America’s poor face many obstacles including health disparities and limited access to affordable primary healthcare services. This study focuses on treatment seeking and knowledge of the Patient Protection and Affordable Care Act among the working poor in Tupelo, Mississippi, where research was conducted in 2014. The working poor cannot afford medical insurance even with government subsidies but earn too much money to qualify for Medicaid, leaving them with few options. Strategies to manage acute and chronic illnesses include frequenting organizations that attempt to fill the gaps in healthcare. This thesis presents a cultural model of health-seeking among the working poor as they attempt to navigate the changing healthcare marketplace. Research indicates that the working poor are largely uninformed and unable to utilize ObamaCare and are still relying on safety net providers.

Gulf Coast communities face many environmental threats that disproportionately impact the health of pregnant women. While the perception of risk strategies often differ across cultural groups, little is known about the detail of these differences. The purpose of this study was to explore the cultural knowledge of environmental threats within an at-risk group (low-income, first-time mothers in Southeast Louisiana). This proposal was a part of a SAMHSA-supplemental-funded study, which was an extension of a National Institutes of Health (NIH) funded U19 consortium called the Transdisciplinary Research Consortium for Gulf Resilience on Women’s Health (GROWH). In the first of a two-phase ethnographic approach, interviews with mothers helped identify risk in the environment, important steps to manage these threats, and trustworthy sources to turn to for help. Next, a larger sample (n=112) of mothers indicated their level of agreement to these items. These ratings were analyzed through cultural consensus analysis which gave a quantitative estimate of cultural sharing and beliefs. Results revealed that mothers shared a common pattern of risk perception and behavior regarding the assessment of different environmental threats. Further analyses detailed these cultural models, and identified if cultural knowledge was associated with key socio-demographic factors. Additionally, subtle areas of intra-cultural variation within the general consensus showed that some mothers emphasized health behaviors that may increase household risk. The results of this study contribute to an understanding of how low-income households manage environmental health threats, how cultural knowledge is distributed, and what factors influence knowledge. Study results can help to identify greater awareness of cultural differences within an at-risk population, which can be used to create culturally-tailored risk messaging. Implications for environmental health research, and public health policy are also discussed. / 1 / Christopher Mundorf

