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IS ACCULTURATION HEALTHY? BIOLOGICAL, CULTURAL, AND ENVIRONMENTAL CHANGE AMONG THE COFAN OF ECUADOR.
DISSERTATION
Presented in Partial Fulfillment of the Requirements
for the Degree Doctor of Philosophy in the Graduate
School of The Ohio State University
By Lori J. Fitton, M.A.
*****
The Ohio State University 1999
Dissertation Committee:
Dr. Douglas E. Crews, Adviser Approved by Dr. Frank E. Poirier Dr. Ivy L. Pike Adviser Department of Anthropology UMI Kumber: 9951654
Copyright 1999 by Fitton, Lori J. All rights reserved
UTVLI
UMI Microform 9951654 Copyright 2000 by Beil & Howell Information and Learning Company. All rights reserved. This microform edition is protected against imauthorized copying under Title 17, United States Code.
Bell & Howell Information and Learning Company 300 North Zeeb Road P.O. Box 1346 Ann Arbor, MI 48106-1346 Copyright by
Lori J. Fitton
1999 ABSTRACT
Economic development of tropical rainforests affects the health of indigenous
populations. Environmental and cultural change can deplete natural resources, undermine
traditional subsistence, increase population densities, and disrupt social systems thereby
modifying health and disease patterns of native populations. Although acculturation can
bring increased opportunities for health education and access to western medicines, it can
cause the estrangement of indigenous groups resulting in lifestyle deterioration and an overall reduction in health.
This research examines cultural and biological variation among the Cofan, an
indigenous Amazonian group of Northeastern Ecuador. Two closely related Cofan
villages, Dureno and Zabalo, undergoing varying rates of acculturation and environmental pressures were chosen. As a population in transition, the Cofan present an opportunity to
examine intrinsic and extrinsic factors related to acculturation. This study combines cultural and biomedical data to examine how these domains interact and change in response
to acculturation and environmental degradation. Anthropometric measures, blood pressure,
fecal samples, dental exams and blood samples determined physiological variability. Social assessments included lifes^le, health, and nutrition questionnaires designed to determine participation in non-Cofan lifeways, general health knowledge and lifestyle stress, unusual health conditions, and dietary diversity.
Results show that environmental degradation initiated a series of cultural changes in and around the village of Dureno. A decrease in wild game and fish reserves resulted in a subsistence shift from hunting and fishing to agriculture and raising livestock. Increasing
ii population density and decreasing land availability are also contributing to a decline in health as seen with higher parasite loads. Residents o f the Zabalo community have escaped environmental degradation by moving further into the rainforest. This group is younger, has a higher material lifestyle and socioeconomic status and scores higher on the acculturation index. Although trying to preserve their traditional subsistence lifestyle they too are affected by culture change. Zabalo residents selectively incorporate elements of the dominant society into their lifeways and supplement their indigenous lifestyle with an ecotourism business. Although not as environmentally destructive, ecotourism too may eventually have sociocultural and health costs for this population. For example, lifestyle stress, as measured by lifestyle incongruity, is higher in Zabalo, especially among males.
Although weight and BMI does not differ between villages, males from Zabalo have larger upper arm and hip circumferences, higher rates of dental caries, and higher cholesterol compared to Dureno males. However, Dureno males and females have higher diastolic blood pressure and pulse rates compared to Zabalo.
The results of this study reveal the complex interplay between environment, culture, and health. The extent to which progressive acculturation will alter the health and disease status of this population, and the specific elements which are causative, are conjectural at the present time. However, by reaffirming their cultural identity and regaining a sense of control over their lives, indigenous groups such as the Zabalo Cofan may be reducing the psychological stress of change, thus reducing their risks of developing chronic conditions such as hypertension.
Ill Dedicated to my parents, Ernest and Lena Biagioni, who instilled in me a love of nature and encouraged me
not only to ask questions but to search for answers.
For this and much more I am forever grateful.
IV ACKNOWLEDGMENTS
This dissertation could not have been completed without out the assistance of many people. First and for most my sincere thanks to the Cofan communities of Dureno and
Zabalo. Thank you for letting me into your lives your kindness will not be forgotten. This study is part of The Ohio State University CEHAB project (Conservation, Education,
Human Adaptability and Biodiversity in Amazonia ) therefore, I thank Dr. Frank E. Poirier and Dr. Gary Mullins (Co-directors of CEHAB) for their support throughout this project.
I express my deepest gratitude to Dr. Frank E. Poirier for introducing me to the Cofan and presenting me with this research opportunity. I will be forever gratefiil for his support, advice, and guidance throughout my years at The Ohio State University. His words of encouragement helped me through some rough times. I especially thank my adviser. Dr.
Douglas Crews for presenting me with many challenging opportunities throughout my graduate studies. His guidance as a researcher along with his editorial and statistical expertise were invaluable. In addition, I am grateful to Dr. Ivy Pike for her statistical help, and for her encouragement and advice throughout the writing process. I also would like to thank Dr. James Bindon for his help with the lifestyle incongruity and dietary data. I am deeply grateful to the Borman families (Bub and Bobbie; Randy and Amelia; Ron and
Esther) for introducing me to the Cofan communities and aiding in data collection. I only hope we can work together again in the near future. I also thank my translator Diego
Vallejo, and my friends at EcoCiencia, Roberto Ulloa, and Mario Garcia. I thank several corporations for graciously donating supplies for this study; Bayer Diagnostics for supplying the Glucometer® supplies, Boehringer Mannheim for supplying the Accustat® HCG pregnancy tests, ChemTrak for supplying the Accumeter® Cholesterol test kits,
HemoCue for supplying microcuvettes for hemoglobin analyses, and Meridian Diagnostics
for supplying the SAF® fecal collection systems. A special thanks to Sharon Williams and
Kevin Organisciak for their help with data collection, and to Bobby Ghaheri and Melissa
Reece-Nelson for their assistance in sample preparation. I also thank Dr. Gillian Harper
for her advice and words of encouragement throughout this study.
Finally, I would like to thank my family and close friends for their support and encouragement during the many hours taken from them to write and think. Most importantly, I thank my husband, Barney Fitton. He was the impetus for me to attend
graduate school, and his unwavering and patient support throughout my field research and
many years of education were truly exceptional. I thank you from the bottom of my heart.
V I VTTA
April 18, 1958 ...... Born - La Salle, Illinois
1978 AAS Medical Technology,
Sauk Valley College, Illinois
1992...... B.A. Anthropology,
The Ohio State University
1994...... M.A. Anthropology,
The Ohio State University 1992-1994...... Graduate Research Associate,
The Ohio State University 1995-1998...... Graduate Teaching Associate,
The Ohio State University
PUBLICATIONS
Fitton LJ, Crews DE.(1993) Glucose determinations in field situations: comparison of portable monitoring devices and chemistry analyzers. American Journal of Human Biology. 5(1) Abstract
Fitton LJ, Crews DE. (1994) Glucose determinations in field situations: comparison of portable monitoring devices and chemistry analyzers. Collegium Anthropologicum 18(1V. 45-52.
Fitton LJ, Crews DE. (1995) Blood pressure in Cofan Indians of Ecuador: another low blood pressure population. American Journal of Human Biology. 7f 1): 122.
Fitton LJ, Crews DE, and Kamboh M Ilyas. (1996) Apolipoprotein polymorphisms: relationships with quantitative lipid and apolipoprotein levels in American Samoans. American Journal of Physical Anthropologv . suppl. 22: 104.
Vll Crews DE, Fitton LJ, and Kottke B. (1996) The ACE insertion/deletion polymorphism in American Samoans: associations with lipitk and interactions with apolipoprotein polymorphisms. American Journal of Physical Anthropology, suppl. 22: 91.
Fitton LJ, and Crews DE. (1997) Fasting and post-load insulin, c-peptide and glycated hemoglobin levels in normoglycemic and hyperglycemic Samoans. American Journal of Physical Anthropology, suppl. 24: 110.
Crews DE, and Fitton LJ. (1997) Glucose, insulin, and c-peptide in American Samoans: associations with body habitus and other risk factors. American Journal of Physical Anthropology, suppl. 24: 97.
Poirier FE and Fitton LJ. (1998) Ecotourism in Ecuador: indigenous survival in the 21st century. The 21st century: the century of anthropology: The International Union of Anthropological and Ethnological Sciences flUvAESL Williamsburg: lUAES, pp. 292.
Fitton LJ. (1998) Heliminthiasis and culture change among the Cofan of Ecuador. American Journal of Human Biology. (10)1: 122-123. Williams SR, Fitton LJ, And Crews DE. (1998) Seasonality of births among the Cofan of Ecuador. American Journal of Human Biology. (10)1:138. Fitton LJ. (1999) Biocultural correlates of health among the Cofan of Ecuador. American Journal of Physical Anthropology, suppl. 26: 127.
FIELDS OF STUDY
Major Field: Anthropology
Specialization: Human Population Biology Biocultural Anthropology Aging and Chronic Disease
V l l l TABLE OF CONTENTS
Page A bstract...... ii
D edication ...... iv
Acknowledgments ...... v V ita...... vii
List of Tables ...... xii List of Figures ...... xix
Chapters: 1. Introduction 1.1 Acculturation and Health ...... 1 1.2 Changes Associated With Acculturation ...... 4 1.2.1 Environmental changes and consequences ...... 5 1.2.2 Social changes and consequences ...... 8 1.2.3 Health changes and consequences ...... 11 1.2.4 Summary ...... 31 1.2.5 Rationale for studying the Cofan ...... 32 1.3 Research Objectives...... 33
2 . Sample and Methods 2.1 R esearch D esign ...... 34 2.2 Study Population ...... 36 2.2.1 General characteristics of the Amazon Region ...... 36 2.2.2 Cofan History ...... 38 2.3 Study Samples ...... 40 2.3.1 Sample selection ...... 40 2.3.2 Village ethnographic description ...... 42 2.4 Data Collection Techniques ...... 44 2.4.1 Overview...... 44 2.4.2 Procedures ...... 45 2.5 Lifestyle and Behavioral Factors ...... 53 2.6 Anthropometric Indices ...... 55 2.7 Statistical Analyses ...... 55 ix 3 . Results I: Inter and Intra*Village Biobehavioral Variables 3.1 Introduction ...... 57 3.2 Household Characteristics ...... 57 3.2.1 Demographic and social composition ...... 57 3.2.2 Material style of life ...... 62 3.2.3 Household food supply ...... 65 3.3 Individual Characteristics ...... 68 3.3.1 Social characteristics...... 68 3.3.2 Personal habits and activity patterns ...... 74 3.3.3 Health related practices and beliefs ...... 76 3.3.4 Indices ...... 78 3.4 Correlation Between Social Variables and Health Risk Index ...... 80 3.5 Comparison of Behavioral Factors and Lifestyle Indices Between Adult Cohorts ...... 81
4 . Results II: Inter and Intra-Village Biological Variables
4.1 Introduction ...... 82 4.2 Growth and Body Composition ...... 82 4.2.1 Children ...... 82 4.2.2 Adults ...... 91 4.3 Physiological Variables ...... 96 4.4 Intestinal Parasites ...... 100 4.5 Dental Health...... 103 4.5.1 Children ...... 104 4.5.2 Adults ...... 106 4.6 Biological and Physiological Variation Among Adult Cohorts ...... 109
5 . Results n i: Associations of Biobehavioral and Biological Variables 5.1 Introduction ...... 120 5.2 Biobehavioral Factors and Dental Health ...... 121 5.3 Biobehavioral Factors and Physiological Variables ...... 126 5.3.1 Total cholesterol ...... 127 5.3.2 Glucose ...... 130 5.3.3 Hemoglobin ...... 132 5.3.4 Blood Pressure ...... 134 5.4 Biobehavioral Factors and Anthropometric Measures ...... 140 5.5 Biobehavioral Factors and Intestinal Parasitic Infections ...... 147
6 . Discussion and Conclusions 6.1 Introduction ...... 152 6.2 Summary of Major Results and Comparisons With Other Studies 153 6.2.1 Hypotheses...... 184 6.2.2 Conclusions ...... 187 6.3 Significance of Research and Future Directions ...... 188 Bibliography ...... 191
Appendix A Maps ...... 206
Appendix B Physical assessment sheets...... 211
Appendix C 24-hour dietary recall form ...... 213
Appendix D Food frequency form ...... 214
Appendix E Individual questionnaries ...... 217
Appendix F Household questionnaires ...... 220
Appendix G Principle components analyses ...... 222
XI UST OF TABLES
Table Page
3.2 Frequencies and p-values for intervillage differences in marital characteristics and number of children between Cofan males and females from Dureno and Zabalo ...... 61
3.3 Frequencies and p-values (based on proportional inferences) for intervülage differences in household variables among adult Cofan from Dureno and Zabalo ...... 64
3 A Frequencies and p-values (based on proportional inferences) for intervillage differences in individual life style variables among adult Cofan from Dureno and Zabalo ...... 70
3.5 Percent participation in non-traditional occupations and p-values (based on proportional inferences) for inter\#age differences among adult Cofan from Dureno and Zabalo ...... 74
3.6 Frequencies and P-values for differences in self-reported illnesses between Cofan from Dureno and Zabalo ...... 77
3.7 Means and P-values (based on t-tests) for intervillage differences in lifestyle and health-related indices between Cofan from Dureno and Z ab alo ...... 80
3.8 Correlation coefficients (p-values) for behavioral factors and lifestyle indices in relation to Health Risk hidex for adult population from Dureno and Zabalo ...... 81
4.1 Intra-village means by sex, and p-values (based on t-tests) for differences in anthropometric variables between age categories from Zabalo ...... 84 4.2 Intra-village means by sex, and p-values (based on t-tests) for differences in anthropometric variables between age categories from Dureno ...... 85 4.3 Inter-village means and p-values (based on t-tests) for differences in anthropometric variables between boys < 12 years of age from Dureno and Z abalo ...... 86
Xll 4.4 Inter-village means and p-values (based on t-tests) for differences in anthropometric variables between girls <12 years of age from Dureno and Z ab alo ...... 87
4.5 Comparison of Dureno boys and girls to NCHS reference values by sex and age group ...... 89
4.6 Comparison of Zabalo children to NCHS reference values by sex and age g ro u p ...... 90
4.7 Intra-village means (standard deviation) and p-values (based on t-tests) for differences in anthropometric variables between sexes among adult participants (> 13 years) from Dureno ...... 92
4.8 Intra-village means (standard deviation) and p-values (based on t-tests) for differences in anthropometric variables between sexes among adult participants (> 13 years) from Zabalo ...... 93
4.9 Comparisons of inter-vülage means and p-values (based on t-tests) for differences in anthropometric variables between males (>13 years) from Dureno and Zabalo ...... 94
4.10 Comparisons of inter-village means and p-values (based on t-tests) for differences in anthropometric variables between females (>13 years) from Dureno and Zabalo ...... 95
4.11 Intra-village means (standard deviation) and p-values (based on t-tests) for differences in physiological variables between sexes among adult participants (> 13 years) from Dureno ...... 97
4.12 Intra-village means (standard deviation) and p-values (based on t-tests) for differences in physiological variables between sexes among adult participants (> 13 years) from Zabalo ...... 98
4.13 Inter-village means (standard deviation) and p-values (based on t-tests) for differences in physiological variables by sex between villages on participants > 13 years old ...... 99
4.14 Means, standard deviations, and ranges for hemoglobin levels (Hb) by age, sex, and village ...... 100
4.15 Cofan age groups based on daily activity patterns ...... 101
4.16 Prevalence of and p-values (based on proportional inferences) by sex for differences in helminth infections in fecal samples from Cofan of Dureno and Zabalo ...... 102
xm 4.17 Prevalence of and p-values (based on proportional inferences) by sex for differences m. Ascaris and hookworm infections in the Cofm from Dureno and Zabalo ...... 102
4.18 Prevalence of and p-values (based on proportional inferences) by sex for differences in single and double helminth infections in fecal samples from Cofan of Dureno and Zabalo ...... 103
4.19 Prevalence of and p-values (based on proportional inferences) by sex for differences in helminth infections in specific age groups of Cofan from Dureno and Zabalo ...... 103
4.20 Intra-village means (standard deviation) and p-values (based on t-tests) by sex for differences in dental measures among participants < 12 years of age from Dureno ...... 105 4.21 Intra-village means (standard deviation) and p-values (based on t-tests) by sex for differences in dental measures among participants < 12 years of age from Zabalo ...... 105
4.22 Inter-village means (standard deviation) and p-values (based on t-tests) by sex for differences in dental measures among participants < 12 years of age ...... 106
4.23 Inter-village comparisons and p-values (based on proportional inferences) for differences in various dentA conditions between Dureno and 2^abalo for the total adult population ...... 107
4.24 Litra-village means (standard deviation) and p-values (based on t-tests) by sex for differences in dental measures among participants > 13 years of age from Dureno ...... 108 4.25 Intra-village means (standard deviation) and p-values (based on t-tests) by sex for differences in dental measures among participants >13 years of age from Zabalo ...... 108
4.26 Inter-village means (standard deviation) and p-values (based on t-tests) by sex for differences in dental measures among participants >13 years of age between Dureno and Zabalo ...... 109
4.27 Means and p-values (based on t-tests) for differences in biological variables between Cohort 1 and Cohort 2 males from Dureno ...... 110
4.28 Means and p-values (based on t-tests) for differences in biological variables between Cohort 1 and Cohort 2 females from Dureno ...... I l l
4.29 Means and p-values (based on t-tests) for differences in biological variables between Cohort 1 and Cohort 2 males from Zabalo ...... I l l
XIV 4.30 Means and p-values (based on t-tests) for differences in biological variables between Cohort I and Cohort 2 females from Zabalo ...... 112 4.31 Means and p-values for differences in biological variables between Cohort 2 and Cohort 3 males from Dureno ...... 113
4.32 Means and p-values (based on t-tests) for difreences in biological variables between Cohort 2 and Cohort 3 females from Dureno ...... 113
4.33 Means and p-values (based on t-tests) for differences in biological variables between Cohort 2 and Cohort 3 males from Zabalo ...... 113 4.34 Means and p-values (based on t-tests) for differences in biological variables between Cohort 2 and Cohort 3 females from Zabalo ...... 114
4.35 Means and p-values (based on t-tests) for differences in biological variables between Cohort 1 and Cohort 3 males from Dureno ...... 115
4.36 Means and p-values (based on t-tests) for differences in biological variables between Cohort 1 and Cohort 3 females from Dureno...... 115
4.37 Means and p-values (based on t-tests) for differences in biological variables between Cohort 1 and Cohort 3 males from Zabalo ...... 116
4.38 Means and p-values (based on t-tests) for differences in biological variables between Cohort 1 and Cohort 3 females from Zabalo ...... 116
4.39 Inter-village means and p-values (based on t-tests) for differences in biological variables between Cohort 1 males from Dureno and Zabalo ...... 117
4.40 Inter-village means and p-values (based on t-tests) for differences in biological variables between Cohort 2 males from Dureno and Zabalo ...... 118
4.41 Inter-village means and p-values (based on t-tests) for differences in biological variables between Cohort 3 males from Dureno and Zabalo ...... 118 4.42 Inter-village means and p-values (based on t-tests) for differences in biological variables between Cohort 1 females from Dureno and Zabalo ...... 119
4.43 Inter-village means and p-values (based on t-tests) for differences in biological variables between Cohort 2 females from Dureno and Zabalo...... 119
4.44 Inter-village means and p-values (based on t-tests) for differences in biological variables between Cohort 3 females from Dureno and Zabalo ...... 119
5.1 Partial correlation coefficients controlling for age and (p-values) for behavioral factors and lifestyle indices in relation to DMFT hidex by sex ...... 121
5.2 Partial correlation coefficients controlling for age (p-values) for behavioral factors and lifestyle indices in relation to Caries Index by sex ...... 122
XV 5.3 Ihter-village partial correlation coefficients, controlling for age and sex, and (p-values) for behavioral factors and lifestyle indices in relation to the DMFT Index ...... 123
5.4 Ihter-village partial correlation coefRcients, controlling for age and sex, and (p-values) for behavioral factors and lifestyle indices in relation to the Caries Index ...... 123
5.5 Partial correlation coefficients controlling for age and (p-values) for dietary factors in relation to DMFT hidex between sexes for combined adult population from Dureno and Zabalo ...... 124
5.6 Partial correlation coefficients, controlling for age and (p-values) for dietary factors in relation to Caries hidex by sex for combined adult population from Dureno and Zabalo ...... 125
5.7 Partial correlation coefficients, controlling for age and sex, and (p-values) for dietary factors in relation to Caries and DMFT Indices for Dureno ...... 126
5.8 Partial correlation coefficients, controlling for age and sex, and (p-values) for dietary factors in relation to Caries and DMFT' Indices for Zabalo ...... 126
5.9 Correlation coefficients and (p-values) by sex for behavioral factors and lifestyle indices in relation to total cholesterol for combined adult population from Dureno and Zabalo ...... 128
5.10 Inter-village partial correlation coefficients, controlling for age and sex, and (p-values) for behavioral factors and lifestyle indices in relation to total cholesterol ...... 128
5.11 Partial correlation coefficients, controlling for age, and (p-values) by sex for anthropometric measures in relation to the total cholesterol for combined adult population from Dureno and Zabalo ...... 129
5.12 Partial correlation coefficients, controlling for age and sex, and (p-values) by village for anthropometric measures in relation to the total cholesterol ...... 129 5.13 Correlation coefficients and (p-values) by sex for behavioral factors and lifestyle indices in relation to blood glucose levels for combined adult population from Dureno and Zabalo ...... 130
5.14 Inter-village partial correlation coefficients, controlling for age and sex, and (p-values) for behavioral factors and lifestyle indices in relation to blood glucose levels ...... 131
5.15 Partial correlation coefficients, controlling for age, and (p-values) by sex for anthropometric measures in relation to blood glucose ...... 131
5.16 Partial correlation coefficients, controlling for age and sex, and (p-values) by village for anthropometric measures in relation to blood g lu co se ...... 132
XVI 5.17 Partial correlation coefficients (p-values) controlling for age, between sexes for behavioral factors and lifestyle indices in relation to hemoglobin levels for combined adult population from Dureno and Zabalo ...... 133
5.18 Inter-village partial correlation coefficients (p-values) controlling for age and sex, for behavioral factors and lifesQrle indices in relation to hemoglobin levels ...... 134
5.19 Correlation coefficients (p-values) between adult males and females for behavioral factors and lifestyle variables in relation systolic blood pressure (SBP) for combined adult population from Dureno and Zabalo ...... 135
5.20 Inter-village correlation coefficients, controlling for age and sex, and (p-values) for behavioral factors and lifestyle variables in relation to systolic blood pressure (SBP) ...... 135
5.21 Correlation coefficients (p-values) between adult males and females for behavioral factors and lifestyle variables in relation to diastolic blood pressure (DBP) for combined adult population from Dureno and Z abalo ...... 136
5.22 Inter-village correlation coefficients, controlling for age and sex, and (p-values) for behavioral factors and lifestyle variables in relation to diastolic blood pressure (DBP) ...... 137
5.23 Correlation coefficients (p-values), by sex, for anthropometric measiues in relation to systolic bloW pressure for combined adult population from Dureno and Zab^o ...... 138
5.24 Partial correlation coefficients, controlling for age and sex, and (p-values) for anthropometric measures in relation to systolic blood pressure in Dureno and Zabalo ...... 139
5.25 Correlation coefficients and (p-values), by sex, for anthropometric measures in relation to diastolic blood pressure ODBP) for combined adult population from Dureno and Zabalo ...... 139
5.26 Partial correlation coefficients, controlling for sex and age, and (p-values) for anthropometric measures in relation to diastolic blood pressure (DBP) in Dureno and Zabalo ...... 140
5.27 Partial correlation coefficients, controlling for age, and (p-values) between sexes for behavioral factors and lifestyle indices in relation to Arm Fat Index for combined adult population from Dureno and Zabalo 141
5.28 Inter-village partial correlation coefficients, controlling for age and sex, and (p-values) for behavioral factors and lifestyle indices in relation to Arm Fat Index ...... 141
5.29 Partial correlation coefficients, controlling for age, and (p-values) between sexes for behavioral factors and lifestyle indices in relation to Body Mass Index (BMI) for combined adult population from Dureno and Z abalo ...... 142 xvii 5.30 Inter-vülage partial correlation coefficients, controlling for age and sex, and (p-values) for behavioral factors and lifestyle indices in relation to Body Mass Index (BMI) ...... 143
5.31 Partial correlation coefficients, controlling for age, and (p-values) between sexes for behavioral factors and lifestyle indices in relation to Summed Skinfolds (Sum SF) for combined adult population from Dureno and Zabalo.... 144
5.32 Inter-village partial correlation coefficients, controlling for age and sex, and (p-values) for behavioral factors and lifestyle indices in relation to Summed Skinfolds ...... 145
5.33 Partial correlation coefficients, controlling for age, and (p-values) between sexes for behavioral factors and lifestyle indices in relation to the Waist Hip Ratio (WHR) for combined adult population from Dureno and Zabalo ...... 146 5.34 Inter-village partial correlation coefficients, controlling for age and sex, and (p-values) for behavioral factors and lifestyle indices in relation to the Waist Hip Ratio (WHR)...... 147 5.35 Correlation coefficients, by sex, and (p-values)for behavioral factors and lifestyle indices in relation to the total parasite load for combined adult population from Dureno and Zabalo ...... 148 5.36 Inter-village partial correlation coefficients, controlling for sex, and (p-values) for behavior^ factors and lifestyle indices in relation to the Total Parasite Load among adults ...... 148
5.37 Partial correlation coefficients (p-values),controlling for age, for hemoglobin levels andeosinopWl counts in relation to infection by each species of nematode and total parasite load for combined adult population from Dureno and Zabalo ...... 149
5.38 Partial correlation coefficients, controlling for age, and (p-values) between sexes for hemoglobin levels and eosinophil counts in relation to the total parasite load for combined adult population from Dureno and Zabalo ...... 150 5.39 Inter-village partial correlation coefficients, controlling for age and sex, and (p-values) for hemoglobin levels and eosinophil counts in relation to the total parasite load among adults ...... 150
5.40 Inter-village partial correlation coefficients, controlling for age, and (p-values) for anthropometric variables in relation to total parasite load for combined adult population from Dureno and Zabalo ...... 151
5.41 Partial correlation coefficients, controlling for age, and (p-values) for anthropometric variables in relation to total parasite load among adults ...... 151
X V lll USTOFHGURES
Figure Page
3.1 Age classes for males from Dureno ...... 58
3.2 Age classes for females from Dureno ...... 59
3.3 Age classes for males from Zabalo ...... 59
3.4 Age classes for females from Zabalo ...... 60
XIX CHAPTER 1
INTRODUCTION
1.1 AcculturatioiL and Health The concept of acculturation has been used to characterize worldwide changes occurring in many indigenous populations. Redfield and colleagues provided a classic definition of acculturation: “those phenomena which result when groups of individuals having different cultures come into continuous first-hand contact with subsequent changes in the original culture patterns of either or both groups" (1936, pp. 149). Culture encompasses behavioral patterns and tangible outgrowths of these behaviors such as
language, ritual, tools, and shelter which allow groups to successfully interact with their environment (Moore et al., 1980). Acculturation can present both costs and benefits to a population with regard to health. Health problems associated with acculturative change can range from poor nutrition due to dietary changes and increased body weight due to reduced physical activity, to emotional stress due to political or economic subordination, and exposure to new hazards in the environment (McElroy, 1989). Major benefits of acculturation can include an increase in medical technology, health education, and various other resources necessary to effectively deal with health problems. Acceptance of health care and education by indigenous groups however, is often determined by the extent to which this encounter promotes or inhibits the synthesis of traditional and Western health- related beliefs and behaviors (Palinkas and Pickwell, 1995). While researchers have tried to generalize about health patterns based on the levels of acculturation, the fact of the matter is that each population will have an individualized reaction to environmental change. The response of a population to acculturation is dependent on the interaction of the physical environment, cultural environment and the gene pool (Bindon etal, 1991). Health consequences of contact and change are associated with multiple interacting and interrelated variables which can include: 1) decreased isolation and mobility, 2) altered group size, 3) major ecological disturbances, 4) dietary changes,
5) deteriorating sanitary and housing conditions, 6) decreased physical activity,
7) development of agricultural systems and cash economies, 8) increased exposure to toxic substances, and 9) cultural and social disruption resulting in new forms of cultural stress
(Garmto 1981). Because these variables are interrelated and interacting, change in any domain can upset the adaptive value of any previously acquired biological or cultural strategy for dealing with the social and physical environment. According to Baker (1986), interrelated changes in the environment include: an increased reliance on a cash economy, increased diversity of occupations, and increased variety of foods, which, in turn, can effect behavioral patterns such as diet and physical activity. These behavioral changes can have physiological and morphological consequences, such as an increase in obesity seen in some populations, and can negatively impact health leading to higher blood pressure and blood glucose levels and higher incidence rates of chronic disorders such as cardiovascular disease and diabetes. In addition, increased population densities and changes in traditional lifestyles can increase the incidence of infectious diseases among indigenous groups
(Croll, 1983; Cheraela and Thatcher, 1989; Garmto et al., 1989; Fitton, 1998). Therefore, acculturation can threaten conditions that had previously, contributed to the health of a group, and this domino effect has been documented in various ethnic groups that have undergone acculturation (Shephard & Rode, 1996; Friedlaender, 1987; Baker et al, 1986). The conceptual and theoretical framework used in this study is derived from human
population biology research and evolutionary theory, which strives to understand human adaptability at the population and individual level by integrating sociocultural and biological
processes that relate to envirorunental concerns (Baker, 1982; Little and Haas, 1989).
Studying the interactions among environmental, cultural and genetic conditions provides a
valuable tool for understanding how human variation has been shaped and why it differs
between populations (Shephard and Rode 1996; Freidlaender 1987; Baker et al., 1986). A
recent concern of anthropologists is how culture change, exemplified today by nutritional and lifestyle patterns, affect the well-being and lifeways of traditional-living peoples (Baker
1987). This research has lead to the suggestion that human population biology shift it's focus to "acculturating populations" (Garruto et al., 1989). Variables linking acculturation
with chronic diseases include; stress, obesity, physical activity, diet, alcohol use, smoking, lack of access to modem health care, occupational risks, and pollution (McGarvey et al.,
1989; Janes, 1990; Gaetano, 1987; Hazuda, 1991; Elder et al., 1991; Solis et al., 1990). Acculturating populations provide a natural experimental setting to examine how humans adapt to new or changing environmental and cultural conditions. Research focusing on health and disease in such settings enables us to better understand the complexity of environmental, cultural, psychological, and physiological risk factors within genetically homogenous groups. Information so gained contributes data for interventive and preventative activities in acculturating populations (Palinkas, 1995).
This study examines social, behavioral, and biological variables to investigate how environmental and cultural change is affecting the health of an indigenous Amazonian population, the Cofan of northeastern Ecuador. This research centered on two Cofan villages, Zabalo and Dureno. Although these villages are genetically homogenous, inter-village differences in traditional lifeways and subsistence have arisen in response to environmental alterations due to the intrusion of non-Cofan, colonists, and oil companies. The problem addressed by this research is whether a traditional lifestyle of hunting, fishing, gardening and gathering is healthier than a more “westernized” lifestyle that includes non-traditional “processed” foods and less exercise. This research follows a natural experimental design, that is not all factors can be controlled for as in a laboratory experiment. These two villages represent peoples of the same ancestry who prior to contact were at the same level of socioeconomic development. Today they are experiencing different levels of interaction with surrounding peoples and cultures therefore, a natural experimental design is inherent to the way these villages have recently fissioned. The goals of this research include: 1) assess the demographic characteristics between the two villages,
2) obtain baseline data to characterize the uniqueness of the Cofan, physiologically and culturally, compared to other human populations; 3) evaluate the impact of environmental, and sociocultural disruption on the lifeways and health of the Cofan; and 4) document the degree of acculturation within and between the two villages.
1.2 Changes Associated With Acculturation The direct and continuous contact of previously isolated groups poses serious risks for indigenous survival. Contact not only disrupts environmental stability and the normal economic and social life of the group, it leaves them physically and psychologically weakened and highly vulnerable to disease (Goodland, 1982; Croll, 1983). Three landmark studies of human population biology addressed the health consequences of a transition from an active traditional lifestyle to that of sedentary modem living; The
Changing Samoans (Baker et al, 1986), The Health Consequences o f ‘Modernization Evidence From Circumpolar Peoples (Shephard & Rode, 1996) and The Solomon Islands
Project (Friedlaender, 1987). These studies provided baseline data on indigenous populations which enabled researchers to document the social processes of acculturation to urban life and the resulting health consequences. The Samoan and Circumpolar projects proposed that a departure from a traditional lifestyle resulted in an increase within these populations of chronic conditions such as coronary artery disease (CAD), diabetes, hypertension, and various forms of cancer. The Harvard Solomon Islands Project, an interdisciplinary study of health and culture change among Melanesian populations, examined the relationship between culture and disease in societies that varied in respect to ethnic background, ecological setting, and exposure to Western culture (Friedlaender,
1987). AU three studies implemented an integrated biocultural research plan showing the adverse effects of environmental and cultural change on health. According to McElroy (1989; 292), “Of all the stressors affecting a population’s health, one of the most devastating is rapid and irrevocable change in a people’s way of Ufe”.
1.2.1 Environmental Changes and Consequences Tropical environments are experiencing rapid change due to deforestation and development, similar to what temperate zones experienced in the past (Hames and Vickers,
1983). Exploitation of natural resources in Latin America has led to the appearance of smaU towns along some tributaries of the Amazon River and indigenous rainforest groups are suffering substantial transformations. Roads cut through indigenous territories by oil and mining companies and logging operations exposed densely forested lands to colonization. Governments eager to exploit natural resources encourage new settlement and provide non-indigenous residents with electricity, streets, and limited health care.
Forest cover is replaced by grass-land for pastures or by cash-crop plantations thus, eroding complex ecosystems and decreasing habitat diversity (Kroeger & Barbira-
Freedman, 1982). Destruction of Ecosystem
Environmental pollution is becoming a major problem for indigenous groups. The
demand for petroleum, which has led governmental and foreign agencies into the rainforest
in search of economic gains, has created problems. For example, it has been estimated that
17 million gallons of crude have been spilled into Ecuador’s rainforest enviromnent (Smith,
1993). Oil wells generate millions of gallons of toxic waste which is released into the
environment without being treated, contaminating countless rivers and streams upon which indigenous peoples are dependent for subsistence (Kimmerling, 1990). Besides releasing high levels of hydrocarbons, known carcinogenic agents in humans, this pollution can
precipitate a number of immediate health consequences. For example, the replacement of
river water, rich in minerals necessary for proper dental health, with mineral-poor rain
water has led to serious oral health problems among some indigenous groups (Fitton, 1999).
Deforestation due to farming, ranching, and logging also have been devastating to tropical rainforests (Moran, 1993). The traditional farming system practiced by indigenous rainforest inhabitants is a slash and bum polyculture, whereby small areas of native vegetation are cleared and a diversity of plants are cultivated. After several seasons, the plots are abandoned allowing for the regeneration of native rainforest species and soil rejuvenation thus preventing mass extinctions (Gomez-Pompa et al., 1972). Recent colonization of areas in the Amazonian rainforest has resulted in the clearing of large sections of virgin rainforest for farming or ranching. Extensive monocropping has led to the rapid destruction of plant nutrients which ultimately erodes the soil (Hiraoka and
Yamamoto, 1980). Conversion of forest to pasture, seen with cattle ranching, is also changing the native ecosystem by replacing diverse forest vegetation with grasslands.
Subsequently , the development of roads into Amazonia has led not only to increased colonization by farmers and ranchers but increased activities of lumber companies. Selective logging in lowland rainforests results in forest fragmentation which reduces biodiversity thus decreasing the subsistence base of indigenous communities (Sierra and Stallings, 1998).
Displacement of Didigenous Populations
All these ecological changes can lead to the disruption of indigenous cultures whose social lifeways are intertwined with their subsistence base. The encroachment of entrepreneurs and colonists upon indigenous rainforest inhabitants has led to rapid destruction of hunting grounds, pollution of rivers, and the crowding of indigenous groups into smaller areas.
According to Uquillas (1984), the colonization of Amazon territory is due to excessive population growth, unequal resource distribution, and few employment opportunities. Amazonia is an area of low population densities and, according to national government standards, ill-defined land ownership. Therefore, indigenous groups are being forced off their traditional land by invading colonists and by national and multinational companies who exploit timber, and minerals. A factor instnunental to the colonization of this region was the construction of access roads through indigenous territories. The main reason people move into the rainforest is to establish farms and ranches, exploit natural resources such as timber or gold, or to work in the petroleum industry. Uquillas (1984, p.
280-281) states;
In many cases colonization has displaced indigenous peoples from their traditional areas of settlement, has reduced the size of their hunting and frshing areas, and has converted many persons into second-class citizens, who are frequently exploited. In summary, the avalanche of inunigrants and enterprises of all kinds has directly threatened the capacity of indigenous peoples to develop their cultures normally.
Unfortunately, the massive influx of colonists and entrepreneurs, who have appropriated indigenous lands, is leading to the systematic destruction of Amazonian flora, fauna, and
7 indigenous cultures. Today’s Amazonian cultures are not representative of the fiiU range of diversity that characterized past populations. Remnant groups that survived habitat
destruction, disease, economic exploitation, missionization, and colonization may carry
unique genetic patterns, unusual differences in physiology, or cultural innovations
important for understanding the patterns of human adaptation and may enhance
understanding of our biological, behavioral and cultural variability (Salzano 1988, Hames and Vickers, 1983).
1.2.2 Social Changes and Consequences
Throughout various studies of acculturation and health two approaches have been
used for measuring culture change (James, 1987). Some researchers use an ecological
assessment of genetically similar populations living under different degrees of acculturation
by contrasting health variables between persons living in traditional villages with those in
more urbanized areas. The second strategy seeks to measure acculturation more precisely.
Lifestyle variables (employment, income, language proficiency, education, interaction with
“non-indigenous” individuals, and travel history) are recorded, and an “acculturation score” is obtained for each person which is then compared to health variables. This study combines these two approaches into a single overarching research design by integrating biological techniques and lifestyle surveys among two genetically similar populations.
Household and Lifestyle
Acculturation encompasses more than just a change in technology, social organization and communication. It is basically goal oriented and includes changes in the way people think, their perception of environmental problems, and how they deal with health problems (McElroy and Townsend, 1989). An important focus of research today is the influence social factors play in the etiology of chronic disease. A number of researchers
8 have developed scales of acculturation/modemizatioa for use among diverse populations with regard to the health consequences of culture change (Patrick and Tyroler, 1972;
Cuellar et al., 1980; NHANES, 1985; Marin et al., 1987; Mitchell et al., 1987; Suiim et al., 1987). Most measures were used to study culture change and its affect on physical and
mental health among ethnic-American immigrants. These surveys included questions
regarding language use, economic status, educational level, social environment (i.e. media
use, social relations, travel, etc.) and ethnic background, and were population specific. However, when assessing individual acculturation it is important to note that some
individuals within a group acculturate more rapidly than others and changes can also appear
at varying rates throughout a person’s lifetime. Szapocznik and colleagues (1978) suggest
that individual acculturation is a linear process related to the length of time the person has
been exposed to the host culture (i.e. the longer exposure the more complete the
acculturation). They also suggest that the rate of acculturation is a function of the
individual’s age (younger individuals acculturate more rapidly) and that males acculturate more rapidly than females.
A model extensively used in anthropological research was initially developed by
Dressier (1982, 1987) to examine the effects of sociocultural factors on arterial blood pressure in the context of acculturation. Dressier (1994) characterizes acculturation with regard to two linked processes. First, there is an increase in economic differentiation
whereby some people can access new economic opportunities and amass economic
resources more than others, resulting in an increase in socioeconomic differentiation.
Closely linked to these changes in economic activities are changes in "style of life," e.g., a set of behaviors that communicate to others a particular social status. These behaviors include consumption of material goods and the adoption of particular leisure activities.
Difficulties arise when individuals try to attain or maintain a lifestyle inconsistent with their economic resources. In this circumstance, individuals are likely to feel frustrated, angry. and uncertain about their social roles and personal identities and often work long hours or
in multiple jobs to acquire certain material goods. People assess the lifestyle of others and
in some cases, a person's lifestyle may not be consistent with other social class indicators such as occupational prestige or educational level. The effect of this status inconsistency
has been referred to as "lifestyle incongruity." The struggle is not only to maintain the idea
of belonging to a higher social status by acquiring certain material goods but always trying
to convince others of the validity of this status claim. In developing countries, style of life tends to be behaviorally oriented, consisting of the adoption of more cosmopolitan
behaviors and the increased use of western material goods.
Lifestyle incongmity can affect health status. Dressier (1982) suggested that two factors were related to blood pressure; 1) "stressors," factors that increase blood pressure
and the risk of disease, and 2) "resistance sources," factors that lower blood pressure and the risk of disease. With regard to stressors, two important components have been identified; lifestyle incongruity, previously discussed, and perceived stress, which is an individual's subjective evaluation of the personal impact common life events hold, for example, marriage, births, and deaths. Individuals who rate these events as having greater personal impact tend to have higher blood pressures and when the style of life exceeds economic resources blood pressure is usually elevated. Psychological coping mechanisms and social support systems are the two most commonly cited resistance resources. Social support refers to the help or assistance an individual can anticipate from family, friends, or neighbors in times of need, hidividuals who perceive a greater availability of social support generally tend to have lower blood pressures.
The above model has been tested in many different social contexts, including those in developing countries. In each instance, lifestyle incongmity was shown to be associated with elevated physiological variables such as blood pressure, plasma glucose, and lipid levels (Dressier et al., 1995,1991; Bindonet al., 1991, 1997). Dressier and colleagues
10 (1995) stress that in order to understand the correlation between social factors and
physiological characteristics we must pay attention to intracultural diversity and variations in meaning by social context. A study conducted by Dressier et ai., (1993:22) in urban
Brazil found that individuals with high lifestyle incongruity and low social support
responded to stressors in a distinctive way which ultimately influenced their lipid levels. Because the deleterious effects of lifestyle incongruity can be moderated by people who
perceive themselves as having greater social support, migrant populations, especially in
developing countries, may be more prone to the negative health effects such as increased risk of cardiovascular disease, due to high lifestyle incongruities coupled with loss of social support from kin. A survey conducted by Bindon and colleagues (1991) on the health
status of Samoans undergoing acculturation found that higher lifestyle incongruity (when
lifestyle exceeds economic means) was associated with higher systolic and diastolic blood
pressure in men under 55 years of age. However, this study showed significant intra
group differences between older and younger men, with older men (over 55) having lower
blood pressure with increasing incongruity. Because older individuals had already
acquired significant amounts of material goods that resulted in higher prestige they had
lower blood pressure. Younger men were making excessive claims to status such as
buying cars and other high priced items beyond their means. The resulting status incongruity presumably led to higher blood pressure.
