Cultural Diversity and Health Psychology
Elizabeth A. Klonoff
Sun Diego State University / University of California-Sun Diego
Joint Doctoral Program in Clinical Psychology
Two social factors that play a role in everyone's health (Bubker et al., 1989) are the nature and quality of their jobs/work environments (J. V. Johnson & Johannson, 1991; Karasek & Theorell, 1990; Sauter, Hurrell, & Cooper, 1989; Schor, 199 l), and their socioeconomic (SES) status (Marmot, Kogevinas, & Elston, 1987; Schnall, Landsbergis, & Baker, 1994). Because U.S. minority groups tend to occupy low status jobs characterized by high job strain and low job control and stability, the nature of their work undoubtedly contributes to their differential morbidity and mortality (Amick, Levine, Tarlov, & Walsh, 1995). Likewise, because many minorities live in poverty (Amick et al., 1995), low SES also plays a role in minority excess morbidity and mortality through a variety of mechanisms (Baquet, Horm, Gibbs, & Greenwald, 1991; Coulehan, 1992; Hampton, 1992; Marmot & Theorell, 1988). These include low access to medical care (Blendon, Aiken, Freeman, & Corey, 1989) and high exposure to stress (King & Williams, 1995), air pollution (Brajer & Hall, 1992), toxic waste sites in their neighborhoods (Commission for Racial Justice, 1987), and carcinogens at work (Gottlieb & Husen, 1982; Samet, Kutvrit, Waxweiler, & Key, 1984).
Although these factors (along with low education) have been demonstrated to play a significant role in the health status of minorities, they nonetheless remain social rather than cultural variables. Social variables are parts (aspects), processes (mechanisms for maintaining), and products (results) of social stratification that may or may not be valued by, and are beyond the control of Whites and minorities alike (Landrine, Klonoff, Alcaraz, Scott, & Wilkins, 1995). Cultural variables, on the other hand, are factors that are purposefully transmitted to successive generations through socialization because they are valued (Landrine, 1992; Landrine (8. Klonoff, 1996a; Landrine, Klonoff, & Brown-Collins, 1992). Manuscripts on culture and minority health abound, but almost always focus on social variables and fail to mention any cultural factors. Poverty, low education, and unemployment, however, never have been aspects of anyone's culture.
Alternatively, other research on culture and minority health rightly ignores social variables as such to focus instead on the role of acculturation. These studies have found that acculturation contributes significantly to the variance in minority health behavior and morbidity irrespective of the minority group in question. For example, studies have found that acculturation plays a role in weight and dieting among Japanese' (Furukawa, 1994) and Chinese (Schultz, Spindler, & Josephson, 1994) Americans, and in chronic disease among Cambodian Americans (Palinkas & Pickwell, 1995). For Mexican Americans, acculturation has been demonstrated to play a role in hypertension (Espino, 1990); AIDS risk and knowledge of AIDS transmission (Epstein, Dusenbury, Botvin, & Diaz, 1994); cancer knowledge and risk reduction behaviors (Balcazar, Castro, & Krull, 1995); compliance with medical treatments (Pachter, Susan, & Weller, 1993); cigarette smoking among children, adolescents (Landrine, Richardson, Klonoff, & Flay, 1994), and adults (G. Marin, B. V. Marin, Otero-Sabogal, Sabogal, & Perez-Stable, 1989; G. Marin, Perez-Stable, & B. V. Marin, 1989); use of health services (Wells, Golding, & Hough, 1989); dietary patterns (Gardner, Winkleby, & Viteri, 1995); salt consumption and exercise frequency (Vega et al., 1987); and chronic disease