Depressive symptoms and C-reactive protein in a Brazilian urban community.

Psychological depression is an independent risk factor for coronary artery disease. C-reactive protein has been implicated as a mediator of the effect of psychological depression. Several studies have found that individuals, especially men, who report higher levels of psychological depression also have higher levels of C-reactive protein. The current study was undertaken to replicate these results in a Brazilian population, in which there is a much wider range of variation in both background characteristics (such as socioeconomic status) and coronary artery disease risk factors. A sample of 271 individuals was interviewed using the Center for Epidemiological Studies Depression Scale. Fasting blood samples were obtained and evaluated for C-reactive protein (assessed by a turbidimetric immunoassay using a Dade Behring kit) analysis in a subsample (N = 258) of individuals. The mean +/- SD C-reactive protein for the entire sample was 0.43 +/- 0.44, with 0.42 +/- 0.48 for men and 0.43 +/- 0.42 mg/L for women. Data were analyzed using multiple regression analysis, controlling for age, sex, body mass index, socioeconomic status, tobacco use, and both total cholesterol and low-density lipoprotein cholesterol. Higher reported depressive symptoms were correlated with higher C-reactive protein for men (partial r = 0.298, P = 0.004) and with lower C-reactive protein for women (partial r = -0.154, P = 0.059). The differences in the associations for men and women could be a result of differential effects of sex hormones on stress reactivity and immune response. On the other hand, this difference in the associations may be related to gender differences in the disclosure of emotion and the effect that self-disclosure has on physical health and immune response.

Hypertension in the African American community: social, cultural, and psychological factors.

The potential influence of social and psychological factors on the risk of hypertension within the African American community must be examined in relation to cultural and historical influences on the community. Blood pressure elevation varies dramatically between and within black populations, with socioeconomically disadvantaged communities in North America showing the highest levels. It is this historical and continuing pattern of socioeconomic disadvantage that forms the context in which social and psychological factors must be examined. The research that is reviewed in this article explicitly takes into account such factors. It is consistent with a model in which African Americans are engaged in a chronic struggle to achieve and maintain valued social and personal goals in the context of few socioeconomic resources. This long struggle is itself associated with higher blood pressure, and may also lead to the greater experience of frustration and anger that compounds blood pressure elevation. Conversely, there are also supportive social institutions in the black community, including the church and the extended family, that appear to provide a protective effect with respect to problematic circumstances and lower the risk of hypertension. The twin goals of lowering blood pressure therapeutically and preventing the onset of hypertension must include the social and cultural context of African American patients, and the social and psychological processes associated with hypertension.

Type A behavior: contextual effects within a southern black community.

The relationships among Type A behavior (assessed by the Framingham Type A scale), reported physical symptoms, and blood pressure were examined in a study of an African-American community in the rural southern U.S.A. The study was designed to determine: (a) if the cultural context of a black community altered the definition of Type A behavior; and (b) if the effects of Type A behavior were modified by this cultural context, as well as by socioeconomic and social structural variables. It was found that the patterning of traits characteristic of Type A behavior was different in the black (vs published studies of the majority) community, and that subscales of Type A behavior in turn had different effects on health variables than those observed in published studies. The health effects of these subscales were also moderated by socioeconomic and social structural variables. Future research should examine more closely how the definition of the Type A behavior pattern, and its effects, are modified by social and cultural context.

Social status and the health of families: a model.

The aim of this study is to examine the association of family health and social status, taking the family as the unit of analysis. One particular dimension of social status, lifestyle incongruity, is examined as a predictor of family health, relative to other stressors and sociodemographic variables. Lifestyle incongruity refers to the degree to which style of life (measured by the accumulation of consumer goods and the adoption of specific leisure activities) exceeds economic status (as assessed by occupational class and educational credentials). Using the 1980 General Household Survey of the United Kingdom, it was found that lifestyle incongruity discriminated between households with and without chronically ill members, and was associated with a global rating of family health, controlling for a variety of factors. The logic of studying the health of families, and the implications of these results for future research are discussed.

The social and cultural context of coping: action, gender and symptoms in a southern black community.

Research was conducted on the relationships of coping styles, chronic economic stressors and symptoms of distress in a black community in the rural South. It was found that the effect of an active coping style in moderating the effects of stressors was different for males and females. For females, active coping buffered the effects of stressors; for males, active coping exacerbated the effects of stressors. These results are consistent with the social and cultural context of the community, and with cultural norms governing gender roles within the community. This study demonstrates the need to systematically incorporate cultural and social structural factors in models of the stress process. Cultural norms and structural constraints interact to systematically alter the meaning of different factors in the stress process and in turn alter the effects of those factors on health.

