states
as well. Native American fare was combined
with immigrant preferences to produce a
new regional cuisine. Unlike New England,
where most of the colonists were from Eng-
land, many settlers in New Jersey, New York,
and Pennsylvania came from the Netherlands
and Germany. They provided a distinctively
different flavor to foods, including a greater
use of pork (especially sausages) and dairy
products, more baked goods, and stronger
seasonings. Later immigrants from southern
and eastern Europe contributed many special-
ties. Further, the warmer climate and fertile
farmlands offered a greater variety of ingre-
dients to the cooks of New York, New Jersey,
and Pennsylvania.
The Dutch in the mid-1600s brought wheat
to the New York area, which at the time was
known as New Netherland. They also grew
barley, buckwheat, and rye. Although these
were preferred grains, the Dutch used what
they called “turkey wheat” (corn) to make a
boiled milk and cornmeal porridge known
as Suppawn that was eaten daily at break-
fast. This same porridge was topped with
meats and vegetables for lunch, then baked
to make the hearty dish called Hutspot, an
American adaptation of a stew common in
the Netherlands.
Dairy cattle provided ample milk, butter,
and cheese. The Dutch were among the first
settlers wealthy enough to import sugar,
brandy, chocolate, and numerous spices,
including pepper, cloves, cinnamon, and saf-including pepper, cloves, cinnamon, and saf-including pepper, cloves, cinnamon, and saf
fron. Many Dutch specialties of the region
have made their way into American cooking,
including pickled cabbage; Kool sla (from
the Dutch word for “cabbage”), now known
as coleslaw; and headcheese, a ball-shaped
sausage made from the head and feet of the
hog. Doughnuts, crullers, pancakes, and waf-hog. Doughnuts, crullers, pancakes, and waf-hog. Doughnuts, crullers, pancakes, and waf
fles were also introduced by the Dutch.
During the same period, German immi-
grants arrived in the United States. Many were
religious outcasts (mostly Mennonites, with
smaller numbers of Amish, Schwenkfelders,
and other sects) who made their home
in the tolerant colony of Pennsylvania
(see Chapter 7). They became known as the
Pennsylvania Dutch, a corruption of the Ger-
man word Deutsc h , which means “German.”
Although some German religious communi-
ties remained isolated (and are even to this
day), many German immigrants gradually
became integrated into the broader popula-
tions of Pennsylvania and surrounding states.
Likewise, many German foods of the region
have become an indistinguishable part of U.S.
cuisine.
Pork was the foundation of the German
diet, and immigrants brought ham, pork chops,
pork schnitzel (pounded into thin slices),
bacon, salt pork, pickled pig’s knuckles, souse
(jellied pig’s feet loaf ), maw (stomach stuffed
with meat and vegetables), and a German ver-
sion of headcheese. Every part of the hog was
used, and leftovers would be stretched with
lima beans to make a Pennsylvania version
of baked beans or with dried green beans and
potatoes (B oh ne mit S c h ink en un’ G r umber r a).
The best-known leftovers dish is scrapple,
still popular throughout the state. Scrapple
is a combination of ground pork or sausage,
cornmeal porridge, and spices formed into
a loaf, sliced into thick slabs when firm, and
fried in butter. It is typically served with fried
eggs, applesauce, and maple syrup. In addi-
tion, smoked and fresh sausages were con-
sumed daily. Chicken stews and soups, made
substantial with homemade noodles or dump-
lings, were also popular with the Pennsylva-
nia Dutch. Beef was used in the braised roast
known as sauerbraten and in the smoked,
cured dried beef called Bündnerfleisch.
Asparagus, green peas, sugar peas (called
Mennonite pod peas), and rhubarb are a few
of the vegetables favored by the Pennsylva-
nia Dutch. Potatoes are eaten mashed, fried,
creamed, baked, scalloped, hashed, as cro-
quettes, as dumplings, in stews and soups,
and as potato salad. Cabbage is also ubiqui-
tous, mostly as sauerkraut and slaw. Apples
are particularly popular—fresh, as apple-
sauce, in pastries, as cider, and in preserves
such as the thick, sweet spread known as apple
butter. Many fruits and vegetables are pickled
or preserved. Examples include spiced pears,
pickled watermelon rind, sweet pickles, and
corn relish. Dark rye breads, cornbreads,
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 5 4 9 3
yeast rolls, potato rolls, cinnamon rolls and
sticky buns, Streuselkuchen (coffeecakes with
a sugarcrumb topping), doughnuts (called
Fastnachts), and buckwheat pancakes are just
a few of the baked goods found in the region.
The Pennsylvania Dutch also make numerous
desserts, especially pies (see Chapter 7).
Though generally considered a rural
cuisine, Pennsylvania Dutch fare was well
accepted in the early urban centers of the
state, such as Pittsburgh, Allentown, Bethle-
hem, and Reading. Even Philadelphia, which
was founded by English Quakers, favored
German foods. Scrapple has become so
associated with the city that it is often called
Philadelphia scrapple, despite its country
beginnings. It is eaten for breakfast, often driz-
zled with catsup, and is used to make deep-
fried croquettes or to stuff vegetables like
green peppers and cabbage for dinner. Leba-
non bologna is a Pennsylvania Dutch smoked
beef sausage that has become a state specialty.
It is traditionally sliced, battered, or dipped
in bread crumbs, fried, and served with sau-
erkraut and mashed potatoes. Although the
origins are lost to history, Philadelphia pep-
per pot, a soup made with tripe, onions, pota-
toes, and black peppercorns, is most likely a
Pennsylvania Dutch recipe and is sometimes
served with dumplings. Cheesesteak (grilled
strips of beef topped with American cheese
and grilled onions in a toasted Italian roll),
the quintessential Philadelphia sandwich, was
supposedly invented during the 1930s when
a frankfurter pushcart vendor was acciden-
tally sent beef instead of his standard order
of hot dogs.
The hearty fare of the Dutch and Germans
combined with many traditional items also
found in New England, such as puddings,
savory pies, and seafood soups and stews, to
produce Mid-Atlantic cuisine. Later immi-
grants to the Mid-Atlantic region introduced
foods that have become associated with
certain cities and states. Notably, southern
Italians in New York and New Jersey brought
pizza, spaghetti with tomato–meat sauce, cal-
zone, cannoli, gelato, and espresso. Eastern
European Jews introduced pastrami, smoked
salmon and whitefish, chopped liver, and
other deli items. Particularly in New York,
other eastern European, Russian, Greek,
Chinese, Caribbean Island, and Middle East-
ern cuisines became popular, due in part to
numerous ethnic eateries (see chapters on
each group for more information). New York
is noteworthy for the influence of its restau-
rant fare. Taverns, boarding houses, oyster
houses, and coffeehouses served the needs
of those eating out in the late eighteenth and
early nineteenth centuries. The first Euro-
pean-style bakery was opened in 1825, and
delicatessens serving the Jewish community
were established in the 1880s. Full-service
continental-style restaurants became popular
in the mid-1800s. By the turn of the century,
New York City had become the gastronomic
center of the nation. Many dishes created for
elite diners are now American specialties,
such as Waldorf salad (originally a mixture
of apples and celery in mayonnaise served
at the Waldorf-Astoria), vichyssoise (chilled
leek and potato soup from the Ritz-Carlton),
Lobster Newburg (lobster tail topped with a
Madeira-flavored cream sauce), and the des-
sert baked Alaska (from Delmonico’s).
New Jersey, often called the garden basket
of New York due to its numerous commercial
Buffalo wings, deep-fried
chicken wings drenched
in spicy (often using
Tabasco sauce) seasoned
butter and served with
celery and blue cheese
dressing, evolved in
Buffalo-area bars during
the 1960s. No one has
established the exact
origins of the appetizer.
The word cookie is
derived from the Dutch
word for a small cake,
Koeckje.
▼
Bagels, introduced
by Polish immigrants,
were paired with an 1872
New York invention,
cream cheese; the chewy
doughnut-shaped roll was
popularized nationwide
during the 1990s.
M
ia
F
os
te
r/
Ph
ot
oE
di
t
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4 9 4 R E G I O N A L A M E R I C A N S
crops, is also known for its contributions in
food technology. Scientific work on hybrid-
ization has yielded new, improved varieties
of peaches, tomatoes, and sweet potatoes.
Food-processing techniques developed in
New Jersey include condensed, canned soups
(the Campbell Soup Company); inspected,
bottled milk (the Borden Company); and the
first application of pasteurization to milk at
a small farm outside Princeton. Black tea,
in convenient individually sized bags, was
introduced in Hoboken in 1880 (the Thomas
J. Lipton Company).
In addition to the Dutch and Pennsylvania
Dutch cookies, doughnuts, pies, pancakes,
and waffles of the region, other sweets have
gained nationwide acceptance, especially
those from Pennsylvania. Philadelphia was
one of the first cities to enjoy ice cream, per-
haps as early as 1782. An ice cream parlor with
frozen treats, cakes, syrups, and cordials was
opened in 1800, and the following years saw
the first wholesale distributor of ice cream
and the first ice cream soda. The city gained
a reputation for a high-quality product, and
ice cream molded into flowers, fruits, animals,
or holiday icons is still a specialty. Another
confectionery contribution was affordable
chocolate. Commercial production of choc-
olate for beverages and bonbons began in
Pennsylvania during the late 1700s, though it
was so costly it was considered a luxury item.
Milton Hershey of Derry Church was the first
manufacturer of chocolate for the mass mar-
ket beginning in 1905 when he reduced his
expenses by making uniform bars instead of
fancy novelties. Two years later, he introduced
the chocolate candy, Hershey’s Kisses.
Several beverages are associated with the
Mid-Atlantic states. American beer, a heavy,
top-fermented beverage similar to English ale,
was first commercially produced during the
late seventeenth century in Pennsylvania. Two
hundred years later, a German immigrant to
Philadelphia founded the first brewery that
made a bottom fermented beverage. The new,
lighter beer known as lager, or pilsner, soon
became synonymous with beer in the United
States (see Chapter 7). New York is the only
major wine producer in the Northeast and is
third nationally behind California and Wash-
ington. Wine varieties include whites (Char-
donnay, White Riesling, and Seyval-Villard
varietals), reds (small amounts of Cabernet
Sauvignon and Merlot), and sparkling wines
as well as some fortified wines, such as sherry
and port. New Jersey is the state where hard
apple cider was first distilled to produce the
apple brandy known as applejack, sometimes
called New Jersey lightning.
Health Concerns
State-specific data suggest that people living
in the New England states are often healthier
than the U.S. average, while those in the Mid-
Atlantic states are closer to national norms
(see chapters on each ethnic group for popu-
lation-specific data). As in all of the regions of
the United States, obesity and rates of diabe-
tes have consistently increased in the North-
east and Mid-Atlantic states (see Table 15.3
and Figure 15.3). For the four regions of the
United States, the Northeast ranks second
lowest for the prevalence of cardiovascular
disease (acute myocardial infarctions, coro-
nary heart disease, strokes). In addition, they
practice lifestyle activities that are healthier,
such as lower prevalence of smoking and
higher prevalence for physical activity).11
S a m p l e M e n u
A Mid-Atlantic Brunch
Philadelphia Scrapplea,c with Eggs
Pecan Sticky Bunsb,c
Toast with Apple Buttera,b,c
Bagels and Cream Cheese
aCunningham, M. 1996. Fannie Farmer cookbook: Anniversary.
New York: Knopf.
bJamison, C.A., & Jamison, B. 1999. American home cooking.
New York: Broadway Books.
cRecipe Source at http://www.recipesource.com
Coffee milk, similar to
chocolate milk but made
with coffee syrup, is the
official state beverage of
Rhode Island.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 5 4 9 5
The Midwest
Regional Profile
The Midwest is known as the Great Plains
region of the United States. The earliest
American settlers and European immigrants
in the area found a vast, flat terrain covered
by tall prairie grasses. Oak-wooded hills and
low mountain ridges ringed the territory. The
rich soil irrigated by the extensive Mississippi
and Missouri River systems proved ideal
for wheat, corn, and numerous fruits. The
region is still renowned for its agricultural
CT ME MA NH NJ NYNH NJ NY PA RI VT
Obesitya ↓↓ ↓ ↓↓ ↓↓ ↓↓ ↓↓ ↓ ↓↓ ↓↓↓↓ ↓ ↓↓ ↓↓ ↓↓ ↓↓ ↓ ↓↓ ↓↓↓↓ ↓ ↓↓ ↓↓ ↓↓ ↓↓ ↓ ↓↓ ↓↓↓↓ ↓ ↓↓ ↓↓ ↓↓ ↓↓ ↓ ↓↓ ↓↓↓↓ ↓ ↓↓ ↓↓ ↓↓ ↓↓ ↓ ↓↓ ↓↓↓↓ ↓ ↓↓ ↓↓ ↓↓ ↓↓ ↓ ↓↓ ↓↓↓↓ ↓ ↓↓ ↓↓ ↓↓ ↓↓ ↓ ↓↓ ↓↓↓↓ ↓ ↓↓ ↓↓ ↓↓ ↓↓ ↓ ↓↓ ↓↓↓↓ ↓ ↓↓ ↓↓ ↓↓ ↓↓ ↓ ↓↓ ↓↓
No Leisure-Time Exerciseb ↓ ↓↓ ↓ ↓↓ ↓↓↓ ↓↓ ↓ ↓↓ ↓↓↓ ↓↓ ↓ ↓↓ ↓↓↓ ↓↓ ↓ ↓↓ ↓↓↓ ↓↓ ↓ ↓↓ ↓↓ AVG AVG AVGAVG AVG AVGAVG AVG AVG ↓↓↓
Diabetesc ↓ ↓ ↓↓ ↓↓ ↓↓ ↓ ↓↓ ↓↓ ↓↓ ↓ ↓↓ ↓↓ ↓↓ ↓ ↓↓ ↓↓ ↓↓ ↓ ↓↓ ↓↓ ↓ AVG AVG AVGAVG AVG AVGAVG AVG AVG ↓↓↓
Hypertensiond ↓ ↓ ↓ ↓ ↓↓ ↓ ↓ ↓ ↓↓ ↓ ↓ ↓ ↓↓ ↓ ↓ ↓ ↓↓ ↓ ↓ ↓ ↓ AVG AVG AVGAVG AVG AVGAVG AVG AVG ↓
High Blood Cholesterole ↑↑ ↑↑ ↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑ ↑↑↑ ↑↑ ↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑ ↑↑↑ ↑↑ ↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑ ↑↑↑ ↑↑ ↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑ ↑↑↑ ↑↑ ↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑ ↑↑↑ ↑↑ ↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑ ↑↑↑ ↑↑ ↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑ ↑↑↑ ↑↑ ↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑ ↑↑↑ ↑↑ ↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑ ↑
Don’t Consume 5 Fruits/Vegs.f ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓↓↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓↓↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓↓↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓↓↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓↓↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓↓↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓↓↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓↓↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓↓
Binge Drinkingg AVG AVGAVG AVG ↑ ↓ ↓↓ ↓ ↓↑ ↓ ↓↓ ↓ ↓↑ ↓ ↓↓ ↓ ↓↑ ↓ ↓↓ ↓ ↓↑ ↓ ↓↓ ↓ ↓ AVG AVGAVG AVG
Low Birth Weighth AVG ↓ AVG ↓ AVG AVG AVG AVGAVG AVG AVG AVGAVG AVG AVG AVGAVG AVG AVG AVG ↓↓
Deaths from Heart Diseasei ↑↑ ↑ ↑ ↑ ↑↑↑ ↑↑↑ ↑↑↑ ↑↑ ↑↑↑ ↑ ↑ ↑ ↑↑↑ ↑↑↑ ↑↑↑ ↑↑ ↑↑↑ ↑ ↑ ↑ ↑↑↑ ↑↑↑ ↑↑↑ ↑↑ ↑↑↑ ↑ ↑ ↑ ↑↑↑ ↑↑↑ ↑↑↑ ↑↑ ↑↑↑ ↑ ↑ ↑ ↑↑↑ ↑↑↑ ↑↑↑ ↑↑ ↑↑↑ ↑ ↑ ↑ ↑↑↑ ↑↑↑ ↑↑↑ ↑↑ ↑↑↑ ↑ ↑ ↑ ↑↑↑ ↑↑↑ ↑↑↑ ↑↑ ↑↑↑ ↑ ↑ ↑ ↑↑↑ ↑↑↑ ↑↑↑ ↑↑ ↑↑↑ ↑ ↑ ↑ ↑↑↑ ↑↑↑ ↑↑↑ ↑↑ ↑
Deaths from Stroke j ↓ ↓ ↓↓ ↓ ↓ ↓↓↓↓ ↓ ↓↓ ↓ ↓ ↓↓↓↓ ↓ ↓↓ ↓ ↓ ↓↓↓↓ ↓ ↓↓ ↓ ↓ ↓↓↓↓ ↓ ↓↓ ↓ ↓ ↓↓↓↓ ↓ ↓↓ ↓ ↓ ↓↓↓ AVG ↓ ↓↓ ↓
Deaths from Cancerk ↑ ↑↑ ↑ AVG AVG AVGAVG AVG AVGAVG AVG AVG ↓ ↑↓ ↑ AVG AVGAVG AVG
aU.S. prevalence 5 27.6 percent (overweight defined as body mass index [BMI] >30.0).
bU.S. prevalence 5 26.3 percent (persons who did no leisure-time physical activity in past month).
cU.S. prevalence 5 9.3 percent (self-reported data based on number of persons who were told they had condition by a health professional).
dU.S. prevalence 5 31.4 percent (self-reported data based on number of persons who were told they had condition by a health professional)
eU.S. prevalence 5 28.4 percent (self-reported data based on number of persons who were told they had condition by a health professional).
fU.S. prevalence 5 77.6 percent (adults who do not consume at least 5 fruits/vegetables per day).
gU.S. median 5 16.8 percent (>5 drinks/day on one occasion in the past month for men, >4 drinks on one occasion in the past month for women).
hU.S. prevalence 5 7.6 percent (live births of infants weighing <2,500 grams).
iU.S. age-adjusted death rate per 100, 000 251000 2515000 251.
jU.S. age-adjusted death rate per 100, 000 54.1000 54.5000 54. .
kU.S. age-adjusted death rate per 100, 000 190000 1905000 190
AVG—similar to national average
↑—slightly above national average
↓—slightly below national average
↑↑—significantly above national average
↓↓—significantly below national average
↑↑↑—exceptionally above national average
↓↓↓—exceptionally below national average
Sources: Centers for Disease Control and Prevention. 2014. National Diabetes Statistics Report: Estimates of diabetes and its burden in the United States, 2014. Atlanta, GA: U.S. Department of Health and
Human Services; Division for Heart Disease and Stroke Prevention: Data Trends & Maps, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for
Chronic Disease Prevention and Health Promotion. 2013. Retrieved from http://www.cdc.gov/dhdsp/; America’s Health Rankings®: A Call to Action for Individuals & Their Communities. 2014. United Health
Foundation. Retrieved from http://www.unitedhealthfoundation.org
TA B L E 15. 3 Northeast State-Specific Health Data Compared to National Averages, 2009–2014
productivity, which is why it is nicknamed
“America’s breadbasket.”
The Midwest encompasses twelve states
with 21 percent of the total land area and just
over 21 percent of the total U.S. population.7
It is divided into the east north central (ENC)
region (Illinois, Indiana, Michigan, Ohio,
and Wisconsin), and the west north central
(WNC) region (Iowa, Kansas, Minnesota,
Missouri, Nebraska, North Dakota, and South
Dakota).
The states of the ENC area are bounded by
the Great Lakes, which temper the climate,
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
4 9 6 R E G I O N A L A M E R I C A N S
ensuring milder weather than that experi-
enced by other areas of the Midwest. Although
the French were the first Europeans to explore
the region, it was Americans from the North-
east states, as well as Virginia and Delaware,
who were the first pioneers. Later immigrants
from Germany, Switzerland, Scandinavia,
central Europe, and the Cornwall area of
England were attracted by the fishing, dairy,
mining, lumber, and meatpacking industries.
The WNC states are geographically near the
center of North America, exposed to long
winters, short summers, and extreme tem-
peratures. Most Americans who settled the
territory were homesteaders, interested in the
inexpensive land and farming opportunities.
They came from New England and the Mid-
Atlantic states, followed by new immigrants
from Germany, Scandinavia, and central
Europe, particularly Poland.
As suggested by the history of immigration
to the area, the Midwest has the largest per-
centage of whites in the nation. Over half of all
U.S. citizens of Czech and Norwegian ancestry
live in the Midwest, as well as large numbers of
people of Finnish, Croatian, Swedish, German,
and Polish heritage. There are below-average
numbers of blacks (approximately 6 percent of
the total population) throughout the Midwest;
the exceptions are in Ohio, Michigan, and Illi-
nois, which have slightly above-average Afri-
can American populations. Native Americans,
Latinos, and Asians/Pacific Islanders are also
underrepresented, although there is a large
population of Latinos in Illinois, approach-
ing the national average, and above-average
numbers of Native Americans in the Dakotas.
Overall, Illinois has the most diverse popula-
tion in the Midwest; nearly one in every three
residents is nonwhite (Table 15.4).
One immigrant group that has made the
Midwest home is Laotians, including Hmong,
who have arrived since the 1970s (see Chapter 12
for immigration history and food habits).
Over 44 percent of all Hmong counted in
the 2013 U.S. Census live in Minnesota and
Wisconsin.7 Other Southeast Asians have not
tended to settle in the area, however. Addi-
tional recent immigrant populations of note
include Asian Indians in Illinois and Michi-
gan, Koreans in Illinois, Middle Easterners in
Michigan, and Russians in Illinois and Ohio.
The Midwest has the lowest percentage
of people living in metropolitan areas in the
United States. Average household income is
slightly above the national average, at $51,367
according to 2013 American Community Sur-
vey data. Approximately 10 percent of indi-
viduals living in the Midwest are considered
to be living in poverty.7
Traditional Fare
Midwestern fare is usually described as no-
frills homestead and farm food, exemplifying
what is called typical American cuisine (see
Table 15.5). Prime meat or poultry is prepared
United States
Estimate Estimate
Total: 311,536,594 67,148,157
White alone 238,007,238 56,326,045
Black or African American alone 42,496,977 7,641,724
American Indian and Alaska Native alone 5,142,542 897,699
Asian alone 17,845,862 2,127,328
Native Hawaiian and Other Pacific
Islander alone
1,177,092 68,484
Some other race alone 16,986,453 1,709,122
Other races 16,399,187 172,334
Source: U.S. Census Bureau, 2013 American Community Survey.
TA B L E 15. 4 Estimates of Ethnicity in the Midwest Region
The number of farms in
the United States has
dropped from 5.7 million
in 1900 to 2.2 million in
2012. During this period
the average size of each
remaining farm has more
than tripled.
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C H A P T E R 1 5 4 9 7
simply, served with vegetables, potatoes, and
fresh bread. Hearty breakfasts start the day,
robust soups and stews replenish body and
spirit, and homespun desserts round out the
meal.
The Midwest is a region of food traditions
maintained over generations. Beef and pork
are preferred meats, although better cuts are
affordable today, and variety cuts may be
consumed less often than in settlement days.
Canning and freezing to preserve summer’s
bounty is still a common activity. Bread is
sometimes baked at home, and pies make
use of seasonal fruits. Midwestern hospitality,
which began with festive sorghum pulls, group
apple peelings, and canning parties, is con-
tinued through buffets, box socials, pitch-in
or potluck suppers, strawberry socials, corn
roasts, and fish boils popular throughout the
region.
East North Central
The earliest American settlement in the East
North Central (ENC) region was in Marietta,
Ohio, in 1788. The people who came to the
area from the original colonies were mostly
farmers who survived in their new homes on
hogs, corn, beans, squash and pumpkins, cab-
bage, and potatoes. Corn was eaten at every
meal as porridge or as baked or fried breads.
Sun-dried or smoked meat strips called jerky
were adopted from the Indians of the region,
used first for game such as venison, then later
for beef. Other wild meats, poultry, and fish,
such as rabbit, squirrel, woodchuck, opos-
sum, raccoon, skunks, duck, quail, sturgeon,
and trout, were widely available. Even bear
meat was consumed.12 Native fruits included
persimmons, blueberries, bush cranberries,
gooseberries, ground cherries, grapes, and
many types of nuts. Later settlers brought
wheat and oats, as well as apples, cher-
ries, peaches, and berries. Fishing provided
salmon, smelt, trout, and other freshwater
fish; dairying, particularly cheese making,
offered further food variety.
Today, agricultural products are still signif-Today, agricultural products are still signif-Today, agricultural products are still signif
icant in the region. In addition to wheat and
corn, soybeans are a primary crop in Illinois
and Ohio, grown for oil (used in products such
as margarine, mayonnaise, salad dressing, and
for industrial purposes), meat substitutes, and
animal feed. Apples are a major crop in Michi-
gan—local preparations include apple salad,
apple meat loaf, and apple bread. The French
introduced sour European cooking cherries to
Michigan, where nearly all of these nationally
used fruits are produced. One unusual Illinois
specialty is horseradish. German immigrants
brought the eastern European food to the
state, and the pungent, gnarly root thrived.
Illinois is the largest producer of horseradish
in the United States.
Dairying remains important in some
regions as well. Wisconsin is the leading U.S.
producer of milk, sweetened condensed milk,
butter, and cheese. Dairying was sparked by
the arrival of Swiss farmers to the state in the
1840s. They brought their expertise in breed-
ing livestock and making cheese. Colby, a
hard cheese similar to cheddar, is an original
Wisconsin cheese that was created in 1885.
Another variety developed in Wisconsin is
brick, a semisoft cheese with holes and a fla-
vor described as sweet, nutty, and spicy. Italian
cheeses, including ricotta, mozzarella, provo-
lone, Romano, and Parmesan, are specialties
of northern Wisconsin, while blue cheese is
made in the caves near Milwaukee.
Contributions in food processing from
ENC states have extended beyond regional
importance to influence the development
of American cuisine. Many of these changes
took place in Illinois during the late 1800s
and early 1900s. Historical accounts include
The origins of meatloaf,
the quintessential mid-
western beef dish, are
unknown. It may have
come with German immi-
grants who sometimes
added rye bread as an
extender, or sauerkraut
for moisture, to ground
meat dishes.10
Fish boils combining fish,
potatoes, onions, and
salt were begun by Scan-
dinavians as an efficient
way to feed the workers
at lumber camps. Today,
fish boils at the edge
of Lake Michigan are
annual tourist events in
Wisconsin.
▼ Wisconsin is known for
its dairy foods, especially
cheeses such as Colby and
brick.
W
ill
S
al
te
r/
Lo
ne
ly
P
la
ne
t I
m
ag
es
/G
et
ty
Im
ag
es
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4 9 8 R E G I O N A L A M E R I C A N S
stories about Philip Armour, who made mil-
lions in pork sales when he founded the Chi-
cago meatpacking industry; Gustavus Swift,
who made his fortune in hams and sausages;
Oscar Mayer, a German immigrant who got
his start in the hot dog business as a butcher
in Chicago; Louis Rich, a Russian immigrant
who became involved in poultry processing
and founded a turkey luncheon meat empire;
and James Lewis Kraft, a grocery clerk who
came up with the idea that home-delivered,
uniform pieces of cheese would be more
popular than freshly cut wedges from a large
wheel. He later introduced processed and pre-
packaged cheeses, including Velveeta.
Developments were not limited to Illinois.
In Ohio, an Austrian immigrant, Charles
Fleischmann, created the first standardized
Group Foods Preparations
Protein Foods
Milk/milk
products
Milk, buttermilk, butter, cream, cheeses Cream gravy, fondue, rømmegrøt, skyr
Meat/poultry/
fish/eggs/
legumes
Native game, including buffalo,
venison, beaver, raccoon, opossum,
turkey, prairie chickens (grouse),
pheasant
Pork in all forms, especially salt pork,
hams (country ham and Westphalian
ham), and sausages (bratwurst,
weinerwurst, kielbasa); beef
Oysters shipped from the East Coast
Freshwater fish, especially smelt,
sturgeon, trout, and whitefish
Dried beans
Jerky, booyaw, Hasenpfeffer
Ham with gravy, pork chops, barbecued
pork, hot dogs, Bubbat
Beef pot pie, stew, barbecued brisket,
bierocks, pasties, Cincinnati chili
Fish boils, fried trout or smelt
Baked beans with salt pork or bacon
Cereals/Grains Corn, wheat, rye, oats, wild rice Cornbreads, porridges; oatmeal;
bannocks; rye breads, pumpernickel;
biscuits, dumplings (including stuffed,
such as pierogi and pierogi and pierogi verenikas)
Baked goods, especially fresh fruit pies
(apple, cherry, persimmon, rhubarb),
iced cakes, strawberry shortcakes,
strudel, kolaches, butter cookies,
pancakes, aebelskivers, Danish pastries
Fruits/Vegetables Apples, berries (blueberries,
elderberries, strawberries), cherries,
grapes, peaches, persimmons,
rhubarb
Cabbage, onions, peas, potatoes,
rutabagas, turnips, wild mushrooms
Applesauce; apple butter, fritters, bread,
salad; fried apples, candied apples;
fruit jams and jellies
Sauerkraut, sauerkraut balls; coleslaw;
potatoes—boiled, fried, baked, as
dumplings, salad; onion pie
Additional Foods
Seasonings Salt, pepper; parsley, dill; cinnamon, Seasonings Salt, pepper; parsley, dill; cinnamon,
ginger, nutmeg, saffron; molasses
Most foods are preferred mildly spiced
Nuts/seeds Almonds, black walnuts, hickory nuts, Nuts/seeds Almonds, black walnuts, hickory nuts,
pecans; poppy seeds
Nut pies, almond paste; nut candies;
poppy seed cakes and pastries
Beverages Apple juice, beer, wine, apple brandy Lager-style (American) beerBeverages Apple juice, beer, wine, apple brandy Lager-style (American) beerBeverages Apple juice, beer, wine, apple brandy Lager-style (American) beer
Fats/oils Butter, lard
Sweeteners Sugar, honey, molasses, sorghumSweeteners Sugar, honey, molasses, sorghum
TA B L E 15. 5 Midwestern Specialties
©
C
en
ga
ge
L
ea
rn
in
g
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C H A P T E R 1 5 4 9 9
yeast cakes for baking (he later formed a
distillery that produced the first American
gin). Michigan is probably best known for its
role in the creation of the U.S. cereal indus-
try. The city of Battle Creek was home to two
health sanitariums during the late nineteenth
century. The first was founded by Seventh-
Day Adventist leader Ellen Harmon White,
who advocated vegetarianism. Her medical
director was Dr. John Kellogg, inventor of
cornflakes (see Chapter 4). C. W. Post, a for-
mer Kellogg patient, started his own health
institute in Battle Creek. He created a coffee
substitute, Postum (a blend of wheat berries,
bran, and molasses), and a cereal based on
his own recipe for digestive problems, called
Grape-Nuts.13
Each group of pioneers in the region
brought favorite dishes. Baked beans, meat
pot pies with biscuit topping, and succotash
were preferred by settlers from New England.
In Ohio these settlers stuffed meats with
breadcrumbs, a practice still popular in the
state. The people from New York and Penn-
sylvania favored sausages, sauerkraut, pick-
les, and relishes when they moved westward.
In Indiana, where the earliest pioneers came
from the South, pork is especially popular,
including roasts and chops, and sometime the
whole roasted pig. Sausage patties and ham
are common for breakfast, typically served
with pancakes or biscuits, cream gravy, and
fried apples. The southern influence is also
seen in batter-fried chicken served with fried
biscuits (made with a yeast dough that puffs
up into spheres when dropped into hot oil,
then slathered with butter while still warm).
In areas where European immigrants con-
gregated in numbers, regional ethnic fare
developed. For example, the Michigan Dutch
(actually from the Netherlands, not Ger-
mans like the Pennsylvania Dutch) brought
ham croquettes, pea soup, saucijzenbroodjes
(now known in English as pigs-in-a-blanket),
and double-salted licorice. In Ohio the fare
of European immigrants was more broadly
integrated into the regional cuisine: Germans
popularized sausage, ham, potato, and cab-
bage dishes, such as the unusual Ohio specialty
called sauerkraut balls (deep-fried sauerkraut
and ham fritters served with mustard sauce);
Polish immigrants introduced pierogis (boiled
dumplings traditionally stuffed with potatoes,
cabbage, onion, and/or meat, or fruit), kiel-
basa sausage, and strudel (flaky pastry rolls
filled with sweetened fruit, nuts, poppy seeds,
or cheese). Fish boils, pickled fish, and meat-
balls are just a few of the items adopted from
Scandinavian immigrants in Wisconsin. Some
European foods are so well accepted that their
ethnic associations have been forgotten. East-
ern Europeans brought to Wisconsin their
pork or veal sausages, which are now consid-
ered state specialties—Sheboygan is the self-
proclaimed “Bratwurst Capital of the World.”
In other cases, European influence has been
more limited, seen mostly in one or two
dishes, such as Swiss cheese fondue in Indi-
ana, and in Michigan, a dish with French roots
known as booyaw or boolyaw (perhaps from
the term bouil l on), a game stew featuring ven-
ison or whatever else was available (includ-
ing rabbit, woodchuck, squirrel, muskrat, or
duck), salt pork, carrots, potatoes, and onions.
Other dishes with ethnic origins have been
adapted to midwestern tastes, losing much of
their heritage along the way. For example,
Ohio is probably best known nationally for
Cincinnati chili. It is an all-beef version cre-
ated by Greek and Macedonian immigrants
in the 1920s, flavored with a balanced blend
of sweet spices (e.g., cinnamon, allspice,
cloves, and nutmeg) and hot spices (garlic,
cumin, black pepper, and dried chiles). Some
researchers note the similarities between the
seasoning of Cincinnati chili and dishes such
as pastitsio or moussaka (see Chapter 13).14
Chili parlors found throughout Ohio (and
parts of nearby Kentucky) serve the mild chili
“one-way” (just the meaty stew alone), “two-
way” (over spaghetti), “three-way” (spaghetti,
chili, grated-cheese topping), “four-way”
(spaghetti, chili, cheese, and diced onions),
or “five-way” (spaghetti, chili, cheese, onions,
and kidney beans).
The origins of some dishes reflect the suc-
cession of immigration to an area. Cornish
pasties are an example. Miners from Corn-
wall arrived in Michigan’s Upper Peninsula
to excavate iron and copper in the 1840s,
bringing their traditional lunch specialty
called pasties (see Chapter 6). This complete
Wisconsin fare is
sometimes called “white
cooking.” Whitefish (from
the Great Lakes) and
white meat (pork, veal, or
chicken) combined with
white dairy products
(such as farmer’s cheese,
cottage cheese, cream
cheese, fresh cream,
or sour cream) are
favored.30
Deep-dish Chicago-style
pizza is baked in a skillet.
It is an American adapta-
tion of the pizza brought
to the region by Italian
immigrants from Naples.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
5 0 0 R E G I O N A L A M E R I C A N S
meal-in-a-turnover often featured venison
in the Michigan versions, with potatoes and
turnips the common vegetable filling. Apples
were the most popular fruit used for the des-
sert end of the pastry. When immigrants
from Finland came in the following years,
they adopted the dish, which was similar to
piiraat and kukko, Finnish pastries filled with
meat or fish, rice, and vegetables. The ori-
gins of the dish are claimed by many Finns in
the region, though those of Cornish descent
point out that the Finnish turnovers are not
pasties because the filling is mixed instead of
layered.15 Today’s pasty shops, often featuring
untraditional fillings (e.g., pizza ingredients),
are common throughout the Upper Peninsula
(UP) and in cities where “UPers” (“Yoopers”)
have settled, such as Detroit.
Sweets, especially baked goods, hold a spe-
cial place in the cooking of the ENC states.
Traditional items such as hickory nut cookies
and pies are found in many areas. In Indiana
dessert favorites include steamed or baked
persimmon pudding; pork cake, a moist des-
sert made with sausage or salt pork, molas-
ses, brown sugar, flour, dried fruits, and
spices that is a Christmas tradition in some
Indiana homes; and sweet cream pie, pastry
filled with a heavily sweetened custard that
is popular all year. In Michigan apple fritters,
caramel-covered apples, candied apples, and
Dutch apple kock (cake) are common. Elder-
berry-flower fritters dipped in powdered
sugar are also a specialty. In Wisconsin many
popular desserts have retained their foreign
names, including German kuchen (yeasted
coffee cake, often with a fruit and cream fill-
ing and crunchy, sugary streusel topping)
and schaum torte (meringue topped with ice
cream and/or whipped cream and fresh fruit);
and Danish kringle (pretzel- or ring-shaped
flaky pastry with fruit, nut, cheese, or butter-
scotch filling).
Beer is especially associated with the
Midwest, particularly Wisconsin. The first
breweries were located in the southwestern
section of the state and produced the ales
and stouts favored by English settlers. By the
middle of the nineteenth century, however,
ten breweries producing German-style lagers
and pilsners had been founded in Milwaukee,
including plants owned by Frederich Miller,
Frederich Pabst, and Joseph Schlitz. At the
beginning of the 1900s, there were over 300
breweries statewide, but Prohibition and con-
solidation in recent years have reduced that
number to eight.
West North Central
In the West North Central (WNC) states,
the settlers of the mid-nineteenth century
came to farm the fertile land of Iowa, Kan-
sas, Minnesota, and Missouri. Harsh winters
and a scarcity of provisions limited variety in
many early pioneer homes. Homemakers of
the period describe burying melons in sand,
which with luck would stay fresh until Christ-
mas. Other cooks would prepare up to a hun-
dred fresh fruit pies at a time, covering the
extras with snow for use throughout the win-
ter months. Parched corn, herbs, bark, or root
brews replaced coffee.15 Prestige foods were
often unavailable, so ample, even excessive,
amounts of common foods became symbolic
of hospitality in the midwestern frontier. The
more western areas of the WNC states, which
are drier and less suitable for crops, provided
limited opportunities for agriculture. The
region attracted trappers, traders, and pros-
pectors. Wild game, such as bear, buffalo, elk,
deer, and small mammals, as well as turkeys,
S a m p l e M e n u
A Great Lakes Sampler
Cheese P ie r ogi a,c
Bratwurst or Kielbasa
Apple Sauerkrautb,c
Danish Kringleb,c or Sour Cherry Piea,c
aFertig, J.M. 1999. Prairie home cooking. Boston: Harvard Common Press.
bFussell, B. 1997. I hear America cooking. New York: Penguin Books.
cCooks.com at http://www.cooks.com
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C H A P T E R 1 5 5 0 1
prairie chickens (grouse), quail, doves, and
frogs, was hunted; the meat or oil was often
sold in settlement towns. These regional foods
were first documented in an American cook-
book in 1902.16
As in the ENC region, pioneers from
New England and the Mid-Atlantic states
contributed dishes eaten frequently in their
eastern homes: Baked beans and pies of all
sorts became as common as sausages and
sauerkraut. One northeastern specialty that
became surprisingly popular throughout the
Midwest was oysters. By the mid-1800s the
live shellfish were shipped regularly to the
region packed in barrels filled with wet straw.
One English visitor commented that the rich
“consumed oysters and Champagne and the
poor [ate] oysters and lager bier.”17 One 1859
recipe for small birds, such as magpies, sug-
gested stuffing a breaded oyster into each bird
before roasting over a hot fire.15
Irrigation improved crop production
throughout the region, and today corn,
wheat, soybeans, and sugar beets are widely
cultivated. Barley, oats, sunflowers, rutabagas,
and rye are other crops in some areas. Wild
rice, called a grain but actually the triangular-
shaped seed of an aquatic grass found in shal-
low rivers and lakes, is a Minnesota specialty
(see Chapter 5). Though Missouri is too hilly
for grain crops, the terrain is well suited for
nut trees. Eastern black walnuts are native to
the area. The nuts are strongly flavored with
a slightly bitter aftertaste and are the primary
ingredient in black walnut pie. Pecans, too,
are indigenous to the state. They are popular
in pies, candies, cookies, and cakes. Further,
beekeepers take advantage of the woodlands
in the state to provide another specialty of the
region—honey.
Iowa is noteworthy for its commercial hog
farms and is the number one producer of
pork in the nation. Pork is also a favorite in
Missouri due to the large number of south-
erners who settled the state. Missouri is well
known for its country hams, which are cured
with salt, then smoked and hung to age in the
cool winter months. The resulting meat is
red, salty, and dry in texture. It is traditionally
served with biscuits and red-eyed gravy made
from ham drippings, coffee, and flour.
Beef is more significant in Kansas,
Nebraska, and the Dakotas. Before the intro-
duction of cattle to the region, over 30 mil-
lion bison roamed the Great Plains, providing
sustenance, clothing, shelter, and fuel to the
local Native Americans. American settlers
and European immigrants also ate what they
called hump-backed beef, at least until other
meats became widely available. However, the
huge bison herds interfered with expand-
ing settlements, the railroads, and Texas
cattlemen, who drove their longhorns through
the prairie states to the slaughterhouses of the
North and East. The bison were systematically
eradicated, providing unimpeded access to
the grazing lands of the plains. Today Kansas
is famous for its corn-fed beef, and cattle are
the most important agricultural commodity
in the state. Steaks, beef stews, barbecued beef,
and hamburgers are all Kansas favorites. In
South Dakota, early settlers introduced long-
horn cattle from Texas; they were soon joined
by Scottish cattle, including Aberdeen, Angus,
and Herefords. Immigrants from Scotland
were soon exporting beef to their homeland.
Cattle ranching is a major industry in the
state, though sheep and hogs are also impor-
tant commodities. South Dakota is one of the
only states in the WNC that features lamb dish
specialties.
Despite a preference for pork or beef,
poultry is well represented in WNC state fare.
Chicken with dumplings or noodles, pan-
fried chicken with cream gravy, and chicken
or turkey pot pies (topped with pastry or bis-
cuits) are classic midwestern dishes.
Several notable religious communities
were founded in WNC states. In Iowa the
Amish who settled around Kalona grew all
of their own food and butchered all of their
own meat, traditions still practiced today.
Cornbread with tomato juice gravy, stews
or hashes with potatoes and peas, fried
meats and eggs, and fresh fruit pies are com-
mon dishes. A group of German Lutherans,
known as True Inspirationists, settled in
seven Iowa villages in 1859 to form what is
known as the Amana Colonies. They lived
communally, with everyone eating three
enormous meals and two coffee breaks each
day in a large dining hall. The weekly menu
Dairying is common
in several WNC states.
Minnesota is one of the
top butter and cheese
producers in the nation,
and Iowa is known for
the development of
American blue cheese,
introduced in the 1920s
by Maytag Dairy Farms.
Pierogi are known as
pelmeni by some Russians,
varenyky by Ukrainians,
and verenikas by German
Russian Mennonites.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
5 0 2 R E G I O N A L A M E R I C A N S
was set and included Mehlspeisen (literally
“flour desserts,” such as simple puddings) on
Tuesdays and boiled beef every Wednesday.
The Colonies now serve German specialties
to visiting tourists in several large restaurants.
German Russian Mennonites (who had first
migrated from Germany to southern Russia)
came to Kansas in the 1870s. They brought
German-style foods familiar in Pennsylvania
Dutch areas, such as chicken noodle soup,
pancakes, sausages, and buttermilk pie. They
also introduced verenikas (their term for
pierogis) served with cream gravy. Beef rolls
stuffed with bacon, onions, and pickles similar
to German Rouladen, and sausage-filled buns
called Bubbat are other Kansas dishes brought
by the German Russian Mennonites.
