Causal inference in ethnographic research: Refining explanations with abductive logic, strength of evidence assessments, and graphical models.

In their classic accounts, anthropological ethnographers developed causal arguments for how specific sociocultural structures and processes shaped human thought, behavior, and experience in particular settings. Despite this history, many contemporary ethnographers avoid establishing in their work direct causal relationships between key variables in the way that, for example, quantitative research relying on experimental or longitudinal data might. As a result, ethnographers in anthropology and other fields have not advanced understandings of how to derive causal explanations from their data, which contrasts with a vibrant "causal revolution" unfolding in the broader social and behavioral sciences. Given this gap in understanding, we aim in the current article to clarify the potential ethnography has for illuminating causal processes related to the cultural influence on human knowledge and practice. We do so by drawing on our ongoing mixed methods ethnographic study of games, play, and avatar identities. In our ethnographic illustrations, we clarify points often left unsaid in both classic anthropological ethnographies and in more contemporary interdisciplinary theorizing on qualitative research methodologies. More specifically, we argue that for ethnographic studies to illuminate causal processes, it is helpful, first, to state the implicit strengths and logic of ethnography and, second, to connect ethnographic practice more fully to now well-developed interdisciplinary approaches to causal inference. In relation to the first point, we highlight the abductive inferential logic of ethnography. Regarding the second point, we connect the ethnographic logic of abduction to what Judea Pearl has called the ladder of causality, where moving from association to intervention to what he calls counterfactual reasoning produces stronger evidence for causal processes. Further, we show how graphical modeling approaches to causal explanation can help ethnographers clarify their thinking. Overall, we offer an alternative vision of ethnography, which contrasts, but nevertheless remains consistent with, currently more dominant interpretive approaches.

Social connection and gene regulation during the COVID-19 pandemic: Divergent patterns for online and in-person interaction.

BACKGROUND: Social connection has been linked to reduced disease risk and enhanced antiviral immunity, but it is unclear whether online social connections have similar effects to those previously documented for in-person/offline social relationships, or whether online connections can substitute for in-person social relations when the latter are restricted. We examined this question in the context of the COVID-19 pandemic, focusing specifically on an immune system gene regulation profile known as the conserved transcriptional response to adversity (CTRA), which is characterized by up-regulation of proinflammatory genes and down-regulation of genes linked to innate antiviral responses and antibody production. METHODS: We analyzed CTRA RNA profiles in blood samples from 142 healthy young adults (69% female, 87% white) during the "social distancing" period of the COVID-19 pandemic. Mixed effect linear models quantified the relation of CTRA gene expression to measures of in-person social connection (number of friends, social eudaimonia, loneliness) and online psychosocial connection (online loneliness, perceived social value in online leisure and educational contexts, and internet use) while controlling for demographic and health factors. RESULTS: Multiple indicators of in-person and generalized social connection were associated with lower CTRA gene expression, whereas no measure of online social connection showed any significant association with CTRA gene expression. CONCLUSION: Experiences of in-person social connection are associated with reduced CTRA gene expression during a period of restricted social interaction. In contrast, online social relationships show no such association. Digitally mediated social relations do not appear to substantially offset the absence of in-person/offline social connection in the context of immune cell gene regulation.

Internet gaming, embodied distress, and psychosocial well-being: A syndemic-syndaimonic continuum.

We examine internet gaming-related suffering as a novel syndemic most prevalent among contemporary emerging adults. Synthetic analysis of our prior research on internet gaming and health affirms how social factors and mental and physical wellness mutually condition each other in this online play context. Employing biocultural anthropological mixed methods, we focus on statistical interactions between intensive gaming and social well-being in relation to genomic markers of immune function. We show that among gamers with low social well-being, intensive game play is associated with compromised immunity markers, but among those with robust social connection, that same play correlates with decreased activation of stress-related immunity activation. The apparently beneficial interaction of higher social well-being and intensive game play resonates with an emerging body of research showing how positive practices-in this case, engaged and pleasurable videogame play-can increase resilience to the negative linked psychological and genomic responses to precarity. Based on these findings, we argue, in relation to gaming behaviors, a syndemics analysis could usefully be expanded by attending to both sides of the synergistic interaction between two social conditions: not just exacerbation of dysfunction in relation to their combined effect, but also non-additive enhancement of health that may stem from such combinations. We draw on literature emphasizing the relevance to health of "eudaimonic" well-being-psychosocial processes that transcend immediate self-gratification and involve the pursuit of meaningful and pro-social goals. On that basis, we propose the term "syndaimonics" to capture synergies between social context and mental flourishing, which, in this context and presumably others, can illuminate sources of health resilience and overall improved psychosocial wellbeing.

