Rewarding the good and punishing the bad: The role of karma and afterlife beliefs in shaping moral norms

Moralizing religions encourage people to anticipate supernatural punishments for violating moral norms, even in anonymous interactions. This is thought to be one way large-scale societies have solved cooperative dilemmas. Previous research has overwhelmingly focused on the effects of moralizing gods, and has yet to thoroughly examine other religious moralizing systems, such as karma, to which more than a billion people subscribe worldwide. In two pre-registered studies conducted with Chinese Singaporeans, we compared the moralizing effects of karma and afterlife beliefs of Buddhists, Taoists, Christians, and the non-religious. In Study 1 (N = 582), we found that Buddhists and Taoists (karmic religions) judge individual actions as having greater consequences in this life and the next, compared to Christians. Pointing to the specific role of karma beliefs in these judgements, these effects were replicated in comparisons of participants from the non-karmic religions/groups (Christian and non-religious) who did or did not endorse karma belief. Study 2 (N = 830) exploited religious syncretism in this population by reminding participants about either moral afterlife beliefs (reincarnation or heaven/hell), ancestor veneration beliefs, or neither, before assessing norms of generosity in a series of hypothetical dictator games. When reminded of their ancestor veneration beliefs, Buddhists and Taoists (but not Christians) endorsed parochial prosocial norms, expressing willingness to give more to their family and religious group than did those in the control condition. Moral afterlife beliefs increased generosity to strangers for all groups. Taken together, these results provide evidence that different religious beliefs can foster and maintain different prosocial and cooperative norms.     

Development of a genetics education workshop curriculum for Native American college and university students.

The long-term goal of Genetic Education for Native Americans (GENA), a project funded by the National Human Genome Research Institute (NHGRI), is to provide a balance of scientific and cultural information about genetics and genetic research to Native Americans and thereby to improve informed decision making. The project provides culturally sensitive education about genetic research to Native American medical students and college and university students. Curriculum development included focus groups, extensive review of available curricula, and collection of information about career opportunities in genetics. Special attention was focused on genetic research to identify key concepts, instructional methods, and issues that are potentially troublesome or sensitive for Native Americans. Content on genetic research and careers in genetics was adapted from a wide variety of sources for use in the curriculum. The resulting GENA curriculum is based on 24 objectives arranged into modules customized for selected science-related conference participants. The curriculum was pretested with Native American students, medical and general university, health care professionals, and basic scientists. Implementation of the curriculum is ongoing. This article describes the development and pretesting of the genetics curriculum for the project with the expectation that the curriculum will be useful for genetics educators working in diverse settings.     

Health,illness, and immigration. East Indians in the United States.

East Indian immigrants to the United States represent the diversity in religion, language, and culture that exists in India, so it is difficult to make unequivocal statements about their health beliefs and behaviors. Despite the diversity, an understanding of Ayurvedic humoral concepts of health and illness provides a key to some pervasive and persistent ideas and practices. India has a pluralistic medical system in which Western medicine, which is increasingly popular for some ailments, is one option among many. Even those who are familiar with the "Western" medical system in India may find American medicine alien.     

Constructs of health and environment inform child obesity prevention in American Indian communities

Objective: Obesity prevention efforts have had limited success in American Indian (AI) populations. More effective prevention programs might be designed using insights into linkages between parental health beliefs, environmental constraints and healthy lifestyle choices. Methods and Procedures: Focus group sessions (n = 42 participants) were conducted to explore parental perspectives on children's health, diet and physical activity in three Wisconsin Tribal communities. Focus group questions were derived from preliminary interviews and observations on environmental barriers surrounding nutrition and physical activity. Results: Two broad thematic areas emerged from the focus groups: child health themes and environmental themes. Health themes included views of child health (emphasizing emotional health), views on parenting, and assessment of risks to child safety. Environmental (social and physical) themes included assessments of personal support networks, assessments of local facilities and programs, and values regarding household relationships. A provisional model of family behaviors related to child nutrition and physical activity was developed to better understand these themes and the potential tensions among them. Discussion: Understanding the unique cultural constructs of health and environment of AI communities can inform decision making in community‐level prevention research. The proposed model served as a useful starting point for designing healthy lifestyle interventions in these AI communities. This model may also be applicable to other minority communities.     

