Culture and the Immune System: Cultural Consonance in Social Support and C-reactive Protein in Urban Brazil

Transition to a market economy and chronic psychosocial stress in northern Laos: An exploratory study of urinary free cortisol in rural residents

OBJECTIVES

The indigenous population in northern Laos has experienced a transition from self-sufficiency to a market-oriented economy, which may have brought about unprecedented chronic psychosocial stress. This study examined the association between the transition to a market economy and urinary free cortisol (UFC) concentration as a stress biomarker among rural residents of three villages with different degrees of integration into the market economy.

METHODS

An interview survey and urine sample collection were conducted in August 2018 and March 2019. We measured the UFC concentration in spot urine samples collected in the morning from participants aged 20-60 years (n = 168) using an enzyme-linked immunosorbent assay. Multiple linear regression analysis was performed to examine differences in UFC concentrations among villages by sex, with time of arrival for the survey, age, and body mass index included as covariates.

RESULTS

The UFC concentration was higher in men living in the village with the highest degree of integration into the market economy than in those in the two villages with a lower dependence on cash, possibly linking increased stress levels with a change in employment type. This trend was not observed in women.

CONCLUSION

Socioeconomic changes incidental to a transition to a market economy may increase the stress levels of men in northern Laos.

Friendship during patients' stable and unstable phases of incurable cancer: a qualitative interview study

OBJECTIVES

Little is known about the added value of friendship during the care of intensive cancer disease trajectories. Friends, however, can play an important (caring-)role to increase their friends' (mental) well-being. We explored the experiences and desires of friends while their ill friends were-most of the time-in a stable phase of incurable cancer.

DESIGN

Qualitative study in the Netherlands based on 14 in-depth interviews with friends of patients living with incurable cancer. Interviews were performed at the home setting or the friend's office. Data gathering was inspired by grounded theory and analysed with a thematic analysis.

SETTING

The home setting/friend's office.

RESULTS

Friends reported to experience difficulties in how and how often they wanted to approach their ill friends. They emphasised the ever-present knowledge of cancer inside their friends' body as a 'time bomb'. They seemed to balance between the wish to take care for their ill friend, having a good time and not knowing what their ill friend desired at specific times. Some friends felt burdened with or forced to provide more care than they could, although they acknowledged that this relationship provided space to reflect about their own life.

CONCLUSIONS

Friends are constantly negotiating and renegotiating their relationship depending on the severity of the disease, transparency of patients about their illness, their previous experiences and personal circumstances in life. Although a decrease in friendship may impact a patient's quality of life, friends also need to be protected against providing more care than they are willing or able to give. Healthcare professionals, being aware of this phenomenon, can assist in this.

Skin Tone and the Health Returns to Higher Status

This study addresses two questions. First, why do Black Americans exhibit worse health outcomes than White Americans even at higher levels of socioeconomic status (SES)? Second, are diminished health returns to higher status concentrated among Black Americans with darker skin color? Novel hypotheses are tested with biosocial panel data from Add Health, a nationally representative cohort of Black and White adolescents who have transitioned to adulthood. We find that White and light-skin Black respondents report improved health after achieving higher SES, on average, while their darker-skin Black peers report declining health. These patterns persist regardless of controls for adolescent health status and unmeasured between-person heterogeneity. Moreover, increased inflammation tied to unfair treatment and perceptions of lower status helps to account for patterns of diminished health returns for dark-skin Black groups. Our study is the first to document skin tone heterogeneity in diminished health returns and one of few studies to identify life course stress processes underlying such disparities. We consider additional processes that could be examined in future studies, as well as the broader health and policy implications of our findings.

Networks, cultures, and institutions: Toward a social immunology

This paper calls for increased attention to the ways in which immune function – including its behavioral aspects – are responsive to social contexts at multiple levels. Psychoneuroimmunology has demonstrated that the quantity and quality of social connections can affect immune responses, while newer research is finding that sickness temporarily affects these same social networks and that some aspects of culture can potentially “get under the skin” to affect inflammatory responses. Social immunology, the research framework proposed here, unifies these findings and also considers the effects of structural factors – that is, a society's economic, political, and environmental landscape – on exposure to pathogens and subsequent immune responses. As the COVID-19 pandemic has highlighted, a holistic understanding of the effects of social contexts on the patterning of morbidity and mortality is critically important. Social immunology provides such a framework and can highlight important risk factors related to impaired immune function.

One size does not fit all: Links between shift-and-persist and asthma in youth are moderated by perceived social status and experience of unfair treatment

The links between low socioeconomic status and poor health are well established, yet despite adversity, some individuals with low socioeconomic status appear to avoid these negative consequences through adaptive coping. Previous research found a set of strategies, called shift-and-persist (shifting the self to stressors while persisting by finding meaning), to be particularly adaptive for individuals with low socioeconomic status, who typically face more uncontrollable stressors. This study tested (a) whether perceived social status, similar to objective socioeconomic status, would moderate the link between shift-and-persist and health, and (b) whether a specific uncontrollable stressor, unfair treatment, would similarly moderate the health correlates of shift-and-persist. A sample of 308 youth (Meanage = 13.0, range 8-17), physician diagnosed with asthma, completed measures of shift-and-persist, unfair treatment, asthma control, and quality of life in the lab, and 2 weeks of daily diaries about their asthma symptoms. Parents reported on perceived family social status. Results indicated that shift-and-persist was associated with better asthma profiles, only among youth from families with lower (vs. higher) parent-reported perceived social status. Shift-and-persist was also associated with better asthma profiles, only among youth who experienced more (vs. less) unfair treatment. These findings suggest that the adaptive values of coping strategies for youth with asthma depend on the family's perceived social status and on the stressor experienced.

Psychological buffers against poor health: the role of the socioeconomic environment

Beliefs, emotions, and other psychological resources can protect physical health. Notably, however, the particular ways of thinking, feeling, and acting that are associated with better health can vary with one's socioeconomic status (SES). Those that are most protective reflect what is afforded in and valued by the context. Specifically, in higher SES environments, where people often have the resources to be independent and influence their own destinies, beliefs that reflect independence and a focus on the individual predict better health. In contrast, in lower SES environments, where people often encounter more constraints, beliefs and coping strategies that reflect connection to others, and adjustment to the environment predict better health. Understanding these differences will help to address health disparities.

Views of a good life and allostatic load: Physiological correlates of theories of a good life depend on the socioeconomic context

This research examines the relationship between one's theory of a good life and allostatic load, a marker of cumulative biological risk, and how this relationship differs by socioeconomic status. Among adults with a bachelor's degree or higher, those who saw individual characteristics (e.g., personal happiness, effort) as part of a good life had lower levels of allostatic load than those who did not. In contrast, among adults with less than a bachelor's degree, those who saw supportive relationships as part of a good life had lower levels of allostatic load than those who did not. These findings extend past research on socioeconomic differences in the emphasis individual or relational factors and suggest that one's theory of a good life has health implications.