1.2.3 Health Changes and Consequences What is Health?
Health is a multidimensional concept which includes the absence of disease and the
semblance of positive physical well-being. Health measures can be applied to individuals or populations. According to Kemm (1992), at the population level, health can be derived from measures of individual health by aggregation, but not the converse. Various
II physiological and psychological measures can assess the absence of disease or ill health, and the presence of positive health. The absence of disease or ill health can be assessed by
measuring death rates, life expectancy, morbidity rates, disease frequencies, risk factors,
lifestyle factors, and mental distress. The presence of positive health can be determined by
physical fitness measures and psychological measures such as state-of-mind (happy vs.
sad), coping mechanisms and social support systems. Lieban (1973:1031) states that
“health and disease are measures of the effectiveness with which human groups, combining biological and cultural resources, adapt to their environments". Therefore, health is a
measure of environmental adaptation. The environment that encompasses a human
population comprises physical, biological, and cultural components forming a total ecosystem. A change in any variable can lead to ecological, physiological, and
psychological imbalances and if severe enough, these imbalances or stressors can cause
disease (McElroy and Townsend, 1989).
It is important to comprehend the limits of our biological capacity to adapt to
environmental change. Baker (1984) noted that broadly speaking, adaptation is concerned
with our biological equilibrium and those adjustments that allow individuals to adapt to
changing environments. Therefore, when studying acculturative change in indigenous
populations assessments must include an integration of responses that facilitates a
population’s health status. According to Goodland (1982,398), “Three major factors impair indigenous health: first, the transmission of disease; second, modification of diet
and living conditions; and third, social change and stress.” Altering any of these factors
can disrupt normal levels of community health and thereby increase vulnerability to disease.
For example, lifestyle variables such as household wealth can affect housing and
sanitation, which are associated with exposure to micro-organisms. Education, one determinant of socioeconomic status, can impact hygiene practices and exposure to
12 micro-organisms. Wealth and education can also affect diet and nutrition, which in turn
influence the health status of the community. Therefore, good health implies the achievement of a dynamic balance between individuals or groups and their physical and cultural environment (Wiesner, 1992). Specific health related changes associated with
acculturation and relevant studies are outlined in the following 8 sections these include;
body composition, blood pressure, glucose, cholesterol, hemoglobin, intestinal parasites, dental health and nutrition.
Bodv Composition
Native South Amerindian groups are, on average, shorter and lighter than European populations (Bogin, 1993). Factors that may contribute to this relatively short stature and
lower weight, aside from genetic and endocrine factors, include poor nutrition, climate,
low socioeconomic status (SES), secular trends, migration, infectious and parasitic diseases, and psychological stress (Haas, 1977; Salzano and Callegari-Jacques, 1988;
Tanner, 1990; Dufour, 1992; Bogin, 1993). One health consequence associated with
acculturation is increased adiposity. More sedentary or urban lifestyles along with dietary
changes, have been associated with changes in body composition among indigenous populations. For example, a metabolic study conducted among the Pima Indians showed that low 24-hour energy expenditure increased the risk of weight gain fourfold over a two
year period (Ravussin et al., 1988). The effects of acculturation on body morphology and
concomitant health risks have been studied in diverse populations (McGarvey et al., 1986,
Salzano and Callegari-Jacques, 1988; Friedlaender, 1989; Howard et al., 1991; Shephard
and Rode, 1996). Although adipose tissue is necessary for a variety of physiological
functions, an excess can lead to significant health problems. Chronic conditions such as
diabetes, heart disease, hypertension, and gallbladder disease have been associated with excess adiposity in various populations (McGarvey et al., 1986; Bailey, 1985; Weiss et al.,
13 1984). Therefore, changes in adiposity with the adoption of modem lifestyles may be a significant predictor of health status among indigenous populations.
Several studies have examined the association of body morphology with socioeconomic and behavioral variables in diverse populations (Reddy, 1998; Santos and
Coimbra, 1996; Dressier et al., 1996; Hodge et al., 1996; Bindon, 1995). Acculturating groups generally show increased adiposity with improved socioeconomic status.
Individuals with a higher socioeconomic status become physically less active and increase their consumption of fat and carbohydrate rich foods. Therefore, socioeconomic differentiation that accompanies acculturation does not necessarily lead to improved health.
In some instances, even when national programs promoting a healthy diet and increased physical activity are instituted, it is difficult to reverse the effects of rapid lifestyle change in acculturating populations (Hodge et al., 1996).
Blood Pressure
In Western societies, age, obesity, fat distribution, and diet are common correlates of blood pressure (BP). However, these variables may not be significant correlates of BP in more traditional-living societies. For example, several traditional-living societies maintain a low BP even as age increases (Silva, 1995; Fitton and Crews, 1995; Harper et al., 1994; Crews and Mancilha-Carvalho, 1993). Today's Amazonian populations present a continuum from very traditional life styles through increased contact with and integration into Western societies. Traditional lifestyles generally include regular physical activity, low sodium diets, low prevalences of obesity and diabetes, moderate use of low alcohol or caffeinated beverages, and social homogeneity (Fleming-Moran and Coimbra, 1990). Several studies on relatively isolated populations subsisting on diets low in salt and fat show low blood pressure and lack of blood pressure increase with age (Neel et al., 1964;
Sinnet and Shy te, 1973; Friedlaender, 1989; Harper et al., 1994). However, significant
14 effects of body habitus on blood pressure are not exclusively related to cosmopolitan life styles and obesity, but also are observed in remote settings among relatively lean individuals (Silva et al., 1995; Crews and Mancilha-Carvalho, 1993).
Low blood pressure populations found in a variety of climates, diets, habitats, and lifestyles, share common features which include: adherence to traditional lifestyles which differ from the dominant westernized culture, relatively high levels of physical activity, and low levels of adiposity. Cassel (1975) foimd that when members of low blood pressure populations experience acculturation there is a subsequent rise in blood pressure and concluded that changes associated with acculturation alter how individuals interact with their environments. When traditional-living populations acculturate to Western lifestyles they develop age-related increases in blood pressure similar to Western populations (Schall, 1992; Page et al., 1974; Cassel, 1975; Carvalho et al., 1985; Dressier et al., 1987; Silva and Eckhardt, 1994; Silva et al., 1995b). Page and colleagues (1974: 1144), suggest that
...the failure of blood pressure to rise with age may be biologically normal, and that with acculturation a constellation of changes is entrained, which include an increase in serum cholesterol, a reduction in semm uric acid, and an age-related rise in blood pressure which expresses itself earliest, and most noticeably in females.”
Two models have been proposed to explain the effects of modernization on blood pressure (as outlined in Schall, 1992). The first emphasizes physical or environmental factors and suggests that an increase in blood pressure is the physiological outcome of biological changes such as reduced physical activity, increased adiposity, or dietary change
(especially sodium and potassium intake). However, environmental changes such as improved sanitation may reduce the incidence of parasitic infections which can consequently lower blood pressure as a by-product of anemia and wasting. The second model emphasizes psychosocial factors and proposes that lifestyle changes that accompany modernization lead to the disintegration of traditional values and goals. Subsequently, the breakdown in traditional values leads to chronic autonomic nervous system arousal which,
15 over time, elevates arterial pressures. Dressier proposed (1982) that modemizatioa in
Caribbean societies changed the traditional idea of what constituted the “good life,” creating new pressures for social mobility through the display of consumer goods. Individuals who lacked economic resources to support a lifestyle of high material consumption (lifestyle incongruity) subsequently had higher blood pressures. Physical, environmental or psychosocial changes accompanying acculturation can affect individual biological fitness, and ongoing research suggests that acculturation and high blood pressure increase in concert.
Several studies (Carvalho et al., 1985; Dressier et al., 1987; Silva and Eckhardt, 1994; Silva et al., 1995b) that have examined acculturation and blood pressure variation among Amazonian populations from Brazil suggest that altered life styles, which include dietary changes, subsistence activities and increased social stratification, that occur with acculturation are predictive of increased blood pressure. However, one study conducted by
Fleming-Moran et al.(199l) among the Surui and Zoro Indians of the Brazilian Amazon, suggests that increases in blood pressures are only in part due to changes associated with acculturation (i.e. dietary changes, decreased physical activity, and increased adiposity).
They suggest, that as a consequence of regular access to medical care, higher blood pressure readings reflect improved health status among indigenous Amazonian groups.
Fleming-Moran and colleagues find that lower blood pressures are reflective of poorer health status and state that those with better access to health care improve their overall health status relative to others without access who experience higher rates of infectious and parasitic diseases.
Psychosocial stressors and lifestyle variability also are implicated as predicting the rise in blood pressure seen with increasing acculturation. Dressier and colleagues (1995) found social and psychological effects on blood pressure within the lower class (small scale farmers and unskilled laborers) that did not exist among middle class (white-collar
16 workers) members o f the same small Jamaican town. They suggest that lower and middle class Jamaicans differ in cultural expectations of success and prestige, stressors, social support and coping styles thus, effects of these variables on blood pressure differ across classes. Middle class groups adopted a model of “success” that is not relevant to the lower class, where the dimensions of success are quite different. Dressier and colleagues (1995) stress that intra-cultural diversity creates variability in reactions to specific social situations therefore, physiological responses to stressors are tied to individual beliefs and behaviors. For example, in the lower class, among males, social support through church groups was associated with lower blood pressure, while among females, economic stress predicted higher blood pressure. These trends are not observed in the middle class sample.
Bindon and colleagues (1991) who examined modernization and adaptation among American Samoan men found a cohort effect with regard to blood pressure and lifestyle incongruity. A higher lifestyle incongruity was associated with higher systolic and diastolic blood pressure in men 55 years old and younger, while men 55 years and older showed lower systolic and diastolic blood pressure with increasing lifestyle incongruity.
Blood Glucose
As acculturation ensues, the incidence of chronic diseases such as non-insulin- dependent diabetes mellitus (NIDDM) and cardiovascular disease progressively increases
(Trowell and Burkitt, 1981; Baker, 1984). Environmental factors play an important role in the expression of these chronic diseases. NIDDM has a global distribution with prevalence rates varying from country to country, from ethnic group to ethnic group, and even within an ethnic group that may be undergoing acculturation (Crews, 1994). Epidemiological studies have contributed to oinr understanding of risk factors involved in the etiology of this disease. NIDDM seems to be rare in populations who practice traditional subsistence lifestyles (Zimmet et al., 1981). However, with progressive acculturation, traditional
17 populations such as the Pima hidians, Nauruans, and Samoans show an increased
prevalence of NIDDM (Bennett et al., 1976; Zimmet, 1981; Baker et al., 1986). These
populations may have an underlying genetic susceptibility to NIDDM which is exposed by
environmental factors. Zimmet (1982) stated that the change in NIDDM prevalence can be understood by looking at the changing patterns of health and disease in relation to changes
in demographic, social, and economic indices in different populations. The lowest prevalence rates (<2%) occur in Eskimos, Alaskan Athabascans, and populations of the Far
East and India, whereas, the highest prevalence of NIDDM (—35%) has been reported in
American Pima Indians and in the Micronesian population of Nauru (Zimmet, 1982). Prevalence rates are also quite high in other Pacific island populations, American hidian populations, Canadian aboriginals, and Mexican American populations (Daniel and
Gamble, 1995; Crews, 1994; Crews etal., 1991; Szathmary and Ferrell, 1990; Hazuda et al., 1988). The high prevalence rates in these populations are correlated with rapid rates of acculturation. Groups now facing the greatest risk for developing diabetes include populations in developing countries, minority groups, and disadvantaged communities in industrialized countries (King et al., 1993).
The importance of environmental factors to NIDDM has been inferred from the difference in prevalence rates between indigenous and migrating populations of the same ethnic group. Groups that move into more urban/industrialized settings have higher prevalence rates of diabetes compared to groups in more traditional settings (Zimmet, 1982). It is difficult to factor out dietary and socioeconomic factors when studying the genetics of NIDDM. Therefore, it is necessary to study genotype-environment interactions. Such interactions are population specific and different populations may vary significantly at the genetic and environmental levels. A changing environment, across generations, will introduce inconsistencies within populations, and create difticulties in deriving specific risk factors for diabetes, since risk factors derived from one generation
IS may not be applicable to the next (Neel, 1976). Therefore, it is not surprising that studies from different countries may differ significantly in their results. The problem researchers
face is identifying which environmental factors contribute to the phenotypic expression of
NIDDM. Some of the most studied diabetogenic factors within populations include:
obesity, reduced physical activity, dietary changes, socioeconomic status, and psychosocial stress due to acculturation (Zimmet, 1982; Hazuda et al., 1988; Crews, 1994; Smith et al., 1994; Dressier et al., 1996).
To account for the rapid rise in the prevalence of chronic diseases in some populations Neel (1962) proposed an evolutionary model called the "thrifty genotype,” surmising that evolution produced "thrifty genotypes" in some human populations that allowed them to cope with fluctuating food availability, hi 1982, Neel revised his model and applied it specifically to NIDDM. He postulated that in the past a diabetic genotype conferred a survival advantage to individuals that possessed this “thrifty genotype”, hi times of abundant food, people with this genotype could process calories more efficiently and store the energy as fat. When food sources became scarce individuals with the thrifty genotype had a selective advantage, i.e. they would outcompete other genotypes. This thrifty genotype would have been maintained in those populations with widely fluctuating food availability. Today the thrifty genotype is of little use, with a steady food supply and the adoption of more sedentary lifestyles, individuals with this genotype store more calories as fat, become obese, and subsequently experience hyperinsulinemia which leads to clinical diabetes.
From an anthropological perspective the study of glucose metabolism allows researchers to examine the process of human adaptation to environmental change not only in terms of how contemporary populations have adapted to past environments, but how individuals are now coping with changing social/cultural environments (Dressier, 1996).
19 Blood Cholesterol
Seram cholesterol levels are influenced by a wide variety of factors including: genetics, age, sex, adiposity, smoking, alcohol intake, diet, activity, anxiety and seasonal fluctuations (Bortz, 1974, PoUard, 1997). Many of these factors are population specific. For example, serum cholesterol levels rise with age in most Westernized populations, but show little or no increase in less acculturated groups (Conner et al., 1978). In general, through the 5th decade of life, men have higher cholesterol levels than women, after which women exhibit progressively higher levels (Bortz, 1974). Although concentrations vary within and among populations, increased lipid levels (total-cholesterol > 200mg/dl;
LDL-cholesterol > 130mg/dl; trigylceride > 200 mg/dl) are well established risk factors for cardiovascular disease (NCEP, 1993).
Genetic factors play an important role in cholesterol metabolism. In addition to well known genetic traits such as familial hypercholesterolemia, studies also suggest interpopulation genetic variation in determining cholesterol levels. For example, the Maasai of East Africa have low cholesterol levels despite the fact that a significant proportion of their calories, obtained from cow’s milk, are high in saturated fat (Keys, 1975, Murray et al., 1978). Researchers have attributed this to an efficient feedback system regulating endogenous cholesterol levels, especially in times of feast and famine (Biss et al., 1971). However, a study by Day and colleagues (1976) argues against this extreme genetic viewpoint. They suggest that recently observed difference in cholesterol levels among rural and urban Maasai, with no differences in dietary fat intake, may indicate that stress and migrational lifestyle alterations can lead to elevated cholesterol levels even in this population.
Additional studies suggest that adverse changes in lipid levels may occur when groups undergo acculturation secondary to changes in diet, lifestyle, and physical activity.
Page and colleagues (1974) studying six Solomon Island groups, report that serum
20 cholesterol levels were higher, regardless of age or sex, in the three more acculturated groups. The major difference seen in these groups was adoption of non-traditional dietary
items including dimed meat and fish, and rice. The Tarahumara Indians of Mexico,
exhibited increased lipid levels upon adopdon of a low fiber high fat diet (McMurry et al., 1991). In Papua New Guinea, Hodge et al. (1996) reported that “modernity,” an index for changes in diet, physical acdvity, and stress, was “a strong independent correlate for total
and LDL cholesterol but not of triglycerides..., indicating the lability of cholesterol
metabolism to changes in lifestyle” (pp. 1140). Age-related increases in total and LDL cholesterol levels, reflecdve of dietary changes, also were reported as was an age-related cohort effect whereby the oldest men, those retaining more tradidonal lifestyles, had lower
modernity levels and lower cholesterol levels. A recent study by Hodge and colleagues
(1997) examined acculturadve changes in lipid levels in Western Samoa. They reported a dramatic increase in cholesterol and triglyceride levels over a 13-year period, and showed that these adverse changes in lipid levels correspond to socioeconomic indicators (higher employment status and educational achievement), obesity, glucose intolerance, and physical inactivity. They also reported that hypertriglyceridaemia was more prevalent in urban groups and that hypercholesterolaemia occurred more frequently in rural groups.
They concluded that increased intake of refined carbohydrates and alcohol may contribute to the elevated triglycerides seen in the urban groups whereas, increased consumption of dietary fat and other lifestyle changes may be contributing to increased cholesterol levels in rural residents.
Hemoglobin Levels
Hemoglobin (Hb), the main component of red blood cells, is a conjugated protein that carries oxygen to tissues throughout the body. Decreased hemoglobin levels in the body is called anemia. The causes of anemia fall into three major categories: decreased red
21 cell production, blood loss, or excessive red cell destruction (Henry, 1996). The development of iron deficiency anemia, the most common anemia in the world, can be the
result of poor nutritional intake. One still may not assume that low hemoglobin levels in developing countries are the consequence of nutrient deficiencies (Jelliffe, 1985). Anemia can be the result of abnormal losses through chronic diarrhea, poor intestinal absorption or parasitic infections (Jelliffe, 1985). For instance. Smith (1970) reported a reduction in hemoglobin levels with increased intestinal parasitic infections, especially hookworm, among the Cofan of Dureno in Ecuador.
Standard reference ranges for normal hemoglobin levels have been established: children 1-15 years 11-15 g/dl; adult men 14-16 g/dl; adult women 12-16g/dl (Rodak,
1995). The World Health Organization (WHO, 1968) criteria for nutritional anemia suggests the following cutoff points for hemoglobin levels; less than 1 Ig/dl for pregnant women, less than 12g/dl for nonpregnant women, and less than 13g/dl for men. However, various research reported lower hemoglobin concentrations for “black” populations compared to “white” populations [range firom 0.5 -1.0 g/dl] and differences in hemoglobin levels do not appear to be directly related with iron intake (Johnson-Spear and Yip, 1994; Perry et al., 1992; Dallman et al., 1978; Gam et al., 1975). Exact reasons for these differences across groups remain imclear, although environmental or genetic factors are believed responsible. For now, inter-ethnic variation must be kept in mind when evaluating iron status of indigenous groups. Femandes-Costa and colleagues (1984) study among a group of IKung San from
Namibia reported that the transition from a forager to a settled lifestyle led to dietary deficiencies, alcoholism and overall poorer health. The abandonment of traditional lifestyles and subsistence strategies seems to have led to a deterioration in blood iron levels and an increase in anemia due to nutritional deficiencies. However, a recent study by Kent and Dunn (1996) among a transitional group of IKung San from Botswana found the
22 incidence of anemia to be quite high, in spite of adequate diets, due to the introduction of
new health problems, bi general, the most frequent health problems were respiratory
infections, with children also exhibiting moderate to severe fungal skin infections. They emphasized the need to distinguish between iron-deficiency anemia (IDA) and anemia of chronic diseases (ACD). Anemia of chronic disease is the term used for anemia associated
with chronic infection, inflammation, or malignancy and is the second most common cause of anemia (Rodak, 1995). Kent and Dunn (1996) referred to increased serum ferritin levels, erythrocyte sedimentation rates (ESR) and other hematological indices to support their conclusion that anemia in this case was due to high levels of chronic infectious diseases. They stated that although mortality decreased with sedentism morbidity increased as sedintism allowed infectious diseases to persist resulting in high levels o f anemia.
Parasitic infections must be considered when studying populations undergoing environmental and cultural change. Because of the association with iron-deficiency anemia, the consequences of hookworm infection are particularly severe in populations where traditional foods have a low iron content (Bulto et al., 1992; Pritchard et al., 1991).
Environmental degradation, due to pollution or human encroachment, can make high protein foods (such as wild game) harder to procure. These foods may be subsequently replaced with refined foods higher in saturated fats and sugar (Popkin, 1994; Bindon, 1982). Thus, protein malnutrition in transitional populations may be due to a combination of poor nutrition and increased parasite loads. We must also address the importance of cultural behavior within and among different ethnic groups. Dunn (1979) states that
“Although bridges, latrines, and laundry sites can be built... there is no assurance that they will be used”. Often because indigenous groups do not understand the Western concept of germs, they do not understand the need for sanitation measures. Cultural beliefs and practices play an important role in the incidence of health and disease within indigenous groups and must be addressed.
23 Kent and colleagues (1994) suggest that a hypoferremic (low hemoglobin and low serum iron) response is an adaptive mechanism against certain infectious diseases such as malaria, brucellosis, amebic dysentery, E. coli. Salmonella, and various viral infections.
They state ' anemia of infection and chronic disease is a non-specific defense the body employs to ward off bacterial, parasitic, and neoplastic invasion” (pp. 23). Various studies suggest that iron enhances the virulence of various microorganisms (Brock, 1986;
Weinberg, 1992). Therefore, low circulating hemoglobin levels deny the infecting bacteria or parasite the essential iron necessary for “in-vivo” growth. Furthermore, the bactericidal effects of neutrophilic white blood cells are inactivated by excess circulating iron.
Individuals with anemia of infections have low serum iron and hemoglobin levels however, their serum ferritin levels are normal to elevated. This indicates that the body is storing iron (taking it out of circulation) and most likely these individuals are consuming adequate dietary sources of iron. A study (Murray et al., 1980) conducted among a group of mildly anemic African Turkana supports the role of hypoferremia as a protective factor against infectious disease. These authors reported fewer incidences of infectious diseases such as malaria, brucellosis, amebic dysentery and other viral infections among anemic individuals as compared to those who were not anemic. Researchers smdying indigenous groups who are known to have diets adequate in iron, should examine the role of hypoferremia as a possible defense mechanism against endemic infectious diseases. This is especially true for sedentary groups where increased population numbers and inadequate sanitation can promote chronic pathogen loads (Kent et al., 1994). It is also important that researchers differentiate between IDA and AŒ) because iron supplementation based on low hemoglobin levels may only contribute to an increase in infectious diseases seen in these populations.
24 Intestinal Parasites
Researchers have investigated the effects of culture change and envirorunental degradation on the prevalence of intestinal parasitic infections in South Amerindian populations (Confalonieri et al., 1991; Chemela and Thatcher, 1989; Salzano and
Callegari-Jacques, 1988; Lawrence et al., 1980; Schwaner and Dixon, 1974).
Envirorunental and cultural factors that can effect the prevalence of helminth infections within a given population include: climatic conditions (including the physical condition of soil), life cycle of ±e helminth, disruption o f geographic isolation, increased population density, changes in housing and hygiene patterns, social stress, poor nutrition, and the introduction of modem medicine. These factors can lead to the introduction of new parasite species, increased soil contamination, differential exposure to infection, increased opportunity for transmission, and greater susceptibility to infections (Confalonieri et al., 1991; Chemela and Thatcher, 1989).
The most common intestinal nematodes include; roundworms {Ascaris lumbricoides and Strongyloides stercoralis), pinworms (Enterobius vermicularis), whipworms
(Trichuris trichiura), and hookworms (Necator americanus or Ancylostoma duodenale).
Nematodes are long-lived and the diagnosis of infection depends on recovery and identification of adult worms, eggs, or larvae from feces or the perianal area as in the case of pinworms. Infections usually occur when embryonated eggs are directly ingested from contaminated soil or food however, direct skin penetration from filariform larvae that have hatched in the soil can also occur. Early clinical symptoms of intestinal parasitosis may include diarrhea, anemia, eosinophilia, and nutritional deficiencies due to the presence of adult worms (Garcia and Bmckner, 1997). These symptoms may differ with each infection and are not necessary precursors to an infection. Hookworm infections are often associated with iron deficiency anemia which is caused by the attachment of adult female worms to the mucosa of the small intestine and subsequent intestinal blood loss.
25 Eosinophilia, an increase in white blood cells associated with an immune response, has been seen in Ascaris infections, but is usually more pronounced in hookworm infections (Garcia and Bruckner, 1997).
Since helminth eggs are eliminated in the feces, the endemic nature of these parasites depends on continuous soil re-contamination. Consequently, the level of infestation within a population can be directly related to contact with contaminated soil
(Chemela and Thatcher, 1989). Settlement patterns, population density, and defecation practices play an important role in the prevalence of intestinal parasites. Croll (1983, 14) states.
The countries in which risk of parasitic diseases are the greatest are also those in rapid sociocultural transition. Social change will affect the prevalence of parasites altering the activities significant to host-parasite interface, in communities now entering the protective but unstable yoke of sanitation, hygiene, and chemotherapy.
Chemela and Thatcher (1989) studied parasite burdens among the Tukano and
Maku, indigenous Brazilian Amazon populations. These populations were distinct in that one was a sedentary fishing and farming village and the other was a foraging population composed of small bands who migrate between hunting camps. Sedentary villagers (Tukano) have a higher incidence and heavier levels of parasite infections than the semi- nomadic group (Maku), which is most likely due to increased contact with contaminated soils. Although the Maku have a high incidence of the long-lived hookworm infections, their subsistence pattem prevents them from contracting Ascaris infections, which require continual contact with infected ground. However, acculturated Maku, those settled into permanent villages, have parasite intensities equal to that of the Tukano.
Schwaner and Dixon (1974) looked at parasitic infections as a measure of culture change when studying two villages of Tucuna Indians (Puerto Narino and Petuna) in southeastern Colombia. Puerto Narino, the more acculturated group, is intermixed with
Europeans and Mestizos and is part of a government project to encourage settlement in the
26 Amazon region. Electricity, piped water, medical care and various other amenities led to
rapid population growth in this area and subsequent grouping of isolated Indian families
into large communities. Modernization (improved sanitation, water procurement and
hygiene measures) of the Puerto Narino group led to a reduced incidence of worm burdens among its inhabitants as compared to the traditional villagers of Pemna. However, if population growth of this region continues at its present pace, health will be negatively
affected in both villages due to heavier contamination of village areas and over-stressed public facilities.
Nwosu (1983) studied the impact of human environments on helminth infections in
four rural Nigerian villages experiencing rapid growth and cultural change due to
government directed programs and new living conditions. The incidence of infection
varied between villages however. Ascaris, hookworm, and Trichuris infections were common in all four villages. The factors responsible for the endemic nature of these parasites included poor sanitation, unhygenic water supplies, and increased population
densities which bring people into closer contact with contaminated soils. Nwosu states that an increase in helminth infections can be expected in rural Nigerian villages that do not have properly planned health and development programs.
Several early studies reported the incidence of intestinal helminthiasis among groups in the Oriente region of Ecuador, the locale for my study. In 1967 Swanson (from Smith 1970) surveyed 56 Secoya Indians living in Cuyabeno and 76 Cofan Indians living in Dureno, the locales of this study, and found the following incidences: among the
Secoyas, Ascaris 37%, hookworm 87%, and Trichuris 33%; among the Cofan, Ascaris
54%, hookworm 85%, and Trichuris 55%. He attributed the lower incidence o f Ascaris infections to the use of Ajcam-specific vermifuges. Battle et al. (1968), examined thirteen fecal samples from the Cayapa, Jivaro, and Quechua Indians and found infections with
Ascaris, hookworms and Trichuras. According to Smith (1970), the first quantitative
27 study of helminthiasis in Ecuador was conducted by Schwaner and Dixon in 1967
(unpublished material). By examining eggs per gram of feces, their study showed high
incidences of parasitic infections and high levels of worm burdens among the 3-12 year old
Cofan of Dureno (Ascaris 87%, hookworm 96%, and Trichuris 87%). In the sununers of 1968 and 1969 Smith (1970), resurveyed the Cofan to measure changes in incidence and
worm burden of Dureno residents. She states that the use of vermifuges (both conomercial and local plants) was probably responsible for the decrease in number of Ascaris infections
(Ascaris 55%, hookworm 93%, and Trichuris 86%). However, the intensity of
hookworm, Trichuris, and total worm burdens (based on eggs per gram of feces) increased
from 1967 to 1969 and is most likely due to cultural and environmental factors such as lack of sanitary measures and favorable soil conditions.
Dental Health
Oral health can be an important indicator of environmental and cultural change.
Rugg-Gunn (1993; 109) stated that, “Environmental factors appear to be of overriding importance in the etiology of dental caries...” hi many areas of the world, pollution is forcing individuals to change their type of water consumption. The Cofan traditionally drank mineral laden river water. Today however, due to chemical pollution, their main source of drinking water is mineral poor rain water. Valuable minerals such as fluoride, a necessary component of good dental health, are not being ingested. Most trace elements can be obtained through dietary sources however, drinking water is the main source of dietary fluoride (Rugg-Gunn, 1993). Several features are important to the development of dental caries (Rugg-Gunn,
1993; 91-102). First, the presence of food and micro-organisms in the mouth is essential to the formation of dental caries. Second, reduced salivary flow leads to the rapid progression of dental caries. Saliva functions to wash away bacteria and food particles
28 from the teeth, and maintain a neutral pH in the mouth to prevent dental caries.
Carbohydrate-containing foods, when incubated with saliva, induce fermentation and increase the production of lactic acid which leads to in-vivo demineralization of teeth. Bacteria, located in saliva, are then able to invade the tooth’s surface creating carious lesions. Finally, decay occurs if the process of demineralization of tooth enamel is greater than that of remineralization. Counting the number of decayed, missing, or filled teeth in a person's mouth is a simple means to quantify the dental decay they have experienced in their lifetime. This is known as the DMFT index (decayed-missing-filled teeth) and is widely used for indicating the prevalence and severity of dental caries experienced in populations (Rugg-Gunn, 1993). Since diet has a great influence on the etiology and control of dental caries, this index is also a good device for measuring change in nutritional patterns. Clinical assessments of physical parameters are an important part of any nutritional assessment and oral symptoms of nutritional deficiencies have been recognized for years (Rugg-Gunn, 1993). The consumption of processed foods high in sugar is a fairly recent phenomenon in many areas of the world. As indigenous communities become exposed to increased contact with Westernized cultures, they subsequently adopt high- sugar, low-fiber diets and experience a concomitant increase in dental caries. Numerous studies have documented dental caries in populations before and after the availability of sugar and processed foods. Niswander (1967) compared the oral status of a more acculturated group of Xavante Indians from Brazil with an earlier study of a more traditional group conducted by Neel and colleagues in 1964. Niswander found a higher incidence of dental caries among the acculturated group who were growing and most likely consuming sugar cane, an activity not seen among the more traditional village. Mayhall
(1977) examined the oral health of two Canadian friuit communities who were undergoing rapid acculturation. This four year study comparing Uving groups and skeletal groups indicated that dental caries have increased gradually since European contact. However, a
29 rapid increase occurred over the four year study period. This rapid increase in the
incidence of caries coincided with a shift firom traditional foods (caribou, seal, fish, flour,
and tea) to processed foods loaded with refined carbohydrates, especially in younger age
groups. Samat et al. (1987) reported an increase in dental caries among Ethiopians who migrated to Israel. They suggested that this was the result of an increase in the
consumption of fermentable carbohydrates and easy access to sweet processed foods such as candy.
Foods containing sugars or fermentable carbohydrates threaten dental health (Edmondson, 1990). However, other variables must be considered, for example, the
introduction of Western foods and eating habits may alter the firequency and amount of
food consumed by acculturating groups. As the frequency and amount of food eaten
increases so does the potential for dental caries. Edmundson (1990,68) notes “The most important dietary aspect of caries etiology is the ‘total cariogenic load’ on any individual”.
The total cariogenic load consists of the frequency in which various carbohydrates are
eaten, the cariogenic potential of the food, and the anti-cariogenic factors in the foods. Some traditional foods may have anticariogenic properties. Several studies
(Makinen and Isokangas, 1988; Scheinin and Makinen, 1975) have examined the non-
cariogenic effect of sugar alcohols on caries prevalence. These studies suggest that the
replacement of sugars with sugar alcohols reduces dental caries by reducing the number of
challenges to the teeth thus increasing remineralization time. Many indigenous populations ingest large quantities of fermented carbohydrates such as “chicha,” a fermented manioc drink. In the absence of refined or processed foods this beverage may confer some protection against dental caries. Other cultural practices such as induced vomiting, done to
develop the diaphragm for blow gun use, may negatively impact dental health by exposing
teeth to gastric acids which cause progressive enamel loss thus increasing an individual’s
susceptibility to caries.
30 Protein deficiency may also play a role in a person’s susceptibility to dental caries.
Increased susceptibility to dental caries was observed in rats whose mothers received low protein diets during pregnancy and lactation (Navia et al., 1970; Navia, 1972). This may be an important factor with regard to dental caries in societies undergoing dietary change resulting in the increased availability of sugar and the decreased availability of good protein sources. Several studies have suggested that the increased incidence of caries in anterior teeth may be due to linear enamel hypoplasia (a mineralization defect) which may be induced by severe gastro-intestinal diarrhea early in life when teeth mineralize, hidividuals with this mineralization defect have been shown to have a higher incidence of dental caries
(Infante and Gillespie, 1976; Rugg-Dunn, 1993).
In addition to enviromnental factors, there is likely a genetic component involved in the susceptibility to dental caries (Murray, 1989). Although specific genetic loci have not been identified, some researchers think that genes involved with tooth structure and alignment or salivary composition and flow rate are likely candidates (Rugg-Gunn, 1993).
1.2.4 Summary The evidence reviewed above supports the following generalizations relevant to this study; I) Populations undergoing acculturation show higher levels of adiposity, total cholesterol, glucose and blood pressure associated with lifestyle change and lifestyle incongruity. 2) In some instances, dietary changes, including increased consumption of processed foods along with decreased physical activity, have led to increased adiposity, a subsequent risk factor for chronic disease. 3) Dietary changes along with enviromnental degradation have increased the incidence of dental caries in some populations, 4) hi some cases, enviromnental change and population pressures that accompany acculturation have led to an increase of infectious diseases, and 5) Socioeconomic differentiation may be leading to an increase in stress related chronic conditions.
31 1.2.5 Rationale for Studying the Cofan
Currently, there are few isolated groups of Native Americans pursuing even modified versions of their traditional lifeways. Those that do exist have been reduced by numerous factors, including land conflicts and infectious diseases, and represent only remnants of populations that existed in Pre-Columbian times (Schmink and Wood, 1984).
Data obtained from these remnant populations indicate unique genetic patterns and large differences in physiology as determined from standard blood analyses, blood pressure measurements, and patterns of growth and development (Evelyth and Tanner, 1976; Salzano and Callegari-Jacques, 1988; Reming-Moran and Coimbra, 1990). If such differences have either a genetic or behavioral basis, their analysis may reveal aspects of past and present human adaptations to diverse environments. These unique natural experiments in human adaptability must be documented now before they are lost forever following behavioral and social acculturation. Few studies have reported on the health and human variation of traditional living populations from the Amazon Basin. Western societies, age, obesity, fat distribution, and diet are common correlates of blood pressure (BP). However, these variables may not be significant correlates of BP in more traditional-living societies. Today’s Amazonian populations present a continuum from very traditional life styles through increased contact with and integration into Western societies. Traditional lifestyles generally include regular physical activity, low sodium diets, low prevalence of obesity and diabetes, moderate use of low alcohol or caffeinated beverages, and social homogeneity among villagers (Fleming-
Moran and Coimbra, 1990). Any of these factors may be important contributors to the growth, development, and overall health in Amazonian populations.
32 1.3 Research Objectives
The goals of this research are to assess the physiological and demographic characteristics of the Cofan from Dureno and Zabalo. Baseline physical and social data will characterize the uniqueness of the Cofan, physiologically and culturally, compared to other human populations. This is necessary to evaluate the impact of both environmental (biophysical) and sociocultural disruption on the lifeways and health of the Cofan and to document the degree of acculturation within and between the two villages. Specific research objectives are:
I) Analyze census data to aid in the establishment of demographic patterns seen in the two groups.
n) Determine the social/cultural variability between the two villages utilizing social assessments that evaluate participation in non-traditional lifeways, health knowledge, activity levels, imusual health conditions, dietary intake of processed foods, socioeconomic status, economic resources, and level of contact or interaction with non-Cofan.
m ) Determine the degree of physiological variability among the Cofan in both villages utilizing selected physical assessments (blood analyses, fecal analyses, dental analyses, blood pressure measurements, anthropometric measurements).
IV) Determine cross-sectional associations of body habitus, lifestyle and dietary behavior with health, as represented by outcomes of blood pressure, glucose and lipid levels, dental and fecal analyses and self-reports. The level of interaction or involvement with non-traditional lifeways (social/cultural variation) will be contrasted and compared with these same measures of physical health to determine the healthier lifestyle.
33 CHAPTER!
SAMPLE AND METHODS
2.1 Research Design
Throughout the Ecuadorian Amazon ecological and environmental changes are occurring with great rapidity making it an ideal and unique setting for examining human variation and responses to acculturation (Kane, 1993, Vickers, 1983). Detailed here is research examining cultural and biological variation in one Native American Amazonian group, the Cofan, of Northeastern Ecuador. The Cofan exist today along a continuum of acculturation from very isolated to surviving on wage-labor. The Cofan are a genetically homogenous population who live in a variety of settings within the Amazon region of
Ecuador (Appendix A). Each settlement appears to be experiencing different environmental pressures. As a population in transition, the Cofan present an opportunity to examine intrinsic and extrinsic factors related to acculturation. For this study, two closely related
Cofan villages undergoing varying rates of acculturation were identified. Given the complexity of this transition, this study combines cultural and biomedical data to provide an examination of how these domains interact and change in response to acculturation and environmental degradation. The main research goal is to examine how environmental and culmral change affect the well-being and health of this indigenous Native American group.
To provide an integrated study, cultural and biomedical techniques were combined into a single research design. Data collection included anthropometric measures, blood pressure, fecal samples, dental exams and fingerstick blood samples to determine
34 physiological variability. Social assessments included lifestyle, health, and nutrition questionnaires designed to determine participation in non-Cofan lifeways, general health knowledge, unusual health conditions, and dietary diversity. Combined biological and cultural/behavioral analyses will allow identification of variables (diet, blood chemistry values, parasitic infections, dental health, blood pressure and anthropometric measures) significantly associated with acculturation.
Hvpotheses
Data obtained in this study will identity environmental and culmral changes that disrupt homeostasis at the individual and village level.
Hypothesis -1 Health stams is negatively correlated with village cultural and environmental change.
la: The village practicing a more traditional life style wiU have
better health and dietary status.
lb: The village reporting higher levels of participation in non-traditional activities will exhibit greater intake of processed foods, higher weight and BMl, higher incidence of dental problems, higher incidence of parasitic infections, higher
glucose and cholesterol, lower hemoglobin, and higher blood pressure than the
village practicing a more traditional life style. Hypothesis -2 Health stams is negatively correlated with level of individual acculturation.
2a: More acculturated individuals wUl exhibit a higher lifestyle
incongmity.
2b: More acculmrated individuals will show greater intake of processed foods,
higher weight and BMI, more dental problems, more parasitic infections, higher
glucose and cholesterol levels, lower hemoglobin levels, and higher blood pressure
than individuals practicing a more traditional lifestyle.
35 2.2 Study Population 2.2.1 General Characteristics of Ecuador’s Amazon Region The Amazon Basin is the largest area of tropical rainforest in the world. In addition to its ecological value, Amazonia is one of the few areas where native groups still preserve traditional lifestyles. Ecuador’s Amazon Region (nationally termed the Oriente) is comprised of five provinces; Napo, Sucumbios (the province of Napo was subdivided in
1989, the northern part became Sucumbios the southern part remained Napo), Pastaza, Morona Santiago and Zamora Chinchipe (Appendix A). According to Hicks et al. (1990), the Oriente has a human population of approximately 350,000, with a population density of
2 inhabitants per km \ compared to 60/km^ for the rest of the country. The Oriente comprises more than half of Ecuador’s territory but only supports approximately 4% of its population. Historically, the Oriente had a relatively low population density; however, between 1974 - 1982 the region’s population grew at 4.9% per year as compared to 2.5% for the entire country. Most of this growth can be attributed to non-indigenous immigration. The municipality of Sucumbios, where Dureno and Zabalo are located, experienced growth rates of 5.7% annually between 1974 - 1982. Population growth in this area has been fueled mainly by the region’s petroleum industry which between 1980-
1985 extracted approximately 90 million barrels of crude per year. Oil extraction was initially concentrated in 700,000 hectares of Napo and Sucumbios Provinces; however, by
1987 almost 3 million hectares were under exploration (Appendix A) (Hicks et al., 1990).
Agricultural reform began in 1978 when the law of colonization of the Amazon region (Ley de la Colonizacion de la Region Amazonica) was adopted leading to accelerated and spontaneous colonization of the rainforest by Andean settlers (Appendix A) (Hicks et al., 1990). According to Southgate and Whitaker (1994), between the 1970’s and I980’s approximately 135,000 hectares were cultivated and approximately 0.5 million hectares were deforested to make way for livestock herds. Cattle ranching is a dominant feature of
36 agricultural frontiers throughout South America. Colonists wül typically allocate between
50% to 65% of farmland to pasmres with the rem aining used to produce subsistence crops such as rice, cassava, bananas, manioc, or commercial crops, such as coffee (Sierra and
Stallings, 1998). The Oriente is a significant national producer of several crops including: tea (100% of national production), naranjilla (79%), manioc (41%), papaya (16%), palm oil (16%), and coffee (14%) (Hicks et al., 1990). In Napo and Sucumbios Provinces
65,300 hectares were allocated to commercial agriculmral production between 1983-1986, this is greater than a three-fold increase in three years (Hicks et al., 1990). Hicks and colleagues (1990, 3) state;
Although the RAE (Ecuador’s Amazon Region) accounts for less than four percent of the country’s total employment, it contributes a disproportionately high share of national employment in the primary sector 5.6 percent in agriculture and related activities; 23 percent in mining, including petroleum extraction.