European influence was seen in secular
settlements as well. German Russian yeast
dough turnovers (typically filled with beef,
cabbage, and onions) are common through-
out the Great Plains. They were derived
from the Russian pirozhki. The turnovers are
called bierocks in Kansas and the Midwest-
ern regions east and south of that state, and
they are known as runsas in Nebraska and the
northern Midwest areas.
In Minnesota, German immigrants
brought hogs and dairy cattle and intro-
duced their dark rye breads, including pum-
pernickel. Specialties such as Hasenpfeffer
(stewed rabbit), Spätzle (tiny dumplings), and
Maultaschen (a sort of German ravioli filled
with ground ham, eggs, onions, and some-
times spinach) were other common German
dishes. Preserved fish were a mainstay for the
Scandinavians. Pickled fish, smoked fish, and
salt-cured fish were popular, particularly the
Norwegian dish known as lutefisk (see Chap-
ter 7), served with butter and potatoes. Ham,
bacon, Swedish meatballs, and Danish frik-
adeller (fried, breaded ground beef and veal
patties) were consumed. Dark breads and the
thin Norwegian potato pancake called lefser
are still common, as are butter cookies (espe-
cially at Christmas) and Danish aebleskiv-
ers, traditionally served with chokecherry or
blueberry syrup or jam. The Scandinavian
concept of the smörgåsbord was introduced
to the nation in Minnesota (see Chapter 7).
Several ethnic communities in Minnesota
maintain their culinary heritage at holidays
and festivals, including the German Catholic
city New Ulm and the Danish town Askov.
In Nebraska, the Swiss introduced plum
tarts and a specialty called Thuna, bread-
sticks topped with creamed greens thickened
with flour. Czech settlers brought jaternice
(pork sausage), jelita (blood sausage), and
houska (a sweet, braided bread). Swed-
ish yeasted waffles and Hungarian chicken
paprika are other examples of European con-
tributions in the state. In Missouri, the French
introduced crêpes and brioche to the region.
They also made hard cider from apples, wine
from native grapes, and brandy from peaches.
In North Dakota the Norwegians brought
spekejøtt (smoked, dried lamb), rullepølse
(cold, spicy rolled beef ), and søtsuppe (fruit
soup) and baked goods, including the large
pyramid of almond paste and meringue rings
called kransekake. A large population of set-
tlers from Iceland smoked mutton, made skyr
(a sweet, cultured milk product similar to
yogurt), fried kleinur (doughnuts), and baked
vinarterta (a multilayered cardamom-flavored
cake with fruit fillings) for dessert. The Scotch
Irish introduced colcannon (mashed potatoes,
onions, and cabbage), and the French Cana-
dians came with croissants and cassoulet (see
Chapter 6).
A unique cuisine of the Midwest is found
in the Ozark Mountains of Missouri. Contrary
to immigration trends in urban areas, the peo-
ple who came to the Ozarks gradually arrived
from other states in small groups and were
scattered throughout the region. They were
known as backwoodsmen, and they subsisted
on hunting, fishing, gathering, and cultivation
of corn, beans, squash, and various tubers.18
Hogs were let loose to forage until butchering
time in December or January. The people of
the Ozarks were known for their stews made
from opossum, raccoon, or squirrel. Sorghum
was used to sweeten foods, ginger root was
brewed for beer, and sassafras was steeped
for tea. Today, the Ozarks are best known as a
vacation and retirement destination.
Popular desserts in the WNC states
include fruit pies and frosted cakes. Czech
kolaches are a specialty found throughout
the region. These yeasted buns are baked
The Danish community
of Askov, Minnesota,
has an annual festival
commemorating the
rutabaga. Although
the tuber is commonly
called a “Swede” or
“ Swedish turnip,” Danes
are believed to have
introduced the rutabaga
to the region.
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C H A P T E R 1 5 5 0 3
with an indentation on top that is filled with
sweetened cheese, poppy seeds, or fruit (apple,
apricot, cherry, and prune are traditional) and
sprinkled with sugar or streusel before they
are baked. The Scandinavian dessert kran-
sekake is also found in many communities.
Health Concerns
Measures of health in the Midwest ranked
second highest for coronary risk factors. This
region has the highest smoking prevalence.12
For more indicators see Table 15.6. Significantly
higher-than-average rates of heavy drinking
are found in Michigan, Minnesota, Wisconsin,
North Dakota, Nebraska, Illinois, and Iowa,
with the highest rate in Wisconsin.
The South
Regional Profile
Most southerners say the South is more
an attitude than a location. This perhaps
explains why there are so many definitions of
the region, such as those states below the his-
toric Mason-Dixon Line or those south of the
culinary grits line (the divide between where
grits are eaten and where they aren’t). While
no one questions that Alabama, Arkansas,
Florida, Georgia, Louisiana, Kentucky, Mary-
land, Mississippi, the Carolinas, Tennessee,
Virginia, and West Virginia are clearly part of
the South, the borderline states of Delaware,
Missouri, Oklahoma, and Texas can be argued
for inclusion either way. Using the U.S.
government definition, Missouri is consid-
ered part of the Midwest, whereas Delaware,
Oklahoma, and Texas are part of the South.
The lands of the South are varied. They
include the fertile coastal plains along the
Atlantic and Gulf Coasts, the rolling hills
leading up to the mountains (called the Pied-
mont in most states), the rugged Appalachian
and Ozark Mountain territories, the lowlands
of the Mississippi Delta, and the high desert
plains of the western reaches. The climate
also ranges from the warm, moderate Atlan-
tic states and the hot, humid Gulf Coast states
to the hot, dry weather in parts of Texas and
Oklahoma.
The development of the South was in many
ways independent from that of the northern
United States. During colonial times, southern
states were predominantly agricultural, grow-
ing tobacco, wheat, corn, rice, and indigo (a
blue dye). The plantation system that emerged
in the coastal regions was characterized by
commercial farms owned by aristocratic
English or French immigrants and worked
by African slaves. Each plantation was a self-
sufficient, independent operation providing
cash crops and food products for use by each
household. It was a comfortable, leisurely life-
style for the upper classes, enlivened by occa-
sional visits to the cultural centers of Atlanta,
Charleston, or New Orleans. For the lower
classes, which included the slaves and the
poor farmers of the inland hill and mountain
regions, it was a hand-to-mouth existence.
During the period when the northern areas
of the nation became more urbanized and
industrialized, the South remained rural and
agricultural, adding cotton as a major crop.
Differences of opinion regarding the role of
the federal government in state issues, par-
ticularly slavery, led to the Civil War in the
mid-1800s. After losing the war, the South
regrouped in the late nineteenth century. The
S a m p l e M e n u
A Hearty Plains Lunch
Chicken Noodle Soupa,b
Meatloafa,bMeatloafa,bMeatloaf
Mashed Potatoes
Pickled Cucumbers (Cucumbers in Vinegar)a
Apricot Kolachesa
aFertig, J.M. 1999. Prairie home cooking. Boston: Harvard
Common Press.
bStern, J., & Stern, M. 2001. Square meals: America’s favorite comfort food
cBabi’s Czech Recipes from the Dumpling Newsletter
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
5 0 4 R E G I O N A L A M E R I C A N S
IA IL IN KS MI MN MO NE ND OH SD WIIA IL IN KS MI MN MO NE ND OH SD WI
Obesitya ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓
No Leisure-Time Exerciseb ↑ AVG ↑ AVG ↓ ↓↓ ↑↓ ↓↓ ↑↓ ↓↓ ↑ AVG ↑ ↑ ↓ ↓↑ ↑ ↓ ↓↑ ↑ ↓ ↓↑ ↑ ↓ ↓
Diabetesc ↓ AVG ↑ ↓↑ ↓ AVG ↓↓↓ AVG ↓↓ ↓↓ ↑ ↓↓ ↓↓↓↓ ↓↓ ↑ ↓↓ ↓↓↓↓ ↓↓ ↑ ↓↓ ↓↓↓↓ ↓↓ ↑ ↓↓ ↓↓↓↓ ↓↓ ↑ ↓↓ ↓↓
Hypertensiond ↓ ↓↓ ↓ AVG ↓ ↓ ↓↓ ↓ ↓↓ ↓ ↓ AVG ↓↓ ↓↓↓↓ ↓↓ AVG ↓ ↓↓↓ ↓↓
High Blood Cholesterole ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑
Don’t Consume 5 Fruits/Vegs.f AVG AVG AVG AVG AVG AVG AVG AVG AVG AVGAVG AVG AVG AVG AVG AVG AVG AVG AVG AVGAVG AVG AVG AVG AVG AVG AVG AVG AVG AVGAVG AVG AVG AVG AVG AVG AVG AVG AVG AVGAVG AVG AVG AVG AVG AVG AVG AVG AVG AVGAVG AVG AVG AVG AVG AVG AVG AVG AVG AVGAVG AVG AVG AVG AVG AVG AVG AVG AVG AVGAVG AVG AVG AVG AVG AVG AVG AVG AVG AVGAVG AVG AVG AVG AVG AVG AVG AVG AVG AVGAVG AVG AVG AVG AVG AVG AVG AVG AVG AVG ↑ AVG
Binge Drinkingg ↑↑ ↑↑ ↑↓ ↓ ↑ ↑↑↑↑ ↑↑ ↑↓ ↓ ↑ ↑↑↑↑ ↑↑ ↑↓ ↓ ↑ ↑↑↑↑ ↑↑ ↑↓ ↓ ↑ ↑↑↑↑ ↑↑ ↑↓ ↓ ↑ ↑↑↑↑ ↑↑ ↑↓ ↓ ↑ ↑↑ AVG ↑↑ ↑↑↑↑↑ ↑↑↑ AVG ↑ ↑↑↑↑ ↑↑↑
Low Birth Weighth ↓ AVG AVGAVG AVG ↓ AVG AVG ↓ ↓↓ ↑ ↓↓ ↓↓ ↓↓ ↑ ↓↓ ↓↓ ↓↓ ↑ ↓↓ ↓↓ ↓↓ ↑ ↓↓ ↓↓ ↓↓ ↑ ↓↓ ↓
Deaths from Heart Diseasei ↑↑ ↑↑ ↑↑↑ ↑↑ ↑↑↑ ↑↑↑ ↑↑↑ ↑↑ ↑ ↑↑↑ ↑ ↑↑↑ ↑↑ ↑↑↑ ↑↑ ↑↑↑ ↑↑↑ ↑↑↑ ↑↑ ↑ ↑↑↑ ↑ ↑↑↑ ↑↑ ↑↑↑ ↑↑ ↑↑↑ ↑↑↑ ↑↑↑ ↑↑ ↑ ↑↑↑ ↑ ↑↑↑ ↑↑ ↑↑↑ ↑↑ ↑↑↑ ↑↑↑ ↑↑↑ ↑↑ ↑ ↑↑↑ ↑ ↑↑↑ ↑↑ ↑↑↑ ↑↑ ↑↑↑ ↑↑↑ ↑↑↑ ↑↑ ↑ ↑↑↑ ↑ ↑↑↑ ↑↑ ↑↑↑ ↑↑ ↑↑↑ ↑↑↑ ↑↑↑ ↑↑ ↑ ↑↑↑ ↑ ↑↑↑ ↑↑ ↑↑↑ ↑↑ ↑↑↑ ↑↑↑ ↑↑↑ ↑↑ ↑ ↑↑↑ ↑ ↑↑↑ ↑↑ ↑↑↑ ↑↑ ↑↑↑ ↑↑↑ ↑↑↑ ↑↑ ↑ ↑↑↑ ↑ ↑↑↑ ↑↑ ↑↑↑ ↑↑ ↑↑↑ ↑↑↑ ↑↑↑ ↑↑ ↑ ↑↑↑ ↑ ↑↑↑ ↑↑ ↑↑↑ ↑↑ ↑↑↑ ↑↑↑ ↑↑↑ ↑↑ ↑ ↑↑↑ ↑ ↑↑↑ ↑↑ ↑↑↑ ↑↑ ↑↑↑ ↑↑↑ ↑↑↑ ↑↑ ↑ ↑↑↑ ↑ ↑↑↑ ↑↑ ↑↑↑ ↑↑ ↑↑↑ ↑↑↑ ↑↑↑ ↑↑ ↑ ↑↑↑ ↑ ↑
Deaths from Stroke j AVG AVGAVG AVG ↑ AVG AVG AVGAVG AVG AVGAVG AVG AVG ↑ AVG ↑ ↑ ↑↑ ↑ ↑↑ ↑ ↑ AVG
Deaths from Cancerk AVG ↑ ↑↑ ↑ AVG ↑ AVG ↑ ↓ ↓↓ ↑ ↓↑ ↓ ↓↓ ↑ ↓↑ ↓ ↓↓ ↑ ↓↑ ↓ ↓↓ ↑ ↓↑ ↓ ↓↓ ↑ ↓ AVG
aU.S. prevalence 5 27.6 percent (obesity defined as BMI >25.0).
bU.S. prevalence 5 25.8 percent (persons who did no leisure-time physical activity in past month).
cU.S. prevalence 5 6.6 percent (self-reported data based on number of persons who were told they had condition by a health professional).
dU.S. prevalence 5 25.7 percent (self-reported data based on number of persons who were told they had condition by a health professional).
eU.S. prevalence 5 30.4 percent (self-reported data based on number of persons who were told they had condition by a health professional).
fU.S. prevalence 5 77.6 percent (adults who do not consume at least 5 fruits/vegetables per day).
gU.S. prevalence 5 5.1 percent (>2 drinks/day in the past month for men, >1 drink per day in the past month for women).
hU.S. prevalence 5 7.3 percent (live births of infants weighing <2,500 grams).
iU.S. age-adjusted death rate per 100, 000 245.8000 245.5000 245. .
jU.S. age-adjusted death rate per 100, 000 57.9000 57.5000 57. .
kU.S. age-adjusted death rate per 100, 000 194.4000 194.5000 194. .
AVG—similar to national average
↑—slightly above national average
↓—slightly below national average
↑↑—significantly above national average
↓↓—significantly below national average
↑↑↑—exceptionally above national average
↓↓↓—exceptionally below national average
SOURCES: Centers for Disease Control and Prevention. 2014. National Diabetes Statistics Report: Estimates of diabetes and its burden in the United States, 2014. Atlanta, GA: U.S. Department of Health and
Human Services; Division for Heart Disease and Stroke Prevention: Data Trends & Maps, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for
Chronic Disease Prevention and Health Promotion. 2013. Retrieved from http://www.cdc.gov/dhdsp/; America’s Health Rankings®: A Call to Action for Individuals & Their Communities. 2014. United Health
Foundation. Retrieved from http://www.unitedhealthfoundation.org
TA B L E 15. 6 Midwest State-Specific Health Data Compared to National Averages, 2009–2014
traditions and practices that give the South its
character became more important than ever.
The South continues to preserve its identity,
in part, through its cuisine.
Over one-third (37 percent) of Americans
make their home in the South, the highest per-
centage of the U.S. population in any region.12
It is divided into the South Atlantic states of
Delaware, Florida, Georgia, Maryland, North
Carolina, South Carolina, Virginia, West Vir-
ginia, and the District of Columbia; the East
South Central (ESC) states of Alabama, Ken-
tucky, Mississippi, and Tennessee; and the
West South Central (WSC) states of Arkansas,
Louisiana, Oklahoma, and Texas. Overall, the
South has below-average numbers of Asians
and Pacific Islanders, Latinos, and Native
Americans, but above-average numbers of
African Americans: 20 percent of all U.S.
blacks live in the South. However, the very size
of the southern population means that signif-of the southern population means that signif-of the southern population means that signif
icant numbers of most ethnic groups reside
in the region. For example, 30 percent of all
Native Americans and 57 percent of Hispanics
live in the South; both Florida and Texas host
above-average populations of Latinos. While
only 22 percent of U.S. Asians are found in
the South, larger numbers of some groups,
such as Vietnamese, Pakistanis, and Asian
Indians, reside there. In addition to African
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 5 5 0 5
Americans, groups with disproportionately
large representation in the South include
persons of British ancestry, Scotch Irish ances-
try, Cuban ancestry, and Cajun ancestry (see
Table 15.7).
The population of the South is notable
for its high numbers of Protestant Christians
and low numbers of people without religious
affiliation. Baptist and evangelical faiths are
especially popular. Three-quarters of the
population in the South live in metropolitan
areas. Census data from 2013 show that aver-
age household income in the South is near
the national average in the South Atlantic—
approximately $49,165. Poverty rates are at
approximately 13 percent for all individuals.12
Traditional Fare
The foods most associated with the South
reflect both the bounty of the plantation and
the scarcity of the slave diet. Corn dishes,
pork, sweet potatoes, and greens began as the
foundation of southern fare and remain char-
acteristic components today (see Chapter 8).
The southern lifestyle has fostered a cul-
ture of graciousness and cordiality. The iso-
lation of the plantations meant socialization
was limited in frequency but lengthy in dura-
tion. Hours of travel to nearby homes typically
resulted in overnight visits or extended stays.
Parties, balls, picnics, barbecues, and seafood
feasts were all occasions for get-togethers.
For the slaves, Sunday meals with extended
kin were the primary way to maintain family
connections. In the hills and mountains of the
South, the difficulties of subsistence farming
necessitated friendly relationships between
neighbors. Poor families often survived
through regular sharing of food. As a result of
these conditions, the South has become syn-
onymous with hospitality.
The first European explorers in the South
Atlantic states were the Spanish, who arrived in
Florida in 1513 and founded St. Augustine in
1565. They were soon followed by the English,
who started in Virginia and spread north and
south along the Atlantic coastline during the
seventeenth and eighteenth centuries into
Delaware, Maryland, the Carolinas, Georgia, and
eventually into Florida. The Native American
population at the time numbered in the hun-
dreds of thousands, including the members of
the Powhatan, Cherokee, Chickasaw, Choctaw,
Creek, and Seminole tribes (see Chapter 5).
The white settlers discovered a region with
plentiful fruits, nuts, game, fish, and seafood.
Native strawberries, blackberries, blueberries,
huckleberries, ground cherries, persimmons,
muscadine grapes, beechnuts, hickory nuts,
and pecans covered the land. Bream, catfish,
perch, pike, and trout filled the rivers, while
oysters, clams, and crab were abundant along
the coast. In Florida pompano, red snapper,
shrimp, spiny lobster, and conch were widely
available. Diamondback terrapin, sea turtles,
and alligators were found in many waterways;
and bear, deer, opossum, rabbits, raccoons,
squirrels, turkey, grouse, ducks, and quail
United States South Region
Estimate Estimate
Total: 311,536,594 116,015,264
White alone 238,007,238 85,340,613
Black or African American alone 42,496,977 23,475,196
American Indian and Alaska Native
alone
5,142,542 1,713,812
Asian alone 17,845,862 3,994,124
Native Hawaiian and Other Pacific
Islander alone
1,177,092 167,976
Some other race alone 16,399,187 1/246,059 4,242,35246,059 4,242,352
SOURCE: U.S. Census Bureau, 2013 American Community Survey.
TA B L E 15.7 Estimates of Ethnicity in the Southern Region
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5 0 6 R E G I O N A L A M E R I C A N S
were prevalent in woodland areas. Indians
of the region grew corn, beans, pumpkin,
squash, sweet potatoes, and sunflowers.
Most of the first white settlers in the region
were farmers who established plantations.
They brought wheat, hogs, cattle, poultry,
cabbage, potatoes, and fruit trees, including
apples. Africans were imported as laborers.
They introduced southern staples, such as
peanuts, okra, watermelon, and sesame seeds,
and taught the farmers of the lowland coastal
areas how to successfully grow and harvest
rice.19 It was these traditional foods of the
Native Americans, the European settlers, and
the African slaves that combined to create the
foundation of southern fare (see Table 15.8).
Group Foods Preparations
Protein Foods
Milk/milk products Buttermilk, milk Cream gravy
Meat/poultry/fish/
eggs/legumes
Native game, including buffalo, venison,
raccoon, opossum, badger, squirrel, turkey,
ducks, alligator, diamond back terrapin
Pork in all forms, especially country-cured and
Smithfield hams; beef, mutton, kid
Chicken
Crab (blue, stone), crawfish, conch, oysters,
shrimp, spiny lobster; ocean fish, such as
mullet, pompano, shad; freshwater fish,
particularly catfish
Chicken eggs
Dried beans; peanuts
Brunswick stew, squirrel stew, possum ‘n’ taters,
turtle soup
Ham on beaten biscuits, sliced ham and red-
eye gravy; barbecued pork; souse (head
cheese); chitterlings; Texas-style barbecued
beef, chili con carne, son-of-a-bitch stew;
cabrito
Fried chicken with cream gravy, chicken and
dumplings
Crab, shrimp, or crawfish boils; crab cakes;
she-crab soup; conch chowder; oyster stew;
shrimp pilau; shrimp Creole; jambalaya;
gumbo; étouffée; fish muddle; fried catfish
Scrambled eggs and brains, scrambled eggs
and ramps
Baked beans, butter bean custard; peanut
soup, peanut brittle
Cereals/Grains Corn, rice, wheat, buckwheat Hominy, grits, corn pone, hush puppies,
cornbread, spoon bread; rice pilaus; beaten
biscuits; buttermilk or sour milk biscuits;
buckwheat pancakes
Fruits/Vegetables Apples, huckleberries, key limes, oranges,
mayhaw, peaches, watermelon
Wild greens (cochan, creases, dandelion, dock,
lamb’s quarters, poke, sorrel, and ramp),
domesticated greens (e.g., mustard, turnip),
black-eyed peas, cabbage, okra, ramps, sweet
potatoes
Preserves and pickles; fried pies; key lime pie;
ambrosia; peach pie
Greens simmered with fat back or salt pork,
consumed with pot likker; poke salad (sallet);
fried ramps; hoppin’ John; coleslaw, fried okra,
okra stews; sweet potato pie
Additional Foods
Seasonings Chile peppers (especially bird’s eye); filé; celery,
garlic, onions, green peppers; bourbon,
sherry, whiskey
Pepper sherry, chile powder, hot sauce; High
Holy mayonnaise; barbecue sauce
Nuts/seeds Black walnuts, hickory nuts, pecans; sesame
(benne) seeds
Nut cakes, brittles, glazed pecans, pecan pie,
pralines; sesame seed candies and cookies
Beverages Buttermilk; bourbon, corn whiskey, Sherry,
Tennessee whiskey
Whiskey and bourbon are added to barbecue
sauces, baked goods, candies
Fats/oils Lard
Sweeteners Sorghum syrup Used over pancakes, grits, cornbread, in coffee
TA B L E 15. 8 Southern Specialties
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C H A P T E R 1 5 5 0 7
South Atlantic
Plantation hospitality was famous in the
South Atlantic region. A description of a
meal served to guests in Georgia from the
early 1800s listed turtle soup, trout, ham with
sweet potatoes, turkey with a cornmeal and
walnut stuffing, rice, asparagus, and green
beans, followed by orange sherbet to cleanse
the diners’ palates before continuing with cold
venison, cheese, corn fritters with syrup, and
sweet potato pie.11 Traditional southern fare,
such as Georgia squirrel stew, ham, hoecakes,
okra with tomatoes, and biscuits served with
preserves, was served at family meals as well.
Hot breads are the cornerstone of every
meal in the states of the South Atlantic, pri-
marily cornbreads (see Table 15.9) or biscuits.
In Virginia, spoon bread is a specialty; it is a
cornbread enriched with eggs and milk then
cooked until it forms a crust on the top but
remains custardy underneath. In Delaware the
biscuits are made with sour milk. Beaten bis-
cuits prepared by hitting the dough repeatedly
with a rolling pin to produce pockets of air for
leavening, are a favorite in many areas.
Country hams, ribs, fatback, cracklings,
and chitterlings were traditionally produced
from hogs, and remain important today. In
Maryland, one recipe that is popular, particu-
larly in the southern sections of the state, is
stuffed ham. It calls for inserting greens (e.g.,
cabbage, kale, and/or watercress) flavored with
onions, mustard seeds, and cayenne into deep
slits of the ham. The ham is served cold and
is often the centerpiece of the Easter meal. In
Virginia, Smithfield ham is a specialty, adapted
from the process used by the local Powhatan
Indians to salt-cure and smoke venison. A
Smithfield ham is similar to a country ham
(see the section “West North Central”), but
it is made with the shank end of the leg and
with the bone in. It is first rubbed with salt,
sugar, and pepper for curing, then smoked
over hickory, and then hung to age. The meat
differs from a country ham in that it is saltier,
darker in color, and leaner. The flavor is very
strong, and it is traditionally eaten in very thin
slices on biscuits or fried with red-eye gravy
(made with the ham drippings and coffee)
and served with fried apples. Another Native
American game dish adopted by the southern
settlers, Brunswick stew, became a mainstay
throughout the region. There are many varia-
tions, but most contain chicken, ham or salt
pork, corn, beans, potatoes, onions, tomatoes,
and lots of black pepper.
Chicken dredged in cornmeal or flour and
fried in lard, traditionally served with cream
gravy, is the quintessential dish of the region.
Though popular throughout the entire South,
poultry is especially associated with Delaware.
The first broilers in the nation were marketed
in the state during the 1920s when an excess of
chicks prompted an enterprising egg producer
to sell the birds when they reached about two
pounds at sixteen weeks of age. This was far
younger than most chickens were sold at the
time and yielded a tender bird that could be
roasted or broiled instead of stewed or fried.
It was the beginning of a national industry,
and today broiled chicken is the state dish
of Delaware. Roasters are also popular in
Maryland where other chicken specialties
include pot pies and chicken seafood stews.
Cornbread Made with white cornmeal, eggs, and water. No sugar is added. Baked in a pan,
sliced into squares, served with butter, honey, or sorghum syrup.
Cracklin’ bread Usually yellow cornmeal bread with added pork cracklings for flavor, traditionally
cooked in a frying pan on the stove.
Spoon bread Yellow cornmeal bread made with eggs and milk. Baked slowly in a pan until
golden crest forms on top and center remains custard-like.
Corn pone Yellow cornmeal and water (lard added if available) mixed into a stiff dough,
formed into sticks (sometimes called “corn sticks”) or patties (sometimes called
“hoecakes”) and cooked in a skillet.
Hush puppies Yellow cornmeal and water dough, with added egg and buttermilk if available, Hush puppies Yellow cornmeal and water dough, with added egg and buttermilk if available,
formed into balls and deep-fried.
TA B L E 15. 9 Southern Corn Breads
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5 0 8 R E G I O N A L A M E R I C A N S
Seafood is especially important in the South
Atlantic coastal areas. Maryland, for example,
is famous for its shellfish. The state is indented
by the largest estuary in the nation, Chesa-
peake Bay, which teems with oysters, clams,
scallops, and crabs. Oysters were so common
that many settlers in the region ate them three
times a day: raw, fried, baked, fricasseed, in
seafood stews, in chowder, in oyster stuff-seafood stews, in chowder, in oyster stuff-seafood stews, in chowder, in oyster stuff
ing for turkeys, and over steaks. Crabs were
equally versatile. A regional specialty is blue
crabs, a swimming crab so named because
the underside of the large claws is blue. They
are traditionally steamed over water flavored
with vinegar and seasoned with salt, pepper,
ground ginger, celery and mustard seeds, and
paprika. Because they are small, half a dozen
or more are served to each diner, with plenty
of beer to wash them down. The meat is used
to make one of Maryland’s most esteemed
dishes, crab cakes. The crab is mixed with a
little mayonnaise, cracker crumbs, and a spicy
seasoning of cayenne, dry mustard, and hot
sauce, and then formed into small patties and
fried. They are served with lemon wedges
and tartar sauce. Crab soup (with beef stock
and bacon) and deviled crabs (baked in the
shell and topped with bread crumbs) are other
common preparations. Another noteworthy
shellfish of the region is soft-shell crab—a
blue crab that has shed its hard shell during
a molt. The new papery shell is completely
edible, but it begins to harden after only a day.
Blue crabs are often kept in tanks until they
shed their hard shells to time harvesting of
the soft-shell crabs. The whole crab is served
deep-fried or sautéed.
The Florida waterways and coastline also
offer a profusion of seafood. Red snapper,
pompano (a very large, meaty fish), mullet,
and tarpon are a few of the fish commonly
available; shellfish includes shrimp (several
varieties), spiny lobster (similar to those of
New England, but without claws), conch
(a large mollusk), and stone crabs (only the
very large claw is eaten—the claw is removed
when the crab is caught, and then the crab is
thrown back in the water to grow a new one).
Many of Florida’s specialties have developed
out of this unique ocean larder. Red snapper
fillets are baked with orange juice. Pompano
is stuffed with shrimp, seasoned with Sherry,
and baked, or prepared en papillote (with
a nod to the French influence of the Gulf
Coast states). Spiny lobster tails are stuffed
with fish and grilled, while stone crab claws
are traditionally boiled and served with garlic
butter or mustard sauce. Rock shrimp, a hard-
shelled, white shrimp that tastes like a cross
between lobster and shrimp, has become
a trendy restaurant item throughout the
country. Conch fritters and conch chowder
(made with onions and tomatoes, seasoned
with Worcestershire sauce, oregano, and bay
leaves) are popular.
Elsewhere in the region, oyster roasts (sim-
ilar to a New England clam bake) are favor-
ites in South Carolina, served with hoppin’
John, biscuits, and small sandwiches, such
as a crab omelet on slices of bread. Oyster
suppers, informal feasts featuring oysters
cooked over a fire in the moonlight, then
served with melted butter, are popular in
Georgia. Shrimp are common in the Caroli-
nas, including shrimp pâté or butter-sautéed
shrimp with grits for breakfast, and deep-fried
shrimp and rice croquettes. In Delaware, one
specialty called muddle (a stew of miscella-
neous fish with potatoes and onions) capital-
izes on coastal resources. A variation unique
to South Carolina is pinebark stew, a muddle
▲
Fried chicken is the
quintessential dish of the
South. It is often served with
cream gravy and biscuits.
Be
th
D
ix
so
n/
A
la
m
y
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 5 5 0 9
flavored with bacon, named for the tiny roots
of pine trees that seasoned it traditionally, or
because it was cooked over a pine bark fire.
Also common in the state are frogmore stew, a
spicy seafood, sausage, and corn combination
similar to gumbo, and she-crab soup simi-
lar to that of Maryland but garnished with a
spoonful of Sherry and a dollop of unsweet-
ened whipped cream.
Long-grain rice is common in many parts
of the South Atlantic region. A variety of rice
native to Madagascar was found suitable for
the coastal plain climate of South Carolina,
and thousands of acres of tidal lands were
diked and flooded to support the crop. By
1700, it was well established, thanks in part
to the skills of slaves from the rice-growing
regions of Africa. It became known as
“Carolina Gold” (due to its amber color when
ripe). The rice was traditionally boiled instead
of steamed to produce individual fluffy grains
that did not stick together. French Hugue-
nots who settled in South Carolina dur-
ing the seventeenth century are thought to
have introduced pilau (also spelled purlow,
or pullow), which has become a specialty of
the region. It is characterized by combin-
ing a single additional ingredient with rice,
which is first simmered in an aromatic broth
(reserved from cooking the secondary ingre-
dient) until dry, then mixed with the other
food. Shrimp pilau and okra pilau are exam-
ples. African-influenced hoppin’ John, made
with black-eyed peas and rice, is also a pilau.
Molded rice dishes that are baked until they
form a golden crust are called rice pies or rice
casseroles. Some include layers of meat or
fish. One unusual rice dish found in Georgia
is Country Captain Chicken, invented by a
sea captain from Savannah who used Indian
spices to liven up his routine fare aboard ship.
It is a curried chicken that includes tomatoes
and green peppers and is served over rice.
In the Carolinas, rice breads, such as philpy
(cooked rice added to cornbread), and des-
serts, such as rice pudding, are also found.
Certain crops historically associated with
the South Atlantic states have been in the
region so long they are occasionally mistaken
as native foods. Some accounts state that
Native Americans of the region cultivated
melons. Melons are not native to the New
World, although it is possible they were
brought to Florida by the Spanish explorers
of the sixteenth century, in which case the
Indians may have been growing them for
perhaps one hundred years by the time white
settlers arrived from the North. Tomatoes are
a food that the Spanish may have brought to
the region from elsewhere in the Americas.
They also introduced peaches to the Caro-
linas, which at one time were so plentiful
they were used as hog feed. Today South
Carolina is the largest producer of peaches
in the South, second only to California in the
nation.
Oranges, the foundation of the Florida
citrus industry, were another early introduc-
tion by the Spanish. Later, grapefruit were
hybridized from pummelos that had been
brought from the Caribbean, and other citrus
fruits, such as tangerines, tangelos, and Per-
sian (also known as Tahiti) limes, were intro-
duced. Key limes—small, thin-skinned yellow
limes with juicy, green flesh—were discovered
in the Florida Keys. It is not known where the
limes came from, but it is assumed that they
drifted to the islands from the Caribbean.
They are grown mostly in home gardens and
are renowned for their tangy flavor. Today,
63 percent of the U.S. citrus crop is grown in
Florida (nearly all the oranges are processed
into juice). Florida is also known for other
subtropical crops, such as avocados, guavas,
kumquats, mangoes, papaya, and pineapples,
as well as early-ripening crops, such as toma-
toes and strawberries. Sugarcane is grown
in the south of the state, and sabal palmetto
palms grow like weeds, providing the deli-
cacy known as hearts of palm. In Georgia,
pecans, peanuts, and watermelon are com-
monly cultivated. Vidalia onions, thought to
be exceptionally sweet due to the mild Geor-
gia weather and the low-sulfur soil around
Vidalia in Toombs County, Georgia, are a
specialty crop sold throughout the nation.
Mayhaw jelly, made from the cranberry-like
fruit of the native mayhaw tree, is a particu-
lar favorite in Georgia and other states along
the Gulf Coast. Other native fruits found in
the South Atlantic are muscadine grapes and
scuppernongs (the bronzy white version of
Hoppin’ John is served on
New Year’s Eve in South
Carolina and other parts
of the South because
eating the rice and black-
eyed peas is thought to
bring good luck in the
upcoming year.
Unlike most states of the
South Atlantic, neither
corn nor rice grows well
in the cool, damp climate
of West Virginia. Buck-
wheat, however, thrives.
Buckwheat pancakes
served with whole-hog
sausage and applesauce
are a specialty.
Thomas Jefferson
brought many French
specialties to his home
in Monticello, such as
boeuf à la daube (jellied
beef ) and crêpes. He also
brought Italian foods,
including pasta, to the
United States. His daugh-
ter, Mary Randolph, is
credited with introducing
macaroni and Parmesan
cheese, which evolved
into the American dish,
macaroni with cheddar
cheese.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
5 1 0 R E G I O N A L A M E R I C A N S
muscadines), which are used to produce jams,
jellies, pies, and wine.
Immigrants from Europe have contrib-
uted only limited ingredients and dishes to
the foods of the South Atlantic. In Virginia,
English settlers favored roasted beef dishes,
mutton, and Yorkshire pudding. In Georgia,
a French nuance can be seen in the popular-
ity of dishes such as crab soufflé; common
German-style dishes include sauerkraut
and pepper pot soup; and the Scots brought
scones and haggis (hog’s stomach stuffed with
oatmeal—see Chapter 6). In South Carolina,
a French influence was seen in many dishes,
particularly elaborate desserts like Huguenot
torte (a sponge cake with pecans and apples)
and charlotte russe (a special cylindrical
mold lined with ladyfingers, then filled with
Bavarian cream and garnished with strawber-
ries and whipped cream). In Florida, Greek
immigrants who came to Tarpon Springs for
sponge-fishing jobs at the beginning of the
nineteenth century (see Chapter 13) intro-
duced traditional dishes such as moussaka
(stuffed eggplant), spanakopita (spinach- or
cheese-filled phyllo dough pastries), and gyros
(pita bread sandwiches). In West Virginia
lasagna, fagiole (pasta with beans), minestra
(vegetable soup), and cannoli are popular in
the area around Clarksburg where more than
half the population is of Italian descent.20
One notable ethnic group in North Caro-
lina is the German Moravians, persecuted
German Protestants who had immigrated to
Pennsylvania originally but moved south in
the early 1700s when they discovered that
much of that land was already claimed. The
Moravians established an insular German
community near the Winston-Salem area,
founding a wholesale produce business that
sold local fruits and vegetables in markets
extending to Philadelphia. They were best
known for their baked goods, such as sugar
cakes (a yeasted, potato bread dough covered
with brown sugar and cinnamon before bak-
ing) and citron tarts (tarts with lemon curd
filling). Moravians commemorate special
occasions, including November 17 (the found-
ing of North Carolina), with Love Feasts fea-
turing wine, creamy coffee, and cakes topped
with a nut frosting. At Christmas, paper-thin
ginger spice cookies and a sweet bread stud-
ded with raisins and candied citron, sprinkled
with sliced almonds, are specialties.
In recent years a more significant culinary
influence in Florida has been the contribu-
tions of Cuban immigrants to the Miami area
(see Chapter 9). Arroz con pollo is made with
chicken and rice, flavored with the Cuban
combination of tomatoes, olives, capers, rai-
sins, and chile peppers. Black beans, tradition-
ally prepared with rice and salt pork or ham,
are common. So-called Cuban sandwiches,
with roast pork, ham, sausage, cheese, and
dill pickle filling mounded on Cuban bread,
are fast-food favorites. Flan, a baked custard
with caramel topping (sometimes flavored
with orange), has become a popular dessert.
Cuban cuisine is not the only spicy food
found in the South. Many settlers, especially
in South Carolina and Georgia, had lived first
in Barbados and other Caribbean Islands.
They brought a taste for tropical flavors and
spicy seasonings. Fruit and vegetable pickles
were common, for example, mango chutney
from India, which was also made with other
local fruits and called “Indian pickle.” Today,
Jerusalem artichoke, okra, green tomato,
squash, and watermelon rind pickles are still
popular condiments in the region. In Geor-
gia, very small (one-fourth to one-half inch)
scorching-hot bird’s eye peppers (also known
as tepin chiles) are sometimes crushed and
placed at the bottom of a bowl before adding
soup or stew. Pepper sherry, made by infusing
incendiary Scotch Bonnet chiles in sherry, is
a popular condiment added to dishes for zing
in South Carolina.
Desserts have always had a place on the
South Atlantic table. Tea breads and cakes
(such as Sally Lunn cake, best described as
a sponge cake–like bread, which is popular
throughout the region), fruitcakes, and pies
are common. Peach pie is the consummate
Georgia dessert, although recipes vary. Some
are custard pies topped with sliced peaches,
others are two-crust pies, and some are indi-
vidual deep-fried pies. Pecan pie is popular
as well. Key lime pie, a specialty from Florida
now found throughout the South, tradition-
ally includes a lime custard filling covered
with a meringue topping but can also be made
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 5 5 1 1
as a chiffon pie (folding the meringue into the
custard to lighten it and then topping the pie
with whipped cream). Ambrosia, made with
sliced oranges and grated coconut, is another
Florida dessert common in other states of the
region. Puddings and custards were an every-
day treat in the early days of settlement, made
with leftover cornmeal, rice, or bread; choco-
late was a favorite but costly, so it was used
only at special occasions. Today, bread pud-
dings are still favorites. Candies, such as divin-
ity with nuts and nut brittles, are specialties.
The cooking of the more rural inland areas
of the South Atlantic states differed from the
more populated coastal areas. During the
early 1800s, Scotch Irish immigrants search-
ing for religious freedom began making their
homes in the Blue Ridge, Cumberland, and
Great Smoky mountains of the Appalachians.
They also spread west to the Kentucky and
Tennessee frontier. English and some Welsh
settlers moved from the coastal South Atlan-
tic states inland to the hilly Piedmont areas.
Germans from Pennsylvania traveled south
along the Shenandoah Valley into Virginia
and North Carolina. Hogs ‘n’ hominy (pork
and corn) kept the pioneers going until they
established small farms. Frontier meals were
robust. For example, the noon meal might
consist of ham, bacon or sausage, chicken or
grouse, game meat, dumplings or biscuits,
cornbread or grits, gravy, sweet potatoes, and
boiled greens served with coffee, milk, or corn
whiskey.
Traditionally every bit of the pig was con-
sumed on Appalachian farms, including the
snout, or rooter (which was roasted), the tail
(which was added to stews), and the brains
(which were usually boiled, mashed, and
scrambled with eggs). Bacon and cabbage, and
ham with cream gravy were typical entrees,
while barbecued pork with spicy hot sauce on
the side was prepared for special occasions.
Most families kept a dairy cow and a breed-
ing cow for a few calves each year. Fresh beef
was preferred. When a cow was slaughtered,
it would be shared with neighbors, who would
later return the favor.
Game supplemented the diet, especially
squirrel, rabbit, raccoon, opossum, turtle,
and frogs. Badger, considered by some a
dish of last resort, was known as bombo in
North Carolina hill country. Brunswick stew
is a favorite. Wild greens were well loved by
adults in the Appalachians, but not so popu-
lar with children.21 Poke, creases (similar to
watercress), dandelion, lamb’s quarters, dock,
sorrel, and ramp (a particularly assertive wild
onion) were added to soups, stews, potatoes,
or eggs, or cooked as a side dish. Poke salad is
representative: a cooked salad (from the Eng-
lish tradition) in which the greens are par-
boiled, then fried in bacon or fatback grease
until tender. They are seasoned with salt, pep-
per, and hot sauce or vinegar. Domesticated
greens such as mustard and turnip greens
were also common.
Other than greens, green beans, hominy,
sweet potatoes, potatoes, okra, and beets
were the most frequently consumed vegeta-
bles. Cornbread (sometimes with cracklings
added), biscuits, dumplings, and/or grits were
served at every meal. Pinto beans, called soup-
beans, were common, served with cornbread
crumbled on top or a dollop of pickled veg-
etable relish (i.e., cabbage, bell peppers, green
tomatoes, onions, chile peppers). Watermelon
was a favorite fruit, eaten fresh or preserved
as pickles or jam. Applesauce, apple pies, and
fried apple slices were popular. Honey was
the most common sweetener, even consumed
▼
Key lime pie, which has
a lime custard filling and is
traditionally covered with
meringue, can also be made
as a chiffon pie (folding the
meringue into the custard to
lighten it and then topping
the pie with whipped cream).
M
ic
ha
el
L
am
ot
te
/C
ol
e
G
ro
up
/P
ho
to
di
sc
/G
et
ty
Im
ag
es
Coca-Cola was invented
by an Atlanta pharmacist
in 1886 as a headache
remedy. “Dope” is a slang
term for cola drinks in
parts of the South.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
5 1 2 R E G I O N A L A M E R I C A N S
alone as a dessert. Thick, caramel-colored
sorghum syrup was also used, poured over
cornbreads or used to sweeten coffee.
