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1.
Pers Soc Psychol Rev ; 28(1): 54-80, 2024 Feb.
Article in English | MEDLINE | ID: mdl-37226514

ABSTRACT

PUBLIC ABSTRACT: Social hierarchy is one fundamental aspect of human life, structuring interactions in families, teams, and entire societies. In this review, we put forward a new theory about how social hierarchy is shaped by the wider societal contexts (i.e., cultures). Comparing East Asian and Western cultural contexts, we show how culture comprises societal beliefs about who can raise to high rank (e.g., become a leader), shapes interactions between high- and low-ranking individuals (e.g., in a team), and influences human thought and behavior in social hierarchies. Overall, we find cultural similarities, in that high-ranking individuals are agentic and self-oriented in both cultural contexts. But we also find important cross-cultural differences. In East Asian cultural contexts, high-ranking individuals are also other oriented; they are also concerned about the people around them and their relationships. We close with a call to action, suggesting studying social hierarchies in more diverse cultural contexts.


Subject(s)
Hierarchy, Social , Humans
2.
Am Psychol ; 2023 Nov 16.
Article in English | MEDLINE | ID: mdl-37971846

ABSTRACT

Emotion regulation is important for psychological health and can be achieved by implementing various strategies. How one regulates emotions is critical for maximizing psychological health. Few studies, however, tested the psychological correlates of different emotion regulation strategies across multiple cultures. In a preregistered cross-cultural study (N = 3,960, 19 countries), conducted during the COVID-19 pandemic, we assessed associations between the use of seven emotion regulation strategies (situation selection, distraction, rumination, cognitive reappraisal, acceptance, expressive suppression, and emotional support seeking) and four indices of psychological health (life satisfaction, depressive symptoms, perceived stress, and loneliness). Model comparisons based on Bayesian information criteria provided support for cultural differences in 36% of associations, with very strong support for differences in 18% of associations. Strategies that were linked to worse psychological health in individualist countries (e.g., rumination, expressive suppression) were unrelated or linked to better psychological health in collectivist countries. Cultural differences in associations with psychological health were most prominent for expressive suppression and rumination and also found for distraction and acceptance. In addition, we found evidence for cultural similarities in 46% of associations between strategies and psychological health, but none of this evidence was very strong. Cultural similarities were most prominent in associations of psychological health with emotional support seeking. These findings highlight the importance of considering the cultural context to understand how individuals from diverse backgrounds manage unpleasant emotions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

3.
Pers Soc Psychol Bull ; : 1461672231162747, 2023 Mar 31.
Article in English | MEDLINE | ID: mdl-37002677

ABSTRACT

High subjective social status (SSS) is believed to protect health in the current literature. However, high SSS entails social responsibilities that can be stressful in collectivistic cultural contexts. Here, we tested the hypothesis that those socialized in collectivistic societies (e.g., Japan) recognize their high social status as entailing social duties difficult to ignore even when they are excessive. Using cross-cultural survey data (N = 1,289) and a measure of biological health risk (BHR) by biomarkers of inflammation and cardiovascular malfunction, we found that higher SSS predicted lower BHR for American males. In contrast, higher SSS predicted higher BHR for Japanese males, mediated by the perceived difficulty of disengaging from their current goals. In both cultural groups, females showed no association between SSS and BHR. These findings suggest that social status has differing health implications, depending on the relative salience of privileges and burden-producing responsibilities in different cultural contexts.

4.
Biol Psychol ; 177: 108495, 2023 02.
Article in English | MEDLINE | ID: mdl-36634810

ABSTRACT

How people perceive and value negative affective states is associated with physiological responses to stressful events and moderates the association between negative feelings and physiological and behavioral outcomes. However, previous studies on valuation of negative affective states have been conducted mostly in Western cultures. Different cultural backgrounds shape how people view negative emotions as well as how people attend to internal emotional states, which may change the effects of valuing negative emotions. The present study thus examined whether valuation of nervousness was associated with the magnitude and duration of cortisol responses to a standardized laboratory stressor and task performance in East Asian and European American students. Two hundred undergraduate students were recruited through a large pool of students taking psychology courses. They engaged in demanding speech and arithmetic tasks as part of the Trier Social Stress Test (TSST). European American participants who had a higher valuation of nervousness showed lower cortisol reactivity. Valuing nervousness was associated with better speech performance in students from both cultural backgrounds, and the strength of this association was moderated by cortisol level. Our findings call attention to the importance of considering whether negative emotions are viewed as beneficial or an impediment, as well as the cultural context when responding to demanding and threatening situations.