The Oriente presents unique characteristics. These include extremely fragile soils that are easily depleted and an extraordinary biological diversity, much of which is not yet documented (Poirier and Mullins, 1994). The indigenous peoples who inhabit the
Ecuadorian Oriente are survivors of ancient ethnic groups transformed by inter-tribal conflicts, colonization, missionary encounters, invasions by rubber collectors, cattle ranchers, farmers, and most recently the expansion of the oil industry and its associated road-building and land settlement activities (Whitten, 1981). The approximately 10O,(XX) indigenous residents of the Ecuadorian Amazon represent several different indigenous cultures including the Cofan, Siona, Secoya, Shuar, Achuar, and Quechua (Hicks et al.,
1990). The Shuar and Quechua make up nearly 85% of the Oriente’s indigenous population and have been in contact with the national society longer. Other groups, including the Cofan, are much smaller in size and remain dependent on rainforest resources for survival. Some groups have remained isolated and retain their cultural identity. Today, these distinct and culturally rich communities, along with associated plant and animal
37 communities, are threatened by oü exploration and colonization. Acculturative environmental change has led to a greater reliance on agriculture and farming by most indigenous groups. However, members of some groups have retreated further into the rainforest, where they are actively fighting to retain land rights and follow traditional lifeways.
2.2.2 Cofan History
According to Borman (1994), before Spanish conquest, the Cofan inhabited northeastern Ecuador and southeastern Colombia and numbered around 20,000 people.
They were a "river people" whose territory surrounded four rivers, the Aguarico, Coca,
San Miguel, and Guamues, and extended to the cloud forests along the eastern Andean slopes. Their first prolonged contact with outsiders came when the Spanish attempted to colonize the area. In the early 1900's an attempt was made by the national government to settle the Cofan in one location, San Savarin, on the San Miguel River. By the 1930’s smallpox, whooping cough, and measles reduced the population to about 400 survivors scattered throughout the headwaters of the San Miguel, Putumayo, and Aguarico rivers.
The neighboring Siona people also were greatly reduced by diseases. They both became nomads, wandering the lands of northern Ecuador and southern Colombia. No further attempt was made by the governments of Ecuador or Colombia to bring the Cofan into the mainstream of national policy. The 1940's brought increased isolation for the Cofan.
Contacts with the Western world were limited to an occasional trader and a yearly visit by a priest who would conduct baptisms and marriages. At this point in time the Cofan lived their traditional lifestyle, hunting, fishing, gardening, artisan work, and shamanism.
In 1945 Royal Dutch Shell arrived in the area. However, low oil prices and governmental demands forced Shell to abandon operations in 1949. In 1954 the Summer
Institute of Linguistics (SEL) made their first contact with the Cofan, beginning the legacy
38 of the Borman family. The Borman's mission was to leam the language, describe it linguistically, and translate the New Testament into the Cofan language. With the Bormans
came Western material items such as beads, cloth, machetes and medicines. According to Randy Borman (1994,5):
An important point to note in this regard is the acceptance of the Cofans of a multi-cultural world. It was taken for granted that different peoples would do things differently. Hence, the Bormans were never faced with the dilemmas of inadvertently creating a "cargo cult". The Cofans, in spite of having a very weak concept of national identity at this time, were culturally very secure. The Bormans reinforced this cultural security by learning their language, bringing in their requested trade goods, living with them, and letting their children grow up within the culture's framework.
Two of the Borman’s children have remained with the Cofan. Ron, who lives in the
village of Dureno and married a missionary’s daughter, continues the religious work of his parents and he and his wife (a registered nurse) help educate the children and treat minor
aliments. Randy, who married a Cofan woman and has three sons, has been instrumental in the Cofans fight to obtain land rights and in their confrontations with oil companies. He was instramental in establishing the village of Zabalo and was elected chief of the Zabalo
community and President of the Ecuadorian Cofan. Although his term as chief and
president expired, he remains active in political issues. The approximately 1400 Cofan in Colombia and Ecuador have experienced varying degrees of contact with outside cultures and, in some instances, have inter-married with
neighboring Siona peoples. According to M 3. Borman (personal communication), the languages of these two groups are completely different. The Siona are of the Western
Tucanoan language family whereas the Cofan are part of the Chibchan language family.
However, the two groups do exhibit many of the same cultural patterns (Whitten, 1981).
The Ecuadorian Cofan, numbering approximately 700 - 1000 people, inhabit riverine areas and are dispersed among five villages: Dureno, Duvuno, Singangoe, Chandia-Nae, and
Zabalo. Drastic changes began in the 1970's with increased oil exploration and the
39 subsequent construction of a road which dissected traditional Cofan territory. This resulted in increased pollution from petroleum extraction, and an increase in the number of colonist
settling in the area to farm. These changes have resulted in further degradation of traditional Cofan lands and various lifestyle changes seen in some of the villages today.
2.3 Study Samples 2.3.1 Sample Selection
The Cofan villages of Zabalo and Dureno (Figure 4) were chosen because of their proximity to one another (Zabalo is located 60 miles east of Dureno and is accessible by boat, 6 hrs upriver) and because of familial associations between the two groups (the
Zabalo group broke from the Dureno group in 1984). The three other villages are not included in this research because they have high amounts of genetic admixture and are located further away (requiring three full days of boat travel or 10-20 hrs of hiking in hiUy forest). The villages of Zabalo and Dureno are somewhat genetically homogenous.
However, they differ with regard to the degree of acculturation and environmental degradation they are experiencing. Inter-village differences in traditional Cofan lifeways and subsistence activities have arisen in response to environmental alterations due to the intmsion of non-Cofan, colonists, and oil companies into the area. Dureno, the “ more acculturated” community (population = 250), is located across the river from an oü town (an enclave of approximately 2000 settlers) which is also caUed Dureno. Zabalo, the “more traditional” community (population = 120), split from the Dureno group in 1984, and is located further into the rainforest. In July, 1993 initial contact was made with the Cofan and permission was obtained from both Cofan communities to study the health effects of cultural and environmental change. At this time background and historical data also were collected. Sampling was conducted over three summer field seasons (1994-1996). Phyical and lifestyle data were obtained in August of each year. Two 24 hour dietary recall
40 questionnaires were obtained, one during the month of August, 1996 (rainy season), and the other in February, 1997 (dry season). Research assistants, who were living in the villages and trained by the author during the August, 1996 field season, collected the 24 hour recall data in February.
As with any study among semi-isolated populations, the smdy design was one of intensive investigation of a relatively small number of individuals, this project’s goal was inclusion of all individuals residing in either Dureno or Zabalo. Participation was by household and any that volunteered to be surveyed were included in the smdy protocols.
In all, 53% of Dureno residents (133/250; 60 males, 73 females) and 93% of Zabalo residents (111/120; 63 males, 48 females) participated in this smdy. A primary concern with any research is that the study sample truly represents the population of interest. Since inclusion into the smdy was on a voluntary basis, this may have attracted more participants who were less active during the day, who were looking for profit or entertainment, who were more closely related to guides or key informants, or individuals that needed/desired some medical attention. However, there were no overt indications of these problems and individuals from 17 of the original 18 Dureno family linaeges are represented in the data.
Therefore, this smdy provides a good representation of the Cofan populations of Dureno and Zabalo. Another consideration is the cross-sectional natme of this smdy. Although it is possible to identify associations between lifestyle variables and biological characteristics, neither the cumulative affects of acculmration on biological variables nor the possible causal nature of these relationships can be discerned. This smdy’s strength is its breadth of baseline data on two indigenous Amazonian villages surviving varying degrees of culmre encroachment and environmental degradation. A variety of health indicators were examined to provide a broad overview of the Cofan’s general state of well-being at the individual- and village-level.
41 2.3.2 Village Ethnographie Description This section describes environmental, social and economic factors for Dureno and
Zabalo, and how these relate to acculturation. This description is based largely on
ethnographic observations made by the investigator during four seasons of fieldwork. A more detailed description, based on information obtained through household and individual
interviews, is presented in Chapter Three.
The Village of Dureno
The Dureno population, 45 families and approximately 250 people, live on 9,500 hectares, which they hold by national title, a mere fraction of their traditional territory which included 300,000 hectares. Their traditional lands have been crossed by roads and encroached upon by colonists and oil companies. Pollution, overhunting, and colonization by farmers have forced the Cofan into ever smaller territories, negatively impacting their cultural activities and traditions.
Through increased contact and awareness of mainstream national culture the Cofan have been introduced to many aspects of Western lifestyles, including, processed foods high in sugar and fat, the use of radios, VCR's and lawnmowers, and Western medical and dental ideologies and practices. Dietary staples in this group include the traditional cooked banana drink, "chocula. " However, overhunting by colonists and oil workers, along with pollution from oil spills, has greatly depleted traditional food sources. Purchased foods such as canned meat or fish, rice, flour, powdered fruit drinks, candy, soda and beer, which they obtain from the nearby oil town, are observed throughout the village. Dureno has a manually powered central well and two non-functioning latrine buildings in the center of the village. Generators and solar panels supply power to run electronic devices .
Manual sickeling of the land to remove undergrowth around the village has been replaced, by gas-powered lawmnowers and bicycle carts transport people and goods throughout the
42 village. In the middle of the village, several concrete buildings include a school room,
meeting room, and a medical clinic, once operated by outside medical personnel. A local Cofan who worked with the medical personnel, currently is in charge of the nominal
supplies (some anthelminthics and anti-inflammatories), and the building. Mr. Ron Borman and his wife Esther, a nurse, provide aid with acute medical problems. Several
Cofan, educated at a missionary school in Limoncocha, have returned to teach villagers in
both Spanish and Cofan.
Economically, the Cofan of Dureno follow a modified subsistence lifestyle.
However, since wild game is scarce, some families raise cash-crops (com, coffee) for local oil towns and purchase food and supplies. Several households also raise pigs and chickens
however, this is atypical. Asked about hunting, one Cofan stated that men must now travel
far into the rainforest to find game and often come back empty-handed. To him, it was
easier to buy canned meats and fish from near-by towns and traders. Most households earn some cash selling souvenirs. Agriculture work, teaching, work as a tourist guide, or doing unskilled labor in oil towns are the major cash-generating occupations available to Dureno Cofan.
The Village of Zabalo
In 1984, Zabalo was established by 60 Cofan from Dureno who moved east into the rainforest in hopes of escaping oil company roads and colonists seeking to return to a more traditional way of life. They relocated 80 kilometers east of Dureno to an area in the
Cuyabeno Faunistic Reserve where the Zabalo River merges with the Aguarico River.
Today the settlement consists of approximately 120 people representing 18 families. In
1992, the Cofan signed an agreement with the central govemment to steward 200,000 acres of Cuyabeno Faunistic Reserve (which was traditionally Cofan territory) thus, allowing them to build homes, hunt, fish, and guide tourists through the area. As deputized guards
43 of the Cuyabeno Reserve, the Cofan are legally empowered to enforce laws protecting the
land, up to, and including, expelling oil prospectors. Negotiations for land rights continue
as the Cofan persist in their attempts to secure approximately 12,000 hectares within the 655.000 hectare Cuyabeno Reserve as their homeland.
The Zabalo group maintains their "traditional" lifestyle by relying on wild game
and fish, gathered vegetable products and small cultivated gardens for their subsistence.
Dietary staples of chocula, yucca, fish and game are occasionally supplemented with
purchased foods, mainly, rice, flour, and cooking oil. In addition to traditional subsistence
activities life in Zabalo is "traditional " in several other ways; most illness is treated with the
use of over 200 varieties of medicinal plants, and many items (blowguns, bows and
arrows, dugout canoes, hammocks, palm fiber bags (chigras), clay pots and bowls) are
produced from forest materials in the style of their ancestors.
The Zabalo Cofan are not completely isolated. They practice a mixed economy
mingling traditional subsistence practices with wage-labor earned as ecotourism guides. They sell handicrafts made from sustainable forest resources and earn fees as cooks, guides, and naturalists from ecotourists. They continue to practice age-old conservation methods and divide the land of Cuyabeno into three zones: Zone 1 - used for housing and gardens is located along the river’s floodplain where the best soil exists. Zone 2- intensively used forest- is utilized by the Cofan for hunting and gathering and must always remain forested. Finally, Zone 3 - is left “wild” to act as a reservoir for the regeneration of species from zone 2 and for ecotourism.
2.4 Data Collection Techniques 2.4.1 Overview
Protocols requiring blood and fecal samples, dental examination, blood pressure and anthropometric measurements, and lifestyle questionnaires were completed for all
44 individuals aged. 13 years and older (these individuals are considered adults in Cofan society). Anthropometric measures, dental exams and fecal samples were also collected on individuals less than 13 years old. In some instances, at the parent’s or spouse’s request,
blood samples were also obtained from individuals less than 13 years of age. All
interviews were conducted in Spanish with the aid of a translator. The main translator was a trained emergency medical technician familiar with medical terminology in both English and Spanish. A Cofan translator was always present to assist in interviewing individuals
not fluent in Spanish, which included most participants.
2.4.2 Procedures Anthropometrv
Standard anthropometric techniques were followed to measure stature, weight, three skinfolds, and three circumferences (Lohman et al., 1988) (Appendix B). All skinfold measurements were completed three times and circumferences twice. Averages of these measurements were used in the final analyses. An assistant recorded measurements and helped the researcher correctly position the instruments. Skinfolds were measured with a Lange® skinfold caliper at three sites: triceps (Tri SF), measured in the middle of the posterior aspect of the arm; subscapular (Subscap SF), measured just inferior to the inferior angle of the scapula; and suprailliac (Supra SF), measured in the midaxillary line immediately superior to the iliac crest. Circumferences were determined with use of a metal tape measure and care was taken on all measurements not to compress the soft tissue. When circumferences were taken around clothing, the clothes were measiured with the
Lange® skinfold calipers, and adjustments were made to the values. The upper arm circumference (UA Circ.) was measured at the midpoint of the upper arm. The waist circumference (Waist Circ.) was measured at the natural waist, which is the narrowest part of the torso, and the measurement was taken at the end of a normal expiration. However,
45 when it was difficult to identify the natural waist the smallest horizontal circumference was
measured in the area between the ribs and iliac crest. The hip circumference (Hip Circ.)
was taken at the maximum extension of the buttock. Reliability was assessed following
standard protocols (Mueller and Martorell, 1988). Stature was measured using a Gnuepel® anthropometer while the participant stood still, barefooted, heels together and toes apart,
with their head held in the Frankfort Horizontal Plane. Stature was recorded to the nearest
millimeter. A portable Health-O-Meter® scale measured body weight (individuals were lightly clothed and barefooted) which was recorded to the nearest pound.
Blood Pressure
Systolic and diastolic blood pressure and pulse rate were measured twice for each
participant 13 years of age and older (Appendix B). Blood pressure measurements were
made on the left arm using a Baumometer® mercury sphygmomanometer and a Lithman®
stethoscope following protocols of the Loyola University Medical Center. Each participant
was seated and rested for at least 5 minutes before the initial measurement and for a
minimum of two minutes between readings. The first appearance of sound, first Korotkoff
sound, was recorded as systolic pressure and the disappearance of sound, fifth Korotkoff sound, as diastolic pressure. Blood pressure measurements were recorded to the nearest
digit. If the mercury column was between two digits, the higher value was recorded.
Radial pulse was taken for 15 seconds on the left wrist before each blood pressure
measurement.
Blood Analyses Fingerstick blood samples, obtained from most participants aged 13 years and over, were used to determine glucose, cholesterol, hemoglobin levels, and eosinophil counts
(Appendix B). Time of blood fingerstick was recorded. Participants reported when they
46 last ate as part of a series of structured questions. However, participants were not
individually monitored (i.e. the researchers did not awaken them in the morning to obtain blood samples) therefore, these samples are considered random. Use of non-fasting
samples does not affect hemoglobin levels (Henry, 1996), however, individuals with high glucose levels were asked to refrain from eating or drinking after dark and the test was
repeated in the morning. The National Cholesterol Education Program’s Laboratory
Standardization Panel (1990) states that total cholesterol levels can be accurately measured in non-fasting individuals. It is only when triglycerides and LDL-cholesterol also are being measured that fasting is required because fatty meals may result in triglyceride-rich
chylomicrons and compositional changes in LDL particles. The fingerstick protocol
included; 1) Wipe middle finger with alcohol and allow to dry completely. 2) When dry,
make a single cutaneous puncture with a Monoject® lancet. 3) Discard first drop of blood
and use minimal pressure to obtain additional blood samples. 4) Use blood to measure glucose, hemoglobin, cholesterol with appropriate meters. 5) Make blood smear. 6) Blot
all additional blood, until clotting occurs, onto filter paper for later DNA analyses (steps followed in this order).
An Ames Glucometer IQ®, used to determine whole blood glucose levels, employs
a dry reagent technology based on the glucose oxidase method and provides a quantitative
measure of glucose in whole blood. To assure proper functioning, the Glucometer® 3 was tested daily against a check strip (provided with meter) with a known operating range. A normal control (standardized solution) also was run daily to assure proper operation o f the meter and validate the test strips. Sealed test strips were stored with desiccant in the manufacturer’s container away from direct sunlight. Each strip was used immediately upon opening the individual foil packets. Following the fingerstick, a single drop of whole blood was placed on an Ames Glucofilm® test strip. Following the automated program of the Glucometer® 3, blood was allowed to saturate the Glucofilm® test pad for 40 seconds
47 and was then blotted from the test pad. Next, the test strip was inserted into the meter. Results were displayed in milligrams/deciliter (mg/dl) and recorded on the individual’s physiological assessment sheet. Normal random glucose reference levels are 45-130 mg/dl (Henry, 1996).
A HemoCue® photometer, used to determine hemoglobin levels, utilizes disposable microcuvettes with reagents in dry form (sodiumdeoxycholate, sodiumnitrite, sodiumazide and sodiumfluorescein) that, when mixed with capillary blood, hemolyzes red blood cells releasing the hemoglobin. Fingerstick blood samples were collected in a disposable hemoglobin microcuvette until it was filled completely. Excess blood was wiped from the exterior of the cuvette and inserted immediately into the photometer. Absorbance was measured at two wavelengths (570 and 880 mm) in order to compensate for turbidity in the sample. After 45 seconds, the hemoglobin value in grams per deciliter (g/dl) was displayed, and then recorded on the individual’s physical assessment sheet. A normal hemoglobin control was run daily and recorded in the log. Normal hemoglobin reference levels for adults are 12-16 g/dl for females and 13.5-18 g/dl for males (Henry, 1996).
The AccuMeter® by ChemTrak (also known as the CholesTrak™ Home
Cholesterol Test), used to measure total cholesterol levels, is a disposable filter paper-based assay that utilizes individual plastic cassettes containing premeasured amounts of reagents.
This test has met guidelines established by the NCEP’s Laboratory Standardization Panel for cholesterol measurements by demonstrating a 97% accuracy level (personal communication with Dr. Umamahesh Babu). Since these are individually packaged pre-calibrated units, daily controls were not mn. Once a foil sealed cassette was opened, whole blood was immediately loaded onto the sample well taking no longer than 5 minutes.
Whole blood then undergoes separation through a pad of glass fibers, and the plasma filters down onto a disk of untreated chromatography paper with uniform thickness and a known saturation volume (the sample disk holds 5 ul of plasma). After approximately 2 minutes a
48 tab is pulled from the cassette removing the disk from the blood filtering area and wiping away excess plasma. The cassette is gently tapped putting the plasma-containing disk into
contact with enzymes necessary to initiate the chemical reaction and laid on a flat surface for
12-15 minutes. According to Noble (1993), the chemical basis for this test is the same
enzymatic reaction used in conventional laboratory assays for total cholesterol. Total cholesterol is determined in a series of reactions whereby cholesterol esters are hydrolyzed,
the 3-OH group of cholesterol is oxidized, and hydrogen peroxide (one of the reaction products) catalyzes a reaction with an immobilized dye giving off a colorimetric reading. Two internal control windows colormetrically verify that the test is successfully
proceeding. Within the first few minutes an “OK” window wül turn purple signifying that
enough plasma has entered the cassette and that the reaction is proceeding. Within 12-15
minutes the “END” window will turn green indicating that the test is complete. If either
window fails to turn the appropriate color the test is discarded and re-run. An individual’s test reading is recorded from the chart on the cassette and then correlated to a cholesterol
value, mg/dl, with use of lot specific result charts. The Accumeter® Cholesterol test, and
accompanying results charts, were calibrated to measure total cholesterol levels between 125-400 mg/dl. Values less than 125 mg/dl were faxed to ChemTrak® and calculated by technical experts famüiar with CholesTrack®. The National Cholesterol Education
Program (1990) considers total cholesterol readings as desirable when levels are less than
200 mg/dl.
Blood smears for eosinophü counts were made directly from capillary blood utilizing the manual wedge technique (Rodak, 1995). After discarding the first drop of blood, a second drop approximately 3 mm in diameter was placed at one end of the slide. A pusher slide held at a 30 to 45-degree angle was then backed into the drop of blood and spread across the width of the slide. It was then quickly pushed forward across the length of the slide creating a wedge shaped smear. Slides were air dried in a covered case to avoid
49 blood ingestion by flies and mosquitoes and transported back to The Ohio State University Human Biological Anthropology Laboratory (HEAL) in Columbus, Ohio. They were processed using Wright’s stain which fixes the cells to the slide and stains the cellular components which is necessary for differentiation. Differential white-cell counts (counting
100 white blood cells) were performed on each slide and resulting percentages were recorded on coded sheets.
Dental Analyses
Decayed, missing, and filled teeth (DMFT/dmft index) were counted on all individuals (Appendix B). A Caries Index also was developed by dividing the number of decayed teeth by the total number of teeth. Due to the severity of dental disease among the Cofan a differentiation of affected tooth types was not attempted. The presence of gingivitis (swollen and bleeding gums), enamel hypoplasia, and excessively worn, missing or broken teeth were noted.
Intestinal Parasites
Parasite loads were ascertained from fecal samples using Meridian Diagnostics’
Para-Pak® SAP preservative system. Fecal specimens were collected in 5 oz. paper cups randomly distributed among families. Each participant was instructed to defecate in a cup and immediately return the sample to the researcher. Samples received an identification number and were preserved in Sodium Acetate/Formalin (SAF) according to the following procedure (Meridian Diagnostics package insert, 1996). Each 50-ml SAF tube contained l5-ml SAF solution. Feces was added to the “fill here line” displacing the SAF solution to 20-ml, representing a 5 gram sample (5 ml). Sample tubes were capped tightly and transported for analysis to HBAL at The Ohio State University. At HBAL each sample was mixed thoroughly with a wooden applicator stick and a surfactant was added to help
50 reduce the adhesive forces and break down fecal aggregates, thus freeing parasites. The samples were then concentrated using the Macro-Con® concentration system. This filtration system contains a mesh covered 50 ml tube that screws into the 50 ml SAF collection tube. After the samples were passed through the mesh filter, removing large clumps of debris (undigested food), formalin and ethyl acetate were added and the tubes were vigorously shaken to emulsify the fecal lipids. Samples were then centrifuged and the lipid plug along with excess ethyl acetate were decanted leaving behind a sediment pellet enriched with parasite eggs, larvae, and cysts (Meridian Diagnostics, 1997 pkg. insert). A few drops of physiological saline was added to the sediment and each sample was mixed thoroughly before an aliquot of 0.20 ml was quickly withdrawn from the middle of the suspension, transferred to a slide, and coversliped. Parasitic eggs were counted in the entire preparation. Two aliquots were examined for each sample and the average was taken. The number of eggs per species was multiplied by 100 and then divided by 5 to obtain the uncorrected count of eggs per milliliter, which is equivalent to eggs per gram of feces (EPG). A negative control was mn through the collection and concentration methods and known parasitic suspensions were also examined to ensure quality control.
Dietary Assessment
Dietary information was collected by the author and by trained assistants (Ecuadorian researchers living in Zabalo, and Ron Borman who lives in Dureno) on a subset of participants. It has been suggested, that to quantify the level of nutrient intake in populations or individuals, that dietary recall is a more accurate method (McGee and
Prewitt 1994). However, because the diet of the Cofan varies considerably from day to day and month to month, a single 24-hour recall would not capture this variation. Two
24-hr recalls (Appendix Q were conducted on each individual, one administered in the wet season (March-August) and one administered in the dry season (September-Febmary).
51 Since this is a population survey to assess the dietary differences between these two villages, a food frequency questionnaire (Appendix D) was also administered to provide an annual overview of diet (dietary differences and food availability). This tool did not include indications of portion size and was developed to obtain information on dietary diversity, and dietary acculturation to a more Euro-Ecuadorian style. This questionnaire listed types of food consumed, frequency (frequently, occasionally), seasonal availability, acquisition (locally grown or purchased), and foods that were never consumed (Appendix
D). This combination of diet assessment methods is complementary one to another. They vary in both accuracy and representativeness and thus should aid in assessing dietary variation between the two villages (Lee and Neiman, 1993; Block 1982).
Life Stvle Assessment
Lifestyle variables were collected according to a modified lifestyle incongruity model (Dressier, 1994; 1995). In developing countries, variation in style of life tends to consist of the adoption of more cosmopolitan behaviors and the increased use of technology and material goods. If Dureno and Zabalo are undergoing different rates of acculturation, as anticipated by the research protocol, this model will show inter-population as well as intra-population differences in material style of life. Interviews focusing on medical, sociodemographic, behavioral, diet, physical activity, and participation in non-traditional lifestyles were completed on all adult participants. Personal habits such as alcohol consumption, smoking, level of physical activity, language proficiency, and amount of travel outside Cofan territory were documented (Appendix E), as were material lifestyle and household data such as house type, type of furniture, type of canoe, etc.
(Appendix F).
52 2.5 Lifestyle Indices and Behavioral Factors Given the lifestyle diversity observed between these two Cofan villages, along with internal variations in lifestyle and exposures to non-traditional economies and goods, data collected from individual and household interviews were condensed into six lifestyle indices and four behavioral factors. Such measures are needed to compare changing patterns of outcomes, i.e. growth, nutrition, blood pressure, glucose, cholesterol levels, or infectious disease, within and between these two villages (Friedlaender, 1987).
The Acculturation Index, developed using principle components analysis, is based on various acculturation scales used in research among Hispanics (National Center for
Health Statistics, 1985; Burmam et al., 1987a, 1987b; Marin et al., 1987; Szapocznik and
Scopetta, 1975), Friedlaender’s (1987) ranking of modernization among Solomon
Islanders, and Dressier’s (1982) material style of life index. The following eight factors were included in the index: I) House construction. Traditional homes are single roomed, one-story stmctures made of thatched roofs with reed floors, non-traditional houses are constructed of tin roofs and milled lumber, some have several rooms and may be two- story. Ownership of the following items, 2) solar panels, 3) canoe, 4) sewing machine, 5) radio, 6) furniture. 7) The ability to speak or understand either Spanish or English. 8)
Travel experience to Quito, and to other countries. The Acculturation Index scale has a range from 0-17 with higher scores representing higher levels of acculturation. Health Risk, Hygiene, and Activity Indices were created using individual interview questions (Appendix E). The Health Risk Index is based on personal habits such as; smoking and alcohol consumption (frequency and kind), visits to a Western doctor and use of Western medication, visits to a traditional healer (Shaman) and use of medicinal plants, physical activity level, and self-reported ailments. The range for the health index was 3-16 with higher scores signifying a greater number of health risk factors. The Hygiene Index is based on type of latrine used and source of drinking water. The range for the Hygiene
53 Index is 0 - 5 with lower scores indicating a greater risk for poor hygiene. The Activity
Index is based on questions regarding an individuals typical level of physical activity (light, moderate, heavy, very heavy) when working and when not working, and level of weekly recreational exercise. The range for the Activity Index is 0-7 with higher scores indicating higher levels of physical activity.
An Economic Resource Index is based on the sum of occupational rankings of all employed persons living within a household. Occupations were ranked as follows;
0= traditional hunting, fishing, gardening, 1= cutting trails, selling handicrafts or garden produce, 2= agriculture, 3= unskilled wage labor, 4= ecotourism related jobs, 5= teacher, 6= ecotour operator. The range for the Economic Resource Index is 1-7 with higher scores representing a greater capacity for a household to earn money. Socioeconomic Status (SES) was constructed by summing the Economic Resource Index and Acculturation Index
The range for SES was 4-24 with higher numbers indicating higher socioeconomic standing. A Lifestyle Incongruity score was created by subtracting the Economic Resource
Index from the Acculturation Index. Positive values indicate an acculturation level that exceeds economic resources resulting in life style stress. The range for Lifestyle
Incongruity was -0.20 - 1.10 with higher scores indicating greater lifestyle stress.
Four behavioral factors (Material Lifestyle, Economic, Individual Lifestyle, and Traditional Medical Beliefs) were compiled from the household and individual data sets using principle components analysis (PCA, Appendix G). The “Material Lifestyle” factor includes ownership of solar panels, sewing machine, canoe, radio, furniture, gun, and number of rooms in house. The “Economic” factor includes marketing produce, animal husbandry, and house construction materials. Jointly, the Material Lifestyle and Economic factors explain 47% of the total variance among household variables. The “Individual
Lifestyle” factor includes language use, travel experience, occupational history, and education. The “Traditional Medical Belief’ factor is based on the following questions: Do
54 you see a shaman when you are ill? Can evil spirits make you ill? Individual Lifestyle and Traditional Medical Beliefs explain 49% of the total variance among individual variables.
2.6 Anthropometric Indices
The following six indices were calculated from the anthropometric data:
1. Body Mass Index (BMI) = weight (kg) I height (m~)
2. Arm Fat Index = (Upper Arm Fat Area / Total Upper Arm Area) x 100
Total Upper Arm Area = Upper Arm Circ’ / (4 x it)
3. Upper Arm Muscle Area (UA Mus) = [Upper Arm Circ - (Tri SF x Jt)]" / (4 x 7t)
4. Upper Arm Fat Area (UA Fat) = Total Upper Arm Area - Upper Arm Muscle Area
5. Sum of Two Skinfolds (Sum SF) = Tri SF + Subscap SF 6. Waist Hip Ratio (WHR) = Waist Circ / Hip Circ
2.7 Statistical Analyses SPSS/PC® was used for all statistical data analyses. Determination of descriptive statistics for all social and physiological measures was the first step in the analyses. Raw means along with means stratified by village, sex, and age groups were determined for all parametric data and compared across classes using t-tests. Statistical significances of inter- and intra-village differences were tested using t-tests for normally distributed variables, and Mann-Whimey U-test for non-parametric variables. Inferences concerning two proportions utilizing the z-test statistic were completed using the following formula (Johnson, 1973):
(P 1 “ P’ 2) - (pi — p2) z = -y/p * * .(1/ral -H1/ n T )
55 where p'l and p'2 are the observed population proportions, pi and p2 are the hypothesized values of population proportion, and p* is the pooled value of proportion for both populations.
Pearson’s correlation coefficients, controlling for village of residence, sex, and in some instances age, are used to examine correlations between lifestyle indices
(Acculturation Index, Economic Resource Index, Health Risk Index, Hygiene Index,
Activity Index, Socioeconomic Status, and Lifestyle Incongruity) and behavioral factors
(material lifestyle, economic, individual lifestyle, and traditional medical beliefs) with diet, anthropometric variables, DMFT index. Caries Index, parasite loads, glucose, cholesterol, hemoglobin levels, and blood pressure. SPSS utilizes a zero-order correlation matrix to compute partial correlations, when controlling for age, sex, or village. Principle
Components Analysis (PCA), a version of factor analysis, is used to examine the interrelationships among the social variables. This technique aided in creating the four behavioral factors by utilizing a correlation matrix to obtain the minimum number of hypothetical factors that accounted for the observed covariation (Appendix G).
Three culturally appropriate adult age cohorts; Cohort 1= 13-20 year olds (N=50),
Cohort 2= 21-40 year olds (N=64), and Cohort 3= 41-76 year olds (N=36), are examined for differences in biological measures, lifestyle indices and behavioral factors. The 13-20 year old cohort is still growing and males usually are not married. Individuals in the 21-40 yezu: old cohort have attained adult height, and most are married with young children. The
41-76 year old cohort can be considered elders, conveyors of traditional knowledge, and most have adult children and grandchildren. This cohort covers a wider age range because only 8 individuals were 60 years and older, to few to subgroup, so they are included in the third cohort.
56 CHAPTERS
RESULTS I: INTERVILLAGE BIOBEHAVIORAL CHARACTERISTICS
3.1 Introduction
To complete Research Objectives I and II, this chapter summarizes demographic, sociocultural, and personal characteristics of the study samples to explore how the Cofan interact with their environment and each other. Described first are household characteristics followed by characteristics of individuals. All data were collected utilizing household and individual surveys along with personalized interviews and observations (see Chapter 2, Appendices E and F). Census data, obtained for each village by observations and interviews, were then verified by comparisons to village records and historical genealogies archived by Mr. M E . Borman.
3.2 Household Characteristics 3.2.1 Demographic and Social Composition Based on 1996 census data, the total number of residents identified in each village is 250 for the 45 households in Dureno (5.6 per household) and 120 for the 18 households in Zabalo (6.7 per household). Age distribution by age classes, village, and sex show that both villages are relatively young (Figs. 3.1-3.4). However, the ratio of males to females differs between villages. In Dureno, for every 4 males there are 5.4 females, while in
Zabalo, for every 4 males there are only 3.2 females. Numbers of people in specific
57 age-sex classes also differ between villages (t=2.20; p= 0.03). Over 50% of the male population in Dureno is between 1- 24 years old, with the largest percentage (15%) in the
10-14 year old range. In Zabalo, over 50% of males are between 1-19 years old, with the largest percentage (21%) between 5-9 years old. For females in Dureno, 50% are between the ages of 1-19 years old, with the largest age group (19%) being the 5-9 year olds. In
Zabalo, over 50% o f females are between the ages of 1-14 years old, with the largest proportion (25%) between the ages of 10-14 years. On ± e opposite end of the scale, only
2% of the population in Zabalo is 60+ years old, whereas 13% of the Dureno group is 60+ years old (t= 1.82; p=0.07). Zabalo is a relatively new village established 1984. Mainly young individuals migrated to establish this village which is deeper into the rainforest than Dureno.
under 5 10-14 20-24 30-34 40-44 50-54 70-74 5-9 15-19 25-29 35-39 45-49 55-59
Years Figure 3.1 Age classes for males from Dureno
58 under 5 10-14 20-24 30-34 40-44 55-59 75-79 5-9 15-19 25-29 35-39 45-49 60-64
Years Figure 3.2: Age classes for females from Dureno
under 5 10-14 20-24 30-34 40-44 55-59 5-9 15-19 25-29 35-39 50-54 60-64
Years Figure 3.3: Age classes for males from Zabalo
59 E 2 (L) CL under 5 10-14 20-24 35-39 45-49 15-19 25-29 40-44
Years Figure 3.4: Age classes for females from Zabalo
Eighty-eight percent of male participants aged 13 years and older from Dureno are married, 8% are single, and 4% are widowed (Table 3.2). In Zabalo, 65% of males are married, and the remaining 35% are single. Sixty-eight percent of Dureno females aged 13 years and older are married, 24% are single, while 8% are widowed. In Zabalo, 80% of females are married, 15% are single, and the remaining 5% are widowed. Average marital age in Dureno is 20 years for males (range 12-27 yrs.) and 16 for females (range 11-27 yrs.); in Zabalo, it is 19 for males (range 15-25 yrs.) and 16 for females (range 11-21 yrs.). Several interviewees stated that if a girl is not married by 16 years of age she is an “old maid” and will have a difficult time finding a husband. It was also stated that older males prefer younger females because “they have more control over them.” In some instances, marriages are arranged based on the economic standing of the male with little regard for the female’s age. It is not unusual for a girl to be married at 11 years old and based on routine observational data, girls become interested in boys and marriage at this age and begin to act accordingly.
60 Dureno males have been married an average of 12 years (range 1-30 yrs.), Zabalo males 16 years (range 2-39 yrs.). Marriage duration among Dureno females averages 17 years, compared to only 8 years for Zabalo females (t= 1.95; p= 0.07). The mean number of children per family in Dureno is 4.2 compared to 4.8 in Zabalo (p= 0.47).
Average age of offspring is 7.4 years in Dureno and 7.0 years in Zabalo (p= 0.57).
Widowed individuals usually reside with relatives until they remarry. Several widowed men remarried younger women during the study period however, no widowed women were observed to remarry. Widowed men usually had children to care for and stated they needed a women to take care of their household. Due to decreasing numbers, over recent years. Cofan have intermarried with other indigenous Amazon groups such as the Siona,
Quechua, Shuar (Jivaro), and in a few instances with non-Indians. Cofan families also have adopted individuals from other groups, who following adoption, are considered
Cofan. Although various descent lines are known to have intermarried (M.B. Borman, personal communication) distinguishing non-Cofan is very difficult.
Marital Status single 8% 24% 35% (0.01) 15% (0.22) married 88% 68% 65% (0.03) 80% (0.20) widowed 4% 8% 0%(0.16) 5% (0.34)
Mean Number of Children 4.2 4.2 5.1 (.40) 4.1 (.94)
Mean Number of Years Married 12 17 16 (.24) 8 (.07)
Mean Age at Marriage 20 16 19 (.93) 16 (.65)
Table 3.2: Frequencies and p-values for inter-village differences in marital characteristics and number of children between Cofan males and females firom Dureno and Zabalo
61 3.2.2 Material Style of Life
Frequency distribution of lifestyle variables were determined for each village
(Table 3.3). At the household level, several differences indicative of culture change were observed between Dureno and Zabalo. More residents of Zabalo (58%) live in traditional house structures with thatched roofs and reed floors, than do those in Dureno, where only
7% of housing structures are traditional (p=0-0001). Houses in Dureno (41%) are more
“modernized,” with tin roofs and milled wooden floors; this style is found in only 16% of houses in Zabalo (p=0.007).
The Cofan were a river people whose main mode of transportation was the dugout canoe. Today 48% of Dureno households lack canoes or boats, whereas in Zabalo only
11% of households are without water transportation (p=0.004). Of all canoes or boats, 4% are motorized in Dureno, whereas 68% have motors in Zabalo (p<.00005). With regard to other amenities, a higher percentage of houses in Zabalo (79%) have solar panels than in
Dureno (4%) (p<.00005). More sewing machines are found in Zabalo households (47%), compared to Dureno (1 l%)(p=0.003). Dureno has a higher proportion of households with gas cooking stoves (p=0.09). About 90% of households in both villages own firearms, mainly shotguns and .22 rifles used for hunting.
Household practices with direct affects on health are methods of water procurement and use of latrines. In Dureno, 96% of households procure drinking and dish washing water from both rain and springs (p<.00005), whereas, 84% of Zabalo households report using rain water exclusively. In both villages rainwater is collected in large plastic containers located next to each house. Individuals with tin roofs also collect water from roof run-off. hi Dureno, a manual pump located in the center of the village, supplies residents with spring water. Water quality at these sources, including spring water used by
Dureno residents, has not been tested. Thus, they may contribute to intestinal parasites
62 and coliform bacterial infections. Four and sixteen percent of households in Dureno and Zabalo, respectively, also use river water, mainly for washing dishes (p=0.08).
Latrine use varied slightly between villages. Seventy percent of households in
Dureno and 63% in Zabalo reported not having (interpreted as not using) latrines
(p= 0.31). Thirty percent of Dureno households have/use private pit latrines located in the forest behind each household compared to 11% of households in Zabalo (p=0.06). No participants from Dureno reported using either of the two centrally located communal latrines. These facilities, constructed of concrete blocks and housing porcelain flush commodes, were inoperative; clarifying the reason these were avoided by most residents.
The main outhouse in Zabalo was a raised wooden building (6x4 feet) with a pit latrine. Twenty-six percent of respondents in Zabalo reported using this communal latrine (p= 0.003).
63 House 0 thatch roof, reed floor 7 58 0.0001 construction 1 mixed construction 52 26 0.04 2 tin roof, plank floor 41 16 0.007 Furniture 0 hammock(h) 18 21 0.40 I h, bed or bench 15 10 0.31 2 h, table, bed or bench 30 32 0.44 3 h, table, bed, bench 37 37 --- Stove 0 no 0 5 <.00005 1 wood 41 53 0.21 2 wood and gas 59 42 0.09 Solar Panels 0 no 96 21 <.00005 I yes 4 79 <.00005 Water 0 rain 0 84 <.00005 1 rain, spring 96 0 <.00005 2 ram, river 4 16 0.08 Latrine 0 none 70 63 0.31 I communal 0 26 0.003 2 private 30 11 0.06 Canoe or 0 none 48 11 0.004 boat 1 without motor 48 21 0.03 2 with motor 4 68 <00005 Sewing 0 no 89 53 0.003 machine 1 yes 11 47 0.003 Gun 0 no 11 10 0.46 1 yes 89 90 0.46 Radio 0 no 67 53 0.14 I yes 33 47 0.17 Garden 0 no 0 5 <.00005 1 yes 100 95 0.16 Sell Produce 0 no 18 74 0.0001 I yes 82 26 0.0001 Animals 0 none 15 32 0.08 1 Iocal(monkey) 0 10 0.04 2 chicken or duck 15 32 0.09 3 dog 37 26 0.22 4 pig or cow 33 0 0.003 SeU 0 no 7 11 0.32 Handicrafts I tourists 90 89 0.46 2 stores 4 0 0.17
Table 3.3: Frequencies and p-values (based on proportional inferences) for inter-village differences in household variables among adult Cofan from Dureno and Zabalo.
64 3.2.3 Household Food Supply
Traditionally the Cofan practiced a subsistence life style that consisted of gardening, hunting, and fishing (Fitton, in press; Borman, 1994; Robinson, 1979). Today, gardening remains an important part of Cofan subsistence (almost 100% participation in each village).