Many of these foods are still favored in
the Appalachians today, though research
suggests changes in preparation techniques
and the use of convenience food items are
increasing as dependence on hunting and
farming decreases.22 A survey of senior adult
Appalachians found that they were interested
in lower-fat diets and had switched to baking
and broiling instead of frying. Shortening has
replaced lard in many dishes. Many also use
items such as cornbread mixes instead of pre-
paring foods from scratch.22 However, even
those who have relocated to other areas may
maintain their heritage by regularly consum-
ing fried chicken with gravy, soupbeans, skillet
cornbread, biscuits and gravy, fried potatoes,
green beans cooked in lard, and other foods
typical of Appalachian fare.23
East South Central and West South
Central
The early fare of the East South Central and
West South Central states was similar to that
of the Atlantic states but with more significant
French overtones. Immigrants from France
settled in the Gulf Coast region during the
seventeenth century, and at the end of the
eighteenth century, French Acadians from
Canada relocated to Louisiana (see Chapter 6).
They were joined by white American and
English settlers arriving from the North. Plan-
tation life in the region was similar to that of
the South Atlantic, except that it was more
dependent on cotton than on tobacco. The
tradition of the big southern breakfast and
dinner may have originated in the region and
was the norm for plantation owners and their
city associates. Coffee and mint juleps were
available for early risers. Late morning repasts
included eggs, grits, biscuits, cornbreads or
muffins, waffles, and several meats, such as
ham, sausage, or fried chicken. A large dinner
with soups, stews, and dishes similar to those
at breakfast was consumed in the early after-
noon; supper was a lighter version of dinner.
Pork and corn remained key to the cook-
ing of the ESC and WSC. The cornbread in
this area is made from white cornmeal with-
out the addition of sugar. The French added
their recipes for soups, stews, fricassees, and
baked goods to the southern mix, as well as
their appreciation for good eating. The result-
ing cuisine is found in some form through-
out the Gulf Coast, from Mobile, Alabama to
Beaumont, Texas. The French factor accounts
for such adopted and adapted specialties as
bouillabaisse (a French fish stew); fish cooked
en papil l ote (in paper packets with a v el outé
sauce); and sauc e mah onaise (homemade
mayonnaise), particularly High Holy mayon-
nais” (a fanciful, Anglicized term for aïoli)
made with fresh garlic and served with shrimp
or cucumbers. Creole cuisine, a blending of
French, Spanish, African, English, and Native
American cooking, is unique to New Orleans.
It is a complex fare with many refined dishes;
celery, tomatoes, bell peppers, onions, and
garlic are the hallmark flavorings.
Cajun fare, created by the French Acadi-
ans, is mostly limited to the bayou country of
Louisiana, though its gumbos, jambalayas, and
é touf f é es have become popular throughout the
region (see Chapter 6). While Oklahoma and
Texas are both southern in attitude and enjoy
many specialties of the South, such as grits,
greens, Gulf Coast seafood, and Brunswick
S a m p l e M e n u
A Southeastern Luncheon
Fried Oystersa,b,c
Shrimp Pilaub,c
Okra with Tomatoesa,c
Biscuits or Cornbread Ambrosiaa
aLewis, E., & Peacock, S. 2003. The gift of Southern cooking. New York:
Knopf.
bJamison, C.A., & Jamison, B. 1999. American home cooking. New York:
Broadway Books.
cSouthern U.S. Cuisine at http://www.southernfood.about.com
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 5 5 1 3
stews, their dishes are also influenced by Native
American, central European, and Latino cook-
ing. Beef is the dominant meat; barbecue is
prevalent; and hot, spicy seasoning emboldens
their dishes.
The fare of the ESC states is more homoge-
neous than that of the WSC region. Alabama,
Kentucky, Mississippi, and Tennessee share
many culinary traditions. The French influ-
ence is limited to the coastal areas, where
dishes feature seafood as the main ingredient.
In Alabama, shrimp are especially prevalent,
prepared fried, boiled in seasoned water, with
rémoulade sauce, and stuffed into mir l eton
(chayote squash), avocados, and other vege-
tables. Plump, local oysters, called Bon Secour
oysters, are plentiful and popular throughout
the Gulf Coast. In Mississippi, rock shrimp
and blue crabs are typically boiled, served
with an assortment of seasonings, such as vin-
egar, lemon juice, bird’s eye chiles, and cloves.
Outdoor oyster bakes and fish muddle served
with corn dumplings are other Mississippi
coastal favorites.
It is the inland foods of the ESC states that
are most associated with the region, however.
Sumptuous breakfasts are still common in
some areas. In western Tennessee, for instance,
the meal may feature eggs, tomatoes, potatoes,
and cornmeal biscuits with sorghum syrup.
During the winter, thick slices of Tennessee
country ham with grits and red-eye gravy are
often served with the meal; in the summer,
fried chicken is more common. ESC dinners
and suppers also include many traditional
items. Fried chicken is found throughout the
region. In Alabama chicken and dumplings,
ham balls (fried fritters), and Brunswick stew
(made with a whole hog’s head) are special-
ties. In many areas biscuits and cornbreads
such as sweet potato biscuits, crackling bread,
hoecake bread (cornmeal and water cooked
in a frying pan), and beaten biscuits are eaten
daily. Tennessee pork sausages are a specialty,
as is spiced beef (marinated in vinegar, brown
sugar, and seasonings, then simmered and
sliced thinly). In the eastern region of the
state, barbecued ribs prepared with a tomato-
whiskey sauce are a favorite. Hominy, greens,
okra, green beans, black-eyed peas, peas, but-
ter beans (similar to lima beans, but slightly
smaller), rutabagas, and turnips are typical
side dishes of the region. Many of these foods
are cooked in lard or flavored with pork. In
Kentucky, for example, green beans are sim-
mered with bacon throughout the day to
make a smoky, mushy stew.
Game meats are prevalent in some areas.
Squirrels and frogs are featured in certain
dishes from Alabama. Early settlers in Ken-
tucky depended on game. Bear meat was pop-
ular because it could be smoked like pork and
was fatty enough to provide bacon. Burgoo, a
stew traditionally made with wild birds and
game meats such as squirrel, is the signature
dish of Kentucky. It is still made this way in
some areas, though most current versions use
chicken, pork, beef, or lamb; cabbage, pota-
toes, tomatoes, lima beans, corn, okra, and
cayenne—and some variations add filé pow-
der, curry powder, or bourbon. In eastern
Tennessee the diet was historically closer to
Appalachian fare than the plantation style of
the western half of the state. Deer, raccoon,
opossum, squirrel, and wild turkey were pri-
mary meats for the settlers of the area and are
still consumed occasionally today.
In Mississippi, catfish up to one hundred
pounds can still be caught in the rivers and
lakes of the state, but most are now farmed in
ponds. Although the first catfish farms were
started in Arkansas, Mississippi is the leading
producer in the nation, with over 250 million
pounds harvested annually. Traditionally,
catfish is deep-fried in a cornmeal crust and
served with hush puppies and coleslaw. Newer
recipes include fried strips served with barbe-
cue sauce or mustard, and catfish pâté.21
Sweets in the ESC states are favorites. In
Alabama seasonal pies were popular, espe-
cially dewberry (the first ripe fruit of the sum-
mer season) and peach. Fried pies, a southern
specialty, are thought to have originated in the
state. Small circles of pie crust are filled with
fruit (typically peaches or peach preserves
in Alabama), then folded into a half-moon
shape, crimped, deep-fried, and sprinkled
with powdered sugar. Rich, chocolaty Mis-
sissippi mud pie has become popular nation-
wide, while butter bean custard pie is a local
specialty of the region, made with mashed
butter beans cooked as a sweet pudding
Moon pies are a
Chattanooga, Tennessee,
confection that have
become an obsession
in the South. They
are graham cracker
sandwiches with a
marshmallow filling
covered in chocolate,
vanilla, banana, or
caramel icing. During
the Great Depression,
a moon pie and an
RC Cola were called a
“ working-class dessert”
because both could be
had for a dime.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
5 1 4 R E G I O N A L A M E R I C A N S
flavored with cinnamon, cloves, and nutmeg.
Banana pudding is another favorite. Pecans
are native to Mississippi and added to breads,
sugar glazed, orange glazed, and baked in the
syrupy sweet pecan pie. Many farms in east-
ern Tennessee had at least one apple tree, pro-
viding fruit for apple butter and pies. Funnel
cakes, undoubtedly introduced by German
immigrants, are topped with sorghum syrup.
Fried pies were also popular.
Traditional beverages consumed in the ESC
states include buttermilk and coffee, though
iced tea and soda (most often called pop) are
more popular now. Sassafras tea is common
in eastern Tennessee. Perhaps the best-known
food products of the region are alcoholic
beverages. Bourbon was developed in Ken-
tucky. Many of the early Scotch Irish settlers
in the state discovered farming corn for corn
whiskey was more profitable than farming it
for cornmeal. It is thought that the first corn
whiskey aged in oak barrels, creating the char-
acteristic flavor of bourbon, was produced in
Bourbon County, Kentucky, in the late eigh-
teenth century. In 1860, a further refinement
occurred when it was accidentally discovered
that charred oak barrels added not only a
touch of color, but also a favorable smoky taste.
The favorite bourbon drink of Kentucky is the
mint julep (bourbon sweetened with a touch
of sugar or syrup and a hint of fresh mint),
traditionally served in a silver cup. Bourbon
also flavors stews, hams, pound cakes, fruit-
cakes, and bourbon balls (a candy made with
chocolate, crushed vanilla wafers, pecans, corn
syrup, and bourbon). Whiskey is associated
with Tennessee. In 1866 Jack Daniel purchased
a corn whiskey still and added an extra refine-
ment to the distillation process, using maple
wood charcoal to filter the whiskey before
aging it in charred oak barrels. This produced
a flavor distinct from bourbon, and the liquor
became known as Tennessee whiskey.
The foods of the WSC states (Arkansas,
Louisiana, Oklahoma, Texas) share some sim-
ilarities due to geographic proximity but also
vary due to historical influences. Arkansas
exemplifies the region. It is at the crossroads
of the South, the Southwest, and the Mid-
west. The diverse terrain in the state includes
the fertile alluvial plains of the Mississippi
River in the southeast of the state, the dry
pasturelands of the Southwest, the orchards
and wheat fields of the Northwest, and the
rocky hills and mountains of the Ozarks in
the Northeast. Settlers were mostly of English
or Scotch Irish heritage, and they brought
the foods they prepared in their home states,
such as cured hams, sausages, baking-soda
biscuits, and molasses pies from the North,
and fried chicken, buttermilk biscuits, sweet
potatoes, and peach cobblers from the South.
Barbecued beef and pinto beans are found in
the areas of the state adjacent to Texas,23 and
in the Ozarks the fare is similar to that found
in the Missouri section of the mountains (see
the previous section on the cooking of the
Midwest), with pork, game meats (especially
baked opossum and raccoon), corn, beans,
and greens the foundation of the diet.
Arkansas specialties include pork chops
with cream gravy (sometimes made with bits
of sausage in it) and pan-fried chicken that is
then baked with a Creole sauce. Arkansas is
also the leading producer of rice in the nation.
Ducks, which are attracted to the rice paddies,
are a specialty in the region, roasted over a
fire, baked with bacon and basted with wine
or port, and prepared as gumbo. Catfish have
long been an Arkansas favorite, dredged in
cornmeal and fried, or in catfish stew. Catfish
is traditionally served with hush puppies
(deep-fried cornmeal biscuits) and coleslaw.
Fare in the other WSC states overlaps with
that of Arkansas. The hilly north areas of Lou-
isiana feature dishes with pork and cornmeal.
The southern portions of Oklahoma are called
Little Dixie, and a study of foods in the east-
ern portion of the state found that pork, fried
chicken, catfish, biscuits and cream gravy,
cornbread, fried okra, and black-eyed peas
were frequent items in local eateries. However,
grits and buttermilk were rarely offered.24 In
the affluent eastern region of Texas, southern-
style dishes frequently feature costly ingredi-
ents and tend to be richer (with extra butter,
eggs, and cream) than versions from other
southern states. Cornbreads, biscuits, hominy
and grits, black-eyed peas, okra, sweet potato
pie, bread pudding, and pralines are a few
common items. Rice is an important crop, and
southern-style rice dishes are popular.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 5 5 1 5
Other similarities in the WSC states are
found. Cooking in parts of Oklahoma is simi-
lar to food in southwestern Arkansas, as seen
in the greater use of flour instead of cornmeal.
Although the Oklahoma territory was not offi-
cially opened up to settlement by whites until
1889, land-hungry homesteaders invaded the
state before then (they were called Sooners).
African Americans, many of whom had been
held as slaves by the Indians, purchased land
in the region after abolition. Most settlers
established small family farms. The plains
regions in the state are arid, and droughts
occurred regularly. The fare in this region of
Oklahoma derived more from scarcity than
from ethnic and regional preferences of the
settlers. Rabbit and turnip stew was flavored
with flour-thickened gravy, while beef and
wheat berries were the primary ingredients
of Oklahoma Stew. Baking-soda biscuits were
common, and black blizzard cake (a pound
cake whose name refers to the frequent dust
storms in the region) was a specialty.
In the Northeast and panhandle areas of
Texas, settlers also scraped out a living on
small family farms, surviving on corn, beans,
and native game and fish. When wheat proved
a successful crop in the region, cornbreads
were replaced with biscuits. In the western
areas of the state, beef has always been pop-
ular. It is served traditionally as stews and
steaks. Chicken-fried steak was one specialty
created to treat tough cuts—the steak is cut
thinly, then pounded with a mallet, coated in
flour, and fried. It is served with a ladleful of
gravy made with coffee. Bread or tortillas and
pinto beans often round out the meal. Today,
Texas pasturelands are the leading producer of
cattle, sheep, and lambs in the nation.
It is the differences in the cuisines of the
WSC states that are most noteworthy. Unlike
Arkansas, Louisiana was colonized by the
French, who established several fortified
settlements along the Gulf Coast, includ-
ing Nouvelle-Orléans (New Orleans) in the
1700s. African slaves were brought in to work
the plantations, and thousands of French Aca-
dians from Canada and French Creoles from
Haiti seeking refuge arrived.
Fish and seafood are more important than
pork in the southern regions of Louisiana.
The famous stews of the area, bouillabaisse,
gumbo, and jambalaya, are examples of dishes
made from coastal plenty. Shrimp is the pri-
mary seafood industry in Louisiana, marketed
throughout the nation fresh and frozen. It is
commonly served boiled with lemon butter or
with sauc e piq uante (tomatoes, green peppers,
onions, bay, vinegar, and hot sauce) over rice,
a dish often called shrimp Creole. Shrimp is
also added to stews and to stuffings for veg-
etables. Oysters are commonly served raw, on
the half shell, and by the dozen in the many
oyster bars of New Orleans. They are tradi-
tionally slurped with a squeeze of lemon juice
and a dash of hot sauce or a sauce mixed to
taste by each diner with catsup, vinegar, and
horseradish. Oysters, too, are added to soups
and stews.
Crawfish, which look like miniature
lobsters, are found in the all the fresh water-
ways of the state. They have become the
ethnic emblem of Cajuns and the regional
symbol of southern Louisiana. Over 100 mil-
lion pounds are produced annually. Some are
harvested from the wild, but most are culti-
vated in approximately 300 crawfish farms.
They are typically served at a crawfish boil,
where they are cooked in water seasoned with
cayenne, salt, and herbs. Potatoes or corn are
often added for side dishes. The crawfish are
placed in a gigantic mound in the center of
the table, and each person takes and peels as
many as desired. Only the meat in the tail and
the claws is edible, along with the fat found
in the head, which is extracted with a finger
or sucked out appreciatively. Crawfish are also
prepared fried, stuffed, as fritters, in soups and
stews, in pies, and étouffée (meaning “smoth-
ered”) in a spicy tomato sauce.
Other regional specialties include rice
dishes, such as the fried cakes called c al as, red
beans and rice, and dirty rice (cooked with
gizzards). Rice is also the foundation of dishes
like gumbo and jambalaya. Baked goods and
sweets are specialties, including French petits
fours, crêpes, beignets (deep-fried squares
similar to doughnuts), and pralines (pecan
candies). Café au lait, a favorite beverage in
New Orleans, is a dark-roasted coffee (some-
times flavored with chicory root) prepared
with equal amounts of hot milk. Café brûlot
Chuck wagon fare was
a cooking style all its
own, dependent on
the skills and whims
of the cowboy chefs
called “Cookie” or “Miss
Sally.” Beans, cornbread,
sourdough biscuits, and
coffee were the staples,
but some specialties
were created on the
trail, including “son-of-
a-bitch stew” (known
as “ son-of-a-gun stew”
in more genteel circles)
made with beef organs,
including tongue, brain,
liver, heart, and kidneys.
The term Creole is
often used to describe
Europeans born outside
Europe and is applied,
for example, to the
descendants of the
original French and
Spanish immigrants to
New Orleans.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
5 1 6 R E G I O N A L A M E R I C A N S
is a sweetened dessert coffee flavored with
brandy and c ur aç ao (orange liqueur).
Restaurant fare in New Orleans is
renowned. Among the nationally recognized
dishes created by local chefs are oysters Rock-
efeller (baked on a bed of salt with a rich
spinach sauce), oysters Bienville (baked with
a béchamel sauce and green pepper, onions,
pimento, and cheese), Bananas Foster (sliced
bananas cooked in butter, brown sugar, rum,
and banana liqueur served over vanilla ice
cream—it started out as a breakfast specialty),
and Ramos gin fizz (a shaken or blended
cocktail with cream, gin, lemon juice, orange
flower water, and egg whites). Street food is
equally tasty in the city. Fried oysters, sliced
tomatoes, and onions with tarter sauce on a
French bread roll are especially popular. They
are called peacemakers, from the nineteenth
century, when men would bring one home as
a surprise for dinner after a fight with their
wives. Po’ boy (for “poor boy”) is another name
for the sandwich, although a po’ boy may also
refer to a sandwich with deli meats, sausages,
and cheeses with or without gravy or toma-
toes. A muffeletta sandwich is yet another ver-
sion, usually including a chopped olive salad
with the meats and cheeses on a whole round
loaf of seeded Sicilian-style bread.
Oklahoma started its U.S. history as Indian
Territory, lands set aside in the 1820s for the
Native American tribes that had been dis-
possessed of their homes in the Gulf Coast
areas. Five major Indian groups lived in
the region: Cherokee, Chickasaw, Choctaw,
Creek, and Seminole. They were primarily
agrarian, growing corn, beans, and squash.
They gathered indigenous foods (such as
acorns, chestnuts, creases, grapes, Jerusalem
artichokes, hickory nuts, persimmons, ramp,
and sorghum) and hunted small game (see
Chapter 5). Today, Native Americans make
up approximately seven percent of the total
population in the state, over eight times the
national average. Traditional foods, such as a
Cherokee soup made with hickory nut cream,
called kanuche, and game dishes, are served
mostly at ceremonial occasions. Fry bread and
adapted dishes, such as scrambled eggs with
spring onions, are more common but have
not been accepted into the broader Okla-
homa cuisine.25 Other ethnic fare is available
in Oklahoma but not widely consumed. Some
Italian American foods are consumed, such as
spaghetti and meatballs, particularly around
Krebs in the southeastern region of the state.
Sauerkraut, potato soup, and dark breads are
evidence of German Russian influence, and
central European traditions are maintained at
heritage festivals. A few Tex-Mex items such
as chili con carne have become very popular.
Ethnic cuisine is much more evident in
Texas. The state is the size of New England, the
Mid-Atlantic states, Ohio, and Indiana com-
bined. It was occupied by Native Americans,
claimed by the Spanish and French, ruled by
Mexico, and existed as an independent nation
before it became part of the United States in
1846. Germans, Czechs, and Poles emigrated
from Europe to central Texas, attracted by
land grants. Sausages, ham, sauerbraten, sau-
erkraut, pumpernickel bread, potato salad,
potato dumplings, bierocks (meat-filled
pocket pastries), and strudel are popular in
areas where the Germans and other central
Europeans settled.
The most distinctive Texan fare evolved
in the south of the state, where Mexican
and Spanish influence added their flavors
to dishes. Some authentic Mexican foods,
such as tortillas, tamales, chalupas, salsas,
guacamole, and buñuelos (see Chapter 9)
were accepted by white settlers in the region.
However, most foods in the area are adapted
dishes with Mexican overtones, often referred
▲ Crawfish is a specialty
in southern Louisiana that
has become popular in other
areas of the South.
L.
F/
Sh
ut
te
rs
to
ck
.c
om
Sandwiches with deli
meats and cheese on
a French bread roll are
found throughout the
country. In addition
to being called “po’
boys” in New Orleans,
they are also known
as “ bombers” (upstate
New York), Cuban
sandwiches (made with
roast pork in Miami),
“grinders” (New England),
heros (New York City),
“ hoagies” (Philadelphia),
Italian meat sand-
wiches (Chicago), and
submarine sandwiches
(from a World War II naval
base in Connecticut).
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 5 5 1 7
to as “Tex-Mex cuisine.” Examples include
tamale pie, nachos, and most tacos and
enchiladas, which usually feature nontradi-
tional fillings. One regional specialty is chili
con carne, known in Texas as “a bowl of red,”
which began as beans, progressed to beans
with beef, and is now typically an all-beef
stew flavored primarily with hot chili pow-
der. Barbecue is also favored. Unlike barbecue
in other regions of the country (e.g., Kansas
City), there are two sauces involved in Texas
barbecue. The first, called the mop, or sop, is
used to marinate the meat before cooking and
for basting the meat on the spit or grill. (The
term mop for the sauce basted on barbecued
meat may have come from the use of a clean
mop to slap the sauce on whole carcasses.)
The second sauce is served on the side with
the cooked meat. Although barbecued beef is
most associated with the state, barbecued goat
kid (c abr ito) is almost as popular in the south-
ern sections. The unifying element in most
of these foods is that they are preferred hot
and spicy. In addition to chili powder, chile
peppers are used in many dishes. Numer-
ous varieties are added, but worth mention
is the tepín chile, the indigenous precursor to
domesticated pequin chiles. They are among
the hottest of all chiles (also called bird’s eye
peppers, described previously). Chiles often
flavor foods in Texas not normally associated
with the spice, such as cornbread and jelly. In
addition to chile peppers, other fresh fruits
and vegetables are now prevalent in south-
ern Texas due to irrigation. Cantaloupe, pink
grapefruit, peaches, sugarcane, and tomatoes
are a few examples of specialty crops.
Health Concerns
Health risk indicators in the South tend
to be higher than in the rest of the nation
(see chapters on each ethnic group for
population-specific data).12 Florida and West
Virginia have average or above-average rates
in every health risk and mortality category—
Alabama, Arkansas, Kentucky, Mississippi,
and Oklahoma show a similar profile, with the
exception of heavy drinking, which is below
average. Rates of obesity are the highest in the
nation with nine states having greater than
30 percent prevalence of obesity and diabetes.12
(See Figure 15.3.) Lack of leisure time exer-
cise, diabetes, low birth weight, and mortality
rates are of concern in many states. Only the
percentage of heavy drinking is substantially
lower in some areas. Nine of the southern
states are ranked lowest in the nation (41–50)
for health indicators.26 (See Table 15.10.)
The West
Regional Profile
The western United States is the largest
region in the nation, encompassing an enor-
mous diversity of lands, from the icy tundra
of Alaska to the tropical volcanic islands of
Hawaii. The tallest mountains in the country,
vast fertile valleys and coastal plains, stretches
of scenic desert, and temperate rainforest add
to the variety. It is the history of the open wil-
derness that links this region. Indigenous peo-
ples adapted their lifestyles to fit each climate
and terrain. Pueblo Indians made their homes
in the cliffs and cultivated corn, beans, chiles,
and squash; the Inuits of Alaska lived in ice
igloos and hunted sea mammals and fish for
food; and the native Hawaiians enjoyed such
fresh abundance that they cooked few dishes
(see Chapters 5 and 12). The first whites in
the West were explorers, trappers, miners,
and traders—hardy individuals (mostly men)
seeking their fortune. Emigrants came from
every direction: the Spanish and Mexicans
▲ Barbecue is a traditional
Tex-Mex method for
preparing food.
iS
to
ck
ph
ot
o.
co
m
/N
oD
er
og
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
5 1 8 R E G I O N A L A M E R I C A N S
from Mexico in the South, Russians from the
North, Chinese and Japanese from the West,
and the numerous pioneers of northern and
southern European descent (mostly English,
Scottish, Welsh, Danes, Swedes, Slavs, Italians,
and Greeks) from the Midwest, looking for
new farming, ranching, and fishing oppor-
tunities. The West is the most diverse region
not only in climate and terrain but also in
population.
The West is divided into the Mountain
states of Arizona, Colorado, Idaho, Montana,
Nevada, New Mexico, Utah, and Wyoming
and the Pacific states of Alaska, California,
Hawaii, Oregon, and Washington. Approxi-
mately 23 percent of all Americans reside in
the Western region,7 and, of these, over half
live in California. Large numbers of many eth-
nic groups reside in the West. Compared to
total U.S. figures, five times as many Pacific
Islanders and nearly twice the Asians, Latinos,
and Native Americans make up approximately
23 percent of the western population. This
includes disproportionate numbers of total
Inuit, Japanese, Aleut, Filipinos, Salvadorans,
Chinese, Vietnamese, Mexicans, American
Indians, and Koreans. African Americans and
whites fall below the U.S. average in the region.
Among whites residing in western states, there
are large numbers with Danish and Spanish
ancestry and Yugoslavian heritage (including
those from what are currently Croatia and
Serbia). (See Table 15.11.)
Furthermore, a few individual western
states report notable ethnic population fig-
ures. Asians and Pacific Islanders account for
over half the population in Hawaii, for exam-
ple. Latinos are a large percentage of both
the New Mexico and California populations.
Arizona and New Mexico host large numbers
of American Indians; Alaska Natives, includ-
ing Inuits and Aleuts, who make up 14 percent
of the population in Alaska. Though only
40 percent of persons living in the West adhere
to a Christian faith, the highest percentage
of Christians in the nation reside in Utah
(80 percent—nearly all are Mormons) and
large numbers are also found in New Mexico
(58 percent—many are Roman Catholics).
Despite the vast open space of the region,
over 86 percent of the population lives in met-
ropolitan areas. Average household income
according to American Community Survey
data is approximately $57,198. Persons living
in poverty is under the national average at
11 percent.7
Traditional Fare
The West was largely unknown to whites
before the nineteenth century. Adventurous
trappers and traders made their way into the
territory from the Great Plains, often surviv-
ing on dried bison meat. Miners who followed
the gold and silver strikes in the California
Mother Lode, Pike’s Peak in Colorado, Mon-
tana’s Grasshopper Creek, and the Alaska
Klondike prepared their own meals, usually
pork, beans, and hardtack (tough, dry, unleav-
ened bread or biscuits) three times a day. Some
were dependent on the way stations, hotels,
and boarding houses that opened to support
the rush.18 Neighborly hospitality, so common
in the Midwest and South, disappeared in the
name of profit; miners were charged the maxi-
mum for supplies (e.g., eggs for 50 cents each,
potatoes for $1 a pound, and a box of apples
for $500), and a meal would cost about $3 in a
local establishment. The farmers and ranchers
who later made their way westward frequently
consumed game with cornbreads and pota-
toes to complete the meal. Sourdough breads
and biscuits were common with settlers in
S a m p l e M e n u
A Gulf Coast Supper
Deviled Craba,b
Chicken and Sausage Gumboa,b,c
Pecan Pralinesa,b,c or Mississippi Mud Piea,b
aBarker, A. 2003. The best of Cajun and Creole cooking. New York:
Gramercy Books.
bClaiborne, C. 1987. Craig Claiborne’s sSouthern cooking. New York: Times Books.
cThe Creole and Cajun Recipe page at http://www.gumbopages.com
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
5 1 9
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Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
5 2 0 R E G I O N A L A M E R I C A N S
the Mountain states, California, and Alaska.
Mashed potato or a milk and flour starter was
left out to catch wild yeast and begin fermen-
tation. Once going, the starter was kept indefi-
nitely, replenished each time a little was used
as leavening (see Table 15.12).
The growth of towns and the success of
irrigation increased the food supply. Expen-
sive goods such as wines and chocolates
became available, and eastern specialties,
including Long Island duck and Smithfield
ham, were offered at restaurants. Depending
on the region, potatoes, corn, apples, wheat,
and hops prospered; cattle, dairy cows, and
sheep became plentiful. In Alaska and Hawaii,
white settlers faced different challenges. With
the arrival of experienced fishermen, more
of the Pacific coast seafood was utilized.
Salmon, crab, oysters, and clams were espe-
cially popular.
Immigrants from other countries came to
the West in search of mining and railroad jobs,
including the Chinese and Mexicans. Both of
these groups enjoyed highly seasoned foods
and promoted the use of chile peppers. Other
groups, such as the Italians, Japanese, and
some Greeks, became involved in fishing and
introduced specialties such as seafood ciop-
pino (a seafood stew using local fish and shell-
fish) and teriyaki. Many immigrants opened
restaurants and markets to serve the needs of
the booming towns. German sausages, Italian
cannoli, and Chinese stir-fried dishes were
all available. Still other immigrants arrived
looking for farmland; they planted the fer-
tile Pacific coastal regions and the California
Central Valley with temperate fruits and veg-
etables such as apples, pears, dates, grapes,
plums, prunes, cherries, artichokes, avocados,
broccoli, brussels sprouts, lemons, grapefruit,
and oranges.
The Mountain States
Cuisine in the Mountain states varies consid-
erably between the North and South. Cooking
in Idaho, Montana, Utah, and Wyoming was
influenced by the American and European
settlers and features the foods available in
the cooler climates of the northern ranges
and plains. Meats are a specialty. The fare in
the southwestern states of Arizona and New
Mexico is shaped by the limitations of the
desert and the significant Native American,
Spanish, and Mexican presence in the area.
The foods of Colorado and Nevada are mostly
northern states in their cooking, with some
southern state influences.
Bighorn sheep, deer, pronghorn antelope,
elk, moose, javelina (wild pig), bear, and bison
were prevalent in many parts of the North.
Recreational hunting is popular in the region,
and game meats are favorites. Venison with
huckleberry sauce is a specialty in Idaho, and
in Montana it is prepared roasted, or as chile
con carne, or into meatballs in a spicy tomato
sauce. Both venison and antelope are favorites
in Wyoming. Tenderloin, sirloin, and T-bone
steaks are cut; the ribs and sirloin tips make
roasts (sometimes marinated and braised in
wine, vinegar, and spices); the brisket, flank,
and plate are used for stews or hamburgers;
the hams are smoked; and miscellaneous meat
United States West Region
Estimate Estimate
Total: 311,536,594 ***** 72,808,624***** 72,808,624
White alone 238,007,238 1/–45,816 53,842,192
Black or African American alone 42,496,977 1/–22,810 4,157,054
American Indian and Alaska Native alone 5,142,542 2,084,294
Asian alone 17,845,862 8,186,351
Native Hawaiian and Other Pacific Islander alone 1,177,092Native Hawaiian and Other Pacific Islander alone 1,177,092 878,088
Some other race alone 16,399,187 7,216,657
Source: U.S. Census Bureau, 2013 American Community Survey.
TA B L E 15.11 Estimates of Ethnicity in the Western Region
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 5 5 2 1
is used to make Polish sausage or salami. In
Nevada deer are ranched for consump-
tion. Numerous game birds are found as
well, including geese, ducks, pheasant, par-
tridge, grouse, and wild turkeys. Pheasant
roasted with apples or in a pie is a favorite in
Wyoming. Fish, such as sockeye salmon, bass,
and catfish, is available in thousands of fresh-
water lakes and streams. Mountain trout is a
regional specialty.
Cattle and sheep ranching are the dominant
agricultural activities of the Mountain states.
TA B L E 15.12 Western Specialties
Group Foods Preparations
P r ot e in F ood s
Milk/milk products Milk, cheese (Cheddars such as Cougar Gold, Monterey
Jack, Tillamook); Basque sheep’s milk cheeses
Meat/poultry/
fish/eggs/
legumes
Native game, including buffalo, deer, elk, moose,
antelope, mountain sheep, mountain goats, bear,
javelina (wild pig), beaver, rabbit
Beef, mutton and lamb, pork
Clams (e.g., geoducks), crab (Dungeness, king, snow),
oysters, shrimp, squid
Salmon, tuna, halibut, mackerel, sardines, anchovies,
mahi mahi, bonito, marlin, snapper; freshwater fish,
particularly trout
Chicken eggs
Dried beans
Game meat steaks, roasts, stews (such as chili con
carne), hamburger, sausages; beaver tail
Steaks; beef enchiladas, tamales, chimichangas,
pirozhki; teriyaki; Indian tacos; pirozhki; teriyaki; Indian tacos; pirozhki; teriyaki; Pueblo pozole; lamb
spit-roasted or roasted with chiles; chorizo; luau (pit-
cooked) pork
Clam chowder, Seattle clam hash; cioppino, steamed
crab, crab cocktails, fried calamari; grilled or
poached salmon, lobimuhenno’s (salmon chowder);
sushi, sashimi, teriyaki; trout grilled with bacon
Hangtown fry
Chickpeas with lamb, chickpea pudding; Basque
beans; lentil soup with lamb, lentil and sausage
casserole, white beans cooked with pimento and
cheese; split-pea soup
C e r e als / G r ain s Wheat, corn Sourdough breads, biscuits, pancakes; sopapillas; fry
bread; panocha; capriotada; whole-wheat Mormon
bread; bara brith; malasadas; Hawaiian bread;
tortillas (corn or wheat); piki; Asian noodle dishes
(e.g., saimin) and dough-wrapped foods (egg/
spring rolls, lumpia, wonton); fortune cookies
F r uits / V e ge table s Apples, apricots, wild and cultivated berries, cactus fruit,
cherries, dates, figs, grapes, kiwifruit, lemons, oranges,
peaches, pears, pineapple, plums, prunes, sugarcane
Artichokes, avocados, asparagus, broccoli, breadfruit,
cauliflower, chile peppers, eggplant, jicama, nopales,
olives, onions, specialty lettuces (arugala, radicchio,
rocket), tomatoes, tomatillos, potatoes, taro root, zucchini
Fresh fruit desserts; fruit added to roasts or poultry
stuffings; preserves, jellies, wines; cold fruit soups
Fresh vegetable side dishes; mesclun salads;
guacamole; Basque potatoes; squash patties; poi
A d d ition al F ood s
Seasonings Chile peppers (especially New Mexico/Anaheim,
jalapeño/chipotle, serrano); cinnamon, cilantro,
epazote, cumin, garlic, oregano, mint, safflowers
(dried petals), yerba buena; chocolate; vanilla
Fresh chiles, dried chile powders, smoked chiles,
pickled chiles; salsas; red or green chile sauces;
mole sauce; fresh, dried, powdered, roasted, pickled
garlic
Nuts/seeds Almonds, hazelnuts, macadamia nuts, pine nuts Nuts/seeds Almonds, hazelnuts, macadamia nuts, pine nuts
(piñon seeds), pumpkin seeds
Beverages Varietal wines; coffee; tea (chamomile, Brigham Beverages Varietal wines; coffee; tea (chamomile, Brigham
Young); hot chocolate
Coffee drinks (lattes, etc.); picón punch
Fats/oils Olive oil
Sweeteners Sugar from beets, caneSweeteners Sugar from beets, cane Sugarcane is eaten fresh in Hawaii
©
C
en
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ge
L
ea
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in
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Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
5 2 2 R E G I O N A L A M E R I C A N S
Colorado is the leading producer in the nation
of lamb, known as Rocky Mountain lamb. In
addition, bison is raised and processed as a
specialty meat in the region. Pork is farmed in
Montana, and poultry, especially turkey and
eggs, is produced in Utah.
Forage is grown to support meat produc-
tion in the region, though wheat, oats, barley,
sugar beets, hops, lentils, beans, cherries, and
apples are cash crops in some areas. Pota-
toes are synonymous with Idaho. They are
grown primarily in the volcanic soils of the
Snake River plain, where 10 billion pounds
are harvested annually, approximately one-
third of national production. Sixty percent
are frozen, dehydrated, or milled into flour.
Peppermint and spearmint (grown for their
oils used in flavorings) are specialty crops in
the state. Native berries are a regional favorite,
especially in Montana, including huckleber-
ries, which are made into breads and pies, and
sour-tasting chokecherries, which are used in
pies, cakes, preserves, jellies, and wine.
Settlers of the region often brought their
favorite foods. For example, Wyoming
attracted a diversity of immigrants, many of
whom opened bakeries, confectionery stores,
and restaurants. French croissants, Middle
Eastern halvah (sesame seed candy), German
schnitzel, and Chinese wonton soup were
reportedly available in southeastern Wyo-
ming as early as 1900.10 In Montana Scandi-
navians who arrived from Minnesota to work
in lumbering brought yellow split-pea soup,
cold fruit soups, Swedish meatballs, and ham
with cherry sauce. Borscht, cheese-filled pas-
try shells (vatroushki), and cherry desserts
were favored by the Russians. The Scots made
oatmeal porridge and Mulligatawny stew
with mutton, and central Europeans brought
stuffed cabbage, dumplings filled with fruit or
cheese, and pancakes rolled around cherries.
In Idaho lobimuhenno’s (a salmon chowder)
was brought by the Finns; and bara brith, a
bread studded with currants, was favored by
the Welsh. Many dishes in Idaho today fea-
ture local ingredients with European nuances,
such as split-pea soup, lentil soup with lamb,
white beans cooked with pimento and cheese,
and ham with apple casserole. Apple jelly is
added to mayonnaise to make salad dressing.
Prunes are used in preserves and desserts,
such as prune-whip pie and prune pudding.10
In Colorado, chile peppers and other spices
came with the Mexicans, and dishes such as
chicken or turkey cooked in mole sauce (a
rich blend of spices, nuts, and unsweetened
chocolate) became popular throughout the
state.
One of the most notable ethnic groups in
the northern Mountain states is the Basques,
who settled in Idaho and Nevada, working
first as shepherds and later as land-owning
sheep ranchers. Initially only men came, later
bringing their families. Women did most of
the cooking, providing meals for the ranch-
ers such as biscuits with sheep’s milk cheese
and coffee for breakfast, and Basque beans
(pinto beans with lamb or pork), lamb stews,
or Spanish-style potato omelets for the main
meal. They introduced sourdough bread
and a pencil-thin version of the spicy Span-
ish sausage chorizo. Sliced potatoes, onions,
and bacon make up a casserole referred to as
Basque potatoes, still a favorite in the region.
Basques often established hotels, which served
as meeting places for Basques doing business
in the area and for new immigrants. The hotels
became famous for their four- or five-course
meals served family-style, and non-Basque
visitors often came for the food. Chickpea
and meat stews, spit-roasted lamb, and even
traditional seafood dishes such as bacalao al
pil-pil (dried salt cod cooked with garlic and
olive oil) were offered when the ingredients
were available. Red wine, chamomile tea, and
picón punch (a beverage no longer common
in Spain but still available where Basques live
in the United States, made from bitter orange
picón liqueur, brandy, grenadine, and soda
water) were popular drinks.
In Utah, another group that has main-
tained many of their food traditions is the
Roman Catholic Italians who originally came
from Calabria for mining and railroad jobs in
the late nineteenth century. They often grow
Mediterranean vegetables and seasonings,
such as eggplants, tomatoes, endive, fava
beans, fennel, zucchini, garlic, parsley, and
basil, in home gardens. Everyday fare includes
bread sticks, pastas, minestras (see Chapter 6),
salads, and fresh fruits for dessert. Specialties
Basques from Nevada
may have introduced
sourdough bread to San
Francisco, where it has
become a signature item.
Legend is that the
famous Denver (or
Western) sandwich,
made with an omelet
containing ham, onions,
and green peppers
between slices of bread,
was invented by a
Chinese chef making
eggs foo yung with
available ingredients.29
Colorado is the highest
state in the nation, with
an average elevation of
nearly 6,800 feet. Pioneer
cooks had difficulties
making baked goods at
high altitudes. Extensive
experimentation found
that leavening must
be reduced and oven
temperatures raised to
produce satisfactory
breads and cakes.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 5 5 2 3
such as goat meats and goat cheeses, vari-
ety meats cooked up with eggs in a frittata
or in a spicy stew, boiled chicken’s feet, and
deep-fried squash patties made with chopped
squash and squash blossoms are traditional
favorites. Outdoor baking ovens used by the
first settlers are still found in the region.27,28
Utah is also home to a large population of
Mormons (nearly 80 percent of all residents
in the state), who settled there in the early
1800s to escape the persecution suffered in
Ohio, Illinois, Missouri, and other areas where
the members of the Church of Jesus Christ
of Latter-Day Saints had lived. Many were
of northern European descent, particularly
British and Scandinavians, and they brought
a preference for hearty foods. Ham, pot roast,
roast beef, stews, and fried chicken remain
favorite entrees, often served with home-
made whole-wheat bread or buttermilk bis-
cuits. Spicing is usually mild. Hamburger bean
goulash, a Utah specialty, is thought to be a
denatured version of chili con carne.10 Milk
gravy, made with browned flour, pork drip-
pings, milk, and seasoned with black pepper,
was served with so many foods that cowboys
riding through the area dubbed it “Mormon
dip.” Potatoes, red cabbage, green beans, and
peas are still common side dishes. The Mor-
mons are well known for their love of sweets,
and desserts are prominent in the diet. Layer
cakes, fruit pies, strawberry shortcake, fruit
candies, chocolates, and ice cream are still
commonly consumed. Sour cream raisin pie is
a popular Utah dessert that recalls the sweet-
ened milk custards and dried fruits of early
pioneer days. Another notable favorite is pep-
parkakor, a Scandinavian ginger cookie often
Anglicized as “pepper cookies.” Mormons do
not drink alcohol or stimulating beverages
such as coffee or tea; lemonade and Brigham
Young tea (sweetened hot water with milk) are
traditional beverages.
In the southwestern regions of the Moun-
tain states, a warm climate conducive to agri-
culture is combined with insufficient rain to
grow most crops without irrigation. Some of
the most scenic terrain in the nation, from the
majestic Grand Canyon to the broad plains
of the Sonoran Desert, is found in Arizona.
New Mexico is a mix of high desert plateaus,
portions of the Great Plains, and sections
of the Rocky Mountains. Southwestern fare
reflects the arid conditions and the prefer-
ences of the people who settled the region,
especially the Native Americans, the Spanish,
and the Mexicans.
Native Americans who lived in the region
prior to European contact, particularly Pueblo
peoples, cultivated small amounts of corn,
▼
Meat stews flavored with
chile peppers are popular in
New Mexico.
st
oc
kc
re
at
io
ns
/S
hu
tt
er
st
oc
k.
co
m
S a m p l e M e n u
A Southwestern Supper
Posole/Pozolea,b,c
Fresh Flour Tortillas
Jicama Saladb or Nopalitos Salada
Biscochitosa,b,c or Flanc
aCox, B., & Jacobs, M. 1996. Spirit of the west: Cooking from ranch house to range.
New York: Artisan.
bFussell, B. 1997. I hear America cooking. New York: Penguin Books.
cCocinas de New Mexico at http://www.visitalbuquerque.org/albuquerque/cuisine/recipes/
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
5 2 4 R E G I O N A L A M E R I C A N S
beans, chile peppers, squash, and pumpkins.
Pine nuts (piñon seeds) were indigenous
foods. Juicy fruits (called tunas, or Indian fig)
and the young pads (nopales) of the saguro
and prickly pear cactus were other native
items. Small game, such as rabbit, provided
meat in the diet. They prepared stews fla-
vored with chiles and very thin, blue corn
tortillas called piki. Other tribes, such as the
Navajo and Apache, were initially hunters
who roamed the region in search of big game
and wild plants (see Chapter 5).
