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.

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.

Socioeconomic factors and adult body composition in a developing society

Objective: To examine socioeconomic variables in relation to three indices of adult body composition: the body mass index: and, percent body fat and lean-to-fat body mass ratio, both derived from bioelectric impedance analysis. Purpose: To investigate the relationship between obesity and socioeconomic variables in a developing country. Research methods and procedures: A cross-sectional survey of four neighborhoods differing in socioeconomic status. A random sample of 304 healthy adults, 181 females and 123 males, age range 18-78. Body composition was measured with the body mass index derived from height and weight, and the assessments of percent body fat and the ratio of lean-to-fat body mass derived from bioelectric impedance analysis. Results: Using a linear model with age as a covariate and sex as an additional factor, there were significant interaction effects between sex and socioeconomic group for all three of the body composition variables (p < 0,005). Analysis of trends within sex revealed primarily a linear association between socioeconomic group and body composition for males (p < 0,001), and a curvilinear association between socioeconomic group and body composition for females (p < 0.03). Discussion: The association of socioeconomic status and body composition is significant for males and females, but the pattern of the association varies by gender. It is argued that these results can be explained by three processes: socioeconomic differences in caloric demands of labor: socioeconomic differences in the social value attached to food: and, gender differences in standards of physical attractiveness

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.

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.

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.

Modernization, stress, and blood pressure: new directions in research.

The relationship between modernization and blood pressure has been formally examined in anthropology for some 3 decades. A prominent hypothesis to account for the increase in blood pressure in more modernized (or economically developed) communities is the stressful nature of cultural and social change. Research has progressed from hypothesizing that culture change is stressful to trying to operationalize theoretical models of what it is about culture change that is stressful and in turn relating those more precise variables to blood pressure variability within and between communities. Here, I selectively review the literature on modernization and blood pressure, especially the research literature that explicitly uses models of the stress process to guide that research. The most interesting results have been obtained when the use of the stress model has been informed by careful ethnographic work. This has enabled researchers to adapt models of the stress process to be culturally appropriate in local populations. In addition, incorporating an explicit model of culture, especially one that is sensitive to intracultural diversity, has led to new hypotheses regarding the modification of the effects of stressors by social and cultural context. I conclude with a discussion of recent innovations in ethnographic methods, specifically the cultural consensus model, and the use of those methods in operationalizing relevant variables in culturally appropriate and sensitive ways. The utility of combining these methods in the study of modernization and blood pressure is illustrated by recent research in Brazil.

Psychosocial moderators of substance use among middle school-aged adolescents.

Recent statistics show a decrease in the overall use of drugs and alcohol in the general population [1]. In sharp contrast to this trend is the indication that adolescents' use of drugs and alcohol is increasing [2]. Because the use of drugs and alcohol can have serious implications for adolescents' physical, emotional, and social development, it is important that human service practitioners working with them understand those factors that influence their substance use, in order to develop effective interventions to deal with this growing problem. This article reports the findings of a study of drug and alcohol use among a sample of 779 adolescents who attended middle schools in a large urban city in the southwest United States. The study examines the relationships between substance use, social support, and a variety of other psychosocial factors. The implications of those relationships for human service practice and research are discussed.

John Henryism, gender, and arterial blood pressure in an African American community.

OBJECTIVE: To examine the interaction between gender and John Henryism in relationship to arterial blood pressure in an African American community in the Southern United States. It was hypothesized that, within this specific social and cultural context, John Henryism would be associated with blood pressure differently for men and women. METHODS: A cross-sectional survey of 600 persons, aged 25 to 65, was conducted in the African American community of a small Southern city. John Henryism was assessed using the 12-item John Henryism Scale for Active Coping. Blood pressure was assessed by conventional methods. RESULTS: The interaction effect between gender and John Henryism was assessed as a cross-product term in ordinary least squares regression analysis using arterial blood pressure as the dependent variable, and with logistic regression using hypertension as the dependent variable. This interaction effect was significant (p < .05) in relation to systolic blood pressure and hypertension, with the effect evident (p < .07) in relation to diastolic blood pressure. For men, as John Henryism increases, blood pressure and the risk of hypertension increases. For women, as John Henryism increases, blood pressure and the risk of hypertension decreases. CONCLUSIONS: The association of the behavioral disposition of John Henryism with blood pressure is dependent on the gender of the individual. Men and women face differing cultural expectations and social structural constraints in this community. The sociocultural context modifies the meaning of the behavioral disposition, and hence its effects.

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.

Culture, socioeconomic status, and coronary heart disease risk factors in an African American community.

In this paper, cultural influences are examined in the relationship between socioeconomic status and health. Cultural definitions of material lifestyles are investigated as a correlate of disease risk in an African American community in the rural South. A new technique--called "cultural consensus analysis"--is used to test for a cultural model of lifestyles indicative of success. Survey data are then used to operationalize the degree to which individuals adhere in their own behavior to that cultural model; this measure is referred to as "cultural consonance in lifestyle." Cultural consonance in lifestyle is more strongly associated with hypertension and smoking (but not serum lipids) than are conventional measures of socioeconomic status (occupation, income, and education). These results suggest that the extent to which individuals are unable to live in accordance with cultural norms regarding lifestyles may contribute to the risk of coronary heart disease in the African American community.

The cultural construction of social support in Brazil: associations with health outcomes.