They practice slash-and-bum horticulture whereby a plot of land is selected, existing vegetation is cut, left to dry and then burned. Although all family members help with maintaining and planting the garden, men usually clear and prepare the sites for planting, whereas women usually weed and harvest the gardens. Garden sites, /nasipa/ in Cofan, are usually located behind or next to houses on higher ground, where flooding is less likely to occur. However, garden sites also were located outside both villages. Each family has several plots, each at different stages of development. These are cultivated with a mix of the 3 main crops; several varieties of bananas {Musa paradisiaca), yucca {Manihot esculenta), and com {Zea mays). Other crops sometimes planted on the periphery of the main plots include; coffee {Coffea arabica), yams {Dioscorea trifida), sweet potatoes
{Ipomoea batatas), pepper plants {Capsicum spp.) and tobacco {Nicotiana Tabaciim).
Bananas, a Cofan dietary staple, are consumed daily in both villages. They are seldom eaten raw; rather they are used in soups and stews and sometimes fried. Bananas are most frequently consumed as a drink, called /kui’ku/ (Cofan) or chocula (Spanish), whereby the fruit is boiled, mashed and mixed with water. When this banana drink is allowed to ferment 3-4 days it is called /anduche/. This is usually taken with the Cofan when they travel since the alcohol acts as a preservative. It is not unusual for the Cofan to only drink /kui’ku/ for 4-5 days. However, their expressed ideal is to eat meat every other day. Another Cofan dietary staple is yucca, served either boiled in a soup or stew, fried, or as a drink, which is prepared by boiling and mashing the yucca with sweet potatoes
(sweet yucca drink). Sweet potatoes act an enzymatic starter which aids in fermenting and preserving the beverage. The yucca drink is consumed alone or sometimes mixed with
65 /kui’ku/. A more potent alcoholic beverage, known as /tse tsepa/ by the Cofan or generically as ‘chicha’, is also prepared using yucca and a yeast starter with fermentation lasting 7-8 days. All of these drinks are basic to the Cofan diet. Other researchers have established that chicha and chocula are important energy sources among indigenous Amazonian groups and supply significant amounts of calcium, ascorbic acid, thiamin, riboflavin, and niacin (Pinkley, 1973: Kroeger and Barbira-Freedman, 1982). Com, yams and coffee, not usually consumed by the Cofan, are raised either to feed domesticated animals or to sell in near-by towns. In fact, 82% of Dureno households sell their produce
(including bananas and yucca), usually to non-Cofan residents of the oil towns of Dureno and Lago Agrio. Only 26% of Zabalo households sell their produce, and this is mainly to other Cofan families in the village (p=0.000l).
A non-traditional mode of subsistence is the recent acquisition of domesticated “grazing” animals such as cows and pigs raised mainly for personal consumption. A significant number of Dureno households (33%) have pigs or cows, whereas no Zabalo households had livestock (p=0.003). Zabalo families do raise chickens and ducks
(p=0.09), and keep pets such as monkeys and parrots (p=0.04), more often than do people in Dureno. These animals, especially the birds, are known to ingest human feces and may aid in controlling parasite levels around the village. Recent environmental degradation has led to a series of detrimental changes in and around Dureno, particularly a decrease in wild game and fish reserves. Changes in wild food availability has resulted in a subsistence shift from hunting and fishing to agriculture and livestock. Consequently, the people of
Dureno are becoming more dependent on purchased food items such as canned tuna and sardines. All foods consumed were divided into traditional and nontraditional categories. The entire food list is shown in Appendix D. Non-traditional purchased foods include: potatoes, carrots, oranges, chicken, eggs, rice, tuna, sardines, fried bread, popcorn,
66 beans, coffee, soda or powdered juice mixes, and candy or sweets. All other foods listed are considered traditional. Seasonality in food procurement occurs in both villages, however, this is most apparent in Dureno with its lower wild game resources. From
August through April, most hunting focuses on rodent-like animals such as agouti
(rabbit-like rodents of the genus Dasyprocta), squirrels, and pacas (large spotted rodents of the genus Cuniculus, which usually are sold in oil towns). From October through March fish becomes an important source of protein. The preferred fish is catfish, of which there are more than 20 species in this area. Although abundant, pirahhnas are eaten less frequently. No significant differences are seen in the total amounts of purchased foods
(starch, sugar, protein/fats, and fruits/vegetables) between villages (p=0.89). However, when each food category is examined separately, Zabalo residents purchased sugar sources such as carbonated drinks, powdered fruit drinks and candy more frequently than Dureno residents (p=0.05) and one Zabalo resident reported consuming beef (purchased from non-
Cofan) at least once a month. No significant differences are observed in any of the other food categories.
Zabalo residents have a wider variety of available protein sources. Food frequency data shows procurement of mammals such as peccary, tapir, woolly monkeys, armadillos, agouti, and squirrels, wild fowl such as currasows, guans, and toucans, along with fish and turtle. Residents reported eating these animals on a weekly basis from August through
April. Dureno residents on the other hand, consume fewer local protein sources as compared to Zabalo residents (p=<.0005) and rely mainly on small animals such as agoutis, and squirrels, along with fish and occasionally mrtle. Overall, Dureno residents report eating meat or fish on average once a week, whereas Zabalo residents report eating meat or fish 3-4 times per week.
67 3.3 Individual Characteristics 3.3.1 Social Characteristics
Individual social data show that more individuals from Dureno (40%) lack a formal education than do those from Zabalo (26%) (p=0.12) (Table 3.4). Among individuals who had attended school, education level does not vary between the two villages. A majority of individuals in each village had between 1-6 years of schooling (Dureno = 56%, iF =2 yrs.;
Zabalo = 66%, x~= 3 yrs.) (p=0.29). Most individuals (from both villages) attended a school in Dureno run by Cofan educated at the Limoncocha Institute, a missionary school.
Zabalo occasionally obtained certified non-Cofan teachers who volunteered their skills and lived in the community for periods of 1-2 years. Language knowledge was significantly different between the two villages. In Dureno, more individuals spoke only Cofan (54%) as compared to Zabalo (19%)(p=0.0007). More individuals in Zabalo spoke Spanish
(65%) as compared to Dureno (46%)(p=0.04). With regard to English, 16% of individuals in Zabalo could speak or understand some English, whereas no individuals from Dureno had this skill (p=0.002). Even though residents of Zabalo have approximately the same education level as individuals in Dureno, they have a broader language base which is probably due to their increased contact with non-Cofan teachers and ecotourism.
Travel experience was examined as an indicator of culture contact or change. Twice as many individuals from Dureno as compared to 2[abalo traveled to Lago Agrio five or more times in the past year. Lago Agrio is an oil boom town located approximately 100 km northwest of Dureno and approximately 160 km from Zabalo. The proximity of Dureno to Lago Agrio is important to bear in mind when comparing travel experiences between the two villages. Incidence of travel to Quito, Ecuador’s capital, which is approximately 275 km from Dureno and 335 km from Zabalo, or to other countries was slightly higher among residents of Zabalo. Thirteen percent of individuals from Zabalo traveled to Quito five or
68 more times in the past year compared to only 4% of Dureno residents (p=0.07). Thirty percent of the residents of Zabalo have traveled to other countries, (mainly Colombia, South America) at least once within the past year compared to 14% in Dureno (p=0.04).
More travel to Quito by residents of Zabalo may be due to ecotourism or political venues such as procuring land rights. The main reason given for traveling to other countries, especially Colombia, is to visit relatives. Inter-village travel between Diureno and Zabalo was significantly different with individuals firom Zabalo visiting Dureno more frequently
(p< .0(X)05). Individuals from Zabalo averaged 3-4 visits to Dureno per year however, individuals firom Dureno rarely (84% never, 16% 1-2 times/year) visited Zabalo. When asked why they did not travel to Zabalo most people replied “It’s too far away.”
However, the lack of travel to Zabalo is most likely due to the fact that it is 60 km (approximately 4 hours) away by boat and a large percentage of the families in Dureno do not have water transportation.
69 Travel to Dureno 0 no 0 I 1-2 times past year ---- 47 — 2 3-4 times past year ---- 10 — 3 5+ times past year ---- 43 --- Travel to Zabalo 0 no 84 —— ------1 1-2 times past year 16 ------2 3-4 times past year 0 ------
3 54- times past year 0 ------
— Inter-village travel —— --- <.00005 Travel to Lago 0 no 2 0 0.18 Agrio 1 1-2 times past year 2 40 <.00005 2 3-4 times past year 12 20 0.23 3 54- times past year 84 40 <.00005 Travel to Quito 0 no 41 34 0.26 1 1-2 times past year 49 50 0.46 2 3-4 times past year 6 3 0.27 3 54- times past year 4 13 0.07 Travel to other 0 no 86 70 0.04 countries I 1-2 times past year 14 30 0-04 2 3-4 times past year 0 0 — 3 54- times past year 0 0 --- Education 0 none 40 26 0.12 1 1-2 years 17 18 0.46 2 3-4 years 27 30 0.39 3 5-6 years 12 18 0.24 4 8 or more 4 8 0.23 Language 0 Cofan only (C) 54 19 0.0007 1 C & Spanish (S) 46 65 0.04 2 C, S, & English 0 16 0.002 Seen Western 0 no 51 55 0.36 doctor I yes 49 45 0.36 Use Western 0 no 20 10 0.11 medications 1 yes 80 90 0.12 Seen Shaman when 0 no 22 52 0.004 ill 1 yes 78 48 0.002 Medicinal plant use 0 no 4 3 0.41 1 yes 96 97 0.46 /Yage/ use 0 no 61 41 0.04 1 yes 39 59 0.04 Can evil spirits 0 no 25 38 0.06 make you ill? I yes 75 62 0.10
Table 3.4: Frequencies and p-values (based on proportional inferences) for inter-village differences in individual life style variables among adult Cofan from Dureno and Zabalo. 70 Participation in Traditional Subsistence
Gardens are an important part of Cofan subsistence. Most gardens are intercropped and cultivation is staggered to meet the needs of specific plants. According to Robinson (1979, 39);
Kofan cultivation is marked by the chontaduro palm {Guillielma gasipaes) calendar- when this palm ripens in late January, the Kofan note this event as an indicator of what we gloss as a ‘year.’ Past events are referred to in terms of so many chontaduro ripenings. Sweet yuca is planted anytime, except in the rainy season from April to July. Yuca harvesting, however, is continues as plantings are staggered to assure a continuous supply. Bananas, plantains, cultivated fruits, com, and tobacco, are transplanted or sown by seed after the heavy rainy season on small plots associated with individual males to their nuclear families.
Because it requires a significant amount of energy to clear a garden plot, once an area is cleared and cultivated it is considered to be the property of that household. Each household usually has three garden plots, one of which is usually located next to their house. Others are spaced randomly, up to a mile, on either side of the Aguarico river. In some instances, garden plots are also cultivated off smaller tributaries of the Aguarico. Although the entire family is responsible for tending the garden, men usually clear the land and do the initial planting, whereas women and sometimes older children are responsible for weeding and harvesting. Cofan men also provide meat for their extended family households. Women may sometimes accompany their husbands on hunting trips, but women never hunt or fish alone. Men hunt in groups of 2-4 individuals and often use domesticated dogs. They usually return the same day however, environmental degradation is causing the Cofan, especially from Dureno, to go farther into the forest to procure food and often they remain in the forest for a few days. When this happens the meat is usually preserved by smoking it above an open fire. Upon return the meat is divided between those who participated in the hunt. The traditional Cofan hunting technology was the blowgun which is still used
71 today if dart poison, generically known as curare, is available. Today the Cofan obtain most of their curare from traders claiming it is stronger than the type they can make from local plants. These days they also use shotguns which they have purchased from traders.
However, in some circumstances the Cofan stated they preferred to use a blowgun. For instance, when hunting birds and monkeys individuals stated they have a better chance of obtaining more than one animal when using a blowgun because it is quiet and does not dismrb the group when fired.
Fishing includes a variety of methods: hook and lines, nets, poison, dynamite, and shotguns. Net fishing is done mainly by men, whereas women and children also participate in hook and line and poison-fishing. Ninety percent of Dureno individuals reported using nets to fish and 88% of Zabalo residents reported using this method
(p=0.42). Ninety three and 94% of residents in Dureno and Zabalo respectively reported using hook and lines to fish (p=0.47). Fish poisons made from indigenous plants from the genera Phyllantaus and Lonchocarpus are frequently used in the dry season when the water recedes and fish are trapped in small pools. Once the poison is placed in the water fish begin to surface because of oxygen deprivation. When they come to the surface they are either struck over the head, speared, and, in a few reports, shot. Ninety percent of Dureno residents and 88% of Zabalo residents reported using the poison method (p=0.42). Only
Dureno residents reported using dynamite (66%) (p <.00005). One source also stated that colonists were known to use commercial tick poison to obtain fish however, the Cofan do not condone this method because it kills everything in the streams for up to a year. Two individuals (13%) from Zabalo also reported using shotguns to fish, especially for the very large catfish, whereas no individuals from Dureno reported using this method (p=0.01).
72 Participation in Wa^e Employment
As environmental degradation and encroachment by colonists continues, the Cofan
are turning to occupations outside the realm of traditional hunting, fishing and gardening.
Table 3.5 lists various non-traditional occupations involving the Cofan and ranks them
according to prestige and monetary gain (number I being less prestigious and the lowest paid).
In the village of Dureno 98% of participants reported being involved in non-
traditional types of work compared to 94% from Zabalo. Seventy eight percent of Dureno
males were primarily involved in agriculture as compared to 16% from Zabalo
(p< .00005). The primary source of outside income for Zabalo males was ecotourism
(63%) whereas relatively few males participate in ecotourism in Dureno (4%) (p< .00005).
Females from both villages were primarily involved with selling handicrafts (Dureno 74%;
Zabalo 92%) (p=0.10). However, Dureno women sell most of their crafts to store owners in the town of Lago Agrio and not directly to tourists. Travel time and expense coupled with lower prices paid by store owners make this a less lucrative market. Zabalo women sell directly to tourists, most of whom visit from the ‘flotel’, a floating riverboat hotel that operates on the Aguarico. Zabalo residents also erected a mock village on the opposite side of the river from where they live for tourists who wish to visit an indigenous group with minimal hardship. Most Sunday afternoons the Cofan from Zabalo meet tourists at this site to sell their wares and to guide them through a short section of rainforest pointing out medicinal plants and various wildlife.
The Zabalo Cofan maintain their own ecotourism business and have developed partnerships with two international tour agencies. They have erected tourist houses and now take tourists on rainforest treks that last from 1-14 days. Along with selling handicrafts made of sustainable resources, they work for fees as cooks, guides, and naturalists. These treks are for tourists who want to learn about the rainforest from those
73 that call it home and the Cofan are most willing to teach tourists about their world. Cofan teachers (2 male, I female) all resided in the village of Dureno. During the 1994 field season one of the male teachers lived in Zabalo. However, in 1995 he moved his family back to Dureno stating that, “Zabalo was just too far away”. Zabalo has since tried to hire foreign teachers to live in the village for a period of 2 years but have had little success.
This has become a major concern for 2Iabalo since it has a high number of youth who need to become educated, at least in Spanish, to continue with a successful ecotourism business.
I Cutting Trails, Selling Handicrafts, Selling Garden Produce 42% 42% .50
2 Agriculmre 46% 10% .0002
3 Unskilled Wage-labor 2% 3% .37
4 Ecotourism 2% 39% <.00005
5 Teacher 6% 0% .09
Table 3.5: Percent participation in non-traditional occupations and p-values (based on proportional inferences) for inter-village differences among adult Cofan from Dureno and Zabalo
3.3.2 Personal Habits Activity Patterns
Physical activity levels when working and at leisure were recorded during individual interviews as well as amount of exercise per week. An activity index was developed by combining these scores. Dureno individuals reported a higher level of physical activity related to work (p=0.03), and higher physical activity when not working
(p<.00005) compared to individuals from Zabalo. Zabalo individuals on the other hand,
74 reported higher levels of exercise such as hiking, or playing volleyball or soccer.
Individuals from 2[abalo may have an abundance of traditional food sources available therefore, they do not have to work as hard procuring them and have more time to pursue other activities. They are also involved in ecotour treks and may have reported this as exercise and not work-related physical activity. When activity levels are combined into an
Activity Index, individuals from Z^abalo are less active overall compared to individuals from
Dureno (p=0.009). When activity levels are examined by sex, females are less active compared to males across all categories (p<.00005).
Alcohol and Tobacco Use
Personal habits such as alcohol and tobacco use were also examined. Each individual was asked if they smoked or drank alcohol, what kind, how often, and the quantity. Individuals from Zabalo reported smoking and drinking more than individuals from Dureno (p=0.04; p=0.005), with males in both villages drinking and smoking more than females (p<.00005). No female participant reported smoking and there were no inter village differences in the number of women who consumed alcoholic beverages (p=0.46).
Females who reported drinking did so occasionally and the drink of choice was chicha.
Forty-three percent of males from Dureno reported drinking chicha and 7% stated they also drink rum or Cristal purchased from the oil-town of Dureno. Twenty-four percent of individuals from Zabalo reported drinking chicha, 3% beer, and 10% rum or Cristal purchased from river trade boats. Males from both villages drink chicha daily. With regard to beer, rum, and Cristal, 46% of Dureno individuals stated they consumed these beverages occasionally, 3% weekly, and 2% daily and in Zabalo 25% reported occasional use, 8% weekly use, and 1% daily use.
75 3.3.3 Health Related Practices and Beliefs
Modernization and accompanying lifestyle change often result in increases in chronic conditions such as diabetes, cardiovascular disease and high blood pressure along with increases in minor health problems such as allergies, dental caries, and psychosocial problems which include alcohol abuse and suicide. Table 3.6 presents self-reported illnesses among individuals firom Dureno and Zabalo. After controlling for general aches which were reported by a majority of individuals in both villages, 50% of respondents from Dureno reported being treated for various illnesses with western medicines or medicinal plants, whereas only 34% of respondents from Zabalo reported health problems (p=0.10).
Major categories of illness among the Cofan based on individual interviews include; intestinal parasites, skin infections, tuberculosis, trauma and female reproductive issues. Miscellaneous maladies (reported by at least one individual) included gall bladder problems, malaria, yellow fever, hypertension, convulsions, nervous conditions, diabetes and suicide. Recessive disorders such as epilepsy, muteness, and dwarfism are frequent in this population, however, none of the participants reported these disorders. Alcohol use is common in traditional Cofan societies. Chicha, /tse sepa/ in Cofan, a low alcohol content home brew made from manioc is consumed daily. However, increased use of distilled cane liquor (Cristal) and rum purchased from near-by towns and river traders has been noted. In most observed instances, when a bottle of distilled liquor was purchased it was completely consumed on the same day.
76 m Ê ^ B Ê B Ê Ê w m Intestinal Parasites 16 17 0.04 Dermatitis 8 3 0.17 Tuberculosis 6 3 0.05 Female reproductive problems 4 0 0.15 Trauma 6 7 0.43 Gall Bladder problems 2 0 0.18 Malaria 2 0 0.18 Yellow Fever 0 3 0.09 Hypertension 2 0 0.18 Convulsions 2 0 0.18 Nervous condition 2 0 0.18
Table 3.6: Frequencies and p-values (based on proportional inferences) for differences in self-reported illnesses between Cofan adults from Dureno and Zabalo.
Even though residents of Dureno live much closer to Western medical facilities, there were no significant differences in the use of Western physicians or Western medicines between the two villages (p=.46, p=0.48). Most individuals in both villages reported taking analgesics for pain and, at one time or another, had been treated for intestinal parasites with Western medications. Tuberculosis vaccinations had also been administered to some individuals in Dureno (personal communication with Esther Borman). Use of multi-vitamins also was noted in both villages. Eighteen percent of individuals from Dureno and 13% from Zabalo reported occasionally taking vitamins (p=.27).
A majority of individuals from both villages use medicinal plants (p=.90). A variety of indigenous plants are used by the Cofan to treat many different problems including: fevers, coughs, diarrhea, pain, swelling, stomach aches, dermatitis, and bums, to name a few. A complete listing of medicinal plants and there uses can be found in
Pinkley, 1973. A potent medicinal plant used by the Cofan in religious ceremonies is called /Yage/. Fifty-nine percent of individuals from Zabalo reported using /Yage/ in their lifetime compared to 39% of individuals from Dureno (p=0.11) and more males reported
77 using this drug than did females (pc.00005). /Yage/ is a hallucinogenic drink prepared from the plant Banisteriopsis rusbayana or Banisteriopsis cappL It is mainly used in Cofan religious ceremonies and has anthelminthic properties that aid in controlling intestinal
parasitic infections (Schwaner and Dixon, 1974). With regard to their view of illness, 75%
of individuals from Dureno thought evil spirits could make a person ill compared to 62%
from Zabalo (p=0.12). Individuals from Dureno were also more likely to visit a shaman when feeling ill (p=0.003).
3.3.4 Indices
Social change and related stressors are major factors in disease susceptibility. To evaluate the impact cultural variables have on health (these associations are reported in
Chapter 5) several indices were developed; a Health Risk Index, Hygiene Index, Activity
Index, Acculturation Index, Economic Resource Index, Socioeconomic Status (SES), and
Life Style Incongruity (all explained in detail in Chapter Two). Reported here are inter-village differences in these indices (Table 3.7).
The range for the Health Risk Index is 3-16 with a mean of 8.3 for Dureno and 10.9 for Zabalo. Higher values on this index signify a greater number of health risk factors. In general, individuals from Zabalo score higher on the Health Risk Index (i.e. more risk factors) when compared to individuals from Dureno (p<.00(X)5) with no significant difference between the sexes (p=0.43). The range for the Hygiene Index is 0 - 5 with a mean of 3.3 for Dureno and 4.4 for 2Iabalo. Lower values signify greater risk of bacterial and amebic contamination. Overall, individuals from Dureno have lower hygiene scores than those from Zabalo (p<.00005), with no significant difference between sexes (p=0.89). The range for the Activity Index is 0-7 with a mean of 3.5 for Dureno and
2.5 for Zabalo. Higher values on this index indicate higher levels of physical activity. In
78 general, individuals from Dureno score higher on the Activity Index when compared to Zabalo (p=0.009), with males scoring higher than females (p<.00005).
The range for the Acculturation Index is 0 - 17 with a mean of 5.5 for Dureno and
9.4 for Zabalo. A higher Acculturation Index score represents greater culture change. In general, individuals from Zabalo score higher on the Acculturation Index when compared to Dureno (p<.00005), with males having higher scores compared to females (p=0.04).
The Economic Resource Index is based on the sum of occupational rankings of all employed persons living within a household. Higher scores represent higher income capability. The range for the Economic Resource Index is 1-7 with a mean of 3.0 for
Dureno and 4.3 for Zabalo. Individuals from Zabalo score higher on the Economic Resource Index when compared to Dureno (p<.00005) with no significant difference between sexes (p=0.30). The range for SES is 4 - 24 with a mean of 12.5 for Dureno and
15.4 for Zabalo. A higher score indicates a greater material lifestyle and economic resources. Individuals from Zabalo have higher SES scores than Dureno (p=0.006) with no significant differences between the sexes (p=0.60). The range for Lifestyle Incongruity is -0.20 - 1.10 with a mean of 0.24 for Dureno and 0.57 for Zabalo. A higher score indicates higher lifestyle stress. Once again, Zabalo residents have higher Lifestyle Incongruity scores (p<.00005), with males having higher scores than females (p=0.05).
79 Health Risk fridex 8.3 10.9 <.00005
Hygiene Index 3.3 4.4 <.00005
Activity Index 3.5 2.5 0.009
Acculturation Index 5.5 9.4 <.00005
Economic Resource fridex 3.0 4.3 <.00005
Socioeconomic Status 12.5 15.4 0.006
Lifestyle Incongruity 0.24 0.57 <.00005
Table 3.7: Means and p-values (based on t-tests) for inter-village differences in lifestyle and health-related indices between Cofan adults from Dureno and Zabalo.
3.4 Correlation Between Social Variables and Health Risk Index Pooled-sample correlation results (Table 3.8) indicate that a higher material style of life may be associated with increased health risks; however, a negative correlation between economic factors and Health Risk Index indicates that a lower economic standing may result in an increase in health risk factors. No significant correlations are seen between the individual lifestyle factor and health risk status; however, a negative correlation is seen between traditional medical beliefs and health risks so that as traditional medical beliefs lessen health risks increase. All lifestyle indices are positively correlated with the Health
Risk Index (Table 3.8). Village of residence also is positively correlated with the Health
Risk Index with individuals from Zabalo presenting a higher number of health risk factors.
80 Factor 1: Material Lifestyle 0.44 (p<.G0005) Factor 2: Economic -0.24 (.05) Factor 3: Individual Lifestyle 0.05 (.66) Factor 4: Traditional Medical Beliefs -0.13 (.24)
Acculturation Index 0.22 (0.06) Socioeconomic Status 0.23 (0.06) Economic Resource Index 0.20 (0.07) Lifestyle Incongruity Index 0.28 (0.02) Village of Residence 0.52 (<.00005)
Table 3.8: Correlation coefficients and (p-values) for behavioral factors and lifestyle indices in relation to Health Risk Index for combined adult population from Dureno and Zabalo.
3.5 Comparison of Behavioral Factors and Lifestyle Indices Between Adult Cohorts
Means for each Cohort, based upon the total combined pooled sample, are examined using the Mann Whimey U test. Cohort I (13-20 year olds) had a lower Economic Resource Index (p=0.02) and SES (p=0.I5) compared to Cohort 2 (21-40 year olds). No other large differences are seen between Cohorts I and 2. The economic
(p=0.09) and individual lifestyle (p=0.09) factors along with the Hygiene Index (p=0.09) are higher in Cohort 1 compared to Cohort 3 (41-76 year olds). No other large differences are seen between Cohorts 1 and 3. As with Cohort 1, Cohort 2 has a higher individual lifestyle factor than does
Cohort 3 (p=0.06). In addition, they score higher on the Economic Resource Index
(p=0.12). Material Lifestyle Factor (p=0.10), and SES (p=0.08). Cohort 3 individuals, on the other hand, score lower on the Acculturation Index (p=0.12). Hygiene Index (p=0.07) and higher on the Traditional Medical Belief Factor (p=0.003).
81 CHAPTER 4
RESULTS m
INTER AND INTRA-VILLAGE BIOLOGICAL VARIABLES
4.1 Introduction
To complete Research Objective ID, means and standard deviations for the major
biological variables - body composition, blood pressure, cholesterol, glucose, hemoglobin,
intestinal parasites, and dental health- are determined. First, measiues of body composition and dental health by village and sex are compared for children aged 12 years and under.
Measures of body composition are then compared to the National Center for Health
Statistics (NCHS) standards for children aged 12 years and under. Second, for all individuals 13 years and older, major biological variables are compared within and between villages by sex. Finally, for all individuals 13 years and older, major biological variables are compared within and between villages by age cohorts.
4.2 Body Composition 4.2.1 Children
Although 53% of Dureno and 93% of Zabalo residents participated in data collection, small N’s by age necessitated dividing children into three age groups: 2-4 years,
5-8 years, and 9-12 years (Tables 4.1 and 4.2). In Zabalo, 2-4 year old girls show slightly higher subscapular skinfold (Subscap SF, p=0.15) than boys, while boys show greater upper arm fat area (UA Fat, p=0.14). The 5-8 year old boys show a higher upper arm
82 circumference (UA Cire, p=0.12), and girls show a slightly larger Arm Fat Index (percent of upper arm fat, p=0.I5). In the 9-12 year old category, a significantly higher average age is seen among girls (p=0.05); however, no significant differences are seen in anthropometric measures between boys and girls (Table 4.1) Results are somewhat different in Dureno (Table 4.2). Two to four year old boys show slightly larger mean summed skinfolds (Sum SF) than girls (p=0.09) and are slightly younger (p=0.10), while boys aged 5-8 years old are heavier (p=0.09) with higher BMI’s (p=0.07) and higher Sum
SF (p=0.12) when compared to girls. Conversely, girls 9-12 years old are slightly taller than boys (p=0.02) and have larger hip circumferences (Hip Circ, p=0.008), upper arm muscle area (UA Mus, p=0.15), and Arm Fat Index (p=0.I2, Table 4.2).
Inter-village comparisons show Zabalo 5-8 year old boys have larger triceps skinfold (Tri SF, p=0.13) however, all other measures did not differ by village for either
2-4 year old or 5-8 year old boys (Table 4.3). Among 9-12 year olds, UA Circ and UA Mus are larger in Zabalo boys (p=0.06, p=0.03) whereas. Arm Fat Index is larger in
Dureno boys (p=0.02) (Table 4.3). Among girls, mean height differed in 2-4 year olds
(p=0.13) and 9-12 year olds (p= 0.12) with Dureno girls being slightly taller (Table 4.4). Inter-village means for all other measures were little different for girls in any age group
(Table 4.4).
83 2 - 4 Age 2.2 3.0 -1.21 0.26 years Height (cm) 90.0 90.0 0.22 0-83 Weight (kg) 12-7 12.8 -0.11 0-91 BMI (v^t^) 15.5 15.9 -0.43 0-69 UACirc (cm) 15.7 14.3 1.06 0-35 Waist Circ (cm) 49.6 52.9 -1.02 0-38 Hip Circ (cm) 51.8 52.7 -0.84 0.46 TriSF (mm) 12.0 10.8 0.71 0.51 Subscap SF (mm) 6-0 9.0 -1.69 0-15* Sum SF (mm) 18-0 19.6 -0.59 0.58 UAMus (cm^) 12-5 9-7 0.85 0.44 UAFat (cm4 7.3 6.7 1.82 0.14* Arm Fat Index (%) 38.0 42.0 -0.49 0.65
5 - 8 Age 6.6 6.7 -0.06 0.95 years Height 112.0 III.O 0.33 0.74 Weight 20.2 19.0 0.67 0.51 N m ales = 1 1 BMI 15.9 15.5 0.62 0.54 ^ f e m a le s " 9 UACirc 17.5 16.5 1.71 0.12* Waist Circ 56.4 53.6 1.40 0.18 Hip Circ 60.8 61.2 -0.22 0.83 TriSF 9.7 10.0 -0.25 0.81 Subscap SF 7.8 8.9 -1.05 0.31 Sum SF 17.5 18.9 -0.74 0.47 UAMus 16.9 13.9 2.27 0.04* UAFat 7.6 7.8 -0.19 0.85 Arm Fat Index 31-1 35.8 -1.52 0.15*
9-12 years Age 10.3 11.1 -2.22 0.05* Height 132.0 128.0 0.98 0.35 ^ m a le s ~ ^ Weight 31.9 29.5 0.62 0.55 N r _ ^ = 7 BMI 18.2 17.9 0.24 0.81 UACirc 21.0 20.1 0.55 0.59 Waist Circ 63.2 59.3 1.17 0.28 Hip Circ 70-6 70.8 -0.03 0.98 TriSF 9.3 10.8 -0.98 0.35 Subscap SF 8-9 9.8 -0.74 0.47 Sum SF 18.1 20.7 -1.06 0.31 UAMus 27.0 22.8 1.11 0.30 UAFat 8.6 10.2 -0.92 0.38 Arm Fat fiidex 24.9 30.4 -1.44 0.18 *p-values <0.15
Table 4.1 : filtra-village means by sex, and p-values (based on t-tests) for differences in anthropometric variables between age categories from Zabalo. 84 2 - 4 Age 3.0 3.7 -1-85 0.10* years Height (cm) 91.0 94.0 -1.01 0.34 Weight (kg) 11.8 13.3 -1.44 0.18 BMI (wt/ht^) 15.2 15.0 0.23 0.82 M _ 7 fe m a le s" ' UA Circ (cm) 14.7 14.3 0.54 0.61 Waist Circ (cm) 51.2 49.4 1.03 0.35 Hip Circ (cm) 53.6 52.7 0.21 0.84 T riS F (mm) 11.7 9.5 1.48 0.18 Subscap SF (mm) 12.3 7.2 1.24 0.33 Sum SF (mm) 24.0 16.7 1.91 0.09* UA Mus (cmj) 9.8 9.8 -0.02 0.98 UA Fat (cm^) 7.5 6.4 1.24 0.27 Arm Fat Index (%) 43.4 40.2 0.62 0.56
5 - 8 Age 6.4 6.7 -0.55 0.59 years Height 111.0 110.0 0.23 0.82 Weight 19.9 17.9 1.79 0.09* N m ales = ^ BMI 16.1 14.8 1.92 0.07* ^ f e m a le s " UACirc 16.3 14.6 0.91 0.38 Waist Circ 55.1 52.4 1.42 0.18 Hip Circ 59.0 58.5 0.03 0.77 TriSF 8.1 9.4 -1.40 0.18 Subscap SF 7.6 9.0 -1.28 0.22 Sum SF 15.8 18.4 -1.64 0.12* UA Mus 14.4 11.6 1.16 0.27 UAFat 6.7 6.5 0.11 0.91 Arm Fat Index 31.6 42.1 -1.16 0.27
9-12 years Age 10.7 10.3 0.78 0.45 Height 128.0 133.0 -2.50 0.02* N m ajes = 12 Weight 28.3 28.6 -0.18 0.86 BMI 17.3 16.4 1.23 0.24 UACirc 18.3 18.9 -0.95 0.37 Waist Circ 59.0 61.9 -1.03 0.33 Hip Circ 66.0 72.6 -3.39 0.008* T riSF 10.1 9.7 0.25 0.81 Subscap SF 9.1 11.0 -1.45 0.17 Sum SF 19.2 20.7 -0.51 0.61 UAMus 16.7 20.4 -1.74 0.15* UAFat 10.1 8.2 1.47 0.18 Arm Fat Index 37.4 29.5 1.74 0.12* •'p-values <0.15
Table 4.2: Intra-village means by sex, and p-values (based on t-tests) for differences in anthropometric variables between age categories from Dureno. 85 h ^ ^ b h h b h ■ 1 WSBSÊ I H i H i
2 - 4 years Height (cm) 91.0 90.0 0.32 0.77 Weight (kg) 11.8 12.7 -0.57 0.59 ^ D u ren o ~ ^ BMI (wt/ht^) 15.2 15.5 -0.35 0.74 ^ Z a b a Io ~ ^ UACirc (cm) 14.7 15.7 -0.74 0.51 Waist Circ (cm) 51.2 49.6 1.41 0.25 Hip Circ (cm) 53.6 51.8 0.41 0.71 TriSF (mm) 11.7 12.0 -0-15 0.89 Subscap SF (mm) 12.3 6.0 1.50 0.20 SumSF (mm) 24.0 18.0 1.03 0.36 UAMus (cm-) 9.8 12.4 -0-73 0.58 UAFat (cm^) 7.5 7.3 0.21 0.84 Arm Fat Index (%) 43.4 38.0 0.71 0.53
5 -8 years Height 111.0 112.0 -0.27 0.79 Weight 19.9 20.2 -0.20 0.85 N D ureno= 8 BMI 16.1 15.9 0.27 0.79 ^Z abalo” ^ ^ UACirc 16.2 17.5 -1.44 0.17 Waist Circ 55.1 56.4 -0.49 0.63 Hip Circ 59.0 60.8 -1.07 0.31 TriSF 8.1 9.7 -1.58 0.13* Subscap SF 7.6 7.8 -0.19 0.85 Sum SF 15.8 17.5 -1.01 0.33 UAMus 14.4 16.9 -1.33 0.21 UAFat 6.7 7.6 -0.87 0.40 Arm Fat Index 31.6 31.1 0.14 0.89
9-12 years Height 128.0 132.0 -1.19 0.27 Weight 28.3 31.9 -1.18 0.28 N o u re n o ^ BMI 17.3 18.2 -0.72 0.40 0.06* ^ Z a b aIo ~ ^ UACirc 18.3 21.0 -2.35 Waist Circ 59.0 63.2 -1.37 0.21 Hip Circ 66.0 70.6 -1.21 0.31 Tri SF 10.1 9.3 0.53 0.60 Subscap SF 9.1 8.8 0.13 0.90 Sum SF 19.2 18.1 0.34 0.74 UAMus 16.7 27.0 -2.98 0.03* UAFat 10.1 8.6 1.04 0.32 AH 37.4 24.9 2.94 0.02* *p-values <0.15
Table 4.3: Inter-village means and p-values (based on t-tests) for differences in anthropometric variables between boys < 12 years of age from Dureno and Zabalo.
86 g g g g H* W m 2 - 4 years Height (cm) 94.0 90.0 1.67 0.13* Weight (kg) 13.3 12.8 0-67 0.52 NDurcno= ^ BMI ( \x ^ f ) 15.0 15.9 -1-19 0.26 Nzabalo~ UACirc (cm) 14.3 14.3 -0.03 0.88 ^ Waist Circ (cm) 49.4 52.9 -1-32 0.24 Hip Circ (cm) 52-7 52.7 -0-02 0.99 TriSF (mm) 9.5 10-8 -1.03 0.33 Subscap SF (mm) 7-2 9-0 -1-17 0.27 Sum SF (mm) 16-7 19-8 -1.55 0.16 UAMus (cm5 9-8 9.7 0.06 0.95 UAFat (cm ) 6-4 6.7 -0.78 0.46 Arm Fat Index (%) 40-2 42.0 -0.32 0.76
5 - 8 years Height 110-0 111.0 -0.13 0.90 Weight 17-9 19.0 -0.89 0.39 NDureno= BMI 14-8 15.5 -0.99 0.34 Nzabalo= 9 UA Circ 14.6 16.4 -1.32 0.21 Waist Circ 52.4 53.6 -0.96 0.36 Hip Circ 58.4 61.2 -1.35 0.20 TriSF 9.4 lO.O -0.57 0.57 Subscap SF 9.0 8.9 0.10 0.92 Sum SF 18.4 18.9 -0.28 0.78 UAMus 11.5 13.9 -1.19 0.25 UAFat 6.5 7.8 -1.22 0.24 Arm Fat Index 42.1 35.8 0.87 0.40
9-12 years Height 133.0 128.0 1.68 0.12* Weight 28.6 29.5 -0.35 0.74 NDureno= ^ BMI 16.4 17.9 -1.42 0.20 NzabaIo= 7 UACirc 18.9 20.2 -1.27 0.23 Waist Circ 61.9 59.3 0.86 0.41 Hip Circ 72.6 70.8 0.53 0.61 Tri SF 9.7 10.8 -0.74 0.47 Subscap SF 11.0 9.8 1.00 0.33 Sum SF 20.7 20-7 0.00 1.00 UAMus 20.4 22-8 -0.95 0.36 UAFat 8.2 10.2 -1.16 0.28 Arm Fat Index 29.5 30.4 -0.22 0.83
Table 4.4: Inter-village means and p-values (based on t-tests) for differences in anthropometric variables between girls < 12 years of age from Dureno and 2Iabalo.
87 Body composition among Cofan children is compared to U.S. data from the
NCHS, as recommended by the World Health Organization (1986). Weighted mean values
(sex and village specific) for all ten variables (HT, WT, BMI, UA Circ, Tri SF, Subscap SF, Sum SF, UA Mus, UA Fat, Arm Fat Index) were computed for comparisons to the three age classes used for the Cofan data. Compared to the NCHS data. Cofan children are shorter and lighter at all ages (Tables 4.5 and 4.6). However, BMI’s of Cofan children are only slightly below NCHS means, except for 5-8 year old boys from Dureno, who are slightly above the NCHS mean (Table 4.5). Girls aged 2-4 years and boys 5-8 years and
9-12 years from Zabalo have slightly higher BMI’s than the NCHS comparison group
(Table 4.6). Skinfold thicknesses (Tri SF, Subscap SF, and Sum SF) are above the
NCHS means at both 2-4 years and 5-8 years in both villages. Among Dureno 9-12 year olds, higher Subscap SF but lower Tri SF than the NCHS means are found. Among Zabalo 9-12 year olds, both boys and girls are below NCHS means for UACirc., Tri SF,
Subscap SF, Sum SF, Arm Fat Index, UAMus, and UAFat. Still in the Zabalo sample.
Arm Fat Index is elevated above NCHS means in all age groups, except 9-12 year olds, for both sexes, and among 9-12 year old girls from Dureno.
88 2 - 4 Height (cm) 91.0 99.0 94.0 97.9 years Weight (kg) 11.8 15.7 13.3 I5.I BMI (wt/h^) 15.2 16.0 15.0 15.7 N m ales = 3 UACirc (cm) 14.7 16.8 14.3 16.6 TriSF (mm) 1L7 9.7 9.5 10.4 Subscap SF (mm) 12.3 5.6 7.2 6.2 Sum SF (mm) 24.0 15.3 16.7 16.6 Arm Fat Index (%) 43.4 32-7 40.2 35.0 UAMus (cm-) 9.8 15.2 9.8 14.4 UAFat (cm-) 7.5 7.4 6.4 7.8
5 - 8 Height III.O 119.5 II 0.0 118.9 years Weight 19.9 22.9 17.9 22.5 BMI I6.I 15.8 14.8 15.8 ^inales ~ ^ UACirc 16.3 18.4 14.6 18.5 12 Tri SF 8.1 9.0 9.4 10.8 Subscap SF 7.6 5.5 9.0 6.6 Sum SF 15.8 14.6 18.4 17.4 Arm Fat Index 31.6 27.9 42.1 32.8 UAMus 14.4 19.5 11.6 21.7 UA Fat 6.7 7.9 6.5 II.O
9 - 12 Height 128.0 144.9 133.0 144.0 years Weight 28.3 37.8 28.6 39.1 BMI 17.3 18.0 16.4 18.4 Nma.cs ^ = 1_ 2 UA Circ 18.3 22.3 18.9 22.5 fem ales" ' T riSF 10.1 11.6 9.7 14.3 Subscap SF 9.1 8.1 II.O 10.2 Sum SF 19.2 19.6 20.7 24.5 Arm Fat Index 37.4 28.7 29.5 34.8 UAMus 16.7 28.0 20.4 26.1 UAFat lO.I 12.4 8.2 I5.I
Table 4.5: Comparison of Dureno boys and girls to NCHS reference values by sex and age group.