When the Spanish arrived in the sixteenth
century, they introduced many of the foods
that became elemental in the cooking of the
Indians in both the United States and Mexico,
including wheat, hogs, sheep, and cattle, as
well as chocolate and other items obtained
through trade in the Americas. The Spanish
explorers were followed by Mexican-born set-
tlers who established small farms called haci-
endas, ranchos, and estancias beginning in the
late 1500s along the banks of the Rio Grande
in New Mexico and in southern Arizona.
Anglo-Americans (those who spoke English)
followed, first to New Mexico and then into
Arizona, adding to the population of Spanish
Americans (mostly of Mexican and Native
American ancestry who spoke Spanish) and
Native Americans. The ethnic heritage of the
region is evident in the many Native Ameri-
can celebrations, adobe villages, and numer-
ous examples of Spanish architecture that still
exist.
Nowhere is the blending of Native Ameri-
can, Spanish American, and Anglo-American
culture more evident than in southwestern
fare. Wheat tortillas became a staple in parts
of the American Southwest and in northern
Mexico. Hearty beef or lamb stews replaced
the mostly vegetarian versions, and fry bread,
made with wheat flour and cooked in lard,
became common. Popular dishes in Arizona
and New Mexico with Native American and
Spanish or Mexican roots include menudo
(spicy tripe soup flavored with mint), pozole
(hominy flavored with pork, chile peppers,
and often epazote or oregano), chimichan-
gas (wheat tortillas wrapped around a beef or
chicken and vegetable filling, then deep-fried),
green chili stew (beef, tomatoes, onions, and
a variety of green chile peppers), chickpeas
with lamb, and Indian tacos (fry bread folded
and filled with meats, cheeses, vegetables,
and salsa). Indian roasted lamb with red
and green chile peppers, Spanish arroz con
pollo (updated with chiles), and Mexican
chilaquiles, enchiladas, tamales, quesadillas,
and flautas are other common dishes in the
region. Chile peppers, onions, garlic, oreg-
ano, y er ba buena, epaz ote, safflower blossoms
(dried and powdered, reminiscent of saffron),
and abundant amounts of mint flavor savory
dishes. Toasted pumpkin seeds or pine nuts
from the native piñon tree were added to spice
blends for sauces, providing a nutty flavor to
roasted meats and poultry. Today almonds are
used in the same way.
Sweets depend on chocolate, vanilla, cin-
namon, and other spices. Popular desserts
include anise cookies called biscochitos (a
Christmas specialty), the light, deep-fried
wheat flour puffs called sopaipillas served with
honey or cinnamon syrup, and flan. Puddings
are also common, including panocha (similar
to Indian pudding from the Northeast, but
made with wheat kernels and flavored with
cinnamon), and capriotada (bread pudding
with pine nuts, raisins, and mild cheese, tra-
ditionally served with a caramel sauce).
Agriculture in Arizona has expanded with
irrigation. Grapefruit, lemons, melons, and
figs flourish in the region. Two vegetables
popular in Mexico have found success in
the state as well. Tomatillos, a relative of the
ground cherry that looks a little like a green
tomato in a papery husk, and jicama, a crispy
tuber related to the morning glory, have both
been transplanted from Mexico to Arizona.
Tomatillos are added to salsa verde and other
green sauces, and the sweet pea–flavored
jicama frequently provides a crunch in local
salads. New Mexico is the leading producer
of chile peppers in the United States. There is
no consensus on the common names for the
hundreds of varieties, nor is there a single heat
classification system. Mild New Mexican (also
called Anaheim) chiles, medium hot ancho
chile (the name for dried, ground poblano
chiles), hotter jalapeños (sliced, pickled
jalapeños are sprinkled on nachos; smoked
jalapeños are called chipotles), and very hot
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
C H A P T E R 1 5 5 2 5
serrano chiles are the most popular in south-
western cuisine.
The Pacific States
No region in the United States is as diverse
as the Pacific states. Significant variations in
climate, terrain, and settlement history have
led to the development of very different cui-
sines in the three coastal states of California,
Oregon, and Washington and that of the two
states separated from the continental nation:
Alaska and Hawaii.
The climate of the Pacific coast states
ranges from cool and moist in the northern
areas near the Canadian border to hot and
dry in the southern deserts abutting Mexico.
Parallel mountain ranges run north–south
through the region, dividing the states into
different agricultural zones. The foods of the
Native Americans depended on their location.
Those near the Pacific survived on clams, mus-
sels, and fish, with local berries and greens.
In inland areas of California, acorns were the
foundation of the diet, leached of tannins and
processed as a meal or flour. Western Oregon
and Washington are endowed with a wealth
of native foods, including deer, elk, antelope,
rabbits, beaver, muskrats, ducks, geese, greens,
wild mushrooms, and a multitude of berries.
In the eastern sections of the states, however,
high prairie-like plateaus and near-desert con-
ditions exist (see Chapter 5).
The first whites to settle in California were
the Spanish in the eighteenth century. They
built several presidios (forts), pueblos (small
farms), and a series of missions (each one
day apart in travel time), with the purpose
of protecting their claim to the territory. The
Spanish cultivated numerous crops, including
wheat, olives, grapes, and oranges in the lands
surrounding the missions, and planted native
foods including corn, beans, and tomatoes
as well. Cattle and hogs were raised. Many
of the local Indians were forced into the mis-
sions as laborers. When Mexico took control
of the state in the early nineteenth century,
much of the mission territory was redis-
tributed as grants to resident families who
founded wealthy rancheros producing mostly
beef. Despite Spanish claims to the contrary,
many other European powers sought access
to California riches. Russia, in particular,
established colonies in northern Califor-
nia to support its fur trade along the Pacific
coast and in Alaska. Trappers were the first
whites to explore Oregon and Washington.
Significant settlement from other states did
not occur in the region until the discovery of
gold in California during the 1840s and the
opening of the Oregon Trail to pioneers from
New England, the Midwest, and the South,
who came to make their fortunes in the new
frontier of the West. Regardless of ancestry,
most early settlers adapted their cuisines to
the local natural pantry.
Coastal seafood was a mainstay for many
settlers. In Oregon items familiar in Atlan-
tic fare, particularly clams, were favored.
Over two dozen varieties (e.g., butter, horse,
Japanese littleneck, Manila, razor) live in
the sands of the Pacific Northwest. Clam
chowder, adapted with whatever local set-
tlers could rustle up, including rice, toma-
toes, and cabbage, was common.29 Geoduck
(pronounced “gooey-duck”) clams are a large,
bivalve native to Oregon and Washington with
necks (siphons) that can stretch several feet.
A geoduck may weigh up to fifteen pounds,
although most are in the two- to three-pound
range. The body is sliced and pounded into
thin steaks (similar to abalone), and the neck
is usually minced or ground for soups or
stews. Washington also has an abundance of
seafood. Beginning in the 1800s the five spe-
cies of salmon in the region (king or chinook,
sockeye, dog, humpback, and silver) were sent
fresh to West Coast markets or pickled and
shipped in barrels to Hawaii, South America,
the East Coast, and Europe. Iced fish was also
sent to Europe, where it was smoked, then
returned to the United States. Washington
still leads the nation in total salmon catch and
products. Oysters are another specialty. The
small native Olympia oyster is a favorite, but
overharvesting has greatly reduced availabil-
ity. Pacific oysters, which were imported from
Japan in the early 1900s, are the species con-
sumed most often on the West Coast, though
European flat oysters are also harvested. Oys-
ters are typically served on the half shell in
the region, although bacon-wrapped broiled
oysters, oyster fritters, barbecued oysters,
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
5 2 6 R E G I O N A L A M E R I C A N S
oyster loaf, and oyster stew are common cook-
ing preparations. Dungeness crab, named for
the town of Dungeness on the Olympic Pen-
insula, are caught during the winter months.
In California, sardines were the leading catch
during the early twentieth century. As their
numbers diminished due to overfishing, other
fish, such as tuna, salmon, halibut, mackerel,
and anchovies, became the predominant
catch. Dungeness crab, traditionally eaten
steamed with melted butter and lemon or in
crab cocktails, and squid, served deep-fried
or over pasta, are popular. Abalone, a large,
flat-shelled mollusk that clings to rocks off
the California coast, is a specialty. The tough
muscle must be pounded into a thin steak to
tenderize it before cooking. It has a delicate,
sweet flavor and is typically lightly floured and
sautéed in butter.
Many early settlers in the Pacific coastal
states started small farms, which over the
years have grown into a significant indus-
try. California produces more than half the
fruits and vegetables consumed nationally
and accounts for nearly the entire U.S. pro-
duction of avocados, artichokes, garlic (some
of which are processed as granules and pow-
der), walnuts, almonds, pistachios, apricots,
nectarines, olives, dates, figs, pomegranates,
prunes, and persimmons. It leads the nation
in growing numerous other crops as well, such
as lettuce, broccoli, grapes, lemons, strawber-
ries, and melons. One hundred percent of U.S.
raisins are produced in California. Specialty
fruits, such as kiwifruit and f eij oa (a small,
green, egg-shaped fruit native to Brazil that
tastes a little like pineapple and eucalyptus
with mint nuances), are now being grown. In
Oregon, fruits such as pears (mostly Bartlett,
with some Anjou, Bosc, Comice, Seckel, and
Winter), apples, prunes, plums, cherries, and
domestic berries, have proved very success-
ful. An Oregon specialty is hazelnuts (also
called filberts). The trees were introduced
from France in the 1800s, and today nearly
all hazelnuts consumed in the United States
are grown in the state. Washington leads the
nation in the production of both apples and
cherries. Apples are especially associated with
the state: Grown on the eastern slopes of the
Cascade mountains, they require extensive
hand labor to thin each cluster of blossoms to
a single king blossom and to pick any fruit that
appears after the initial crop sets. This process
produces exceptionally large, well-formed
apples. Nearly the entire crop is devoted to
Red Delicious and Golden Delicious variet-
ies, although several other types are grown
in small amounts, such as Fuji, Gala, Granny
Smith, and Winesap. Hops, Walla Walla
onions (a cool weather sweet onion that is a
different variety from the sweet onions grown
in Georgia and Hawaii), mint, and spearmint
are specialty crops.
Dairying is significant in the Pacific states,
with California first in milk production
nationwide. Best known are the cheeses of the
region, including several Cheddar styles such
as Cougar Gold from Washington, Tillamook
from Oregon, and Monterey Jack (a mild,
white cheese) from California. More recently,
French-style c h è v r e goat cheeses and other
cheese varieties are being produced.
The abundance of seafood, dairy products,
and fruits and vegetables in the region has led
to the creation of cuisines that emphasize what
is fresh and local. In California, celebrity chefs,
▲
California produces more
than half of the fruits and
vegetables consumed in the
nation and takes pride in a
cuisine based on fresh, local
ingredients.
Pa
ul
B
ar
to
n/
Co
rb
is
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C H A P T E R 1 5 5 2 7
such as Wolfgang Puck and Alice Waters, have
popularized dishes such as pasta with chan-
terelles and grilled duck breasts, goat-cheese
salad with arugula and radicchio, poached
salmon with fresh basil and olive butters,
and pears and figs poached in Zinfandel with
Cassis cream (by Alice Waters, founder of
the restaurant Chez Panisse in Berkeley)—all
examples of the California approach to cook-
ing. Other trendy items started in California
include mesclun salads (made with a mixture
of baby lettuces) and roasted garlic, which
can be added to salads and stews or spread
on bread like butter. Grilled fish, especially
salmon and halibut, is a specialty in all three
states. In Oregon, abundant use of fruit is seen
in both savory and sweet dishes, such as fruit
soups, poultry stuffed with prunes or apricots,
and salads with fresh berries or dried fruit, as
well as various fruit pies, soups, preserves,
jams, and jellies.
Few distinctively ethnic flavors are found
in the cooking of Washington, and limited
influence from the settlers of Oregon is seen
in German items (schnitzels, sauerbraten,
sage sausages, stuffed cabbage, sauerkraut,
and strudels) and southern-style fried chicken
served with biscuits and hominy. In contrast,
thousands of Chinese, Italian, and Japanese
immigrants came to California in the early
twentieth century, lured by jobs in farming,
ranching, fishing, fish processing, meatpack-
ing, and the canning of fruits and vegetables.
Agriculture continues to draw immigrants
from Mexico and Central America looking
for migrant farm work. Other recent immi-
grants adding to the diversity of the state
include Vietnamese, Cambodians, Laotians
(particularly Hmong), Koreans, Asian Indi-
ans, Ethiopians, Filipinos, and Samoans.
Many California specialties are attributable
to the ethnic preferences of the population.
The Mexicans brought corn tortillas, refried
beans, guacamole, and popular filled dishes
like tacos and enchiladas. Italians introduced
northern Italian favorites, such as polenta and
pesto, as well as seafood dishes, such as the
tomato-based fish stew made with local fish
and Dungeness crab called cioppino, as well
as fried calamari (squid). The Chinese offered
authentic stir-fried dishes, wontons, egg rolls,
and adapted dishes such as chop suey and for-
tune cookies. The Japanese added sukiyaki,
teriyaki, tempura, sushi, and other favorites
to the mix. Armenians in the Central Valley
brought flavorful lamb skewers, dolma (rice-
and lamb-stuffed eggplant or grape leaves),
and specialty desserts such as baklava. Newer
immigrants have popularized hot Thai dishes,
Vietnamese pho, Filipino lumpia, and Indian
tandoori cooking and flat breads in the state
(see the chapter specific to each ethnic group
for more details).
California, Oregon, and Washington are
famous for their wines. The European set-
tlers of the mid-nineteenth century first
introduced the superior varietal grapes used
in French and German wine making to Cali-
fornia. Today there are many premier wine
regions in the state, including Napa Valley,
Sonoma, Santa Cruz, Monterey, San Luis
Obispo, and Santa Barbara. The Central Val-
ley accounts for most of the grapes cultivated
for the bulk wine market. Successful varietals
include Cabernet Sauvignon, Merlot, Syrah,
and Zinfandel among red wines and Char-
donnay and Sauvignon Blanc among whites.
Sparkling wines, which may be made from
red or white grapes, and dessert wines are
also specialties of the state. Oregon wines
have gained a reputation for quality, especially
for cool weather varietals such as Pinot Gris
(a white wine) and Pinot Noir (a red grape
used in French-style burgundies). Washing-
ton is best known for its white wines, such as
Chenin Blanc, Gewürtztraminer, and White
Riesling. In more recent years, fruit wines,
such as those made from blackberries, cur-
rants, cranberries, or peaches, have become
common, especially in Oregon.
The cooking of Alaska has been hampered
in its development by the limited variety
of foods. The climate and terrain are by no
means uniform throughout the state, with
warmer regions found along the coastal pan-
handle extending south into Canada, around
the Yukon River Delta, and the protected
Matanuska Valley in the south-central region,
but there is little land suited for agriculture.
The Indians, Inuits, and Aleuts of the region
lived primarily on seafood and game. Wild
berries and roots were harvested in the short
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
5 2 8 R E G I O N A L A M E R I C A N S
summer months (see Chapter 5). The first
permanent white settlement in Alaska was
on Kodiak Island. The Russians arrived in the
1700s to hunt fur seals. They brought kasha, a
cooked buckwheat porridge, buckwheat blini,
and soups of fish or cabbage. Pirogs, large
filled pastries, were made with fish, game, or
cabbage. On Easter, they prepared traditional
dishes such as the rich fruitcake called kulich
(see Chapter 7). A rush of prospectors search-
ing for gold arrived in the Klondike area in
the 1800s. Supplies were severely limited, and
the new settlers lived on little more than flour,
bacon, salt pork, lard, and a bit of coffee or tea.
Most kept a sourdough culture going to make
breads and biscuits. Sourdough specialties
included poppy seed potato bread, rye bread
with caraway seeds, and whole-wheat bread.
Kelp was collected at the coast, and wild flow-
ers were boiled to make syrup. Some miners
hunted to supplement their diets, and game,
such as deer, caribou, moose, Dall sheep,
rabbits, and ptarmigan, was available. Game
meats are still popular today, including steaks,
roasts, and hamburgers made from moose
meat, and caribou meat sausages and Swiss
steaks.
Sheep are now raised on the Aleutian
Islands, providing lamb for the mainland.
Cattle ranches are found on Kodiak Island and
in the Delta and Matanuska. Reindeer herds
were imported to Alaska in the late 1800s
from Siberia and Scandinavia in the hopes
they would become a profitable meat source.
Many starved to death when the ranges were
overgrazed, and others are thought to have
become part of caribou herds. Today, some
reindeer in the Seward Peninsula are raised
for meat and for supplying antlers to Asia.
More important are the dairy operations pro-
viding fresh milk, butter, and cream. Potatoes
are the most successful crop, but vegetables
such as cabbage, cauliflower, and rhubarb
also grow in the region. Many of the veg-
etables attain gigantic proportions in the long
daylight hours of summer; for example, cab-
bages may reach seventy pounds, and rhubarb
sometimes grows four feet tall.
Seafood is the main commodity in Alaska,
ranking first nationally in quantity and value
of the yearly catch. Salmon, herring, and
halibut are the most prevalent fish. Shrimp
and crab, including Dungeness, Snow (also
known as Tanner), and limited King crabs,
are trapped during the winter months. Most
are frozen or canned for export to the rest of
the United States and Japan.
In Hawaii, a mild tropical climate and
abundant natural food resources greeted the
earliest inhabitants. The volcanic islands are
believed to have been first settled by Polyne-
sians from the Marquesa Islands and Tahiti in
the fifth century. The foundation of their diet
was starchy vegetables such as taro root (tradi-
tionally made into poi—boiled, pounded into
a paste, and slightly fermented), breadfruit,
plantains, cassava, and yams. Seafood and
possibly pork and chicken were also eaten (see
Chapter 12). British explorers discovered the
islands in the late 1700s; the area became a
major American port for whaling ships in the
nineteenth century, and Japanese, Chinese,
Korean, Filipino, and Asian Indian agricul-
tural workers came to support the developing
pineapple and sugarcane industries.
Traditional native dishes and foods intro-
duced to the islands by the many immigrants
coalesced into Hawaiian fare. Unlike some
areas of the nation, where various foreign
contributions have melded into a single
cuisine with occasional European, Latino,
or Asian overtones, many dishes in Hawaii
maintain their ethnic integrity. Foods from
▼ Salmon and other
seafood are favorites in
Alaska and the Pacific
Northwest.
Bu
dd
y
M
ay
s/
Co
rb
is
Coffee drinks such as
lattes have become a
specialty item associated
with Seattle. The city is
home to the Starbucks
Corporation, which
started the trend of U.S.
coffee bars (modeled
after Italian espresso
bars) in 1984. There were
over 12,000 Starbucks
coffee bars nationwide
in 2014.
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C H A P T E R 1 5 5 2 9
different cultures are commonly served at the
same meal, however, representing the state’s
diverse heritage. Popular Hawaiian foods
include those with Japanese origins, such as
teriyaki-grilled meats and fish, sashimi (raw,
thinly sliced fish), and noodle dishes such as
saimin, an island adaptation of ramen noo-
dles, topped with pork and frequently eaten
for lunch. The Chinese brought wok cook-
ing, dim sum, long-grain rice, soybeans, bok
choy, lotus root, kumquats, litchi, and ginger
to the region. Scottish scones and shortbreads
are available, and Portuguese sweet bread is
so common it is often called Hawaiian bread.
Another Portuguese specialty, malassadas
(fried doughnuts without a hole), is especially
popular, and local variations made with poi
or macadamia nuts are novelty items. Fili-
pino fish sauces and lumpia (Filipino-style
egg rolls), Korean kimchi (hot cabbage relish)
and spicy beef dishes, and Indian curries are
other contributions.
Historically, sugarcane was the most
important crop in Hawaii, accounting for 20
percent of the raw sugar produced nationally.
But soaring costs and environmental concerns
AK AZ CA CO HI ID MT NV NM OR UT WA WY
Obesitya ↓↓ ↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓↓ ↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓↓ ↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓↓ ↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓↓ ↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓↓ ↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓↓ ↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓↓ ↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓↓ ↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓↓ ↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓↓ ↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓↓ ↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓↓ ↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓
No Leisure-Time Exerciseb ↓↓ AVG ↓↓ ↓↓↓ ↓ ↓ ↓↓ ↓ ↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓ ↓ ↓↓ ↓ ↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓ ↓ ↓↓ ↓ ↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓ ↓ ↓↓ ↓ ↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓ ↓ ↓↓ ↓ ↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓ ↓ ↓↓ ↓ ↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓ ↓ ↓↓ ↓ ↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓ ↓ ↓↓ ↓ ↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓ ↓ ↓↓ ↓ ↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓ ↓ ↓↓ ↓ ↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓ ↓ ↓↓ ↓ ↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓
Diabetesc ↓↓↓ ↓↓↓↓↓ ↓↓ AVG ↓↓↓ ↓↓↓ ↓↓ ↓↓↓ ↓ ↓↓↓↓ ↓↓↓ ↓↓ ↓↓↓ ↓ ↓↓↓↓ ↓↓↓ ↓↓ ↓↓↓ ↓ ↓↓↓↓ ↓↓↓ ↓↓ ↓↓↓ ↓ ↓↓↓↓ ↓↓↓ ↓↓ ↓↓↓ ↓ ↓↓↓↓ ↓↓↓ ↓↓ ↓↓↓ ↓ ↓ AVG ↓↓ ↓↓ ↓↓↓↓ ↓↓ ↓↓↓↓ ↓↓ ↓↓
Hypertensiond ↓↓ ↓↓ ↓ ↓↓↓↓ ↓↓ ↓ ↓↓↓↓ ↓↓ ↓ ↓↓↓↓ ↓↓ ↓ ↓↓ AVG ↓↓↓ ↓↓↓ ↓↓↓↓ ↓↓↓ ↓↓↓↓ ↓↓↓ ↓ AVG ↓↓ ↓ ↓ ↓↓↓↓ ↓ ↓ ↓↓↓↓ ↓ ↓ ↓↓↓↓ ↓ ↓ ↓↓
High Blood Cholesterole ↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑↑ ↑ ↑AVG ↑↑ ↑ ↑ ↑↑ ↑↑ ↑ ↑ ↑ ↑↑↑ ↑ ↑ ↑↑ ↑↑ ↑ ↑ ↑ ↑↑↑ ↑ ↑ ↑↑ ↑↑ ↑ ↑ ↑ ↑↑↑ ↑ ↑ ↑↑ ↑↑ ↑ ↑ ↑ ↑↑↑ ↑ ↑ ↑↑ ↑↑ ↑ ↑ ↑ ↑↑↑ ↑ ↑ ↑↑ ↑↑ ↑ ↑ ↑ ↑↑↑ ↑ ↑ ↑↑ ↑↑ ↑ ↑ ↑ ↑↑↑ ↑ ↑ ↑↑ ↑↑ ↑ ↑ ↑ ↑↑↑ ↑ ↑ ↑↑ ↑↑ ↑ ↑ ↑ ↑
Don’t Consume 5 Fruits/Vegs.f AVG AVGAVG AVG ↓ AVG AVG AVG AVG AVG AVGAVG AVG AVG AVG AVG AVGAVG AVG AVG AVG AVG AVGAVG AVG AVG AVG AVG AVGAVG AVG AVG AVG AVG AVGAVG AVG AVG AVG AVG AVG ↓ AVG AVG AVGAVG AVG AVGAVG AVG AVG
Binge Drinkingg ↑↑ ↓ ↑↑↑ ↑↑↑ ↓ ↑↑↑ ↑↑↑ ↓ ↑↑↑ ↑↑↑ ↓ ↑↑↑ ↑ AVG ↓ ↑↑ ↓ ↓↓ ↑↑ ↓ ↓↓ ↑↑ ↓ ↓↓ ↑↑ ↓ ↓ AVG ↓↓↓ AVG AVGAVG AVG
Low Birth Weighth ↓↓↓ ↓ ↓↓ ↓↓↓↓ ↓ ↓↓ ↓↓↓↓ ↓ ↓↓ ↓↓↓↓ ↓ ↓↓ ↓ AVG ↓↓↓ ↓↓↓↓↓ ↓↓ AVG AVGAVG AVG ↓↓↓ ↓ ↓↓↓ ↑↑↓↓↓ ↓ ↓↓↓ ↑↑↓↓↓ ↓ ↓↓↓ ↑↑↓↓↓ ↓ ↓↓↓ ↑↑
Deaths from Heart Diseasei AVG ↑ ↑↑↑ ↑↑ AVG ↓↓↓
AVG
↑ ↑ ↑↑ ↓ ↑↑ ↑ ↑↑ ↓ ↑↑ ↑ ↑↑ ↓ ↑↑ ↑ ↑↑ ↓ ↑↑ ↑ ↑↑ ↓ ↑ AVG ↓↓↓ ↑↓↓↓ ↑
Deaths from Stroke j ↓ ↓↓ ↓↓ ↓ ↓ ↑ ↑ ↓ ↓↓ ↓↓ ↓↓ ↓ ↓ ↑ ↑ ↓ ↓↓ ↓↓ ↓↓ ↓ ↓ ↑ ↑ ↓ ↓↓ ↓↓ ↓↓ ↓ ↓ ↑ ↑ ↓ ↓↓ ↓↓ ↓↓ ↓ ↓ ↑ ↑ ↓ ↓↓ ↓↓ ↓↓ ↓ ↓ ↑ ↑ ↓ ↓↓ ↓↓ ↓↓ ↓ ↓ ↑ ↑ ↓ ↓↓ ↓↓ ↓↓ ↓ ↓ ↑ ↑ ↓ ↓↓ ↓↓ ↓↓ ↓ ↓ ↑ ↑ ↓ ↓ AVG ↓ ↓ ↓↓↓ ↓ ↓↓↓ ↓ ↓↓
Deaths from Cancerk AVG ↓↓ ↓↓↓ ↓↓↓ ↓↓ ↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓ ↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓ ↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓ ↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓ ↓↓ ↓↓↓ ↓↓↓ ↓↓↓ ↓↓ ↓↓ ↓ AVG AVG AVGAVG AVG AVGAVG AVG AVG ↓↓↓ AVG ↓
aU.S. prevalence 5 58.4 percent (overweight defined as BMI >25.0).
bU.S. prevalence 5 25.8 percent (adults who did no leisure-time physical activity in past month).
cU.S. prevalence 5 6.6 percent (self-reported data based on number of adults who were told they had condition by a health professional).
dU.S. prevalence 5 25.7 percent (self-reported data based on number of adults who were told they had condition by a health professional).
eU.S. prevalence 5 30.4 percent (self-reported data based on number of adults who were told they had condition by a health professional).
fU.S. prevalence 5 77.6 percent (adults who do not consume at least 5 fruits/vegetables per day).
gU.S. prevalence 5 5.1 percent (>2 drinks/day in the past month for men, >1 drink per day in the past month for women).
hU.S. prevalence 5 7.3 percent (live births of infants weighing <2,500 grams).
iU.S. age-adjusted death rate per 100,000 245.8000 245.5000 245. .
jU.S. age-adjusted death rate per 100, 000 57.9000 57.5000 57. .
kU.S. age-adjusted death rate per 100, 000 194.4000 194.5000 194. .
AVG—similar to national average
↑—slightly above national average
↓—slightly below national average
↑↑—significantly above national average
↓↓—significantly below national average
↑↑↑—exceptionally above national average
↓↓↓—exceptionally below national average
Sources: Centers for Disease Control and Prevention. 2014. National Diabetes Statistics Report: Estimates of diabetes and its burden in the United States, 2014. Atlanta, GA: U.S. Department of Health and
Human Services; Division for Heart Disease and Stroke Prevention: Data Trends & Maps, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for
Chronic Disease Prevention and Health Promotion. 2013. Retrieved from http://www.cdc.gov/dhdsp/; America’s Health Rankings®: A Call to Action for Individuals & Their Communities. 2014. United Health
Foundation. Retrieved from http://www.unitedhealthfoundation.org
TA B L E 15.13 Western State–Specific Health Data Compared to National Averages, 2009–2014
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
5 3 0 R E G I O N A L A M E R I C A N S
have put most sugarcane plantations out of
business. Pineapples have also been a signifi-
cant commodity, though pressures from Asia
are reducing their profitability. Hawaii grows
most of the world’s supply of macadamia nuts
and also exports famous kona coffee, grown
on the western slopes of the island of Hawaii.
Cattle ranches are found on the islands of
Maui, Hawaii, and the privately owned Nii-
hau; most provide beef for local consumption.
Seafood, another Hawaiian specialty, is also
mostly fished for Hawaiian markets, although
some tuna is canned and exported. In addi-
tion to tuna, common food fish include mahi
mahi (also called dorado), bonito, mackerel,
and snapper.
Health Concerns
In general, people living in the West are health-
ier than the national average (see chapters on
each ethnic group for population-specific
data).12,26 The western states have the low-
est prevalence of cardiovascular diseases and
higher rates of healthy lifestyle activities. (See
Table 15.13.) Rates of obesity range from the
lowest in Colorado at 20 percent to the highest
among the western region in Idaho, Wyoming
and Alaska.12 (See Figure 15.3).
D I S C U S S I O N S T A R T E R S
Examination of Ethnicity, Culture, Diet, and Health
For Chapter 1, you described your cultural identity (your race and ethnicity) and the foods that you typically eat (what you like to eat, what foods are eaten
in your home). Now, identify the regional area (Northeast, Midwest, South, or West) that your diet most reflects—and any more specific area(s) within
that larger region (New England, Mid-Atlantic, East North Central, West North Central, South Atlantic, East South Central, West South Central, Mountain
states, or Pacific states). Next, identify any even more specifically localized area and/or culture within that specific area that your diet seems to reflect.
Are the region, area, and culture that your diet seems to reflect the same as the region, area, and culture that apply to you? Do other factors affect
your diet, such as ethnicity?
Look at the appropriate table of health concerns for the area that your diet reflects and think about your family members’ individual health histories,
as well as your racial and ethnic background(s). Next, identify health concerns that you might need to address in the future. For example, if your diet is
southern and, in particular, West Virginian, you would definitely identify high blood cholesterol, hypertension, and diabetes as possible future health
concerns. On the other hand, if your diet is western and, in particular, Californian, but is also heavily influenced by a Greek heritage, you will want to
analyze whether that Greek influence on your diet is strong enough that you should identify overweight and obesity as possible future health concerns,
even though studies suggest that Californians generally are similar to the national average in those two categories. In small groups, share your findings.
Together, brainstorm about what each person in your group could begin doing now to address possible future health concerns.
Review Questions
1. List and describe three factors influencing
regional cuisine. Pick one region and summa-
rize its influences.
2. How did Native American foods/cooking
methods influence regional U.S. cuisine?
3. Compare and contrast the preparation of
beans, corn, and apples in different regions of
the United States.
4. Describe one unique recipe associated with a
particular region of the United States that you
were not familiar with prior to reading this
chapter. Would you try it? Why or why not?
5. Based on health statistics, which region of the
country would you choose to live in to stay
healthy? What dietary factors may be influ-
encing these health statistics? If you wanted to
eat “unhealthy” one day, which regional cuisine
would you try? Why?
6. You have decided to eat local. What does this
mean, and what foods would be available for
you to purchase? List some of the arguments
for eating local.
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C H A P T E R 1 5 5 3 1
References
1. Ferdman, Roberto A. 2014, July 29. Where the
greatest beer, wine, and liquor drinkers live in
the U.S. Th e W ash ington P ost.
2. U.S. brewery count by category. n.d. Statistics,
Brewers Association. Retrieved from https://www.
brewersassociation.org/ (accessed May 1, 2015).
3. New Strategist. 2005. W h o’ s buy ing gr oc er ies (3rd
ed.). Ithaca, NY: Author.
4. Trubek, A.B. 2005. P l ac e matter s. In C. Korsmeyer
(Ed.), Th e taste c ul tur e r eader . New York: Berg.
5. Pitzer, G.R. 2004. E nc y c l opedia of h uman geogr aph y .
Westport, CN: Greenwood.
6. Lipard, L.R. 1997. Th e l ur e of th e l oc al : S enses of
pl ac e in a mul tic enter ed soc iety . New York: New
Press.
7. U.S Census. 2013. A mer ic an C ommunity S ur v ey ,
2013. Retrieved from http://www.census.gov/acs/
www/ (accessed May 1, 2015).
8. Oliver, S.L. 1995. S al tw ater f oodw ay s. Mystic, CT:
Mystic Seaport Museum.
9. Neustadt, K. 1992. C l ambak e: A h istor y and
c el ebr ation of an A mer ic an tr adition. Amherst:
University of Massachusetts Press.
10. Lee, H.G. 1992. T aste of th e states: A f ood h istor y
of A mer ic a. Charlottesville, VA: Howell.
11. Division for Heart Disease and Stroke Prevention:
Data Trends & Maps, U.S. Department of Health
and Human Services, Centers for Disease Con-
trol and Prevention (CDC), National Center for
Chronic Disease Prevention and Health Promo-
tion. 2013. Retrieved from http://www.cdc.gov/
dhdsp/
12. Wilcox, E.W. 2002. B uc k ey e c ook er y and
pr ac tic al h ousek eeping, 1877 (facsimile edition). pr ac tic al h ousek eeping, 1877 (facsimile edition). pr ac tic al h ousek eeping
Bedford, MA: Applewood Books. (Original work
published 1887)
13. Deutsch, R.M. 1962. Th e nuts among th e ber r ies.
New York: Ballantine Books.
14. Lockwood, Y.R., & Lockwood, W.G. 1991. Pasties
in Michigan’s Upper Peninsula. In S. Stern & J.A.
Cicala (Eds.), C r eativ e eth nic ity : S y mbol s and
str ategies of c ontempor ar y eth nic l if e. Logan: Utah
State University Press.
15. Luchetti, C. 1993. H ome on th e r ange. New York:
Villard.
16. Anderson, J. 1997. T h e A mer ic an c entur y
c ook book . New York: Clarkson Potter.
17. Mandel, A. 1996. C el ebr ating th e midw ester n tabl e.
New York: Doubleday.
18. Matson, M. 1994. F ood in M issour i. Columbia:
University of Missouri Press
19. Hess, K. 1992. T h e C ar ol ina r ic e k itc h en.
Columbia: University of South Carolina Press.
20. Carlson, B. 1997. F ood f estiv al s. Detroit: Visible
Ink.
21. Page, L.G., & Wigginton, E. 1984. T h e f ox f ir e book
of A ppal ac h ian c ook er y . New York: Dutton.
22. Smith, C. 2003. F ood and c ul tur e in A ppal ac h ian
K entuc k y : A n eth nogr aph y . J our nal f or th e S tudy of
F ood and S oc iety , 6 , 64–71.
23. Sohn, M.F. 2005. A ppal ac h ian h ome c ook ing:
H istor y , c ul tur e, and r ec ipes. Lexington: University
Press of Kentucky.
24. Milbauer, J.A. 1990. The geography of food in
eastern Oklahoma: A small restaurant study.
N or th A mer ic an C ul tur e, 6 , 37–52.
25. Milbauer, J.A. 1990. The geography of food in
eastern Oklahoma: A small restaurant study.
N or th A mer ic an C ul tur e, 6 , 37–52.
26. America’s health rankings. 2014. United Health
Foundation. Retrieved from http://www.united-
healthfoundation.org (accessed May 1, 2015).
27. Notarianni, P.F. 1994. Italians in Utah. In A.K.
Powell (Ed.), U tah h istor y enc y c l opedia. Salt Lake
City: University of Utah Press.
28. Raspa, R. 1984. Exotic foods among Italian-
Americans in Mormon Utah: Food as nostalgic
enactment of identity. In E th nic and r egional f ood-
w ay s in th e U nited S tates. Knoxville: University of
Tennessee Press.
29. Jones, E. 1981. A mer ic an f ood: T h e gastr onomic
stor y (2nd ed.). New York: Vintage.stor y (2nd ed.). New York: Vintage.stor y
30. Fussell, B. 1997. I h ear A mer ic a c ook ing. New
York: Penguin Books.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
St a r c h F o o d s
Starchy foods form the foundation of nearly all diets.
A. Rice and rice-like grains are eaten by millions worldwide
and come in many varieties, including short-grain (far right),
long-grain (in scoop), and wild rice (long, black grains in
lower left mix). Rice products, such as noodles and papers, are
also common.
B. Wheat is popular in drier regions, typically eaten as bread,
as pasta, and in cereal form, such as couscous (lower bag)
and bulgar (upper bag).
C. Corn is an important New World starch,
traditionally prepared as flat breads (including these
tortillas), as dumplings, in steamed packets, in stews,
and as gruel.
D. In tropical areas, fruit and root vegetables are significant
sources of starch, including breadfruit (upper basket), cassava
(lower basket), yams (lower left corner), taro root (left upper
corner), lotus root (cut root with hollow spaces in center), sweet
potatoes (ruby orange roots on right), and burdock root (long,
pencil-thin roots). Potatoes are more important in cooler climates.
E. Acorns are a starch consumed in some Native American,
European, Middle Eastern, and Asian cultures.
Ju
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te
r I
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es
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om
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y
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D
an
ny
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eh
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an
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di
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to
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A
nd
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st
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ee
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Pr
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oc
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ag
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Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
P r o t e i n F o o d s
Protein foods include a wide variety of meat prod-
ucts, dairy foods, fish, and shellfish, as well as nu-
merous legumes.
A. Sausages are eaten in nearly every culture. They come in
hundreds of types and make use of miscellaneous cuts and
leftovers, such as blood (dark red links).
Ch
ris
S
ho
rt
en
/C
ol
e
G
ro
up
/P
ho
to
di
sc
/G
et
ty
Im
ag
es
B. Dairy products, including yogurt and cheese, are available
in even more varieties. Yet many cultural groups consume only
limited amounts of milk or other dairy foods.
G
on
ch
ar
uk
M
ak
si
m
/S
hu
tt
er
st
oc
k.
co
m
C. Soy products, such as soy milk and bean
curd (known as tofu or tobu) are especially
significant in the diet of many Asians.
na
ito
8/
Sh
ut
te
rs
to
ck
.c
om
E. Legumes, such as beans, peas, and lentils, are
eaten daily in many cultures.
Co
m
st
oc
k/
G
et
ty
Im
ag
es
F. Nuts are an extra source of protein in some regions,
including many European, Middle Eastern, Indian, and
traditional Native American cuisines.
S.
M
el
tz
er
/P
ho
to
Li
nk
/G
et
ty
Im
ag
es
D. It is estimated that nearly 30 percent of the population
worldwide is dependent on fish, such as this dried salmon.
Ed
B
en
ne
tt
/A
la
sk
a
St
oc
k/
D
es
ig
n
Pi
cs
In
c/
A
la
m
y
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
A. Greens, such as this mizuna and bok choy, are
especially common.
KP
G
_M
eg
a/
Sh
ut
te
rs
to
ck
.c
om
D. Examples of vegetables grown on bushes or vines include egg-
plants, which come in many shapes (from round to oblong, to long-
thin) and colors (white, striped, green, orange, purple); chile peppers,
which vary in heat from mild to mouth-searing; and numerous types
of tomatoes.of tomatoes.
to
p,
C
LS
D
es
ig
n/
Sh
ut
te
rs
to
ck
.c
om
; m
id
dl
e,
R
F
Im
ag
es
; b
ot
to
m
, S
he
be
ko
/S
hu
tt
er
st
oc
k.
co
m
B. Root, tubers, and bulb vegetables, such
as beets, carrtos (above), celeriac, gobo,
Jerusalem artichokes, onion, radishes,
turnips, and water chestnuts, are prevalent in
many regions.
M
ic
ha
l M
or
av
ec
9
8/
Sh
ut
te
rs
to
ck
.c
om
C. Mushrooms, fungi that are eaten as
vegetables, are usually edible, but can
be highly toxic. Types include shiitake
(large, dark brown cap), oyster mush-
rooms (yellow, funnel-shaped), lobster
mushrooms (orange, knobby), and
black cloud ears (dark, curly fungus).
D
an
L
am
on
t/
CO
RB
IS
Ve g e t a b l e s
Vegetables are featured in the cuisines of almost
all cultures.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
Fruit is a favorite worldwide.
A. Some regions have only a few fruit types avail-
able, such as certain desert areas where prickly
pear cactus fruit is a specialty.
D
ea
n
U
hl
in
ge
r/
CO
RB
IS
B. Temperate regions have a broader selection of
fruits, including apples, citrus fruits, berries, and
more unusual fruit such as pomegranates.
A
nd
re
w
U
na
ng
st
/C
or
bi
s
F. The fruits of palm trees, which include
coconuts (above), dates, palmyra fruit,
and pej ibay e, add variety in warmer re-
gions worldwide.
H
an
dm
ad
eP
ic
tu
re
s/
Sh
ut
te
rs
to
ck
.c
om
E. Durian, another tropical specialty, has
a strong odor similar to rotting onions
esteemed by its fans.
Ke
vi
n
R.
M
or
ris
/C
O
RB
IS
D. The variety of fruit in the tropics is extensive, includ-
ing breadfruit (knobby, green), c asimir oa, (smooth, round,
green), guavas, mangoes, papaya, and plantains.
16
7
M
ic
ha
el
M
el
fo
rd
/O
ce
an
/C
or
bi
s
C. The seeds of some fruits are
more important than the flesh,
such as these cacao pods, which
are the source of chocolate.
Coffee, nutmeg, tamarind, and
vanilla are the other examples.
St
ep
he
n
B.
G
oo
dw
in
/S
hu
tt
er
st
oc
k.
co
m
Fr u i t s
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
5 3 3
Angelica root: Herb with a licorice-flavored root common in
European dishes. Usually available candied. Used medici-
nally in China.
Annatto (achiote, atchuete): Seeds of the annatto tree used to color
foods red or golden yellow. Used in Latin America, India,
Spain, and the Philippines. In the United States annatto is
added to some baked goods, Cheddar-style cheeses, ice creams,
margarines, and butter for color. May be cooked whole in oil or
lard to produce the right hue or used as a ground spice.
Apio: See A r r ac ac h a.
Apios: See G r oundnuts.
Apon seeds (agonbono): Seeds of the wild mango commonly
used in West Africa. Basis of the soup known as agonbono.
Areca nuts: See B etel .
Arracacha (apio; Peruvian carrot): Starchy white root of the carrot Arracacha (apio; Peruvian carrot): Starchy white root of the carrot Arracacha
family with flavor similar to chestnuts and parsnips used in
South America, especially Colombia, Peru, and Venezuela.
Arrowroot (chee koo): Many varieties of a bland, mealy tuber
found in Asia and the Caribbean. When made into a
powder, it is used to thicken sauces and stews.
Artichoke (carciofo): Globelike vegetable member of the thistle Artichoke (carciofo): Globelike vegetable member of the thistle Artichoke
family, with multiple edible bracts (leaves) crowning the unde-
veloped edible flower (the heart). The flavor is slightly sweet.
Popular in Middle Eastern and southern European dishes.
Arugula (rocket): Small member of the cabbage family native
to the Mediterranean; the peppery leaves are popular in
salads throughout Europe.
Asafetida (devil’s dung): Dried resin with a pungent odor rem-
iniscent of burnt rubber, which nonetheless imparts a deli-
cate onion-like flavor. It is available as a lump or powder
and is commonly used in Asian-Indian dishes.