Subject(s)
Hydrocortisone , Stress, Psychological , Task Performance and Analysis , Humans , Anxiety/psychology , East Asian People/psychology , Saliva , Stress, Psychological/psychology , Students/psychology
5.
Pers Soc Psychol Bull ; 49(8): 1213-1230, 2023 Aug.
Article in English | MEDLINE | ID: mdl-35652552

ABSTRACT

Cross-cultural research suggests that rumination may have weaker maladaptive effects in Eastern than in Western cultural contexts. This study examines a mechanism underlying cultural differences in mental health correlates of rumination from sociocultural cognitive perspective. We propose that cultures differ in how people attribute rumination, which can lead to cultural differences in the link between rumination and mental health correlates. We developed the Attribution of Rumination scale, tested cultural differences (Study 1), and examined its relationship with theoretically related constructs (Study 2). In Study 3, self-doubt attribution moderated the association between rumination and mental health, partly explaining cultural differences in the rumination-mental health link. Study 4 replicated self-doubt attribution moderating the link between rumination and mental health among Asians. Furthermore, greater exposure to American culture was associated with self-doubt attribution. This work provides a novel approach to understanding cultural differences in the association between rumination and negative psychological correlates.

6.
Jpn Psychol Res ; 64(2): 90-108, 2022 Apr.
Article in English | MEDLINE | ID: mdl-35509718

ABSTRACT

Evidence of cultural differences in relationships and emotions has accumulated over the past few decades. As findings on cultural differences in psychological processes have accumulated, there has been growing interest in investigating whether they have implications for other phenomena such as health. Using scientific advances from the MIDUS and MIDJA studies, both publicly available, we examine links between culture and health. We first briefly review the accumulated evidence on cultural influences on health correlates of psychosocial factors. We then feature two recent developments - a more micro-level perspective on biological factors that may be involved in the culture and health linkage, and a more macro-level view of socioeconomic inequality, which also matters for health. Both perspectives inform the pathways through which health effects occur. Finally, we conclude our review by highlighting the changing historical contexts surrounding these cross-cultural investigations. Specifically, we draw attention to widening of economic inequality across cultures and the world-wide COVID-19 pandemic. These happenings bring notable implications for future research on health across cultural contexts.

7.
Emotion ; 22(8): 1801-1814, 2022 Dec.
Article in English | MEDLINE | ID: mdl-33818116

ABSTRACT

Cultural context shapes individuals' valuation of emotions. Although studies have documented cultural differences in beliefs about the utility of negative emotions, little is known about how such cultural valuation is associated with physiological stress responses. In the present work, we examined whether East Asians and European Americans differ in how they value nervousness in a demanding situation and whether such valuation predicts acute cardiovascular responses. We found that East Asians were more likely than European Americans to believe feeling nervous in a demanding situation was useful. Furthermore, greater valuation of negative emotion predicted attenuated cardiovascular responses to a laboratory mental stressor and partially mediated the relationship between culture and cardiovascular stress responses. The present results highlight the importance of valuation of emotions as a psychological mechanism underlying cultural as well as individual differences in stress-evoked cardiovascular responses. We discuss one implication for this line of research, unpacking how cross-cultural differences in valuation of negative emotions may lead to cultural variation in physiological patterns related to health outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).


Subject(s)
Emotions , White People , Humans , Emotions/physiology , Asian People , Heart
8.
J Biochem ; 170(2): 255-264, 2021 Oct 11.
Article in English | MEDLINE | ID: mdl-33768253