Resiliency factors protecting against teenage alcohol use and smoking: influences of religion, religious involvement and values, and ethnicity in the Missouri Adolescent Female Twin Study.

The objective of this study was to investigate the contribution of ethnicity (African American vs European/other ancestry), family religious affiliation, religious involvement, and religious values, to risk of alcohol and cigarette use in adolescent girls; and to estimate genetic and shared environmental effects on religious involvement and values. Telephone interviews were conducted with a sample of female like-sex twin pairs, aged 13-20 (n = 1687 pairs, including 220 minority pairs), as well as with one or both parents of twins aged 11-20 (n = 2111 families). These data, together with one-year follow-up twin questionnaire data, and two-year follow-up parent interview data, were used to compare ethnic differences. Proportional hazards regression models and genetic variance component models were fitted to the data. Despite higher levels of exposure to family, school and neighborhood environmental adversities, African American adolescents were less likely to become teenage drinkers or smokers. They showed greater religious involvement (frequency of attendance at religious services) and stronger religious values (eg belief in relying upon their religious beliefs to guide day-to-day living). Controlling for religious affiliation, involvement and values removed the ethnic difference in alcohol use, but had no effect on the difference in rates of smoking. Religious involvement and values exhibited high heritability in African Americans, but only modest heritability in EOAs. The strong protective effect of adolescent religious involvement and values, and its contribution to lower rates of African American alcohol use, was confirmed. We speculate about the possible association between high heritability of African American religious behavior and an accelerated maturation of religious values during adolescence.     

American Indians with African Ancestry: Differential Fertility and the Complexities of Social Identity

Interethnic marriage represents a major trend in the demographic history of American Indians. While the majority of these unions involved Indian women and Caucasian men, a sizeable number occurred between Indians and African Americans. The children of these bicultural marriages were “mixed bloods” who in turn typically married non-Indians or other mixed bloods. Using data from the 1910 Census on American Indians in the United States and Alaska, this article explores why American Indians with African ancestry enjoyed high fertility. Differential rates of fertility among American Indians in the past were due to a number of underlying genetic, cultural, and environmental factors. By identifying these factors, the paradox of why Indian women with African heritage did so well in terms of fertility largely disappears. African admixture, however, greatly complicates Indian social identity.     

Effects of environmental stressors on stem cells

Environmental toxicants are ubiquitous,and many are known to cause harmful health effects.However,much of what we know or think we know concerning the targets and long-term effects of exposure to environmental stressors is sadly lacking.Toxicant exposure may have health effects that are currently mischaracterized or at least mechanistically incompletely understood.While much of the recent excitement about stem cells(SCs)focuses on their potential as therapeutic agents,they also offer a valuable resource to give us insight into the mechanisms and risks of toxicant effects.Not only as a response to the increasing ethical pressure to reduce animal testing,SC studies allow us valuable insight into the true effects of human exposure to environmental stressors under controlled conditions.We present a review of the history of publications on the effects of environmental stressors on SCs,followed by a consolidation of the literature over the past five years on a subset of key environmental stressors of importance to human health and their effects on both embryonic and tissue SCs.The review will make constructive suggestions as to areas of toxicant research where further studies are needed,as well as making indications of the potential utility for advancing knowledge and directing research on environmental toxicology.     

Down cancer alley: the lived experience of health and environmental suffering in Louisiana's chemical corridor

With the massive Gulf oil spill of 2010, there has been intensified concern about the impacts of industrial contamination on physical environments, human health, and social well-being. Based on ethnographic research in a primarily African American town in an area of Southern Louisiana colloquially known as the Chemical Corridor because of the large number of local chemical manufacturing plants, this article engages arguments made by Auyero and Swistun concerning the uncertainties and confusions that emerge when official or empowered pronouncements about the health impacts of living near waste-generating factories conflict with the everyday experience of perceived health-related contamination in an impoverished community. The article seeks to address gaps in our understanding of how communities conceive of environmental health risk, what their sources of information and level of knowledge about this issue are, and how they handle potential conflict between access to needed employment and the local presence of industrial polluters.     