Asian pear (apple pear): Round, yellow fruit from Asia with
the crispness of an apple and the flavor of a pear.
Atemoya: Hybrid of the cherimoya and sweetsop. See
C h er imoy a; S w eetsop.
Aubergine: See E ggpl ant.
Avocado (aguacate; alligator pear; coyo): Pear-shaped to round
fruit with leathery skin (green to black) and light green,
buttery flesh. Native to Central America. Numerous variet-
ies; eaten mostly as a vegetable, though considered a fruit
in some cuisines.
Bacalao (bacalhau, baccala): Cod preserved by drying and
salting, popular in northern and southern European
Glossary of Ethnic Ingredients
Abalone (paua): Large, flat mollusk with finely textured, sweet
flesh in the broad muscular foot that holds it to rocks (must
be pounded before use). It is common in the waters off
Asia, California, Mexico, and New Zealand. Available fresh,
frozen, canned, and dried.
Abiu (caimito): Yellow egg-shaped or round fruit native to the
Amazon; popular throughout Brazil and Peru. Translucent
white flesh with caramel-like flavor.
Acerola cherries (Barbados cherries): Exceptionally sour
Caribbean berries resembling small, bright red cherries
with orange flesh.
Achiote: See A nnatto.
Adzuki bean (aduki, azuki; red bean): Small, dark red bean used
primarily in Japanese cooking, often as a sweetened paste.
Ahipa: See J ic ama.
Ajowan (ajwain; carom; omum or lovage seeds): Similar to
celery seeds in appearance and to thyme in flavor. Used in
Asian-Indian and Middle Eastern cooking.
Ajwain: See A j ow an.
Akee (ackee, ache; seso vegetal; pera roja): Red fruit with three
segments containing large inedible seeds and flesh resem-
bling scrambled eggs. Nearly all parts toxic, causing fatal
hypoglycemia. Fresh, dried, frozen akee banned in United
States; some canned types permitted.
Alligator: Reptile native to rivers and swamps throughout the
southern Gulf Coast region, from Florida to Texas. Mild white
meat, with texture similar to veal. Tail and other parts eaten.
Almond paste: Arab confection of ground almonds kneaded
with sugar or cooked sugar syrup (some brands also con-
tain egg white) used in many European and Middle Eastern
desserts. Marzipan is a type of almond paste made with
finely ground, blanched almonds.
Amaranth (tampala; yien choy; Chinese spinach): Leafy, dark
green vegetable similar to spinach; red and purple leaf vari-
eties, also. The high-protein seeds can be ground into flour
and used in baked products, or boiled and eaten as cereal.
Popular throughout Asia and Latin America.
Ambarella (hog or Jew plum; kadondong; otaheite or golden Ambarella (hog or Jew plum; kadondong; otaheite or golden Ambarella
apple; vi-apple): Small, oval-shaped fruit with very strong
flavor native to Polynesia but also found in Southeast Asia and
Caribbean. Used unripe for preserves and ripe in desserts.
Amchoor (amchur; khati powder): Dried, unripe mango slices
or powder, with a sour, raisin-like flavor.
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5 3 4 G L O S S A R Y O F E T H N I C I N G R E D I E N T S
cooking (especially Portuguese). Must be soaked, drained,
and boiled before use.
Bagoong: See F ish paste.
Bagoong-alamang: See S h r imp paste.
Bambara groundnut (Congo goober; kaffir pea): Legume very
similar to peanuts, native to Africa.
Bamboo shoot (juk suhn): Crisp, cream colored, conical shoot
of the bamboo plant. Used fresh (stored in water) or avail-
able canned in brine (whole or sliced).
Banana flower (plantain flower): Native to Indonesia and
Malaysia, bananas are now found in most tropical regions.
Male inflorescence of the plant (female inflorescence that
develops into fruit not eaten) is sheathed in inedible red-
purple petals. Starchy interior must be boiled repeatedly to
remove bitterness; used fresh in salads, cooked in curries,
soups, or as side dish in palm oil or coconut milk.
Bangus: See M il k f ish .
Baobab (monkey bread, lalu powder): Slightly sweet seeds
from the large fruit of the native African baobab tree. Used
roasted or ground. Pulp of the fruit is also consumed.
Basmati rice: See R ic e.
Bean curd (cheong-po, tempeh, tofu, tobu): Custard-like,
slightly rubbery white curd with a bland flavor made from
soybean milk. Japanese bean curd (tofu) tends to be softer
than Chinese, which is preferred for stir-fried dishes. A
chewier version common in Southeast Asia is called
tempeh. Cheong-po, a Korean bean curd, is made from
mung beans.
Beans: See specific bean type.
Bean sprouts (nga choy): The young sprouts of mung beans or
soybeans popular in Asian cooking (sprouts may also be
grown from the tiny seeds of alfalfa or peas, also from
legumes). The crisp 1- to 2-inch sprouts are eaten fresh or
added to stir-fried dishes.
Belgian endive: See C h ic or y .
Berbere: Ethiopian spice mix (typically very hot) used to
season many foods, usually including allspice, cardamom,
cayenne, cinnamon, cloves, coriander, cumin, fenugreek,
ginger, nutmeg, and black pepper.
Bergamot orange: Pear-shaped orange with exceptionally tart
flesh. Rind used to flavor dishes in the Mediterranean and
North Africa; oil extracted from rind flavors Earl Grey tea.
Betel (areca nuts; catechu): The heart-shaped leaves of the
betel vine (related to black pepper) are used to wrap areca
nuts (from the Areca palm; the nuts are usually called betel
nuts because of their use with betel leaves) and spices for
paan in India. Betel nuts and leaves are chewed together in
many Southeast Asian countries and in India to promote
digestion. May stain teeth red.
Bindi: See O k r a.
Bird’s nest: Swallows’ nests from the cliffs of the South China
Sea made from predigested seaweed; added to Chinese
soups or sweetened for dessert. Must be soaked before use.
Bitter almond: An almond variety with an especially strong
almond flavor, often used to make extracts, syrups, and
liqueurs. Grown in the Mediterranean region, bitter
almonds are used in European dishes. They contain prussic
acid and are toxic when raw (they become edible when
cooked) and are unavailable in the United States.
Bitter melon (balsam pear; bitter gourd, foo gwa): Bumpy-
skinned Asian fruit similar in shape to a cucumber; pale
green when ripe. The flesh has melon-like seeds and an
acrid taste due to high quinine content (flavor and odor
become stronger the longer it ripens).
Bitter orange: See S ev il l e or ange.
Black bean (frijol negro; turtle bean): Small (less than 1.2
inches) black bean used extensively in Central American,
South American, and Caribbean cooking.
Black beans, fermented: Black soybeans salted and fermented
to produce a piquant condiment. Used in Chinese cooking
as a seasoning or combined with garlic, ginger, rice wine,
and other ingredients to make black bean sauce.
Black-eyed peas (cow peas; crowder peas): Small legume
(technically neither a pea nor a bean), white with a black
spot, native to Africa and southern Asia.
Black mushrooms: See M ush r ooms.
Blood orange: Old variety of orange with deep maroon-
colored flesh, sometimes streaked with white. Intense
sweet-tart flavor. Common in Spain and North Africa.
Blowfish (bok; fugu; globefish; puffer): A popular Japanese
specialty, blowfish contain a deadly neurotoxin in the liver
and sex organs. Must be carefully prepared by expert; flesh
has a slight tingle when eaten.
Bok choy (Chinese chard; pak choi; white cabbage): Vegetable Bok choy (Chinese chard; pak choi; white cabbage): Vegetable Bok choy
of the cabbage family with long, white leaf stalks and
smooth, dark green leaves used in Chinese cooking.
Boonchi: See L ong bean.
Bottlegourd: See C al abash .
Boxthorn: See M atr imony v ine.
Breadfruit: Large, round, tropical fruit with warty green skin
and starchy white flesh popular in nearly all tropical
regions. It must be cooked. Unripe, green fruits are gener-
ally prepared as a vegetable, boiled, fried, or even pickled.
In South Pacific may be fermented to make poi-like starchy
dish. Ripe, yellow-fleshed fruit usually sweetened and
served as dessert. Available canned; frozen.
Breadroot (Indian breadroot; prairie turnips; timpsil a; tipsin):
Hairy perennial plant ( P sor al ea esc ul enta) with large brown
root eaten by Native Americans of the Plains and adopted
by European immigrants who knew it as pomme de pr air ie.
Brinjal: See E ggpl ant.
Buckwheat (kasha): Nutty-flavored cereal native to Russia
(where it is called kasha), sold as whole seeds (groats) and
ground seeds (grits if coarsely ground, flour if finely
ground). It is common in Russian and eastern European
cooking.
Buffalo berry: Scarlet berry of the S h eper dia genus, so called
because it was usually eaten with buffalo meat by Native
Americans of the plains.
Bulgur (bulghur, burghul): Nutty-flavored cracked grains of
whole wheat that have been precooked with steam.
Available in coarse, medium, and fine grades.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
G L O S S A R Y O F E T H N I C I N G R E D I E N T S 5 3 5
Burdock root (gobo): Long thin root with thin brown skin
and crisp white flesh and an earthy, sweet flavor. Popular in
Asian cooking.
Cactus fruit (cactus pears, cholla, Indian figs, pitaya, sabra,
strawberry pear, thang long): Succulent fruit of various
cacti popular in numerous nations. Red prickly pear cactus
fruit—cactus pears, cholla, Indian figs, sabra, tuna—
common in Mexico, U.S. Southwest, Central America,
Israel and some other Middle Eastern countries, Australia,
South Africa, and Italy. Fruit of the organ pipe cactus sold
in the United States as strawberry pear or pitaya. Fruit of
saguaro cactus, nopales cactus, and apple cactus eaten in
desert areas of Mexico and U.S. Southwest. Climbing epi-
phytic cacti common in South America, Australia, Israel,
and Vietnam; one variety called thang long red pitaya or
dragon fruit.
Cactus pads (nopales, nopalitos): Paddles of the prickly pear
cactus or nopales cactus commonly eaten in Mexico and
parts of the U.S. Southwest, fresh, cooked, or pickled.
Available canned.
Cactus pears: See C ac tus f r uit.
Caimito: See S tar appl e.
Cajú: See C ash ew appl e.
Calabash (bottlegourd; calabaza; West Indian pumpkin):
Gourd-like fruit of a tropical tree native to the New
World.
Calabaza: See C al abash ; C ush aw
Calamansi (calamondin, Chinese or Panama orange, golden
or scarlet lime, musk lime): Small sour lime native to China
but widely distributed in Indonesia and the Philippines,
also available in Southeast Asia, Malaysia, and India. Prized
for its sour flavor in Filipino cooking.
Callaloo (cocoyam): Edible leaves of root vegetables, especially
amaranth, malanga, and taro. Callaloo is sometimes the
name of a dish made from these leaves.
Camass root: Sweet bulb of the camass lily common in the
U.S. Pacific Northwest.
Candlenut (kemini; kukui nut): Oily tropical nut sold only in
roasted form (toxic when raw). Popular in Malaysia,
Polynesia, and Southeast Asia.
Càng cua: See P eper omia.
Cannellini: See K idney bean.
Capers: Small gray-green flower buds from a bush native to
the Mediterranean; commonly pickled.
Carambola: See S tar f r uit.
Cardoon: Member of the artichoke family resembling a spiny
celery plant, popular in Italian cooking.
Cashew apple ( c aj ú ): The fleshy false fruit attached to the
cashew nut. Native to Brazil, it is also eaten in the
Caribbean and India.
Casimiroa (white sapote, zapote blanco): Dark green to yellow
fruit native to Central America; resembles an Asian pear.
Soft, white flesh is eaten fresh or prepared as jellies, ices,
milkshakes, and fruit leather.
Cassarep: Caribbean sauce made from the juice of the bitter
variety of cassava cooked with raw sugar.
Cassava (cocoyam; fufu; manioc; yuca): Tropical Latin
American tuber (now eaten in most tropical areas of the
world) with rough brown skin and mild white flesh. Two
types exist: bitter (poisonous unless leached and cooked)
and sweet. Flour used in Africa (gari), the Caribbean, and
Brazil (farinha). Cassava starch (fufu) is used to make the
thickening agent tapioca. Leaves also consumed.
Caviar (red caviar, ikura, tarama, tobikko): Fish roe from a
variety of fish eaten worldwide, including sturgeon (techni-
cally the only roe that is called caviar), salmon (red caviar,
ikura in Japan), flying fish (tobikko), carp (tarama, most
often made into a paste with lemon juice and other ingredi-
ents, in Greece called taramasalata), herring, and mullet.
Sturgeon caviar graded according to size and quality.
Celeriac (celery root): Gnarled, bulbous root of one type of
celery, with brown skin, tan flesh, and nutty flavor.
Cèpes: See M ush r ooms.
Chanterelles: See M ush r ooms.
Chayote (christophine, chocho, huisquil, mirliton, vegetable
pear): Thin-skinned, green (light or dark), pear-shaped
gourd. Native to Mexico, it is now common in Central
America, the Caribbean, the southern United States, and
parts of Asia.
Cheong-po: See B ean c ur d.
Cherimoya (anona, custard apple, graviola): Large, dimpled,
light green fruit native to South America. White, creamy,
flesh has a flavor reminiscent of strawberries, cherries, and
pineapple. See also C ustar d appl e.
Chicharrónes (pork cracklings): Deep-fried pork skin, fried
twice to produce puffy strips.
Chickpeas (Bengal gram dal, chana dal, garbanzo bean): Pale
yellow, spherical legume popular in Middle Eastern,
Spanish, Portuguese, and Latin American cooking. Can be
purchased canned or dried.
Chico: See Z apote.
Chicory (Belgian endive, witloof ): European chicory plant. Chicory (Belgian endive, witloof ): European chicory plant. Chicory
Leaves used as salad green; bitter root roasted to prepare a
coffee substitute. Often added to dark coffee in Creole
cooking.
Chile pepper: Although chile peppers, or chiles, are often
called hot peppers, the fruits are not related to Asian
pepper (such as black pepper) but are pods of capsicum
plants, native to Central and South America. The alkaloid
capsaicin, found mostly in the ribs of the pods, is what
makes chile peppers hot. In general, the smaller the chile,
the hotter it is. More than 100 varieties are available, from
less than one-quarter inch in length to over eight inches
long. Used fresh or dried. Common types include mild
pods (see P epper s), slightly hot peppers such as Anaheim
(also called C al if or nia or N ew M ex ic o c h il e) and Cayenne
(used mostly dried and powdered as the spice cayenne);
dark green, medium hot Jalapeño (often available canned—
when smoked are known as Chipotle); spicy, rich green
Poblano (used fresh, or ripened and dried, called Ancho);
hot Serrano (small, bright green or red); and very hot Chile
de Arbol, Japones, Péquin (tiny berrylike pepper,
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5 3 6 G L O S S A R Y O F E T H N I C I N G R E D I E N T S
meat valued for its smoky flavor; can be bitter. Used espe-
cially in soups and stews.
Copra: Dried coconut kernels used in the extraction of coco-
nut oil.
Coriander (cilantro, Chinese parsley, dhanyaka, yuen sai):
Fresh leaves of the coriander plant with a distinctive
“soapy” flavor, common in Asian, Middle Eastern, Indian,
and Latin American cooking. Seeds used as spice; root used
in Thai cooking.
Corn smut (huitlacoche): Fungus ( U stil aginal es) that grows on
corn ears. Prized in Chinese, Mexican, and Native
American cooking.
Couscous (cuscus, cuzcuz): Small granules of semolina flour
used as a grain in African, Italian, Brazilian, and Middle
Eastern dishes.
Cow pea: See B l ac k - ey ed pea.
Cracked wheat: Cracked raw kernels of whole wheat used in
Middle Eastern cooking.
Crawfish (crawdad, crayfish, mudbug): Small freshwater crus-
tacean, 4 to 6 inches long, that looks and tastes something
like lobster. Found in Europe and the United States
(California, Louisiana, Michigan, and the Pacific
Northwest). The names c r aw f ish and c r ay f ish are also
applied to the langostino, a saltwater crustacean that lacks
large front claws.
Crème fraîche: Slightly thickened, slightly fermented cream
popular in France.
Culantro (bhandhani, ngo gai, recao, siny coriander): Herb
(E r y ngium f oetidum) that is close relative of cilantro (see
C or iander ); however, looks more like a dandelion with a
pungent flavor reminiscent of crushed beetles. Used inter-
changeably with cilantro in the Caribbean and Central
America, especially associated with Puerto Rican sofrito.
Seasons Thai curries, Malaysian rice dishes, Indian chut-
neys and snacks; larger leaves used as a wrap for foods in
Vietnam. Reportedly high in riboflavin, carotene, calcium,
and iron.
Curry leaves (kari): Herb with tangerine overtones used
throughout India, Sri Lanka, and in parts of Malaysia. Fresh
leaves are briefly fried in ghee, then added to dishes before
other seasoning. Not usually a component of curry powder.
Curry powder: The western version of the fresh Asian-Indian
spice mixture (garam masala) used to flavor curried dishes.
Up to twenty spices are ground, then roasted, usually
including black pepper, cayenne, cinnamon, coriander,
cumin, fenugreek, ginger, cardamom, and turmeric for
color.
Cushaw (calabaza, green pumpkin): Round or oblong winter Cushaw (calabaza, green pumpkin): Round or oblong winter Cushaw
squash with yellow flesh and a flavor similar to pumpkin.
Custard apple (anona roja, bullock’s heart, mamon): Green-
skinned, irregular (heart-, spherical-, or ovoid-shaped) fruit
about 3 to 6 inches in diameter, with granular, custardy
flesh. Flavor sweet but considered inferior to related fruits
such as cherimoya and sweetsop. See also C h er imoy a.
Cuttlefish (inkfish): A mollusk similar to squid, but smaller.
Available fresh or dried.
exceptionally hot, also known as bird or bird’s eye peppers),
Piri-piri (favored in West Africa for sauces and marinades;
also name of dishes that include some form of the pepper)
and Tabasco (small, red chiles, often used dried and for
sauce of same name). Those with extreme heat include
Habanero and Scotch Bonnet; similar varieties native to the
Caribbean.
Chile pepper sauce/paste (harissa, kochujang, pili-pili,
Tabasco): Fiery condiments based on hot chile peppers.
Sauce typically made from fermented chile peppers, vine-
gar, and salt (Tabasco sauce is the best-known U.S. brand).
Pastes often include other ingredients, such as garlic and oil
(Chinese-style and North African harissa). Pili-pili used in
West Africa made with the piri-piri chile (see C h il e pepper s)
and other ingredients such as tomatoes, onions, or horse-
radish. Korean kochujang includes soybeans and is fer-
mented.
Chili powder: Ground, dried chile peppers, often with added
spices such as oregano, cumin, and salt.
Chinese date (dae-chu; jujube): Small Asian fruit (not actually
belonging to the date family) usually sold dried. Red dates
are the most popular, but black and white are also available.
Chinese parsley: See C or iander .
Chitterlings (chitlins): Pork small intestines, prepared by boil-
ing or frying.
Chokecherry: Tart, reddish black cherry ( P r unus v ir giniana)
native to the Americas.
Cholla: See C ac tus f r uit.
Chrysanthemum greens (chop suey greens, crowndaisy
greens, sookgat): Spicy leaves of a variety of chrysanthe-
mum (not the American garden flower), popular in Asian
stir-fried dishes, especially in Korea.
Cilantro: See C or iander .
Citron: Yellow-green, apple-size citrus fruit. Valued primarily
for its fragrant peel that is used raw to flavor Indonesian
foods, and candied in European baked goods. Available
crystallized and as preserves.
Citronella: See L emon gr ass.
Clotted cream (Cornish cream, Devonshire cream): Very thick
cream made by allowing cream to separate from milk, then
heating it and cooling it so that it ferments slightly. Finally,
the cream is skimmed from the milk (although Cornish
cream is skimmed before heating and cooling). Popular in
southwest England, where it is spread on bread or used as a
topping for desserts.
Cloud (wood) ears: See M ush r ooms.
Coconut cream: High-fat cream pressed from fresh grated
coconut.
Coconut milk: Liquid extracted with water from fresh grated
coconut.
Cocoplum: Bland plum with white flesh native to Central
America, found in the Caribbean, Central America, and
Florida. Eaten fresh or dried.
Cocoyam: See C al l al oo; C assav a.
Conch: Large, univalve mollusk found in waters off Florida
and Caribbean (where it is sometimes called lambi). Chewy
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G L O S S A R Y O F E T H N I C I N G R E D I E N T S 5 3 7
little like celery. Used as a root vegetable, especially in Italy
(known as finnochio). Delicate licorice or anise flavor.
Fenugreek (methi): Tan seeds of the fenugreek plant, with a Fenugreek (methi): Tan seeds of the fenugreek plant, with a Fenugreek
flavor similar to artificial maple flavoring. Essential in the
preparation of Asian-Indian spice mixtures. Leaves, called
methi, also commonly eaten.
Fiddlehead ferns: Young unfurled fronds a specialty dish of
the U.S. Northeast and southeastern Canada. Roots were
eaten by Native Americans.
Filé powder: See S assaf r as.
Fish paste (bagoong, kapi, pa dek, prahoc): Thick fermented
paste made from fish, used as a condiment and seasoning
in the Philippines and Southeast Asia.
Fish sauce (nam pla, nam prik, nuoc mam, patis, tuk-trey):
Thin, salty, brown sauce made from fish fermented for sev-
eral days. Asian fish sauces vary in taste from mild to very
strong, depending on the country and the grade of sauce.
Filipino patis is the mildest; Vietnamese nuoc mam is
among the most flavorful. Nuoc cham is a sauce made from
nuoc mam by the addition of garlic and chile peppers.
Five-spice powder: A pungent Chinese spice mixture of anise,
cinnamon, cloves, fennel seeds, and Szechuan pepper.
Fufu: See C assav a; Y am.
Fugu: See B l ow f ish .
Fuzzy melon (hairy melon, mo gwa): Asian squash similar to
zucchini with peach fuzz-like skin covering. Called fuzzy.
Gai choy: See M ustar d.
Gai lan (Chinese broccoli, Chinese kale): Thick, broccoli-like
stems and large, dark or blue-green leaves, with slightly
bitter flavor. Used especially in stir-frying.
Garbanzo bean: See C h ic k pea.
Gari: See C assav a.
Geoduck: Large (up to 15 pounds) clam native to U.S. Pacific
Northwest, with neck or siphon as long as 3 feet. Neck used
in soups, stews; body sliced for steaks.
Ghee: Clarified butter (usl i gh ee) from cow’s or buffalo milk
used in India. The term gh ee is also used for shortening
made from palm or vegetable oil.
Ginger root: Knobby brown-skinned rhizome with fibrous
yellowwhite pulp and a tangy flavor. Used sliced or grated
in Asian dishes. Immature root with milder flavor used in
some preparations, particularly pickled ginger popular in
Japanese cuisine and candied ginger. Dried, ground ginger
provides ginger flavor without the bite of fresh.
Ginkgo nut: Small pit of the fruit of the ginkgo tree (ancient
species related to the pine tree), dried or preserved in brine,
common in Japan.
Ginseng: Aromatic forked root with bitter, yellowish flesh,
used in some Asian dishes and beverages; best known for
therapeutic uses.
Glutinous rice: See R ic e.
Granadilla: See P assion f r uit.
Grape leaves: Large leaves of grape vines preserved in brine,
common in Middle Eastern cooking.
Graviola: See C h er imoy a.
Gravlax: See S al mon, c ur ed.
Daikon (icicle radish, white radish, mooli): Relatively mild
white radish common in Asian cooking. The Japanese vari-
ety is the largest, often 12 inches long, and is shaped like an
icicle. The Chinese variety tends to be smaller.
Dals: Indian term for hulled and split grains, legumes, or
seeds. Many types are available, such as lentils and split
peas.
Dashi: Japanese stock made from kelp and dried fish (bonita).
Dash i- no-m oto is the dried, powdered, instant mix.
Dilis (daing): Small fish related to anchovies, dried and salted.
Used in Filipino dishes.
Dragon’s eyes: See L ongan.
Drumstick plant (horseradish tree, malunggay, reseda, sili
leaves): Small, deciduous tree native to India, now popular
in India, Southeast Asia, the Philippines, and West Africa.
Fern-like leaves (very spicy flavor), flowers, seeds (resem-
bling bean pods but not a legume), and roots (indistin-
guishable from horseradish) consumed.
Duhat: See J ambol an.
Durian: Football-size spiked fruit with a strong odor reminis-
cent of gasoline or rotten onions and sweet, creamy flesh
prized in Malaysia, Southeast Asia, and parts of China.
Edamame: See S oy bean.
Eddo: See T ar o.
Eggplant (ai gwa, aubergine, brinjal, melananza, nasu): Large,
pear-shape to round member of the nightshade family with
smooth, thin skin (white or deep purple in color) and
spongy, off-white flesh. Native to India, where it is called
brinjal, it has a mildly bitter flavor. Especially popular in
Mediterranean and Asian cuisine. Asian varieties known as
Japanese (nasu) and Chinese (ai gwa) eggplant are widely
available; the Thai type is small, round, and white with
green stripes and is less common.
Egusi: See W ater mel on seeds.
Elderberries: Small shrubs up to 20 feet. Numerous species
found throughout northern hemisphere. In the United
States the small, dark purple berries used fresh and in pre-
serves, pies, and wine. Blossoms fried as fritters.
Enoki: See M ush r ooms.
Epazote (Mexican tea; pigweed, wormseed): Pungent herb
related to pigweed or goosefoot (and sometimes called by
these names). Found in Mexico and parts of the United
States. Often added to bean dishes to reduce gas.
Farinha: See C assav a.
Fava bean (broad bean, brown bean, horse bean, Windsor
bean): Large, green, meaty bean sold fresh in the pod.
Smaller white or tan fava beans are dried or canned and
cannot be used interchangeably with the fresh beans.
Common in Italian and Middle Eastern cooking.
Feijoa (pineapple guava): Small (up to 3 inches), ovoid fruit
with greenish skin and white flesh. Flavor is similar to
strawberries and pineapple with minty overtones. Shrub
native to central regions of South America, but now also
found in California, Australia, and New Zealand.
Fennel (finnochio, sweet anise): Light green plant with slightly
bulbous end and stalks with feathery, dark green leaves, a
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5 3 8 G L O S S A R Y O F E T H N I C I N G R E D I E N T S
Hot pepper: See C h il e pepper .
Huisquil: See C h ay ote.
Icicle radish: See Daik on.
Ikura: See C av iar .
Imli: See T amar ind.
Indian breadroot: See B r eadr oot.
Indian fig: See C ac tus f r uit.
Indian potato: See G r oundnuts.
Irish moss (carrageen): Gelatinous seaweed extract added to
milk or rum as a beverage in the Caribbean.
Jaboticaba (guapuru, sabara): Brazilian shrub or small tree
with 0.5- to 1.5-inch fruit clustered like grapes. Gelatinous
pulp is mild and sweet.
Jackfruit: Large (up to 100 pounds) fruit related to breadfruit
and figs, native to India, now cultivated in Asia, Malaysia,
and Southeast Asia. Two varieties are widely eaten, one
with a crisp texture and bland flavor, the other softer and
sweeter. Immature fruit is usually prepared like other
starchy vegetables such as breadfruit and plantains, or pick-
led. Sweeter types are popular as dessert. Available dried or
canned.
Jaggery: Unrefined sugar from the palmyra or sugar palm
common in India.
Jagua: See M amonc il l a.
Jambolan (duhat, Indian blackberry, jaman, Java plum, rose
apple, voi rung): Small sour fruit grown in India and
Southeast Asia, especially the Philippines. Used primarily
in preserves, juices, and sherbets.
Jerusalem artichoke (sunchoke, sunroot): Small nubby-
skinned tuber that is the root of a native American sun-
flower. It is neither from Jerusalem nor related to the
artichoke, though the flavor when cooked is similar. It is
used raw and cooked.
Jicama (ahipa, sa got, singkamas, yambean): Legume with
medium to large tuber with light brown skin and crisp
white flesh, indigenous to Brazil. Used raw in Latin
American cuisine, it has a sweet, bland flavor, similar to
peas or water chestnuts. Also found in Asia, where it is typ-
ically stir-fried or added to other cooked dishes.
Jujube: See C h inese date.
Juneberries (saskatoons, serviceberries; shadbush): Red to
deep purple berries on large bush native to the Great Plains
region of the United States and Canada. White blooms in
June associated with shad migratory run on East Coast;
favorite of Native Americans.
Juniper berry: Distinctively flavored dark blue berry of the
juniper evergreen bush, native to Europe. Used to flavor
gin.
Kadondong: See A mbar el l a.
Kaffir lime (ichang lime, makrut, wild lime): Aromatic citrus
popular in Southeast Asia, especially in Thai cooking. Juice,
rind, and leaves used to flavor curries, salad dressings, and
sauces.
Kamis: Sour, cucumber-like vegetable native to the
Philippines. Used to achieve a sour, cool flavor in Filipino
cooking.
Greens: Any of numerous cultivated or wild leaves, such as
chard, collard greens, creases, cochan (coneflower), dande-
lion greens, dock, kale, milkweed, mustard greens, poke-
weed, purslane, and spinach.
Grits: Coarsely ground grain, especially hominy, which is typi-
cally boiled into a thick porridge or fried as a side dish.
Served often in the U.S. South.
Ground-cherries (Cape gooseberries, poha, golden berries):
Yellow fruit that looks similar to a tiny husked tomato,
from a bush native to Peru or Chile. Now popular through-
out Central and South America, Central and South Africa,
and the South Pacific. Also available in Australia, China,
India, Malaysia, and the Philippines.
Groundnuts (apios, Indian potatoes): South American tuber
A pios amer ic ana eaten by Native Americans, adopted by
European settlers. Different from Africa groundnuts (refer-
ring to either peanuts or Bambara groundnuts).
Guanabana: See S our sop.
Guapuru: See J abotic aba.
Guarana (Brazilian cocoa): Shrub, P aul l inia c upana indige-
nous to the Amazon. Dried leaves and seeds of the fruit are
used to make a stimulating tea (containing caffeine) or
mixed with cassava flour to form sun-dried sticks.
Guava (araca de praia, cattley guava, waiwai): Small sweet fruit
with an intense floral aroma, native to Brazil. Skin is yel-
low-green or yellow, and the grainy flesh ranges from white
or yellow to pink and red. Many varieties are available,
including strawberry guava (also known as cattley guava,
araca de praia, and waiwai) and pineapple guava. Guava is
popular as jelly, juice, or paste.
Guayo: See M amonc il l a.
Guineps: See M amonc il l a.
Headcheese: Loaf of seasoned meat made from the hog’s head
and sometimes also feet and organs.
Heart of palm (palmetto cabbage, palmito): White or light
green interior of the palm tree, especially popular in the
Philippines. Available canned.
Hickory nuts: Tree indigenous to North America, in same
family as pecans. Eaten fresh, roasted, or ground into meal
or pressed for a cream-like fluid by Native Americans; used
in confections in the U.S. South.
Hog peanut: A high-protein underground fruit that grows on
the root of the vine F al c ata c omosa in the central and
southern United States. The peanut has a leathery shell that
can be removed by boiling or soaking. The nut meat can be
eaten raw or cooked.
Hoisin sauce: Popular Chinese paste or sauce, reddish brown
in color, with a spicy sweet flavor. It is made from fer-
mented soybeans, rice, sugar, garlic, ginger, and other
spices.
Hominy (posole, pozole): Lime-soaked hulled corn kernels Hominy (posole, pozole): Lime-soaked hulled corn kernels Hominy
(yellow or white) with the bran and germ removed.
Traditionally prepared by some Native Americans with
culinary ash, which increases potassium, calcium, iron,
phosphorus, and other mineral values. Ground, commonly
called grits (see G r its).
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G L O S S A R Y O F E T H N I C I N G R E D I E N T S 5 3 9
North Carolina; meat from large claws and tail, premature
eggs called c or al , and liver eaten. Spiny lobster ( P anul ir us
ar gus and other species) looks similar to American lobster
but is a different animal. Found in warm waters from North
Carolina to Brazil; small claws, only tail meat eaten.
Longan (dragon’s eyes): Fruit of an Asian Indian tree related to
litchis. Used fresh, canned, or dried.
Long bean (boonchi, dau gok, sitao, yardlong bean): Roundish
Asian bean, 12 to 30 inches long. Similar in taste to string
beans, long beans are softer, and chewier, less juicy, and less
crunchy than string beans.
Long-grain rice: See R ic e.
Loquat (nispero): Slightly fuzzy yellow Asian fruit about
2 inches across, easily peeled, with tart peach-flavored flesh.
Cultivated worldwide; available fresh, dried, and in syrup.
Lotus root (lian, lin gau hasu, renkon, water lily root): Tubular
vegetable (holes, as in Swiss cheese, run the length of the
root, producing a flower-like pattern when the root is
sliced) with brownish skin and crisp, sweet, white flesh.
Becomes starchy when overcooked or canned.
Lox: See S al mon, smok ed.
Luffa (cee gwa, Chinese okra, loofa, padwal, silk melon): Long,
thinskinned Asian vegetable, a member of the cucumber
family, with spongy flesh. Immature luffas consumed fresh,
stir-fried, and in curries; mature luffa becomes bitter. Also
see S ponge gour d.
Lulo: See N ar anj il l o.
Lupine seeds (tremecos): Bitter seeds of a legume used pri-
marily for fodder. Must be leached in water before eating.
Macadamia nut: Round, creamy nut native to Australia, now
grown in Africa, South America, and Hawaii.
Mahi-mahi (dolphinfish, dorado): A saltwater finfish found in
parts of the Pacific and the Gulf Coast (not the mammal
also known as dolphin).
Mahleb: Middle Eastern spice made from ground black cherry
kernels, which impart a fruity flavor to foods.
Makrut: See K af f ir l ime.
Malagueta pepper (grains of paradise, guinea pepper): Small
West African berries related to cardamom, with a hot, pep-
pery flavor. In Brazil the term refers to a tiny Pequin chile
pepper.
Malanga (cocoyam, tannier, yautia): Caribbean tuber with
creamcolored, yellow, or pinkish flesh, dark brown skin,
and nutty flavor. Name also applied to other tubers (see
T ar o).
Mamey (sapote): Medium-size egg-shaped fruit with brown Mamey (sapote): Medium-size egg-shaped fruit with brown Mamey
skin and soft flesh ranging in color from orange to yellow-
ish to reddish. It has a flavor similar to pumpkin. See also
M ammea.
Mammea (mamey apple): South American fruit with reddish-
brown skin and bright yellow flesh that tastes like peaches.
Mamoncilla (guayo, guineps, jaguar, macao, Spanish lime):
Small 1- to 2-inch green fruit found in the Caribbean and
South America that grow in clusters like grapes but have
thicker skin and distinctive sweet, citrusy flesh around a
large seed.
Kang kong: See W ater c onv ol v ul us.
Kanpyo (kampyo): Ribbons of dried gourd used mostly for
garnishing dishes in Japan.
Kaong: See P al m nuts.
Kapi: See F ish paste.
Kasha: See B uc k w h eat.
Kava: See P epper pl ant.
Kemini: See C andl enut.
Kewra: See P andanus.
Key lime (dayap, nimbu, West Indian or Mexican lime):
Small, tart lime indigenous to the Caribbean, popular in
Florida Keys; also used in east and north Africa, India,
and Malaysia. Known best as primary ingredient in key
lime pie.
Khati powder: See A mc h oor .
Kidney bean (cannellini, red peas): Medium-size, kidney-
shaped bean, light to dark red in color (a white variety is
popular in Europe, especially Italy, where they are known
as c annel l ini). The flavorful beans are common in Europe,
Latin America, and the United States.
Kochujang: See Ch il e pepper sauc e/ paste.
Kohlrabi (tjin choi tow): Light green or purple bulbous vegeta-
ble that grows above the soil and produces stems bearing
leaves on the upper part. A member of the cabbage family,
it can be eaten raw or cooked.
Kola nut: Bitter nut of the African kola tree (extracts from this
nut were used in the original recipe for Coca-Cola).
Kudzu (ge gen, Japanese arrowroot): Japanese vine valued for
its tuberous root (up to 450 pounds) that is dried and pow-
dered for a starch used in sauces and soups and to coat
foods before frying. Now found in much of Asia and U.S.
Southeast where it is best known for its growth rate of up to
1 foot per day. May alleviate hangovers or induce sobriety.
Kukui nut: See C andl enut.
Kumquat (kin kan): Small, bright orange, oval fruit with a
spicy citrus flavor common in China and Japan. Also avail-
able in syrup and candied.
Laverbread: Thick purée of laver (see S eaw eed) that is baked.
Used in sauces and stuffings in Great Britain.
Lemon grass (citronella root): Large, dull green, stiff grass
with lemony flavor common in Southeast Asian dishes.
Available fresh, dried, or powdered.
Lily buds (golden needles, gum chum): The buds of lily flow-
ers used both fresh and dehydrated in the cooking of
China.
Lingonberry (low-bush cranberry): Small wild variety of the Lingonberry (low-bush cranberry): Small wild variety of the Lingonberry
cranberry found in Canada and northern Europe. Usually
available as preserves.
Litchi (lychee): Small Chinese fruit with translucent white
flesh and a thin brown hull and single pit. The flavor is
grape-like but less sweet. Available fresh and canned. Dried
litchis, also called litchi nuts, have different flavor and tex-
ture.
Lobster: Ocean-dwelling crustacean valued for its sweet flesh.
Two main species consumed in United States. American
lobster ( H omar us amer ic anus) found from Labrador to
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5 4 0 G L O S S A R Y O F E T H N I C I N G R E D I E N T S
Popular mushrooms in Europe, available both fresh and
dried, include c h anter el l es (a golden mushroom with an
inverted cap), mor el s (a delicately flavored mushroom with
a dark brown wrinkled cap), and por c ini or c è pes (large
brown mushrooms with caps that are spongy underneath;
also called bol etus).
Musk lime: See C al amansi.
Mustard (Chinese green mustard, gai choy, kyona, mizuna,
potherb): Though best known for the condiment made
from its seeds, greens of several varieties are popular in
Asia, called gai choy in China (dark green-reddish leaves),
mizuna (small yellowish, notched leaves) in Japan. Usually
steamed, boiled, or stir-fried. Root also consumed.
Nam pla: See F ish sauc e.
Nam prik: See F ish sauc e.
Nance: Small, yellow tropical fruit native to Central America
and northern South America. Similar to cherries with a
slightly tart flavor. Two varieties are available.
Napa cabbage (celery cabbage, Chinese cabbage, Peking cab-
bage, wong bok): Bland, crunchy vegetable with broad
white or light green stalks with ruffled leaves around the
edges. Several types are available, similar in taste.
Naranjilla (lulo): Walnut-size, orange-skinned, green-fleshed
fruit indigenous to the Americas, used mostly for its juice.
Particularly popular in Central America.
Naseberry: See Z apote.
Nigella seed (“black cumin,” “black onion,” kalonji): Small,
black seeds native to Europe, North Africa, and the
Middle East. Sometimes used as a substitute for black
pepper, the flavor of the seeds (which are related neither
to cumin nor onions) is pungent, slightly bitter. Added to
spice mixtures in India and the Middle East, sprinkled on
savory breads and cakes in both regions, as well as in
Eastern Europe.
Nispero: See L oq uat.
Nku: See S h ea nut.
Nongus (palmyra): Fruit of the palmyra palm, grown in India,
Indonesia, and Malaysia primarily as a source of sugar. See
also J agger y .
Nopales, Nopalitos: See C ac tus pads.
Nuoc cham: See F ish sauc e.
Nuoc mam: See F ish sauc e.
Oca: Tuber of Andean plant ( O x al is tuber osa). Resembles a
pink potato. Tastes lemony when fresh, sweet after storage.
Used in South America, prepared like potatoes or eaten
fresh.
Okra (bindi, lady’s fingers): Small, green, torpedo-shaped pod
with angular sides. A tropical African plant valued for its
carbohydrates that are sticky and mucilaginous. Used as a
vegetable and to thicken soups and stews.
Olive: Fruit of a tree native to the Mediterranean. Green olives
are preserved unripe. Large, soft Kalamata olives are a
medium size, purplish Greek olive. Dark olives (such as
Niçoise) are picked in autumn, often cured in salt, with a
tannic flavor. Ripe, black olives are smooth-skinned and
mild-flavored or wrinkled with a strong tannic flavor.
Mango (mangoro, mangue): Fruit native to India, now found
throughout Africa, Asia, Latin America, and parts of the
South Pacific. Yellow to red when ripe, averaging 1 pound
in weight. The flesh is pale and sour when the fruit is
unripe, bright orange and very sweet when it is ripe. Used
unripe for pickles and chutneys, ripe as a fresh fruit.
Manioc: See C assav a.
Marzipan: See A l mond paste.
Masa: Dough used to make tortillas and tamales. Made fresh
from dried corn kernels soaked in a lime solution, or from
one of two flours available: masa harina (tortilla mix made
from dehydrated fresh masa) or masa trigo (wheat flour
tortilla mix).
Mastic: Resin from the lentisk bush that has a slightly piney
flavor, used to flavor Middle Eastern foods. Available in
crystal form.
Matai: See W ater c h estnut.
Mate: Plant in holly family native to South America. Dried,
powdered leaves, called y er ba, are brewed to make a stimu-
lating tea (containing caffeine) that is popular in Argentina,
Brazil, and Paraguay.
Matrimony vine (boxthorn, wolfberry): Asian vine with culi-
nary and medicinal uses; both leaves and fruit are used in
China.
Mayhaw: Type of hawthorn tree found in U.S. South. Its fruit
looks like cranberries. Tart apple flavor. Used in preserves,
syrups, and wines.
Methi: See F enugr eek .
Mikan: Japanese citrus related to tangerines and mandarin
oranges. Eaten fresh, frozen, and canned in syrup.
Milkfish (awa, bangus): Silvery, bony fish with oily flesh espe-
cially popular in Filipino cooking.
Millet: Cereal native to Africa, known for its high-protein,
low-gluten content and ability to grow in arid areas. The
variety common in Ethiopia is called teff ..
Mirin: Sweet rice wine used in Japanese dishes.
Miso: Fermented soybean-barley or soybean rice paste
common in Japanese cooking. Light or white (shiro miso)
is mild flavored; dark or red (aka miso) is strongly flavored.
Also available sweetened and as powder.
Mizuna: See M ustar d.
Morels: See M ush r ooms.
Mullet (ama ama): Finfish of two families that can be black,
gray, or red. The flesh is a mix of dark, oily meat and light,
nutty-tasting meat. The texture is firm but tender.
Mung beans (green gram dal, mung dal): Yellow-fleshed bean
with olive or tan skin used in cooking of China, India. See
also B ean c ur d; B ean spr outs.
Mushrooms: Fresh or dried fungi used to flavor dishes
throughout the world. Common Asian types include enok i
(tiny yellow mushrooms with roundish caps), oy ster mush -
r ooms (large, delicately flavored gray-beige caps that grow
on trees), sh iitak e (dark brown with wide flat caps, available
dried as Chinese black mushrooms), str aw mush r ooms
(creamy colored with bell-like caps), and c l oud ear s or w ood
ear s (a large, flat fungus with ruffled edges, available dried).