ABSTRACT

Heat shock protein 90 (Hsp90) is essential for eukaryotic cells, whereas bacterial homologs play a role under stresses and in pathogenesis. Identifying species-specific Hsp90 inhibitors is challenging because Hsp90 is evolutionarily conserved. We found that a cyclic lipopeptide surfactin inhibits the ATPase activity of Hsp90 from the cyanobacterium Synechococcus elongatus (S.elongatus) PCC 7942 but does not inhibit Escherichia coli (E.coli), yeast and human Hsp90s. Molecular docking simulations indicated that surfactin could bind to the N-terminal dimerization interface of the cyanobacterial Hsp90 in the ATP- and ADP-bound states, which provided molecular insights into the species-selective inhibition. The data suggest that surfactin inhibits a rate-limiting conformational change of S.elongatus Hsp90 in the ATP hydrolysis. Surfactin also inhibited the interaction of the cyanobacterial Hsp90 with a model substrate, and suppressed S.elongatus growth under heat stress, but not that of E.coli. Surfactin did not show significant cellular toxicity towards mammalian cells. These results indicate that surfactin inhibits the cellular function of Hsp90 specifically in the cyanobacterium. The present study shows that a cyclic peptide has a great specificity to interact with a specific homolog of a highly conserved protein family.


Subject(s)
Anti-Bacterial Agents/pharmacology , HSP90 Heat-Shock Proteins/antagonists & inhibitors , Lipopeptides/pharmacology , Peptides, Cyclic/pharmacology , Synechococcus/drug effects , Adenosine Triphosphatases/metabolism , Adenosine Triphosphate/metabolism , Animals , Anti-Bacterial Agents/metabolism , COS Cells , Chlorocebus aethiops , Colistin/pharmacology , Dimerization , Escherichia coli/drug effects , HSP90 Heat-Shock Proteins/metabolism , Humans , Hydrolysis , Lipopeptides/metabolism , Mice , Molecular Docking Simulation/methods , NIH 3T3 Cells , Peptides, Cyclic/metabolism , Saccharomyces cerevisiae/drug effects
9.
Front Psychol ; 11: 1761, 2020.
Article in English | MEDLINE | ID: mdl-32793075

ABSTRACT

The main goal of the present research is to examine socio-ecological hypothesis on apology and compensation. Specifically, we conducted four studies to test the idea that an apology is an effective means to induce reconciliation in a residentially stable community, whereas compensation is an effective means in a residentially mobile community. In Studies 1, 2a, and 2b, American and Japanese participants (national difference in mobility; Study 1) or non-movers and movers (within-nation difference in mobility; Studies 2a and 2b) imagined the situations in which they were hurt by their friends and rated to what extent they would be willing to maintain their friendships upon receipt of apology or compensation. The results showed that compensation was more effective in appeasing residentially mobile people (i.e., Americans and movers) than stable people (i.e., Japanese and non-movers), while apology was slightly more effective appeasing residentially stable people than residentially mobile people (significant in Study 1; not significant in Studies 2a and 2b). In Study 3, by conducting an economics game experiment, we directly tested the hypothesis that mobility would impair the effectiveness of apology and enhance the effectiveness of compensation. The results again partially supported our hypothesis: In the high mobility condition, compensation increased one's willingness to continue the relationship with the offender, when compared to willingness in the low mobility condition. The importance of socio-ecological perspective on the forgiveness literature is discussed.

10.
Brain Behav Immun ; 90: 385-392, 2020 11.
Article in English | MEDLINE | ID: mdl-32805392

ABSTRACT

Japan is an exceptionally healthy East Asian country with extended longevity. In addition, the typical levels of several proinflammatory proteins, including both C-reactive protein (CRP) and interleukin-6 (IL-6), are often reported to be low when compared to American and European populations. This analysis determined if blood levels of CRP and IL-6 were associated with 4 cultural practices reflective of Japanese behavior and customs -- drinking tea, eating seafood, consuming vegetables, and partaking in relaxing baths regularly - among 382 adults living in Tokyo. Regression models controlled for demographic factors, adiposity (BMI), physical exercise, smoking, alcohol use, and chronic illness (e.g., diabetes). Consuming a Japanese diet was associated with significantly lower CRP and IL-6 levels. More frequent bathing was associated with lower IL-6, but not specifically predictive of low CRP. This study has confirmed prior evidence for low inflammatory activity in Japanese adults and its association with several behavioral practices common in Japan.