Adolescent Popularity: Distinct Profiles and Associations with Excessive Internet Usage and Interpersonal Sensitivity.

Peer popularity constitutes a pivotal developmental task to adolescents' current and future adaptation. This study identified distinct adolescent popularity profiles and explored their links with excessive Internet usage and interpersonal sensitivity. The sample included 2090 students attending Greek high schools (Mage = 16.16, SD = 0.91). Their popularity was measured via self-report and peer sociometric means. They also responded to the Internet Addiction Test (IAT) and the Interpersonal Sensitivity subscale of the Symptom Checklist-90-Revised (SCL-90-R). A sequence of latent profile analysis, ANOVAs and linear regression models were performed. Three distinct popularity profiles were revealed: the "Average Confident" (68.4%), the "Socially Vulnerable" (26.8%), and the "Insecure Bi-Strategic" (4.8%). These profiles did not significantly vary regarding their Internet usage and interpersonal sensitivity behaviours. Interestingly, lower self-perceived popularity predicted higher interpersonal sensitivity, whereas higher actual popularity predicted excessive Internet use. Findings have important implications for student-tailored mental health prevention and intervention practices.

Avatar Creation in Videogaming: Between Compensation and Constraint.

Objective: We examine the extent that videogame avatars provide players with opportunities for identity exploration, aiming to test the findings of self-discrepancy theory research on the user/avatar relationship with novel cognitive anthropological methods. Specifically, we examine if avatar traits are idealized (more representative of players' ideal rather than actual self) or actualized (more representative of players' actual self) as a function of players' self-esteem. Materials and Methods: Utilizing cognitive anthropological methods, we examine the relationship between actual, avatar, and ideal selves. We first asked 21 respondents to list traits they associated with their various selves. We then asked 57 new respondents to perform four pile sorts of the salient items from these lists (1 unconstrained sort of like-traits, and 3 sorts of terms indicative of respondents' ideal/actual/avatar self). Analysis of this "free list" and "pile sort" data allowed us to clarify (in a manner sensitive to gamer culture) relationships between respondents' various conceptions of self, including how those relationships were modified by self-esteem. Illustrative quotes from the interviews further clarified these relationships. Results: Paired t-test analysis shows that informants as a whole describe their avatar compared with actual selves with fewer negative terms (idealization). Low-esteem players actualize what they deem as positive traits onto their avatars, while simultaneously idealizing avatars' negative traits by minimizing them. Compared with low-esteem gamers, high-esteem players associate significantly more positive attributes with all their various selves-actual, avatar, and ideal-while describing avatar compared with actual selves with fewer positive terms and comparable numbers of negative terms (the latter a process of actualization). Conclusion: Results point to the necessity of theoretical accounts that recognize that avatars may reflect a complex relationship with the user's actual and ideal self, without assuming that avatar play frees gamers from offline social, psychological, or bodily constraints.

Positive mental well-being and immune transcriptional profiles in highly involved videogame players.

Previous research has identified a link between experiencing life as meaningful and purposeful-what is referred to as "eudaimonia"-and reduced expression of a stress-induced gene profile known as the "conserved transcriptional response to adversity" (CTRA). In the current study, we examine whether similar links between eudaimonic well-being and CTRA reduction occur in a sample of 56 individuals with a particularly strong engagement with virtual worlds: avid online videogame players. Results consistently linked higher eudaimonic well-being, and more specifically the social well-being subdomain of eudaimonia, to lower levels of CTRA gene expression. That favorable psychobiological relationship between eudaimonia and CTRA appeared most strongly among individuals reporting high levels of positive psychosocial involvement with gaming. Findings are consistent with the hypothesis that committed social/recreational activity may help damp CTRA expression especially among persons who are already experiencing some kind of threshold of positive eudaimonic experience.

The cross-cultural expression of internet gaming distress in North America, Europe, and China.

