Social support plays a crucial role in both the physical and mental adjustment to the diagnosis of breast cancer and its treatment. However, the mediating effects of social support are embedded within the larger, social and cultural contexts in which support given and received. Due to language, culture and economic issues, immigrants may find themselves without the social support and networks that had previously enabled them to cope with illness and disease. This research grounds our understanding of social support and breast cancer within that larger context that includes the social environment and the experience of health disparities. Ethnographic methods were used to explore the cultural domains of social support and to examine cultural and structural factors that influence this multifaceted construct. Participant observation, key informant interviews and 28 in-depth interviews with Latina immigrants diagnosed with breast cancer were conducted in Phase I. The qualitative data gathered in Phase 1 informed the development of the structured questionnaire that was administered in Phase II to 60 Latina immigrants in West Central Florida who had been diagnosed with breast cancer. Breast cancer not only affects individuals, it impacts their social relationships, finances, work, and social roles. The analysis provides a rich and in-depth understanding of social support and contextualizes the breast cancer experience of Latina immigrants. Results suggest that cultural expectations about gender roles shape what kinds of support and assistance is provided by men and women. Spirituality and prayer were identified as non verbal sources of support. Beliefs about not burdening the family with personal concerns and beliefs that family needs should come before one's own were negatively associated with social support. English proficiency and length of time in the United States were not associated with social support. Regardless of length of time in the US there appears to be strong ties with family in their native country. While family both in the US and in their native country were identified as sources of support, they were also identified as a source of stress. Recommendations for clinicians, practitioners and community-based organizations that provide supportive services and programs to Latinos are included.

Introduction: This project explores the links between shared cultural beliefs in the illness domain, specific to lymphatic filariasis, and a support group program implemented in three Haitian towns. The purpose is to introduce an innovative approach to evaluation, the cultural model evaluation technique (CM Evaluation), as well as gain an understanding of the shifting cognitive belief structure around the cultural domain of lymphatic filariasis in the Haitian setting as associated with a support group intervention. Method: The sample population was comprised of 241 women across three sites in Haiti: Archaie, Cabaret, and La Plaine. Data were collected from longitudinal surveys in 2003, baseline, and 2005, outcome. Descriptive statistics and CM Evaluation were utilized to assess the success of the support group program. CM evaluation is a two-pronged approach, comprised of cultural consensus analysis (CCA) and cultural consonance analysis (CC), that differs from standard evaluation tools in that it measures beliefs and behaviors at the shared community level and is culturally contextualized. Results: At baseline, most participants were not single (59%), Catholic (49%), literate (57%), relatively poor (71%), and engaged in selling at home or the market (46%). In the reduced model longitudinal CM comparisons, intervention and control groups, the intervention group had the highest rate of consensus (ER=4.71), significant changes in the culturally correct answer key (chi-sq=5.1, df=1, p<.02) and cultural competence (t=3.63, p<.0006). Alternately, controls exhibited no significant differences in the culturally correct answer key (Fisher’s Exact two-tailed p<1.00) or cultural competence (t=.62, p<.5407) from baseline to outcome. Conclusion: Evidence suggests that support group participation does significantly impact the shared illness beliefs surrounding lymphatic filariasis, and that this format is appropriate for resource poor settings lacking clinical support. Also, this study suggests that the CM evaluation approach is an appropriate and effective evaluation indicator for assessing changes in shared belief, cultural consensus analysis, resulting from public health interventions while the behavioral piece, cultural consonance, requires further refinement.

An estimated 300,000 people contract Lyme disease in the USA every year, 10-20% of whom will experience long-term symptoms even after antibiotic treatment. These patients are said to have Chronic Lyme Disease (CLD). However, diagnostic guidelines, treatment protocols, and the etiological existence of CLD have been the subject of much controversy in the biomedical field, leading to negative mental and physical health outcomes for of patients with CLD. Patient support networks focused on illness experience, known as biosocialities, have formed in response to this controversy. CLD biosocialities create opportunities for patients to participate in biomedical activism and the scientific research process. A historical precedent for biosocial impact on biomedical knowledge and improved health outcomes has been established from patient activists with HIV/AIDS, breast cancer, and PTSD. The impact of CLD patients’ biosocial activism on a scientific and sociological level is evaluated through an examination of the publications of CLD support networks and biomedical research publications. CLD biosocial activism has resulted in more patient-centered research endeavours, etiological proof of CLD, improved diagnostic technologies, and new treatment protocols. These biomedical results have implications for improved CLD patient health outcomes and credibility for CLD as a legitimate disease on a biological and sociological level.