Status incongruence and serum cholesterol in an English general practice.

The relationship between status incongruence and serum cholesterol was examined in a case-control study carried out in an English general practice population. Patients (n = 54) with elevated serum cholesterols (greater than or equal to 7.0 mmol/l) were compared to age and sex matched controls (n = 54). A specific type of status incongruence--lifestyle incongruity--was measured as the degree to which style of life (material consumption and status-enhancing behaviors) exceeded occupational status. Lifestyle incongruity was associated with higher serum cholesterol and an increased odds of being a case. This association was independent of age, sex, the body mass index, family history of cardiovascular disease, alcohol use, and, for women, menopausal status. Implications of these results for research on social inequality and the risk of cardiovascular disease are discussed.

Arterial blood pressure and individual modernization in a Mexican community.

The relationship between changes in individual behavior and arterial blood pressure was studied in a town in central Mexico. Two models relating modern behaviors and blood pressure were examined. The first, or 'accretion model' suggests that any adoption of modern behaviors results in stress and deleterious health change. The second, or 'discrepancy model', suggests that the adoption of modern behaviors is problematic only when the individual has limited access to economic resources. Empirical support for both models was found, but the best predictor of blood pressure was a single index of modern lifestyle, including acquisition of material culture and engaging in cosmopolitan behaviors. The effect of modern lifestyle on blood pressure was independent of the effects of age, sex, sodium intake, and body mass index. Overall the results are consistent with a model in which degree of community modernization, especially as it influences social class structure, is a boundary condition determining the relationship between the adoption of modern behaviors and health status.

Social and dietary predictors of serum lipids: a Brazilian example.

The importance of an unfavorable profile of serum lipids in the atherosclerotic process has been unequivocally established, but the determinants of serum lipids remain a source of controversy. This controversy includes both the importance of diet as a precursor of an unfavorable lipid profile, and the potential importance of social and psychological factors in determining lipid values. These questions were addressed in a study of serum lipids in urban Brazil. It was found that both dietary and social-psychological factors were associated with total serum cholesterol, high density lipoprotein cholesterol, and serum triglycerides. This exploratory study highlights the importance of the careful measurement of dietary intake, and the inclusion of theoretically relevant social and psychological variables, in any study of serum lipids.

Social factors mediating social class differences in blood pressure in a Jamaican community.

Research on the factors mediating social class differences in blood pressure was carried out in a Jamaican community. It was found in a previous report that higher social class is related to lower blood pressure for females, while for males higher social class is related to higher blood pressure. These differences are examined in greater detail here, especially in terms of the historical context of the specific community studied, which is on the fringe of the Kingston urban area, and in terms of the continuing importance of a social class system established under colonial rule. In the current study it is shown that social class differences in blood pressure for males are mediated by perceptions of social support. Social class differences in blood pressure for females are mediated by perceptions of economic stress. It is suggested that specific patterns of the growth of the city, and the historically-based social class system, have resulted in the juxtaposition of lower and middle class Jamaicans within this community, who in turn are influenced by different factors affecting blood pressure.

Education, lifestyle and arterial blood pressure.

Lower education is associated with higher blood pressure and mortality from cardiovascular disease. Reasons for this are explored in this paper. It is hypothesized that education is most important as a risk factor for high blood pressure to the extent that an individual's style of life is incongruent with his or her education. Style of life is defined here on the basis of the accumulation of consumer goods and exposure to mass media. It was found, in a study of blood pressure in an African-American community, that lifestyle incongruity, or the degree to which style of life exceeded education, was associated with higher systolic and diastolic blood pressure, adjusting for age, sex, Body Mass Index, income, chronic social stressors, and Type A behavior. It is argued that this incongruity leads to recurring frustrating social interactions, which in turn are related to higher blood pressure.

Social class, skin color, and arterial blood pressure in two societies.