We compare the forms online gaming-related distress takes cross-culturally, and examine how much such distress resembles the World Health Organization's (WHO) "Gaming disorder," understood to be an "addiction." Our preliminary exploratory factor analysis (EFA) in North America (n = 2025), Europe (n = 1198), and China (n = 841) revealed a constant four-factor structure across the three regions, with classic "addiction" symptoms always clustering together on the first and most important factor, though with some variability in regional factors' exact item composition. In the present study, we use second-order confirmatory factor analysis (CFA) to further examine this factor structure and the cultural similarities and differences. Specifically, we focus on confirming the regional structure and composition of an ethnographically developed 21-item gaming distress scale, which contains a wider symptoms pool than typical gaming disorder scales, and thus allows us to better separate generalized gaming distress's "addictive" from other culturally-influenced "problem" experiences and behaviors in each regional case. We use propensity score matching to separate the impact on gaming-related distress of regional culture from demographic variables (North America/Europe: n = 1043 pairs; North America/China: n = 535 pairs). Although our results support current WHO formulations of gaming-related distress as an addictive disorder, we show how cultural forces can shape how "addictive" and "problem" gaming are experienced and thus psychiatrically presented in different parts of the world. In particular, generalized gaming distress's addictive and problematic dimensions seem to be shaped by culture-specific expressions of achievement motivations, social connection and disconnection, and unique psychosomatic experiences.

Intensive online videogame involvement: A new global idiom of wellness and distress.

Extending classic anthropological "idioms of distress" research, we argue that intensive online videogame involvement is better conceptualized as a new global idiom, not only of distress but also of wellness, especially for emerging adults (late teens through the 20s). Drawing on cognitive anthropological cultural domain interviews conducted with a small sample of U.S. gamers (N = 26 free-list and 34 pile-sort respondents) (Study 1) and a large sample of survey data on gaming experience (N = 3629) (Study 2), we discuss the cultural meaning and social context of this new cultural idiom of wellness and distress. Our analysis suggests that the "addiction" frame provides a means for gamers to communicate their passion and commitment to online play, even furthering their enthusiasm for the hobby and community in the process, but also a way for players to express and even resolve life distress such as depression and loneliness. The American Psychiatric Association (APA) has recently included "Internet gaming disorder" (IGD) as a possible behavioral addiction, akin to gambling, warranting further consideration for eventual formal inclusion in the next iteration of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Our study leads us to suggest that clinicians only sparingly use IGD as a clinical category, given that medical and gamer understandings of "addictive" play differ so markedly. This includes better distinguishing positive online gaming involvement-also sometimes framed by gamers as "addictive"-from other play patterns more clearly entailing distress and dysfunction.

Distinguishing Core from Peripheral Psychiatric Symptoms: Addictive and Problematic Internet Gaming in North America, Europe, and China.

We explore the problem of distinguishing the relatively constant versus culturally variable dimensions of mental suffering and disorder in the context of a cross-cultural study of Internet gaming-related distress. We extend the conceptual contrast of "core" and "peripheral" symptoms drawn from game studies and use a framework that synthesizes cultural and neurobiological understandings of emotional distress. In our framework, "core" symptoms are relatively constant across cultures and therefore presumed to be more closely tied to a neurobiological base. By contrast, we treat as "peripheral" symptoms those that are more culturally variable, and thus less directly tied to the neurobiology of addiction. We develop and illustrate this approach with a factor analysis of cross-cultural survey data, resting on previous ethnographic work, through which we compare online gaming distress experienced in North America (n = 2025), Europe (n = 1198), and China (n = 841). We identify the same four-factor structure across the three regions, with Addiction always the first and most important factor, though with variability in regional factors' exact item composition. The study aims to advance an integrative biocultural approach to distinguishing universal as opposed to culturally contingent dimensions of human suffering, and to help resolve debates about whether problem gaming represents a form of addiction.

Social genomics of healthy and disordered internet gaming.

OBJECTIVES: To combine social genomics with cultural approaches to expand understandings of the somatic health dynamics of online gaming, including in the controversial nosological construct of internet gaming disorder (IGD). METHODS: In blood samples from 56 U.S. gamers, we examined expression of the conserved transcriptional response to adversity (CTRA), a leukocyte gene expression profile activated by chronic stress. We compared positively engaged and problem gamers, as identified by an ethnographically developed measure, the Positive and Negative Gaming Experiences Scale (PNGE-42), and also by a clinically derived IGD scale (IGDS-SF9). RESULTS: CTRA profiles showed a clear relationship with PNGE-42, with a substantial linkage to offline social support, but were not meaningfully associated with disordered play as measured by IGDS-SF9. CONCLUSIONS: Our study advances understanding of the psychobiology of play, demonstrating via novel transcriptomic methods the association of negatively experienced internet play with biological measures of chronic threat, uncertainty, and distress. Our findings are consistent with the view that problematic patterns of online gaming are a proxy for broader patterns of biopsychosocial stress and distress such as loneliness, rather than a psychiatric disorder sui generis, which might exist apart from gamers' other life problems. By confirming the biological correlates of certain patterns of internet gaming, culturally-sensitive genomics approaches such as this can inform both evolutionary theorizing regarding the nature of play, as well as current psychiatric debates about the appropriateness of modeling distressful gaming on substance addiction and problem gambling.