A influência da cultura na adaptação individual tem sido uma questão de considerável importância na psicologia, antropologia e em outras ciências sociais; no entanto, dificuldades teóricas e metodológicas têm limitado a possibilidade de investigar diretamente esses processos. A investigação de modelos da vida familiar faz-se importante devido ao papel estrutural da família na sociedade brasileira e sua relação com a saúde mental e desenvolvimento dos indivíduos. Na antropologia cognitiva, modelos culturais servem como uma função diretiva para o comportamento, construindo processos de significação para os indivíduos. O conceito de consenso cultural refere-se ao modo em que os modelos culturais são compartilhados e valorados pelos indivíduos. Enquanto que o conceito de consonância cultural foi proposto para descrever o grau com que o indivíduo, em seu próprio comportamento ou percepção, se aproxima do modelo cultural compartilhado. O presente estudo propôs-se a identificar a presença de modelos culturais na vida familiar, a existência de um consenso cultural acerca desses modelos e analisar a consonância cultural da população urbana estudada em Ribeirão Preto. Este trabalho integrou o Projeto “Cultura e Adaptação Individual" (CADI) e analisou parte dos dados relacionados à vida familiar. Participaram desta pesquisa 295 habitantes de Ribeirão Preto, com idades entre 18 a 67 anos. No método foram empregados técnicas cognitivas (lista livre, agrupamento livre e entrevista de consenso cultural), grupo focal e a Escala de Consonância Cultural da Vida Familiar desenvolvida pela equipe do projeto CADI. Os dados foram analisados utilizando modelos estatísticos apropriados e a análise temática de conteúdo. Nos resultados verificou-se que há um único modelo de vida familiar sendo compartilhado, há um bom compartilhamento desse modelo e uma valorização de elementos afetivos em detrimento de uma dimensão relacionada à estrutura familiar. O modelo cultural da vida familiar foi composto por elementos positivos e negativos aos vínculos familiares. Os elementos positivos puderam ser relacionados à estrutura familiar e ao funcionamento afetivo e qualidade das relações familiares. Os elementos negativos puderam ser distribuídos em um “continuum de poder prejudicial aos vínculos familiares e aos indivíduos". Sendo que “vício", “violência" e “irresponsabilidade" foram os elementos relacionados como potencialmente mais destrutivos aos vínculos familiares e às funções protetivas que a família poderia desempenhar. A configuração familiar vem sendo afetada por transformações sociais, relacionadas principalmente à evolução tecnológica, ao desejo por um novo estilo estilo de vida e a entrada da mulher no mercado de trabalho. A consonância cultural da vida familiar não apresentou diferenças significativas entre os quatro bairros estudados o que demonstra que os sujeitos se percebem vivendo a vida familiar independentemente das diferenças sócio-econômicas. O método empregado mostrouse adequado para a investigação dos objetivos do projeto. Espera-se que este trabalho possa contribuir para um melhor entendimento da família no Brasil e assim auxiliar na adequação e efinição de políticas públicas em nossa sociedade. / The influence of culture on individual adaptation has been a question of considerable importance in Psycology, in Anthropology and other social sciences; however, theoretical and methodological difficulties have limited the ability of researchers to directly investigate these processes. The investigation of familiar life models is important due to the structural role of a family in the Brazilian society and its relation with mental health and the development of individuals. In cognitive Anthropology, cultural models construct meaning for individuals and serve as a directive function for individual behavior. The term cultural consensus has been defined as the way cultural models are shared and rated by individuals. Whereas the concept of cultural consonance has been proposed to describe the degree to which an individual, in their own behavior or belief, approximate shared cultural model in some domain. The present work has been proposed to identify the presence of cultural models in familiar life, the existence of a cultural consensus related to these models and analyze the cultural consonance of the urban population studied in Ribeirão Preto. This work integrated the project “Culture and Individual Adaptation" (CADI- in Portuguese) and analyzed part of the data related to familiar life. Two hundred and ninety-five inhabitants from Ribeirão Preto, between 18 and 67 years old, participated in this research. In the methodology, cognitive techniques were used (free list, pile sort and cultural consensus interview), focal group and the Cultural Consonance Scale of Familiar Life developed by the team of the CADI project. The data was analized using appropriate statistical models and the thematic analysis of contents. In the results, it was observed that there is a single model of familiar life being shared, there is a good division of this model and a valorization of affective elements instead of a dimension related to familiar structure. The cultural model of the familiar life was composed by positive and negative elements in terms of family bonds. The positive elements could be related to familiar structure and the affective functioning and the quality of family relations. The negative elements could be divided into a “continuum of power which is harmful to family bonds and individuals", while “addiction", “violence" and “irresponsibility" were the elements reported as potentially more harmful to family bonds and the protective functions that a family could perform. The familiar configuration has been affected by social changes, due mainly to technological evolution, the desire of a new life style and the growing role of women in the working market. The cultural consonance of familiar life has not shown significant differences among the four neighborhoods studied, a fact that shows that individuals are aware of familiar life no matter the social and economical differences. The methodology applied has proved to be appropriate for the investigation of the goals of the project. This work is expected to contribute to a better understanding of families in Brazil and then, help to fit and define the public politics in our society.

After more than twenty years of increasing understanding of the human immunodeficiency virus known as HIV, the virus continues to spread throughout the world, manifesting itself lethally in the form of the Acquired Immune Deficiency Syndrome (AIDS). With no cure or affordable treatment presently available for the majority of the people of sub-Saharan Africa and the African nation of Malawi, work aimed at preventing the spread of the virus continues to be the best strategy for lessening its impact, both at a personal level and across populations. Most people and communities in this part of the world demonstrate some understanding of HIV and its impact, and strategies such as condom use and abstinence education are familiar program interventions. However, less is known about how social and cultural processes influence personal risk taking and decision making related to HIV/AIDS. In this research, participatory research activities involving planning and producing dramas provide a venue for exploration of how rural Malawian communities can investigate and confront HIV/AIDS social causality through analyzing, planning and acting, presenting, and critiquing research. This research studies the role that shared agreement or consensus plays in developing a community's AIDS-related knowledge and in creating community-specific priorities for AIDS prevention activities. This aspect of the research is significant for applications of participatory research in community AIDS work. The research was designed so that information was collected from individuals participating in the interventions both before and after the interventions. This was intended to facilitate a better understanding of how participatory research affected group knowledge. The analytical process of Cultural Domain Analysis was used in conjunction with the non-probabilistic analytical technique of consensus modeling to gauge whether changes in agreement or consensus occurred as a result of participatory activities among intervention groups.