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G L O S S A R Y O F E T H N I C I N G R E D I E N T S 5 4 1
Pawpaw (Hoosier banana, Poor Man’s banana, tree melon): Pawpaw (Hoosier banana, Poor Man’s banana, tree melon): Pawpaw
Light orange fruit that tastes like a cross between a banana
and a melon. Native to the Americas, it is approximately 6
inches long. See also P apay a.
Peanuts (groundnuts, goobers, monkey nuts): Legume
native to South America, introduced to Africa by the
Portuguese, then brought to the United States in the 17th
century by black slaves. Eaten raw, roasted, or pulverized
into peanut butter. Popular in Africa and the United
States; used in some Chinese, Southeast Asian, and Asian-
Indian dishes.
Pejibaye (peach palm): Fruit of a Central American palm,
especially popular in Costa Rica.
Peperomia ( c à ng c ua) : Small plant with heart-shaped leaves
P eper omia pel l uc ida found throughout Central and South
America, Africa, and Southeast Asia. Used as a culinary
herb in Vietnam, and as a medicinal herb in the
Philippines, Polynesia, and parts of Latin America.
Pepitas (cushaw seeds): Pumpkin or squash seeds, typically
from cushaw, common in Latin-American cooking. May be
hulled or unhulled, raw or roasted, salted or unsalted.
Pepper plant ( P iper meth y stic um) : Leaves of the South Pacific
plant used to produce the intoxicating beverage called k av a
or aw a.
Peppers: Misnamed pods of the capsicum plants native to
South and Central America (not actually related to Asian
pepper plants, which produce black pepper). Peppers are
divided into sweet and hot types (see C h il e pepper ). Sweet
peppers include bell peppers (green, red, yellow, and
purple), pimentos, and peppers used to make paprika (see
P apr ik a).
Perilla (shiso; beefsteak plant; quen-neep): Aromatic herb with
distinctive minty flavor; green or red. Available fresh or
pickled. Used mostly as a seasoning or garnish in many
Japanese and Korean dishes; sometimes served as a side
dish or to wrap rice and other items.
Pigeon pea: Small pea in a hairy pod (a member of the
legume family, but not a true pea) common in the cooking
of Africa, the Caribbean, and India. Yellow or tan when
dried.
Pignoli: See P ine nut.
Pigweed: See A mar anth ; E paz ote.
Pili nut: Almond-like nut of a tropical tree found in the
Philippines eaten raw and toasted. Popular also in Chinese
desserts.
Pili-pili: See C h il e pepper sauc e/ paste.
Pine nut (pignoli, piñon seed): Delicately flavored kernel from
any of several species of pine tree. Pine nuts are found in
Portugal (most expensive type), China (less costly, with a
stronger taste), and the U.S. Southwest. Common in some
Asian, European, Latin American, Middle Eastern, and
Native American dishes.
Pink bean (rosada): Small oval meaty bean that is a light tan-
nish pink in color.
Pinto bean: Mottled bean similar to kidney beans, especially
popular in U.S. Southwest and Mexico.
Olive oil: Extracted from the olive flesh, it is labeled according
to percent acidity, from ex tr a v ir gin to v ir gin (or pur e). U.S.
labeling laws restrict the use of the term virgin to only olive
oil made from the first press; virgin olive oils mixed with
refined olive oils to reduce acidity are labeled pur e.
Ostiones: Oyster native to the Caribbean that grows on the
roots of mangrove trees.
Otaheite apple: See A mbar el l a.
Oyster mushrooms: See M ush r ooms.
Oyster sauce: Thick, brown Chinese sauce made with soy
sauce, oysters, and cornstarch.
Pacaya bud: The bitter flower stalk of the pacaya palm found
in Central America. The edible stalk is about 10 inches long
and is encased in a tough green skin, which must be
removed before cooking.
Pa dek: See F ish sauc e.
Palillo: Peruvian herb, used dried and powdered to provide a
yellowish- orange color to foods.
Palmetto cabbage: See H ear t of pal m.
Palm nuts (kaong): Seeds from palms; pounded into palm
butter in West Africa. Also boiled and added to halo-halo
mix in Philippines. Available canned, in syrup.
Palm oil (aceite de palma, dende oil): Oil from the African
palm, unique for its red-orange color, used extensively in
West African and Brazilian Bahian cuisine. Crude oil con-
tains high levels of carotenoids and tocopherols; refined oil
deodorized and decolorized, significantly reducing nutri-
tional value. Oil from the seed of the palm fruit high in sat-
urated fats; should be labeled palm kernel oil, but often
mislabeled as palm oil.
Pandanus (flowers—kewra, screw pine; leaves—duan pandan,
pandan, rampa, screw pine): Perfume essence of the male
screwpine flower P andanus f asc ic ul ar is used primarily in
north Indian cooking. Screw-pine leaves P andanus amar y l -
l if ol ius reminiscent of mown hay, used to flavor the foods of
Southeast Asia, Malaysia, South India, Bali, and New
Guinea. Fresh withered leaves used in rice puddings and as
wrappers for steaming foods in Thailand. Bright green
screw-pine essence also available.
Papaya (kapaya, pawpaw, tree melon): Thin-skinned green
(underripe), yellow, or orange fruit with sweet flesh colored
gold to light orange to pink; native to Central America,
now found throughout the tropics. Mexican (large and
round) and Hawaiian (smaller and pear shaped) varieties
are commonly available. The shiny round black seeds are
edible. Unripe papaya is used in pickles; the ripe fruit is
eaten fresh.
Paprika: Powdered red peppers especially popular in
Hungarian cooking. Paprika is made from several types of
pods related to bell and chile peppers. Paprika is usually
designated sweet or hot. Spanish paprika, used in Spanish
and Middle Eastern dishes, is more flavorful.
Passion fruit (granadilla, lilikoi): Small oval fruit with very
sweet, gelatinous pulp. Its berries are used dried; leaves
brewed to make herbal tea.
Patis: See F ish sauc e.
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5 4 2 G L O S S A R Y O F E T H N I C I N G R E D I E N T S
Saewujeot: See S h r imp paste.
Saffron: Dried stamens of the crocus flower. It has a delicate,
slightly bitter flavor and bright red-orange color. Available
as threads or powder.
Sa got: See J ic ama.
Salal: Thick-skinned black berries of a native American plant
in the heath family. Used fresh and dried, good for pre-
serves. Leaves used for tea.
Salmon, cured: Salmon fillets cured in a mixture of salt, sugar,
and dill weed, common in Sweden (where it is known as
gravlax), Finland, and Norway.
Salmon, smoked: Raw, tender salmon slices lightly smoked
and cured in salt produced in Norway, Nova Scotia, and
Scotland. Smoked salmon soaked in a brine solution is
called l ox , a Jewish specialty.
Salmon roe: See C av iar .
Salt pork: White fat from the side of the hog, streaked with
pork meat, cured in salt.
Saluyot (jute, okra leaves, rau day): Leaves from Southeast
Asian jute bush with slippery texture when cooked (not
related to okra). Added to soups and stews in Filipino
cooking.
Samphire (beach asparagus, glasswort, sea pickle, pousse-
pied): Several species of samphire thought to have origi-
nated in Brazil, but now found worldwide, especially in
Australia and the South Pacific. Yellow- and purple-
skinned varieties are available. Passion fruit is often made
into juice.
Sapodilla: See Z apote.
Sapote: See Z apote.
Saskatoons: See J uneber r ies.
Sassafras (filé powder): Native American herb used to thicken
soups and stews.
Screwpine: See P andanus.
Sea cucumber (sea slug): Brown or black saltwater mollusk up
to 1 foot in length. They lack a shell, but have a leathery
skin and look something like smooth, dark cucumbers.
Sold dried, they are rehydrated for Chinese dishes, becom-
ing soft and jellylike, with a mild flavor.
Sea urchin roe (uni): Small, delicate eggs of the spiny sea
urchin, popular in Japan.
Seaweed (kim): Many types of dried seaweed are used in
Chinese, Korean, and Japanese dishes, including aonor ik o
(powdered green seaweed), k ombu (kelp sheets), and nor i
(tissue-thin sheets of dark green seaweed, also known as
laver). Also popular in the Pacific Islands. See also I r ish
moss; L av er br ead.
Serviceberries: See J uneber r ies.
Sesame seeds (benne seeds): Seeds of a plant native to
Indonesia. Two types are available: tan colored (white when
hulled) and black (slightly bitter). Untoasted sesame paste
popular in the Middle East (tahini); toasted sesame paste
and powdered seeds common in Asia, especially Korea.
Widely grown for their oil. Light sesame oil is pressed from
raw seeds, dark oil from toasted seeds; the dark oil has a
strong taste and is used as a flavoring.
Pitanga (Surinam cherry, Brazilian cherry): Small, bright red,
ribbed fruit of shrub or small tree E ugenia unif l or a native
to northeastern South America; found also in the
Caribbean and Florida. Thin skin with orange flesh that
melts in the mouth. Sweet with a slightly bitter bite.
Pitaya, Pitahaya, Pitajaya: See C ac tus f r uit.
Plantain: Starchy type of banana with a thick skin, which can
be green, red, yellow, or black. There are many varieties,
ranging in size from 3 to 10 inches. The pulp is used as a
vegetable and must be cooked. It is similar in taste to
squash. Flower also consumed (see B anana f l ow er ).
Poha: See G r ound-c h er r ies.
Poi: See T ar o.
Porcini: See M ush r ooms.
Posole, Pozole: See H ominy .
Prahoc: See F ish paste.
Prairie turnips: See B r eadr oot.
Prickly pear: See C ac tus f r uit; C ac tus pads.
Pulses: Term used especially in India for edible legume seeds,
including peas, beans, lentils, and chickpeas.
Quinoa: Cereal native to the Andes, typically prepared like
rice. Also available as flour and flakes (hojuelas).
Radicchio: Magenta-colored, slightly bitter member of the
chicory family used throughout southern and northern
Europe.
Rambutan: Bristly, juicy, orange or bright red fruit used in
Southeast Asian cooking; related to the litchi.
Ramp: Strong-flavored indigenous American onion that tastes
somewhat like a leek. Both leaves and bulbs are edible.
Recao: See C ul antr o.
Red bean: Small, dark red bean native to Mexico and the
southwestern U.S.
Red caviar: See C av iar .
Red pea: See K idney bean.
Rice: Grain native to India. More than 2,500 varieties are avail-
able worldwide, including basmati rice (small grain with a
flavor similar to popcorn, very popular in India and the
Middle East); brown rice (unmilled rice with the bran layer
intact; can be short-, medium-, or long-grain); glutinous
rice (also called sw eet or sw eet or sw eet pear l r ic e; very short grain and
very sticky when cooked); long-grain rice (white, polished
grains that flake when cooked, common in China and
Vietnam); and short-grain rice (slightly sticky when
cooked, popular in Japan and Korea). Rice flour is used to
prepare rice noodle, rice paper, and baked products.
Roseapple (pomarrosa, kopo): Small, thin-skinned pink or red
fruit native to Southeast Asia with somewhat spongy flesh
that has slightly acidic flavor.
Roselle (Florida cranberry; karkadeh; red sorrel; sorrel): Pods
of a hibiscus plant relative, common in Africa, the
Caribbean, Southeast Asia, Australia, and Florida. Used to
make a tart tea popular in Egypt and Senegal and a rum-
laced punch in the Caribbean. Also used for chutneys, pre-
serves, and candies. Young leaves are eaten raw as salad or
cooked as greens.
Sabra: See C ac tus f r uit.
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G L O S S A R Y O F E T H N I C I N G R E D I E N T S 5 4 3
Sponge gourd (luffa): Immature vegetable consumed in Asia
fresh and in soups; tough fibrous skin used for sponges
(loofah), filters, and stuffing.
Star anise: Eight-armed pods from a plant in the magnolia
family, with an anise-like flavor. Native to China.
Star apple (caimito): Purple, apple-size fruit with mild, gelati-
nous, lavender-colored flesh native to the Caribbean. Seeds
form a star around the center.
Star fruit (carambola): Small, deeply ribbed, oval fruit with
thin skin shaped like a star when sliced. Green and sour
when unripe, yellow and slightly sweet (though still tart)
when ripe. Unripe fruit is used in Indian and Chinese
dishes. Ripe it is eaten fresh.
Strawberry pear: See C ac tus f r uit.
Straw mushrooms: See M ush r ooms.
Sumac: Sour, red Middle Eastern spice made from the ground
berries of a nontoxic variety of the sumac plant.
Sunflowers: Native to the United States (genus H el ianth us);
over 60 varieties. Seeds eaten by Native Americans raw,
dried, and powdered (in breads). Unopened flower head
can be cooked and eaten like an artichoke. Petals are dried
and used like saffron in Southwest.
Sweet peppers: See P epper s.
Sweetsop (annona blanca, ata, sugar apple): Sweet, white-
fleshed fruit related to the cherimoya, custard apple, and
soursop.
Szechwan pepper (fagara): Aromatic berries with a hot flavor
popular in some Chinese and Japanese dishes.
Tabasco sauce: See c h il e pepper sauc e/ paste.
Tahini: See S esame seeds.
Tamarind (imli, tamarindo): Tart pulp from the pod of the
tamarind bean. Available in the pod, as a paste, in a brick,
or as a liquid concentrate. Unripe pulp used extensively in
flavoring numerous foods and beverages, especially Asian
Indian and Latino dishes, as well as Worcestershire sauce
and prepared salad dressings. Ripe pulp eaten fresh.
Tampala: See A mar anth .
Tannier (tannia): See T ar o; M al anga.
Tapioca: See C assav a.
Taramasalata: See C av iar .
Taro (cocoyam, eddo, dasheen, tannier, malanga, yautia):
Starchy underground vegetable similar to cassava with
brown hairy skin and white to grayish flesh, common in
the Caribbean and Polynesia. In Hawaii the boiled,
pounded taro paste called poi is a staple in the traditional
diet. The young shoots and large leaves are also eaten (see
C al l al oo; M al anga).
Tarpon: Large silver fish of the herring family found off the
coasts of Mexico and Central America.
Teff: See Teff: See Teff M il l et.
Tempeh: See B ean c ur d.
Tepary beans: Small, high-protein bean with wrinkled skin.
Grows wild in the U.S. Southwest.
Ti: Tropical plant popular in Polynesia (not related to tea). Ti
leaves are used to wrap food packets, and the root is eaten
and brewed for a beverage.
Seville orange (bitter orange; naranja aria, sour orange):
Orange with tough skin and dark flesh native to
Mediterranean. Inedible raw; juice used in liqueurs (Grand
Marnier, Cointreau, Curaçao) and in cooking of the
Mediterranean, Caribbean, Central America, and Korea.
Shadbush: See J uneber r ies.
Shallot: Very small bulb covered with a reddish, papery skin,
related to onions but with a milder, sweeter flavor.
Shea nut (bambuk butter, nku): Nut from the African shea tree,
grown for its thick oil, called shea nut butter or shea nut oil.
Shiitake mushrooms: See M ush r ooms.
Shiso: See P er il l a.
Short-grain rice: See R ic e.
Shoyu: See S oy sauc e.
Shrimp paste: Strongly flavored fermented Asian sauce or
paste made from small dried shrimp or similar crustaceans.
Many types are available (bagoong-alamang is the Filipino
variety; saewujeot is the Korean type).
Singkamas: See J ic ama.
Snail (escargot): Small, edible land snail (a common variety of
garden snail, cleansed with a commercial feed), popular in
France. Giant, baseball-sized snails popular in parts of
Africa and the South Pacific.
Snow pea (Chinese pea pod, ho lan dow, mange-tout, sugar
pea): Flat, edible pod with small, immature peas.
Sorghum (guinea corn, kaffir corn): Cereal common to tropi-
cal regions of Africa with seeds produced on a stalk. In the
Appalachians, Ozarks, and the U.S. South, sorghum is often
processed to make sweet syrup.
Sorrel (dock, sour grass, wild rhubarb): Small, sour green pop-
ular in Europe and parts of United States. See also R osel l e.
Sour orange: See S ev il l e or ange.
Soursop (guanabana): Large (often 12 inches long) rough-
skinned fruit with cottony, fluffy flesh that can be white,
pink, or light orange. Native to northern South America or
the Caribbean, now found in many parts of the Americas,
Africa, India, China, Southeast Asia, Malaysia, and South
Pacific. Often made into juice or conserves.
Soybean: Small high-protein bean common in Asia. Many
varieties of different colors, including black, green, red, and
yellow, are available; immature beans in the pod (called
edamame) popular in Japan. They are used fresh, dried,
and sprouted, most often processed into sauces, condi-
ments, and other products (see B ean c ur d; B ean spr out;
H oisin sauc e; M iso; O y ster sauc e; S oy mil k , S oy sauc e).
Soy milk: Soybeans that are boiled, pureed, then strained and
boiled again to produce a white milk-like drink.
Soy sauce (shoyu, tamari): Thin, salty, brown sauce made from
fermented soybeans. Several types are available. Chinese
and Korean soy sauces tend to be lighter in flavor than the
stronger, darker Japanese shoyu. Very dark soy sauces, such
as Chinese black soy sauce and Japanese tamari may be
thickened with caramel or molasses.
Spicebush: Shrub ( L inder a benz oin) with spicy-smelling bark
and leaves; red berries. Used to make Native American teas.
Spiny lobster: See L obster .
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5 4 4 G L O S S A R Y O F E T H N I C I N G R E D I E N T S
White bean: Three types of white bean are widely used: cannel-
lini (see K idney bean); Great Northern beans, which are large,
soft, and mild tasting; and the smaller, firmer navy beans.
White radish: See Daik on.
Wild rice: Seeds of a native American grass.
Winged bean: Edible legume called the soybean of the tropics.
All parts of the plant are consumed, including the shoots,
leaves, flowers, pods and seeds, and tuberous root. The
pods are large, from 12 to 24 inches long, and feature wing-
like flanges.
Winter melon (dong gwa, petha, wax melon/gourd): Round
greenskinned member of the squash family with a waxy
white coating and translucent white green or pink flesh.
Similar in taste to zucchini, it is used cooked in Chinese
dishes. Called fuzzy melon when immature, winter melon
when mature. See also F uzzy mel on.
Witloof: See Witloof: See Witloof C h ic or y .
Wolfberry: See M atr imony v ine.
Wong bok: See N apa c abbage.
Worcestershire sauce: Sauce developed by the British firm of
Lea and Perrins including anchovies, garlic, onions, molas-
ses, sugar or corn sweetener, tamarind, and vinegar, among
other ingredients.
Yacón (yakon, leafcup): Sweet-tasting root, P ol y mnia sonc h if o-
l ia, with brown skin and white flesh native to Andes. Eaten
throughout South America; in some regions confusingly
called j ic ama (See J ic ama).
Yam (ñame; yampi; cush-cush; mapuey): Tuber with rough
brown skin and starchy white flesh (not related to the orange
sweet potato called y am in the United States). Numerous
varieties; may grow quite large, up to 100 pounds. Found in
all tropical regions. Yam paste called f uf u in West Africa.
Yambean: See J ic ama.
Yard-long bean: See L ong bean.
Yautia: See M al anga; T ar o.
Yerba buena: A variety of mint used in some Native American
teas.
Yuca: See C assav a.
Yucca (Navajo banana): Spiky-leaved desert plant ( Y uc c a bac -
c ata) with large, pulpy fruit that ripens in summer. Eaten
fresh, boiled, baked, or dried into fruit leather.
Zapote (chico, black sapote, naseberry, sapodilla): Drab-
colored fruit of the sapodilla tree (which is the source of
chicle used in chewing gum). It has granular, mildly sweet
flesh, which can be yellow, red, or black. The zapote is a
member of the persimmon family. Potato valued primarily
for its sprouts and young leaves. Native to China; signifi-
cant crop in Southeast Asia, Malaysia, and South India.
Tilapia: Small freshwater fish with sweet, firm, white flesh.
Timpsila: See B r eadr oot.
Tipsin: See B r eadr oot.
Tobikko: See C av iar .
Tobu, Tofu: See B ean c ur d.
Tomatillo (husk tomatoes, miltomate): Small, light green,
tomato-like fruit surrounded by a green or tan papery husk,
common in Mexico. The flesh is slightly tart and is eaten
cooked, usually in sauces and condiments. Available fresh
or canned.
Tremecos: See L upine seeds.
Truffle: Black (French) or white (Italian) fungus found under-
ground. Truffles vary from the size of small marbles to as
large as tennis balls and are distinctively flavored, similar to
a wild mushroom. Available fresh or canned.
Tuk-trey: See F ish paste.
Tuna: See C ac tus f r uit.
Turtle: Popular in Caribbean, Central America, and U.S.
South. Diamondback terrapin ( M al ac l emy s ter r apin) is the
primary ingredient in turtle soups of the Atlantic states.
Green turtle ( C h el onia my das) is a sea turtle, commonly
eaten as steaks or stews. Other turtles eaten occasionally
(including eggs) are alligator snapping turtle, common
snapping turtle, and loggerhead turtle.
Ugli fruit: Citrus fruit that is a cross between a pommelo and
a mandarin orange, with a very bumpy yellow-orange skin
and a sweet orange-like flavor. Especially popular in
Jamaica.
Uni: See S ea ur c h in r oe.
Usli ghee: See G h ee.
Verjuice: Juice of unripe lemons used in Middle Eastern fare
to give a tang to dishes.
Voi rang: See J ambol an.
Wasabi: Light green Japanese condiment from root of plant
similar to horseradish with a powerful pungency. Available
fresh or powdered; green-dyed horseradish often sold as
wasabi.
Water chestnut (matai): Aquatic, walnut-size tuber with
fibrous brown peel and crunchy, sweet, ivory-colored flesh.
Available fresh or canned.
Water convolvulus (kang kong, ong choi, rau muong, water
spinach) Plant related to sweet potato valued primarily for
its sprouts and young leaves. Natives to China; significant
crop in Southeast Asia, Malaysia, and South India.
Watermelon seeds: Seeds often eaten in Africa (called egusi,
toasted and ground or pounded into meal or paste for
thickening soups and stews) and in Asia (toasted as a
snack; sometimes flavored or dyed red).
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
5 4 5
management, medicine, nursing, psychol-
ogy, and sociology publications are occa-
sionally good resources as well.
There are numerous books that have
contributed to research on foods and food
habits. Cookbooks and other popular lit-
erature often include anecdotal informa-
tion of interest. Online websites are an
additional source of data. Some of the
many resources available follow.
Observation and participation in the
community, at markets, at festivals and
fairs, and at public religious events are
also good ways to learn about a popu-
lation. Community leaders, traditional
healers, restaurateurs, and grocers can all
contribute to cultural knowledge about
foods and food habits. Accumulated expe-
rience with a minority population can be
an important adjunct to printed research.
The authors encourage food profes-
sionals to undertake and publish studies
on cultural foods to expand the limited
information on the topic. We also hope
that all professionals share their diver-
sity experiences through associations,
journals, and online nutrition websites or
list servers. Such research and commu-
nication help us become more culturally
competent and thus become more effec-
tive health care providers and educators.
General Bibliography
Abala, K. (Ed.). 2003–present. F ood
c ul tur e ar ound th e w or l d ser ies
(14 vols.). Westport, CT: Greenwood
Press.
Academy of Nutrition and Dietetics/
American Diabetes Association.
1998–2000. E th nic and r egional f ood
pr ac tic es: A ser ies (11 booklets).
Chicago: Author.
Anderson, E.N. 2005. E v er y body eats:
U nder standing f ood and c ul tur e.
New York: New York University
Press.
Avakian, A.V., & Haber, B. 2005. F r om
B etty C r oc k er to f eminist f ood studies:
C r itic al per spec tiv es on w omen
and f ood. Amherst: University of
Massachusetts Press.
Beardsworth, A., & Keil, T. 1997. S oc iol -
ogy on th e menu: A n inv itation to th e
study of f ood and soc iety . New York:
Routledge.
Belasco, W. (Ed.) 2001. F ood nations:
S el l ing taste in c onsumer soc ieties.
New York: Routledge.
Bell, D., & Valentine, G. 1997.
C onsuming geogr aph ies: W e ar e
w h er e w e eat. New York: Routledge.
Bryant, C.A., Dewalt, K.M., Courtney,
A., & Schwartz, J. 2003. T h e c ul tur al
f east: A n intr oduc tion to f ood and
soc iety (2nd ed.). Belmont, CA: soc iety (2nd ed.). Belmont, CA: soc iety
Brooks/Cole.
Caldwell, M., & Watson, J.L. 2005. T h e
c ul tur al pol itic s of f ood and eating.
Oxford: Blackwell.
Carlson, B. 1997. F ood f estiv al s: E ating
y our w ay f r om c oast to c oast. Detroit:
Visible Ink.
Civetello, L. 2003. C uisine and c ul tur e: A
h istor y of f ood and peopl e. New York:
Wiley.
Counihan, C.M. (Ed.). 2002. F ood in th e
U S A : A r eader . New York: Routledge.
Counihan, C.M., & Van Esterik, P.
(Eds.). 1997. F ood and c ul tur e: A
r eader . New York: Routledge.
Dalby, A. 2002. Danger ous tastes: T h e
stor y of spic es. Berkeley: University
of California Press.
Dassanowsky, R.V., & Lehman, J. (Eds.).
G al e enc y c l opedia of mul tic ul tur al
In many ways a book like this poses
more questions than it answers. Knowl-
edge of cultural foods is neither balanced
nor complete. Many interested readers
are undoubtedly asking why there is so
little research on adaptations of food
habits in the United States or why there
are such limited data available on certain
cultural groups. As stated in the Preface,
only the major American cultural groups
are presented in this book. Although the
authors reviewed many resources, the
resulting text is undeniably inadequate
in some areas.
Thus, the most urgent question is:
“Where to go from here?” Classes, semi-
nars, association memberships, research,
client interaction, and community
involvement are all useful ways to learn
more about cultural foods. In the nutri-
tion field, many departments of dietet-
ics, nutrition, and home economics offer
courses in food and culture. Culinary
schools often offer similar classes. Nutri-
tion, dietetic, and food service organiza-
tions occasionally sponsor seminars on
general topics in food habits, as well as on
culturally specific diets.
Academic research on foods habits
and nutrition is published in a limited
number of journals. A mer ic an J our nal of
C l inic al N utr ition, A mer ic an J our nal of
P ubl ic H eal th , E th nic ity & Disease, E th -
nic ity & H eal th , J our nal of th e A mer ic an
Dietetic A ssoc iation, J our nal of N utr ition
E duc ation & B eh av ior , J our nal of T r ans-
c ul tur al N ur sing, and S oc ial S c ienc e and
M edic ine are a few that frequently feature
articles on diet and culture. Food ser-
vice, hospitality, and restaurant journals
sometimes address cultural food issues.
Anthropology, folklore, history, home
economics, human resources, geography,
Resources
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
5 4 6 R E S O U R C E S
MacClancy, J. 1992. C onsuming c ul tur e:
W h y y ou eat w h at y ou eat. New
York: Holt.
McClelland, D.A. 1991. G ood as gol d—
F oods A mer ic a gav e th e w or l d.
Washington, DC: National Museum
of History/Smithsonian Institution.
McIntosh, W.A. 2002. S oc iol ogies of f ood
and nutr ition. New York: Springer.
Meiselman, H.L. (Ed.). 2000. Dimen-
sions of th e meal: Th e sc ienc e,
c ul tur e, business, and ar t of eating.
Gaithersburg, MD: Aspen.
Meiselman, H.L., & MacFie, H.J.H.
1996. F ood c h oic e, ac c eptanc e and
c onsumption. Gaithersburg, MD:
Aspen.
Menzel, P., & D’Alusio, F. 1998. M an
eating bugs: Th e ar t and sc ienc e of
eating insec ts. Berkeley, CA: Ten
Speed Press.
Miller, W.I. 1997. Th e anatomy of disgust.
Cambridge, MA: Harvard University
Press.
Mintz, S. 1997. T asting fo od, tasting
f r eedom: E x c ur sions in eating,
pow er , and th e past. Boston:
Beacon Press.
Montanari, M. 2006. F ood is c ul tur e.
New York: Columbia University
Press.
Morgan, L. 1997. T h e eth nic mar k et
guide: A n ingr edient enc y c l opedia f or
c ook s, tr av el er s, and l ov er s of ex otic
f ood. New York: Berkeley.
Newman, J.M. 1993. M el ting pot: A n
annotated bibl iogr aph y and guide to
f ood and nutr ition inf or mation f or
eth nic gr oups in A mer ic a (2nd ed.).
New York: Garland.
Pilcher, J.M. 2005. F ood in w or l d h istor y .
New York: Routledge.
Powers, J.M., & Stewart, A. (Eds.). 1995.
O ur nor th er n bounty : A c el ebr a-
tion of C anadian c uisine. Toronto:
Random House of Canada.
Purnell, L.D., & Paulanka, B.J. 2003.
T r ansc ul tur al h eal th c ar e: A c ul tur -
al l y c ompetent appr oac h (2nd ed.).
Philadelphia: F.A. Davis.
Rappoport, L. 2003. H ow w e eat: A ppe-
tite, c ul tur e, and th e psy c h ol ogy of
f ood. Toronto: ECW Press.
Roberts, C. 1992. C ul tur al per spec tiv es
on f ood and nutr ition. Beltsville,
MD: National Agricultural Library.
Rundle, A., Carvalho, M., & Robinson,
M. 2002. C ul tur al c ompetenc e in
h eal th c ar e. New York: Jossey-Bass.
Satcher, D., & Pamies, R.J. 2005.
M ul tic ul tur al medic ine and h eal th
dispar ities. New York: McGraw-Hill
Professional.
Schivelbusch, W. 1992. T aste of par adise:
A soc ial h istor y of spic es, stimu-
l ants and intox ic ants. New York:
Pantheon.
Shepard, S. 2000. P ic k l ed, potted, and
c anned: H ow th e ar t and sc ienc e of
f ood pr eser v ing c h anged th e w or l d.
New York: Simon & Schuster.
Shortridge, B.G., & Shortridge, J.R.
(Eds.). 1998. Th e taste of A mer ic an
pl ac e. Lanham, MD: Rowman &
Littlefield.
Simoons, F.J. 1994. E at not th is f l esh :
F ood av oidanc es f r om pr eh istor y
to th e pr esent (2nd ed.). Madison: to th e pr esent (2nd ed.). Madison: to th e pr esent
University of Wisconsin Press.
Smith, A. (Ed.) 2004. O x f or d enc y c l o-
pedia of f ood and dr ink in A mer ic a.
New York: Oxford University
Press.
Sokolov, R. 1991. W h y w e eat w h at w e
eat: H ow C ol umbus c h anged th e w ay
th e w or l d eats. New York: Simon &
Schuster.
Spector, R.E. 2003. C ul tur al div er sity
in h eal th and il l ness (6th ed.).
New York: Prentice-Hall.
Tannahill, R. 1995. F ood in h istor y .
New York: Three Rivers Press.
Trager, J. 1995. Th e f ood c h r onol ogy .
New York: Holt.
Van Wyk, B.E. 2005. F ood pl ants of th e
w or l d: A n il l ustr ated guide. Portland:
Timber Press.
Vissar, M. 1991. Th e r itual s of dinner :
Th e or igins, ev ol ution, ec c entr ic ities
and meaning of tabl e manner s. New
York: Grove Weidenfeld.
Whit, W.C. 1995. F ood and soc iety : A
soc iol ogic al appr oac h . Dix Hills, NY:
General Hall.
Wilson, D.S., & Gillespie, A.K. 1999.
R ooted in A mer ic a: F oodl or e of
popul ar f r uits and v egetabl es.
Knoxville: University of
Tennessee Press.
Wood, R.C. 1995. Th e soc iol ogy of
th e meal . Edinburgh: Edinburgh
University Press.
A mer ic a (3 vols.). Farmington Hills,
MI: Gale Group.
Davidson, A. 1999. Th e O x f or d c om-
panion to f ood. Oxford: Oxford
University Press.
Farb, P., & Armelagos, G. 1980.
C onsuming passions: Th e anth r opol-
ogy of eating. New York: Washington
Square Press.
Fieldhouse, P. 1995. F ood and nutr i-
tion: C ustoms and c ul tur e (2nd ed.).
London: Chapman & Hall.
Gabaccia, D.R. 2000. W e ar e w h at w e
eat: E th nic f ood and th e mak ing
of A mer ic ans. Cambridge, MA:
Harvard University Press.
Germov, J., & Williams, L. 1999. Th e
soc ial appetite: A soc iol ogy of f ood
and nutr ition. South Melbourne,
Australia: Oxford University Press.
Growther, G. 2013. E ating c ul tur e. North
York: University of Toronto Press.
Harris, M. 1998. G ood to eat: R iddl es of
f ood and c ul tur e. Long Grove, IL:
Waveland Press.
Heiser, C.B. 1990. S eed to c iv il iz ation:
T h e stor y of f ood. Cambridge, MA:
Harvard University Press.
Hess, J.L., & Hess, K. 2000. Th e taste
of A mer ic a. Chicago: University of
Illinois Press.
Hopkins, J. 1999. S tr ange f oods: B ush
meat, bats, and butter f l ies: A n epi-
c ur ean adv entur e ar ound th e w or l d.
North Clarendon, VT: Periplus.
Inness, S.A. (Ed.). 2001. P il af , poz ol e,
and pad th ai: A mer ic an w omen and
eth nic f ood. Amherst: University of
Massachusetts Press.
Jacobs, J. 1995. T h e eaten w or d: Th e l an-
guage of f ood, f ood in our l anguage.
New York: Birch Lane.
Katz, S., & Weaver, W.W. (Eds.). 2003.
E nc y c l opedia of f ood and c ul tur e
(3 vols.). New York: Thomson-Gale.
Lee, H.G. 1992. T aste of th e states: A f ood
h istor y of A mer ic a. Charlottesville,
VA: Howell.
Levenstein, H. 2003. P ar adox of pl enty :
A soc ial h istor y of eating in mod-
er n A mer ic a (Rev. ed.). Berkeley:
University of California Press.
Livingston, A.D., & Livingston, H. 1993.
E dibl e pl ants and animal s: U nusual
f oods f r om aar dv ar k to z amia. New
York: Facts on File.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
R E S O U R C E S 5 4 7
W or l d F ood H abits B ibl iogr aph y : An
outstanding listing of research in
the field of food and culture. Search
by region or topic (such as eating
attitudes, festivals and feasting, and
taboos).
Religious
B uddh ism and M edic al E th ic s (http://
www.changesurfer.com/Bud/
BudBioEth.html): An introduction
to Buddhist perspective on abortion,
death and dying, and euthanasia
with numerous links.
C ath ol ic E nc y c l opedia (http://newadvent.
org/cathen): This comprehensive
resource includes articles on feast-
ing, abstinence, and fasting with
detailed histories.
I ndia Div ine (http://www.indiadivine.
com): Comprehensive listing of
articles on philosophy, mysticism,
meditation, alternative health prac-
tices, scriptures, and more.
O r th odox C h r istian I nf or mation C enter
(http://www.orthodoxinfo.com/):
Provides extensive guidance on
fasting. Click on “Church (Old)
Calendar” within the text to get
more information on the Orthodox
calendar.
S ev enth - Day A dv entist C h ur c h (http://
www.adventist.org): The official
site of the faith; the church manual
provides information on health and
temperance under the standards for
Christian living.
Botanical/Alternative Health
A M ini- C our se in M edic al B otany (http://A M ini- C our se in M edic al B otany (http://A M ini- C our se in M edic al B otany
www.ars-grin.gov/duke/syllabus/):
Excellent source of information on
phytochemicals, ethnic plant uses,
GRAS botanicals, and more, with a
link to the search site to obtain data
by plant name or active ingredient.
H er bM ed (http://www.amfoundation.H er bM ed (http://www.amfoundation.H er bM ed
org): Database maintained by the
Alternative Medicine Foundation
with information on evidence for
activity, warnings, preparations,
mixtures, and mechanisms of action.
An enhanced version requires sub-
scription, though daily use rates are
available.
C ul tur al and E th nic F ood and N utr ition
E duc ation M ater ial s: A R esour c e
L ist f or E duc ator s. 2013. Avail-
able at: http://fnic.nal.usda.gov/
resource-lists-0
( C ul tur al and E th nic ) H ol iday F ood and
N utr ition R esour c es L ist. November
2012. http://www.nal.usda.gov/
fnic/pubs/holiday : annotated
site run by the Food and Nutri-
tion Information Center (FNIC) of
the United States Department of
Agriculture.
E th noM ed (http://ethnomed.org/E th noM ed (http://ethnomed.org/E th noM ed
ethnomed/): An ethnic medicine
guide from the Harborview Medical
Center, University of Washington.
Provides somewhat inconsistent
information on the groups profiled,
but everything presented is reviewed
by members of the target commu-
nity for accuracy.
I ndian H eal th S er v ic e (http://www.ihs.
gov): Information about health pro-
grams and resources for American
Indians and Alaska Natives.
M edl ineP l us (http://www.nlm.nih.gov/
medlineplus/): Government site is a
great resource for quick updates on
African American, Asian (includ-
ing Pacific Islander), Hispanic, and
Native American (including Alaska
Native) health issues. Each listing
(under Health Topics) includes latest
news, prevention, research, diseases
and conditions, organizations, sta-
tistics, and information specific to
seniors, teens, and women.
M ul tic ul tur al H eal th C l ear ingh ouse
(http://www.mckinley.illinois.edu/
multiculturalhealth/index.htm) An
exceptional site run by the Univer-
sity of Illinois with information on
U.S. ethnic group health needs and
links to other cultural health sites.
N ational A l l ianc e f or H ispanic H eal th
(http://www.hispanichealth.org):
Health information of interest to
Latinos. Catalog of resource materi-
als offers several useful brochures.
N ew M ex ic o S tate U niv er sity T r ansc ul -
tur al and M ul tic ul tur al H eal th L ink s
(http://nmsu.libguides.com/border-
health): Listing of sites for numer-
ous religious, ethnic, and special
populations.
Zibart, E. 2001. Th e eth nic f ood l ov er ’ s
c ompanion. Birmingham, AL:
Menasaha Ridge Press.
PERIODICALS
F l av or and F or tune: Dedic ated to th e
A r t and S c ienc e of C h inese C uisine.
Expert articles, reviews, and recipes
on Chinese food and cooking. Pub-
lished quarterly by the Institute for
the Advancement of the Science and
Art of Chinese Cuisine (PO Box 91,
Kings Park, NY 11754; http://www
.FlavorandFortune.com).
F ood and F oodw ay s: E x pl or ations in
th e H istor y and C ul tur e of H uman
N our ish ment. Interdisciplinary
research on the history and culture
of human nourishment. Quarterly
peer-reviewed journal (phone:
800-345-1420; fax: 215-625-8914;
http://www.tandf.co.uk/journals/
titles/07409710.html).
F ood, C ul tur e & S oc iety . A multidisci-
plinary, international approach with
an emphasis on the social aspects
of food and food habits. Published
by the Association for the Study of
Food and Society (ASFS). Journal
available with membership (http://
food-culture.org/).
F ood H istor y N ew s. Food historians
tackle subjects in America’s culinary
past in this newsletter. Published
quarterly by S.L. Oliver (19061 Main
Road, Islesboro, ME 04848; http://
foodhistorynews.com).
G astr onomic a: T h e J our nal of F ood and
C ul tur e. This gorgeous quarterly
offers provocative articles on every
aspect of cultural foods, from his-
tory, sociology, anthropology, and
geography to literature, poetry, art,
and film. (University of California
Press–Journals Division, 2000 Center
St. #303, Berkeley, CA 94704-1223;
http://www.Gastronomica.org).
Online Resources
Ethnic
A sian and P ac if ic I sl ander H eal th F or um
(http://www.apiahf.org): Health fact
sheets on Asian and Pacific Islander
groups; links to other health sites.
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
5 4 8 R E S O U R C E S
website that organizes information
on cultural food studies.
G er not K atz er ’ s S pic e P ages (http://
gernot-katzers-spice-pages.com/
engl/index.html?redirect=1): Well-
maintained site is run by an Aus-
trian chemist. Over 100 herbs and
spices listed, indexed alphabetically,
by region, and by part used in cook-
ing; glossary of spice mixtures. Great
links.
I nter national F ood C omposition Dir ec -
tor y (http://www.fao.org/infoods/tor y (http://www.fao.org/infoods/tor y
infoods/tables-and-databases/
en/): Resources of the International
Network of Food Data Systems
(INFOODS) under the auspices of
the Food and Agricultural Organiza-
tion (FAO) of the United Nations,
including listings for published
and online food composition tables
worldwide.
R ec ipeS our c e. c om (http://www.recipe-
source.com): This site has a search-
able online archive of recipes that
has cataloged over 70,000 recipes
from throughout the world. Search
by ethnic group or type of dish.
Excellent selection, though recipes
in ethnic categories are often not
traditional.
S al l y ’ s P l ac e (http://www.sallys-place.
com): An overview of several inter-
national cuisines can be found at
this site. Recipes, restaurants, and
ingredient sources are listed in
some. Another useful page on this
site lists professional food organiza-
tions, including descriptions and
addresses.
and breaking food news, as well as
tantalizing recipes. Information on
some ethnic ingredients and cultural
food events.
F ood C omposition R esour c e L ist f or
P r of essional s (http://riley.nal.usda.
gov/nal_display/index.php?tax_
level=1&info_center=4&tax_sub
ject=279): These food composi-
tion resources are all available from
the National Agricultural Library,
including books, U.S. government
publications, software databases,
and journals. There is also a contact
for assistance with specific requests
and a bulletin board.
I nter national F ood C omposition
R esour c es (https://fnic.nal.usda.gov/
food-composition/international-
food-composition-resources):
USDA resource.
F ood M useum (http://www.foodmu-
seum.com): Described as a “one stop
source for food exhibits, news/issues,
resources, food history, answers to
your food questions, book reviews
and just plain fun.” Good for history
information.
F ood, N ation and C ul tur al I dentity
(http://www.bl.uk/learning/citizen-
ship/foodstories/Accessible/food
nationidentity/foodnationidentity.
html): A British website that explores
the cultural diversity of food within
the UK and be able to listen to actual
stories of individuals about their
experiences trying new foods.
FOS T —FOS T —FOS T S oc ial and C ul tur al F ood S tudies
(http://research.vub.ac.be/food-
history/food-links/): Well-organized
J iv a A y ur v edic (http://www.ayurvedic J iv a A y ur v edic (http://www.ayurvedic J iv a A y ur v edic
.org/ayurveda/): A site that offers
extensive information on beliefs and
practices. Includes brief research
reviews and an online consultation
system.
N ational C enter f or C ompl ementar y
and A l ter nativ e M edic ine (http://
nccam.nih.gov): This center run
by the National Institutes of Health
conducts research and disseminates
information on complementary and
alternative medical practices. Its
CAM on PubMed (http://www
.nlm.nih.gov/nccam/camonpubmed.
html) limits your search to the cita-
tion index.
T r opic al P l ant Database (http://wwwT r opic al P l ant Database (http://wwwT r opic al P l ant Database
.rain-tree.com/plants.htm): Search by
common or scientific name, condi-
tion, plant properties, or recorded eth-
nobotanical uses. A commercial site.
Foods and Cooking
C ul inar y H istor y T imel ine (http://www
.foodtimeline.org/food1.html): This
fun links site is set up chronologi-
cally—from articles on prehistoric
diet to the slow food movement with
numerous ethnic and cultural topics.