Black people have higher blood pressure relative to whites; darker-skinned black people have higher blood pressure relative to lighter-skinned black people in some studies. These findings have been attributed either to racial-genetic factors or to sociocultural factors associated with social class. It is argued here that conventional social class theory is inadequate for the development of testable research hypotheses regarding skin color and blood pressure. New developments in social class theory are used to generate an alternate hypothesis. It is suggested that darker skin color is related to higher blood pressure in combination with the struggle to establish and maintain a middle-class life-style. Darker-skinned persons' claims to this social status are rejected in social interaction because of the use of skin color as a criterion of low social class in color-conscious societies. This hypothesis accounts for black-white differences in blood pressure in Brazil and for the association of darker skin color and blood pressure in a black American community in the United States. These results are consistent with a model in which skin color and blood pressure are associated solely through sociocultural processes.

Social identity and arterial blood pressure in the African-American community.

It has been suggested that racism may account in part for health inequalities between African Americans and other ethnic groups in the United States. While there is a strong plausibility to this suggestion, specifying the causal pathways through which enduring patterns of prejudice and discrimination affect pathophysiologic processes has proven difficult. The aim of this paper is to suggest just such a specification of this effect, building on prior work locating this process in social interaction. It is argued that, in mundane social interaction, African-American ethnicity as a status attribute overrides the other social attributes through which individuals structure the social identities that mediate mundane social interaction. Three specific variables that influence social identity are examined: lifestyle incongruity, stressful life events, and identity accumulation. Using data collected in an African-American community in the rural South, it was found that these three variables are related to blood pressure in interaction with socioeconomic status. Additionally, each of the three variables is related to individuals' perceptions of racism in mundane interactions. This pattern of results suggests that the attribution of lower social status to African-American ethnicity within the color-conscious society of the U.S., and the subsequent effect of this attribution on social interaction, in part account for observed health inequalities.

Comparative research in social epidemiology: measurement issues.

The aim of comparative research in social epidemiology is to determine how risk factors for disease may vary within and between sociocultural and ethnic groups and in relation to outcomes. This aim assumes that measurement equivalence within and between social groups can be established, an assumption usually left untested. A model is presented here for deriving cross-culturally valid measures that are also intraculturally sensitive. Measurements so derived can then be used to compare cross-cultural and intracultural effects in a single analytic model. This approach is illustrated by pooling data on social stressors, social supports, and blood pressure from three studies.

The relationship between zinc and copper status and lipid levels in African-Americans.

Studies examining the role of zinc and copper nutriture as risk factors for cardiovascular disease in European Americans have produced conflicting results. This study assessed the associations between zinc and copper status and serum lipid levels in an adult African-American community. A cross-sectional study was conducted on 600 individuals (233 males, 367 females) from 25 to 65 yr of age using a random sampling design in a small city in Alabama. Anthropometric, dietary, and serum zinc, copper, and lipid measurements were made. The mean serum zinc and copper levels and dietary zinc intake were similar to that reported previously for European Americans. There were no significant associations between serum zinc, copper, or zinc/copper ratio and total serum cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), or triglyceride levels. For males, there was a small but significant association between dietary zinc and the total cholesterol/HDL-C ratio (r = -0.17, p = 0.03). Similarly, females taking either zinc supplements or a multivitamin including zinc had higher HDL-C values than nonsupplementing females. Further prospective studies of the relationship between zinc status and lipid levels in African Americans are needed to verify these results.

Sociocultural and behavioral influences on health status among the Mississippi Choctaw.

Native American populations in North America are at increased risk of a variety of health problems, including (but not limited to) diabetes. This risk is presumed to be a result of the interaction of environmental influences with a population genetic susceptibility. Anthropologists have subsumed those environmental influences under the term "acculturation." Here, we break that broad concept into physical, behavioral, and sociocultural components in an examination of the correlates of arterial blood pressure and plasma glucose among the Mississippi Choctaw. In a sample of 93 adults, higher plasma glucose was associated with the lower physical activity, higher body mass index, and higher lifestyle incongruity, after controlling for age, sex, and recency of food consumption. Higher arterial blood pressure was associated with higher body mass index and being single. These results suggest that the risk of disordered glucose metabolism within this Native American population is associated with acculturation broadly construed, but that refined models of health and disease must take into account the multiple dimensions of this concept. Physical, behavioral, and sociocultural factors combine to describe more precisely the concept of acculturation, and hence the factors contributing to the risk of disease in Native American communities.

Medical anthropology: toward a third moment in social science?