This project describes and analyzes explanatory models of Chagas disease among people in a highly endemic area of eastern Bolivia, and examines the role that cultural and structural factors play in shaping explanatory models of this disease. Dressler (2001) characterizes medical anthropology as divided between two poles; the constructivist, which focuses on the "meaning and significance that events have for people," and the structuralist, which emphasizes the relationships between the components of a given society. This project endeavors to synthesize structuralist and constructivist perspectives by understanding the interaction between structural processes and explanatory models of Chagas disease. The research took place in the spring of 2013, in collaboration with the Centro Medico Humberto Parra, a non-profit clinic servicing low income populations in Palacios, Bolivia and surrounding communities. Semistructured interviews (n=68) and consensus analysis questionnaires (n=48) were administered to people dealing with Chagas disease, and free lists of possible treatments were collected. Overall, participants largely accepted the biomedical model, but also emphasized the emotional and social aspects of Chagas disease. The consensus analysis procedure indicated a clear shared model of Chagas disease, with coherent social, vector, symptoms, and ethnomedical domains. Furthermore, the model differed between groups based on ethnicity, gender, income and occupation. Significant differences were found in cultural knowledge of the disease based on community of residence and occupation status, two clear markers of how people are tied into the global economy. In the interviews, participants associate their Chagas disease with structural factors including poverty, rural living and traditional housing. They describe substantial barriers to getting biomedical care for their disease despite the existence of a free treatment program in Bolivia. However, participants reported numerous ethnomedical treatments; the study identified 39 ethnomedical treatments for Chagas disease and 66 for its cardiac symptoms. In sum, explanatory models include structural processes that shape disease, and are in turn influenced by these processes. In Bolivia, although structural constraints limit the scope of biomedical treatment, ethnomedical approaches to the disease are in a process of dynamic growth. The methods used here for assessing the structural component of the explanatory model of Chagas disease can be replicated in future research on explanatory models or political economy of health.

In the U.S., individuals of Afro-Caribbean and Latino descent are two to three times more likely to develop type 2 diabetes than non-Hispanic whites. Caribbean and Latin America migrants, particularly minority women bear a disproportionate burden of type 2 diabetes and its risk factors. The purpose of this research is to investigate if Afro-Caribbean women share a cultural belief model about type 2 diabetes and how this belief model, along with structural barriers to health care, influence disease risk and management. A sample of 40 women, primarily Jamaican and Trinidadian, 35 to 90 years of age previously diagnosed with type 2 diabetes were recruited in southwest Florida. Socio-demographic, medical history, and self-reported height and weight data were collected from women. A 53 item yes/no cultural beliefs questionnaire about type 2 diabetes' etiology, treatment, and symptoms was administered to 30 women. Semi-structured interviews about diet and lifestyle type 2 diabetes management were conducted with 38 women, 24 interviews were conducted over the telephone. The cultural consensus analysis used to analyze the cultural beliefs questionnaire found that the women shared a single cultural belief model (.72 ±.081 SD) about type 2 diabetes. Body mass index was calculated from self-reported height and weight data, and correlated with socio-demographic and cultural belief variables. The age-adjusted prevalence of obesity was 40.39 percent. The spearman correlation found that women with higher BMI (rs = -0.42993, p = .0125) and individual cultural knowledge scores (rs = -0.41730, p = .0218) were significantly younger at age of type 2 diabetes diagnosis than women with lower BMI and individual cultural knowledge scores. The women's cultural belief model about type 2 diabetes was similar to the biomedical model. Women struggled to modify their traditional Caribbean diet and failed to engage in regular leisure physical activity which may have contributed to their high BMI. Inadequate health insurance and transnational migration prevented women from accessing regular medical care and effectively managing the disease. Afro-Caribbean women face an ongoing struggle to control their glucose levels and BMI to prevent the onset of type 2 diabetes complications.