89 2 - 4 Height (cm) 90.0 99.0 90.0 97.9 y ears Weight (kg) 12.7 15.7 12.8 15.1 BMI (wt/ht ) 15.5 16.0 15.9 15.7 N e a l e s = 3 UACirc (cm) 15.7 16.8 14.3 16.6 N f c ™ a lc s = 4 TriSF (mm) 12.0 9.7 10.8 10.4 Subscap SF (mm) 6.0 5.6 9.0 6.2 Sum SF (mm) 18.0 15.3 19.6 16.6 Arm Fat Index (%) 38.0 32.7 42.0 35.0 UAMus (cm;) 12-5 15.2 9.7 14.4 UAFat (cm^) 7.2 7.4 6.7 7.8
5 - 8 Height 112.0 119.5 111.0 118.9 years Weight 20.2 22.9 19.0 22.5 BMI 15.9 15.8 15.5 15.8 N _ ,^ = ll UACirc 17.5 18.4 16.5 18.5
N f e m a l « = 9 TriSF 9-7 9.0 10.0 10.8 Subscap SF 7.8 5.5 8.9 6.6 Sum SF 17.5 14.6 18.9 17.4 Arm Fat Index 31.1 27.9 35.8 32.8 UAMus 16.9 19.5 13.9 21.7 UAFat 7.6 7.9 7.8 II.O
9 - 12 Height 132.0 144.9 128.0 144.0 years Weight 31.9 37.8 29.5 39.1 BMI 18.2 18.0 17.9 18.4 N„,,„ = 7 UACirc 21.0 22.3 20.1 22.5 N - 7 f e m a l e s " ' TriSF 9.3 11.6 10.8 14.3 Subscap SF 8.9 8.1 9.8 10.2 Sum SF 18.1 19.6 20.7 24.5 Arm Fat Index 24.9 28.7 30.4 34.8 UAMus 27.0 28.0 22.8 26.1 UAFat 8.6 12.4 10.2 15.1
Table 4.6: Comparison of Zabalo children to NCHS reference values by sex and age group.
90 4.2.2 Adults
Among individuals aged 13 years and over, several anthropometric measures differ
between the sexes (Table 4.7 and 4.8). Dureno men are taller (p<.00005) and heavier
(p=0.01), and have larger WHR (p=0.02), UA Mus (p<.00005), and UA Circ (p=0.13) than do Dureno women. However, women in Dureno have somewhat higher BMI’s
(p= 0.07), Hip Circ (p=0.02), skinfold measures (Tri, Subscap, Supra) (p=<.00005), and UA Fat (p<.00005) than do Dureno men (Table 4.7). 2^balo men are taller (p<.00005)
and heavier (p= 0.008), and have larger UA Circ (p=0.03), WHR (p=0.08), and UA Mus (p<.00005) than Zabalo women. On the other hand, Zabalo women have larger skinfold
measures (Tri, p<.00005; Subscap, p<.00005; Supra, p= 0.002), UA Fat (p<.00005), and Arm Fat Index (p<.00005).
Across villages, men are slightly older in Dureno (p=0.10). Zabalo men have
slightly larger UA Circ (p=0.14). Hip Circ (p=0.11), and UA Mus (p=0.13). Other
anthropometries were little different between the men (Table 4.9). Conversely, women in
Dureno were taller (p=0.02), with higher Supra SF (p=0.04) and Arm Fat Index (p=0.05)
than those in Zabalo. However, Zabalo women show higher UA Mus (p=0.10).
91 Age male 34.0 15.8 female 31.0 15.7 0.85 0.40 HT (cm) male 157.8 7.0 female 147-9 5.1 7.49 <.00005 WT (kg) male 59.9 8.4 female 54.8 8.7 2.51 0.01 BMI (wt/hri) male 23.9 2.2 female 25.1 3.2 -1.86 0.07 UA Circ (cm) male 27.6 2.1 female 26.8 2.8 1.59 0.13 Waist Circ (cm) male 81.1 7.9 female 79.9 10.9 0.58 0.56 Hip Circ (cm) male 92.4 1.3 female 95.7 1.3 -2.47 0.02 WHR(%) male 87.8 4.8 female 83.8 9.7 2.28 0.02 Tri SF (mm) male 9.1 2-4 female 20.2 6.7 -10.50 <.00005 Subscap SF (mm) male 15.9 5.3 female 30.9 10.9 -8.27 <.00005 Supra SF (mm) male 17.7 8.6 female 30.8 9.3 -6.55 <.00005 UA Mus (cm'^) male 49.4 8.5 female 33.5 5.6 10.17 <.00005 UA Fat (cm"") male 11.8 3.2 female 24.2 9.9 -8.07 <.00005 Arm Fat Index (%) male 19.5 5.0 female 40.9 8.3 -14.57 <.00005
Table 4.7: Intra-village means (standard deviation) and p-values (based on t-tests) for differences in anthropometric variables between sexes among adult participants (>13 years) from Dureno.
92 Age male 28.0 14.0 female 27.0 13.2 0.25 0.80 HT (cm) male 156.6 7.7 female 145.1 4.5 7.00 <00005 WT (kg) male 60.2 10.9 female 53.1 9.8 2.72 0.008 BMI (wt/ht^) male 24.4 2.9 female 25.1 3.7 -0.91 0.36 UA Circ (cm) male 28.5 3.1 female 26.8 3.2 2.23 0.03 Waist Circ. (cm) male 83.3 9.1 female 80.9 9.7 1.02 0.31 Hip Circ (cm) male 94.7 6.5 female 94.8 9.1 -0.06 0.95 WHR (%) male 87.9 6.3 female 85.2 5.2 1.79 0.08 Tri SF (mm) male 9.3 3.1 female 17.9 6.3 -6.59 <.00005 Subscap SF (mm) male 16.1 9.0 female 28.6 11.3 -5.06 <.00005 Supra SF (mm) male 18.6 9.6 female 26.1 8.1 -3.28 0.002 UA Mus (cm'') male 52.9 11.2 female 36.1 7.9 6.72 <.00005 UA Fat (cm") male 12.7 5.0 female 21.9 8.8 -4.92 <.00005 AFI (%) male 19.3 5.6 female 36.8 9.3 -8.80 <.00005
Table 4.8: Intra-village means (standard deviation) and p-values (based on t-tests) for differences in anthropometric variables between sexes among adult participants (>13 years) from Zabalo. 93 Age 34.0 28-0 1.64 0.10*
HT (cm) 157.8 156.6 0.72 0.47
WT(kg) 59.9 60.2 -0-15 0.88
BMI (wt/ht^) 23.9 24.4 -0-80 0.42
UA Circ (cm) 27.6 28.5 -1-50 0.14*
Waist Circ (cm) 81.2 83-3 -1-06 0.29
Hip Circ (cm) 92.4 94-7 -1-61 0.11*
WHR(%) 87.8 87-9 -0-10 0.92
Tri SF (mm) 9.0 9.3 -0.37 0.71
Subscap SF (mm) 15.9 16.0 -0.11 0.91
Supra SF (mm) 17.7 18.6 -0.44 0.66
UA Mus (cm^) 49.4 52.9 -1.54 0.13*
UA Fat (cm-) 11.8 12.7 -0.91 0.37
Arm Fat Index (%) 19.5 19.3 0.19 0.85 *p-values <0.15
Table 4.9: Comparisons of inter-village means and p-values (based on t-tests) for differences in anthropometric variables between males (>13 years) from Dureno and Zabalo.
94 Age 31-0 27-0 0-98 0-33
HT (cm) 147-9 145-1 2.36 0-02*
WT (kg) 54-8 53-1 0-76 0-45
BMI (wt/ht^) 25-1 25-1 -0-05 0-96
UA Circ (cm) 26-7 26-8 -0-06 0-95
Waist Circ (cm) 79-9 80-9 -0-37 0-71
Hip Circ (cm) 95-7 94-8 0-48 0-64
WHR(%) 83-7 85-2 -0-72 0-47
Tri SF (mm) 20-2 17-9 1-39 0.17
Subscap SF (mm) 30-9 28-6 0-85 0-40
Supra (mm) 30-8 26-1 2-14 0.04*
UA Mus (cm") 33-5 36-1 -1-66 0.10*
UA Fat (cm^) 24-2 21-9 1-00 0.32
Arm Fat Index (%) 40-9 36-8 1-96 0.05* *p-values < 0.15
Table 4.10: Comparisons of inter-village means and p-values (based on t-tests) for differences in anthropometric variables between females (>13 years) from Dureno and Zabalo.
95 4.3 Physiological Variables
For total cholesterol, random glucose, systolic blood pressure (SBP), diastolic blood pressure (DBF), and pulse rate the Cofan are well within reference standards
(Henry, 1996; Isselbacher et al., 1994). Common laboratory reference standards for the above measures are: total cholesterol less than 200 mg/dl, random glucose 45-130 mg/dl,
SBP 100-140 mmHg, DBF 60-90 mmHg, and Pulse Rate 70-80 bpm (Henry, 1996; Isselbacher et al., 1994).
Average blood pressure of women from Dureno is 117/70, that of men is
121/74. Zabalo is similar, blood pressures of 112/65 and 118/68 respectively. Pulse rate and cholesterol levels are higher among Dureno women than men (p=0.02, p=0.02. Table
4.11). Although not statistically significant, both SBP and DBP are slightly higher in
Dureno men than women (p=0.23, p=0.16. Table 4.11). In Zabalo, pulse rate and cholesterol levels are higher in women (p=0.0007, p=0.10) while SBP is greater in men
(p=0.07. Table 4.12). Although not statistically significant, DBP is slightly higher in
Zabalo men than women (p=0.17. Table 4.12). Glucose levels do not differ greatly across sex in either village (Tables 4.11 and 4.12).
96 aKBH— j■ 0 0 0 0 AGE male 36 34 (15-8) female 47 31 (15.7) -0.85 0.40 DBP male 36 74 (9.8) female 45 70 (9.1) -1.42 0.16 SBP male 36 121 (14.1) female 45 117(13.3) -1.21 0.23 Pulse male 36 74(11.7) female 45 79 (7.5) 2.34 0.02* Cholesterol male 19 114(35.0) female 29 149 (54.2) 2.51 0.02* Glucose male 38 113 (21.9) female 46 116 (27.0) 0.56 0.58 *p-values <0.15
Table 4.11: Intra-village means (standard deviation) and p-values (based on t-tests) for differences in physiological variables between sexes among adult participants (> 13 years) from Dureno.
97 AGE male 40 28 (14.0) female 27 27 (13.2) -0.25 0.80 DBP male 32 68 (5-4) female 25 65 (8.3) -1.38 0.17 SBP male 32 118 (9.6) female 25 112 (12.9) -1.86 0.07* Pulse male 32 68 (8.3) female 25 76 (7.1) 3.58 0.0007* Cholesterol male 21 136 (37.8) female 16 162 (55.2) 1.70 0.10* Glucose male 28 111 (16.2) female 19 110 (26.2) -0.16 0.87 *p-values <0.15
Table 4.12: Intra-village means (standard deviation) and p-values (based on t-tests) for differences in physiological variables between sexes among adult participants (>13 years) from Zabalo.
Various physiological measures differ between these two villages. Although within normal range, DBP (males/p=0.004, females/p=0.02) and Pulse Rate (males/ p=0.02, females/p=0.07) are higher in Dureno (Table 4.13). Although total cholesterol levels are below normal laboratory guidelines, participants from Zabalo show higher cholesterol
levels especially in males (p=0.06. Table 4.13). Random glucose levels are within normal range for both villages and do not differ significantly by sex (males/p=0.74, females/ p=0.44. Table 4.13).
98 AGE male 36/40 34 (15.8) 28 (14.0) 1.64 0.10* female 47/27 31 (15.7) 27 (13.2) 0.98 0.33 DBP male 36/32 74 (9.8) 68 (5.4) 3.03 0.004* female 45/25 70 (9.1) 65 (8.3) 2.40 0.02* SB? male 36/32 121 (14.1) 118 (9.6) 1.08 0.29 female 45/25 117 (13.3) 112(12-9) 1.54 0.13* Pulse male 36/32 74(11.7) 68 (8.3) 2.37 0.02* female 45/25 79 (7.5) 76 (7.1) 1.82 0.07* Cholesterol male 19/21 114(35.0) 136 (37.8) -1.93 0.06* female 29/16 149 (54.2) 162 (55.2) -0.76 0.45 Glucose male 38/28 113 (21.9) 111 (16.2) 0.33 0.74 female 46/19 116(27.0) 110 (26.2) 0.77 0.44 *p-values <0.15
Table 4.13: Inter-village means (standard deviation) and p-values (based on t-tests) for differences in physiological variables by sex between villages on participants >13 years old.
Although hemoglobin levels varied across ages and sexes, only Zabalo women
aged 13-20 years could be considered mildly anemic (p=0.l4). When individually
determined, following The World Health Organization’s (WHO) anemia classification, 25% of women aged 13-20 years and 28% of those 21+ years from Dureno are anemic with Hb levels less than 12 g/dl. Whereas in Zabalo, 75% of women aged 13-20 years and
8% aged 21+ years are anemic. Twenty-five percent of Dureno men age 13-20 years, and 24% of those 21+ years old are anemic with Hb levels below 13 g/dl. In Zabalo men these proportions are 17% and 29%, respectively. No severe cases of anemia (Hb < 7 g/dl) are
observed among the Cofan however, two cases of moderate anemia (Hb 7-10 g/dl) are
noted among Cofan women; one from Dureno (21+ age category) and the other from
Zabalo (13-20 year age category).
99 Fem ales
13-20 yrs 12.6 (1-3) 11.3 (1.3) 0.14
^ D u ren o ~ ^ [10.6-14.7] [9.9-12.9]
21+yrs 12.7 (1.4) 13.2 (1.0) 0.24
^ D u ren o ~ [9.7-14.8] [11.3-14-9]
Males
13-20 yrs 14.4 (1.7) 14.5 (1.6) 0-87
^Dureno” 4 [12.0-15.9] [12.3-16.5] Nzabr.Io= 6
21+ yrs 13.6 (1.5) 14.0 (1.6) 0-46
^Dureno~ 21 [10.3-17.5] [10.6-16.0]
Table 4.14: Means, standard deviations, and ranges for hemoglobin levels (Hb) by age, sex, and village.
4.4 Intestinal Parasites
To determine helminthiasis by village, seventy four fecal samples were collected, representing 20% of each village’s population (Dureno N=50; Zabalo N=24). Following Smith (1970), individuals are age grouped based on daily activity patterns. This was thought to be an optimal technique for dividing this population since exposure to parasites, rather than host age, is ± e definitive factor in helminthiasis. Smith’s age categories were modified slightly in accordance with field observations made as part of this research. Girls
100 13 years of age are included in group 4 since their activity patterns are more sedentary and they begin to assume activities of older females (Table 4.15).
1 (male and female) 0-1 yrs. crawling inside, carried outside
2 (male and female) 2-3 yrs. learning to walk, more time outside
3 (male and female) 4-12 yrs. play all day in village and surrounding forest 4 (females) 13 yrs. and older more sedentary, activities confined to home 5 (males) 13 yrs. and older traditionally away from village hunting and fishing
Table 4.15; Cofan age groups based on daily activity patterns.
Upon microscopic examination, fecal samples show infections by two species of intestinal nematodes; roundworms (Ascaris lumbricoides) and hookworms (Ancylostoma duodenale and Necatoramericanus). Although there are distinct morphological differences between adult worms of Ancylostoma duodenale and Necator americanus, these parasites cannot be differentiated by their eggs, which is the diagnostic stage (Garcia and Bruckner,
1997). Therefore, hookworm is used throughout to designate this type of infection. The number of adult worms infecting an individual generally is proportional to the number of eggs observed in feces; therefore counting all eggs in a standard quantity of feces provides a measure of individual worm burden (Smith, 1970).
Overall, helminth infections are more frequent in both sexes from Dureno (Table
4.16). In particular. A scaris infections are 4-5 times higher in Dureno, while hookworm infections are twice those in Zabalo (Table 4.17). fri Dureno, men show a higher prevalence of A scaris infections, whereas women have more hookworm infections (Table
101 4.17). Based on EPG data, the intensity of individual worm burdens was somewhat higher in Dureno (EPG-Ajcam p=0.07; EPG-hookworm p=0.12).
50 Dureno male & female 44% 24 Zabalo male & female 16% 0.01 20 Dureno male 50% 12 Zabalo male 8% 0.03 30 Dureno female 40% 12 Zabalo female 17% 0.06
Table 4.16: Prevalence of and p-values (based on proportional inferences) by sex for differences in helminth infections in fecal samples from Cofan of Dureno and Zabalo.
50 Dureno m & f 20 34 24 Zabalo m&f 4 (0.03) 16 (0.06) 20 Dureno m 30 45 12 Zabalo m 8 (0.07) 2 (0.11) 30 Dureno f 13 33 12 Zabalo f 0 (0.09) 17 (0.05)
Table 4.17: Prevalence of and p-values (based on proportional inferences) by sex for differences in Ascaris and hookworm infections in the Cofan from Dureno and Zabalo.
Dureno shows three times the number of single helminth infections as are found in Zabalo (p=0.03, Table 4.18). Dureno males have the highest level of single helminth infections (p=0.04). Among females, single helminth infections are twice as high in
Dureno (p=0.14), while double helminth infections are not observed in 2^balo (Table
4.18). The prevalence of helminth infections by specific age groups does not differ significantly between villages, although Dureno males aged 13 years and older are infected about twice as often as are those in Zabalo (p=0.11, Table 4.19).
102 50 Dureno m & f 56 34 10 24 Zabalo m & f 84 12 (0.03) 4 (0.18) 20 Dureno m 50 35 15 12 Zabalo m 84 8 (0.04) 8 (0-22) 30 Dureno f 60 33 7 12 Zabalo f 83 17 (0.14) 0 (0-17)
Table 4.18: Prevalence of and p-values (based on proportional inferences) by sex for differences in single and double helminth infections in fecal samples from Cofan of Dmeno and Zabalo
1 (0-1 yr.) 0 0 2 0 2 (2-3 yrs.) 2 0 1 0 3 (4-12 yrs.) 11 27 8 25 0.46 4 (female 13 4- yrs.) 21 43 7 0 0.32 5 (male 13 + yrs.) 16 62 6 33 0.11
Table 4.19 : Prevalence of and p-values (based on proportional inferences) by sex for differences in helminth infections in specific age groups of Cofan from Dureno and Zabalo.
4.5 Dental Health
Oral health is an important indicator of environmental and cultural change therefore, dental examinations were completed on 75 individuals from Dureno and 59 individuals from Zabalo. Two indices were calculated; a Caries Index [(number of decayed teeth/total number of teeth)xlOO], and a DMFT/dmft fridex which denotes the total number of decayed, missing, and filled teeth. The count for permanent teeth is upper case DMFT, whereas deciduous teeth are designated with lowercase dmft (Rugg-Gunn, 1993). Both dental caries and periodontal disease, the build up of dental plaque and subsequent
103 break down of periodontal tissue, can ultimately lead to tooth loss. Therefore, conditions such as gingivitis (bleeding and swollen gums) and enamel hypoplasia were noted.
4.5.1 Children
Linear enamel hypoplasia, a neonatal enamel defect which mainly occurs in deciduous incisor teeth, was noted among children in both villages. Teeth with this defect are especially prone to develop dental caries and are often reduced to blackened stumps
(Rugg-Gunn, 1993). Several children from both villages had deciduous incisors that were blackened stumps. Notable differences appear in the dmft and caries indices between males and females from Dureno (Table 4.20). Females from Dureno have a higher dmft index compared to males, with means of 7.9 and 5.2 respectively (p=0.04), and a higher rate of caries with means of 34% and 19.4% respectively (p=0.02) (Table 4.20). In 2^balo, mean dmft and caries rate are little different between the sexes (p=0.40; p=0.46. Table 4.21). In
Dureno, females have higher dmft scores than in Zabalo, 7.9 and 5.3, respectively (p=0.05), a higher caries index 34% and 20.6% (p=0.02), respectively, and a higher absolute number of decayed teeth, 7.2 and 4.6 (p=0.05), respectively. Males show no inter-village differences in any dental measures (Table 4.22).
104 dmft Index 5.2 (2.9) 7.9 (3.9) -2.19 0.04 Caries Index (%) 19.4 (12.8) 34.0 (19.2) -2.39 0.02
# decayed 4.1 (2.3) 7.2 (4.1) -2.45 0.02
# missing 1.0 (1.3) 0.8 (1.9) 0.36 0.72
#fiUed 0.1 (03) 0.0 (0.0) 1.00 0.34
Table 4.20: Intra-village means (standard deviation) and p-values (based on t-tests) by sex for differences in dental measures among participants <12 years of age from Dureno
dmft Index 6.4 (3.1) 5.3 (3.5) 0.86 0.40
Caries Index (%) 24.6 (14.2) 20.5 (13.6) 0.76 0.46 # decayed 5.4 (3.3) 4.6 (3.2) 0.66 0.52
# missing 0.4 (0.9) 0.7 (1.1) -0.81 0.42
# filled 0.6 (1.8) 0.0 (0.0) 1.17 0.27
Table 4.21: Intra-village means (standard deviation) and p-values (based on t-tests) by sex for differences in dental measures among participants < 12 years of age from Zabalo.
105 dmft Index male 13/11 5.2 (2.9) 6.4 (3.1) -1.06 0.30 female 18/16 7.9 (3.9) 5.3 (3.5) 2.06 0.05 Caries Index (%) male 13/11 19.4 (12-8) 24.7 (14.2) -0.96 0.35 female 18/16 34.0 (19.2) 20.6 (13.6) 2.33 0.02
# decayed male 13/11 4.1 (2.3) 5.4 (3.3) -1.20 0.24 female 18/16 7.2 (4.1) 4.6 (3.2) 2.01 0.05
# missing male 13/11 I.O (1.3) 0.4 (0.9) 1.36 0.19 female 18/16 0.8 (1.9) 0.7 (1.1) 0.17 0.87 # filled male 13/11 0.1 (0.3) 0.6 (1.8) -1.02 0.33 female 18/16 0.0 (0.0) 0.0 (0.0) ------
Table 4.22: Inter-village means (standard deviation) and p-values (based on t-tests) by sex for differences in dental measures among participants < 12 years of age.
4.5.2 Adults
Thirty-four percent of adult participants from Dureno and 16% from Zabalo exhibited gingivitis, a condition which predisposes individuals to periodontal disease and subsequent tooth loss (p= 0.02, Table 4.23). Eight percent of participants from Dureno
(age range 48-70 years) and 4% from Zabalo (age range 34-54 years) exhibited flattened occlusal surfaces indicative of extreme wear (p= 0.22). Five percent of adult participants from Dureno had broken central incisors compared to 20% of Zabalo individuals (p=0.01).
Twenty-five percent of Dureno individuals were missing at least one of their maxillary central incisors compared to 2% in Zabalo (p=0.0008). Five percent of Dureno individuals were edentulous (without teeth) whereas only 2% of individuals from Zabalo experienced this condition (p= 0.22). Seven percent of Dureno individuals had partial or full dentures
(all females), whereas none from Zabalo had dentures (p= 0.06).
106 Gingivitis 34% 16% 0.02
Excessive wear 8% 4% 0.22
Front teeth broken 5% 20% 0.01
Front teeth missing 25% 2% 0-0008
Edentulous 5% 2% 0.22
Dentures 7% 0% 0.06
Table 4.23: Inter-village comparisons and p-values (based on proportional inferences) for differences in various dental conditions between Dureno and Zabalo for the total adult population.
The DMFT Index is higher in females than males in Dureno (p=0.005. Table 4.24).
Females from Dureno also exhibit more missing teeth than males (p=0.001). On the other hand, males have more filled teeth than females (p=0.04), while the Caries Index and number of decayed teeth did not differ significantly between the sexes (p=0.43, p=0.88).
In Zabalo, females have more missing teeth than males (p=O.11). No other significant differences were found (Table 4.25).
Inter-vUlage differences between the sexes were seen for the various dental measures (Table 4.26). The DMFT index was not significantly different between females or between males by village (p=0.27,0.88). However, the Caries Index was higher in males from Zabalo compared to males from Dureno (p=0.07) although it did not differ significantly between females (p=0.l7). The number of decayed teeth was higher in both males and females from Zabalo (p=0.04, p=0.04. Table 4.26). Missing teeth, on the other hand, were more frequent in females firom Dureno than firom Zabalo (p= 0.02), but did not differ greatly between males (p=0.34. Table 4.26). Dureno males exhibited a higher
107 number of filled teeth than Zabalo males (p=0.05). Although not statistically significant^
females from Zabalo have more filled teeth than Dureno females (p=0.29. Table 4.26).
DMFT Index 9.6 (4.7) 14.8 (9.0) -2.90 0.005
Caries Index (%) 13-1 (10.9) 15.7 (12.5) -0.80 0.43
# decayed 3.3 (2.6) 3.2 (2.6) 0.15 0.88
# missing 5.4 (3.2) 11.5 (9.7) -3.42 0.001
# filled 0.8 (1.6) 0.1 (0.5) 2.14 0.04
Table 4.24: Intra-village means (standard deviation) and p-values (based on t-tests) by sex for differences in dental measures among participants >13 years of age from Dureno.
DMFT Index 9.8 (5.3) 12.2 (6.9) -1.26 0.21
Caries Index (%) 19.9 (14.1) 22.1 (20.5) -0.41 0.68 # decayed 5.2 (3.4) 4.9 (3.3) 0.25 0.80
# missing 4.5 (3.6) 6.7 (5.3) -1.64 0.11
#fiUed 0.1 (0.4) 0.5 (2.1) -0.83 0.41
Table 4.25: Intra-village means (standard deviation) and p-values (based on t-tests) by sex for differences in dental measures among participants >13 years of age from Zabalo
108 DMFT Index male 24/25 9.6 (4.7) 9.8 (5.3) -0.15 0.88 female 35/19 14.8 (9.0) 12.2 (6.9) 1.12 0.27 Caries Index (%) male 24/25 13.2 (10.9) 19.9 (14-1) -1.88 0.07 female 35/19 15.7 (12.5) 22.1 (20.5) -1.38 0.17
# decayed male 24/25 3.3 (2.6) 5.2 (3.4) -2.14 0.04 female 35/19 3.2 (2.6) 4.9 (3.3) -2.13 0.04
# missing male 24/25 5.4 (3.2) 4.5 (3.7) 0.95 0.34 female 35/19 11.4(9.7) 6.7 (5.3) 2.33 0.02
# filled male 24/25 0.8 (1.6) 0.1 (0.4) 2.04 0.05 female 35/19 0.1 (0.5) 0.5 (2.1) -1.06 0.29
Table 4.26: Inter-village means (standard deviation) and p-values (based on t-tests) by sex for differences in dental measures among participants >13 years of age between Dureno and Zabalo.
4.6 Biological and Physiological Variation among Adult Cohorts All biological and physiological variables are compared both inter and intra-village, for each age cohort by sex. Only measures showing a significant difference at p > 0.15 are reported (Tables 4.27- 4.44). The age ranges for the cohorts are as follows;
Cohort 1= 13-20 year-olds. Cohort 2= 21-40 year-olds, and Cohort 3= 41-76 year-olds.
Comparing Cohort 1 to 2, Dureno Cohort 2 men have larger UA Circ (p=0.01).
Hip Circ (p=0.09), HT (p=0.06), Subscap SF,(p= 0.10), Supra SF (p=0.12), UA Mus
(p=0.007). Waist Circ (p=0.12), WT (p=0.07), and higher DBF (p=0.08). Only Pulse
Rate was higher in Cohort 1 men (p=0.13. Table 4.27). Cohort 2 women from Dureno
109 have higher Cholesterol levels Cp=0.15), Hip Circ (p=0.15), and Waist Circ (p=0.05), whereas those of Cohort 1 show higher Pulse Rates (p=0.002. Table 4.28).
In Zabalo, Cohort 2 men have higher UA Circ (p<.00005), BMI (p=0.002). Cholesterol (p= 0.15), Hip Circ. (p=0.01), HT (p<.00005). Supra SF (p=0.06), Subscap
SF (p=0.02), UA Fat (p=0.1I), UA Mus (p=<.G0GG5), Waist Circ (p=0.01), and WT
(p<.00005) than does Cohort 1 (Table 4.29). Cohort 2 women have higher UA Circ
(p=0.02), BMI (p= 0.02), Hip Circ (p=0.004). Supra SF (p=0.(X)3), Subscap SF
(p=0.003). Sum SF (p=0.003), Tri SF (p=O.OI), UA Fat (p=0.005). Waist Circ (p=0.009), and WT (p=0.08) than those in Cohort 1 (Table 4.30).
UACirc 25.8 28.2* -2.79 0.01 DBF 68.7 76.8* -1.82 0.08 Hip Circ 87.8 92.9* -1.91 0.09 HT 153 158* -1.98 0.06 Pulse Rate 81.0* 73.0 1.58 0.13 Subscap SF 13.0 16.0* -1.69 O.IO Supra SF 12.7 17.5* -1.62 0.12 UA Mus 42.9 52.3* -3.00 0.007 Waist Circ 75.6 80.2* -1.61 0.12 WT 54.2 61.1* -1.88 0.07 higher value
Table 4.27: Means and p-values (based on t-tests) for differences in biological variables between Cohort 1 and Cohort 2 males from Dureno.
110 i m m 0 0 # 0 0 Cholesterol 117.5 156.8* -1.49 0.15 Hip Circ 92.7 95-7* -1.49 0.15 Pulse Rate 85.2* 76.8 3.29 0.002 Waist Circ 76.6 81.8* -2.00 0.05 higher value
Table 4.28: Means and p-values (based on t-tests) for differences in biological variables between Cohort I and Cohort 2 females from Dureno.
UACirc 26.1 30.3* -4.97 <.00005 BMI 22.4 25.4* -3.45 0.002 Cholesterol 116.8 148.8* -1.52 0.15 Hip Circ 90.0 96.5* -2.79 0.01 HT 152.0 162* -4.36 <.00005 Supra SF 13.9 18.7* -1.92 0.06 Subscap SF 11.1 17.9* -2.63 0.02 UAFat 11.0 13.8* -1.65 0.11 UA Mus 44.0 59.8* -5.27 <00005 Waist Circ 76.1 83.7* -2.76 0.01 WT 52.0 66.5* -4.68 <.00005 higher value
Table 4.29: Means and p-values (based on t-tests) for differences in biological variables between Cohort 1 and Cohort 2 males from Zabalo.
I l l UACirc 27.7* BMI 22.5 25.9* -2.42 G.G2 Hip Circ 87.4 97.2* -3.30 0.004 Supra SF 19.4 28.9* -3.41 0.003 Subscap SF 19.3 31.3* -3.43 0.003 Sum SF 32.6 49.8* -3.45 0.003 TriSF 13.3 18.5* -2.77 0.01 UAFat 15.G 23.1* -3.18 0.005 Waist Circ 73.5 83.6* -2.89 0.009 WT 47.2 54.8* -1.87 0.08
Table 4.30: Means and p-values (based on t-tests) for differences in biological variables between Cohort I and Cohort 2 females from Zabalo.
Comparing Cohorts 2 and 3, Cohort 3 men from Dureno have larger Hip Circ
(p=0.14), Tri SF (p=0.08), UA Fat (p=0.06). Waist Circ (p=0.01), and WHR (p=O.Ol,
Table 4.31); Cohort 3 women have larger UA Circ (p=0.06). Hip Circ (p=0.06). Supra SF
(p=0.G9), Subscap SF (p=0.05). Sum SF (p=0.05), and UA Mus (p=0.02. Table 4.32).
In Zabalo, Cohort 3 men have higher Pulse Rate (p=0.08). Supra SF (p=0.09). Waist
Circ. (p=0.01) and WHR (p=0.003) however. Cohort 2 men are taller (p=0.008. Table
4.33). Cohort 3 women have higher Cholesterol levels (p=0.07), and larger Hip Circ (p=G.G6), Subscap SF (p=G.G6), Sum SF (p=G.G2), Tri SF (p=G.GG7), and UA Fat (p=G.Gl) than Cohort 2 (Table 4.34).
112 ■ ■ ■ h h h h h h m i Hip Circ. 92.9 95.2* -1.51 0.14 T riSF 8.3 10.2* -1.90 0.08 UAFat 11.2 13.5* -1.96 0.06 Waist Circ 80.2 86.6* -2.69 0.01 WHR 86.3 91.0* -2-73 0.01 higher value
Table 4.31 : Means and p-values for differences in biological variables between Cohort 2 and Cohort 3 males from Dureno.
UA Circ 26.6 28.6* -1.97 0.06 Hip Circ 95.7 100.2* -1.91 0.06 Supra SF 30.4 36.8* -1.76 0.09 Subscap SF 30.6 38.5* -2.04 0.05 Sum SF 51.0 61.2* -2.02 0.05 UA Mus 32.5 37.0* -2.51 0.02
Table 4.32: Means and p-values (based on t-tests) for diffeences in biological variables between Cohort 2 and Cohort 3 females from Dmeno.
HT 162* 156 2.92 0.008 Pulse Rate 66.5 73.5* -1.87 0.08 Supra SF 18.7 27.9* -1.91 0.09 Waist Circ 83.7 92.5* -2.74 0.01 WHR 86.7 94.8* -3.33 0.003
Table 4.33: Means and p-values (based on t-tests) for differences in biological variables between Cohort 2 and Cohort 3 males from Zabalo.
113 Cholesterol 155-9 222.5* -2.03 0.07 Hip Circ 97-2 104.1* -2.04 0.06 Subscap SF 31.3 40.8* -1.99 0.06 Sum SF 49.8 66.8* -2.53 0.02 Tri SF 18.5 26.0* -3.16 0.007 UAFat 23.1 33.0* -2.89 0.01 * higher value
Table 4.34: Means and p-values (based on t-tests) for differences in biological variables between Cohort 2 and Cohort 3 females from Zabalo.
Comparing Cohorts 1 and 3, Cohort 3 men from Dureno have larger UA Circ
(p= 0.01), Hip Circ (p=0.01). Supra SF (p=0.02), Subscap SF (p=0.07). Sum SF (p=0.06), UA Fat (p=0.07), UA Mus (p=0.06). Waist Circ (p=0.004), WHR (p=0.02),
WT (p=0.03), and are taller (p=0.02), while Cohort 1 men have higher Pulse Rate
(p=0.03) (Table 4.35). Dureno women of Cohort 3 have larger UA Circ (p=0.006), BMI
(p=0.14), Hip Circ (p=0.002). Supra SF (p=0.003), Subscap SF (p=0.001). Sum SF
(p<.00005), Tri SF (p=0.02), UA Fat (p=0.007), and UA Mus (p=0.07), and higher Cholesterol (p=0.13), and Glucose (p=0.04), while Cohort 1 women have higher Pulse
Rates (p=0.003. Table 4.36). Zabalo men of Cohort 3 show larger UA Circ (p=0.005), BMI (p=0.002). Hip Circ (p=0.02). Supra SF (p= 0.02), Subscap SF
(p=0.02). Sum SF (p= 0.04), UA Mus (p=0.005). Waist Circ (p<.00005), WHR (p<.00005), and WT (p=0.008), and higher Pulse Rate (p= 0.07) (Table 4.37). Zabalo women of Cohort 3 have larger UA Circ (p=0.002), BMI (p=0.003). Hip Circ (p=0.001).
Supra SF (p=0.001), Subscap SF (p<-00005). Sum SF (p<.00005), Tri SF (p<.00005),
UA Fat (p<.00005). Waist Circ (p<.00005), WT (p=0.001) and higher Glucose levels
(p=0.14) than Cohort 1 (Table 4.38).
114 UACirc 25-8 28-3' -2-74 0 - 0 1 Hip Circ 87-8 95.2* -2.73 0.01 HT 153 161* -2-50 0-02 Pulse Rate 80-7* 71-0 2-36 0-03 Supra SF 12-7 21-7* -2-68 0-02 Subscap SF 13-0 17-9* -1-94 0-07 Sum SF 21-7 28-2* -1-99 0-06 UAFat 10-6 13.5* -1-91 0-07 UAMus 42-9 50.5* -2.03 0-06 Waist Circ 75-6 86-6* -3-30 0-004 WHR 86-0 91.0* -2-60 0-02 WT 54-2 63-0* -2.36 0-03 * higher value
Table 4-35: Means and p-values (based on t-tests) for differences in biological variables between Cohort 1 and Cohort 3 males from Dureno. IMH UACirc 25.7 28-6* -3.03 0-006 BMI 24-4 26.1* -1.53 0-14 Cholesterol 117-5 157-4* -1.61 0.13 Glucose 91-8 110-2* -2.16 0.04 Hip Circ 92.7 100.2* -3.59 0.002 Pulse Rate 85-2* 76-7 3.24 0.003 Supra SF 27-3 36.8* -3.35 0.003 Subscap SF 25-7 38.5* -3.96 0.001 Sum SF 43-7 61.2* -4.29 <.00005 Tri SF 18.0 22.6* -2.55 0.02 UAFat 20.8 28.5* -2.94 0.007 UA Mus 32.4 37.0* -1.88 0.07 * higher value
Table 4.36: Means and p-values (based on t-tests) for differences in biological variables between Cohort 1 and Cohort 3 females from Dureno.
115 UACirc 26.2 29.7* -3.08 0.005 BMI 22.4 26.1* -3.43 0.002 Hip Circ 90.0 97.6* -2.47 0-02 Pulse Rate 67.0 73.5* -1.99 0.07 Supra SF 13.9 27.9* -2.98 0.02 Subscap SF 11.1 22.4* -2.94 0.02 Sum SF 19.9 32.1* -2.35 0.04 UAMus 44.0 56.8* -3.15 0.005 Waist Circ 76.2 92.5* -5.21 <00005 WHR 84.7 94.8* -5.10 <.00005 WT 52-0 64.0* -2.92 0.008 higher value
Table 4.37: Means and p-values (based on t-tests) for differences in biological variables between Cohort 1 and Cohort 3 males from 2^baio.
UACirc 24.5 29.4* -3.88 0.002 BMI 22.5 28.4* -3.67 0.003 Glucose 92.8 103.5* -1.74 0.14 Hip Circ 87.4 104.1* -4.37 0.001 Supra SF 19.4 33.4* -4.30 0.001 Subscap SF 19.3 40.8* -5.32 <.00005 Sum SF 32.6 66.8* -5.63 <.00005 TriSF 13.3 26.0* -4.79 <.00005 UAFat 15.0 33.0* -5.25 <.00005 Waist Circ 73.5 89.1* -4.69 <.00005 WT 47.2 61.0* -4.49 0.001 higher value
Table 4.38: Means and p-values (based on t-tests) for differences in biological variables between Cohort 1 and Cohort 3 females from Zabalo.
Within Cohort 1, Dureno men show a higher Pulse Rate (80.7) than do those in
Zabalo (67.0) (p=0.001, Table 4.39). Zabalo men of Cohort 2 have larger UA Circ
(p=0.003), Hip Circ (p=0.02), UA Fat (p=0.09), UA Mus (p=0.007). Waist Circ
116 (p=0.15), W T (p=0.06) and are taller (p=0.09) than those from Dureno, the latter have a higher DBF (p=0.004) and Pulse Rate (p=0.14. Table 4.40). In Zabalo, Cohort 3 men also have larger BMI (p=0.07), UA Mus (p=0.I4), Waist Circ (p=0.09), WHR (p=0.09), and higher Cholesterol (p=0.05), than those form Dureno, who are slightly taller (p=0.13. Table 4.41).
Cohort 1 women from Dureno have larger Arm Fat hidex (p=0.007), BMI
(p=0.14). Hip Circ (p=0.05). Supra SF (p=0.009), Subscap SF (p=0.07). Sum SF
(p=0.02), Tri SF (p=0.008), UA Fat (p=0.02), WT (p=0.09), are taller (p=0.08), and have a higher Pulse Rate (p=0.06) than Zabalo women (Table 4.42). In Cohort 2, Dureno women are taller (p=0.09), whereas those from Zabalo have higher UA Mus (p=0.05. Table 4.43). Higher Cholesterol (p=0.15) and WT (p=0-10) characterize Zabalo women of
Cohort 3 compared to those of Dureno, while the latter have higher DBP (p=0.14. Table 4.44).
;. 1 I - I r- ) 1 t
Pulse Rate 80.7* 67.0 4.20 0.001 * higher value
Table 4.39: friter-village means and p-values (based on t-tests) for differences in biological variables between Cohort 1 males from Dureno and Zabalo.
117 UACirc 28.2 30.3* -3.22 0.003 DBP 76-8* 66.5 3.16 0.004 Hip Circ 92.9 96.5* -2.52 0.02 HT 158 162* -1.77 0.09 Pulse Rate 73.0* 66.5 1.52 0.14 UAFat 11.2 13.8* -1.73 0.09 UAMus 52.3 59.8* -2.92 0.007 Waist Circ 80.2 83.7* -1.49 0.15 WT 61.1 66.5* -1.99 0.06 * higher value
Table 4.40: Inter-village means and p-values (based on t-tests) for differences in biological variables between Cohort 2 males from Dureno and Zabalo.
BMI 24.1 26.1* -1.94 0.07 Cholesterol 108 148* -2.28 0.05 HT 160* 156 1.61 0.13 UAMus 50.5 56.8* -1.55 0.14 Waist Circ 86.6 92.5* -1.81 0.09 WHR 91.0 94.8* -1.79 0.09 * higher value
Table 4.41: Inter-village means and p-values (based on t-tests) for differences in biological variables between Cohort 3 males from Dureno and Zabalo.
118 Arm Fat Index 39.0* 30.8 2.94 0.007 BMI 24.4* 22.5 1.51 0.14 Hip Circ 92.7* 87.4 2.09 0.05 HT 148* 144 1.84 0.08 Pulse Rate 85.2* 78.0 2.04 0.06 Supra SF 27.3* 19.4 2.84 0.009 Subscap SF 25.7* 19.3 1.89 0.07 Sum SF 43.7* 32.6 2.49 0-02 T riSF 18.0* 13.3 2.92 0-008 U A Fat 20.7* 15.0 2.58 0-02 W t 53.6* 47.2 1.79 0-09
Table 4.42: Inter-village means and p-values (based on t-tests) for differences in biological variables between Cohort I females from Dureno and Zabalo.
HT 148* 145 1.75 0.09 UAMus 32.5 38.5* -2.19 0.05
Table 4.43: Inter-village means and p-values (based on t-tests) for differences in biological variables between Cohort 2 females from Dureno and Zabalo.
