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Cultural Models, Pregnancy, and Stress

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Cultural Models, Pregnancy, and Stress CULTURAL MODELS, PREGNANCY, AND STRESS: EXAMINING INTRACULTURAL VARIATION IN JALISCO, MEXICO by MEREDITH ANN JACKSON A DISSERTATION Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Anthropology in the School of Arts and Sciences of the University of Alabama TUSCALOOSA, ALABAMA 2009 Copyright Meredith Ann Jackson 2009 ALL RIGHTS RESERVED ABSTRACT The purpose of this research was to use cultural domain analysis (n=73) to determine if one or more shared models of a good pregnancy exist in Jalisco, Mexico, and to use cultural consonance analysis (n=88) to statistically determine the association between a woman‟s ability to approximate the shared model and maternal psychosocial and physiological health. Jalisco has a pluralistic reproductive health care system, including midwives and medical doctors, and widely varying sites with differential access to biomedical and traditional health care. In an effort to capture intracultural variability, the research was conducted in an urban area, a semi- urban city, rural municipal seats, small towns, and villages. I predicted that women who are more consonant with the specified model will have lower levels of psychosocial stress and altered immune response, and that social support moderates these relationships. Anthropologists have studied the effects of culture change and stress using both psychosocial and physiological markers, and have employed cultural domain analysis to build models based on informant knowledge and information. Intracultural variation in consonance with the models is associated with stress. Furthermore, psychosocial and physiological stress markers measured during pregnancy are associated with poor birth outcomes. In this study psychosocial measures of stress are pregnancy-related anxiety (PRA) and perceived stress (PSS). Epstein-Barr Virus antibody levels were analyzed to indicate stress-related altered immune function. The analysis controls for socioeconomic status, social class, site, household elements, gestation, parity, and age. ii Cultural consensus analysis found one cultural model of a good pregnancy with strong agreement. The model blends tradition and biomedicine with slight variation in belief in the traditional elements. Linear regression models indicate that participants who are more consonant in the model have lower levels of both PSS and PRA. Consonance is not associated with EBV antibody levels. Perceiving social support from family and non-family enhances the effect of consonance on PRA, unless perceived family support is above the mean. In this case, the effect is blunted. Social support does not moderate the effect of cultural consonance on PSS. This research demonstrates the critical role of culture in health outcomes. iii This work is dedicated to two beautiful souls, Sage and Asa. iv LIST OF ABBREVIATIONS AND SYMBOLS AGEB Área Geoestadística Básica (Basic Geostatistical Area) CRP C-Reactive Protein CV Coefficient of variation EBV Epstein-Barr Virus F Ratio of variances IMSS Instituto Mexicano del Seguro Social (Mexican Institute of Social Security) INEGI Instituto Nacional de Estadística, Geografía, e Informática (National Institute of Statistics, Geography, and Informatics) ISSSTE Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (Insitute of Social Security and Services for State Workers) SLE Stressful life events N, n Number p Probability of results or outcome PAN Partido Acción Nacional (National Action party) PRA Pregnancy-related anxiety PRD Partido de la Revolución Democratíca (Democratic Revolutionary Party) PRI Partido de la Revolucionario Institucional (Institutional Revolutionary Party) PSS Perceived Stress Scale r Pearson product moment correlation v R2 Multiple correlation coefficient SD Standard deviation SES Socioeconomic Status SJE San Juan Espanatíca t Computed value of t-test X2 Computed value of chi-square x¯ Mean ZDV Zapotitlán de Vadillo ZMG Zona Metropolitína de Guadalajara (Metropolitan Zone of Guadalajara) α Alpha = Equal to < Less than > Greater than ≤ Less than or equal to vi ACKNOWLEDGMENTS In the years it has taken to see this dissertation to completion, there have been countless individuals who have guided and supported me, each in no small way. First and foremost, I thank Kathryn S. Oths for her unyielding patience and perseverance in keeping my efforts moving forward, always steering me back from sideways moments; and picking me up when my feet seemed to have slipped from beneath me. No student could ask for a more dedicated mentor, teacher, and friend. This dissertation would never have been completed without her. Thank you to William W. Dressler for years of answering statistical queries, many times in duplicate. His patience and