"Developing culturally sensitive affect scales for global mental health research and practice: Emotional balance, not named syndromes, in Indian Adivasi subjective well-being".

We present a perspective to analyze mental health without either a) imposing Western illness categories or b) adopting local or "native" categories of mental distress. Our approach takes as axiomatic only that locals within any culture share a cognitive and verbal lexicon of salient positive and negative emotional experiences, which an appropriate and repeatable set of ethnographic procedures can elicit. Our approach is provisionally agnostic with respect to either Western or native nosological categories, and instead focuses on persons' relative frequency of experiencing emotions. Putting this perspective into practice in India, our ethnographic fieldwork (2006-2014) and survey analysis (N = 219) resulted in a 40-item Positive and Negative Affect Scale (PANAS), which we used to assess the mental well-being of Indigenous persons (the tribal Sahariya) in the Indian states of Rajasthan and Madhya Pradesh. Generated via standard cognitive anthropological procedures that can be replicated elsewhere, measures such as this possess features of psychiatric scales favored by leaders in global mental health initiatives. Though not capturing locally named distress syndromes, our scale is nonetheless sensitive to local emotional experiences, frames of meaning, and "idioms of distress." By sharing traits of both global and also locally-derived diagnoses, approaches like ours can help identify synergies between them. For example, employing data reduction techniques such as factor analysis-where diagnostic and screening categories emerge inductively ex post facto from emotional symptom clusters, rather than being deduced or assigned a priori by either global mental health experts or locals themselves-reveals hidden overlaps between local wellness idioms and global ones. Practically speaking, our perspective, which assesses both emotional frailty and also potential sources of emotional resilience and balance, while eschewing all named illness categories, can be deployed in mental health initiatives in ways that minimize stigma and increase both the acceptability and validity of assessment instruments.

Stress and telomere shortening among central Indian conservation refugees.

Research links psychosocial stress to premature telomere shortening and accelerated human aging; however, this association has only been demonstrated in so-called "WEIRD" societies (Western, educated, industrialized, rich, and democratic), where stress is typically lower and life expectancies longer. By contrast, we examine stress and telomere shortening in a non-Western setting among a highly stressed population with overall lower life expectancies: poor indigenous people--the Sahariya--who were displaced (between 1998 and 2002) from their ancestral homes in a central Indian wildlife sanctuary. In this setting, we examined adult populations in two representative villages, one relocated to accommodate the introduction of Asiatic lions into the sanctuary (n = 24 individuals), and the other newly isolated in the sanctuary buffer zone after their previous neighbors were moved (n = 22). Our research strategy combined physical stress measures via the salivary analytes cortisol and α-amylase with self-assessments of psychosomatic stress, ethnographic observations, and telomere length assessment [telomere-fluorescence in situ hybridization (TEL-FISH) coupled with 3D imaging of buccal cell nuclei], providing high-resolution data amenable to multilevel statistical analysis. Consistent with expectations, we found significant associations between each of our stress measures--the two salivary analytes and the psychosomatic symptom survey--and telomere length, after adjusting for relevant behavioral, health, and demographic traits. As the first study (to our knowledge) to link stress to telomere length in a non-WEIRD population, our research strengthens the case for stress-induced telomere shortening as a pancultural biomarker of compromised health and aging.

"I swear to God, I only want people here who are losers!" cultural dissonance and the (problematic) allure of Azeroth.

We use ethnographically informed survey and interview data to explore therapeutic and problematic play in the online World of Warcraft (WoW). We focus on how game-play in WoW is driven by shared and socially transmitted models of success that we conceptualize as cultural ideals. Our research reveals associations between having higher online compared to offline success, on the one hand, and gamers' reports about how their play both adds to and subtracts from their mental wellness, on the other. Fusing William Dressler's notion of "cultural consonance" (an individual's relative consistency with his or her culture) with Leon Festinger's "cognitive dissonance" (the tendency of individuals to suffer distress when they cannot eliminate incompatibilities in conflicting beliefs and attitudes), we develop the notion of "cultural dissonance," which in this context refers to how conflicts between online and offline lives, and also subsequent attempts to minimize the conflicts through psychological negotiations, impact gamers' mental health.