The idea of health: history,medical pluralism,and the management of the body in Emilia-Romagna,Italy

Basic beliefs about health in north central Italy derive from an approach to the personal management of the body that is not just reactive but also proactive. This article examines a complex field of health factors in relation to historical processes and a system of medical pluralism. Rapid demographic and social changes over the past century have brought an accommodation of ancient medical beliefs to more recent germ-oriented principles. An enduring belief in the permeability of the body leads to an emphasis on moderation in personal conduct to prevent debilitation, whether by atmospheric insults, microbial infection, or modern-day miasmas such as pollution or additives in food. The idea of health itself is analyzed to show how biomedicine varies across societies and how historical processes have shaped contemporary cultural patterns and led to generational continuities and differences in beliefs and behaviors. This information may also improve interactions between patients and health care providers.     

Transcultural Diabetes Care in The United States – A Position Statement by the American Association of Clinical Endocrinologists

The American Association of Clinical Endocrinologists (AACE) has created a transculturalized diabetes chronic disease care model that is adapted for patients across a spectrum of ethnicities and cultures. AACE has conducted several transcultural activities on global issues in clinical endocrinology and completed a 3-city series of conferences in December 2017 that focused on diabetes care for ethnic minorities in the U.S. Proceedings from the “Diabetes Care Across America” series of transcultural summits are presented here. Information from community leaders, practicing health care professionals, and other stakeholders in diabetes care is analyzed according to biological and environmental factors. Four specific U.S. ethnicities are detailed: African Americans, Latino/Hispanics, Asian Americans, and Native Americans. A core set of recommendations to culturally adapt diabetes care is presented that emphasizes culturally appropriate terminology, transculturalization of white papers, culturally adapting clinic infrastructure, flexible office hours, behavioral medicine—especially motivational interviewing and building trust—culturally competent nutritional messaging and health literacy, community partnerships for care delivery, technology innovation, clinical trial recruitment and retention of ethnic minorities, and more funding for scientific studies on epigenetic mechanisms of cultural impact on disease expression. It is hoped that through education, research, and clinical practice enhancements, diabetes care can be optimized in terms of precision and clinical outcomes for the individual and U.S. population as a whole.Lay AbstractThe American Association of Clinical Endocrinologists (AACE) has created a diabetes care model for patients of different backgrounds. AACE led meetings in New York, Houston, and Miami with health care professionals and community leaders to improve diabetes care. Information from these meetings looked at biological and environmental diabetes risks. Four American patient groups were studied: African Americans, Latinos, Asian Americans, and Native Americans. Diabetes care should use culturally appropriate language and search for better ways to apply science and clinic design. Talking to patients more clearly can improve their diabetes control. There are many other needed changes in the American health care system discussed in this paper. It is hoped that through better education, research, and practice, diabetes care can be improved for the entire U.S. population. This means that important differences among patients' ethnic and cultural backgrounds are addressed.Executive Summary

