550 Cultural Aspects of Health Psychology
Major Biobehavioral Risk Factors
There is emerging evidence that acculturative stress among
Hispanics may impact health. Ontiveros, Miller, Markides,
and Espino (1999) found that higher levels of education and
language acculturation among Mexican Americans were risk
factors for having a stroke. They interpret their “nding to
suggest that Mexican Americans who are less acculturated
are more healthy and that acculturation may increase stroke
morbidity and mortality. Goslar et al. (1997) found that
among Mexican American women, there was a relationship
between acculturation and higher systolic and diastolic blood
pressure that was independent of diet, body composition, and
physical activity.
Native Americans
Morbidity and Mortality
American Indians (AI)/Alaskan Natives (AN) represent
greater than 1% of the total U.S. population (272 million
persons) and are culturally diverse; 557 of the many tribes are
federally recognized (•HIV/AIDS among American Indians,Ž
1998). Mortality data reveal excess overall mortality among
AI/AN, as well as excesses for speci“c causes of death, in-
cluding accidents, diabetes, liver disease, pneumonia/
in”uenza, suicide, homicide, and tuberculosis (Mahoney &
Michalek, 1998). For example, in an analysis of data from
NHANES II, age-speci“c prevalence of diabetes in Alaskan
Eskimos was similar to that found in U.S. Caucasians but
were the highest reported to date (Ebbesson et al., 1998). In
contrast, there is almost a •de“citŽ of deaths noted for heart
disease, cancer, and HIV infections in this population.
Major Behavioral Risk and Protective Factors
Poor socioeconomic conditions, lack of education, and cul-
tural barriers contribute to the enduring poor health status of
AI/AN. While health care is free to many in this population,
it is limited, inadequately funded, or has a limited focus on
preventative care (Joe, 1996). For example, only 50% of
AIs/ANs have had their cholesterol checked in the past two
years (NCHS, 2000).
Tobacco Use. Unusually high rates of smokeless to-
bacco have been found in some Native American populations
(Spangler et al., 1999). Kimball, Goldberg, and Oberle
(1996) found that cigarette smoking was more prevalent
among American Indian men and women than it was in the
general population in the same geographic area. Of the
American Indians interviewed, 43% of men and 54% of
women reported that they currently smoked (Kimball et al.,
1996). However, on closer examination of their smoking
habits, they tended to smoke much less heavily than smokers
in the general population.Diet. As in other ethnic groups, diet has been implicated
as a primary risk factor in the development of chronic dis-
eases among American Indian tribes. There is concern that
the dietary transition from traditional foods to more market
(store-bought) foods among indigenous populations will
bring about a rise in diet-related chronic disease (Whiting &
Mackenzie, 1998). Foods like bacon, sausage, and fried
bread and potatoes are high-fat foods frequently consumed
by Native Americans (Ballew et al., 1997; Harnack, Story, &
Rock, 1999). As in many other ethnic groups, research has
found low levels of consumption of fruits and vegetables
(Ballew et al., 1997; Harnack et al., 1999). The lack of fruit
and vegetable consumption is thought to be due to barriers
such as cost, availability, and quality (Harnack et al., 1999).Physical Activity. As with the other risk factors for
chronic illness among Native Americans, the signi“cant het-
erogeneity and unique aspects of individual tribes produce
variability in the results on physical activity reported in the
current literature. However, most of the previous research
suggests that Native Americans do not participate in physical
activity at levels suf“cient to protect against the development
of cardiovascular disease risk factors, obesity, and noninsulin-
dependent diabetes mellitus (NIDDM; Adler, Boyko,
Schraer, & Murphy, 1996; de Groot & van Staveren, 1995;
Harnack, Story, & Rock, 1999; Yurgalevitch et al.). This lack
of physical activity has been ascribed to a change from tradi-
tional activities and lifestyle that require greater energy
expenditure (Adler et al., 1996; Ravussin, Valencia, Esparza,
Bennett, & Schulz, 1994).Sexual Behavior. There is relatively little literature on
sexual behavior, sexually transmitted diseases, and HIV/
AIDS among AI/AN populations. Less than 1% of the AIDS
cases reported to the Centers for Disease Control (CDC) from
1981 through December 1997 (1,783 or 0.3%) occurred in
AI/AN populations (•HIV/AIDS among American Indians,Ž
1998). While the number of AIDS cases is low among this
population, there is concern that the future could bring
signi“cant increases in prevalence. The primary sources of
increases in the number of AIDS cases are predicted to occur
from increases in nontraditional lifestyles and sexual
partnerships composed of Native American women and
Caucasian men who are injection drug users (Fenaughty
et al., 1998).