The association of social support and health outcomes has received considerable attention in recent years, but the cultural dimension of social support has not been extensively investigated. In this paper, using data collected in a Brazilian city, we present results indicating that those individuals whose reported access to social support more closely approximates an ideal cultural model of access to social support have lower blood pressure and report fewer depressive symptoms and lower levels of perceived stress. The cultural model of social support is derived using a combination of participant observation, semi-structured interviews, and the systematic ethnographic technique of cultural consensus modelling. These results are then used to develop a measure of an individual's approximation to that model of social support in a survey of four diverse neighborhoods in the city (n = 250). We call this approximation to the ideal cultural model of social support "cultural consonance" in social support. The association of health outcomes with cultural consonance in social support is independent of individual differences in the reporting of social support, and of standard covariates. In the case of blood pressure and perceived stress, it is independent of diet, and other socioeconomic and psychosocial variables. The association with depressive symptoms is not independent of other psychosocial variables. The implications of these results are discussed with respect to research on cultural dimensions of the distribution of disease.

Social context and psychosocial influences on blood pressure among American Samoans.

This study explores social and explores social and economic influences on health within a model formulated to address explicitly both individual and household level phenomena. Dressler's lifestyle incongruity model is used as a basis from which to predict the effects of intracultural contexts of variability on blood pressure. The sample for this survey consists of 134 Samoan men and women living in American Samoa. Based on previous experience and ethnographic sources, two key intracultural contexts were examined; gender, i.e., male-female differences in response to psychosocial stress, and household employment as indicated by whether or not both spouses in a household are employed. Our analysis indicates that lifestyle incongruity, defined as the difference between the material culture presented by a household and the economic resources of the family, is significantly associated with both systolic and diastolic blood pressure. Furthermore, males and females show opposite blood pressure associations with both lifestyle incongruity (male blood pressure increases with increasing incongruity while female blood pressure does not) and household employment (male blood pressure is higher when both spouses work but female blood pressure is lower).

Social status, social context, and arterial blood pressure.

As social change and economic development have proceeded, the prevalence of chronic diseases, especially cardiovascular diseases, has increased in the developing world. In part this is due to the adoption of diets and other health behaviors characteristics of industrialized nations; in part it is a function of changing social and economic circumstances. In this paper, we describe the development and testing of a model designed to account for social and economic effects on cardiovascular disease risk. The model incorporates the fact that global economic processes have made a lifestyle characterized by the consumption of Euroamerican material goods and information a basis for the assignment of social status in local communities. But economic change at the local level is rarely sufficient to provide a foundation for individuals' status aspirations. Hence, many individuals attempt to maintain lifestyle inconsistent with their economic standing, a variable we term lifestyle incongruity. Here we described how this factor is associated with higher blood pressure in a variety of settings and also how the effects of lifestyle incongruity can be modified in local contexts by social class and social role processes. This latter process, contextual modification, is illustrated by data from American Samoa. In this example, the association of lifestyle incongruity with blood pressure is examined in 30 male household heads and 26 spouses. After an examination of Samoan ethnography focused attention on the importance of age and gender differences as defining social contexts of intracultural variation, the model was modified to assess interactions between age and gender as they affect the association of lifestyle incongruity and blood pressure. Lifestyle incongruity is strongly associated with higher systolic and diastolic blood pressure for the younger household heads, minimally associated with blood pressure for older household heads, and only slightly associated with blood pressure of their spouses. The regression coefficients for the lifestyle incongruity by age by sex interaction term was significant at P < or = 0.01 for both systolic and diastolic blood pressure. The consistency of these results with expectations based on the ethnographic record is emphasized in the interpretation. We feel that the lifestyle incongruity model represents and empirically successful attempt to link global political-economic processes, local social structure, and biological outcomes.

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.

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.

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.

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.

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.

[Risk factors of coronary artery disease and their relationships with dietetic and social variables]. / Fatores de risco de doença arterial coronariana e suas correlações com variáveis dietéticas e sociais.

PURPOSE: To examine the relationships between diet, sociocultural factors, and the major coronary artery disease (CAD) risk factor: arterial blood pressure, serum lipids, and cigarette smoking. METHODS: Four residential areas that sampled groups differing in their economic-sector participation were identified. Twenty families of each group were evaluated: "bóias-frias", agricultural labourers employed full-time on a plantation outside the city, factory workers and bank employees. Blood samples and other medical data were obtained either in health centers or in the work places. All blood samples were 12-16h fasting samples. Standard techniques were used to analyse total cholesterol, triglycerides and high-density lipoprotein cholesterol. Dietary intake was estimated for each individual as an average of four 24h dietary recalls. These recalls, collected by trained nutritionists were converted to nutrient intake using USDA food tables, supplemented with Brazilian foods. Lifestyle incongruety was calculated from two components scores: a scale of style of life and a measure of household occupational class. Lifestyle incongruety is calculated by subtracting occupational class from style of life. Social support was assessed by asking respondents to whom they would turn to help in response to a variety of common problems. People with high social support and low lifestyle incongruety were classified as low social stress; people with low social support and high lifestyle incongruents as high social stress. RESULTS: Higher dietary cholesterol, percent calories in the diet from polyunsaturated fat, calcium intake, and fiber intake were related to serum lipid; socioeconomic status to dietary intake; high social stress to higher diastolic blood pressure and an unfavorable pattern of serum lipids and smoking to age, sex, socioeconomic status, and lifestyle incongruety. CONCLUSION: The process by which social change leads to an increased risk of CAD, and the specific behaviors of individuals could be altered to lower their risks.