• Cultural adaptation of evidence-based recommendations is a necessary component of optimal diabetes care.
• Biological factors that contribute to the pathophysiology of diabetes vary according to race and ethnicity and can be affected by social determinants that vary with culture.
• The “Transcultural Diabetes Nutrition Algorithm” was developed in 2010 to optimize diabetes nutrition care globally and represents a validated methodology where evidence-based recommendations from a source culture can be adapted and implemented in a different culture using a toolkit.
• The 2015 AACE Pan-American Workshop examined diabetes care in 9 Latin American nations and concluded that there should only be one level of diabetes care for a population and that level should be “excellent;” also, that A1C measurements should be utilized and that more educational and nutritional options are needed to optimize diabetes care.
• The “Diabetes Care Across America – A Series of Transcultural Summits” was an AACE program conducted in 2017 in New York, Houston, and Miami to examine cultural factors that influence diabetes care domestically; the findings of this program are presented here.
• The African American, Hispanic/Latino, Asian American, and Native American populations are each comprised of different ancestries, anthropometrics/body compositions and physical appearances, and cultures and degrees of acculturation, with a significant evidence base that associates specific gene variants with specific phenotypic traits affecting diabetes care.
• For each ethno-cultural population, health messaging and diabetes care will need to consider issues of potential distrust of health care professionals, history of discrimination, religious practices, food preferences, attitudes toward physical activity, and despite the full range of socio-economics, the impact of poverty on engagement, self-monitoring, adherence with lifestyle and medical recommendations, and recruitment for clinical trials.
• Diabetes care should be as precise as possible, incorporating clinical trial evidence that best reflects the ethno-cultural attributes of a specific patient, with particular emphasis on cardiovascular disease risk mitigation, technology to assess the effects of eating patterns on glycemic status, adjusting traditional eating patterns to more healthy options that are still acceptable to the patient, flexibility in lifestyle and medication recommendations that take into account cultural factors, and the utilization of community-based resources to improve implementation.
• Pragmatic first steps to prepare a diabetes practice for an ethno-culturally diverse patient population include: learning more about biological-cultural interactions; gaining experience with lifestyle and behavioral medicine, especially motivational interviewing; creating a safe and immersive clinical environment; incorporating translation services, social prescribing, wearable technologies, web-based resources, and community engagement; and establishing referral networks with clinical trialists in diabetes research to improve recruitment of different populations.

ABSTRACTAbbreviations: A1C = hemoglobin A1c; AACE = American Association of Clinical Endocrinologists; ABCD = adiposity-based chronic disease; BMI = body mass index; CPA = clinical practice algorithm; CPG = clinical practice guideline; DBCD = dysglycemia-based chronic disease; DPP = Diabetes Prevention Program; GWAS = genome-wide association study; HCP = health care professional(s); IHS = Indian Health Service; LDL = low-density lipoprotein; MetS = metabolic syndrome; T2D = type 2 diabetes mellitus; tDNA = transcultural Diabetes Nutrition Algorithm; TG = triglyceride; WC = waist circumference     

Effects of Minority Stress,Group-Level Coping,and Social Support on Mental Health of German Gay Men

Objective

According to epidemiological studies, gay men are at a higher risk of mental disorders than heterosexual men. In the current study, the minority stress theory was investigated in German gay men: 1) it was hypothesized that minority stressors would positively predict mental health problems and that 2) group-level coping and social support variables would moderate these predictions negatively.

Methods

Data from 1,188 German self-identified gay men were collected online. The questionnaire included items about socio-demographics, minority stress (victimization, rejection sensitivity, and internalized homonegativity), group-level coping (disclosure of sexual orientation, homopositivity, gay affirmation, gay rights support, and gay rights activism), and social support (gay social support and non-gay social support). A moderated multiple regression was conducted.

Results

Minority stressors positively predicted mental health problems. Group-level coping did not interact with minority stressors, with the exception of disclosure and homopositivity interacting marginally with some minority stressors. Further, only two interactions were found for social support variables and minority stress, one of them marginal. Gay and non-gay social support inversely predicted mental health problems. In addition, disclosure and homopositivity marginally predicted mental health problems.

Conclusions

The findings imply that the minority stress theory should be modified. Disclosure does not have a relevant effect on mental health, while social support variables directly influence mental health of gay men. Group-level coping does not interact with minority stressors relevantly, and only one relevant interaction between social support and minority stress was found. Further longitudinal or experimental replication is needed before transferring the results to mental health interventions and prevention strategies for gay men.     

Claiming respectable American motherhood: homebirth mothers, medical officials, and the state

Based on ethnographic research regarding public policy and grassroots organizing for midwifery in Virginia, this article explores how medical discourses around appropriate health care practices intersect with state discourses about what practices are considered "respectable" versus "pathological" for its citizens. In recent legislative debates about the legalization of direct-entry midwifery, medical officials have extended their criticism of midwifery and homebirth to mothers who resist state-sanctioned childbirth practices. This article examines how medical officials challenge the respectable mothering practices of homebirthers by linking them with women they deem pathological--child abusers, negligent mothers, and drug users--and placing them outside the cadre of "normal" American mothers who acknowledge the "logical" and "natural" superiority of biomedical childbirth practices. I also address homebirth mothers' responses, which assert that their political advocacy for midwives is a respectable mothering practice because they are responsible citizens who desire what they deem the best care for their children.     

