Roberta D. Baer

Variation in Asthma Beliefs and Practices Among Mainland Puerto Ricans, Mexican-Americans, Mexicans, and Guatemalans

This study reports on community surveys of 160 representative Latino adults in Hartford, CT; Edinburg, TX; Guadalajara, Mexico; and in rural Guatemala. A 142-item questionnaire covered asthma beliefs and practices (e.g., causes, symptoms, and treatments). The cultural consensus model was used to analyze the agreement among respondents within each sample and to describe beliefs. Beliefs were then compared across the four samples. Analysis of the questionnaire data shows that there was overall consistency or consensus regarding beliefs and practices among individuals at each site (intraculturally) and to a lesser extent across respondents of all four different Latino cultural groups (i.e., interculturally). This pattern of response is indicative of a shared belief system among the four groups with regard to asthma. Within this shared belief system though, there is systematic variation between groups in causes, symptoms, and treatments for asthma. The most widely recognized and shared beliefs concerned causes of asthma. Notable differences were present between samples in terms of differences in beliefs about symptoms and treatments. The biomedical model is shown to be a part of the explanatory model at all sites; in addition to the biomedical model, ethnocultural beliefs such as the humoral (“hot/cold”) aspects and the importance of balance are also evident. The Connecticut Puerto Ricans had a greater degree of shared beliefs about asthma than did the other three samples (p<0.00005). It was concluded that the four Latino groups studied share an overall belief system regarding asthma, including many aspects of the biomedical model of asthma. In addition, traditional Latino ethnomedical beliefs are present, especially concerning the importance of balance in health and illness. Many beliefs and practices are site-specific, and caution should be used when using inclusive terms such as “Hispanic” or “Latino,” since there is variation as well as commonality among different ethnic groups with regard to health beliefs and practices.

A Cross-Cultural Approach to the Study of the Folk Illness Nervios

To systematically study and document regional variations in descriptions of nervios, we undertook a multisite comparative study of the illness among Puerto Ricans, Mexicans, Mexican Americans, and Guatemalans. We also conducted a parallel study on susto (Weller et al. 2002, Culture, Medicine and Psychiatry 26(4): 449– 472), which allows for a systematic comparison of these illnesses across sites. The focus of this paper is inter- and intracultural variations in descriptions in four Latino populations of the causes, symptoms, and treatments of nervios, as well as similarities and differences between nervios and susto in these same communities. We found agreement among all four samples on a core description of nervios, as well as some overlap in aspects of nervios and susto. However, nervios is a much broader illness, related more to continual stresses. In contrast, susto seems to be related to a single stressful event.

Empacho in four Latino groups: a study of intra- and inter-cultural variation in beliefs.

It is usually impossible to know if reported differences between cultures are due to cultural differences or due to a difference in the methods used to study the cultures. This paper describes a collaborative, multisite study using a shared methodology to study intra- and inter-cultural variation in beliefs. A series of standard interview schedules were used to study Latin American beliefs about empacho in Guatemala, Mexico, and in the United States (Mexican-Americans and Puerto Ricans). Results showed consistency in beliefs about empacho both within and between the four samples.

Regional variation in Latino descriptions of susto.

Susto, a folk illness notrecognized by biomedical practitioners as adisease, is now formally part of the diagnosticclassification system in psychiatry as a“culture-bound syndrome.” Susto has beenreported among diverse groups of LatinAmericans, but most of those reports areseveral decades old and many were conducted inIndian communities. This study focuses oncontemporary descriptions of susto anduses a cross-cultural, comparative design todescribe susto in three diverse Latinopopulations. Mestizo/ladino populations wereinterviewed in Guatemala, Mexico, and southTexas. An initial set of open-ended interviewswas conducted with a sample of “key” informantsat each site to obtain descriptive informationabout susto. A structured interviewprotocol was developed for use at all threesites, incorporating information from thoseinitial interviews. A second set of structuredinterviews was then conducted with arepresentative sample at each site. Resultsindicate a good deal of consistency in reportsof what susto is: what causes it, itssymptoms, and how to treat it. There appear tobe, however, some notable regional variationsin treatments and a difference between pastdescriptions and contemporary reports ofetiology.