Maternal exposure to hurricane destruction and fetal mortality.

BACKGROUND: The majority of research documenting the public health impacts of natural disasters focuses on the well-being of adults and their living children. Negative effects may also occur in the unborn, exposed to disaster stressors when critical organ systems are developing and when the consequences of exposure are large. METHODS: We exploit spatial and temporal variation in hurricane behaviour as a quasi-experimental design to assess whether fetal death is dose-responsive in the extent of hurricane damage. Data on births and fetal deaths are merged with Parish-level housing wreckage data. Fetal outcomes are regressed on housing wreckage adjusting for the maternal, fetal, placental and other risk factors. The average causal effect of maternal exposure to hurricane destruction is captured by difference-in-differences analyses. RESULTS: The adjusted odds of fetal death are 1.40 (1.07-1.83) and 2.37 (1.684-3.327) times higher in parishes suffering 10-50% and >50% wreckage to housing stock, respectively. For every 1% increase in the destruction of housing stock, we observe a 1.7% (1.1-2.4%) increase in fetal death. Of the 410 officially recorded fetal deaths in these parishes, between 117 and 205 may be attributable to hurricane destruction and postdisaster disorder. The estimated fetal death toll is 17.4-30.6% of the human death toll. CONCLUSIONS: The destruction caused by Hurricanes Katrina and Rita imposed significant measurable losses in terms of fetal death. Postdisaster migratory dynamics suggest that the reported effects of maternal exposure to hurricane destruction on fetal death may be conservative.

Influence of aesthetic appreciation of wildlife species on attitudes towards their conservation in Kenyan agropastoralist communities.

The influence of human aesthetic appreciation of animal species on public attitudes towards their conservation and related decision-making has been studied in industrialized countries but remains underexplored in developing countries. Working in three agropastoralist communities around Amboseli National Park, southern Kenya, we investigated the relative strength of human aesthetic appreciation on local attitudes towards the conservation of wildlife species. Using semi-structured interviewing and free listing (n = 191) as part of a mixed methods approach, we first characterized local aesthetic judgments of wildlife species. With a Generalized Linear Mixed Models (GLMM) approach, we then determined the influence of perceiving four species as beautiful on local support for their protection ("rescuing them"), and of perceiving four other species as ugly on support for their removal from the area, while controlling for informant personal and household socioeconomic attributes. Perceiving giraffe, gazelles and eland as beautiful is the strongest variable explaining support for rescuing them. Ugliness is the strongest variable influencing support for the removal of buffalo, hyena, and elephant (but not lion). Both our qualitative and quantitative results suggest that perceptions of ugly species could become more positive through direct exposure to those species. We propose that protected areas in developing countries facilitate visitation by local residents to increase their familiarity with species they rarely see or most frequently see in conflict with human interests. Since valuing a species for its beauty requires seeing it, protected areas in developing countries should connect the people who live around them with the animals they protect. Our results also show that aesthetic appreciation of biodiversity is not restricted to the industrialized world.

A quasi-experimental analysis of maternal altitude exposure and infant birth weight.

OBJECTIVES: We analyzed singleton births to determine the relationship between birth weight and altitude exposure. METHODS: We analyzed 715,213 singleton births across 74 counties from the western states of Arizona, California, Colorado, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, and Washington from January 1, 2000, to December 31, 2000. Birth data were obtained from the Division of Vital Statistics, National Center for Health Statistics, for registered births. RESULTS: Regression analyses supported previous research by showing that a 1000-meter increase in maternal altitude exposure in pregnancy was associated with a 75.9-gram reduction in birth weight (95% confidence interval = -84.1, -67.6). Quantile regression models indicated significant and near-uniform depressant effects from altitude exposure across the conditional distribution of birth weight. Bivariate sample-selection models showed that a 1000-meter increase in altitude exposure, over and above baseline residential altitude, decreased birth weight by an additional 58.8 grams (95% confidence interval = -98.4, -19.2). CONCLUSIONS: Because of calculable health care-related costs associated with lower birth weight, our reported results might be of interest to clinicians practicing at higher altitudes.

A formal anthropological view of motivation models of problematic MMO play: achievement, social, and immersion factors in the context of culture.