abstract: Native American communities face an ongoing challenge of effectively addressing cancer health disparities, as well as environmental racism issues that may compound these inequities. This dissertation identified the shared cultural knowledge and beliefs about cancer in a southwest American Indian community utilizing a cultural consensus method, an approach that combines qualitative and quantitative data. A community-based participatory research (CBPR) approach was applied at all stages of the study. The three phases of research that were undertaken included: 1) ethnographic interviews - to identifying the themes or the content of the participants' cultural model, 2A) ranking of themes - to provide an understanding of the relative importance of the content of the cultural model, 2B) pile sorts - identify the organization of items within specific domains, and 3) a community survey - access whether the model is shared in the greater community. The cultural consensus method has not been utilized to date in identifying the collective cultural beliefs about cancer prevention, treatment or survivorship in a Native American community. Its use represents a methodological step forward in two areas: 1) the traditional ethnographic inferences used in identifying and defining cultural meaning as it relates to health can be tested more rigorously than in the past, and 2) it addresses the challenge of providing reliable results based on a small number of community informants. This is especially significant when working with smaller tribal/cultural groups where the small sample size has led to questions concerning the reliability and validity of health-related research. Results showed that the key consultants shared strong agreement or consensus on a cultural model regarding the importance of environmental and lifestyle causes of cancer. However, there was no consensus found among the key consultants on the prevention and treatment of cancer. The results of the community survey indicated agreement or consensus in the sub-domains of descriptions of cancer, risk/cause, prevention, treatment, remission/cure and living with cancer. Identifying cultural beliefs and models regarding cancer could contribute to the effective development of culturally responsive cancer prevention education and treatment programs. / Dissertation/Thesis / Ph.D. Anthropology 2011

A influência da cultura na adaptação individual tem sido uma questão de considerável importância na psicologia, antropologia e em outras ciências sociais; no entanto, dificuldades teóricas e metodológicas têm limitado a possibilidade de investigar diretamente esses processos. A investigação de modelos da vida familiar faz-se importante devido ao papel estrutural da família na sociedade brasileira e sua relação com a saúde mental e desenvolvimento dos indivíduos. Na antropologia cognitiva, modelos culturais servem como uma função diretiva para o comportamento, construindo processos de significação para os indivíduos. O conceito de consenso cultural refere-se ao modo em que os modelos culturais são compartilhados e valorados pelos indivíduos. Enquanto que o conceito de consonância cultural foi proposto para descrever o grau com que o indivíduo, em seu próprio comportamento ou percepção, se aproxima do modelo cultural compartilhado. O presente estudo propôs-se a identificar a presença de modelos culturais na vida familiar, a existência de um consenso cultural acerca desses modelos e analisar a consonância cultural da população urbana estudada em Ribeirão Preto. Este trabalho integrou o Projeto “Cultura e Adaptação Individual” (CADI) e analisou parte dos dados relacionados à vida familiar. Participaram desta pesquisa 295 habitantes de Ribeirão Preto, com idades entre 18 a 67 anos. No método foram empregados técnicas cognitivas (lista livre, agrupamento livre e entrevista de consenso cultural), grupo focal e a Escala de Consonância Cultural da Vida Familiar desenvolvida pela equipe do projeto CADI. Os dados foram analisados utilizando modelos estatísticos apropriados e a análise temática de conteúdo. Nos resultados verificou-se que há um único modelo de vida familiar sendo compartilhado, há um bom compartilhamento desse modelo e uma valorização de elementos afetivos em detrimento de uma dimensão relacionada à estrutura familiar. O modelo cultural da vida familiar foi composto por elementos positivos e negativos aos vínculos familiares. Os elementos positivos puderam ser relacionados à estrutura familiar e ao funcionamento afetivo e qualidade das relações familiares. Os elementos negativos puderam ser distribuídos em um “continuum de poder prejudicial aos vínculos familiares e aos indivíduos”. Sendo que “vício”, “violência” e “irresponsabilidade” foram os elementos relacionados como potencialmente mais destrutivos aos vínculos familiares e às funções protetivas que a família poderia desempenhar. A configuração familiar vem sendo afetada por transformações sociais, relacionadas principalmente à evolução tecnológica, ao desejo por um novo estilo estilo de vida e a entrada da mulher no mercado de trabalho. A consonância cultural da vida familiar não apresentou diferenças significativas entre os quatro bairros estudados o que demonstra que os sujeitos se percebem vivendo a vida familiar independentemente das diferenças sócio-econômicas. O método empregado mostrouse adequado para a investigação dos objetivos do projeto. Espera-se que este trabalho possa contribuir para um melhor entendimento da família no Brasil e assim auxiliar na adequação e efinição de políticas públicas em nossa sociedade. / The influence of culture on individual adaptation has been a question of considerable importance in Psycology, in Anthropology and other social sciences; however, theoretical and methodological difficulties have limited the ability of researchers to directly investigate these processes. The investigation of familiar life models is important due to the structural role of a family in the Brazilian society and its relation with mental health and the development of individuals. In cognitive Anthropology, cultural models construct meaning for individuals and serve as a directive function for individual behavior. The term cultural consensus has been defined as the way cultural models are shared and rated by individuals. Whereas the concept of cultural consonance has been proposed to describe the degree to which an individual, in their own behavior or belief, approximate shared cultural model in some domain. The present work has been proposed to identify the presence of cultural models in familiar life, the existence of a cultural consensus related to these models and analyze the cultural consonance of the urban population studied in Ribeirão Preto. This work integrated the project “Culture and Individual Adaptation” (CADI- in Portuguese) and analyzed part of the data related to familiar life. Two hundred and ninety-five inhabitants from Ribeirão Preto, between 18 and 67 years old, participated in this research. In the methodology, cognitive techniques were used (free list, pile sort and cultural consensus interview), focal group and the Cultural Consonance Scale of Familiar Life developed by the team of the CADI project. The data was analized using appropriate statistical models and the thematic analysis of contents. In the results, it was observed that there is a single model of familiar life being shared, there is a good division of this model and a valorization of affective elements instead of a dimension related to familiar structure. The cultural model of the familiar life was composed by positive and negative elements in terms of family bonds. The positive elements could be related to familiar structure and the affective functioning and the quality of family relations. The negative elements could be divided into a “continuum of power which is harmful to family bonds and individuals”, while “addiction”, “violence” and “irresponsibility” were the elements reported as potentially more harmful to family bonds and the protective functions that a family could perform. The familiar configuration has been affected by social changes, due mainly to technological evolution, the desire of a new life style and the growing role of women in the working market. The cultural consonance of familiar life has not shown significant differences among the four neighborhoods studied, a fact that shows that individuals are aware of familiar life no matter the social and economical differences. The methodology applied has proved to be appropriate for the investigation of the goals of the project. This work is expected to contribute to a better understanding of families in Brazil and then, help to fit and define the public politics in our society.