Research report: Susto and pesticide poisoning among Florida farmworkers

This paper discusses research designed to investigate farmworker interpretation of a serious incident of pesticide poisoning, specifically, whether this incident was considered to precipitate the Mexican folk illness “susto.” The study revealed that a total of 23% of the population interviewed felt that they definitelyor possibly had developed susto as a result of the pesticide exposure. These patients complained of more residual symptoms from the pesticide exposure than did those who had been affected by the poisoning but who did not feel they suffered from susto. The findings have implications for medical providers working with these populations. A self diagnosis of “susto” may indicate that a patient is indeed sicker than other indicators suggest, and point to a need for increased follow-up.

Toxic Mexican folk remedies for the treatment of empacho: The case of azarcon, greta, and albayalde

This article discusses the availability of three lead-based salts which are being used as folk remedies in Mexico. Distribution systems and geographic availability were determined, and purchased samples were found to be very high in lead content. The findings suggest the need for further research to understand the reasons why such remedies are chosen, and the development of an educational program to discourage their use.

Measuring Within- and Between-Group Agreement: Identifying the Proportion of Shared and Unique Beliefs Across Samples

Questions about culture sharing and uniqueness can be addressed by measuring the amount of agreement within and between groups. This article describes methods to measure withinand between-sample agreement with particular emphasis on finding, using, and interpreting agreement. The discussion focuses on the case of a single set of related questions asked of two or more groups of informants, but the methods apply to the more general case with a set of related variables recorded for two or more sample units (e.g., culture traits or inventory materials). Methods are illustrated with Weller and Baers study of withinand between-group agreement for four Latino samples for beliefs about each of five illnesses (AIDS, diabetes, the common cold, empacho, and mal de ojo ).

Lead based remedies for empacho: Patterns and consequences

This paper discusses research designed to investigate the patterns and consequences of the use of lead based folk remedies in the treatment of some gastrointestinal problems in Mexico. Use of lead is seen in 35% of the population sampled in Guadalajara who treated the folk illness empacho, and 5% of a similar population in Oaxaca. Lead use seems to be associated with mestizo ethnic background, and with lower levels of parental education and income.

Explanatory models of diabetes in the U.S. and Mexico: The patient–provider gap and cultural competence

Successful management of type 2 diabetes requires support and collaboration between diabetic patients, their health care providers, family and community. Using data collected in 1994-2001, we describe illness beliefs of physicians, patients, and representative samples of community members in the US and Mexico. We test whether differences in conceptualizations of diabetes are greater across national and linguistic boundaries or between physicians and lay groups. Interviews were conducted in southern Texas on the Mexican border and in Guadalajara, Mexico. Culturally appropriate interview materials were developed with a mixed-methods approach. Qualitative interviews elicited beliefs about causes, risks, symptoms, and treatments for diabetes and salient themes were incorporated into structured interviews. A cultural consensus analysis was used to verify salient themes within each of the six samples. The consistency in responses in each of the six samples indicated a shared core of beliefs that transcended individual variations. The greatest differences occurred between physician and lay samples; patient and community models were more similar to one another than to the physician models. Differences between physicians and patients may affect optimal management of diabetes, but these differences do not appear to be simply a function of differences in national culture and language, as the largest differences occurred in Mexico. This suggests that rather than cultural competence per se, formal educational levels and class differences may also play an important role in patient understanding and the gap in patient-provider understanding.

Mexican use of lead in the treatment of empacho: Community, clinic, and longitudinal patterns

This paper discusses research designed to investigate community, clinic, and longitudinal patterns in use of lead as a treatment for empacho, a folk illness manifest by gastrointestinal symptoms. The same questionnaire used in a clinic-based study seven years previously in Guadalajara, Mexico, was used to interview a randomly selected community sample: in addition, the study was repeated at the same clinic sites that had been studied previously. The goals were to investigate: (1) What are community wide prevalences of empacho and use of lead based remedies? (2) To what extent are current patterns of use of lead for treatment of empacho in clinic-based samples similar to those seven years ago. The attributable risk to the population as a whole from use of lead based remedies was found to be 11% of the households of Guadalajara. Essentially this same estimate was seen for the 1987 and 1994 clinic populations. Interestingly, while percentages of lead users have declined since 1987, twice as great a percentage of informants reported treating empacho. Other patterns originally identified in 1987 persisted in 1994; lead use continues to be associated with lower levels of parental education and income.