Prescription opioids are associated with rising rates of overdose deaths and hepatitis C and HIV infection in the US, including in rural Central Appalachia. Yet there is a dearth of published ethnographic research examining rural opioid use. The aim of this dissertation is to document the gendered inequalities that situate women’s encounters with substance abuse treatment as well as additional state interventions targeted at women who use drugs. These results are based on ethnographic fieldwork completed from 2013 to 2016 and centered around one county seat in rural Central Appalachia. Data are ascertained through semi-structured interviews with women who have experiences with at least one of three types of substance abuse treatment offered in the area. Additional interviews were completed with program staff, institutional administrators, and community leaders. These data are supplemented with the collection of program documents, informal and follow-up communications, and participant observation in Eastern Kentucky communities, substance abuse treatment programs, and funding agencies. Social locations based on gender, income, access to quality health care, and place of residence contextualize women’s participation in illicit economies, entrance into and maintenance of drug use, particularly but not limited to opioids, and efforts to limit deleterious use. The state’s responses to drug use are manifested in these women’s lives through child protective services, incarceration, and substance abuse treatment. The sociopolitical and financial limitations on institutions often create instances in which policies exacerbate women’s marginalization. These policies are based on specific cultural understandings of women who use drugs, motherhood, Appalachia, and care. Women develop strategies, often based on care networks, to make it through these programs. Despite their navigations of marginalized and marginalizing programs, clients and institutional staff are materially and discursively constrained in their actions.

India has one of the highest rates of cervical cancer morbidity and mortality globally. Despite this, there are no national or state-wide screening efforts for cervical cancer and its prevention in India. In an effort to understand the magnitude of cervical cancer in Bangalore, India, this research draws upon data collected in hospital contexts over a month-long period to explore the ways in which physician attitudes contribute to understandings of cervical cancer and its prevention in the growing urban context of Bangalore.

This project is concerned with obstetric complications and cesarean births in a Yucatec Maya community that has recently began interacting with global market economies and Western biomedicine. ​This research engages with maternal health, reproductive biology, colonial histories, and the global trend of increasing cesarean births. The Yucatec Maya are a short statured population [average adult female height 2010 = 143.2 cm] with historically low obstetric complications and maternal mortality. In the last 30 years, CS rates have risen to account for 25% of all births in this community. Because extreme short stature for population has been linked to obstructed labor and birth complications, this project was designed to determine if stature is impacting the rising rate of CS. Reproductive outcomes and obstetric complications were modeled against height in 3 age cohorts of mothers using one-way ANOVA with a Bonferroni-post hoc test and univariate general linear models. No statistical evidence was found to indicate that stature is related to reproductive outcomes or obstetric complications; however, there is an association between short stature and likelihood of cesarean birth. The dramatic change in birth mode in this population may be attributed to increased availability of biomedical resources, doctor-driven perceptions of indigenous women, and low capacity of rural public hospitals to serve numerous patients in labor.

This research explores the relationship between testosterone and conceptions of masculinity and maleness in North America. The purpose of this study was to discover how men's experiences and enactments of their own masculinity and maleness add dimensions to cultural tropes of masculinity. Aging men (ages 39-75) and transgender men (male-identified, though not born biological men), illuminate the extent to which masculinity and maleness are a cultural achievement, enacted in concert with both cultural mores and individual desires. The research is based on over 27 months of fieldwork, in and around Boston, Massachusetts, using the methods of participant observation, semi-structured interviewing, and discourse analysis. I interviewed of 21 aging men and 24 transgender men. Men responded to semi-structured questions on their identity, experiences of living within their bodies, and understandings of testosterone as an object, commodity, and metaphor. Part commodity, part multi-faceted symbol, testosterone at once establishes, maintains, and enforces a coherently embodied gender. This comparative research suggests that we cannot fully understand the complexity of experiential gender identity without first unpacking the multiple elements of identity (e.g., cultural ideals, individual performances, and biological bodies) which come together in a single human being. This dissertation exposes cultural ideals of masculinity, and shows how men work with, and against, these ideals in constructing their own identities. This research shows that men have enduring and particularistic relationships with their own bodies which both reflect and challenge dominant stereotypes of the male body. I articulate strategies for aging men and transgender men to simultaneously identify and disidentify with cultural masculinity, demonstrating the shifting relevance of cultural masculinity in men's actual gendered lives. This work coins the term "maskulinity," the act of men utilizing cultural notions of masculinity to pass as men at will. I argue that in their acceptance and rejection of cultural masculinity, men in turn modify U.S. understandings of masculinity. This dissertation illuminates striking similarities between aging men and transgender men, showing how these men live in and through their bodies.