Yee (2006) found three motivational factors-achievement, social, and immersion-underlying play in massively multiplayer online role-playing games ("MMORPGs" or "MMOs" for short). Subsequent work has suggested that these factors foster problematic or addictive forms of play in online worlds. In the current study, we used an online survey of respondents (N = 252), constructed and also interpreted in reference to ethnography and interviews, to examine problematic play in the World of Warcraft (WoW; Blizzard Entertainment, 2004-2013). We relied on tools from psychological anthropology to reconceptualize each of Yee's three motivational factors in order to test for the possible role of culture in problematic MMO play: (a) For achievement, we examined how "cultural consonance" with normative understandings of success might structure problematic forms of play; (b) for social, we analyzed the possibility that developing overvalued virtual relationships that are cutoff from offline social interactions might further exacerbate problematic play; and (c) in relation to immersion, we examined how "dissociative" blurring of actual- and virtual-world identities and experiences might contribute to problematic patterns. Our results confirmed that compared to Yee's original motivational factors, these culturally sensitive measures better predict problematic forms of play, pointing to the important role of sociocultural factors in structuring online play.

Economics of disaster risk, social vulnerability, and mental health resilience.

We investigate the relationship between exposure to Hurricanes Katrina and/or Rita and mental health resilience by vulnerability status, with particular focus on the mental health outcomes of single mothers versus the general public. We advance a measurable notion of mental health resilience to disaster events. We also calculate the economic costs of poor mental health days added by natural disaster exposure. Negative binomial analyses show that hurricane exposure increases the expected count of poor mental health days for all persons by 18.7% (95% confidence interval [CI], 7.44-31.14%), and by 71.88% (95% CI, 39.48-211.82%) for single females with children. Monthly time-series show that single mothers have lower event resilience, experiencing higher added mental stress. Results also show that the count of poor mental health days is sensitive to hurricane intensity, increasing by a factor of 1.06 (95% CI, 1.02-1.10) for every billion (U.S.$) dollars of damage added for all exposed persons, and by a factor of 1.08 (95% CI, 1.03-1.14) for single mothers. We estimate that single mothers, as a group, suffered over $130 million in productivity loss from added postdisaster stress and disability. Results illustrate the measurability of mental health resilience as a two-dimensional concept of resistance capacity and recovery time. Overall, we show that natural disasters regressively tax disadvantaged population strata.

Magical flight and monstrous stress: technologies of absorption and mental wellness in Azeroth.

Videogame players commonly report reaching deeply "immersive" states of consciousness, in some cases growing to feel like they actually are their characters and really in the game, with such fantastic characters and places potentially only loosely connected to offline selves and realities. In the current investigation, we use interview and survey data to examine the effects of such "dissociative" experiences on players of the popular online videogame, World of Warcraft (WoW). Of particular interest are ways in which WoW players' emotional identification with in-game second selves can lead either to better mental well-being, through relaxation and satisfying positive stress, or, alternatively, to risky addiction-like experiences. Combining universalizing and context-dependent perspectives, we suggest that WoW and similar games can be thought of as new "technologies of absorption"--contemporary practices that can induce dissociative states in which players attribute dimensions of self and experience to in-game characters, with potential psychological benefit or harm. We present our research as an empirically grounded exploration of the mental health benefits and risks associated with dissociation in common everyday contexts. We believe that studies such as ours may enrich existing theories of the health dynamics of dissociation, relying, as they often do, on data drawn either from Western clinical contexts involving pathological disintegrated personality disorders or from non-Western ethnographic contexts involving spiritual trance.

Maternal hurricane exposure and fetal distress risk.

Logistic regression and spatial analytic techniques are used to model fetal distress risk as a function of maternal exposure to Hurricane Andrew. First, monthly time series compare the proportion of infants born distressed in hurricane affected and unaffected areas. Second, resident births are analyzed in Miami-Dade and Broward counties, before, during, and after Hurricane Andrew. Third, resident births are analyzed in all Florida locales with 100,000 or more persons, comparing exposed and unexposed gravid females. Fourth, resident births are analyzed along Hurricane Andrew's path from southern Florida to northeast Mississippi. Results show that fetal distress risk increases significantly with maternal exposure to Hurricane Andrew in second and third trimesters, adjusting for known risk factors. Distress risk also correlates with the destructive path of Hurricane Andrew, with higher incidences of fetal distress found in areas of highest exposure intensity. Hurricane exposed African-American mothers were more likely to birth distressed infants. The policy implications of in utero costs of natural disaster exposure are discussed.