Subject(s)
C-Reactive Protein , Interleukin-6 , Adult , C-Reactive Protein/analysis , Asia, Eastern , Humans , Japan , Life Style , Obesity
11.
Pers Soc Psychol Bull ; 46(9): 1378-1391, 2020 09.
Article in English | MEDLINE | ID: mdl-32065030

ABSTRACT

Functional limitations-difficulty in carrying out activities of daily living-have been linked to poorer well-being in Western cultures. This might be partly due to the lower personal control associated with functional limitations. However, compared with the West, in Asian cultural contexts (e.g., Japan) where agency and control are based less predominantly on individual attributes, the link between functional limitations and well-being may be weaker. Using cross-sectional probability samples from the United States and Japan (Study 1), functional limitations were associated with lower well-being in both cultures, though the association was weaker in Japan than in the United States and personal control played a mediating role. Furthermore, analyses of longitudinal data (Study 2) showed the cross-cultural patterns generally consistent with the cross-sectional analyses of Study 1, though the cultural moderation was found for fewer well-being measures. Such findings enrich our understanding of how health status and well-being are related across cultures.


Subject(s)
Activities of Daily Living , Cross-Cultural Comparison , Health Status , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Humans , Japan , Male , Middle Aged , United States
12.
Emotion ; 20(5): 804-817, 2020 Aug.
Article in English | MEDLINE | ID: mdl-30896203

ABSTRACT

The present research proposes that Buddhist teachings involve a noninfluence emotion regulation strategy, an emotion regulation strategy that consists of individuals not influencing their emotions in any way, more so than do Protestant teachings. We examined religious teachings surrounding the strategy, practitioners' use of the strategy, and its links with depression. Further, the nature of this noninfluence strategy was explored. Across 3 studies that used student, community, and online samples, results showed that in fact Buddhist practitioners were more likely than were Protestant practitioners to report that their religion teaches them to use noninfluence strategies of emotion regulation, and that they use noninfluence strategies of emotion regulation. Moreover, the use of noninfluence emotion regulation strategies was predictive of lower depressive symptoms across both religions (Studies 1 and 2). In addition, it was found that to practitioners, noninfluence strategies of emotion regulation are active, purposeful strategies and, especially to Buddhist practitioners, they involve acceptance of emotions (Study 2). Furthermore, religion was indirectly linked to the behavioral preference for a noninfluence strategy through the self-reported general use of a noninfluence emotion regulation strategy (Study 3). Implications for research on religion, self-regulation, and mental health are briefly discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Subject(s)
Buddhism/psychology , Depression/psychology , Emotional Regulation/physiology , Emotions/physiology , Protestantism/psychology , Adult , Female , Humans , Male , Young Adult
13.
Emotion ; 20(2): 164-178, 2020 Mar.
Article in English | MEDLINE | ID: mdl-30676038

ABSTRACT

Feeling good is linked to better health in Western contexts. Recent studies show, however, that the affect-health link is not consistent across cultures. We suggest two reasons for such inconsistency. The first follows from research showing that North American (vs. East Asian) cultures tend to value high arousal positive (HAP) states, for example, excited, more than low arousal positive (LAP) states, for example, calm. The second is one we propose for the first time. Positive affective experience is manifest in internal feelings but also in affective practices, such as taking a bath (a highly valued affective experience in Japan) or a fitness workout (a highly valued affective experience in the United States). We hypothesized that the HAP feelings/practices-health link would be stronger in the United States versus Japan, and the LAP feelings/practices-health link would be stronger in Japan versus the United States. Using survey samples from the United States (N = 640) and Japan (N = 382), we examined how health outcomes are shaped by positive affective feelings and practices varying in arousal. In a first set of analyses, HAP feelings predicted better physical and biological health in the United States but not in Japan. No cultural differences were consistently found for the effect of LAP feelings on health. In addition, engaging in HAP practices predicted better physical and biological health in the United States whereas engaging in LAP practices predicted better physical health in Japan but not in the United States. These findings suggest that the pathways underlying the culture-health link are culturally variable. (PsycINFO Database Record (c) 2020 APA, all rights reserved).


