The cultural specificity of parent-infant interaction: Perspectives of urban middle-class and rural indigenous families in Costa Rica

Caregiver-infant interactions in Western middle class often take place in dyadic play settings, engaged in infant-initiated object stimulation, and surrounded by a positive emotional tone, reflecting a distal parenting style. With this study we aim to investigate whether the same conception of caregiver-infant interaction is embodied in the proximal parenting style. For this purpose, we compare the context and pattern of caregiver-infant interactions in two cultural groups in Costa Rica: Urban middle-class families in San José and rural indigenous Bribri families. Naturalistic observations and caregiver interviews revealed significant differences between the groups, with San José families resembling the Western middle-class interaction pattern. Among the Bribris, adult-child play is uncommon so that children interact with adults in primary care settings and with older siblings in play settings. Bribri interactions are further characterized by emotional neutrality. The groups did not differ in terms of body contact. Also, caregivers in both samples took the lead in interactions more often than infants. The results are discussed in the context of an autonomous-relational style as combining psychological autonomy and hierarchical relatedness. We argue that early childhood theories and intervention programs need to abandon the assumption that Western middle-class strategies are universal and recognize locally relevant patterns of caregiver-infant interaction.

Mortality in first- and second-generation immigrants to Sweden diagnosed with type 2 diabetes: a 10 year nationwide cohort study

AIMS/HYPOTHESIS

Non-Western immigrants to Europe are at high risk for type 2 diabetes. In this nationwide study including incident cases of type 2 diabetes, the aim was to compare all-cause mortality (ACM) and cause-specific mortality (CSM) rates in first- and second-generation immigrants with native Swedes.

METHODS

People living in Sweden diagnosed with new-onset pharmacologically treated type 2 diabetes between 2006 and 2012 were identified through the Swedish Prescribed Drug Register. They were followed until 31 December 2016 for ACM and until 31 December 2012 for CSM. Analyses were adjusted for age at diagnosis, sex, socioeconomic status, education, treatment and region. Associations were assessed using Cox regression analysis.

RESULTS

In total, 138,085 individuals were diagnosed with type 2 diabetes between 2006 and 2012 and fulfilled inclusion criteria. Of these, 102,163 (74.0%) were native Swedes, 28,819 (20.9%) were first-generation immigrants and 7103 (5.1%) were second-generation immigrants with either one or both parents born outside Sweden. First-generation immigrants had lower ACM rate (HR 0.80 [95% CI 0.76, 0.84]) compared with native Swedes. The mortality rates were particularly low in people born in non-Western regions (0.46 [0.42, 0.50]; the Middle East, 0.41 [0.36, 0.47]; Asia, 0.53 [0.43, 0.66]; Africa, 0.47 [0.38, 0.59]; and Latin America, 0.53 [0.42, 0.68]). ACM rates decreased with older age at migration and shorter stay in Sweden. Compared with native Swedes, first-generation immigrants with ≤ 24 years in Sweden (0.55 [0.51, 0.60]) displayed lower ACM rates than those spending >24 years in Sweden (0.92 [0.87, 0.97]). Second-generation immigrants did not have better survival rates than native Swedes but rather displayed higher ACM rates for people with both parents born abroad (1.28 [1.05, 1.56]).

CONCLUSIONS/INTERPRETATION

In people with type 2 diabetes, the lower mortality rate in first-generation non-Western immigrants compared with native Swedes was reduced over time and was equalised in second-generation immigrants. These findings suggest that acculturation to Western culture may impact ACM and CSM in immigrants with type 2 diabetes but further investigation is needed. Graphical abstract.