Cholesterol 157.4 222.5* -1.56 0-15 DBP 71.0* 63.5 1.57 0-14 w r 56.5 61.0* -1.76 0.10 * higher value
Table 4.44: Inter-village means and p-values (based on t-tests) for differences in biological variables between Cohort 3 females from Dureno and Zabalo.
119 CHAPTERS
RESULTS ni:
ASSOCIATIONS OF BIOBEHAVIORAL AND BIOLOGICAL VARIABLES
5.1 Introduction
To complete Research Objective IV, correlation coefficients are used to examine
possible associations of behavioral factors and lifestyle indices with dental health, total
cholesterol, glucose, hemoglobin, systolic and diastolic blood pressure, anthropometric indices (Arm Fat Index, BMI, Sum SF, WHR) and parasite loads. Behavioral Factors
include; Material Lifestyle (measures ownership material goods). Economic Factor
(measures household participation in non-traditional activities). Individual Lifestyle
(measures language use, travel experiences, and occupation), and finally. Traditional
Medical Belief Factor (based on the use of shamans and belief in evil spirits). Lifestyle Indices include; the Acculturation Index, Health Risk Index, Hygiene Index, Activity
Index, Economic Resource Index (sum of all occupational rankings in a household).
Socioeconomic Status (SES, sum of Economic Resource Index and Acculturation Index), and a Lifestyle Incongruity score (measure of lifestyle stress). Furthermore, dietary data is examined for associations with dental health, and anthropometric variables are examined for possible associations with total cholesterol, glucose, hemoglobin, and blood pressure.
1 2 0 5.2 Biobehavioral Factors and Dental Health Behavioral Factors and Lifestyle Indices
Using partial correlations, controlling for age, the Economic Factor (r=-0.24,
p=0.15) and SES (r=-0.32, p=0.06) are negatively correlated with the DMFT Index
among males but not among females (Table 5.1). The Acculturation Index is not significantly correlated with the DMFT Index in either sex; however, the direction of the
nonsignificant correlation is negative for males and positive for females (Table 5.1).
For females the Caries Index is positively correlated with Material Lifestyle
(r=0.46, p=0.02) the Acculturation Index (r=0.37, p=0.05). Lifestyle Incongruity (r=0.29, p=0.14), Socioeconomic Status (r=0.36, p=0.07), and Economic Resource Index
(r=0.45, p=0.02. Table 5.2). Among males, the Economic factor (r=-0.31, p=0.06) and
SES (r=-0.34, p=0.04) are negatively correlated with the Caries Index (Table 5.2). Neither
Individual Lifestyle nor Traditional Medical Beliefs are correlated with the DMFT or Caries Indices in either sex.
Factor 1: Material Lifestyle -0.22(0.19) 0.18(0.38) Factor 2: Economic -0.24(0.15) -0.05 (0.82) Factor 3: Individual Lifestyle 0.05 (0.77) 0.01 (0.95) Factor 4: Traditional Medical Belief -0.11 (0.55) 0.48 (0.28)
Acculturation hidex -0.23 (0.18) 0.23 (0.24) Lifestyle Incongraity -0.18 (0.29) 0.16(0.40) Socioeconomic Status -0.32 (0.06) 0.21 (0.30) Economic Resource Index -0.12 (0.49) 0.25 (0.20) Health Risk Index -0.16 (0.36) 0.14 (0.46)
Table 5.1 : Partial correlation coefficients controlling for age and (p-values) for behavioral factors and lifestyle indices in relation to DMFT hidex by sex.
121 Factor 1: Material Lifes^le -0.10 (0.55) 0.46 (0.02) Factor 2: Economic -0.31 (0.06) -0-16 (0.43) Factor 3: Individual Lifestyîë" -0.01 (0.98) -0.06 (0.77)"" Factor 4: Traditional Medical Belief -0.14(0.42) 0.08 (0.86)
Acculturation Index -0.18 (0.30) 0.37 (0.05) Lifestyle Incongruity -0.13 (0.46) 0.29 (0.14) Socioeconomic Status -0.34 (0.04) 0.36 (0.07) Economic Resource Index -0.06 (0.74) 0.45 (0.02) Health Risk Index 0.07 (0.69) 0.04 (0.84)
Table 5.2: Partial correlation coefficients controlling for age (p-values) for behavioral factors and lifestyle indices in relation to Caries Index by sex.
The Economic factor (r=-0.50, p=0.01). Lifestyle Incongruity (r=-0.31, p=0.14), and SES (r=-0.31, p=0.14) are negatively correlated with the DMFT Index in Zabalo (Table 5.3). No significant correlations are observed between any of the lifestyle indices and DMFT Index in Dureno (Table 5.3).
In Zabalo, the Economic factor (p=-0.45, p=0.03). Traditional Medical Beliefs
(r=-0.33, p=0.13). Acculturation Index (r=-0.32, p=0.12), and SES (r=-0.39, p=0.06) are negatively correlated with the Caries Index (Table 5.4). No significant correlations occur between any lifestyle indice or behavioral factor and the Caries Index in Dureno
(Table 5.4).
122 Factor 1: Material LifesQ^le 0.06 (0.70) -0.24 (0.27) Factor 2: Economic -0.10 (0.55) -0.50 (0.01) Factor 3: Individual Lifestyle 0.04 (0.80) 0.13 (0.55) Factor 4: Traditional Medical Belief 0.01(0.97) -0.26 (0.21)
Acculturation Index 0.14(0.38) -0.28 (0.18) Lifestyle Incongruity 0.17(0.31) -0.31 (0.14) Socioeconomic Status 0.08 (0.63) -0.31 (0.14) Economic Resource Index -0.02 (0.91) 0.03 (0.90) Health Risk Index -0.10 (0.53) -0.20 (0.33)
Table 5.3: Inter-village partial correlation coefficients, controlling for age and sex, and (p-values) for behavior^ factors and lifestyle indices in relation to the DMFT hidex.
Factor 1: Material Lifestyle 0.12 (0.47) -0.24 (0.28) Factor 2: Economic 0.23 (0.16) -0.45 (0.03) Factor 3: Individual Lifestyle -0.16 (0.32) 0.07 (0.75) Factor 4: Traditional Medical Belief 0.08 (0.61) -0.33 (0.13)
Acculturation Index 0.04 (0.79) -0.32 (0.12) Lifestyle Incongruity 0.01 (0.99) -0.29 (0.17) Socioeconomic Status 0.18 (0.29) -0.39 (0.06) Economic Resource Index 0.15 (0.36) -0.12(0.57) Health Risk Index -0.13 (0.43) -0-14 (0.48)
Table 5.4: Inter-village partial correlation coefficients, controlling for age and sex, and (p-values) for behavior^ factors and lifestyle indices in relation to the Caries Index.
Dietarv Data
Dietary data (based on food frequency and twenty-four hour recall questionnaires) documenting the frequency (frequent verses occasional) with which processed/ purchased
123 foods are consumed within households, are examined for correlations with the DMFT and Caries Indices. Among females, frequent consumption of purchased sugar (r=-0.59,
p=0.08) is negatively correlated with the DMFT Index. No significant correlation of the
DMFT Index with any dietary factor is observed for males (Table 5.5). Frequent
consumption of starch (r=0.94, p= <.0(XX)5), sugar (r^.69, p=0.04), and total amount of
purchased foods (r=0.71, p=0.03) are positively correlated with caries in females. No significant correlations between the Caries Index and any dietary factor is observed for males (Table 5.6).
■ H U Frequent household p u rch ases starch -0.03 (0.88) -0.30 (0.43) sugar 0.25 (0.17) -0.33 (0.38) protein/fats -0.01 (0.98) -0.44 (0.24)
Occasional household purchases starch -0.09 (0.62) -0.20 (0.60) sugar -0.20 (0.26) -0.59 (0.08) protein/fats -0.04 (0.81) 0.43 (0.24)
Total purchased foods -0.21 (0.25) -0.46 (0.22)
Table 5.5: Partial correlation coefiîcients controlling for age and (p-values) for dietary factors in relation to DMFT Index between sexes for combined adult population from Dureno and Zabalo.
124 Frequent househol starch 0.01 (0.94) -0.48 (0.02) sugar 0.04 (0.82) 0.06 (0.88) protein/fats 0.11 (0.55) -0.30 (0.43) Occasional household food purchases starch -0.12 (0.50) 0.94 (<.00005) sugar 0.02 (0.89) 0.69 (0.04) protein/fats -0.07 (0.70) 0.30 (0.42)
Total purchased foods 0.04 (0.82) 0.71 (0.03)
Table 5.6: Partial correlation coefRcients, controlling for age and (p-values) for dietary factors in relation to Caries Index by sex for combined adult population from Dureno and Zabalo.
Since dietary factors are based on household food frequencies, these correlations also are determined by village, while controlling for sex. In Dureno, the Caries Index positively correlates with frequently purchased starch (r=0.30, p=0.14) and sugar (r=0.41, p=0.04. Table 5.7), but the DMFT Index negatively correlates with frequently purchased starch (r=-0.35, p=0.07) and sugar (r=-0.46, p=0.02. Table 5.7). Total purchased foods (frequent and occasional household purchases of starch, sugar, and protein/fat), correlates positively with the Caries Index (r=0.49, p=0.01), but negatively with the DMFT Index
(r=-0.48, p=0.01. Table 5.7). In Zabalo, the Caries (r=-0.67, p=0.01) and DMFT
(r=-0.52, p=0.06) Indices both negatively correlate with occasionally purchased starch.
However, the Caries Index positively correlates with frequently purchased starch (r=0.45, p=0.13, Table 5.8). No signifrcant correlations occur between the amount of total purchased foods and either dental indice in Zabalo (Table 5.8).
125 Frequent household &od purchases starch 0.07 (0.74) 0.08 (0.70) sugar -0.08 (0.70) 0.17 (0.40) protein/fats -0.20 (0.32) -0.09 (0.66) Occasional household food purchases starch 0.30 (0.14) -0.35 (0.07) sugar 0.41 (0.04) -0.46 (0.02) protein/fats 0.22 (0.25) -0.04 (0.86)
Total purchased foods 0.49 (0.01) -0.48 (0.01)
Table 5.7: Partial correlation coefficients, controlling for age and sex, and (p-values) for dietary factors in relation to Caries and DMFT Indices for Dureno .
W B Ê t Ê M Frequent household food purchases starch -0.67 (0.01) -0.52 (0.06) sugar 0.20(0.51) 0.22 (0.46) protein/fats 0.04 (0.88) -0.16(0.59) Occasional household food purchases starch 0.45(0.13) 0.40(0.18) sugar -0.04 (0.89) -0.20(0.51) protein/fats -0.01 (0.99) 0.22 (0.46) Total purchased foods -0.04 (0.90) 0.07 (0.82)
Table 5.8: Partial correlation coefficients, controlling for age and sex, and (p-values) for dietary factors in relation to Caries and DMFT Indices for ^balo.
5.3 Biobehavioral Factors and Physiological Variables. Next, correlations of total cholesterol, glucose, hemoglobin, pulse rate, SBP, and
DBP with each of the four behavioral factors and all lifestyle indices are examined by sex
126 and village. Correlations also are examined between these six physiological variables and several anthropometric measures: Body Mass bidex (BMI), Waist-Hip Ratio (WHR) and
Supra-iliac skinfold (Supra SF), and Sum SF and Arm Fat Index. Last, correlations of
Pulse Rate with Diastolic Blood Pressure (DBP) and Systolic Blood Pressure (SBP) are examined.
5.3.1 Total Cholesterol Behavioral Factors and Lifestyle Indices
Material Lifestyle positively correlates with total cholesterol levels in men (r=0.59,
p<.00005), a correlation that is not significant for women (r=0.01, p=0.99. Table 5.9). Other behavioral factors did not correlate significantly with total cholesterol in either sex
(Table 5.9). The Acculturation Index (r=0.50, p=0.003). Lifestyle Incongruity (r=0.43,
p=0.01). Socioeconomic Status (r=0.43, p=O.Ol), Economic Resource Index (r=0.52,
p=0.001), and the Health Risk Index (r=0.29, p=0.09) all positively correlate with total cholesterol levels in men (Table 5.9). For females, a positive correlation is observed
between total cholesterol and the Health Risk Index (r=0.44, p=0.009), and a negative
correlation is observed with the Activity Index (r=-0.31, p=0.08. Table 5.9). Total
Purchased Food does not correlate highly with total cholesterol in either males (r=0.01, p=0.95) or females (r=-0.23, p=0.52. Table 5.9).
In Dureno, Material Lifestyle (r=0.50, p=0.02). Lifestyle Incongruity (r=0.31,
p=0.08), and Health Risk Index (r=0.38, p=0.03) positively correlate with total cholesterol (Table 5.10). Among Zabalo residents, positive correlations are seen with the Economic
Factor (r=0.50, p=0.11) and Material Lifestyle (r=0.59, p=0.05. Table 5.10). No correlations are seen between total cholesterol and either the Health Risk Index or Activity
Index in either village (Table 5.10).
127 Factor 1: Material Lifestyle 0.59 «.00005) 0.01 (0.99) Factor 2: Economic -0.13 (0.49) -0.25 (0.18) Factor 3: Individual Lifestyle 0.18 (0.30) 0.13 (0.46) Factor 4: Traditional Medical Belief -0.04(0.80) 0.10 (0.59)
Acculturation Index 0.50 (0.003) 0.03 (0.86) Lifestyle Incongruity 0.43 (0.01) 0.15(0.43) Socioeconomic Status 0.43 (0.01) -0.11 (0.55) Economic Resource Index 0.52 (0.001) -0.08 (0.64) Health Risk Index 0.29 (0.09) 0.44 (0.009) Activity Index -0.23 (0.20) -0.31 (0.08) Total Purchased Food* 0.01 (0.95) -0.23 (0.52) *(MaIe N=34; Female N=l 1)
Table 5.9: Correlation coefficients and (p-vaiues) by sex for behavioral factors and lifestyle indices in relation to total cholesterol for combined adult population from Dureno and Zabalo. WÊÊÊÊÊÊÊÊÊÊÊÊÊÊÊÊÊÊM Factor 1: Material Lifestyle 0.50 (0.02) 0.59 (0.05) Factor 2: Economic 0.07 (0.77) 0.50(0.11) Factor 3: Individual Lifestyle 0.29 (0.21) 0.33 (0.32) Factor 4: Traditional Medical Belief 0.09 (0.70) -0.04 (0.92)
Acculturation Index 0.23 (0.20) 0.31 (0.16) Lifestyle Incongruity 0.31 (0.08) 0.24(0.28) Socioeconomic Status 0.04 (0.84) 0.28 (0.21) Economic Resource Index -0.08 (0.66) 0.28 (0.21) Health Risk Index 0.38 (0.03) 0-01 (0.96) Activity Index -0.06 (0.70) 0.09 (0.65) Total Purchased Food* -0.01 (0.97) -0.01 (0.97) *(Dureno N=29; Zabalo N=16)
Table 5.10: Inter-village partial correlation coefficients, controlling for age and sex, and (p-values) for behavioral factors and lifestyle indices in relation to total cholesterol. 128 Anthropometric Variables
When controlling for age, positive correlations are observed between total cholesterol and Supra SF (r= 0.27, p=O.IO) and Arm Fat Index (r=0.26, p=0.I2) among men. However, no signiricant correlations are observed among women (Table 5. II).
Inter-village comparisons show that Sum SF (r=0.36, p=0.03), and Arm Fat Index
(r=0.29, p=0.09) positively correlate with total cholesterol in Zabalo, while no significant correlations are observed in Dureno (Table 5.12).
BMl 0.22(0.18) 0.07 (0.65) WHR -0.12(0.47) 0.20 (0.21) Supra SF 0.27(0.10) 0.05 (0.75) Sum SF 0.36 (0.03) 0.04 (0.78) Arm Fat Index 0.26 (0.12) 0.13 (0.42)
Table 5.11: Partial correlation coefficients, controlling for age, and (p-values) by sex for anthropometric measures in relation to the total cholesterol for combined adult population from Dureno and Zabalo. — BMl 0.02 (0.91) 0.13 (0.44) WHR 0.16 (0.29) 0.01 (0.98) Supra SF -0.07 (0.64) 0.24(0.17) Sum SF 0.01 (0.95) 0.36 (0.03) Arm Fat Index 0.14(0.37) 0.29 (0.09)
Table 5.12: Partial correlation coefficients, controlling for age and sex, and (p-values) by village for anthropometric measures in relation to 6 e totd cholesterol.
129 5.3.2 Glucose Behavioral Factors and Lifestyle Indices
No significant correlations of behavioral factors or lifestyle indices with glucose are
observed between sexes (Table 5.13). Although not statistically significant, there is a negative correlation between the Activity Index and glucose levels in both sexes (Table
5.13). Negative correlations occur between glucose and the Economic Resource Index
(r=-0.27, p=0.08) among Dureno residents, while in Zabalo, Individual Lifestyle is negatively correlated (r=-0.45, p=0.14. Table 5.14).
Factor 1: Material Lifestyle -0.01 (0.94) -0.08 (0.66) Factor 2: Economic 0.03 (0.87) -0.06 (0.76) Factor 3: Individual Lifestyle -O.ll (0.46) -0.25 (0.16) Factor 4: Traditional Medical Belief -0.04 (0.80) 0.22 (0.22) BHIHHHHHiHHHI Acculturation Index -0.08 (0.62) -0.14(0.42) Lifestyle Incongraity -0.09 (0.58) -0.06 (0.75) Socioeconomic Status -0.04 (0.80) -0.16 (0.39) Economic Resource Index -0.08 (0.61) -0.21 (0.20) Health Risk Index -0.01 (0.96) 0.03 (0.84) Activity Index -0.08 (0.60) -0.18 (0.28) Total Purchased Food 0.03 (0.85) -0.27 (0.43) *(MaIe N=34; Female N=11)
Table 5.13: Correlation coefficients and (p-values) by sex for behavioral factors and lifestyle indices in relation to blood glucose levels for combined adult population from Dureno and Zabalo.
130 Factor 1: Material Lifestyle 0.14 (0.50) -0.12(0.70) Factor 2: Economic -0.08 (0.72) -0.01 (0.99) Factor 3: Individual Lifestyle 0.09 (0.67) -0.45 (0.14) Factor 4: Traditional Medical Belief -0.06 (0.78) -0.29 (0.35)
Acculturation Index -0.15 (0.34) 0.01 (0.96) Lifestyle Incongruity -0.06 (0.70) 0.02 (0.94) Socioeconomic Status -0.18 (0.26) 0.06 (0.78) Economic Resource Index -0.27 (0.08) -0.07 (0.74) Health Risk Index -0.06 (0.70) -0.12 (0.57) Activity Index -0.05 (0.76) -0.23 (0.26) Total Purchased Food -0.18 (0.39) 0.01 (0.99) *(Dureno N=29; Zabalo N=16)
Table 5.14: Inter-village partial correlation coefficients, controlling for age and sex, and (p-values) for behavioral factors and lifestyle indices in relation to blood glucose levels.
Anthropometric Variables
No significant correlations between glucose and any of the anthropometric variables are observed between sexes when controlling for age, or between villages when controlling for sex and age (Table 5.15 and 5.16).
WÈÊÊÊÊÊ BMl -0.17 (0.30) 0.12(0.44) WHR -0.12 (0.47) 0.19 (0.21) Supra SF 0.13 (0.43) 0.12 (0.44) Sum SF 0.06 (0.73) 0.05 (0.77) Arm Fat Index 0.21 (0.20) -0.01 (0.95)
Table 5.15: Partial correlation coefficients, controlling for age, and (p-values) by sex for anthropometric measures in relation to blood glucose.
131 BMl -0.07 (0.64) 0.15 (0.37) WHR -0.01 (0.94) 0.21 (0.21) Supra SF 0.17 (0.23) 0.13 (0.44) Sum SF 0.12 (0.42) 0.07 (0.67) Arm Fat Index 0.20 (0.16) -0.11 (0.52)
Table 5.16: Partial correlation coefficients, controlling for age and sex, and (p-values) by village for anthropometric measures in relation to blood glucose.
5.3.3 Hemoglobin Behavioral Factors and Lifestvie Indices
When controlling for age. Material Lifestyle is positively correlated with
hemoglobin levels in both men (r=0.42, p=0.01) and women (r=0.39, p=0.04. Table
5.17). Individual Lifestyle factor positively correlates with hemoglobin in men (r=0.40,
p=0.02) but not women (Table 5.17). Most of the lifestyle indices correlate positively with
hemoglobin in both sexes: Acculturation Index (men/r=0.40, p=0.01; women/iM).40,
p=0.03). Lifestyle Incongruity (men/r=0.32, p=0.05; women/0.35, p=0.06).
Socioeconomic Status (men/r=0.45, p=0.005; women/r=0.48, p=0.007), and the Economic resource Index (men/r=0.34, p=0.04; women/r=0.33, p=0.08. Table 5.17).
Hemoglobin levels are negatively correlated with # of diagnosed illnesses (r=-.31, p=.05) in men but not in women (Table 5.17). Significant correlations are not observed between
hemoglobin levels and the Health Risk Index, Total Purchased Foods, or # Self-reported
illnesses, regardless of sex (Table 5.17).
Controlling for age and sex, positive correlations are seen between hemoglobin
and Material Lifestyle (r=0.63, p=0.001), hidividual Lifestyle (r=0.47, p=0.02), and
Traditional Medical Beliefs (r=0.39, p=0.06) in Dureno (Table 5.18). Only the Economic factor positively correlates with hemoglobin in Zabalo (r=0.32, p=0.14. Table 5.18). The
132 Acculturation Index (r=0.47, p=0.002). Lifestyle Incongruity (r=0.36, p=0.02).
Socioeconomic Status (r=0.55, p<.00005), and Economie Resource Index (r=0.39, p=0.01) ail positively correlate with hemoglobin in Dureno (Table 5.18), while only SES
positively correlates in Zabalo (r^.31, p=0.13. Table 5.18). No significant correlations
are observed between hemoglobin levels and the Health Risk Index, # of Self-reported
illnesses, or # of diagnosed illnesses in either village (Table 5.18).
i m ■ H i l Factor 1: Material Lifestyle 0.42 (0.01) 0.39 (0.04) Factor 2: Economic 0.02 (0.89) 0.16 (0.40) Factor 3: Individual Lifestyle 0.40 (0.02) -0.04 (0.83) Factor 4: Traditional Medical Belief 0.17(0.31) -0.03 (0.87) muHHBUMMiift Acculturation Index 0.40 (0.01) 0.40 (0.03) Lifestyle Incongruity 0.32 (0.05) 0.35 (0.06) Socioeconomic Status 0.45 (0.005) 0.48 (0.007) Economic Resource Index 0.34 (0.04) 0.33 (0.08) Health Risk Index 0.21 (0.21) 0.25 (0.18) # Self-reported aliments 0.05 (0.75) 0.21 (0.23) # Diagnosed illnesses -0.31 (0.05) 0.14(0.42) Total Purchased Food* 0.08 (0.66) 0.13 (0.71) *(MaleN=34; Female N = ll)
Table 5.17: Partial correlation coefficients (p-values) controlling for age, between sexes for behavioral factors and lifestyle indices in relation to hemoglobin levels for combined adult population from Dureno and Zabalo.
133 Factor 1: Material Lifestyle 0.63 (0.001) 0.25 (0.25) Factor 2: Economic 0.24 (0.26) 0.32 (0.14) Factor 3: Individual Lifestyle ______0.47 (0.02) 0.17 (0.44) Factor 4: Traditional Medical Belief 0.39 (0.06) 0.02 (0.94)
Acculturation Index 0.47 (0.002) 0.28 (0.18) Lifestyle Incongruity 0.36 (0.02) 0.26 (0.21) Socioeconomic Status 0.55 (<.00005) 0.31 (0.13) Economic Resource Index 0.39 (0.01) 0.14(0.51) Health Risk Index 0.10 (0.53) 0.20 (0.33) # Self-reported aliments 0.04 (0.80) 0.01 (0.95) # Diagnosed illnesses -0.02 (0.90) -0.21 (0.30) Total Purchased Food* 0.09 (0.66) 0.24(0.41) *(Dureno N=29; Zabalo N=16)
Table 5.18: Inter-village partial correlation coefficients (p-values) controlling for age and sex, for behavioral factors and lifestyle indices in relation to hemoglobin levels.
5.3.4 Systolic and Diastolic Blood Pressure Behavioral Factors and Lifestvie Indices
Traditional Medical Beliefs correlates positively with SB? in both men (r=0.27,
p=0.08) and women (r=0.36, p=0.04). For men the Economic Factor (r=0.26, p=0.12)
also is correlated with SBP (Table 5.19). The only significant correlation with lifestyle indices is SBP with Total Purchased Food in females (r^-0.54, p=0.09. Table 5.19). In
Dureno, positive correlations are seen between SBP and Material Lifestyle (r=0.27,
p=0.10). Traditional Medical Beliefs (r=0.25, p=0.11). Acculturation Index (r=0.32,
p=0.11), and the Economic Resource Index (r=0.23, p=0.12. Table 5.20). For Zabalo, a
positive correlation was observed between SBP and the Economic Factor (r=0.35, p=0.10.
Table 5.20).
134 Factor 1: Material Lifestyle 0.12 (0,46) -0.12 (0.51) Factor 2: Economic 0.26 (0.12) 0.02 (0.90) Factor 3: Individual Lifestyle 0.02(0.92) -0.04 (0.83) Factor 4: Traditional Medical Belief 0.27 (0.08) 0.36 (0.04)
Acculturation Index -0.01 (0.95) -0.09 (0.62) Lifestyle Incongruity -0.01 (0.93) -0.02 (0.90) Socioeconomic Status 0.01 (0.98) -0.13 (0.48) Economic Resource bidex -0.04(0.78) -0.17 (0.28) Health Risk Index -0.08 (0.62) 0.12 (0.50) Total Purchased Food 0.17 (0.32) -0.54 (0.09) (Male N=34; Female N=ll)
Table 5.19: Correlation coefficients (p-values) between adult males and females for behavioral factors and lifestyle variables in relation systolic blood pressure (SBP) for combined adult population from Dureno and Zabalo.
Factor I: Material Lifestyle 0.27 (0.10) -0.27 (0.22) Factor 2: Economic 0.04 (0.80) 0.35 (0-10) Factor 3: Individual Lifestyle 0.22 (0.18) -0.14 (0.53) Factor 4: Traditional Medical Belief ihmmu0.25(0.11) mmmm0.03 (0.88) Acculturation Index 0.32(0.11) -0.18 (0.52) Lifestyle Incongruity 0.29 (0.17) -0.11 (0.71) Socioeconomic Status 0.28 (0.17) -0.21 (0.45) Economic Resource Index 0.23 (0.12) -0.15(0.45) Health Risk Index 0.21 (0.16) 0.10 (0.64) Total Purchased Food -0.17 (0.42) 0.28 (0.32) (Dureno N=29; Zabalo N=16)
Table 5.20: Inter-village correlation coefficients, controlling for age and sex, and (p-values) for behavioral factors and lifestyle variables in relation to systolic blood pressure (SBP).
135 The Economic factor (r=0.29, p=0.08) and Traditional Medical Beliefs (r=0.24, p=0.04) positively correlate with DBF in men (Table 5.21). No significant correlations are observed between DBF and behavioral factors in women, or of any lifestyle index with DBF in either sex (Table 5.21).
Material Lifestyle (r=0.39, p=0.01). Acculturation Index (r=0.32, p=0.12), SES
(r=0.36, p=0.08), and the Economic Resource Index (r=0.23, p=0.12) all positively correlate with DBF in Dureno (Table 5.22). No significant correlations are observed between any of the behavioral factors or lifestyle indices and DBF in Zabalo (Table 5.22).
n n 0 0 0 Factor 1: Material Lifestyle 0.02 (0.93) 0.05 (0.77) Factor 2: Economic 0.29 (0.08) 0.06 (0.74) Factor 3: Individual Lifestyle -0.18 (0.27) 0.01 (0.99) Factor 4: Traditional Medical Belief 0.32 (0.04) 0.06 (0.73) 000000B Acculturation Index 0.01 (0.96) 0.09 (0.62) Lifestyle Incongruity 0.01 (0.95) 0.11 (0.53) Socioeconomic Status 0.08 (0.64) 0.04 (0.82) Economic Resource Index 0.11 (0.49) -0.07 (0.68) Health Risk Index -0.07 (0.65) 0.13 (0.45) Total Furchased Food 0.24(0.17) -0.04 (0.91) (Male N=34; Female N= 11)
Table 5.21: Correlation coefficients (p-values) between adult males and females for behavioral factors and lifestyle variables in relation to diastolic blood pressure (DBF) for combined adult population from Dureno and Zabalo.
136 Factor 1: Material Lifestyle 0.39 (0.01) 0.02 (0.93) Factor 2: Economic 0.10 (0.53) 0.19 (0.38) Factor 3: Individual Lifesp^Ie -0.04(0.80) 0.06 (0.80) Factor 4: Traditional Medical Belief 0.18(0.25) -0.23 (0.28)
Acculturation Index 0.32 (0.12) 0.15 (0.62) Lifestyle Incongmi^ 0.29 (0.16) 0.18 (0.54) Socioeconomic Status 0.36 (0.08) 0.08 (0.79) Economic Resource Index 0.23 (0.12) 0.15 (0.45) Health Risk Index 0.21 (0.16) 0.10 (0.64) Total Purchased Food 0.13 (0.52) 0.21 (0.47) (Dureno N=29; Zabalo N=16) ______
Table 5.22: Inter-village correlation coefficients, controlling for age and sex, and (p-values) for behavioral factors and lifestyle variables in relation to diastolic blood pressure (DBF).
Cohort Comparisons
Since studies have found a cohort effect with regard to blood pressure and lifestyle incongruity among Samoans (Bindon et al., 1991), correlation coefficients were calculated for DBF and SBP with lifestyle incongruity between Cofan cohorts. No significant correlations were found, regardless of sex for either DBF or SBP and lifestyle incongruity.
However, inter-village comparisons (controlling for sex) show significant correlations of
Lifestyle Incongruity with DBP (r=0.58, p=0.006) and SBP (r=0.64, p=0.002) among Dureno individuals aged 21-40 years old. Significant correlations are not observed between other age cohorts in Dureno, or any of the age cohorts from Zabalo.
137 Anthropometric and Biological Variables
SBP positively correlates with EMI (r=0.27, p=0.03), WHR (r=0.23, p=0.06).
Supra SF (r=0.22, p=0.06). Sum SF (r=0.22, p=0.08). Arm Fat Index (r=0.20, p=O.IO), and Hemoglobin (r=0.47, p=0.04) among men (Table 5.23); while, BMl (p=0.51, p=<.00005). Supra SF (r=0.40, p=0.001). Sum SF (r=0.50, p<.00005). Arm Fat Index
(r=0.39, p=0.001) and Pulse Rate (r=0.19, p=0.12) correlate positively with SBP in women (Table 5.23). SBP correlates with BMl (r=0.45, p=0.004), WHR (r=0.38, p=0.02). Supra SF (r=0.52, p=O.OOI),Sum SF (r=0.3l, p=0.07) and Hemoglobin
(r^O.52, p=0.I2) in Zabalo (Table 5.24). In Dureno, no significant correlations are observed between SBP and anthropometric measures, however Hemoglobin is positively correlated with SBP (r=0.36, p=0.04. Table 5.24)).
BMl 0.27 (0.03) 0.51 (<.00005) WHR 0.23 (0.06) 0.08 (0.49) Supra SF 0.22 (0.06) 0.40 (0.001) Sum SF 0.22 (0.08) 0.50 (<.00005) Arm Fat Index 0.20(0.10) 0.39 (0.001) Pulse Rate -0.04(0.71) 0.19 (0-12) Hemoglobin 0.47 (0.04) 0.20(0.31) Total Parasite Load -0.30 (0.20) -0.04 (0.84)
Table 5.23: Correlation coefficients (p-values), by sex, for anthropometric measures in relation to systolic blood pressure for combined adult population from Dureno and Zabalo.
138 BMl 0.10 (0.50) 0.45 (0.004) WHR -0.09 (0.54) 0.38 (0.02) Supra SF -0.06 (0-70) 0.52 (0.001) Sum SF 0.07 (0.63) 0.31 (0.07) Arm Fat Index 0.15 (0.29) 0.02 (0.91) Pulse Rate -0.06 (0.68) 0.14 (0.41) Hemoglobin 0.36 (0.04) 0.52 (0.12) Total Parasite Load -0.16 (0.37) -0.35 (0.32)
Table 5.24: Partial correlation coefficients, controlling for age and sex, and (p-values) for anthropometric measures in relation to systolic blood pressure in Dureno and Zabalo.
DBP positively correlates with BMl (r=0.26, p=0.12). Supra SF (r=0.25, p=0.04). Sum SF (r=0.32, p=0.007). Arm Fat Index (r=0.32, p=0.007). Pulse Rate
(r=0.21, p=0.08), and Hemoglobin (r=0.28, p=0.15) among women, while no significant correlations are observed for men (Table 5.25). DBP correlates with BMl (r=0.26, p=0.12), WHR (r=0.31, p=0.06), and Hemoglobin (r=0.48, p=0.15) in Zabalo, while no significant correlations are observed in Dureno (Table 5.26).
0 0 BMl 0.07 (0.56) 0.44 (<.00005) WHR 0.16 (0.19) -0.01 (0.96) Supra SF 0.10 (0.43) 0.25 (0.04) Sum SF 0.02 (0.82) 0.32 (0.007) Arm Fat Index 0.03 (0.78) 0.32 (0.007) Pulse Rate 0.11 (0.36) 0.21 (0.08) Hemoglobin 0.02 (0.94) 0.28 (0.15) Total Parasite Load -0.14 (0.56) 0.09 (0.67)
Table 5.25: Correlation coefficients and (p-values), by sex, for anthropometric measures in relation to diastolic blood pressure (DBP) for combined adult population from Dureno and Zabalo. 139 BMl 0.10(0.50) 0.26 (0.12) WHR -0.08 (0.54) 0.31 (0.06) Supra SF -0.05 (0.70) 0.14(0.39) Sum SF 0.07 (0.62) 0.10 (0.58) Arm Fat Index 0.15 (0.29) -0.07 (0.66) Pulse Rate -0.06 (0.68) 0.14(0.41) Hemoglobin 0.06 (0.72) 0.48(0.15) Total Parasite Load -0.03 (0.87) -0.18 (0.61)
Table 5.26: Partial correlation coefficients, controlling for sex and age, and (p-values) for anthropometric measures in relation to diastolic blood pressure (DBP) in Dureno and Zabalo.
5.4 Biobehavioral Factors and Anthropometric Measures Behavioral Factors and Lifestvie Indices
Arm Fat Index
Traditional Medical Beliefs positively correlate with Arm Fat Index in both men (r=0.26, p=0.10) and women (r=0.26, p=0.14. Table 5.27); although no significant correlations of any Lifestyle Indice with the Arm Fat Index are observed among either sex
(Table 5.27). No significant correlations were observed between the Arm Fat hidex and the Activity Index, Health Risk Index, or Total Purchased Food for either sex. In Dureno, the Economic Factor (r=0.36, p=0.09), SES (r=0.29, p=0.06), Economic Resource Index
(r=0.24, p=0.13), and Total Purchased Foods (r=0.36, p=0.09) positively correlate with
Arm Fat Index (Table 5.28). Among Zabalo residents, the Health Risk Index (r=-0.31, p=0.14) correlates negatively with the Arm Fat Index (Table 5.28). No significant correlations were observed between the Arm Fat Index and the Activity Index for either village.
140 Factor 1: Material Lifestyle -0.01 (0.96) -0.10 (0.58) Factor 2: Economic ______-0.01 ( 1.0) 0.02 (0.92) Factor 3: Individual LifesQfl^ -0.12 (0.45) -0.20 (0.27) Factor 4: Traditional Medical Belief 0.26(0.10) 0.26 (0.14)
Acculturation Index -0.01 (0.98) -0.10 (0.59) Lifestyle Incongruity -0.04 (0.82) -0.10 (0.57) Socioeconomic Status 0.02 (0.89) -0.05 (0.78) Economic Resource Index 0.11 (0.48) -0.08 (0.65) Health Risk Index -0.02 (0.92) 0.11 (0.53) Activity Index 0.07 (0.66) -0.15 (0.39) Total Purchased Food* 0.17 (0.34) 0.25 (0.46) "(Male N=34; Female N=11)
Table 5.27: Partial correlation coefficients, controlling for age, and (p-values) between sexes for behavioral factors and lifestyle indices in relation to Arm Fat Index for combined adult population from Dureno and Zabalo.
Factor 1: Material Lifestyle 0.17 (0.43) 0.16 (0.62) Factor 2: Economic 0.36 (0.09) -0.04 (0.90) Factor 3: Individual Lifestyle 0.16 (0.44) 0.34 (0.28) Factor 4: Traditional Medical Belief 0.37 (0.07) 0.32(0.31)
Acculturation Index 0.11 (0.49) _ -03010.65) Lifestyle Incongruity 0.03 (0.84) -0.05 (0.83) Socioeconomic Status 0.29 (0.06) -0.22 (0.30) Economic Resource Index 0.24 (0.13) -0.14(0.52) Health Risk Index 0.01 (0.98) -0.31 (0.14) Activity Index -0.18 (0.26) 0.14(0.46) Total Purchased Food* 0.36 (0.09) 0.38 (0.22) *(Dureno N=29; Zabalo N=16)
Table 5.28: Inter-village partial correlation coefficients, controlling for age and sex, and (p-values) for behavioral factors and lifestyle indices in relation to Arm Fat Index.
141 Body Mass Index rBMD
Both the Acculturation (r=0.26, p=0.12) and Economic Resource (r=0.24, p=0.13) Lidices are positively correlated with BMl for men. Among women, the Economic factor
(r=0.30, p=0.10) and Health Eüsk hidex (r=0.35, p=0.04) are positively correlated with
BMl, while the Activity hidex (r=-0,31, p=0.08) is negatively correlated (Table 5.29). In
Dureno, Material Lifestyle (r=0.33, p=0.13). Individual Lifestyle (r=0.40, p=0.06).
Traditional Medical Beliefs (r=0.52, p=0.01). Acculturation Index (r=0.33, p=0.04). Lifestyle Incongruity (r=0.25, p=0.11), SES (r=0.33, p=0.04), and the Economic
Resource Index (r=0.30, p=0.06) all positively correlate with BMl (Table 5.30). No significant correlations between any of the behavioral factors or lifestyle indices and BMl are observed in Zabalo (Table 5.30).
Factor 1: Material Lifestyle 0.22 (0.18) 0.14(0.43) Factor 2: Economic -0.20 (0.24) 0.30 (0.10) Factor 3: Individual Lifestyle 0.23 (0.16) -0.13 (0.48) Factor 4: Traditional Medical Belief 0.22(0.17) 0.24(0.17)
Acculturation Index 0.26 (0.12) 0.18 (0.32) Lifestyle Incongruity 0.23 (0.17) 0.17 (0.34) Socioeconomic Status 0.18 (0.28) 0.20 (0.26) Economic Resource Index 0.24(0.13) 0.13 (0.43) Health Risk Index -0.03 (0.85) 0.35 (0.04) Activity Index 0.07 (0.66) -0.31 (0.08) Total Purchased Food* -0.10 (0.57) 0.10(0.78) *(MaIe N=34: Female N=11)
Table 5.29: Partial correlation coefficients, controlling for age, and (p-values) between sexes for behavioral factors and lifestyle indices in relation to Body Mass Index (BMl) for combined adult population from Dureno and Zabalo.
142 Factor 1: Material Lifestyle 0.33 (0.13) 0.02 (0.95) Factor 2: Economic ______0.23 (0.28) 0.19 (0.56) Factor 3: Individual Lifestyle 0.40(0.05^ 0.12 (0.70) Factor 4: Traditional Medical Belief 0.52(0.01) -0.09 (0.77)
Acculturation Index 0.33 (0.04) 0.03 (0.89) Lifestyle Incongruity 0.25(0.11) 0.04 (0.85) Socioeconomic Status 0.33 (0.04) 0.09 (0.67) Economic Resource Index 0.30 (0.06) -0.06 (0-79) Health Risk Index -0.07 (0.65) 0.02 (0.91) Activity Index 0.03 (0.87) 0.04 (0.85) Total Purchased Food* 0.07 (0.75) 0.01 (0.98) •'(Dureno N=29; Zabalo N=16)
Table 5.30: Inter-village partial correlation coefficients, controlling for age and sex, and (p-values) for behavioral factors and lifestyle indices in relation to Body Mass Index (BMl).
Sum of Skinfolds (Sum SF>
Traditional Medical Beliefs (r=0.30, p=0.06). Economic Resource Index (r=0.32, p=0.04) and, to a lesser degree, the Acculturation Index (r=0.26, p=0.12) positively correlate with Sum SF among men (Table 5.31). Among women, positive correlations occur with Traditional Medical Beliefs (r=0.44, p=0.01) and Health Risk Index (r=0.33, p=0.05), but Individual Lifestyle (r=-0.33, p=0.06) negatively correlates with Sum SF
(Table 5.31). No significant correlations were observed between Sum SF and the Activity
Index for either sex. In Dureno, Individual Lifestyle (r=0.39, p=0.06). Traditional Medical Beliefs (r=0.35, p=0.09). Acculturation Index (r=0.24, p=0.12), and SES
(r=0.33, p=0.03) positively correlate with Sum SF (Table 5.32). No significant correlations were observed between Sum SF and the Activity Index or Health Index for
143 Dureno. Furthermore, no significant correlations between Sum SF and any of the behavioral factors or lifestyle indices are observed in Zabalo (Table 5.32).
Factor 1: Material LifesQ^le 0.20 (0.23) 0.01 (0.98) Factor 2: Economic -0.10 (0.56) 0.08 (0.67) Factor 3: Individual Lifestyle 0.15 (0.33) -0.33 (0.06) Factor 4: Traditional Medical Belief 0.30 (0.06) 0.44(0.01)
Acculturation Index 0.26 (0.12) 0.02 (0.89) Lifestyle Incongruity 0.20 (0.22) 0.05 (0.76) Socioeconomic Status 0.22(0.18) 0.05 (0.77) Economic Resource Index 0.32 (0.04) -0.02 (0.92) Health Risk Index -0.01 (0.97) 0.33 (0.05) Activity Index 0.12 (0.48) -0.25(0.16) Total iWchased Food* 0.09 (0.60) -0.28 (0.40) *(MaIe N=34; Female N=l 1)
Table 5.31: Partial correlation coefficients, controlling for age, and (p-values) between sexes for behavioral factors and lifestyle indices in relation to Summed Skinfolds (Sum SF) for combined adult population firom Dureno and Zabalo.