A companion site (http://www
.foodtimeline.org) provides links on
specific foods.
E pic ur us (http://www.epicurus.com):
Sponsored by a leading food and
hospitality industry consultant,
this site features a monthly e-zine
with short, informative articles on
foods, beverages, herbs, and spices;
interviews with chefs and hoteliers;
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
5 4 9
Index
demographics and socioeconomic status,
211–212
East African cuisine, 217
emancipation, 210–211
enslavement, 210
Ethiopian, Eritrean, Somali, and Sudanese
cuisine, 215–217
family, 212
food after abolition of slavery, 219
historical influences, 214–221
history of, in United States, 210–212
ingredients and common foods, 214–221,
224–225
meal composition and cycle, 221–225
nutritional intake, 225–228
nutritional status, 225–230
religion, 212–214
role of food in African American society
and etiquette, 223
slave diet, 218–219
South Africa, 217–218
special occasions, 222–223
therapeutic uses of food, 223–224
traditional food habits, 214–224
traditional health beliefs and practices,
212–214
West African cuisine, 214–215
worldview, 212–214
Afro-Brazilian fare, 309
Agave tequiliana, 248
Agemono, 346
Aging, 38
Agnis, 468
Agobono, 215
Ahimsa, 100–101, 453, 458
Ahipa, 304
Aioli, 512
Ajowan, 430
Ajwain, 457
Akamiso, 345
Alaska Natives, 107
demographics of, 109
diet of, 118–120
mortality rates of, 127
nutritional status of, 126–128
religion and, 111
socioeconomic status of, 109–110
Albanian fare, 435
Albanians. see Balkans, people of
Alcohol use
central Europeans and people of former
Soviet Union, 194
East Asians, 350
Japanese Americans, 350
Koreans, 361
Midwestern Americans, 503
Northern Europeans, 155–156
people of Balkans and Middle
Easterners, 442
Southern Americans, 517
Southern Europeans, 169
Western Americans, 530
Alcoholism
Mexican-Americans, 259
Native Americans, 128
Russian-speaking immigrants, 194
AleutIndians, 107, 119
Alfeñique, 251
Alioli, 163
Almonds, 163, 190, 201
Almuerzo, 250
Âm, 392
Amchoor, 457, 459
American burritos, 253
Amish, 194–195
Ampalaya, 392
Anaheim chiles, 524
Ancho chiles, 248, 524
Angulas, 166
Animism, 454
Anjeero, 216
Anju, 357
Anorexia, 46
Anticuchos, 307
Aonoriko, 346
Apache Indians, 110, 117
Apio, 304
Apon, 215
Applejack, 148, 494
Apples
ackee, 215
brandy, 148
butter, 492
cider, 491, 494
in Michigan, 497
strudel, 187
in Western America, 526
Applesauce, 492
Appropriate language, 67–68
Aquavit, 201
Arabs. see Middle Easterners
Arak, 430, 437
Arapaho Indians, 117
Argentina. see South Americans
Armenian Apostolic Church, 181
Armenians
cuisine of, 188
demographics and socioeconomic
status, 179
family, 182
immigration patterns, 178
religion, 181
A
À la bordelaise, 149
À la Provençal, 149
Abalone, 525
Abendbrot, 187
Ablimu, 440
Abstinence
Hinduism and, 101
Roman Catholicism and, 90
Acculturation
of food habits, 6–7
health and, 20
process, 6
Aceto balsamico di Modena, 164
Achiote, 249
Ackee apples, 215
Açorda d’azedo, 166
Açordu, 163
Acorns, 119
Action chain, 56
Acupuncture/acupressure, 48, 325
Adaptations of food habits
Africans, 224–230
Asian Indians, 470–472
Caribbean Islanders, 295–296
Central Americans, 268–269
central Europeans and people of former
Soviet Union, 192–194
Chinese, 335–336
Japanese, 348–349
Koreans, 359–360
Native Americans, 123–125
Native Hawaiians and Pacific Islanders,
406–407
Northern Europeans, 153–155
Pakistanis, 472
people of Balkans, 441–442
Scandinavians, 203
South Americans, 312
Southeast Asians, 393–394
Southern Europeans, 169
Adobo, 289, 380, 389
Adolescents, food choice and, 17
Advertising, 16
Adzuki beans, 345, 355
Aebleskivers, 201
Africans
adaptations of food habits, 224–230
African American southern staples,
219–221
contemporary food habits in United States,
224–230
counseling of, 228–230
cultural perspective, 208–212
daily patterns of meals, 221–223
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
5 5 0 I N D E X
Arracacha, 304
Arroz a la Tumbada, 248
Arroz con pollo, 510
Arroz negro, 166
Artha, 101
Asian Indians, 450–482
adaptations of food habits, 470–472
caste system in India, 453
contemporary food habits in United States,
470–476
counseling, 474–476
cultural perspective, 450–456
demographics and socioeconomic
status, 452
etiquette, 467–468
family, 454–455
fasting, 103, 467
feasting, 102–103, 466
Hindu dietary practices, 101
history of, in United States, 450–453
immigration patterns, 451–452
ingredients and common foods, 457–464
meal composition and cycle, 464–465
nutritional intake, 472–474
nutritional status, 472–476
purity and pollution, 467
regional variations, 459–463
religion, 453–454
religious variations, 463–464
role of food in Indian society and etiquette,
467–468
self-identity and, 2
special occasions, 466
staples, 457–458
therapeutic uses of food, 468–470
traditional food habits, 456–470
traditional health beliefs and practices,
455–456
women and food, 467
worldview, 453–456
Asians. see Asian Indians; East Asians;
Pakistanis; Southeast Asians
Assada no espeto, 163
Assyrians. see Middle Easterners
Ataques, 283
Ataques de nervios, 283
Australian fare, 409
Austrian Americans. see Austrians
Austrians
demographics and socioeconomic
status, 178
immigration patterns, 176–177
religion, 180
Avgolemono, 438
Avocados, 248
Ayurvedic medicine, 48, 455–456, 468
Aztecs, 242–243
B
Babalorixá, 304
Bacalao a la vizcaina, 166
Bacalao al pil-pil, 166
Bacalhau, 163, 168
Badger, 511
Bagels, 493
Bagoong, 383
Bagoong-alamang, 383
Baked beans, 489
Baklava, 216, 426
Balance, 378
Balkans, people of, 416–449
adaptations of food habits, 441–442
contemporary food habits in United States,
441–445
cultural perspective, 416–425
daily patterns of meals, 434
demographics and socioeconomic
status, 419
family, 421–422
history of, in United States, 416–418
ingredients and common foods, 426–434
meal composition and cycle, 434–441
Middle East and, 416–449
nutritional intake, 442–443
nutritional status, 442–445
regional variations, 430–431
religion, 420–421
special occasions, 438–440
staples, 426–430
therapeutic uses of food, 440–441
traditional food habits, 425–441
traditional health beliefs and practices, 424
worldview, 420–421
Balsam vodka, 192
Balsamic vinegar. see Aceto balsamico di
Modena
Bananas, 215, 514
Bananas Foster, 516
Barbecue, 513, 517
Barley water, 355
Basmati rice, 461
Basques, 522
Bawang, 392
Beans
adzuki, 345, 355
in Asian Indian diet, 457
baked, 489
Basque, 522
black, 264
bread, 124
cacao, 243
in Central American diet, 264
frijoles refritos, 243
mung, 355
pinto, 511
in South American cuisine, 304
as staple food for Aztecs, 243
as staple food for Mexicans, 243
as staple food of Native Americans, 114
Béchamel, 150
Beef
assada no espeto, 163
in cuisine of Central Europe and former
Soviet Union, 185
in food of New Mexico, 253
in food of Sonora, 253
heart, 310
Kobe, 345
in Midwestern American cuisine, 501
in Northeastern American cuisine, 492
in Pakistani cuisine, 459
in Portuguese cuisine, 166
in South American cuisine, 307, 310
in Southern American cuisine, 513, 517
Tajima, 345
in Tex-Mex food, 253
Beer, 147
American, 494, 500
bitters, 147
bock, 187
kvass, 187
lager, 187
Märzenbier, 187
pilsner, 187
stout, 147
Weissbier, 187
Bel paese, 164
Belize. see Central Americans
Beluga caviar, 186
Bento, 347
Berbere, 216
Bhuna, 459
BIA. see Bureau of Indian Affairs
Bigos, 190
Bilis, 252, 263
Biomedical healing, 50–51
Biomedicine
aging and, 38
degree of formality/degree of directness
and, 38
human equality and, 38
materialism/spirituality, 38
perception of time and, 38
personal control and, 37
relationship to nature and, 37
state of being and, 37
worldview, 37–39
Bird’s eye peppers, 510
Bison, 501
Bitter orange, 335
Bitters, 147
Black beans, 264
Black Forest cake. see Schwarzwälder
Kirschtorte
Black nightshade, 456
Black tea, 329
Blackfeet Indians, 120
Bock beer, 187
Body image, 40, 258
Bogatá chicken stew, 308
Bokors, 284
Bolivia. see South Americans
Bombay duck, 462
Bon Secour oysters, 513
Bordeaux, 149
Bosnians. see Balkans, people of
Boston brown bread, 489
Botanical remedies, 47, 260, 380
Botánicas, 48
Boudin blanc, 152
Boudin noir, 152
Bouillabaisse, 149, 160
Bourbon, 514
Brandy
apple, 148
Cognac, 149
metaxia, 430
Pisco, 307
plum, 430
Schnapps, 187
Bratwurst, 186
Brauche, 182
Braucherei, 182
Brazil. see South Americans
Breads
in Balkan cuisine, 426
East African cuisine, 217
Ethiopian, 216–217
in Filipino diet, 381
French, 150, 264
Italian, 164
in Middle Eastern cuisine, 426
in Midwestern American cuisine, 501
Native Hawaiians and Pacific Islanders, 403
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
I N D E X 5 5 1
Cambodians
adaptations of food habits, 393–394
demographics and socioeconomic
status, 374
family, 376
nutritional intake, 396
religion, 375
special occasions, 391
staples, 384–389
therapeutic uses of food, 392–393
traditional health beliefs and practices,
379–380
Camel milk, 217
Camembert, 148
Campinha-Bacote model of competence, 18
Candelaria Day, 250
Candies, 223
Candomblé, 302, 304, 311
Candomblé orixás, 311
Cannoli, 165
Cantonese, 330–331
Cape Cod turkey, 489
Carbonada criolla, 308
Carbonada en zapallo, 308
Cardiovascular disease
Chinese Americans, 337
Mexican Americans, 258
Native Americans, 128
Scandinavians, 203–204
Caribbean Islanders, 278–301
adaptations of food habits, 295–296
contemporary food habits in United States,
295–301
counseling, 299–301
cultural perspective, 278–285
daily patterns of meals, 291–293
demographics and socioeconomic status,
280–281
etiquette, 293
family, 282–283
foreign influence, 285–286
history of, in United States, 278–281
indigenous foods, 285
ingredients and common foods, 285–291,
295–296
meal composition and cycle, 291–293
nutritional intake, 296–299
nutritional status, 296–301
regional variations, 288–291
special occasions, 293
staples, 286–288
traditional food habits, 285–295
traditional health beliefs and practices,
283–285
worldview, 282–285
Carolina Gold rice, 509
Carp, 190
Cassareep, 309
Cassava, 215, 217, 264, 295, 304
Cassis, 149
Castagnaccio alla Fiorentina, 165
Catfish, 513
Catholicism. see al so Roman Catholicism
French, 143
Irish, 143
Cattle, 217
Causerras, 168
Caviar, 186, 189
Cecinas, 249
Celiac disease, 443
Cena, 250
Central Americans, 261–271
adaptations of food habits, 268–269
contemporary food habits in United States,
268–271
cultural perspective, 261–264
demographics and socioeconomic status,
261–262
etiquette, 267
family, 263
history of, in United States, 261–262
immigration patterns, 261
meal composition and cycle, 266–267
nutritional intake, 269
nutritional status, 269–271
regional variations, 266
religion, 263
special occasions, 267
staples, 264–266
therapeutic uses of food, 268
traditional food habits, 264–268
traditional health beliefs and practices,
263–264
worldview, 262–264
Central Europeans, 174–207
adaptations of food habits, 192–194
contemporary food habits in United States,
192–196
cultural perspective, 175–183
daily patterns of meals, 187–189
demographics and socioeconomic status,
178–180
etiquette, 189
family, 181–183
history of, in United States, 175–180
immigration patterns, 175–178
ingredients and common foods of, 183–187
meal composition and cycle, 187–192
nutritional status, 194–196
religion, 180–181
special occasions, 189–192
staples and regional variations, 183–187
therapeutic uses of food and, 192
traditional food habits, 183–192
traditional health beliefs and practices,
182–183
worldview, 180–183
Cerasse tea, 295
Cereal, 499
Cevapi, 431
Ceviches, 307
Chagas’ heart disease, 269
Chaldeans. see Middle Easterners
Chamomile, 268
Champagne, 148
Chapanas, 306
Chapati, 217
Charcuterie, 148
Charqui, 307
Chawanmushi, 346–347
CHD. see Coronary heart disease
Cheese
Bel paese, 164
Brie, 149
brunost, 199
camel, 429
Camembert, 148
Colby, 497
Crèma Dania, 199
farmer’s, 186
goat, 429
Gorgonzola, 164
Havarti, 199
Jarlsberg, 199
in Northeastern American cuisine, 489,
492–493
Northern India, 461
Scandinavian, 201
in Southern American cuisine, 507, 511
as staple food in Central Europe and
former Soviet Union, 185
as staple food in Great Britain, 146
symbolic use of, 3
Breast feeding
African Americans, 226
Asian Indians, 473
Central Americans, 269
Central Europeans and people of former
Soviet Union, 194
Mexican Americans, 255
Middle Easterners, 443
Bredie, 218
Brie, 149
Briki, 430
Brioche, 151
British. see al so Great Britain
adaptations of food habits, 153
demographics and socioeconomic
status, 142
family, 143
immigration patterns, 140–141
nutritional status, 155–156
religion, 143
traditional health beliefs and practices, 144
Bruhwurst, 186
Brujos, 284
Brunost, 199
Brunswick stew, 511
Bubble tea, 330
Buckwheat noodles, 343, 355
Buddhism, 103–105
Asian Indians and, 453
Chinese, 323
dietary practices, 104
feasts and fasts, 104
Japanese, 341, 342
Koreans, 352
Theravada, 375
Vietnamese, 375
Buffalo wings, 493
Bulgur, 426
Bündnerfleisch, 492
Buñuelos, 247
Bureau of Indian Affairs (BIA), 108–109, 129
Burek, 426
Burghul, 426
Burgoo, 513
Burgundy, 149
Burns’s Night, 152
Butter, 149, 463, 492
Butter Festival, 191
Buttermilk, 514
C
Cacao beans, 243
Cachaça, 310
Caida de la mollera (fallen fontanel), 241, 260
Cajuns, 143–144, 153, 512
Calas, 515
Caldo verde, 163
Calvados, 148
CAM. see Complementary and alternative
medicine
Cambodia, 373
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
5 5 2 I N D E X
concepts, 57–64
direct v s. indirect, 36
effective, 66–73
iceberg model, 56–57
intercultural, 56–77
intercultural counseling, 69–71
intercultural nutrition assessment, 71–73
intercultural nutrition education, 73–77
intercultural skills, 66–69
nonverbal, 62–64
role in health care, 64–66
verbal, 57–60
Compadrazgo, 282
Complementary and alternative medicine
(CAM), 34
Complementary foods, 7–8
Confucianism, 322, 341, 352
Congee, 328
Consumer food choice model, 13–18
Contemporary food habits in United States
Africans, 224–230
Caribbean Islanders, 295–301
Central Americans, 268–271
Central Europeans and people of former
Soviet Union, 192–196
Chinese, 335–340
Japanese, 348–351
Mexicans, 252–261
Native Americans, 123–133
Native Hawaiians and Pacific Islanders,
406–410
of northern Europeans, 153–157
of Scandinavians, 203–204
South Americans, 312–314
Southeast Asians, 393–399
of southern Europeans, 169–170
Convenience, 15
Cookie, 493
Core foods, 7–8
Corn
African American southern staples,
218–219, 221
beer, 216
in Central American diet, 264
liquor, 308
in Northeastern American cuisine, 489
in Pakistani cuisine, 459
in South American cuisine, 307
in Spanish cuisine, 166
as staple food of Native Americans, 114
staple grain for Aztecs, 243
symbolic use of, 117
therapeutic uses of food and, 122
West African cuisine, 215
whiskey, 514
Corn ear smut, 122
Cornbread, 511–512
Cornish pasty, 150
Cornmeal
breads, 183
cuzcuz paulista, 310
piki, 118
porridge, 489
therapeutic use of, 122
Coronary heart disease (CHD), 228. see al so
Heart disease
Cost, 15
Costa Rica. see Central Americans
Counseling, 69–71
Africans, 228–230
Asian Indians, 474–476
Caribbean Islanders, 299–301
ingredients and common foods, 325–331,
335–336
meal composition and cycle, 331–334
northern, 330
nutritional intake, 336–337
nutritional status, 336–340
pickled, 264
regional variations, 330–331
religion, 322–323
southern, 330
special occasions, 333–334
staples, 325–330
therapeutic uses of food, 334–335
traditional food habits, 325–335
traditional health beliefs and practices,
323–325
traditional medicine, 323–325, 339
worldview, 322–325
Chinese medicine. S ee Traditional Chinese
Medicine (TCM)
Ch’ing Ming, 333–334
Chipotle chiles, 248
Chippewa Indians. see Ojibwa Indians
Chirashisushi, 343
Chocolate, 152, 494
Choctaw Indians, 107
Chorizo, 162
Chouriço, 163
Christian Palestinians. see Middle Easterners
Christianity, 89–94, 212, 454. see al so Eastern
Orthodox Christianity; Protestantism;
Roman Catholicism
Christmas, 152–153, 168, 189–192, 202–203,
222, 251, 293, 390–391
Chucula, 307
Chundo Kyo, 352
Church of England, 143
Churrascaria rodizio, 310
Churrasco, 310
Chusok, 358
Chutney
mango, 510
South African cuisine, 218
Cincinnati chili, 499
Cipaille. see Cipate
Cipate, 154
Citrus fruits, 249, 509
Civek, 430
Clambake, 490
Clams, 490, 525
Clotted cream, 146
Coastal India, 462
Coca leaves, 268
Cochon de lait, 154
Cocido, 162
Coconut, 383–384
cream, 383
milk, 215, 217, 383–384, 463
in Native Hawaiians and Pacific Islanders
diet, 403, 405
Cod, 490
Coffee, 187, 215, 266, 388
health and, 432
Cognac, 149
Coining, 48
Colby cheese, 497
Cólera, 263
Coleslaw, 492
Colombia. see South Americans
Comida, 167, 250
Communication
as action chain, 56
Cheese (C ontinued )
kurutz, 463
Limburger, 186
Manchego, 163
Mozzarella, 165
paneer, 461
Pecorino romano, 165
Pont-l’Évêque, 148
Provolone, 165
queso flameado, 247
Ricotta, 165
sheep, 429
as staple food in Great Britain,
144–146
Tybo, 199
Cheesesteak, 493
Chelo kebab, 433
Cheong-po, 355
Cherokee Indians, 107, 111, 113, 116, 124
Cherries, 497
Cheshm-i-bad, 425
Chestnut bread, 124
Cheyenne Indians, 117
Chianti, 165
Chicanos. see Mexicans
Chicha, 308
Chichimecs, 246
Chickasaw Indians, 107
Chicken
Bogatá chicken stew, 308
in cuisine of China, 328
gallina rellena Navidena, 267
in Japanese cuisine, 345
Kiev, 185
in Midwestern American cuisine, 501
in Native Hawaiians and Pacific Islanders
diet, 403
in Northeastern American cuisine, 492
in Pakistani cuisine, 459
relleno, 381
in slave diet, 218
in Southern American cuisine, 507
in tomato sauce, 267
in West African cuisine, 215
Chickpeas, 428
Chilaca chiles, 248
Chile. see South Americans
Chile colorado, 253
Chile peppers, 524
Chili
Cincinnati, 499
con carne, 253
Chili peppers, 248, 307
Chimichangas, 253
Chin-chins, 215
Chinese, 319–340
adaptations of food habits, 335–336
coleslaw, 492
contemporary food habits in United States,
335–340
counseling, 338–340
in cuisine of Central Europe and former
Soviet Union, 173
cultural perspective, 320–325
daily patterns of meals, 331–332
demographics and socioeconomic status,
321–322
etiquette, 332–333
family, 323
healing therapies, 48
history of, in United States, 320–322
immigration patterns, 320–321
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
I N D E X 5 5 3
Spaniards, 158–159
Swiss, 179
Ukrainians, 179
Western Americans, 518
Desayuno, 167, 250
Desserts
in cuisine of central Europe and FSU, 187
in cuisine of Germany, 190
in cuisine of Scandinavia, 201
in cuisine of Slovakia, 190
in Midwestern American cuisine, 500, 502
in Northeastern American cuisine, 491
in Pakistani cuisine, 459
in Southern American cuisine, 510
in Western American cuisine, 524
Dewberry pie, 513
Dhal, 457
Dharma, 101
Día de los Reyes Magos, 250
Día de los Santos Reyes, 250
Día del campo, 293
Diabetes mellitus, 128, 195
Africans, 224
Asian Indians, 456, 473
Asians, 337
Filipinos, 395
Gypsies, 195
herbal remedies, 268
Japanese Americans, 350
Mexican remedies for, 252
Middle Easterners, 442–443
Native Americans, 128
Native Hawaiians and Pacific Islanders,
407–408
Northeastern Americans, 494
Pakistanis, 474
soursop leaves as treatment for, 304
South Americans, 312
theories of, 129
type 2 ( S ee Type 2 diabetes mellitus)
Días de los Muertos (Days of the Dead), 251
Dietary Guidelines for Americans 2010, 7
Dietary Supplement Health and Education
Act (DSHEA) (1994), 47
Digger Indians, 120
Dim sum, 331
Direct communication, 36, 68
Dirty rice, 154
Disease, illness and sickness. see al so
Alcoholism; Cardiovascular disease;
Coronary heart disease; Diabetes
mellitus; Heart disease
becoming sick, 43
cultural definitions of, 42–46
etiology of, 43–44
folk illnesses, 45–46
healing practices, 46–50
kidney, 128
in Native Americans, 128
natural world, 44
patient, 43
social world, 44–45
supernatural world, 45
Diversity
Canadian population, 19–20
U.S. population, 19
Dobosch torte, 187
Dominicans
demographics and socioeconomic
status, 281
family, 283
history of, in United States, 280
family, 181
immigration patterns, 176–177
religion, 180
D
Dahi, 459
Daikon, 345
Daily patterns of meals
Africans, 221–223
Caribbean Islanders, 291–293
Central Europeans and people of former
Soviet Union, 187–189
Chinese, 331–332
Japanese, 347
Koreans, 357–358
Mexicans, 250, 255
Native Americans, 120–121
Native Hawaiians and Pacific
Islanders, 405
Northern Europeans, 151–153
Scandinavians, 201–202
South Americans, 310
Southeast Asians, 389–390
Southern Europeans, 166–167
Dairy products. see Cheese; Milk
Dakota Indians, 109–110, 112, 117, 120,
124–125
Dal
in Asian Indian diet, 457–458, 463
in South American cuisine, 309
Danes. see Scandinavians
Dashi, 346
Days of the Dead. see Días de los Muertos
De arbol chiles, 248
Demerara sugar, 309
Demographics and socioeconomic status
Africans, 211–212
Armenians, 179
Asian Indians, 452
Austrians, 178
British, 142
Central Americans, 261–262
Central Europeans and people of former
Soviet Union, 178–180
Chinese, 321–322
Czechs, 179
French, 142–143
Germans, 178
Gypsies, 179
Hungarians, 179
Irish, 142
Italians, 158
Japanese, 340–341
Koreans, 352–333
Lithuanians, 179
Mexicans, 239
Middle Easterners, 419–420
Midwestern Americans, 496
Northeastern Americans, 485–487
Northern Europeans, 142–143
Pakistanis, 452–453
people of Balkans, 419
Poles, 178
Portuguese, 159
Russians and people of former Soviet
Union, 179–180
Scandinavians, 198
Slovaks, 179
Southern Americans, 504–505
Southern Europeans, 158–159
Central Europeans and people of former
Soviet Union, 195–196
in-depth interview, 69–71
Koreans, 361–362
Mexicans, 259–261
Middle Easterners, 443–445
Native Americans, 129–133
Native Hawaiians and Pacific Islanders,
408–409
northern Europeans, 156–157
Pakistanis, 476
people of Balkans, 443–445
preparation, 69
South Americans, 312–314
Southeast Asians, 396–399
southern Europeans, 170
Country Captain Chicken, 509
Couscous, 165–166
Cow peas, 215
Cozinha baiana, 309
Crabs, 508, 526
Crack seed, 406
Cracklings, 154
Cranberries, 491
CRASH, 66
Crawfish, 515
Cream
clotted, 146
crème fraîche, 149
double, 146
fleurette, 149
Creek Indians, 107, 113, 116, 125
Crèma Dania, 199
Crème fraîche, 149
Creole cuisine, 512
Creton, 154
Croatians. see Balkans, people of
Croissants, 151
Crow Indians, 117, 120
Cuban sandwiches, 510
Cubans
demographics and socioeconomic
status, 280
family, 282
history of, in United States, 280
Culatello, 164
Cultural competency
diversity in Canadian population, 19–20
diversity in U.S. population, 199
ethnicity and health, 20–22
Cultural Food Practices (Goody and Drago),
124, 132
Cultural identity, food as, 4–6
Cultural imposition, 37
Culture
acculturation of food habits, 6–7
acculturation process, 6
communication in low-and high-context,
58–60
definition of, 6
Cupping, 49, 380, 425
Curaçao, 516
Curanderos/curanderas, 241, 260, 263, 304
Curanto, 306
Curry
in Asian Indian diet, 463
in South American cuisine, 309
in West African cuisine, 215
Cuzcuz paulista, 310
Czechs
demographics and socioeconomic
status, 179
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
5 5 4 I N D E X
demographics and socioeconomic
status, 373
etiquette, 390
family, 375–376
meal composition and cycle, 389
nutritional intake, 395
religion, 374
special occasions, 390–392
staples, 380–384
therapeutic uses of food, 392
traditional health beliefs and practices,
377–378
Filo, 426
Finns. see Scandinavians
Fireek, 426
Fish
Buddhism and, 104
chips and, 144
in coastal Indian cuisine, 462
Eastern Orthodox Christianity and, 90–91
fermented paste of, 383
fermented sauce of, 355, 387
in German cuisine, 186
halal, 97
Hinduism and, 102
Kashrut/Kosher dietary laws and, 82,
84–86
in Korean cuisine, 355
in Native Hawaiians and Pacific Islanders
diet, 403
in Northeastern American cuisine, 490
in Portuguese cuisine, 163
in Scandinavian cuisine, 199
in Southern American cuisine, 513–515
in West African cuisine, 215
in Western American cuisine, 525
Flan, 245, 510
Flank steak, 308
Flautas, 245
Flavor principles, 8–10
Fleurette, 149
Flummeries, 489
Flushing, 378
Folk illnesses, 45–46
Folk religions, 282
Food. see al so Hot-cold classifications of
foods; Ingredients and common foods;
Therapeutic uses of food
availability, 12–13
cultural identity and, 4–6
culture and, 1–33
definition of, 1–2
edible/inedible, 13
indigenous, 112–113, 285–286
introduced from Europe, 113–114
religion and, 82–105
role in African American society, 223
role in Indian society, 467–468
role in Mexican society, 251
role in Native American culture, 121–122
as self-identity, 2–3
soul, 224
status, 5
symbolic use of, 3, 117
sympathetic quality of, 42
taste and, 14–15
women and, 467
Food and Drug Administration (FDA), 47
Food choice
adolescents and, 17
advertising and, 16
convenience and, 15
Etiquette
Asian Indians, 467–468
Caribbean Islanders, 293
Central Americans, 267
Central Europeans and people of former
Soviet Union, 189
Chinese, 332–333
Japanese, 347–348
Koreans, 357
Native Americans, 121–122
Native Hawaiians and Pacific Islanders, 405
northern Europeans, 152
role of food in African American society
and, 223
role of food in Mexican society and, 251
Scandinavians, 202
South Americans, 311
Southeast Asians, 390
southern Europeans, 167–168
Étouffées, 512, 515
Europeans. see Northern Europeans;
Southern Europeans
Evaluation, 77
Evangelical Lutheran Church in America, 198
Evaporated milk, 383
Evil eye. see Mal de ojo
Eye contact, 63–64
F
Facial expressions, 63
Faith healers, 182
Fallen fontanel. S ee Caida de la mollera
(fallen fontanel)
Family
Africans, 212
Asian Indians, 454–455
Caribbean Islanders, 282–283
Central Americans, 263
central Europeans and people of former
Soviet Union, 181–183
Chinese, 323
Japanese, 341–342
Koreans, 352–353
Mexicans, 240
Middle Easterners, 422–423
Native Americans, 111
Native Hawaiians and Pacific Islanders, 401
Northern Europeans, 143–144
Pakistanis, 455
people of Balkans, 421–422
Scandinavians, 198
South Americans, 303
Southeast Asians, 375–377
Southern Europeans, 159–160
Fasching, 191
Fasting, 10–11
Fatique, 284
Fatout, 433
FDA. see Food and Drug Administration
Feasting, 102–103, 466
Febles, 284
Feijoa, 526
Feijoda completa, 309
Fen, 330
Feta, 429
Fettucine Alfredo, 165
Filé powder, 219
Filipinos
adaptations of food habits, 392
counseling, 396–397
daily patterns of meals, 389
Doro wat, 216
Double cream, 146
Dried rattlesnake powder, 260
Dried rice noodles, 384
Dried salt cod, 309. see al so Bacalhau
Drunken pudding, 253
DSHEA. see Dietary Supplement Health and
Education Act
Duan wu, 334
Duck, 328
Dukkha, 103
Dulse, 147
Dum, 459
Dumplings
in Balkan cuisine, 426
in cuisine of Central Europe and former
Soviet Union, 183, 185
in cuisine of China, 328
metamgee, 309
in Middle Eastern cuisine, 426
in Scandinavian cuisine, 201
in sopa de rosquillas, 267
Dungeness crab, 526
Duong, 392
Dussehra, 466
Dyslipdemia, 258
E
East Africa, 217
East Asians, 319–369
Chinese, 319–340
Japanese, 340–351
Koreans, 351–362
Easter, 152–153, 168, 189–192, 391,
438–439
Eastern Orthodox Christianity, 90–91, 111,
181, 420, 421
Ecuador. see South Americans
Edamame, 346
Edible foods, 13
Eggplant, 428
Eggs
and childbirth, 441
in cuisine of China, 328
in Native Hawaiians and Pacific Islanders
diet, 403
in Spanish cuisine, 162
Eid al-Adha, 439
Eid al-Azha, 98, 467
Eid al-Fitr, 98, 439, 466
Eintopf, 186
El Salvador. see Central Americans
Electrotherapy, 49
Emancipation, of Africans,
210–211
Empacho, 242, 260, 283
Empadinhas, 306
Empanadas, 264, 306
En papillote, 512
Enchiladas, 245, 253, 255, 264
Enryo, 341
Enslavement, of Africans, 210
Epazote, 524
Eritrea, 215–217
Escargot, 149
Eskimos. see Inuit Indians
Espagnole, 150
Espanto, 241
Espiritos, 284
Ethiopians, 215–217, 228
Ethnocentric, term, 6
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
I N D E X 5 5 5
demographics and socioeconomic
status, 400–401
family, 401
immigration patterns, 400
nutritional intake, 407–408
religion, 401
traditional food habits, 402–406
Guaraná, 310
Guascas, 308
Guatemala. see Central Americans
Guava, 335
Gulyás, 186
Gumbo z’herbes, 219
Gumbos, 155, 512
Guyana. see South Americans
Gypsies
demographics and socioeconomic
status, 179
family, 181
religion, 180
therapeutic uses of food, 192
traditional health beliefs and
practices, 183
H
Habañero chiles, 248
Haggis, 152
Haitians. see Caribbean Islanders
Haji, 341
Hakka cuisine, 331
Halal
dietary laws, 96–97, 216, 459
food symbols, 97
Hallacas, 306
Halo-halo, 383
Haloumi, 429
Han, 354
Hanui, 354
Hanukkah, 87
Hanyak, 354
Hard cider, 491
Hasenpfeffer, 185
Hasty pudding, 489
Havarti, 199
Havasupai Indians, 123, 127
Hawaiian bread, 403
Hawaiians
contemporary food habits in United
States, 406–410
demographics and socioeconomic
status, 400
family, 401
immigration patterns, 399
nutritional intake, 407–408
religion, 401
traditional food habits, 402–406
traditional health beliefs and
practices, 402
Western American cuisine and, 528
Hazelnuts, 526
Headcheese, 492
Healing therapies, 47–50. see al so Therapeutic
uses of food; Traditional health beliefs
and practices
administration of therapeutic substances,
47–48
application of physical forces or devices,
48–49
Chinese, 48
magico-religious interventions,
49–50
French Americans, 143, 153–154
French bread, 150, 264
French Canadians, 143–144
Fricot, 154
Frijoles refritos, 243
Frikkadels, 218
Frittata, 217
Fritters, 309
Frog legs, 219
Fruits
citrus, 249, 509
in Middle Eastern cuisine, 429
in Northeastern American cuisine, 491
in Spanish cuisine, 163
in Western American cuisine, 526
FSU. S ee Former Soviet Union (FSU),
people of
Fufu, 215
Ful medames, 433
G
Gai lan, 328
Gallina rellena Navidena, 267
Gallo pinto, 264
Gaman, 341
Game meats, 249, 511, 513, 520
Gari foto, 215
Garlic, 162, 441
Gatorade, 268
Gaz, 284
Gelatin, 42
Gender, eating habits and, 17
Geoduck clams, 525
Germans
demographics and socioeconomic
status, 178
family, 181
immigration patterns, 175–176
religion, 180
therapeutic uses of food, 192
traditional health beliefs and practices, 182
Gestures, 63
Ghee, 457, 459
Gin, 147, 499
Ginseng, 334–335, 355, 357
Gnocchi, 165
Goat, 249, 459
Gohan, 343
Goi go, 387
Goldwasser, 187
Goose, 185
Goose fat, 148
Gorgonzola, 164
Great Britain. see al so British
cooking styles, 150
ingredients and common foods of, 144–147
meal composition and cycle, 151, 154–155
special occasions, 152
staples and regional variations, 144–147
Great Plains Native Americans, diet of, 117
Greek Orthodox Church, 420–421
Greeks. see Balkans, people of
Green tea, 329
Greens, 219
Grissini, 164
Grunts, 489
Guacamole, 248
Guajillo chiles, 248
Guamanians
contemporary food habits in United States,
407–408
cost and, 15
ethnic identity and, 16
health and, 17
older adults and, 17
physical and spiritual well-being and,
16–17
self-expression and, 15–16
self-identity and, 16
taste and, 14–15
Food habits. see al so Adaptations of food
habits; Contemporary food habits in
United States; Traditional food habits
acculturation of, 6–7
American paradox, 23–28
consumer food choice model, 13–18
core and complementary foods model,
7–8
cultural, 7–12
cultural competency, 18–22
definition of, 1
developmental perspective of food culture,
11–12
flavor principles, 8–10
food availability, 12–13
health-promoting, 41–42
individual, 12–18
influence from children, 261
meal patterns and meal cycles, 10–11
nutrition and, 18–23
taste and, 14–15
in United States, 24–27
yin-yang diet theory, 41
Food processing, 497
Former Soviet Union (FSU), people of,
174–207
adaptations of food habits, 192–194
contemporary food habits in United States,
192–196
cultural perspective, 175–183
demographics and socioeconomic status,
179–180
etiquette, 189
family, 181–182
history of, in United States, 175–180
ingredients and common foods of, 183–187
meal composition and cycle, 187–192
nutritional status, 194–196
religion, 180–181
staples and regional variations, 183–187
therapeutic uses of food and, 192
traditional food habits, 183–192
traditional health beliefs and practices,
182–183
worldview, 180–183
France. see al so French
cooking styles, 150
etiquette, 152
ingredients and common foods of, 147–150
meal composition and cycle, 151–152, 155
special occasions, 152–153
staples and regional variations, 147–150
Franco-Americans. see French Americans
Frankfurter, 186
French. see al so France
adaptations of food habits, 153–154
demographics and socioeconomic status,
142–143
family, 143–144
immigration patterns, 141–142
nutritional status, 155–156
religion, 143
traditional health beliefs and practices, 144
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
5 5 6 I N D E X
people of Balkans, 426–434, 441–442
South Americans, 304–310
Southeast Asians, 380–389
Southern Europeans, 160–166
Injera, 216
Insects, 214, 328
Integrative medicine, 34
Interpreters, use of, 68–69
Inuit Indians, 14, 107, 112, 119, 124, 127
Inupiat Indians, 119
Iranians. see Middle Easterners
Iraqis. see Middle Easterners
Ireland. see al so Ireland; Irish
cooking styles, 150
ingredients and common foods of,
144–147
special occasions, 152
Irish
adaptations of food habits, 153
demographics and socioeconomic
status, 142
family, 143
immigration patterns, 141
meal composition and cycle, 151, 154–155
nutritional status, 155–156
religion, 143
traditional health beliefs and practices, 144
Iroquois Indians, 107, 112–114, 121, 125
Isca de figado, 163
Islam, 94–98
Africans, 212
Asian Indians and, 453
fast days, 98
feast days, 98
halal dietary laws, 96–97
halal food symbols, 97
Islamic Food and Nutrition Council of
America (IFNCA), 97
Israelis. see Middle Easterners
Issei, 341
Italians. see al so Italy
demographics and socioeconomic
status, 158
family, 159
immigration patterns, 157
religion and, 159
traditional health beliefs and practices, 159
Italy. see al so Italians
etiquette, 167
foreign influence, 160, 162
meal composition and cycle, 166–167
regional variations, 164–166
staples, 162
Iyar, 440
J
Jainism, 453
Jalapeño chiles, 248, 524
Jamaicans. see Caribbean Islanders
Jambalayas, 153, 512
Jansson’s frestelse, 199
Japanese, 340–351
adaptations of food habits, 348–349
contemporary food habits in United States,
348–351
counseling, 350–351
cultural perspective, 340–343
daily patterns of meals, 347
demographics and socioeconomic status,
340–341
etiquette, 347–348
Hot-cold classifications of foods
in Ayurvedic medicine, 456
for Caribbean Islanders, 284, 294
for Central Americans, 263, 268
definition of, 41
for Mexicans, 252
Pakistanis, 469
for South Americans, 311
Hot cross buns, 152
Hougans, 284
Hua diao, 330
Huachinango, 246
Huachinango a la Veracruzana, 248
Huascas, 308
Human equality, 38
Humitas, 306
Hummus, 428
Hungarian Americans. see Hungarians
Hungarians
demographics and socioeconomic status, 179
family, 181
immigration patterns, 177
religion, 180
Hunger, 21
Hwabyung, 354
Hydrotherapy, 49
Hypertension
African Americans, 228
Asian Indians, 473
Chinese Americans, 337
Filipinos, 395
Koreans, 361
Mexican Americans, 258
Mexicans, 254
I
Ialorixá, 304
Ibimi, 491
Iceberg model, 56–57
Ichiju issei, 347
Ichiju sansei, 347
IFNCA. see Islamic Food and Nutrition
Council of America
Iftar, 439
IHS. see Indian Health Service
Ikura, 343
Imam bayildi, 428
Imperial caviar, 186
Imu, 403
India. see Asian Indians
Indian Health Service (IHS), 129
Indian pudding, 489
Indirect communication, 36
Inedible foods, 13
Influence channels, 76
Ingredients and common foods
Africans, 214–221, 224–225
Asian Indians, 457–464, 470–471
Caribbean Islanders, 285–291, 295–296
central Europeans and people of former
Soviet Union, 183–187
Chinese, 325–331, 335–336
Japanese, 343–347
Koreans, 354–357, 359–360
Mexicans, 242–250
Middle Easterners, 426–434, 441–442
Native Americans, 112–120
Native Hawaiians and Pacific Islanders,
403–405, 406–407
Northern Europeans, 144–151
Pakistanis, 457–464, 472
Health, 111–112. see al so Traditional health
beliefs and practices
attributes, 39
body image, 40
cultural definitions of, 39–40
disease, illness and sickness, 42–50
ethnicity and, 20–22
food choice and, 17
habits, 40–41
maintenance, 40–42
meaning of, 39
Health care
biomedical healing, 50–51
interaction between provider and client,
64–65
medical pluralism, 50
responsibilities of provider, 66
role of communication in, 64–66
Health-promoting food habits, 40–42
Healthy Eating Index (HEI), 256
Heart disease. see al so Coronary
heart disease
black nightshade and, 456
Chinese Americans, 337
French paradox, 144
Irish Americans, 155
Native Americans, 128
Vietnamese, 395
Heating, 378
HEI. see Healthy Eating Index
Hemochromatosis, 156
Herbal remedies, 259, 268
Herbalists, 263
Herring, 186
Hershey’s Kisses, 494
Hibiscus, 268
Hierbabuena, 268
High blood, 223
High-context cultures
nonverbal communication and, 62
verbal communication and, 58–60
High Holy mayonnais, 512
High priest, 304
High priestess, 304
High tea, 151
Hijiki, 346
Hima’a, 403
Himmel und Erde, 186
Hinduism, 98–103
Asian Indians and, 453
dietary practices, 101–102
fast days, 103
feast days, 102–103
Gypsies and, 180
Hmong, 376–377, 379–380, 393, 396,
397–399
Hoisin sauce, 330
Hoja santa, 249
Holi, 466
Holidays. see Special occasions; spec if ic
h ol iday s
Hollandaise, 150
Holy Ghost Festival, 168
Holy Ghost soup, 169
Holy Week, 168
Homeopathy, 48
Honan, 330
Honduras. see Central Americans
Honey, 216, 260
Hoodoo, 213
Hopi Indians, 110, 117, 122, 124
Horseradish, 497
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
I N D E X 5 5 7
Laver, 147, 355
Laws of Manu, 101
Lebanese. see Middle Easterners
Lebanon bologna, 493
Lebneh, 429
Lefse, 201
Legumes, 215, 428
Lentils, 428
Lepinja, 431
Limes, 248, 509
Lingonberries, 201
Lithuanians, 178