Subject(s)
Affect , Arousal/physiology , Baths/psychology , Cultural Characteristics , Exercise/psychology , Asian People/psychology , Female , Humans , Japan/ethnology , Male , Middle Aged , Surveys and Questionnaires , United States/ethnology
14.
Emotion ; 20(5): 721-733, 2020 Aug.
Article in English | MEDLINE | ID: mdl-31008620

ABSTRACT

Prior research has demonstrated that the daily experience of negative affect is associated with increased levels of proinflammatory activity as evidenced by higher interleukin-6 among Americans but not among Japanese. This cultural difference may be driven by culturally divergent beliefs about negative affect as a source of threat to self-image versus as natural and integral to life. Here, we examined whether culture may moderate the relationship between negative affect and biological stress responses, with a focus on the hypothalamic-pituitary-adrenal (HPA) axis activity. By using culturally matched surveys of Americans (N = 761) and Japanese (N = 328), we found that negative affect was associated with a flattening of the diurnal cortisol slope among Americans after controlling for demographic variables, personality traits, sleep patterns, and health behaviors. In contrast, the association between negative affect and the HPA axis activity was negligible among Japanese. Moreover, we assessed biological health risk with biomarkers of both inflammation (interleukin-6 and C-reactive protein levels) and cardiovascular function (higher systolic blood pressure and total-to-HDL cholesterol ratio) and found that the relationship between negative affect and increased biological health risk, which was observed only among Americans, was mediated by the flattening of the diurnal cortisol rhythm. These findings suggest that cultural differences in how emotions are construed may make the experience of negative affect more or less stressful and differentially consequential for health. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Subject(s)
Affect/physiology , Circadian Rhythm/physiology , Culture , Emotions/physiology , Hydrocortisone/metabolism , Female , Humans , Male , Surveys and Questionnaires
15.
J Pers Soc Psychol ; 115(3): 427-445, 2018 Sep.
Article in English | MEDLINE | ID: mdl-29771553

ABSTRACT

Current theorizing on socioeconomic status (SES) focuses on the availability of resources and the freedom they afford as a key determinant of the association between high SES and stronger orientation toward the self and, by implication, weaker orientation toward others. However, this work relies nearly exclusively on data from Western countries where self-orientation is strongly sanctioned. In the present work, we predicted and found that especially in East Asian countries, where other-orientation is strongly sanctioned, high SES is associated with stronger other-orientation as well as with self-orientation. We first examined both psychological attributes (Study 1, N = 2,832) and socialization values (Study 2a, N = 4,675) in Japan and the United States. In line with the existent evidence, SES was associated with greater self-oriented psychological attributes and socialization values in both the U.S. and Japan. Importantly, however, higher SES was associated with greater other orientation in Japan, whereas this association was weaker or even reversed in the United States. Study 2b (N = 85,296) indicated that the positive association between SES and self-orientation is found, overall, across 60 nations. Further, Study 2b showed that the positive association between SES and other-orientation in Japan can be generalized to other Confucian cultures, whereas the negative association between SES and other-orientation in the U.S. can be generalized to other Frontier cultures. Implications of the current findings for modernization and globalization are discussed. (PsycINFO Database Record


Subject(s)
Cross-Cultural Comparison , Hierarchy, Social , Social Class , Social Values , Socialization , Adult , Aged , Female , Humans , Japan/ethnology , Male , Middle Aged , United States/ethnology
16.
Pers Soc Psychol Bull ; 44(6): 809-822, 2018 06.
Article in English | MEDLINE | ID: mdl-29380686

ABSTRACT

Neuroticism, a broad personality trait linked to negative emotions, is consistently linked to ill health when self-report is used to assess health. However, when health risk is assessed with biomarkers, the evidence is inconsistent. Here, we tested the hypothesis that the association between neuroticism and biological health risk is moderated by behavioral adjustment, a propensity to flexibly adjust behaviors to environmental contingencies. Using a U.S.-Japan cross-cultural survey, we found that neuroticism was linked to lower biological health risk for those who are high, but not low, in behavioral adjustment. Importantly, Japanese were higher in behavioral adjustment than European Americans, and as predicted by this cultural difference, neuroticism was linked to lower biological health risk for Japanese but not for European Americans. Finally, consistent with prior evidence, neuroticism was associated with worse self-reported health regardless of behavioral adjustment or culture. Discussion focused on the significance of identifying sociocultural correlates of biological health.