This article about medical anthropology was inspired by the work of Pierre Bourdieu, specifically, his efforts to reconcile the antinomy of a "social structuralist" and a "cultural constructivist" perspective. These perspectives are often opposed in the literature, but, in Bourdieu's view, human life cannot be studied without taking into account both how individuals are situated within and constrained by social structures and how those individuals construct an understanding of and impose meaning on the world around them. I argue that the special subject matter of medical anthropology--human health--demands that a synthetic approach be taken in our theory and research. I illustrate this argument with examples from my own research on social and cultural factors associated with blood pressure, and I point to other examples of this synthesis in medical anthropology. The results of this research hold promise for the continuing refinement of culture theory.

Intracultural diversity and the sociocultural correlates of blood pressure: a Jamaican example.

Attention to intracultural diversity in anthropological research has increased, but the implications of that diversity for research design and data analysis in medical anthropology have not proceeded as far. An examination of diversity and its use in guiding data analyses is given here, based on the study of blood pressure and its social and psychological correlates. It is argued that in the specific ethnographic setting of a small West Indian town, social class structures the diversity of the meanings of beliefs and behaviors. Diversity of meanings, in turn, alters the associations of those beliefs and behaviours with blood pressure. Data analyses guided by this orientation demonstrate that the social patterning of blood pressure varies between and within social class. Specifically, it is shown that one model of social and psychological influences on blood pressure applies only to middle-class persons in a small Jamaican community and not to lower-class persons. Medical anthropologists need to be more sensitive to the range of intracultural diversity and to how that diversity can influence the results of research.

Culture, socioeconomic status, and physical and mental health in Brazil.

The association of socioeconomic variables with poor health status has been widely observed, if not well understood, and cultural dimensions of socioeconomic differences have rarely been incorporated into research models. In this article, a cultural dimension of socioeconomic status is examined in a Brazilian city through the use of ethnographic and social survey techniques. It suggests that lifestyle, defined in terms of the relative ability to accumulate consumer goods and the adoption of associated behaviors, is an important component of socioeconomic differences. Further research using cultural consensus analysis, a structured ethnographic technique that may be used to study shared cultural knowledge, demonstrates significant consensus regarding the definition of the successful lifestyle. Then, using that culturally defined model of the successful lifestyle as the central tendency, an individual-level measure of approximation to that lifestyle was developed for a representative sample of 250 persons. This culturally defined measure of lifestyle was inversely associated with arterial blood pressure (beta = -.216, p < .01), depressive symptoms (beta = -.236, p < .01), and globally perceived stress (beta = -.358, p < .01); furthermore, it absorbed the explained variability in these outcomes that is associated with conventional socioeconomic variables (occupation, education, income). For arterial pressure, cultural consonance explained almost 10 percent of the differences in blood pressure between individuals; for the psychological outcome variables, cultural consonance explained between 10 percent and 20 percent of the differences between individuals. Finally, its statistical effects were independent of other socioeconomic, dietary, anthropometric, and psychosocial variables. These results suggest that an individual's approximation to the cultural ideal of lifestyle, his or her "cultural consonance," mediates the observed effects of socioeconomic variables on health status.

Stress and sorcery in three social groups.

The hypothesis that stress factors associated with culture change are related to higher levels of belief in sorcery is tested here. It is hypothesized that these beliefs function as a "culturally constituted defense mechanism" for individuals as a means of coping with stressors. The hypothesis is tested in three different social groups, using two different measures of stress factors associated with culture change. The general proposition receives substantial empirical support, although the direction of the relationship is reversed in one case. The importance of the results and suggestions for future research are discussed.

Social and cultural dimensions of hypertension in Brazil: a review.

Elevated arterial blood pressure varies substantially in relation to social and cultural variables. Early work on acculturation, socioeconomic status, and blood pressure documented this variation, which could not be explained entirely by conventional factors such as diet, physical activity, or access to medical care. These findings stimulated the development of a model of stress and disease. The stress model emphasizes social and psychological factors that are perceived by individuals to be stressful, as well as factors that help individuals to respond to those stressors. Conventional stress models are, however, problematic because the primary emphasis is on individual perception, with little consideration of the social and cultural context in which stress occurs. This paper describes a complementary model of social and cultural influences on disease risk, placing greater emphasis on how individuals are able to approximate, in their own behaviors, shared cultural models of life, referred to as "cultural consonance". Findings from research in Brazil indicate that the higher an individual's cultural consonance, the lower his or her blood pressure. These results indicate the importance of linking different levels of analysis - the cultural, the individual, and the biological - to understand disease risk.