Traditional Health Beliefs and Practices Among Lower Class Black Americans

The medical belief system of lower class black Americans reflects their social, political and economic marginality in the larger society. A moderate life-style is regarded as the basis for good health with special emphasis on protecting one''s body from cold, keeping it clean inside and out and maintaining a proper diet. Illnesses and other life events are classified as “natural” or “unnatural.” Natural illnesses result from the effects of cold, dirt and improper diet on the body causing changes in the blood. A number of beliefs about blood and its functions have important clinical implications for the treatment of hypertension and venereal disease and for family planning. Natural illnesses also result from divine punishment and serve as an instrument of social control. Unnatural illnesses are the result of witchcraft and reflect conflict in the social network. It is believed that physicians do not understand and cannot effectively treat such illnesses, but a variety of traditional healers offer help to the victims. Physicians must elicit such beliefs if they are to interact effectively and sensitively with black patients. Social change is required, however, to eliminate the feelings of powerlessness at the root of many of the health problems of poor black Americans.     

'India Shopping': Indian Grocery Stores and Transnational Configurations of Belonging

The cost of health services within the USA has increased in recent years, limiting access for many Americans. In response, a growing number of Americans are traveling to medical border towns in Mexico to meet their needs. However, many US patients feel uncomfortable traveling to Mexico for healthcare because they are unsure how the system works and believe that Mexico is dangerous, unregulated, unsanitary, and premodern. To reconcile these beliefs with the need for quality medical care, Mexican medical providers appropriate aspects of the US medical system to encourage patronage and alleviate the concerns of patients. This paper examines how some Mexican dentists, pharmacists and physicians in the Mexican border town of Nuevo Progreso have broadened their appeal to American patients by (a) associating their procedures with US biomedical standards, (b) building facilities that shadow US counterparts, and (c) facilitating access to the Mexican medical system.     

Racialized national identity construction in the ancestral homeland: Japanese American migrants in Japan

This article examines Japanese Americans in Japan to illuminate how ‘Japanese American’ – an ethnic minority identity in the US – is reconstructed in Japan as a racialized national identity. Based on fifty interviews with American citizens of Japanese ancestry conducted between 2004 and 2007, I demonstrate how interactions with Japanese in Japan shape Japanese Americans’ racial and national understandings of themselves. After laying out a theoretical framework for understanding the shifting intersection of race, ethnicity, and nationality, I explore the interactive process of racial categorization and ethnic identity assertion for Japanese American transnationals in Japan. This process leads to what I call racialized national identities – the intersection of racial and national identities in an international context – and suggests that US racial minority identities are constructed not only within the US, but abroad as well.     

Differences between African Americans and Whites in their attitudes toward genetic testing for Alzheimer's disease

The possibility of predictive genetic testing for Alzheimer's disease (AD) has prompted examination of public attitudes toward this controversial new health-care option. This is the first study to examine differences between Whites and African Americans with regard to: (1) interest in pursuing genetic testing for AD, (2) reasons for pursuing testing, (3) anticipated consequences of testing, and (4) beliefs about testing. We surveyed a convenience sample of 452 adults (61% white; 39% African American; 78% female; mean age = 47 years; 33% with family history of AD). Both racial groups indicated general interest in predictive genetic testing for AD, viewed it as having many potential benefits, and believed it should be offered with few restrictions. However, in comparison to whites, African Americans showed less interest in testing (p < 0.01), endorsed fewer reasons for pursuing it (p < 0.01), and anticipated fewer negative consequences from a positive test result (p < 0.001). These preliminary findings show important distinctions between whites and African Americans in their attitudes toward genetic testing for AD. These differences may have implications for how different racial and ethnic groups will respond to genetic testing programs and how such services should be designed. Future research in real-life testing situations with more representative samples will be necessary to confirm these racial and cultural differences in perceptions of genetic testing.     