144 Factor 1: Material Lifestyle 0.14 (0.51) 0.33 (0.29) Factor 2: Economic 0.26 (0.21) 0.20 (0.54) Factor 3: Individual Lifestyle 0.39 (0.06) 0.43(0.16) Factor 4: Traditional Medical Belief 0.35 (0.09) 0.30 (0.34)
Acculturation Index 0.24(0.12) 0.25 (0.24) Lifestyle Incongruity 0.18 (0.26) 0.28 (0.19) Socioeconomic Status 0.33 (0.03) 0.19 (0.36) Economic Resource Index 0.22(0.17) 0.08 (0.69) Health Risk Index 0.05 (0.76) -0.23 (0.27) Activity Index -0.05 (0.76) 0.19 (0.35) Total Purchased Food* 0.05 (0.83) 0.26 (0.41) *(DuTGno N=29; Zabalo N=16)
Table 5.32: Inter-village partial correlation coefficients, controlling for age and sex, and (p-values) for behavioral factors and lifestyle indices in relation to Summed Skinfolds.
Waist Hip Ratio rWHRl
The Economic factor (r=-0.29, p=0.07) negatively correlates with WHR in men,
while Traditional Medical Beliefs (r=0.34, p=0.03) are correlated positively (Table 5.33).
In women, Individual Lifestyle (n=-0.41, p=0.02) and Total Purchased Food (r=-0.50,
p=0.14) negatively correlate with WHR (Table 5.33). No significant correlations were observed between the WHR and the Activity Index or Health Index between sexes.
In Dureno, Material Lifestyle (r=0.34, p=0.11). Individual Lifestyle (r=0.39, p=0.06).
Traditional Medical Beliefs (r=0.46, p=0.03), and SES (r=0.33, p=0.04) are positively
correlated with WHR (Table 5.34). In Zabalo, Material Lifestyle (r=-0.63, p=0.03), the
Economic Factor (r=-0.63, p=0.03). Acculturation Index (r=-0.50, p=0.01). Lifestyle
Incongruity (r=-0.45, p=0.03), SES (r=-0.47, p=0.02), and Economic Resource hidex
(p=-0.42, p=0.04) are negatively correlate with WHR (Table 5.34). No significant
145 correlations were observed between the WHR and the Activity Index or Health Risk Index for either village.
Factor 1: Material Lifestyle -0.01 (0.98) 0.01 ( 1.0) Factor 2: Economic -0.29 (0.07) -0.16 (0.40) Factor 3: Individual Lifestyle -0.01 (0.93) -0.41 (0.02) Factor 4: Traditional Medical Belief 0.34(0.03) 0.22 (0 .22)
Acculturation Index -0.04 (0.82) -0.19 (0.30) Lifestyle Incongruity -0.07 (0.66) -0.14(0.44) Socioeconomic Status -0.08 (0.64) -0.12 (0.51) Economic Resource Index 0.10(0.52) 0.16 (0.35) Health Risk Index 0.17 (0.29) 0.03 (0.85) Activity Index 0.10 (0.52) -0.08 (0.64) Total Purchased Food* 0.02 (0.91) -0.50 (0.14) *(Male N=34 ; Females N =11)
Table 5.33: Partial correlation coefficients, controlling for age, and (p-values) between sexes for behavioral factors and lifestyle indices in relation to the Waist Hip Ratio (WHR) for combined adult population from Dureno and Zabalo.
146 Factor 1: Material Lifestyle 0.34(0.11) -0.63 (0.03) Factor 2: Economic -0.11 (0.61) -0.63 (0.03) Factor 3: Individual Lifestyle 0.39 (0.06) -0.01 (0.96) Factor 4: Traditional Medical Belief 0.46 (0.03) -a i6 (0 ^ D
Acculturation Index 0.12 (0.45) -0.50 (0.01) Lifestyle Incongruity 0.05 (0.78) -0.45 (0.03) Socioeconomic Status 0.22(0.17) -0.47 (0.02) Economic Resource Index 0.33 (0.04) -0.42 (0.04) Health Risk Index -0.03 (0.81) 0.01 (0.95) Activity Index 0.08 (0.61) 0.14(0.48) Total Purchased Food* 0.08(0.71) -0.12(0.69) *(Dureno N=29; 2^baIo N=I6)
Table 5.34: Inter-village partial correlation coefficients, controlling for age and sex, and (p-values) for behavioral factors and lifestyle indices in relation to the Waist Hip Ratio (WHR).
5.5 Biobehavioral Factors and Intestinal Parasitic Infections Behavioral Factors and Lifestyle Indices
Material Lifestyle (r=-0.36, p=0.13). Traditional Medical Beliefs (r=-0.38, p= 0.09), and Lifestyle Incongruity (r=-0.40, p=0.09) negatively correlate with total parasite loads among men, while Socioeconomic Status (r=-0.36, p=0.13) and the Economic Resource hidex (r=-0.36, p=0.08) are negatively correlated among women
(Table 5.35), In Dureno, the Economic resource Index (r=-0.27, p=0.15) negatively correlates with total parasite loads (Table 5.36). No significant correlations are observed between any of the lifestyle indices and total parasite loads in Zabalo (Table 5.36).
147 Factor 1: Material Lifestyle -0.36 (0.13) -0.24 (0.32) Factor 2: Economic -0.10 (0.67) 0.07 (0.78) Factor 3: Individual Lifestyle -0.004 (0.99) 0.02 (0.94) Factor 4: Traditional Medical Belief -0.38 (0.09) -0.10 (0.69)
Acculturation Index -0.31 (0.20) -0.24 (0.30) Lifestyle Incongruity -0.40 (0.09) -0.09 (0.69) Socioeconomic Status -0.27 (0.26) -0.36 (0.13) Economic Resource fiidex 0.14(0.55) -0.36 (0.08) Health Risk Index -0.27 (0.25) -0.10 (0.66) Hygiene Index -0.02 (0.93) -0.11 (0.65) Total Purchased Food -0.25 (0.33) 0.24 (0.69)
Table 5.35: Correlation coefficients, by sex, and (p-values)for behavioral factors and lifestyle indices in relation to the total parasite load for combined adult population firom Dureno and Zabalo.
Factor 1: Material Lifestyle -0.36 (0.24) -0.47 (0.53) Factor 2: Economic 0.11 (0.70) -0.32 (0.68) Factor 3: Individual Lifes^le -0.10(0.72) 0.14 (0.86) Factor 4: Traditional Medical Belief -0.15 (0.61) -0.51 (0.50)
Acculturation Index -0.18 (0.36) -0.51 (0.30) Lifestyle Incongruity -0.09 (0.64) -0.54 (0.27) Socioeconomic Status -0.23 (0.24) -0.65(0.16) Economic Resource Index -0.27 (0.15) -0.39 (0.44) Health Risk Index -0.08 (0.68) 0.63 (0.18) Hygiene Index -0.12 (0.53) 0.24 (0.64) Total Purchased Food 0.16 (0.59) -0.80 (0.20)
Table 5.36: Inter-village partial correlation coefficients, controlling for sex, and (p-values) for behavioral factors and lifestyle indices in relation to the Total Parasite Load among adults.
148 Biological Factors
Hemoglobin levels are not significantly correlated with prevalence of helminth infection (Table 5.37). However, negative correlation between hookworm Infections and
hemoglobin levels support the clinical disease course, whereby individuals infected with hookworms usually experience iron deficiency anemia. Eosinophil counts are correlated positively with total parasite loads (r=0.34, p= 0.02) and hookworm infections (r=0.40, p=0.005. Table 5.37). Among men, hemoglobin levels are correlated negatively with total parasite loads (r=-0.50, p=0.03), while women show little correlation (r=-0.05, p=0.83)
(Table 5.38); conversely, eosinophil counts correlated positively with total parasite loads in women (r=0.66, p=0.(X)3), while no correlation is seen in men (r=0.02, p=0.93. Table
5.38). In Dureno, eosinophil counts are correlated positively with total parasite loads
(r=0.40, p=0.006), but no significant correlations are observed in Zabalo (Table 5.39). Hemoglobin levels negatively correlate with total parasite loads in both villages, but are not statistically significant (Table 5.39).
Hemoglobin level -0.13 (0.37) -0.18 (0.30) 0.03 (0.80)
Eosinophil count 0.34 (0.02) 0.40 (0.005) 0.02 (0.90)
Table 5.37: Partial correlation coefficients (p-values),controlling for age, for hemoglobin levels and eosinophil counts in relation to infection by each species of nematode and total parasite load for combined adult population firom Dureno and Zabalo.
149 Hgno^obitiljevd 0.50 (0.03) -0.05 (0.83)
Eosmophil Count 0.02 (0.93) 0.66 (0.003)
Table 5.38: Partial correlation coefficients, controlling for age, and (p-values) between sexes for hemoglobin levels and eosinophil counts in relation to the total parasite load for combined adult population from Dureno and Zabalo.
-0.21 (0.23) -0.37 (0.32)
Eosmophil Count 0.48 (0.004) -0.50(0.17)
Table 5.39: Inter-village partial correlation coefficients, controlling for age and sex, and (p-values) for hemoglobin levels and eosinophil counts in relation to the total parasite load among adults.
Anthropometric Variables
No significant correlations, in either males or females, are observed between Total
Parasite Load and anthropometric variables (Table 5.40). However, inter-viUage comparisons, controlling for age and sex, show negative correlations between Total Parasite Loads and Supra SF in both Dureno and Zabalo (Table 5.41).
150 Arm Fat Index -0.26 (0.30) -0.22 (0.36) BMl -0.30 (0.23) -0.08 (0.74) Supra SF -0.26 (0.29) -0.34(0.16) Sum SF -0.29 (0.25) -0.34 (0.16) WHR -0.03 (0.89) -0.17 (0.48)
Table 5.40: Inter-village partial correlation coefficients, controlling for age, and (p-values) for anthropometric variables in relation to total parasite load for combined adult population from Dureno and Zabalo. HMBHHH Arm Fat Index -0.16 (0.39) -0.41 (0.19) BJVH -0.01 (0.96) -0.30(0.51) Supra SF -0.29 (0.12) -0.76 (0.05) Sum SF -0.14(0.44) -0.52 (0.23) WHR -0.19 (0.31) -0.06 (0.89)
Table 5.41: Partial correlation coefficients, controlling for age, and (p-values) for anthropometric variables in relation to total parasite load among adults.
151 CHAPTERS
DISCUSSION AND CONCLUSIONS
6.1 Introduction
Human variability results from a complex interplay among environment, biology, and culture. Such variability occurs because human populations developed an array of adaptations and cultural innovations to survive in diverse habitats. Culture is integral to humankind’s interactions with and accommodations to the environment. Thus, culture often is viewed as a human adaptive mechanism (Harrison, 1993; Frisancho, 1993). There is a direct relationship between the physical environment and cultural systems. Therefore, changes in the biophysical realm (climatic factors, fauna, flora) may precipitate changes in the cultural realm and vice-versa (Moran, 1979; Baker, 1982; Little, 1982; Armelagos et. al., 1992)..
A major question to be answered is: How do environmental and cultural change affect health? Individuals and populations interact with their environments using a culturally prescribed system of ideological, technological, and social organizational components (Armelagos et al., 1992). Acculturation to new cultural patterns disrupts both culture and environment. While striving to preserve their biological and cultural identity, populations acquire new adaptive strategies necessary for survival. Such strategies may not provide the basis for better or even equal health among it’s members (Wirsing, 1985).
152 Data examined here confirm that environmental and cultural change have affected health among the Cofan.
6.2 Summary of Major Results and Comparisons With Other Studies Environmental and Lifestyle Variation
The Cofan’s physical and cultural environments have changed dramatically in the past 20 years. Roads built by oil companies opened more than a third of the Cofan territory to colonization and a number of oil consortiums are producing or have pumped oil in the region. Waterways have been polluted by oil spills, while illegal logging has become so widespread that even the Ecuadorian Army caimot stop the intrusion of loggers (Poirier and
Mullins, 1994). The increased number of colonists entering the area have depleted natural resources and rainforest flora has been destroyed for farmland and pasture to graze cattle.
Dureno
Environmental degradation initiated a series of changes, that include a decrease in wild game and fish reserves in and around the village of Dureno. Observational data and personnel interviews suggest that it is hard to procure wild game around Dureno, such that today dietary meat comes from small rodents such as squirrels and agoutis. Fish remain a major protein source for the Dureno Cofan however, some individuals now rely on non- traditional procurement methods such as dynamite. Overall, they consume protein less frequently than Zabalo residents and also consume fewer local protein sources. A major source of income is sales of crops such as coffee, yams and com to nearby towns; in addition, a third of residents raise either pigs or cows for local consumption or sale. Traditionally, the Cofan were considered a river people whose main mode of transportation was the dugout canoe. Currently, however, less than half of Dureno Cofan have either a canoe or a boat. In Dureno, more houses are constructed of cormgated tin
153 roofs and milled lumber compared to Zabalo. The village center has an infirmary, two school houses, which also are used for town meetings, a church, and two non-functioning concrete block latrines with porcelain flush-style commodes. A manual water pump system supplies spring water to the village and many households have gas cooking stoves. More
Dureno individuals lack a formal education and less than half speak Spanish compared to
2^baIo residents. Many Dureno residents frequently travel to Lago Agrio, an oil-town approximately 100 km away.
Dureno is the “parent’ village to Zabalo and it’s residents are somewhat older.
Mostly younger individuals migrated to establish the village of Zabalo. This is evident when addressing traditional beliefs, more Dureno individuals believe evil spirits can make a person ill, fewer have trust in Western medical practices, and more are likely to visit a shaman when ill. A lower Socioeconomic Status and Economic Resource Index along with an overall mistmst of Western medical practices play important roles with regard to medical decisions made by Dureno residents. At one time a medical doctor frequently visited
Dureno and was housed in the infirmary building. A key informant stated that the doctor ran off with all their supplies, medicines, and medical equipment, and the people of Dureno have been leery of outside help ever since. With regard to other health related issues,
Dureno individuals report higher work and leisure activity levels compared to Zabalo. Self-reported drinking and smoking was lower in Dureno; however, based on observational data this was probably under-reported. Overall, Dureno individuals scored lower on the Hygiene Index and had more self-reported illnesses compared to Zabalo residents.
Zabalo Increasing population densities along with decreasing land and resource availability led to the most dramatic change in the Cofan’s cultural environment, the fragmentation of
154 the Aguarico Cofan into two separate villages, Dureno and Zabalo. Residents of the splinter village Zabalo, are younger, more acculturated, and have a higher Material
Lifestyle, Economic Resource Index, and Lifestyle Dicongruity. Although they are trying to preserve their traditional subsistence lifestyle, the Zabalo group also is affected by culture change. They have selectively chosen elements of the intrusive outside society and incorporated them into their lifeways while rejecting others. Although many of their houses are traditional in style, i.e. constructed of thatch and reed, most of their canoes or boats have motors, and most houses have solar panels and foot-powered sewing machines.
Waterways remain an important mode of transportation to Zabalo families, who live deeper in the rainforest than the Dureno Cofan. Furthermore, their participation in ecotourism necessitates having motorized canoes. Other items, such as solar panels, were obtained through negotiations with oil companies over land and mineral exploration rights. One of the main reasons individuals moved to Zabalo was to return to a traditional subsistence lifestyle. Hunting, fishing, and gardening remain important apects of their subsistence-based lifestyle. Although traditional blowguns and curare are still used in these pursuits, shotguns also are used for hunting and sometimes even fishing. Wild game is more abundant in Zabalo and protein is eaten more frequently than in Dureno.
The Zabalo Cofan supplement their indigenous lifestyle with a locally owned and operated ecotourism business (Poirier and Fitton, 1998). Although not as destructive to the environment, ecotourism may eventually have sociocultural and health costs for this population. For example, lifestyle incongruity scores are higher in Zabalo residents, especially males. Zabalo’s inhabitants have a higher material lifestyle but limited/ uncertain funds to acquire commercial goods. This is causing a status inconsistency (lack of economic resources to support their material style of life) which leads to “life style stress” typically seen in modernizing populations (Bindon, Crews and Dressier, 1991). Even though residents of Zabalo have approximately the same average achieved education level
155 as those in Dureno, they have a broader language base, more than half speak Spanish and a few even speak English, probably due to their increased contact with non-Cofan teachers and ecotourism. Zabalo individuals travel to Quito and other countries more frequently, which may be due to ecotourism or political venues such as procuring land rights, and they frequently travel to Dureno to visit family and obtain supplies.
Regarding health related issues, Zabalo residents report lower work and leisure activity levels compared to Dureno, but report higher levels of exercise linked to hiking, volleyball, and soccer. The Activity Index may be problematic in that trekking is a major part of ecotourism and the Cofan do not see this as “work.” Therefore, the Zabalo Cofan may have under-reported their level of physical activity when working. They also did not consider subsistence activities as “work,” it was something that was necessary to survive.
A higher incidence of smoking and drinking were reported in Zabalo than Dureno, and males have higher scores than females. More males from Zabalo reported using /Yage/, a hallucinogenic drink used in a traditional religious context. Zabalo individuals had a higher Hygiene Index and Health Risk Index with no differences between the sexes.
When comparing lifestyle variation between age cohorts (combined sample includes both villages), the 13-20 year olds have a higher Economic Factor and Individual Lifestyle
Factor than either Cohort 2 (21-40 year olds) or 3 (41-76 year olds). Whereas, Cohort 2 has a higher Economic Resource Index and SES than Cohort 1 and higher Economic
Resource Index, SES, Material Lifestyle, and fridividual Lifestyle compared to Cohort 3.
Cohort 3 individuals are less acculturated than Cohort 2 and have a lower Hygiene Index, and higher acceptance of Traditional Medical Beliefs than either Cohort 1 or 2.
156 Biological Variation Growth and Body Habitus
In the younger age categories (2-4 year olds and 5-8 year olds) there is little
difference in anthropometric measures between the boys and girls regardless of village. Although girls in the 9-12 year category are slightly older in Zabalo, there are few
differences between sexes in anthropometric measures, hi Dureno, 9-12 year old girls are
taller with larger Hip Circ and UA Mus, whereas boys show a larger Arm Fat Index. The only inter-village difference is in the 9-12 year old category with Zabalo males having larger UA Circ and UA Mus, while Dureno males have a larger Arm Fat Index. When
comparing Cofan children to NCHS standards they are lower for Ht, Wt, UA Circ, and UA Mus in every age group regardless of sex or village. Among 2-4 and 5-8 year olds,
regardless of sex or village, skinfold measures and Arm Fat Index are above NCHS
standards with 2-4 year old boys also having slightly higher UA Fat. BMI’s are below
NCHS standards in all age categories regardless of sex or village, except among 5-8 and 9-12 year-old boys from Zabalo who have BMI’s that are close to NCHS standards.
The growth and development of children is a sensitive indicator relating to the health of a population, and patterns of growth and development are shaped by multiple
interacting factors including genetics, climate, nutrition, and the incidence and prevalence of disease (Malina et al., 1988). Although the number of children in each age category is
small, it was important to include this data to establish a general picture of Cofan society.
Cofan children were compared by sex and village, and to NCHS standards as summarized
above. It is important to note that the NCHS growth curves are based on a U.S. Caucasian sample, and even though the World Health Organization has promoted them as reasonable standards for growth and development, they do not take into account environmental and genetic variation (Mascie-T ay lor, 1991). Most South Amerindians are exposed to some degree of undemutrition during their growth and development, and the high prevalence of
157 infectious and parasitic diseases are likely contributing factors to their growth patterns (Dufour, 1992; Santos, 1993; Hass 1977; Eveleth and Tanner, 1976).
While Cofan children are below average for height, weight and UA Circ when compared to the NCHS standards, they are comparable to other Latin Amerindian populations (Johnson et al., 1971; Malina, 1981; Stinson, 1989; Santos and Coimbra,
1991; Bogin, 1999). Furthermore, signs of marasmus (caloric-deficiency malnutrition) or kwashiorkor (protien-deficiency malnutrition) were not observed in either village (Silva and
Crews, 1995a). In fact, individuals in younger age categories (2-5 and 5-8 years old) have skinfold measures and an Arm Fat Index above NCHS standards and Zabalo males between 5-12 years old have BMI’s close to NCHS standards. Inter-village comparisons show 9-12 year old Zabalo males have more muscular upper arms and Dureno males have more upper arm fat. These differences are most likely due to diet and activity patterns.
Zabalo males at this age appear to participate more in himting and ecotourism activities, while Dureno males appear more inactive; however, further research is needed to substantiate this conclusion.
Genetic factors are crucial components to short adult stature among South
Amerindians (Silva et al, 1995; Holmes, 1995; Bogin, 1993). According to Holmes (1995), “Amazonian indigenes” have a genetically determined small stature. She states that
“Amazonian Indians share a common Mongoloid ancestry with other South American
Indians; their small body size is consistent with this genetic heritage” (pp. 132). Various studies have shown that South and Central Amerindians are shorter and lighter than North
American Indians (Holmes, 1995). It has been hypothesized that small body size is an adaptation in populations with low food availability (Frisancho et at. 1973; Stini, 1972a), while others think it is an accommodation to undemutrition and poor health (Scrimshaw and Young, 1989). However, several groups of South Amerindians were found to be
158 short in stature even in the presence of good nutritional status (Dufour, 1992; Black et al.,
1977; Johnston et al., 1971). Mean heights for 22 Amazonian groups ranged from
146.2 - 172-9 cm. among men and 161.1 - 138.1 cm. among women, while weights ranged from 61.4 - 43.7 kg. among men and 52.8 - 37.9 kg. among women (from
Holmes, 1995). Among the Cofan, mean adult heights and weights are consistent with other Amazonian populations.
Various studies of diverse populations have noted correlations between culture change and increased adiposity (Labarthe et al., 1973; Friedlaender and Rhoads, 1982; Bindon and Zansky, 1986; Young, 1994; Bindon, 1995; Santos and Coimbra Jr., 1996;
Shephard and Rode, 1996). Before summarizing the results of adult body measurements, it is important to note that “a one-time cross-sectional survey cannot distinguish the effects of individual weight change with age, and the effects of important basic differences in body size and composition between the cohorts at different ages due to their different life experiences” (Friedlaender and Rhoads, 1982). Further longitudinal research following these same participants is necessary to distinguish between these two effects.
Among adults. Cofan men weigh more than women and have larger UA Mus and
Waist/Hip ratios, while women have larger skinfold measures, UA Fat, and Arm Fat
Index, and in Dureno, higher BMI’s. Between village comparisons show that Zabalo men between 21-40 years old are taller and heavier overall, with larger BMI’s, UA Circ, Hip
Circ, Waist Circ, UA Fat, and UA Mus. Zabalo men 41-76 years old also surpass their
Dureno counterparts in Waist Circ, WHR, and Supra SF. Dureno women 13-20 years old, on the other hand, are heavier and taller with larger BMI’s, Arm Fat Index, Hip Circ,
Supra SF, Sum SF, and UA Fat than their Zabalo counterparts. However, Zabalo women between 41-76 years of age surpass their Dureno counterparts only in weight. Studies have shown that among women in traditional societies there is a general pattern of weight loss with aging but among acculturating groups women show sustained patterns of weight
159 gain well into old age (Friedlaender and Rhoads, 1982). hi fact, in populations that have been subjected to rapid acculturation, it is the women who gain the most weight
(Friedlaender and Rhoads, 1982). Among the Cofan, especially in Dureno, women in general have higher BMI’s than men.
Anthropometric measures such as body mass index (BMI), ratio of waist-to-hip circumference (WHR), and either the sum of subscapular and triceps skinfold (Sum SF) or ratio of subscapular-to-triceps skinfold (STR) are the most used measures of obesity
(Ashwell et al., 1985, Bray, 1979; Beller, 1977). BMI measures overall adiposity while
WHR measures lower-body adiposity and Sum SF or STR measures upper-body adiposity. BMI, the most widely used indicator of adiposity, is based on the relative weight-for-height of an individual, with higher BMI scores indicative of more body fat
(Bogin, 1999). However, cut-points for overweight and underweight are somewhat arbitrary and care must be taken when using these cut-points to describe diverse populations. As with any measure, particularly absolute height and weight, a large number of environmental and genetic variables influence body size and shape. According to Bray
(1989; 175), “Overweight, as distinct from obesity, is defined in relation to tables of desirable weight that generally have been prepared from insurance company information.
Desirable weights are those associated with the most favorable mortality experience.
Overweight is defined as a BMI between 25 and 30, and obesity as a BMI above 30.” The World Health Organization (1986) states that a BMI above 30 is associated with an increased risk of mortality from noninfectious disease. Health complications related to obesity include; a predisposition to gallstones, adult-onset diabetes, hypertension, and an increase risk of cardiovascular disease (Scrimshaw et al., 1995). Both overweight and obese individuals are at risk for developing these chronic diseases; however, obese individuals have a substantially higher risk. With these criteria in mind, approximately
40% of the Cofan are overweight and 5% are obese, regardless of village of residence.
1 6 0 Forty-eight percent of Cofan. women have BMI’s 25 compared to 31% of men. Bray (1989) states that from puberty onward women tend to gain more weight than men, and
have lower risks for diseases associated with higher body fat. This may be partially due to differences in fat distribution.
Malina (1969) reported that as men age an increase in torso fat occurs, as measured by subscapular skinfold, however, as women age there is an increase in triceps fat.
Among Cofan men, the oldest cohort from Zabalo shows the highest abdominal body fat
(as measured by Waist Circ, WHR, and Supra SF), while the oldest cohort from Dureno show both higher upper and abdominal body fat (as measured by Hip Circ, Sum SF, and
UA Fat). Older cohort women, from both villages, show large Hip Circ, Sum SF, and UA
Fat. This apparent pattern of weight gain into old age may be the result of changes in dietary intake and decreased activity patterns. More sedentary or urban lifestyles along with dietary changes, have been associated with changes in body composition among indigenous populations. For example, a metabolic study conducted among the Pima
Indians showed that decreased energy expenditure increased the risk of weight gain fourfold over a two year period (Ravussin et al., 1988). However, when comparing activity levels among the Cofan, only the Arm Fat Index and Sum SF are significantly correlated with an individual’s activity level, whereas BMI and WHR are not.
Several studies have examined the association of body morphology with socioeconomic and behavioral variables in diverse populations (Reddy, 1998; Santos and
Coimbra, 1996; Dressier et al., 1996; Hodge et al., 1996; Bindon, 1995). Acculturating groups, in general, show increased adiposity with improved socioeconomic status.
Individuals with a higher socioeconomic status become physically less active and increase their consumption of fat and carbohydrate rich foods. Therefore, socioeconomic differentiation that accompanies acculturation does not necessarily lead to improved health.
Ih fact, Santos and Coimbra (1996) reported that socioeconomic differentiation and
161 increased obesity among the Sunu from Brazil led to increased chronic metabolic disorders. Among Cofan men, increasing levels of acculturation and a higher Economic Resource
Index (which is the sum of household occupations) are correlated with increasing BMI’s
and Sum SF. However, we do not see this pattern among women. In fact, the most
significant correlation between BMI and Sum SF in women are increased health risks. A
negative correlation is also seen among women with regard to Individual Lifestyle and Sum
SF and WHR. Among males, an increase in Traditional Medical Beliefs is correlated with
an increase in Arm Fat Index and WHR, whereas in females the correlation is with Arm Fat Index and Sum SF.
Inter-village comparisons show that as acculturation and socioeconomic status
increase there is an increase in BMI and Sum SF in Dureno; however these correlations are
not seen in 2[abalo. Among Dureno residents as Material Lifestyle and Economic
Resources increase so does WHR; whereas among Zabalo residents WHR decreases. Changes in adiposity with the adoption of modem lifestyles may be a significant predictor
of health status among indigenous populations. Research has shown that BMI, WHR and
Sum SF are significant predictors of diabetic and hypertensive status in diverse populations
(Young and Sevenhuysen, 1989; Haffheret al., 1987). Overall, Cofan men show higher
BMI’s with acculturation and economic improvement, whereas women show an increase in health risks with increasing BMI’s. There is evidence that in Amerindian populations,
obesity is associated with hypertension, non-insulin-dependent diabetes mellitus, and gall
bladder disease (Weiss et al., 1984). Recent research has shown that the regional
distribution of body fat, more than overall obesity, has important health implications
(Young, 1994; Young and Sevenhuysen, 1989; Haffher et al., 1987). Fat that accumulates
around the waist and abdomen, lower-body adiposity, is an important risk factor in diabetes and cardiovascular disease (Stem and Haffher, 1986). Cofan men, show a pattem of lower-body adiposity even into old age, which may predispose them to chronic
162 conditions in the future. Other research has shown that individuals with upper-body
adiposity are more insulin resistant than equally obese individuals with predominantly
lower-body adiposity (Krotkiewski et al., 1983; Kissebah et al., 1982; Stem et al., 1973; Bjomtorp et al., 1971). Cofan women show a pattem of upper-body adiposity which may
predispose them to impaired glucose tolerance in the future. Another interesting finding,
which carmot be explained at this time, is that strong Traditional Medical Beliefs are
associated with an increase in the Arm Fat Index, regardless of sex, along with an increase in Sum SF for women and WHR for men. Intervillage comparisons show that an increase in Traditional Medical Beliefs among Dureno residents is associated with increases in the
Arm Fat Index, BMI, Sum SF, and WHR; whereas no significant correlations are observed in Zabalo. This may be indicative o f an underlying struggle between traditional ways and the outside world which is leading to increased adiposity, especially in Dureno. Further research into how traditional beliefs and practices affect lifestyle choices are necessary to substantiate this claim.
Cholesterol, Glucose, and Hemoglobin Cholesterol
Serum cholesterol levels are influenced by a wide variety of factors including: genetics, age, sex, adiposity, smoking, alcohol intake, diet, activity, anxiety and seasonal fluctuations (Bortz, 1974, Pollard, 1997). A limitation to the present study is that the cross-sectional design does not allow identification of seasonal fluctuations in cholesterol levels among the Cofan. Overall, total cholesterol levels were very low among both men
(114 mg/dl) and women (149 mg/dl ), with women, regardless of village, having significantly higher values than men. This is comparable to a study conducted among the
Yanomami Indians of Brazil by Mancilha-Carvalho and Crews (1990). A study by Conner and colleagues (1978) noted that serum cholesterol levels rise with age in most Westernized
163 populations, but show little or no increase in less acculturated groups. However,
Mancilha-Carvalho and Crews (1990) reported moderately higher cholesterol levels at older ages among the Yanomami Indians, regardless of sex. Among the Cofan, women 41-76 years old have higher cholesterol levels than men. A recent study in Papua New Guinea reported an age-related cohort effect whereby the oldest men, those retaining more traditional lifestyles, had lower acculturation and cholesterol levels (Hodge et al., 1996).
However, inter-village comparisons among the Cofan show that 41-76 year olds from
Zabalo, regardless of sex, had higher cholesterol levels compared to Dureno. The total combined pooled sample revealed that this age cohort is also less acculturated. Additional studies suggest that adverse changes in lipid levels may occur when groups undergo acculturation secondary to changes in diet, lifestyle, physical activity, and stress (Page et al., 1974; McMurry et al., 1991, Hodge et al., 1996). A recent study by
Hodge and colleagues (1997) examined acculturative changes in lipid levels in Western
Samoa. They reported a dramatic increase in cholesterol and triglyceride levels over a
13-year period, and showed that these adverse changes in lipid levels correspond to socioeconomic status, obesity, and physical inactivity. Similar results have been reported by Bindon and colleagues (1991) among residents o f American Samoa. Although cross-sectional in design, this study demonstrates that among Cofan men, higher cholesterol levels are associated with higher levels of acculturation, material lifestyle, socioeconomic status, lifestyle incongruity, and economic resources. Higher cholesterol levels also correlate with higher health risks for both men and women. Furthermore, among women, as activity levels decrease cholesterol levels increase. Total purchased food however, did not correlate highly with total cholesterol in either males or females.
Inter-village comparisons show that in Zabalo, cholesterol levels are positively correlated with the Economic Factor and Material Lifestyle. However, in Dureno, Material
Lifestyle, Lifestyle Incongruity, and the Health Risks are positively correlated to total
164 cholesterol. Physiological responses to acculturation are a function of the combined effects of physical, dietary, and sociocultural factors. A recent study demonstrates that BMI along with dietary and sociocultural factors (socioeconomic rank, lifestyle incongruity, and
kin-support) are significantly correlated with serum lipid levels among urban residents from
Brazil (Dressier et al., 1993). High Lifestyle hicongruity (LSI) (when lifestyle exceeds
economic means) and low social support interact "psycho-physiologically" with high levels of arousal and cardiovascular reactivity and may, in turn, influence their lipid levels.
Among Cofan men. Supra SF, Sum SF, and Arm Fat Index are positively correlated with total cholesterol. No significant associations were observed among women. Inter-village comparisons show that Sum SF and Arm Fat Index are positively correlated with total cholesterol in Zabalo, while no significant correlations are observed in Dureno. Total purchased food does not correlate highly with total cholesterol either between sexes or between villages. However, a more intensive dietary study is necessary to assess relationships between fat intake and cholesterol levels among the Cofan. Although the
Cofan have relatively low cholesterol levels compared to Western industrialized populations such as the United States, with increasing acculturation and lifestyle stress, along with increased adiposity and decreased levels of physical activity. Cofan cholesterol levels may continue to increase predisposing them to cardiovascular disease in the future.
Glucose
An important factor to this part of the study is that, although individuals were told to not to eat before being tested, some stated they drank chocula (banana drink) before having their blood drawn; therefore all samples are considered non-fasting. It has been noted that as acculturation ensues the incidence of chronic diseases such as non-insulin- dependent diabetes mellitus (NIDDM) and cardiovascular disease progressively increases
(Trowell and Burkitt, 1981; Baker, 1984). NIDDM seems to be rare in populations who
165 practice traditional subsistence lifestyles (Zinunet et al., 1981). However, with progressive acculturation, traditional populations such as the Pima Indians, Nauruans, and Samoans show an increased prevalence of NIDDM (Bennett et al., 1976; Zimmet, 1981; Baker et al., 1986; Crews, 1994). These populations may have an underlying genetic susceptibility to NIDDM which is exposed by environmental factors. Various studies have shown that high prevalence rates of NIDDM in diverse populations are correlated with rapid rates of acculturation (Daniel and Gamble, 1995; Crews, 1994; Crews et al., 1991;
Szathmary and Ferrell, 1990; Hazuda et al., 1988). However, among the Cofan, glucose levels did not vary greatly across sex or village, ranging on average between 110-116 mg/dl, well within the standard laboratory reference range (45-130 mg/dl). The only significant difference was among 41-76 year old women, who regardless of village, had higher glucose levels than men. However, it is important to note that their values remain well within the normal non-fasting range. Two individuals, a 33 year-old women and a 52 year-old man from Dureno, known to be fasting and whose blood glucose levels were re-checked on three consecutive days, had average fasting glucose readings of 170 mg/dl and 143 mg/dl, respectively (normal range for fasting glucose is 60-100 mg/dl). A caveat to this part of the study is that these two villages have been separate entities for only ten years in 1994 when this study began. Perhaps too short a time for major health consequences associated with glucose metabolism and environmental or cultural change to precipitate. However, based on the two abnormal glucose findings stated above, further studies regarding glucose metabolism and culture change among the Cofan are warranted.
Research has shown that BMI, WHR and Sum SF are significant predictors of diabetic and hypertensive status in diverse populations (Young and Sevenhuysen, 1989; Haffner et al., 1987). However, among the Cofan, no significant correlations between glucose and any of the anthropometric variables are observed between sexes or between villages. Although mean glucose levels are within normal reference ranges, the increases in
166 central and upper-body adiposity seen among the Cofan may be early warning signs of latent diabetes in this population. Future smdies that obtain fasting and 2hr post-load glucose data along with anthropometric indices, are necessary to evaluate the glycémie status of this population.
Dressier and colleagues (1996) recently reported that various measures of increased acculturation are associated with elevated random plasma glucose levels. More specifically, they find that higher a BMI along with increased Lifestyle hicongruity, are associated with higher glucose levels, while higher physical activity is associated with lower glucose levels. However, among the Cofan, neither BMI nor Lifestyle hicongruity are correlated with glucose levels. Studies of diverse populations have shown that increasing acculturation fiom more traditional to more Westernized lifestyles, has negative effects on obesity and diabetes (Reed et al., 1982; Prior, 1971; Zimmet et al., 1981; Zimmet et al.,
1983; King et al., 1984). However, research among Mexican Americans (Hazuda et al.,
1988) shows a beneficial effect of increasing acculturation on obesity and diabetes. Mean random glucose levels were within normal range among the Cofan; however, as the
Economic Resource Index increased glucose levels decreased among Dureno Cofan. The interaction of genetics and sociocultural factors are probably responsible for increases in obesity and the prevalence of diabetes among acculturating populations (Hazuda et al.,
1987). As the Cofan, especially in Dureno, face the continuing onslaught of cultural and environmental change, further research into social and genetic links to diabetes are necessary to imderstand the complexities involved in disease expression. Individuals of lower socioeconomic status may be more at risk for developing chronic conditions such as non-insulin-dependent diabetes mellitus in transitional settings.
167 Hemoglobin
The World Health Organization (WHO, 1968) criteria for nutritional anemia provides specific cut-points for hemoglobin level; less than I Ig/dl for pregnant women, less than 12g/dl for nonpregnant women, and less than I3g/dl for men. Although hemoglobin levels vary across age and sex, only Zabalo women aged 13-20 years show mild anemia (p=0.14). These results must be treated with caution because women were not tested for pregnancy due to cultural reasons. Although urine pregnancy kits were taken to each village, women were reluctant to provide urine samples therefore, those who may have been in the very early stages of pregnancy (not aware they were pregnant) are included in these analyses. When individually determined, following World Health
Organization (WHO) criteria, 25% of Dureno women aged 13-20 years and 28% of those 21+ years are anemic with Hb levels less than 12 g/dl. Whereas, in Zabalo, 75% of women aged 13-20 years and 8% aged 21+ years are anemic. Twenty-five percent of
Dureno men aged 13-20 years, and 24% of those 21+years old are anemic with Hb levels below 13 g/dl. In Zabalo men, these proportions are 17% and 29%, respectively. Lower hemoglobin concentrations in “black” populations compared to “white” samples [range from 0.5 -1.0 g/dl] have been reported; however, differences in hemoglobin levels between these groups do not appear directly related to iron intake (Johnson-Spear and Yip, 1994;
Perry et al., 1992; Dallman et al., 1978; Gam et al., 1975). Although causes for such differences across various populations remain unclear, envirorunental and genetic factors are thought responsible. One must be mindful of inter-ethnic variability when evaluating iron status of indigenous groups. Development of iron deficiency anemia, the most common anemia in the world, may result from poor intake. However, an a priori assumption that low hemoglobin levels in developing countries are the consequence of nutrient deficiencies is not acceptable
(Jelliffe, 1985). Anemia can result from abnormal iron losses through chronic diarrhea,
168 poor intestinal absorption or parasitic infections (Jelliffe, 1985). For instance. Smith
(1970) reported a reduction in hemoglobin levels with increased intestinal parasitic infections, especially hookworm, among the Cofan of Dureno. In this study, hemoglobin
levels are negatively correlated with total parasite loads among men, with no significant
differences between villages, suggesting that some aspect of men’s life may be associated with lower iron levels.
Abandonment of traditional lifestyles and subsistence strategies are associated with
a deterioration in blood iron levels and increasing anemia due to nutritional deficiencies
among the !Kung San of Naibia (Feraandes-Costa et al., 1984). Among the Cofan,
Material Lifestyle, Acculturation Index, Lifestyle Incongruity, Socioeconomic Status, and the Economic Resource Index correlate positively with hemoglobin in both sexes.
However, Individual Lifestyle positively correlates with hemoglobin only among men, while purchased foods consumed were not correlated with hemoglobin levels in either sex. Inter-village comparisons show positive correlations of hemoglobin level with Material
Lifestyle, Individual Lifestyle, and Traditional Medical Beliefs in Dureno, although the
Economic factor positively correlates with hemoglobin levels in Zabalo. In addition, the Acculturation Index, Lifestyle Incongruity, Socioeconomic Status, and Economic Resource
Index all positively correlate with hemoglobin in Dureno, while only SES positively correlates in Zabalo.
A recent study by Kent and Dunn (1996) among a transitional group of IKung San from Botswana found the incidence of anemia to be high in spite of adequate diets. They equated lifestyle change with the introduction of new health problems and stated that although mortality decreased with sedentism, morbidity increased as sedintism allowed infectious diseases to persist resulting in high levels of anemia. Among the Cofan, neither the Health Risk Index nor the number of self-reported ailments correlated significantly with hemoglobin level in either sex. However, among Cofan males, hemoglobin level is
169 negatively correlated with diagnosed illnesses that include tuberculosis, dermatitis, intestinal parasites and malaria. However, these correlations are not significant among females or between villages.
Murray and colleagues (1980) suggest that low hemoglobin levels may protect against infectious diseases among the Turkana from Northern Kenya. They reported fewer incidences of infectious diseases, such as malaria, brucellosis, amebic dysentery and other viral infections, among mildly anemic individuals as compared to those who were not anemic. It also has been suggested that future researchers should examine the role of hypoferremia as a possible defense mechanism against endemic infectious diseases among indigenous groups with adequate dietary iron. This may be of importance in sedentary groups where increased population numbers and inadequate sanitation promote chrortic infections and parasitism (Kent et al., 1994). Another important point is to differentiate between iron deficiency anemia and anemia due to chronic infections because iron supplementation based on low hemoglobin levels may only contribute to an increase in infectious diseases seen in these populations. Additional research among the Cofan, including assessment of serum iron and ferritin will improve our understanding of dietary change and its health consequences in the Cofan.
