ABSTRACT

INTRODUCTION

PART 1

Health Locus of Control
Psychosomaticism
Psychosomaticism and Psychoimmunology
HLC and Psychosomaticism

PART 2

Health Reality Models
The (Cultural) Etiology of Illness
Mode of Acculturation
Well-Being and Mode of Acculturation
Mode of Acculturation and HLC

METHODS

Participants
Materials
Design
Procedure

RESULTS

DISCUSSION

Discussion of Results
Confluence Approach
Cultural Competence
Creativity Amidst Disillusionment
Stress in the 90's
Regaining Control
When Externality is Better
Future Studies

REFERENCES

APPENDIXES

Appendix A Appendix B Appendix C

SPECIAL THANKS

Part II; Culture and Health

Mode of acculturation and health beliefs:
I have established the not so simple relationship between acculturation strategy and health, suggesting that:

Dominant Society Immersion is beneficial in most cases

Ethnic Society Immersion is beneficial for those who are subjugated in this culture

and that a separated mode might be beneficial in cases where the country of origin provides better strategies for placating stress or when discrimination is a high stressor (as possible to conclude from Montgomery's 1992 findings)

Less established in the literature than the relationship between Mode of Acculturation and health is a connection between Mode of Acculturation and HLC. As HLC is comprised of a set of health beliefs, I will discuss how Mode of Acculturation is applicable to such belief structures.

An assimilated individual will generally hold health beliefs consistent with the mainstream. An individual who is separated is more likely to be influenced by health beliefs of their culture of origin. The following is an illustration of this:

Indigenous systems of health beliefs, practices, and medicines exist in all societies, and they exert profound influences on patients' attitudes and behaviors. These belief systems persist in immigrant populations, even among subsequent generations, and they are more strongly held to among certain individuals than others. -Levy & Hawks, 1996.

Generalized LOC:
Because of the dearth in literature on HLC and acculturation, it might be appropriate to illustrate the connections found between LOC and acculturation. But first it is relevant to examine some socio-cultural variables. Previous studies have linked LOC with ethnicity and social class, middle-class whites exhibiting the highest internality (McLaghlin, & Saccuzzo, 1997). Racism, according to Graham (1994) (ctd. in McLaughlin, & Saccuzzo, 1997, p. 277) may proliferate the development of an external locus of control. The following illustrates the inter-connectivity between SES and locus of control: "An internal locus of control may facilitate selection into higher status groups and occupations by fostering an increased sense of self-efficacy with associated gains in planning, effort and motivation. Additionally social roles linked with status may influence locus of control" (Smith et al, 1997).

Mode of acculturation, on top of these socio-cultural influences, has profound impact. The following demonstrates the role of acculturation on LOC: "These authors found that Anglo-American students were more internally oriented than American born Chinese who were, in turn, more internally oriented than the Hong-Kong Chinese students; this, therefore suggests the importance of the role that cultural context plays in the socialization process" (McLaughlin, & Saccuzzo, 1997, p. 270). They explain that this relationship is dependant on values maintained in cultures like ours: "Individuals reared in a culture that values independence, uniqueness, self-reliant individualism, and personal output of energy are likely to be more internally oriented than individuals from a culture that tends to emphasize a different set of values" (seeming to mark the difference between collectivist and individualist nations) (McLaughlin, & Saccuzzo, 1997, p. 270). The socialization process (acculturation) therefore predicts traits like LOC, consistent with mainstream ideology.

HLC:
It is well supported that cultures vary on health outcomes as influenced by different beliefs and life stressors (Comer, 1998; Duffy, 1997; Levy & Hawks, 1996; Marano, 1999; Watkins, 1996; etc.). There is no doubt in the literature over the influence of acculturation on health (Balcazar, et al., 1997; Montgomery, 1992; Tran, et al., 1996; Zambrana, et al., 1997, etc.). Nor would one find contention with the notion that cultures influence the belief models of those who are immersed in them, as verified by studies involving generalized locus of control (etc.). There is little if any literature regarding the influence of acculturation on HLC style, however. Given the irrefutable connection between culture and belief, and the influence of culture over generalized LOC, it is extremely likely that there will be an association. My assumption is that being immersed in the dominant society of the US is liable to increase the chances of displaying an internal HLC for a number of reasons. This is an individualistic nation, which values self-sufficiency over co-operation. Individuals in such an environment are generally more internal on LOC (Hamid, 1994), and HLC in the health domain is likely to coincide. This country also has access to education, and economic advantages not available world-wide, or to those not integrated into this society. According to this country's values, education and economic advantage increase one's chances of adopting an internal HLC. The MAS is used in this study because it demonstrates whether or not one is immersed in this country and its belief structures.