Stages of Change and Weight Loss Among Rural African American Women

Objective: Obesity is a prevalent public health problem in the United States, especially for rural African American women, and causes increased morbidity and mortality. The purpose of this analysis was to determine whether the transtheoretical stages of change model was generalizable to weight loss intention among overweight and obese rural African American women and to identify important predictors of the stages of change. Research Methods and Procedures: The study was conducted in two rural counties in central Virginia. A population‐based sample of 200 women under the age of 40 completed questionnaires concerning weight loss behavior and beliefs about weight. Ordinal logistic regression was used to predict stage of change. Results: A total of 142 of the 200 women (71%) were overweight or obese (body mass index of ≥25) and were classified into a stage of change. Overall, 30% of respondents were in the precontemplation stage, 15% in the contemplation stage, 48% in the preparation stage, 4% in the action stage, and 3% in the maintenance stage. Education, what friends think about weight, body mass index, and a scale of the positive aspects of weight loss were significant predictors of the stage of change (p < 0.05). Conclusions: Several predictors of stage were the same as those found in studies of other health behaviors, and this research provides support for applying a stages of change model for weight loss intention among rural African American women. Two predictors in particular, significance of what friends think about weight and a scale of the positive aspects of weight loss, have implications for health education initiatives and social support in weight loss interventions.     

Beliefs about genetic influences on mathematics achievement: a cross-cultural comparison

The poor mathematics performance of children in the United States has become a topic of national concern. Numerous studies have shown that American children consistently perform worse than their counterparts in many parts of the world. In contrast, children in China, Japan, Taiwan, and other Asian countries consistently perform at or near the top in international comparisons. This paper examines possible causes of the poor performance of American children and the excellent performance of Asian children. Contrary to the beliefs of many Americans, the East Asian advantage in mathematics is probably not due to a genetically-based advantage in mathematics. Instead, differences in beliefs about the role of genetics may be partly responsible. Asians strongly believe that effort plays a key role in determining a child's level of achievement, whereas Americans believe that innate ability is most important. In addition, despite the relatively poor performance of their children, American parents are substantially more satisfied with their children's performance than Asian parents. The American emphasis on the role of innate ability may have several consequences for children's achievement. For example, it may lead children to fear making errors and to expend less effort on mathematics than their Asian counterparts. As research on genetic influences on behavior, traits, and abilities increases scientists should be careful to ensure that the public understands that genetics does not directly determine the exact level of a child's potential achievement. This revised version was published online in August 2006 with corrections to the Cover Date.     

Does size really matter? Weight and values in public health

The medical community has long regarded obesity and overweight as serious health risks, and popular culture reflects these concerns. A focus on body weight reduction motivates many contemporary exercise and diet practices, especially among women. Yet, there is significant evidence that those risks have been exaggerated, that weight loss regimens may be more detrimental to health than moderate obesity, and that pressure to be thin leads to disordered eating and unhealthy lifestyle choices. This paper examines the problematic manners in which some national health policies regard the problems of overweight and obesity. It contends that concepts of aesthetics, grounded in 19th-century beliefs about the body, guide clinicians to emphasize measurement of the body in health assessment at potential cost to individual wellness.     

The French are different. French and American medicine in the context of AIDS.

Medicine has often been approached as a thing apart from culture, as a uniform Western science. Within the past 10 years, we have begun to recognize that medicine is a system of beliefs and practices intrinsically linked to its larger sociocultural context. Still, it is generally perceived as uniform across North America and Western Europe. My recent research on French and American medical perspectives on the acquired immunodeficiency syndrome (AIDS) challenges this view by exploring differences in the structure of health care, the physician-patient relationship, and the conceptualizations of disease, particularly AIDS. These differences are not specific to AIDS, but the disease serves to exemplify them and to act as a medium for expressing what makes French and American medicine distinct. Global epidemics such as AIDS require both international response and cross-cultural understanding.