willingness to walk me through complicated analyses have been invaluable, as are his advice and guidance in the research design and methodology. Thanks to James R. Bindon for giving advice and answers when needed, and especially pointing out the good humor in critical moments when it may have been easy to see the negative. Thank you to Jason DeCaro for his incredible patience as he demonstrated, taught, and watched while I learned hands-on in the laboratory. I would also like to thank him for his quick and thoughtful responses to the many questions I posed to him. Thanks to Ida Johnson for her comments, suggestions, and time that aided in finalizing this dissertation. Many thanks Enriqueta Valdez Curiel for helping me to find and get to the research area, initiate the project in Mexico, provide work space, and, most especially, for her friendship. To Evangelina Villanueva Garcia, I could never have achieved this research project without her friendship, advice, mentorship, and assistance. Thanks for taking me under her wing and trusting me. To Javier Eduardo Garcia de Alba Garcia, Ana L. Salcedo Rocha, Rafael Saldaña Bustos, Georgina Diaz, and Iliana Romo, thank you for vii welcoming me and helping me to complete this project in a foreign land. Their support is very much appreciated. To the midwives who trusted me with their clients and who opened their lives to me, I cannot thank them enough. Also, thanks to all of the doctors, nurses, and staff at the IMSS Clinic in Ciudad Guzmán, the Health Centers in the cabeceras, and the New Civil Hospital in Guadalajara. To my family and friends, I could never thank anyone enough for their support. To Jeff deGraffenried, who endured living apart for my fieldwork and living together for the analysis and writing, and is still here willing to endure more of life with anthropology. There are not enough words to express my gratitude. A huge thank you to my children, Sage and Asa, who moved to another country, went to school in a foreign language, had to say goodbye to friends and family twice, and have made many other sacrifices along the way while I focused on my research. This dissertation belongs to these two children. I never would have made it this far without the love and support of my parents, Mike and Jeanie. Thank you for always encouraging me to keep on keeping on. A world of gratitude goes to Josalyn Randall for her friendship, emotional support, tinctures and teas, and for helping me with childcare and life, both in the States and Mexico. Many thanks go to Sarah Szurek for her unending encouragement, friendship, and professional support. I hope that I can return the favor. Also, to Toni Copeland and Mary Campbell, thank you for helping to keep my head high when I needed a nod. Thanks to Josh Moore, Rachel Shuttlesworth, Chris Humphries, Justy Brown, and Rick Brown for emotional, material, and instrumental support in all things. I will forever be indebted to Bob Boshell for lending space in his home-away-from-home. To Drs. Forero, Vaughn, Salzman, and Lopez at UAB, thank you for keeping me alive to carry out the research and write this dissertation. viii Thank you to the National Science Foundation and the University of Alabama for their financial support, without which I could not have completed this research. Finally, to all of the women who participated in this research, and all of the women and men who participated from the sidelines, I could never sufficiently express to them my gratitude for their involvement. It is my hope that this research can benefit future generations of mothers, sisters, and daughters as they experience the blessing of reproduction. ix CONTENTS ABSTRACT .................................................................................................................................... ii DEDICATION ............................................................................................................................... iv LIST OF ABBREVIATIONS AND SYMBOLS ............................................................................v ACKNOWLEDGMENTS ............................................................................................................ vii LIST OF TABLES ...................................................................................................................... xvii LIST OF FIGURES .......................................................................................................................xx 1. INTRODUCTION ......................................................................................................................1 2. THEORETICAL ORIENTATION AND BACKGROUND ....................................................11 a. Introduction ...............................................................................................................................11
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