Supplementary feeding continues to be a widespread strategy for child health promotion though its efficacy remains contested. The long-standing, Malaysian national food assistance program for children - Program Pemulihan Kanak-Kanak Kekurangan Zat Makanan (PPKZM) - fits this pattern, receiving severe criticism for its limited impact on child nutritional status. Still, the program remains, producing a seeming paradox and prompting questions of how it fits into (1) the larger political context of national health policy and (2) more localized village and clinic environments. This research combines historical inquiry with the in-depth, ethnographic study of two predominantly Malay coastal villages in Malaysian Borneo, where child anthropometry and household food insecurity rates establish a clear need for the PPKZM despite low coverage rates. This study assesses the ways in which common, local foods are perceived and categorized and the degree to which these understandings are shared both (1) within the communities and (2) between the communities and the clinics that serve them. Community members do not share a single core set of well-known food items. Instead, multiple microenvironments within the fieldsites likely dictate differential diets and prioritize distinct sets of foods. Agreement is more pronounced among clinic workers, who display a simple food classification system based almost exclusively on taxonomic differences with the rationale for these distinctions expressed in nutritional terms. Although community members recognize the same constitutive kinds, their categories are more nuanced and reflect the concerns of day-to-day practice, encompassing when and how a food item is encountered; its origins, relative expense, and common usage; and who will likely consume it. The dissertation relates cultural models for food classification to health education messages, PPKZM programming guidelines, community conditions, and food beliefs and practices. It facilitates an understanding of place - as viewed through the lens of food security - and addresses the relative fit of current nutritional programming within this context. The study offers concrete design recommendations for a successful, child-specific food package in the short-term while arguing for a more holistic, household-level solution.

Mental illness is a complex phenomenon that is social and psychological as well as biological. But since the creation of the DSM-III in the 1980s, the landscape of mental health research and treatment in the United States has been heavily influenced by the biomedical model. The thoughts and beliefs of the lay public about mental illness are often ignored despite the push for greater cultural understanding among biomedical professionals. This disconnect, coupled with the poor mental health infrastructure, has left Mississippi with an inadequate ability to help Mississippians address mental illness. This research uses cognitive anthropological methods and biocultural theory to begin to address this disconnect. A shared cultural model of mental illness by causes, symptoms, and treatments was found. There were systematic differences between the two groups’ knowledge of causes of mental illness. Understanding these will assist in providing more culturally appropriate care for the mentally ill.