Blood Pressure In Western societies, age, obesity, fat distribution, and diet are common correlates of blood pressure (BP). Several studies examining acculturation and blood pressure variation among Amazonian populations suggest that altered life styles, which include changes in diet, subsistence activities and social stratification, that occur with acculturation are predictive of increased blood pressure (Carvalho et al., 1985; Dressier et al., 1987;
Bindon et al., 1991 ; Silva and Eckhardt, 1994; Silva et al., 1995). The Cofan are a
“transitional” population, some continue to engage in traditional activities, while all have
170 some contact with the dominant Ecuadorian society. The Cofan have relatively low blood pressures, the average for women from Dureno is 117/70 nunHg, and that of men is 121/74 mmHg. Zabalo is little different, 112/65 and 118/68, respectively. Previous studies have shown that relative fat patterns may be important factors in the etiology of
elevated blood pressure, especially increases in abdominal and subscapular fat (Schall,
1992; McGarvey and Schendel, 1986). Significant positive correlations of blood pressure
with increases in adiposity (measured by BMI), abdominal fat (measured by WHR and
Supra SF), and upper-body fat (measured by Sum SF and Arm Fat Index) are observed
among the Cofan. Among Cofan men, SB? positively correlates with an overall increase in adiposity along with increases in abdominal and upper body fat. No significant correlations are observed between DBF and anthropometric measures in men. Among
women, SB? and DBF positively correlate with an overall increase in adiposity and with increases upper body fat. In Zabalo, higher SBF readings positively correlate with an overall increase in adiposity including increases in abdominal and upper body fat, whereas
DBF correlates positively with an overall increase in adiposity and an increase in abdominal fat. No significant correlations are observed between SBF or DBF and anthropometric measures in Dureno.
Several studies have shown that traditional-living societies maintain a low BP even as age increases (Neel et al., 1964; Sinnet and Shyte, 1973; Friedlaender, 1989; Crews and
Mancilha-Carvalho, 1993; Harper et al., 1994; Silva et al., 1995). Other studies indicate that when members of low blood pressure populations experience acculturation there appears to be a subsequent rise in blood pressure along with age-related increases in blood pressure similar to those seen in Western populations (Fage et al., 1974; Cassel, 1975;
Carvalho et al., 1985; Dressier et al., 1987; Silva and Eckhardt, 1994; Silva et al., 1995;
Schall, 1992; Crews and Williams, 1999). When comparing age cohorts among the Cofan,
Dureno men age 21-40 years have higher DBF than younger or older individuals however,
171 no differences are observed in SBP across age cohorts. Among Dureno women, no significant differences are observed in SBP or DBP across age cohorts. Regardless of sex, Dureno individuals aged 13-20 years have higher pulse rates. In Zabalo, men aged 41-76 years have higher pulse rates and slightly higher DBP (although not statistically signifîcant) compared to men 21-40 years of age. No other significant differences are observed in
SBP, DBP, or pulse rate across age cohorts. Among Zabalo women, no significant differences are observed in SBP, DBP, or pulse rates across age cohorts. In inter-village same-sex comparisons, among individuals 13-20 years old, Dureno men and women have higher pulse rates compared to Zabalo; however, no differences are seen in DBP or SBP.
Among individuals aged 21-40 years old, Dureno men have significantly higher DBP and pulse rates compared to Zabalo men, while women show no significant differences in
DBP, SBP, or pulse rate. Among individuals 41-76 years old, no significant differences are seen between villages for DBP, SBP, or pulse rate among men. However, Dureno women in this age group have significantly higher DBP than Zabalo women with no significant differences in SBP or pulse rate. One caveat of this cross-sectional study is that individual increases in BP with age cannot be discerned.
Psychosocial stressors and lifestyle variability also are implicated as predicting the rise in blood pressure seen with increasing acculturation. It has been suggested that lifestyle changes lead to the disintegration of traditional values and goals. Subsequently, the breakdown in traditional values and new social pressures associated with an increasing desire for non-traditional consumer goods leads to chronic autonomic nervous system arousal which, over time, elevates blood pressure (Dressier, 1982). Previous research has shown that individuals who lacked economic resources to support a lifestyle of high material consumption (lifestyle incongruity) subsequently had higher blood pressures
(Dressier et al., 1995; Bindon et al., 1991; Dressier et al., 1987, Dressier, 1982). Dressier and colleagues (1995) stress that intra-cultural diversity creates variability in reactions to
172 specific social situations therefore, physiological responses to stressors are tied to individual beliefs and behaviors.
The range for Lifestyle Incongruity among the Cofan is -0.20 to 1.10 with a mean of 0.24 for Dureno and 0.57 for Zabalo. Zabalo residents experience higher lifestyle stress with males having significantly higher scores than females. Among Cofan men, SBP and
DBP are positively correlated with the Economic Factor (an indication of participation in the market economy) and Traditional Medical Beliefs. Among women, SBP is negatively correlated with the consumption of purchased foods and positively correlated with
Traditional Medical Beliefs. However, no significant correlations are observed between blood pressure and acculturation or lifestyle incongruity in either men or women. When comparing villages, in Dureno, SBP and DBP are positively correlated with Material
Lifestyle, Acculturation hidex, and the Economic Resource Index. Traditional Medical
Beliefs also are positively correlated with SBP, while SES is positively correlated with
DBP. For Zabalo, a positive correlation was observed between SBP and the Economic
Factor. Once again, no significant correlations are observed between blood pressure and lifestyle incongruity among the Cofan.
Bindon et al., (1991) examining modernization and adaptation among American Samoan men, found a cohort effect with regard to blood pressure and lifestyle incongmity.
A higher lifestyle incongruity was associated with higher systolic and diastolic blood pressure in men under 55 years old, while men 55 years and older showed lower systolic and diastolic blood pressures with increasing lifestyle incongruity. Among the Cofan, no significant correlations between DBP or SBP and lifestyle incongruity among age cohorts, regardless of sex, are observed. However, intervillage comparisons (controlling for sex) show significant correlations of Lifestyle Incongruity with DBP (r=0.58, p=0.006) and
SBP (r=0.64, p=0.002) among Diureno individuals aged 21-40 years old. Significant
173 correlations are not observed between other age cohorts in Dureno, or any age cohorts from 2[abalo.
Increases in blood pressures may be partly due to acculturation in some settings.
For example, as a consequence of regular access to medical care, higher blood pressure
readings may reflect improved health status among indigenous Amazonian groups, whereas lower blood pressure may reflect poorer health status and higher rates of infectious and
parasitic diseases (Fleming-Moran et al.l991). No signihcant correlations were observed
between intestinal parasite loads and blood pressure among the Cofan. However, better
hemoglobin status was positively correlated to blood pressure in most cases. Overall, it
does not appear that improvement in health is raising blood pressures among the Cofan;
however, longitudinal research into infectious disease status and blood pressure will better answer such questions.
In general. Cofan men show higher SBP with higher adiposity, whereas women show higher SBP and DBP with higher adiposity, particularly upper-body fat. Controlling for sex, Zabalo residents show higher SBP and DBP with greater overall adiposity, and
DBP is highly correlated with abdominal fat. No significant correlations of SBP and DBP with adiposity are seen among Dureno residents. Continued investigation of changing adiposity and fat patterning with regard to cardiovascular health is warranted in this population. Cohort comparisons show Dureno individuals aged 13-20 years, regardless of sex, have higher pulse rates. It is metabolically normal for individuals in this age range to have moderately higher pulse rates (Tortora and Anagnostakos, 1975). However, Zabalo men aged 41-76 years have higher pulse rates along with slightly higher DBP compared to other Zabalo cohorts. Dureno men aged 21-40 years, have significantly higher DBP and pulse rates compared to Zabalo men, while Dureno women have significantly higher DBP than Zabalo women. The variance in blood pressure between ± e sexes and between villages may be related to psychosocial stressors. Emotions such as fear, anger, and
174 anxiety that occur with acculturation can ulthnately lead to a general stress response (increased levels of epinephrine and norepinephrine) manifested as higher pulse rate and blood pressure (Tortora and Anagnostakos, 1975). hi fact, Dureno individuals, aged
21-40 years, show significant positive correlations of lifestyle incongruity, which measures lifestyle stress, with both SBP and DBP. These are the individuals (the age category) one would expect to be most affected by culture change. They are the “sandwich generation,” in the prime of their life striving to provide for their families and stmggling between traditional values and a changing culture. However, correlations between lifestyle stress and blood pressure are not seen among Zabalo individuals in any age category, even though Zabalo residents, overall, experience higher lifestyle stress than Dureno residents.
This may be the result of several factors; first, by moving further into the rainforest Zabalo individuals removed themselves from many of the social and environmental stressors that face Dureno residents, and second, by returning to somewhat of a traditional lifestyle, the
Zabalo Cofan appear to be reaffirming their cultural identity and regaining a sense of control over their lives thus, reducing the effects psychological stress has on their health.
Intestinal Parasites
Overall, helminth infections (Ascaris and hookworm) were higher in Dureno than Zabalo, regardless of sex. Dureno males had a higher prevalence of Ascaris infections, whereas females show a higher level of hookworm infections. The intensity of individual worm burdens, the number of eggs per gram of feces, also was higher in Dureno. The number of single helminth infections was three times higher in Dureno males and twice as high in females. The prevalence of helminth infections by specific age groups was not significantly different; however, Dureno males 13 years and older, were infected almost twice as often as those in Zabalo.
175 A confounding factor with regard to these analyses is that people from both villages
are not isolated and Zabalo residents make frequent (5+ times/ yr.) trips back to Dureno. Therefore, infected individuals from Zabalo may have contracted their infections in Dureno.
Also it is common to find whipworm (Trichuris trichiurd) in association with roundworm
(Ascaris lumbricoides) infections. A study conducted in Dureno in 1968 and 1969 (Smith,
1970) reported the presence of all three intestinal nematodes; Ascaris lumbricoides,
hookworms, and Trichuris trichiura. The present study however, did not recover Trichuris eggs in any of the 74 specimens. These frndings may be due to the fact that Trichuris
infections usually result in diarrheatic stools and the consistency of samples submitted in the 1996 survey was either soft or well formed.
As stated previously, the Cofan’s physical and cultural environments have changed dramatically in the last 20 years. Intestinal parasites flourish in communities where social conditions are characterized by poor housing, inadequate sanitary practices, and overcrowding (Sanjur, 1989). Many cultural changes noted in this study were precipitated by environmental degradation. Dureno has undergone considerable change in its natural environment which has led to changes in housing patterns, modes of travel, water procurement, and overall subsistence strategies. When examining correlations between the cultural variables and parasitic infections, it appears that when material lifestyle is lower there is an increased prevalence of parasitic infections. Another interesting correlation is that a decline in Traditional Medical Beliefs may foreshadow an increase in parasitic infections. Although the correlation is weak, which may be due to sample size, it suggests the hypothesis that a break down in traditional beliefs may lead to a deterioration in health status. Overall, no single cultural factor appears responsible for the development or distribution of parasite infections within these two communities however, several cultural and environmental situations can be considered contributing factors to helminth prevalence in both populations.
176 According to Smith (1970), defecation habits of various age groups creates heavy fecal contamination in the village and surrounding forest. Children from walking age to 3 years old usually defecate under or beside the houses. As they get older they begin to defecate in the vegetated areas behind the houses (the usual defecation area for adults).
Although the areas surrounding the houses are kept clear of vegetation and swept regularly, soil conditions (sandy, moist, and shaded) combined with moderate daily temperatures provide the proper climate for embryonation and hatching of ova which rapidly become infective. Helminth ova are ingested or penetrate the skin (in the case of hookworms) by various means. The usually barefooted Cofan track dirt and ova into the houses especially on rainy days and direct infection may occur by skin penetration. Children 4-12 years old play all day in the village and surrounding forest which are areas of heaviest fecal contamination. They frequently go into the houses carrying the contamination into the living quarters. Infants crawling on the floors come into contact with ova and ingest them directly. Food contamination also occurs since older girls and adult females prepare much of the food by mixing it with their unwashed hands, and children will eat by dipping their unwashed hands into the food containers. Also, there is community access to food, especially for children, so contamination from one household could easily be spread to another household by the children.
Activity patterns also play an important role in the prevalence of helminth infections. Individuals harboring the heaviest worm burdens in both villages are males 13 years and older. These results differ from Smith’s 1970 study of the Dureno Cofan, where she found higher parasite burdens in 3-12 year olds. Smith concluded that 3-12 year olds spent more time in and around the village putting them in direct contact with larvae-infested soil. Today environmental depletion and destruction has lead to decreased hunting and fishing which is usually done by males 13 years and older. The increased prevalence of infections seen in this Dureno age group may be due to the fact that they spend more time in
177 the village during the day thereby increasing their exposure to these parasites, whereas males from Zabalo frequently leave the village to hunt or fish. Also increasing agricultural practices in Dureno put these individuals into more frequent contact with infected areas surrounding the village.
Several other factors must be considered when assessing helminthiasis within the
Cofan communities. First, individuals from both villages have indicated taking commercial parasitic medications. Second, a drink made from the Banisteriopsis plant, consumed in
/Yage/ religious ceremonies, has anthehninthic effects. Two compounds, harmine and harmaline, isolated from Banisteriopsis species grown in Dureno, are especially effective on ascarid worms (Der Marderosian et al., 1968). Smith (1970) noted that individuals from Dureno reported passing large white worms after consuming /Yage/. Furthermore, although latrines and well sites can be built to combat intestinal parasitic infections, there is no assurance that these facilities will be used. This is evidenced in Dureno, where modem latrines (porcelain flush commodes) are non-functional and a manually operated well is seldom used because it is located far from many homes.
The general pattern of change occurring among the Cofan, an initial decline in health with culture change, is similar to other acculturating populations (Shephard and
Rode, 1996; Friedlaender, 1987; Kroeger and Barbira-Freedman, 1982). Several studies reported increased parasitic burdens among acculturating Amazonian populations (Chemela and Thatcher, 1989; Nwosu, 1983), while other research (Schwaner and Dixon, 1974) found reduced incidence of worm burdens among more acculturated Amerindians.
Although acculturation in some cases, can bring increased opportunities for health education and access to western medicines, it can also cause the estrangement o f indigenous groups resulting in the deterioration of their lifestyle resulting in an overall reduction in health (Shephard and Rode, 1996). The extent to which progressive acculturation will alter the health and disease status of this population, and the speciflc
178 elements which are causative, are matters for conjecture at the present time. Longitudinal
data on health and lifestyle, collected while these populations are undergoing sociocultural
change, are needed to strengthen the validity of this study. Future studies to determine the
relative distribution of worm burdens within the Cofan communities may help identify
earner individuals that should be monitored and treated periodically in order to reduce the level of contamination within each village.
Dental Health
Among children, linear enamel hypoplasia was noted in boys and girls from both
villages. Various researchers have noted that hypoplasias are more common in children
from lower socioeconomic groups and are most likely due to hypocalcemia induced by
severe diarrhea early in life when teeth mineralize (Holm, 1990; Nikiforuk, 1985). Several smdies show that children with this type of enamel defect have an increased number of
dental caries (Infante and Gillespie, 1977; Schamschula et al., 1978). In Dureno, girls exhibit a higher dmft index and more decayed teeth than boys, whereas no differences in dental measures are seen between the sexes in Zabalo. Girls from Dureno have a higher dmft Index, and more decayed teeth compared to Zabalo girls, while no differences are seen among boys. The World Health Organization defined the degree of severity for dental caries at age twelve, based on the dmft index, as follows: 0.0- 1. 1= very low, 1.2-2.6 = low, 2.7-4.4 = moderate, 4.5-6.S high, and >6.5 very high. Six countries with the highest dmft scores at age 12 are; Brazil 4.9, El Salvador 5.1, Grenada 5.5, Lebanon 5.7, Latvia
5.8, and the former Yugoslavia 6.1 (Nithilaet al., 1998). Cofan children 2-12 years of age have a mean dmft of 6.3. Since the dmft is a cumulative index, that is, you would expect the rate of affected teeth to increase with age. Cofan children < 12 years of age from
Ecuador have a substantially higher dmft compared to means for 12 year-olds from other countries. A previous study (Infante and Gillespie, 1977) among rural Guatemalan
179 children stated that the caries rate was significantly higher in boys than girls. However,
this was not the case among the Dureno Cofan, girls had a significantly higher caries rate.
Research on rodents has shown that moderate protein deficiency imposed during tooth
development can delay eruption, and increase caries susceptibility (Shaw and Griffiths,
1979; Navia, 1970). On several occasions (based on observational data), individuals from Dureno stated they needed to go hunting because “their son needed meat.” These were
families with both sons and daughters under 3 years of age. Gender bias, with regard to
food allocation, has been reported in a number of populations (Graham, 1997; Messer,
1997; Miller, 1997; Frongillo and Begin, 1993). Although further studies must be
conducted to substantiate this claim among the Cofan, girls may be experiencing moderate
protein deficiency during early childhood with parents making protein more available to male children.
Among individuals 13 years and older, Dureno residents have more gingivitis, broken front teeth, missing front teeth, and dentures compared to Zabalo. This may be due
to the fact that Dureno individuals are on average older than Zabalo residents. Dureno men have more filled teeth, while women have a higher DMFT index and more missing teeth.
When comparing villages, Dureno men have more filled teeth, while Zabalo men have more
decayed teeth. The reason that Dineno men have more filled teeth overall is two-fold; 1)
the proximity to dental care, since Dureno is nearer to Lago Agrio which has a number of dental clinics, and 2) men interact more with non-Cofan and tend to go into the oil towms more than women, or men from Zabalo. Dureno women have more missing teeth, while
Zabalo women have more decayed teeth, this may be related to the age of individuals in each village and to the fact that Dureno girls, in general, have more decayed teeth at earlier
ages. However, women have more missing teeth than men regardless of village. This may be the result of using their teeth as tools. Many women were seen using their teeth to break palm vines that are used in making various traditional items. Also enamel hypoplasia,
180 which appears at an early age among the Cofan, may weaken teeth making them more susceptible to breakage.
When comparing cultural variables with dental indices, among males as the
Economic Factor and SES decrease there is a subsequent increase in the DMFT and Caries Indices. Among females, as Material Lifestyle, Acculturation Index, Lifestyle Incongruity, SES, and Economic Resource Index increase so does the caries rate. In Zabalo, as the
Economic Factor, Lifestyle Incongruity, and SES increase the DMFT Index decreases; while as the Economic Factor, Traditional Medical Beliefs, Acculturation Index, and SES increases the Caries Index decreases. No significant correlations between cultural variables and dental indices were observed in Dureno. Types of purchased foods were also correlated with the dental indices after controlling for age. Among females, an increase in occasionally purchased sugar was correlated with a decrease in the DMFT Index; while an increase in occasionally purchased starch was correlated with an increase in the Caries
Index. Overall among females, as the amount of total purchased foods increased so did the number of caries. No significant correlations were observed among men. Some traditional foods may have anticariogenic properties; for example, replacement of sugars with sugar alcohols reduces dental caries by reducing the number of challenges to the teeth thus increasing remineralization time. Cofan men ingest large quantities of fermented carbohydrates such as “chicha,” a fermented manioc drink. Several studies have shown that in the absence of refined or processed foods, sugar alcohols may confer some protection against dental caries (Makinen and Isokangas, 1988; Scheinin and Makinen, 1975).
Birkhed (1990) emphasizes that dental caries are a multifactorial disease and a number of factors (cariogenicity of food, fluoride ingestion, eating patterns, oral hygiene, host susceptibility) determine whether teeth develop decay. Previous research has shown that populations undergoing acculturation experience increased dental caries (Price, 1945;
181 Niswander, 1967; Mayhall, 1977; Sam atet al.,1987; Holm, 1990). Although a rapid
increase in dental caries is governed by multiple factors, in most instances, it coincides with a shift from traditional foods to processed foods with refined carbohydrates. Recent studies
suggest that sugar continues to be the main threat to dental health in spite of improved oral
hygiene and increased use of fluoride (Marthaler, 1990). Inter-village comparisons among
the Cofan show that an increase in purchased/processed foods is associated with an
increase in dental caries. In Dureno, an increase in ftequently purchased sugar, starch, and total purchased foods were correlated with an increase in the Caries Index. In Zabalo,
an increase in frequently purchased starch was associated with an increase in the Caries
Index; however, an increase in occasionally purchased starch was associated with a decrease in the Caries Index. Other factors such as increased affluence and altered eating patterns also have been cited as important correlates to caries development (Edmondson,
1990), while other researchers associate a low socioeconomic level with increased caries prevalence (Samuelson et al., 1971; Infante and Russel, 1974; Holm et al., 1975).
Research results among the Cofan are mixed. The Cofan stated they would eat more often when they had meat, and an increase in affluence among women, shown by a higher
Material Lifestyle, SES, and Economic Resource Index, is correlated with increased caries rate; however, a decrease in affluence among men, as shown by a lower Economic Factor and SES, is correlated with an increased caries rate. Overall, it appears that more Cofan men seek dental help than women, as evidenced by the increased number of men with filled teeth. Therefore, increasing affluence in females leads to an increase in dental caries that go medically unattended whereas, among men, lower levels of affluence prohibits them from seeking dental help leading to an increased number of dental caries.
Dental health is poor in both villages, regardless of sex, and is associated with environmental and cultural change. A major factor is a decease in the amount of minerals obtained from drinking water. Pollution has forced the Cofan to cease drinking mineral
182 rich river water and rely on rainwater which is void of essential minerals necessary for
dental health. This combined with poor dental hygiene (brushing their teeth once every
week or two), and increased consumption of purchased sugar and starch, has led to higher
DMFT and Caries Indices. Indeed, diets richer in traditional foods may help protect against dental caries (McDonald, 1985). Among the Cofan, staples such as chocula (banana gruel)
and chicha (fermented yucca beverage) contain sugar alcohol which is absorbed more
slowly than glucose and metabolized mostly in the liver. A 2-year study at the University
of Turku in Finland showed that individuals consuming the sugar alcohol xylitcl
experienced a 90% reduction in caries compared to individuals consuming sucrose and
fructose (Randolph and Dennison, 1981). Therefore, the traditional Cofan diet combined
with essential minerals obtained from river water was most likely anticariogenic. Less
frequent brushing of teeth was offset by chewing fibrous foods which increased salivary
flow and prevented carbohydrates from sticking to the tooth enamel.
Overall, Cofan females show an increase in dental caries with increasing levels of acculturation; whereas males show an increase in dental caries and DMFT Index with lower Socioeconomic Status and Economic Factors, two components of acculturation. Some
variables are harder to explain, for instance, why in some instances, does the DMFT and
Caries Indices decrease with an increase in the amounts of purchased sugar or starch? This may be related to better health education, improved oral hygiene, and vitamin supplementation, or the actual amounts of sugars or starches consumed; however, further research is necessary to answer this question. Another interesting result is the negative correlation between Traditional Medical Beliefs and the DMFT and Caries Indices in
Zabalo. Since Traditional Medical Beliefs are not correlated with level of acculturation, the decrease in Traditional Medical Beliefs and subsequent increase in dental problems may be related to medicinal plant use. Perhaps forest products used to treat various illnesses may
183 also confer protection against dental caries. Once again, further research is necessary to establish this connection.
6.2.1 Hypotheses
Hypothesis I - Health status is negatively correlated with village cultural and environmental change.
la: The village practicing a more traditional life style will have better health and dietary status.
lb: The village reporting higher levels of participation in non-traditional activities will exhibit greater intake of processed foods, higher weight and BMI, higher incidence of dental problems, higher incidence of parasitic infections, higher glucose and cholesterol, lower hemoglobin, and higher blood pressure than the village practicing a more traditional life style.
These hypotheses are partially supported by the data. Although more houses in Zabalo are traditional in style and construction, residents own non-traditional items such as motors for their boats, sewing machines, radios, guns, and solar panels. While Dureno residents participate in the market economy through agriculture and handicraft sales, Zabalo residents participate through ecotourism and handicraft sales. Overall, Zabalo residents have higher socioeconomic status, and score higher on the acculturation and economic resource indices than Dureno residents. Zabalo residents frequently consume more purchased sugar, starch, and protein products compared to Dureno. Children 12 years old and younger show little anthropometric variance between villages. However, 9-12 year old boys from Zabalo have more upper arm muscle area whereas Dureno boys have more upper arm fat. Among adults, weight and BMI does not differ between villages; however, 2[abalo males have larger upper arm and hip circumferences than Dureno males. Females from Dureno are taller and have larger suprailliac skinfolds and a higher percentage of upper arm fat compared to Zabalo females. Girls 12 years old and younger from Dureno have higher
DMFT, and Caries Index than in Zabalo, while no differences are seen among boys. More
Dureno adults have gingivitis, predisposing them periodontal disease and subsequent tooth
184 loss. Missing teeth were more frequent among Dureno females compared to Zabalo;
however, the number of decayed teeth was higher in both sexes from Zabalo. Dureno males had more filled teeth than Zabalo males, hitestinal parasitic infections are more
frequent in both sexes from Dureno. Cholesterol levels are higher among Zabalo residents,
especially males. Hemoglobin levels were slighdy lower among Zabalo females aged 13 -20 years. No differences in glucose levels exist between villages. Diastolic blood pressure and pulse rates are higher in Dmreno. However, more individuals from Dureno report being treated for intestinal parasites, tuberculosis, and female reproductive problems compared to Zabalo. Although not statistically significant, conditions such as hypertension, gall bladder problems and nervous conditions occur in Dureno but not in Zabalo.
Therefore, the data partially supports Hypothesis la, the village practicing a more traditional life style (Zabalo) has better health status; however, based on the consumption of processed foods, they do not have better dietary status. With regard to Hypothesis lb, the data support the following components; the village with higher levels of non-traditional activities (Dureno) has more dental problems, more parasitic infections, and higher blood pressure. However, Dureno residents, in general, do not consume more processed foods, weigh more, or have higher BMI’s, glucose, or cholesterol levels, or lower hemoglobin levels compared to Zabalo residents.
Hypothesis 2 - Health status is negatively correlated with level of individual acculturation.
2a: More acculturated individuals will exhibit a higher lifestyle incongruity.
2b: More acculturated individuals will show greater intake of processed foods, higher weight and BMI, more dental problems, more parasitic infections, higher glucose and cholesterol levels, lower hemoglobin levels, and higher blood pressure than individuals practicing a more tradition^ lifestyle.
185 These hypotheses are partially supported by the data. Males from both villages have higher
acculturation and lifestyle incongruiQf scores compared to females, with Zabalo males
having higher scores than Dureno males. Zabalo residents frequently consume more
purchased sugar, starch, and protein products compared to Dureno; however, there are no
between sex differences in either village. Males from Dureno are taller, weigh more and
have higher BMI’s compared to females from Dureno. Males from Zabalo are taller and
weigh more than females however, their BMI’s are not significantly different. Weight and BMI do not differ between villages; however, males from Zabalo have larger upper arm
and hip circumferences than Dureno males. Dureno males have more filled teeth compared to females, whereas females from both villages have more missing teeth compared to
males. Males from Zabalo have a higher rate of dental caries compared to Dureno males.
Overall, intestinal parasitic infections are more frequent in both sexes from Dureno;
however, Dureno males, 13 years and older, are infected twice as often as those in Zabalo. Females from both villages have higher cholesterol levels than males. However, Zabalo
males have higher cholesterol levels compared to Dureno males. Glucose levels are not
significantly different regardless of sex or village, and hemoglobin levels do not differ between villages (controlling for sex and age). In Zabalo, males have higher systolic blood
pressure compared to females. Dureno males and females have higher diastolic blood pressure and pulse rates compared to Zabalo.
Thus, these data support Hypothesis 2a, more acculturated individuals (Zabalo
males) have higher lifestyle incongruity scores i.e. higher lifestyle stress. With regard to
Hypothesis 2b, the data support the following components, more acculturated individuals
have more parasitic infections and higher cholesterol levels; however, they do not consume more processed foods, weigh more, have higher BMI’s, glucose levels, or blood pressure,
and they do not have more dental problems or lower hemoglobin levels.
186 6.2.2 Conclusions
The general pattern of change occurring among the Cofan, an initial decline in
health with culture change, is similar to other acculturating populations (Shephard and
Rode, 1996; Friedlaender, 1987; Kroeger and Barbira-Freedman, 1982). However, the
initial assumption, that Zabalo is a more traditional village and Dureno is more acculturated
is not supported by the data presented. Both villages should be considered transitional
because both have contact with and access to non-indigenous people and goods. Although
acculturation might bring increased opportunities for health education and access to
Western medicines, it also can cause the estrangement of indigenous groups resulting in the
deterioration of their lifestyle and an overall reduction in health (Shephard and Rode,
1996). Increasing population density and decreasing availability of land are contributing to a decline in health as seen in the higher parasite loads among Dureno residents.
Furthermore, dietary changes may be contributing to the higher skinfold measures and arm fat index seen among Dureno residents. Acculturation and accompanying changes in lifestyle often result in an increasing prevalence of such chronic conditions as diabetes and hypertension along with increases in dental caries, and psychosocial problems which include alcohol abuse and suicide (Bindon and Crews, 1990). We are beginning to see these problems among the Cofan. However, the Cofan are not static entities and each, in their own way, continues to adapt to changing cultural and physical environments. The extent to which ongoing acculturation will alter the health and disease status of this population, and the causative elements, are matters for speculation at the present time.
However, by reaffirming their cultural identity and regaining a sense of control over their lives, indigenous groups such as the Zabalo Cofan may be reducing the psychological stress of change, thus reducing their risk of developing chronic conditions such as hypertension. Longitudinal data on health and lifestyle, collected while these populations
187 are undergoing sociocultural change, are needed to strengthen the conclusions of this study.
6.3 Significance of Research and Future Directions
Rapid ecological and environmental changes occurring in the Ecuadorian Amazon make this region uniquely suited for examining human variation and adaptability. Studying acculturating populations such as the Cofan with a focus on health and disease will aid in understanding how humans adapt to new environmental and cultural conditions. Today’s
Amazonian cultures are groups of survivors affected by habitat destruction, disease, economic exploitation, missionization, and colonization. Data from these remnant populations, including the Cofan, may indicate unique genetic patterns and differences in physiology that are important for studying human adaptation (Salzano 1988).
A major concern for anthropology is how culture change and modem patterns of nutrition and lifestyle affect the well-being and lifeways of traditional populations (Baker et al., 1986). Often such research has focused on the natural environment as the source of stressors which lead to biological, behavioral, or psychological dismption (Little and Haas,
1989). If the disruption is serious enough, illness, disease, or death may result; however, adaptive processes may intervene and reduce the probability of an undesirable outcome. This process may occur at different levels depending on the circumstances; adaptation may be biological (genetic change over a long time or shorter term accUmatory or developmental responses) or it may be behavioral (sociocultural or individual). Adaptation is therefore an intervention mechanism in health-threatening processes. This study contributes to our understanding of human biological, behavioral and cultural adaptability occurring in the face of worldwide environmental change, and provides unique physiological and health data to examine processes and consequences of acculturation within a genetically homogenous population (i.e., a geographically isolated, semi-closed breeding group).
188 An important result of the present study is that cultural revitalization may be buffering the stressors of lifestyle change among the Cofan from Zabalo. It appears that ecotourism is helping revitalize their culture and possibly lessening stress reactions (Poirier and Fitton, 1998). Zabalo residents are proud to be Cofan, have traditional houses, wear traditional dress (cushma), produce traditional household items and are happy to explain their customs to visitors. Dureno residents on the other hand, seem to be trying hard not to be Cofan. Rapid territorial encroachment has caught them between two worlds. Very few wear traditional dress and many of their houses and household items are non-indigenous.
How ecotourism differentially impacts the lifestyle and health of men and women will be an important component of future research.
Results of this study also reveal strong gender differences in physiological measures, body fat distribution, dental health, parasitic infections, and blood pressure. Future research among the Cofan should include the examination of gender differences with regard to health, nutrition, and access to medical care. Other research issues should include: the affects hemoglobin levels have on work patterns, activity levels, and subsequent adiposity; the relationships between fat patterning and chronic disease outcome; nutritional studies that address patterns of household food distribution; how social support may mediate stresses of cultural and environmental change and ultimately affect health. Children appear to be the key to the survival of Cofan society, both biologically and cuimrally. Future studies pertaining to the health and nutrition of children are necessary for understanding and possibly averting health problems reported herein among the adult population. Important questions are: Will the Cofan children of tomorrow embrace their culture or will they succumb to non-indigenous lifestyles? and. What health consequences can be anticipated? Continued longitudinal research on growth and development of Cofan children, both socially and biologically, are necessary to answer these questions.
189 The impact of human activities on health should be a cause for concern. Since they may hold keys to our own survival, perhaps traditional living communities should be protected like other endangered species. The rapidity of lifestyle change among the Cofan necessitates ongoing research into their adaptive responses and health outcomes. Baker states (1974; 520), “With rapid changes now occurring in our biosphere, the problems of adaptive limits and mechanisms may be critical to the survival of human civilization as we know it”. The consequences of enviromnental change and degradation are not limited to this small indigenous group in the Ecuadorian Amazon, their effects will be felt worldwide.
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205 APPENDIX A
MAPS
206 Dureno
Location of Cofan villages of Dureno and Zabalo
207 IBRD 22053
P A S r . A % A
E C U A D O R . AA4AZON REGION STUDY \ ! .Cusyaqu// REGIONAL PROVINCES
Province Boundaries (with in study area only)
Selected Roads National Capital Cities and Towns Rivers River Flow International Boundaries
0CCCMietl9t9
Used with permission from: Hicks JF et ai. (1990). Ecuador's Amazon Region: Development Issues and Options. Washington, D.C.: The World Bank.
208 IBRO 22052
:
CuayaçfUffA ECUADOR AA4A20N REGION STUDY
OIL EXPLORATION AND EXPLOITATION VS NATURAL RESERVE AREAS
ARCO I Oil Exploration Areas
Oil Exploitation Areas
Selected Roads National Capital Cities and Towns Rivers —» River Flow International Boundaries
0ECEMaai9f9 Used with permission from: Hicks JF et al. (1990). Ecuador's Amazon Region: Development Issues and Options. Washington, D.C.: The World Bank.
209 IBRD 22048
ECUADOR Cuayaquf/ ^ AMAZON REGION STUDY - xfT SETTLEMENT FRONTIER
4 S#ttlemenc Frontier
Selected Roeds National Capital Cities and Towns Rivers River Flow International Boundaries
D K B « tai9 l9 Used with permission &om: Hicks JF et al. (1990). Ecuador’s Amazon Region: Development Issues and Options. Washington, D.C.: The World Bank.
210 APPENDIX B
PHYSICAL ASSESSMENT FORM
Physical M easures Participant Id No. .Date . Time. Name______Village D
Sex f Age_ Spouse.
Pulse #1 B /P#l
Pulse #2_ B/P#2.
Pulse #3 B/P#3
Environmental Conditions .Quiet. .Noisey Other.
Glucose Reading.
Hemoglobin Reading.
Cholesterol reading __
Malaria Slide Obtained N
Buccal Swab Obtained N
Fecal sample obtained Y N
If yes, color ______consistency.
Dental Index: Total#teeth. . #Decayed_ #Missing #Filled
211 Anthropometric Measures Height______
Weight______
Triceps,
Subscapular.
Suprailliac__
ArmCirc. Waist Circ._
Hip C irc ._
Clothing measurements Top ______Bottom,
212 APPENDIX C
24-HOUR DIETARY RECALL QUESTIONNAIRE
24-HOUR RECALL
Participant Id#______Name
Day of the week: Time* ______Food _Items______Preparation** ______Amount
I - Morning ** 5- fried 2- Midday 6- roasted 3- Afternoon 7- boiled 4- Evening 8- canned
213 APPENDIX D
FOOD FREQUENCY QUESTIONNAIRE
FOOD FREQUENCY CHECKLIST DATE.
PARTICIPANT ID#______NAME______
Please tell me how many servings of these foods you eat each week, which foods you seldom eat (less than 6 times/year), which foods you never eat, which foods are only available in the dry season (D) or wet season (W) and which are locally grown (L) or bought (B).
Food______staple freq eat occas eat never eat D W L B yucca ______yucca drink ______maize______plantains ______bannanas ______chocula______peach palm______palm bruit______potatoe ______sweet potatoe ______peppers______carrots ______papaya______214 Food staple freq eat occas eat never eat P W L B | orange ______lemon ______avocado ______inga ______achira______cacao ______guyaba ______pecary______turtle______squiriils______monkeys woolly howler squirill______agoutis ______fish pacas pirannas catfish______tapirs______armadillos ______curassows ______guans ______ocelots ______j aguar ______snake______
215 Food______staple freq eat occas eat never eat D W L B chicken, eggs ___ rice___ tuna sardines fried bread, popcorn __ beans coffee coca-cola candy / sweets. yoco (caffine drink), morete ______sapotes, huito uvillas pokeweed, inchi_____
1. Other foods not listed that you eat regularly. 2. How many times a day do you eat? What times EM MM LM EA MA LA E
3. Are there any available food items that you won't eat because of cultural taboos?
4. How do you fish? nets poles posion dynamite
5. How do you hunt? blowguns shotguns snares
6. Do you sell anything you catch or grow to other towns or people?
216 APPENDIX E
INDIVIDUAL INTERVIEW QUESTIONNAIRE
INDIVIDUAL INTERVIEW **lf head of Household skip to question 14
Personal ID # ______Village D Z 1. Name______2. Sex / Age ______
3. Where were you bom?_
4. What is your mothers name?_
fathers name? - Where were they bom? M_ 6. How many living brothers and sisters do you have?
Name Sex / Age Where do they live
Any deceased siblings Any twin siblings.
Any siblings that died at birth or before birth.
7. Are you married or single? How old were you when you were married.
- Spouses name ______8.How many children do you have?
Name Sex / Age Where do they live
217 9. Have you attended any school? Y N
If yes where and how long? ______
10. Do you have a job now/being paid to work? Y N
If yes what is your Job? ______11. How often did you get paid to work in the last year?_
12. What other kinds of work do you do? ______
13. Can you speak Spanish? Y N
Can you speak English? Y N
14. In the past year how many times have you gone to Dureno?
0 1-2 3-4 5+
15. Have you ever gone to Lago Agrio? Y N If yes how many times in the last year? 0 1-2 3-4 5+
16. Have you ever gone to Quito? Y N
If yes how many times in the last year? 0 1-2 3-4 5+
17. Have you ever travelled any where else? Y N If yes where and what for?
18. Which describes your typical level of physical activity when working
______Light (mostly sitting and lying down) ______Moderate ( some standing, walking )
.Heavy ( very little sitting activities such as, gardening .cleaning. caring for children) _Very Heavy ( walking/ running such as hunting and gathering)
19. How would you describe your level of activity when you are not working?
L M H VH 20. How many times a week do you get exercise such as, volleyball, soccer, hiking?
none ______1-2/week 3+/week
218 21. Do you smoke? Y N If yes what.
If yes how often? occasionally daily weekly
How many 1-2 3-4 5+ 22. Do you drink alcoholic beverages? Y N
If yes what kind? Chicha Rum Beer Other
How often? occasionaly daily weekly
How much? 1-2 3-4 5+
23. Have you ever seen a doctor? Y N If ves what for?
24. Are you taking any medications? Y N
If ves what kind?
25. Have you ever seen a shaman when you are feeling ill? Y N
26. Can evil spirits make a person ill? Y N
27. What makes you happy?
28. What makes you sad?
29. What is your biggest worry?
219 APPENDIX F
HOUSEHOLD INTERVIEW QUESTIONNAIRE
HOUSEHOLD DATA Household ID #
Personal ID #______Village Z D
1. Name 2. Sex / Age ______
3. Where were you bom?______
4- What is your mother name______
fathers name______Where were they bom? M_ 5. How many living brothers and sisters do you have? (D=any deceased? B=any that died at or before birth? T=any twins?) Name Age Sex
6. Are you married or single?. How old were you when you were married.
- Spouses name ______7.How many children do you have?. Name Sex / Age Where do they live
8. Do any other people live in your house? Y N Name Sex / Age Relationship to respondent
9. Have you attended any school? Y N If yes where and how long.
220 10. Do you have a job that pays you to work? Y N ff yes what is it?_
11. How often did you get paid to work in the last year? ______
12. What other kind of work do you do (not paid for)? ______
13. Can you speak Spanish? Y N English? Y N Can your wife? Y N Y N
Can your children? Y N Y N SOCIAL SUPPORT
14. If you need advice who would you ask? family friend neighbor Randy/Zabalo or Ron/Dureno
15. If you are sick, in trouble or just need help who would you turn to? family friend neighbor Randy ( Zabalo) or Ron (Dureno) MATERIAL STYLE OF LIFE
16. Do you own your own house? Y N If No who do you live with? ______Relationship?______
17. What is it contracted of ? (thatched roof or tin, 2x4 floors or reeds)
18. Does the house have more than one room? Y N Is it 1-story or 2-story
19. Is there a wood cooking stove inside house? Y N
20. Do you have solar panels? Y N 21. Where do you get your drinking water? 22. Do you have a latrine? Private or Commimal
23. Do you own a canoe? Y N if yes do you have a motor? Y N
24. Do you own a shot gun? Y N
25. Do you own a radio? Y N if yes what do you like to listen to? ____
26. Do you have a garden? Y N if yes who takes care of it? ______27. Do you sell the produce Y N If yes to whom ______
28. Do you have any animals? Y N if yes what kind?_ 221 APPENDIX G
PRINCIPLE COMPONENTS ANALYSES
Components From Household Data Set m m agag solar panels 0.815 -0.389 (0.701) sewing machine 0.769 0.061 (0.442) canoe 0.756 -0.288 (0.573) radio 0.675 0.175 0.340) furniture 0.618 0.465 (0.819) gun 0.495 0.438 (0.517) # of rooms in house 0.468 0.463 (1.273) raise domestic animals -0.059 0.665 (0.172) sell produce -0.228 0.641 (0.284) house construction materials -0.422 0.517 (2.212) Variance explained by components 3.469 2.211
% variance explained by 28.9% 18.4% components
222 Components From Individual Data Set
- ' - nt. g “ —- ^_, , - a occupaaon 0.712 0.275 (2-815) language 0-672 -0.416 (2-024) education 0-669 -0-123 (0-225) travel to other countries 0-644 0-034 (1.110) travel to Quito 0.642 0.148 (1-560) see shaman when ill 0-082 0-712 (0-398) believe evil spirits can make -0-064 0-674 a person ill (0-374) Variance explained by 2.815 2-024 components
% variance explained by 27.6% 21-7% components
223