This thesis focuses on the private sector response to the human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) in the Republic of South Africa (RSA) and the United States (US) in multinational businesses and corporations. From an epidemiological perspective HIV/AIDS and its co infections cause acute and chronic illness in the workforce leading to programs and interventions of various complexity and effectiveness. Workforce HIV/AIDS epidemiology in South Africa and the US is reviewed and discussed. From a critical medical anthropology perspective multinational corporations are political and economic entities with immense resources and power over people, communities, and governments globally. Corporate culture becomes important in the design of prevention and treatment strategies. Working with the Centers for Disease Control and Prevention's (CDC) global AIDS program (GAP) allowed the researcher to conduct key informant interviews and participant observation in five multinational business in South Africa. Important issues are raised regarding workforce education, stigma, workplace and community relationships, rapid-saliva versus blood sample testing, and the need for more disclosure and involvement of people with HIV/AIDS (PWHAs) in the workplace. In light of increasing global capitalization, poor government services for prevention and treatment, and the fact that HIV/AIDS discrimination is a human rights abuse, from a collective standpoint businesses have been slow to respond to HIV/AIDS, in southern Africa as well as in the United States, and should make it a core component of corporate social responsibility (CSR) strategies regardless of disease prevalence in the workforce.

The focus of this research was to: 1) study the perceptions of female students attending the university Student Health Center, concerning available services, 2) learn how they describe their decisions to obtain care, and 3) identify perceived barriers to reproductive health care and contraception. This exploratory study used a mixed-methods approach that included clinic public-space observations, interviews with health care providers and staff at Student Health Services (SHS), surveys distributed to clients of the campus clinic, and in-depth interviews to contextualize emergent themes. Topics addressed included sexual health behaviors and perceptions, influence of peers and partners, the propagation of health myths, and past experiences with SHS. Gathering practitioner perspectives on student barriers to care, goals of the clinic, and perceived health needs of the student community, allowed for measurement of incongruence between student and staff, thereby adding greater context to results. SHS sought recommendations in order to improve student's use of the Sexual Health and Gynecology clinic, increase accuracy of student's sexual health knowledge, and guide future clinic operations. SHS is now working with the College of Public Health to create improvement projects based on my results, including a peer education program. Research such as this can result in greater student awareness of available services, and more productive communication between patients and provide. Implications on the larger issues of gender and the search for health care, acceptance and knowledge of STI testing, and client comfort are addressed, and provide opportunity for future work in this area.

Chuuk, one state of the Federated States of Micronesia (FSM), experiences significant transnational migration to the United States (U.S.), particularly to the Territory of Guam. This migration is facilitated by the Compact of Free Association (COFA), an agreement with several Micronesian countries previously under U.S. administration that allows for free movement of their citizens into the U.S. Although part of Micronesia, Guam's colonized residents resist an identity connected to rest of Micronesia. With very poor health outcomes, the Chuukese represent a political and social body of bodies that bring sickness, babies and increased costs to the Guam government without adequate compensation by their colonizer sanctioning the migration. In order to better understand why Chuukese women suffer disproportionately poor reproductive health outcomes as compared to the rest of Guam's residents, this multi-sited dissertation examines how Chuukese women's reproduction is constructed and conceptualized by women, their families, and their "home" and "host" communities, and how these meanings are mediated by transnational migrant experiences between Chuuk and Guam. Using a critical interpretive framework, this study utilized participant observation in the clinics and communities, interviews with health care workers, and in-depth life history interviews with fifteen Chuukese women. This dissertation situates Chuukese women's reproduction in the context of transnational migration through an analysis of social, economic and political processes, health and social services policies and practices, postcolonial migration and sociocultural meanings of reproduction for Chuukese women in both Chuuk and Guam.