The many aspects of life that fall under the broad headings socioeconomic status and ethnicity have long been thought of as key contributors to health status, especially during pregnancy. That’s why the groundbreaking findings of Robert Wood Johnson Foundation (RWJF) Health & Society Scholar 2008-2010 Cleopatra Abdou, Ph.D., may significantly advance our understanding of how culture and resources affect physical and mental well-being in pregnant women. “Our primary discovery was that culture should and can be differentiated from ethnicity and social class, both as a scientific concept and in terms of its real-world impact on health,” Abdou said.
To add clarity and perspective to the existing body of research on health and health care disparities, Abdou and her team asked if communalism—defined as feelings, beliefs and participation in interdependent relationships with family and friends—had a positive effect on the physical and mental health of 297 pregnant women. “Our sample included African American and European American women in the early stages of pregnancy. We followed them through the end of their pregnancies and asked that they complete interviews, questionnaires and medical exams at three stages of gestation,” Abdou explained.
The study, “Communalism Predicts Prenatal Affect, Stress and Physiology Better than Ethnicity and Socioeconomic Status,” was published in the July 2010 issue of the journal Cultural Diversity and Ethnic Minority Psychology.
Previous research has shown that African American women and women who have experienced socioeconomic disadvantages in childhood, adulthood or both are likely to have higher levels of prenatal blood pressure and stress, as did the members of this group who were included in Abdou’s study. Yet, her research revealed that for the members of this group who were studied, higher levels of communalism were "associated with lower levels of prenatal blood pressure and stress. Emotional health was better as well," Abdou noted.
This important finding contradicts existing research that suggests that ethnicity and socioeconomic status are more important predictors of prenatal health than factors such as communalism. It is also interesting to note that the health benefits of communalism were not altered by whether the pregnancy was planned, the women’s feelings about being pregnant, their levels of depression at study entry or levels of self-esteem.
An Emphasis on the Meaning of Relationships
To fully understand the implications of Abdou's work, it helps to take a look at the definitions of communalism used in the study. Rather than simply looking at the size of social networks or how much time the women spent with family and friends, Abdou and her colleagues looked for the deeper meaning in those relationships. Using established instruments, such as the Gaines Familism Scale, study participants were asked about commitment to family and prioritization of family goals. Hui's INDCOL Scale, a tool for measuring individualism and collectivism, was also used to examine feelings, beliefs and behavioral intentions toward family and broader social networks, a sense of solidarity and concern for others.
"We possess some popular notions about connectedness to family that may not be supported in the research," Abdou said. "Poorer families are seen as close-knit, but people with higher incomes and greater material resources have more choices about relationships. Not only do they often have more time to spend with family and friends, they also have more opportunities to cultivate and savor positive social relationships. My hypothesis was that communalism is a non-material cultural resource that anyone--regardless of ethnicity, educational level or income--can possess and benefit from in terms of both physical and mental health. So rather than base our research on the assumption that certain minority groups are more likely to have tightly-woven social circles, we looked at how individuals see themselves in relation to their families and broader social networks and how those feelings figure into personal goals and ultimately impact health and well-being," Abdou added.
Breaking New Ground in Disparities
This study, along with Abdou's larger body of work, is shaped by her interest in advancing research into how ethnicity, race, economics and culture influence health. "Now, more than halfway through 2010, we are very far from reaching the Healthy People 2010 goals that were laid out for our country a decade ago," Abdou said. "Some of the evidence suggests that we may even be losing ground. There is still a good deal of work to be done to increase quality of life for all people and we need creative ways of thinking about this challenge. Our tendency in quantitative research is to talk about culture and ethnicity as the same thing; while they are related, they are defined by different things that both operate independently of one another and interact with one another to affect health and other important life outcomes. My mission is to continue to expand our understanding of the unique challenges minorities face and how those challenges become embedded in biology," she continued.
Abdou, who received her Ph.D. in social health psychology from UCLA in 2008 added, "I can't say enough about the support I received as a Health & Society Scholar. I learned about the program in my second year of graduate school, through my community mentor--Loretta Jones, director of the Healthy African American Families Program in Los Angeles--and it became my dream to be selected as a Scholar. My mentors at the University of Michigan, especially the program directors and James Jackson, Ph.D., were critical to the development of my ideas, particularly from an interdisciplinary lens," Abdou said.
Abdou is now working to contribute new theories of disparities and the role they play in health and health care. "I now have several studies underway looking at cultural resources and how they affect health. We are doing longer-term research on maternal stress and physiology and its impact over the lifespan and across generations. A follow-up study evaluating whether the health benefits of communalism extend across generation is currently under review, as is another study of the effects of familism in mothers on birthweight and the development of asthma symptoms later in childhood," Abdou said. "These health problems--asthma and low birthweight--are significant issues for African Americans and Latinos in the U.S.," said Abdou, who is now an assistant professor of Gerontology and Psychology at the University of Southern California.
The Robert Wood Johnson Foundation Health & Society Scholars program is intended to produce leaders in the fields of health and medicine who will expand on the questions asked and the methods employed to reduce population health disparities and improve the health of all Americans.