Subject(s)
Health Risk Behaviors , Health , Neuroticism , Aged , Biomarkers , Cross-Cultural Comparison , Female , Health Status , Humans , Japan , Male , Middle Aged , Risk Factors , Self Report , United States
17.
Emotion ; 18(1): 138-152, 2018 02.
Article in English | MEDLINE | ID: mdl-28414476

ABSTRACT

We propose a sociocultural instrumental approach to emotion regulation. According to this approach, cultural differences in the tendency to savor rather than dampen positive emotions should be more pronounced when people are actively pursuing goals (i.e., contexts requiring higher cognitive effort) than when they are not (i.e., contexts requiring lower cognitive efforts), because cultural beliefs about the utility of positive emotions should become most relevant when people are engaging in active goal pursuit. Four studies provided support for our theory. First, European Americans perceived more utility and less harm of positive emotions than Japanese did (Study 1). Second, European Americans reported a stronger relative preference for positive emotions than Asians, but this cultural difference was larger in high cognitive effort contexts than in moderate or low cognitive effort contexts (Study 2). Third, European Americans reported trying to savor rather than dampen positive emotions more than Asians did when preparing to take an exam, a typical high cognitive effort context (Studies 3-4), but these cultural differences were attenuated when an exam was not expected (Study 3) and disappeared when participants expected to interact with a stranger (Study 4). These findings suggest that cultural backgrounds and situational demands interact to shape how people regulate positive emotions. (PsycINFO Database Record


Subject(s)
Asian People/psychology , Cross-Cultural Comparison , Culture , Emotions/physiology , White People/psychology , Adolescent , Europe/ethnology , Female , Humans , Japan/ethnology , Male , Young Adult
18.
A A Pract ; 10(4): 79-82, 2018 Feb 15.
Article in English | MEDLINE | ID: mdl-28968259

ABSTRACT

We report 3 cases of thoracic surgery that required 1-lung ventilation where venovenous extracorporeal membrane oxygenation was prophylactically used because severe hypoxemia and ventilatory failure were anticipated intraoperatively. The surgery was successfully completed in all 3 cases. However, we had to withdraw the extracorporeal membrane oxygenation support in 1 case because of uncontrollable hemorrhage. Venovenous extracorporeal membrane oxygenation is a feasible option when severe hypoxemia and/or ventilatory failure is anticipated during 1-lung ventilation.

19.
J Mech Behav Biomed Mater ; 78: 56-64, 2018 02.
Article in English | MEDLINE | ID: mdl-29132101

ABSTRACT

Fish scales are an interesting natural structural material and their functionality requires both flexibility and toughness. Our previous studies identified that there are spatial variations in the elastic properties of fish scales corresponding to the anatomical regions, and that they appear to be attributed to changes in the microstructure. In the present study, a model is proposed that describes the elastic behavior of elasmoid fish scales in terms of the relative contributions of the limiting layer and both the internal and external elasmodine. The mechanical properties of scales from the Megalops atlanticus (i.e. tarpon) were characterized in tension and compared with predictions from the model. The average error between the predicted and the experimental properties was 7%. It was found that the gradient in mineral content and aspect ratio of the apatite crystals in the limiting layer played the most important roles on the elastic modulus of the scales. Furthermore, misalignment of plies in the external elasmodine from the longitudinal direction was shown to reduce the elastic modulus significantly. This is one approach for modulating the fish scale flexibility for a high mineral content that is required to increase the resistance to puncture.


Subject(s)
Elastic Modulus , Fishes/anatomy & histology , Minerals/metabolism , Animals , Biomechanical Phenomena , Models, Biological
20.
Curr Opin Psychol ; 18: 67-72, 2017 12.
Article in English | MEDLINE | ID: mdl-28826007

ABSTRACT

A large body of research in Western cultures has demonstrated the psychological and health effects of social class. This review outlines a cultural psychological approach to social stratification by comparing psychological and health manifestations of social class across Western and East Asian cultures. These comparisons suggest that cultural meaning systems shape how people make meaning and respond to material/structural conditions associated with social class, thereby leading to culturally divergent manifestations of social class. Specifically, unlike their counterparts in Western cultures, individuals of high social class in East Asian cultures tend to show high conformity and other-orientated psychological attributes. In addition, cultures differ in how social class impacts health (i.e. on which bases, through which pathways, and to what extent).


Subject(s)
Culture , Social Behavior , Social Class , Health Status , Humans
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