demographics and socioeconomic
status, 179
family, 182
llapingachos, 307
religion, 181
Lobster, 490
Lokum, 433
Lomi-lomi, 403
Low blood, 223
Low-context cultures
nonverbal communication and, 62
verbal communication and, 58–60
Lutheran, 198
M
Madeira, 166
Mäe-de-santo, 304
Magga, 103
Magico-religious interventions, 49–50
Maguey cactus, 247
Mahayana Buddhism, 104
Mahleb, 429
Makisushi, 343
Mal de ojo (evil eye), 44, 242, 252, 260, 263,
283, 425
Malagueta, 309
Maltash, 463
Manchego, 163
Manger mort, 284
Mango seeds, 215
Mangoes, 266, 510
Manju, 347
Mansaf, 433
Mansin, 354
Manzanilla, 268
Maple syrup
cherries stewed with, 116
dried beans and, 114, 116
French American use, 154
Native American use, 107, 113
in Northeastern American cuisine,
487, 491
wild rice and, 117
Mardi Gras, 153, 155
Marketing mix, 76–77
Marsala, 165
Märzenbier, 187
Marzipan, 160, 190, 201
Mashbooh, 97
Massa sovoda, 169
Massage, 380
Matambre, 307–308
Maté, 308
Materialism, 38
Matzah, 88
Maultaschen, 185
Maulud n’Nabi, 98
Mayans, 264
Mead, 187
Kokum sharbat, 462
Kombu, 345–346
Königsberger Klopse, 185
Kool-Aid, 268
Kool sla, 492
Koreans, 351–362
adaptations of food habits, 359–360
contemporary food habits in United States,
359–362
counseling, 361–362
cultural perspective, 352–354
demographics and socioeconomic
status, 352
etiquette, 357
family, 352–353
history of, in United States, 352
immigration patterns, 352
ingredients and common foods, 354–357,
359–360
meal composition and cycle, 357–358
nutritional intake, 360–361
nutritional status, 360–362
religion, 352
special occasions, 357–358
staples, 355–357
therapeutic uses of food, 358
traditional food habits, 354–358
traditional health beliefs and practices,
353–354
worldview, 352–354
Korma, 459
Koroshi, 343
Kosher. see Kashrut/Kosher dietary laws
Kranbeere, 491
Kransekake, 201
Krsna Slava, 439
Kudzu, 343
Kukuye sabzi, 440
Kurban Bayram, 439
Kurutz, 463
Kvass, 187, 192
Kwakiutl Indians, 119
Kwanzaa, 222
L
Labni, 429
Lager, 187
Lakota Indians, 110, 126
Lamb
in Greek American cuisine, 441
in Iranian cuisine, 433, 434
in Pakistani cuisine, 459
as staple food in Great Britain, 144
as staple food of Native Americans,
113–114
Lambropsomo, 438
Lamprey, 163
Laotians
adaptations of food habits, 393–394
demographics and socioeconomic
status, 374
family, 376–377
immigration patterns, 373
nutritional intake, 396
religion, 375
special occasions, 391
staples, 384–389
traditional health beliefs and
practices, 379
Latinos. see Mexicans
Lavash, 426
family, 341–342
history of, in United States, 340–341
immigration patterns, 340
ingredients and common foods, 343–347
meal composition and cycle, 347–348
nutritional intake, 349–350
nutritional status, 349–351
regional variations, 343–347
religion, 341
special occasions, 348
staples, 343–347
therapeutic uses of food, 348
traditional food habits, 343–348
traditional health beliefs and practices,
342–343
worldview, 341–343
Jarlsberg, 199
Jeberos, 263
Jicama, 304
Jing, 324
Jinn, 425
Judaism, 83–89
fast days, 89
holidays, 86–89
immigration to United States, 84
Kashrut/Kosher dietary laws, 84–86
nutritional status, 89
K
Kabobs, 429
Kabocha, 346
Kajmak, 431
Kalonji, 462
Kam kuhn, 424
Kanpo, 342
Kanpo-i, 342
Kanya, 215
Kapha, 468
Kappamaki, 343
Karaoke, 348
Karma, 103
Kaseri, 429
Kashkaval, 429
Kashrut/Kosher dietary laws, 84–86
Katsu, 346
Kava, 406
Kawali, 381
Kelp, 355
Kenya, 217
Key lime pies, 511
Khat, 466
Khella, 425
Khichri, 459
Khoresh, 428
Ki, 353
Kibbeh, 433
Kiddush, 440
Kidney disease, 128
Kielbasa, 186
Kim, 355
Kimchi, 355
Kinilaw, 383
Kitchen God, 333
Knockwurst, 186
Kobe beef, 345
Kocho, 216
Kochujang, 355
Koeksister, 218
Kofta, 429
Ko’hl, 424, 445
Koko, 341
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
5 5 8 I N D E X
Moroccan cooking, 436. see al so Middle
Easterners
Mortadella, 164
Moussaka, 428
Mozzarella, 165
Mudang, 354
Muharram, 439
Muktuk, 119
Mulato chiles, 248
Mullet, 403
Mung beans, 355
Musaka, 428
Mushrooms, 329
Muslims. see Islam
Mutton, 218, 329, 459
Myzithra, 429
N
Nabemono, 346–347
Nactamal, 264
Naharati qalb, 424
Nam pa, 387, 389
Name traditions, 67
Narahati, 424
Native Americans
adaptations of food habits, 123–125
body image and, 40
contemporary food habits, 123–133
counseling of, 129–133
cultural perspective, 97
current demographics of, 108–109
daily patterns of meals, 120–121
family, 111
Great Plains, diet of, 117
history of, 107–110
ingredients and common foods of, 112–120
meal composition and cycle, 120–121
Northeastern, diet of, 114–116
Northwest Coast/Alaska, diet of, 118–120
nutritional status, 126–133
organizations, 110
overweight and obesity among, 127
regional variations, 114–120
religion, 110–111
role of food in culture and etiquette,
121–122
self-identity and, 2
settlement patterns of, 107–108
socioeconomic status of, 109–110
Southern, diet of, 116
Southwestern, diet of, 117–118
special occasions, 121
therapeutic uses of food, 122
Western American cuisine and, 523–524
worldview, 110–112
Native Hawaiians and Pacific Islanders
(NHPIs), 399–409
adaptations of food habits, 406–407
contemporary food habits in United States,
406–410
counseling, 408–409
cultural perspective, 399–402
demographics and socioeconomic status,
400–401
etiquette, 405
family, 401
history of, in United States, 399–402
immigration patterns, 399–400
ingredients and common foods, 403–405,
406–407
meal composition and cycle, 405–406, 407
nutritional status, 256–261
regional variations, 246–250
religion, 239–240
role of food and etiquette, 251
Spanish contributions, 243
special occasions, 250–251, 255–256
staples, 243–246
therapeutic uses of food, 252
traditional food habits, 242–252
traditional health beliefs and practices,
241–242
worldview, 239–242
Middle Easterners, 416–449
adaptations of food habits, 441–442
contemporary food habits in United States,
441–445
cultural perspective, 416–425
daily patterns of meals, 434–437
demographics and socioeconomic status,
419–420, 496
etiquette, 437–438
family, 422–423
health concerns, 503
history of, in United States, 418
ingredients and common foods, 426–434
meal composition and cycle, 434–441
Midsummer’s Day, 203
Midwestern Americans, 495–503
nutritional intake, 442–443
nutritional status, 442–445
people of Balkans and, 416–449
regional profile, 495–496
regional variations, 432–434
religion, 421
special occasions, 438–440
staples, 426–430
therapeutic uses of food, 440–441
traditional fare, 496–503
traditional food habits, 425–441
traditional health beliefs and practices,
424–425
worldview, 421
Milk
African Americans, 226
in Balkan cuisine, 429
camel, 217
coconut, 217
consumption by Chinese Americans, 335
evaporated, 383
food habits, 42
Mexicans, 255
in Middle Eastern cuisine, 429
in Midwestern American cuisine, 497
in Scandinavian cuisine, 201
whole, 254
Millet, 215
Mincemeat pies, 152, 490
Mint, 268
Mint julep, 514
Mirin, 345
Mirleton, 513
Miso, 345–346
Misoshiru, 346
Mississippi mud pie, 513
Miwok Indians, 120, 124
Mixtas, 264
Mizuna, 345
Mochi gashi, 347
Moksha, 101
Moles, 248
Morilla, 162
Mormons, 93–94
Meals
Africans, 221–225
Asian Indians, 471–472
Caribbean Islanders, 291–293, 296
Central Americans, 266–267
Central Europeans and people of former
Soviet Union, 187–192
Chinese, 331–334
Japanese, 347–348
Koreans, 357–358, 360
Mexicans, 250–251, 255–256
Middle Easterners, 434–442
Native Americans, 114–121
Native Hawaiians and Pacific Islanders,
405, 407
northern Europeans, 151–153
Pakistanis, 472
patterns and cycles, 10–11
people of Balkans, 434–442
portion size of, 10
Scandinavians, 201–203
South Americans, 310–312
Southeast Asians, 389–392
southern Europeans, 166–169
Meat
Buddhism and, 104
in cuisine of Central Europe and former
Soviet Union, 185
Eastern Orthodox Christianity and, 90–91
halal, 97
Hinduism and, 101
indigenous, 304
Kashrut/Kosher dietary laws and, 84–86
in Mexican cuisine, 249–250
Mormons, 93
in Northeastern American cuisine, 489
prohibitions, 96, 99
Roman Catholicism and, 90
in Scandinavian cuisine, 199–201
Seventh-Day Adventists, 94
in Southern American cuisine, 511–513
Media noche, 390
Medical pluralism, 50
Medicine men/women. see Shamans
Mediterranean diet, 442
Melons, 509
Membillo, 163
Merienda, 167, 250
Mescal, 243
Metabolic syndrome, 258, 312, 473–474
Metamgee, 309
Metaxia, 430
Metheglyn, 147
Mexican-Americans, 258
diabetes mellitus type 2 in, 258
immigrant experience of, 257
Mexicans, 237–261
Aztec food, 242–243
contemporary food habits in United States,
252–261
counseling, 259–261
cultural perspective, 238–242
daily patterns of meals, 250, 255
demographics and socioeconomic
status, 239
family, 240
history of, in United States, 238–239
immigration patterns, 238–239
ingredients and common foods of, 242–250
meal composition and cycle, 250–251,
255–256
nutritional intake, 256–261
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
I N D E X 5 5 9
Filipinos, 395
France, 145
Italy, 170
Japanese Americans, 349
Koreans, 361
Mexicans, 258
Middle Easterners, 442
Native Americans, 127
Native Hawaiians and Pacific Islanders, 407
Northeastern Americans, 494
people of Balkans, 442
Portugal, 170
Scandinavians, 204
South Americans, 312
Southern Americans, 517
Spain, 170
Western Americans, 530
Object messages, 58, 64, 69
Obsessive-compulsive disorder, 224
Ocopa, 307
Offal, 150
Og bono, 215
Ojibwa Indians, 122
Okra, 225
Oktoberfest, 187, 189
Old clothes, 308
Olive oil, 162, 428, 441
Olives, 162, 428
Omnivore’s paradox, 2, 17
Ong Tao, 391
Oolong tea, 329
Oplatky, 191
Oranges, 509
Orixá, 304
Orthodox, 421
Orthodox Church in America, 181
Osso buco, 164
Ouzo, 430, 437
Overweight. see Obesity/overweight
Oyakodon, 347
Oyatsu, 347
Oysters, 491, 501, 508, 515–516, 525
Oysters Rockefeller, 516
P
Pa dek, 387, 389
Paan, 465–466
Pacha, 433
Pachamanca, 306
Pacific Islanders. S ee Native Hawaiians and
Pacific Islanders (NHPIs)
Padecer de los nervios, 283
Pai-de-santo, 304
Painted rooster, 264
Paiute Indians, 111
Pakistanis, 450–482
adaptations of food habits, 472
contemporary food habits in United States,
470–476
counseling, 476
cultural perspective, 450–456
demographics and socioeconomic status,
452–453
family, 455
history of, in United States, 450–453
immigration patterns, 452
ingredients and common foods, 457–464
meal composition and cycle, 465–466
nutritional intake, 474
nutritional status, 474, 476
regional variations, 463
family, 143–144
history of, in United States, 140–143
immigration patterns, 140–142
ingredients and common foods of, 144–151
meal composition and cycle, 151–153
northern Europeans, 144
nutritional status, 155–157
religion, 143
therapeutic uses of food, 153
traditional food habits, 144–153
worldview, 143–144
Northern India, 459, 461–462
Northwest Coast/Alaska Native Americans,
diet of, 118–120
Norwegian flatbrød, 201
Norwegians. see Scandinavians
Nuoc mam, 387
Nutrition
cultural competency, 18–22
food habits and, 18–23
intercultural, 22–23
intercultural assessment, 71–73
Nutrition education
comic bopoks as, 271
developing message, 75–76
evaluation, 77
goals and objectives, 74–75
identification of target audience, 74
implementation strategies, 76–77
influence channels, 76
intercultural, 73–77
marketing mix, 76–77
program preparation, 74–76
triangulation, 75
Nutritional status
Africans, 225–230
Asian Indians, 472–476
Central Americans, 269–271
Central Europeans and people of former
Soviet Union, 194–196
Chinese, 336–34
Judaism, 89
Koreans, 360–362
Mexicans, 256–261
Middle Easterners, 442–445
Native Americans, 126–133
Native Hawaiians and Pacific Islanders,
407–409
northern Europeans, 155–157
Pakistanis, 474–476
people of Balkans, 442–445
Scandinavians, 203–204
South Americans, 312–314
Southeast Asians, 395–399
southern Europeans, 169–170
Nutritional therapy, 48
Nuts, 304
O
O sonae mochi, 348
Oatmeal
breakfast meal in Great Britain, 151
health benefits of, 42
Obesity/overweight rate, 21
African Americans, 227
Asian Indians, 472–473
Central Americans, 269
Central Europeans and people of former
Soviet Union, 194
Chinese, 337
Chinese Americans, 336–337
nutritional intake, 407–408
nutritional status, 407–409
religion, 401
role of food, 405–406
special occasions, 405
staples, 403–405
therapeutic uses of food, 406
traditional food habits, 402–406
traditional health beliefs and practices,
401–402
worldview, 401–402
Naturopathic medicine, 48
Nau-Roz, 98, 440
Navajo bananas, 118
Navajo Indians
contemporary food habits of, 124
counseling of, 131–132
diet of, 117–118
foods introduced from Europe and, 114
meal composition and cycle of, 124
nutritional status, 127
religion and, 110
socioeconomic status of, 110
therapeutic uses of food and, 122
traditional health beliefs and practices,
111–112
Nervios, 241, 260, 271, 283
New England boiled dinner, 489
New Mexico, 253
New Zealand fare, 409
Nez Perce Indians, 120
NHPIs. S ee Native Hawaiians and Pacific
Islanders (NHPIs)
Nicaragua. see Central Americans
Nigella seeds, 462
Nigerians, 228
Nigirisushi, 343
Nimono, 346
Nirodha, 103
Nisei, 349
Noche Buena, 293
Nogada, 266
Nonverbal communication, 62–64
eye contact and, 63–64
gesture, facial expression, and posture, 63
among Native Americans, 131
spatial relationships and, 64
touching, 62–63
Noodles, 328
buckwheat, 343
in Filipino diet, 381
in Korean cuisine, 355
rice, 343
Vietnamese, 384
Nori, 346
Northeastern Americans, 485–495
demographics and socioeconomic status,
485–487
health concerns, 494–495
regional profile, 485–487
traditional fare, 487–494
Northeastern Native Americans, diet of,
114–116
Northern Chinese, 330–331
Northern Europeans, 139–171
adaptations of food habits, 153–155
contemporary food habits in United States,
153–157
counseling of, 156
cultural perspective, 140–144
demographics and socioeconomic status,
142–143
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
5 6 0 I N D E X
Prunes, 203
Puddings
in Northeastern American cuisine, 489
plum, 150, 152
in Southern American cuisine, 511,
513–514
Pueblo Indians, 108, 110, 117, 122, 125, 523
Puerto Ricans
demographics and socioeconomic status,
280–281
family, 282
history of, in United States, 279–280
Pulao, 459
Pulaski Day, 194
Pulla, 201
Pumpkin pie, 153
Purim, 87
Q
Qi, 324
Qorma, 459
Quesadillas, 267
Queso flameado, 247
Queso fundido, 247
Quiche Lorraine, 148
Qur’an, 454
R
RAFT. see Renewing America’s Food
Traditions
Rajus, 468
Raki, 430
Ramen, 343
Red beans, 264
Red chile stew. see Chile colorado
Red-flannel hash, 489
Red jujubes, 335
Refrescas, 266
Regional Americans, 483–530
Midwestern, 495–503
Northeastern, 485–495
regional divisions, 485
regional food habits, 483–485
Southern, 503–505
Western, 517–530
Religion
Africans, 212–214
Animism, 454
Asian Indians, 453–454
Buddhism, 103–105, 323, 341–342, 352
Caribbean Islanders, 282
Central Americans, 263
Central Europeans, 180
Chinese, 322–323
Christianity, 89–94, 212, 454
Chundo Kyo, 352
Confucianism, 322, 352
Eastern, 98–105
Eastern Orthodox Christianity, 90–91,
111, 181, 421
folk, 282
food and, 82–105
Germans, 180
Gypsies, 180
Hinduism, 98–103
Islam, 94–98
Jainism, 453
Judaism, 83–89
Mexicans, 239–240
Pisco, 308
Pita, 426
Pitta, 468
Plantains, 215, 217, 295
Pljeskavica, 431
Plum pudding, 150, 152
Plums, 502
Po’ boy, 516
Poblano chiles, 248, 524
Poles
demographics and socioeconomic
status, 178
family, 181
immigration patterns, 176–177
religion, 180
therapeutic uses of food, 179
traditional health beliefs and practices, 170
Polo, 428
Pombas, 169
Pomo Indians, 120
Pont-l’Évêque, 148
Ponzu, 346
Pork
African American southern staples, 219
in cuisine of Central Europe and former
Soviet Union, 185
in cuisine of central Europe and FSU, 185
in cuisine of China, 329
in Filipino diet, 381
in Japanese cuisine, 345
in Mexican cuisine, 249–250
in Midwestern American cuisine, 501
in Native Hawaiians and Pacific Islanders
diet, 403
in Northeastern American cuisine, 492
in Pakistani cuisine, 459
pie, 154
prohibitions against, 96, 99
in Southern American cuisine, 506, 512
as staple food in Great Britain, 144
Port wine, 147, 166
Portugal. see al so Portuguese
etiquette, 167
meal composition and cycle, 167
regional variations, 166
staples, 163–164
Portuguese. see al so Portugal
demographics and socioeconomic
status, 159
family, 160
immigration patterns, 158
religion and, 159
Portuguese garlic pork, 309
Portuguese sweet bread, 403
Posadas, 251
Postum, 499
Posture, 63
Potatoes
in cuisine of Central Europe and former
Soviet Union, 186
in South American cuisine, 304
as staple food in Ireland, 146
in Western American cuisine, 522
Potawatomi Indians, 110
Powhatan Indians, 114
Powwowing, 182
Prahoc, 387
Promesa, 283
Prosciutto, 164
Protection, 378
Protestantism, 91–94, 111, 282
Provolone, 165
Pakistanis (C ontinued )
religion, 454
religious variations, 463–464
special occasions, 467
staples, 459
therapeutic uses of food, 470
traditional health beliefs and practices, 456
worldview, 453–456
Paklava, 426
Palillo, 307
Palm oil, 215
Pamonhas, 306
Pan de sal, 381
Panama. see Central Americans
Pancetta, 164
Pancit, 381
Paneer, 461
Papa seca, 307
Pappadams, 463
Paraguay. see South Americans
Parmesan cheese, 164
Pasilla chiles, 248
Pasmo, 284
Passover, 87–88
Pasta, 162, 164–165, 308
Pau d’ arco, 304
Pawnee Indians, 117
Peach palm, 266
Peaches, 509–510
Peanuts, 215
Pearl tea, 330
Pears, 527
Pecan pralines, 154
Pecans, 514
Pelmeni, 185
Pennsylvania Dutch, 182
Peppermint candies, 223
Pequin chiles, 248
Perilla, 345
Personal control, 37
Personal messages, 58, 64
Peru. see South Americans
Philippines, 370
Pho, 384
Phyllo, 426
Pica, 224, 228
Picanha, 310
Pida, 426
Pierogi, 185
Pies
cipate, 154
Cornish pasty, 150
in cuisine of central Europe and FSU, 185
Franco-American, 155
in Northeastern American cuisine, 193,
489–490, 493
peach, 510
pork, 154
pumpkin, 153
in Southern American cuisine, 513
steak and kidney, 150
walnut and raisin, 168
Piki, 118
Pilaf, 426, 428
Pili-pili, 215
Pilsner beer, 187
Pima Indians, 117, 128
Piñatas, 251
Pine nuts, 118, 246
Piñon seeds. see Pine nuts
Pinto beans, 511
Pirão, 310
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
I N D E X 5 6 1
demographics and socioeconomic
status, 198
etiquette, 202
family, 198
history of, in United States, 196–198
immigration patterns, 197–198
meal composition and cycle, 201–203
nutritional status, 203–204
religion and, 198
special occasions, 202–203
staples and regional variations, 199–201
traditional food habits, 199–203
traditional health beliefs and practices,
198–199
worldview, 198–199
Schnapps, 187
Schnitzel, 185
Schwarzwälder Kirschtorte, 187
Scotch whisky, 147
Scrapple, 492
Sea pie. see Cipate
Seafood
in Southern American cuisine, 508, 515
in Spanish cuisine, 162
in Western American cuisine, 525, 530
Seaweed
aonoriko, 346
dulse, 147
hijiki, 346
kelp, 355
laver, 147, 355
nori, 346
wakame, 346, 355
Seeb, 440
Seer, 440
Sekeh, 440
Seker Bayram, 439
Self-expression, 15–16
Self-identity
food as, 2–3
food selection and, 16
Seminole Indians, 107, 116, 122, 125
Sencotan Indians, 124
Serbet, 430
Serbs. see Balkans, people of
Serke, 440
Serrano chiles, 248, 524
Serrano ham, 162
Seventh-Day Adventists, 94
Sezisman, 284
Shab-i-Barat, 98
Shabu shabu, 346
Shamans, 50, 112, 125, 354
Shandong, 330
Sharbat, 430
Shavout, 89
Shawarma, 429
Sheep balls, 215
Sheermal, 461
Shellfish
Cajun dishes, 153
in Northeastern American cuisine, 490
Sheng, 324
Sherry, 147, 163
Shiitake, 329, 346
Shintoism, 341
Shiromiso, 345
Shiso, 345, 355
Shoofly pie, 193
Shoshone Indians, 120
Shoyo, 343, 345
Shrewsbury simnel, 152
Russians
counseling of, 195–196
demographics and socioeconomic status,
179–180
family, 181–182
immigration patterns, 177–178
religion, 180–181
traditional health beliefs and practices,
182–183
worldview, 180–181
Ryaninjun, 489
Rye, 489
S
Sabadores, 263
Sabbath, 86
Sabzi, 440
Sabzu polo, 440
Saewujeot, 355
Saffron custard, 441
Sage tea, 252
Salade Niçoise, 149
Salami, 164
Sally Lunn cake, 510
Salmon, 525
Salmorejo, 166
Salsa de ají, 307
Salteñas, 306
Saltimbocca, 165
Samana, 429
Samanu, 440
Samoans
contemporary food habits in United States,
407–408
demographics and socioeconomic
status, 400
family, 401
immigration patterns, 399–400
nutritional intake, 407–408
religion, 401
traditional food habits, 402–406
traditional health beliefs and
practices, 402
Samovar, 187
Samudaya, 103
Sangria, 163
Sanjed, 440
Sansei, 342, 349
Santería, 282, 284
Santeros, 284
Sardines, 163, 526
Sashimi, 343, 345
Sassafras tea, 153, 223, 514
Sassamanesh, 491
Sattwa, 468
Sauce piquante, 515
Sauerbraten, 185, 492
Sauna, 198
Sausages
in German cuisine, 186
in Portuguese cuisine, 163
in Spanish cuisine, 162
Scallops, 491
Scampi, 164
Scandinavians, 196–204
adaptations of food habits, 203
contemporary food habits in United States,
203–204
counseling of, 204
cultural perspective, 196–199
daily patterns of meals, 201–202
Middle Easterners, 421
Native Americans, 110–111
northern Europeans, 143
Pakistanis, 454
people of Balkans, 420–421
Poles, 180
Protestantism, 91–94, 111, 282
Roman Catholicism, 90, 111, 159, 180,
239–240, 282, 302–303
Russians and people of former Soviet
Union, 180–181
Scandinavians, 198
Shintoism, 341
Sikhism, 453–454
South Americans, 302–303
Southeast Asians, 374–375
southern Europeans, 159
Taoism, 322–323
Tonghak, 352
traditional food habits, 112–122
Western, 83–98
Zoroastrianism, 180, 454
Remedies, botanical, 47, 260, 380
Renewing America’s Food Traditions
(RAFT), 124
Retsina, 430
Rice
in Asian Indian diet, 457
basmati, 461
in cuisine of southern China, 328
dried noodles, 384
as foundation of Filipino diet, 381
in Japanese diet, 343, 345
as key ingredient in Cajun cuisine, 154
in Korean cuisine, 355
Luzon, 383–384
noodles, 343
paper, 384
in Southern American
cuisine, 509
as staple food in Middle Eastern cuisine,
426, 428
as staple food in Vietnam, 384
tea, 357
in West African cuisine, 215
Ricotta, 165
Rio Grande Pueblos, 110
Roe. see al so Caviar
tarama, 433
taramasalata, 433
Rohwurst, 186
Roman Catholicism
Caribbean Islanders, 282
Central Americans, 263
Central Europeans and people of former
Soviet Union, 180
Filipinos, 374
Mexicans, 239–240
Native Americans and, 111
South Americans, 302–303
southern and, 159
Romanian fare, 434
Romescu sauce, 163
Rømmegrøt, 199
Root doctors, 213
Ropa vieja, 308
Rosa de jamaica, 268
Rosh Hashanah, 86–87
Roti, 217, 309, 461
Rouladen, 185
Rum, 309, 491
Russian Orthodox Church, 180
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
5 6 2 I N D E X
Spaniards
demographics and socioeconomic status,
158–159
family, 159
immigration patterns, 157–158
religion and, 159
Spätzle, 185
Special occasions
Africans, 222–223
Asian Indians, 466
Caribbean Islanders, 293
Central Americans, 267
central Europeans and people of former
Soviet Union, 189–192
Chinese, 333–334
France, 152–153
Great Britain, 152
Ireland, 152
Italy, 168
Koreans, 357–358
Mexicans, 250–251, 255–256
Native Americans, 121
Pakistanis, 467
Portugal, 168–169
Scandinavians, 202–203
South Americans, 310–311
Southeast Asians, 390–392
Spain, 168
Spices
in Asian Indian cuisine, 457
in Balkan cuisine, 429
in Middle Eastern cuisine, 429
in Pakistani cuisine, 459
Spiny palm, 266
Spirit of the Hearth, 391
Spiritualist healers, 284
Spirituality, 38
Spoon bread, 507
Spumoni, 165
Squash, 221
in cuisine of China, 329
as staple food of Native Americans, 114
St. Nicholas Day, 194
St. Patrick’s day, 152
Staples
African American, 219–221
Asian Indians, 457–458
Caribbean Islanders, 286–288
Central Americans, 264–266
Central Europeans and people of former
Soviet Union, 183–187
Chinese, 325–330
France, 147–150
Great Britain, 144–147
Italy, 162
Japanese, 343–347
Koreans, 355–357
Mexicans, 243–246
Middle Easterners, 426–430
Native Americans, 114
Native Hawaiians and Pacific Islanders,
403–405
Pakistanis, 459
people of Balkans, 426–430
Portugal, 163–164
Scandinavians, 199–201
South Americans, 304–306
Southeast Asians, 380–389
Southern Europeans, 162–164
Spain, 162–163
State of being, 37
Status, 5
traditional health beliefs and practices,
303–304
worldview, 302–304
South Asians. see Asian Indians; Pakistanis
South Atlantic American cuisine, 507–512
Southeast Asians, 370–399
adaptations of food habits, 393–394
contemporary food habits in United States,
393–399
counseling, 396–399
cultural perspective, 370–380
daily patterns of meals, 389–390
demographics and socioeconomic status,
373–374
etiquette, 390
family, 375–377
history of, in United States, 370–374
immigration patterns, 370–373
ingredients and common foods, 380–389
meal composition and cycle, 389–392
nutritional intake, 395–396
nutritional status, 395–399
regional variations, 380–389
special occasions, 390–392
staples, 380–389
therapeutic uses of food, 392–393
traditional food habits, 380–393
traditional health beliefs and practices,
377–380
worldview, 374–380
Southern Americans, 503–517
demographics and socioeconomic status,
504–505
health concerns, 517
regional profile, 503–505
traditional fare, 505–517
Southern Chinese, 330
Southern Europeans, 139–171
adaptations of food habits, 169
contemporary food habits in United States,
169–170
counseling of, 170
cultural perspective, 157–160
demographics and socioeconomic status,
158–159
family, 159–160
history of, in United States, 157–159
immigration patterns, 157–158
ingredients and common foods of,
160–166
meal composition and cycle, 166–169
nutritional intake, 169–170
nutritional status, 169–170
regional variations, 164–166
religion, 159
staples, 162–164
traditional food habits, 160–169
traditional health beliefs and
practices, 160
worldview, 159–160
Southern India, 462–463
Southern Native Americans, diet of, 116
Southwestern Native Americans, diet of,
117–118
Souvlaki, 429
Soy sauce, 343, 345
Soybeans, 328, 497
Spain. see al so Spaniards
etiquette, 167
meal composition and cycle, 167
regional variations, 166
staples, 162–163
Shrimp
fermented paste of, 383
scampi, 164
in Southern American cuisine, 509, 515
Shrove Tuesday, 153, 191
Shuro, 216
Si-pallie. see Cipate
Sichuan-Hunan, 330
Sikhism, 453–454
Sitsaron, 383
Six-pates. see Cipate
Sljivovica, 430
Slovaks
demographics and socioeconomic
status, 179
family, 181
immigration patterns, 177
religion, 180
Slovenians. see Balkans, people of
Slumps, 489
Smithfield ham, 507
Snakeroot, 425
Soave, 164
Soda bread, 146
Sol, 358
Somalians, 215–217, 228
Somen, 343
Somun, 431
Sonora, 253
Sopa de rosquillas, 267
Sopresseta, 164
Sorghum, 215
Sosaties, 218
Soul food, 224
Soup
açordu, 163
caldo verde, 163
canned, 494
chicken, 42
dashi, 346
Fricot, 154
Holy Ghost, 169
Iraqi, 433
in meal patterns and meal cycles, 10
misoshiru, 346
in South American cuisine, 308
Vietnamese, 388
zuppa di pesce alla marinara, 160
South Africa, 217–218
South Americans, 301–314
adaptations of food habits, 312
contemporary food habits in United States,
312–314
counseling, 312–314
cultural perspective, 301–304
daily patterns of meals, 310
demographics and socioeconomic status,
301–302
etiquette, 311
family, 303
history of, in United States, 301–302
immigration patterns, 301
ingredients and common foods,
304–310
meal composition and cycle, 310–312
nutritional intake, 312
nutritional status, 312–314
regional variations, 306–310
religion, 302–303
special occasions, 310–311
therapeutic uses of food, 311–312
traditional food habits, 304–312
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
I N D E X 5 6 3
Central Europeans and people of former
Soviet Union, 183–192
Chinese, 325–335
Japanese, 348–351
Mexicans, 242–252
Native Americans, 112–133
Native Hawaiians and Pacific Islanders,
402–406
northern Europeans, 144–153
Pakistanis, 459
Scandinavians, 199–203
South Americans, 304–312
Southeast Asians, 380–393
southern Europeans, 160–169
Traditional health beliefs and practices,
34–55. see al so Healing therapies
Africans, 212–214
Asian Indians, 455–456
biomedical worldview, 37–39
Caribbean Islanders, 283–285
Central Americans, 263–264
Central Europeans and people of former
Soviet Union, 182–183
Chinese, 323–325
cultural outlook, 34–37
health and, 39–42
Japanese, 342–343
Koreans, 353–354
Mexicans, 241–242
Middle Easterners, 424–425
Native Americans, 111–112
northern Europeans, 144
Pakistanis, 456
people of Balkans, 424
pluralistic health care systems, 50–52
Scandinavians, 198–199
Southeast Asians, 377–380
southern Europeans, 160
worldview, 34–39
Triangulation, 75
Trifle, 150
Tsukemono, 346
Tuk-trey, 387
Tunnbrød, 201
Turkey, 501
Turkish delight, 433
Turks. see Middle Easterners
Turnovers, 426
Turtle, 219
Tybo, 199
Type 2 diabetes mellitus
Asians, 337
Filipinos, 395
Gypsies, 195
Japanese Americans, 350
Mexican Americans, 258
Native Americans, 128
Native Hawaiians and Pacific Islanders,
407–408
prevalence of, 21
South Americans, 312
U
Udon, 343
Ugali, 217
Uganda, 217
Ukrainians, 178
demographics and socioeconomic
status, 179
family, 182
religion, 181
Tej, 216
Tella, 216
Tempura, 346
Teppanyaki, 346
Tequila, 243, 246
Teriyaki sauce, 345
Tet, 391
Tex-Mex cuisine, 253, 517
Thai fare, 394
Thanksgiving, 293
Tharid, 433
Therapeutic massage, 199
Therapeutic uses of food
Africans, 223–224
Asian Indians, 468–470
Caribbean Islanders, 294–295
Central Americans, 268
Central Europeans and people of former
Soviet Union, 192
Chinese, 334–335
Japanese, 348
Koreans, 358
Mexicans, 252
Middle Easterners, 440–441
Native Americans, 122
Native Hawaiians and Pacific
Islanders, 46
Northern Europeans, 153
Pakistanis, 470
people of Balkans, 440–441
South Americans, 311–312
Southeast Asians, 392–393
Southern Europeans, 169
Theravada Buddhism, 104, 375
Three Kings Day, 250
Tiffin, 465
Tiropetas, 426
Tiste, 266
Tlingit Indians, 119
Tobikko, 343
Tobu, 355
Toenjang, 355
Tofu, 343
Togbei, 215
Tomatillos, 524
Tomato sauce, 150
Tomatoes
in cuisine of Central Europe and former
Soviet Union, 186
in South American cuisine, 304
in Southern American cuisine, 509
in southern European cuisine, 162
in Western American cuisine, 524
Tongans
demographics and socioeconomic
status, 401
family, 401
immigration patterns, 400
religion, 401
traditional food habits, 402–406
Tonghak, 352
Tortas de aceite, 168
Tortillas, 243, 253, 264
Tou yun, 324
Touching, 62–63
Traditional Chinese Medicine (TCM), 48,
323–325, 339, 392–393, 401–402
Traditional food habits
Africans, 214–224
Asian Indians, 457–458
Caribbean Islanders, 285–295
Central Americans, 264–268
Steak and kidney pie, 150
Steamers, 490
Stereotyping, 5, 21, 22
Sterlet caviar, 186
Stews
as national dish of Ethiopia, 216
in slave diet, 219
in South American cuisine, 308
Stobhach Gaelach, 146
Stout, 147
Sturgeon, 82
Su, 343
Succotash, 116, 489
Sudan, 215–217
Sudden unexpected nocturnal death
syndrome (SUNDS), 45
Sugar, Demerara, 309
Sugarcane, 245, 309, 530
Sui mai, 331
Sukiyaki, 346
Sukkot, 87
Sumagh, 440
SUNDS. see Sudden unexpected nocturnal
death syndrome
Sushi, 343
Suspiros, 168
Susto, 241, 252, 263, 270, 283
Swedes. see Scandinavians
Swedish knäckebröd, 201
Swedish massage, 199
Sweet potatoes, 304
Swiss
demographics and socioeconomic
status, 179
immigration patterns, 177
Symbolic use of food, 3
Syrians. see Middle Easterners
T
Tabasco, 154
Tabouli, 433
Tacos, 245
Tagdir, 425
Tajima beef, 346
Tamales, 245, 250–251, 255, 264, 268
Tamas, 468
Tandoor, 461–462
Tandoori, 459
Tanzania, 217
Taoism, 322–323
Tapas, 167, 168, 357
Tarama, 433
Taramasalata, 433
Taro root paste, 403
Taste, 14–15
TCM. see Traditional Chinese Medicine
Tea, 147, 153
black, 494
cerasse, 295
in cuisine of Central Europe and former
Soviet Union, 187
in cuisine of China, 329–330
green, 345
herbal, 268, 284, 355
high, 151
in Northeastern American cuisine, 491
rice, 355
sage, 252
sassafras, 223, 514
wild sage, 295
yellowroot shrub, 223
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
5 6 4 I N D E X
Worldview
biomedical, 37–39
Caribbean Islanders, 282–285
Chinese, 322–325
comparison of common values, 35
cultural outlook, 34–37
Native Americans, 110–112
South Americans, 302–304
Y
Yacón, 304
Yadu Nal, 358
Yakimono, 346
Yams
in African American cuisine, 225
in West African cuisine, 215
Yataklete kilkil, 216
Yeast, 499
Yellowroot shrub, 223
Yemiser selatta, 216
Yemiser wat, 216
Yerba buena, 524
Yerbeterías, 304
Yin-yang
acupuncture and, 325
diet theory, 41, 323–324, 334, 348
in Korean system of health and
illness, 353
in Taoism, 323
Vietnamese and balance of, 378
Yo-kan, 345
Yogurt, 429, 457, 459
Yom Ha-Atzma’ut, 440
Yom Kippur, 87
Yorkshire pudding, 144
Yucca, 118. see al so Cassava
Yugeno, 307
Yunnan, 330
Yupik Indians, 119, 124
Z
Za’atar, 429, 436
Zabaglione, 167
Zakuski, 189
Zampa, 333
Zamzam water, 424
Zapote, 248
Zen Buddhism, 345
Zeppole, 165
Znakarki, 183
Zoroastrianism, 180, 454
Zunaad, 424
Zuni Indians, 117, 122, 127
Zuppa di pesce alla marinara, 160
Vodka, 187, 192
Voodoo, 213, 282, 284
Vouvray, 148
W
Wakame, 346, 355
Walnuts, 335
Wasabi, 347
Wat, 216
Weissbier, 187
West Africa, 214–215
Western Americans, 517–530
demographics and socioeconomic
status, 518
health concerns, 530
regional profile, 517–518
traditional fare, 518–530
Westphalian ham, 185
Wheat, 328, 426, 459
Whiskey, 147, 514
WHO. see World Health Organization
Wienerbrød, 201
Wild mushrooms, 186, 201
Wild rice, 117
Wild sage tea, 295
Wine(s)
Bordeaux, 149
Burgundy, 149
California, 494, 527
Central Europe, 187
Champagne, 148
Chianti, 165
Chinese, 330
Civek, 430
dandelion, 491
France, 148
German Rhine, 148
gooseberry, 491
Madeira, 166
Mexican, 246
mirin, 345
New York, 494
Oregon, 527
port, 147, 166
retsina, 430
rice, 357
Sangria, 163
sherry, 147
Soave, 164
South American, 308
Vouvray, 148
Washington, 527
Witchcraft, 213, 263
Worcestershire sauce, 150
World Health Organization (WHO), 39
Ulasaming bato, 392
Um, 353, 358
Umu, 403
Uni, 343
Uruguay. see South Americans
V
Varenyky, 185
Variety, 17–18
Vata, 468
Veal, 164, 185
Vegetables
in Balkan cuisine, 428, 431
in Mexican cuisine, 245
in Middle Eastern cuisine, 428, 431
in Northeastern American cuisine, 492
in Pakistani cuisine, 459
Vegetarianism, 457, 458
Velouté, 150
Venado, 266
Venezuela. see South Americans
Verbal communication, 58–62
individuals and groups, 60
in low-and high-context cultures, 58–60
power, authority, and status, 61–62
time perception, 62
uncertainty avoidance and, 60–61
Vermouth, 164
Vertigo, 324
Vibora de cascabel, 260
Vidalia onions, 509
Vienna bread, 201
Vietnam, 371–373
Vietnamese
adaptations of food habits, 393–394
counseling, 397–399
daily patterns of meals, 389–390
demographics and socioeconomic status,
373–374
etiquette, 390
family, 376
meal composition and cycle, 389
nutritional intake, 395–396
religion, 375
special occasions, 391–392
staples, 384–389
therapeutic uses of food, 392–393
traditional Chinese medicine and,
392–393
traditional health beliefs and practices,
378–379
Vinegar
aceto balsamico di Modena, 164
rice, 343
Vitello tonnato, 164
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-209
Cover
IFC
Half Title
Title
Statement
Copyright
Contents
Preface
Ch 1: Food and Culture
Ch 1: Introduction
What Is Food?
What Is Culture?
Cultural Food Habits
Individual Food Habits
Nutrition and Food Habits
The American Paradox
Ch 1: Review Questions
Ch 1: References
Ch 2: Traditional Health Beliefs and Practices
Ch 2: Introduction
Worldview
What Is Health?
Disease, Illness,and Sickness
Pluralistic Health Care Systems
Ch 2: Review Questions
Ch 2: References
Ch 3: Intercultural Communication
Ch 3: Introduction
The Intercultural Challenge
Intercultural Communication Concepts
Role of Communication in Health Care
Successful Intercultural Communication
Intercultural Nutrition Education
Ch 3: Review Questions
Ch 3: References
Ch 4: Food and Religion
Ch 4: Introduction
Western Religions
Eastern Religions
Ch 4: Review Questions
Ch 4: References
Ch 5: Native Americans
Ch 5: Introduction
Cultural Perspective
Traditional Food Habits
Contemporary Food Habits
Ch 5: Review Questions
Ch 5: References
Ch 6: Northern and Southern Europeans
Ch 6: Introduction
Northern Europeans
Southern Europeans
Ch 6: Review Questions
Ch 6: References
Ch 7: Central Europeans, People of the Former Soviet Union, and Scandinavians
Ch 7: Introduction
Central Europeans and the People of the FSU
Scandinavians
Ch 7: Review Questions
Ch 7: References
Ch 8: Africans
Ch 8: Inroducion
Cultural Perspective
Worldview
Traditional Food Habits
Ingredients and Common Foods
Meal Composition and Cycle
Meal Composition and Cycle
Contemporary Food Habits in the United States
Adaptations of Food Habits
Ch 8: Review Questions
Ch 8: References
Ch 9: Mexicans and Central Americans
Ch 9: Introduction
Mexicans
Ch 9: Review Questions
Ch 9: References
Ch 10: Caribbean Islanders and South Americans
Ch 10: Introduction
Caribbean Islanders
South Americans
Ch 10: Review Questions
Ch 10: References
Ch 11: East Asians
Ch 11: Introduction
Chinese
Japanese
Koreans
Ch 11: Review Questions
Ch 11: References
Ch 12: Southeast Asians and Pacific Islanders
Ch 12: Introduction
Southeast Asians
Native Hawaiians and Pacific Islanders
Ch 12: Review Questions
Ch 12: References
Ch 13: People of the Balkans and the Middle East
Ch 1: Introduction
Cultural Perspective
Traditional Food Habits
Contemporary Food Habits in the United States
Ch 13: Review Questions
Ch 13: References
Ch 14: South Asians
Ch 14: Introduction
Cultural Perspective
Traditional Food Habits
Contemporary Food Habits in the United States
Ch 14: Review Questions
Ch 14: References
Ch 15: Regional Americans
Ch 15: Introduction
American Regional Food Habits
The Northeast
The Midwest
The South
The West
Ch 15: Review Questions
Ch 15: References
Glossary of Ethnic Ingredients
Resources
Index
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