Racial differences in birth outcomes: the role of general, pregnancy, and racism stress.

OBJECTIVE: This study examined the role of psychosocial stress in racial differences in birth outcomes. DESIGN: Maternal health, sociodemographic factors, and 3 forms of stress (general stress, pregnancy stress, and perceived racism) were assessed prospectively in a sample of 51 African American and 73 non-Hispanic White pregnant women. MAIN OUTCOME MEASURES: The outcomes of interest were birth weight and gestational age at delivery. Only predictive models of birth weight were tested as the groups did not differ significantly in gestational age. RESULTS: Perceived racism and indicators of general stress were correlated with birth weight and tested in regression analyses. In the sample as a whole, lifetime and childhood indicators of perceived racism predicted birth weight and attenuated racial differences, independent of medical and sociodemographic control variables. Models within each race group showed that perceived racism was a significant predictor of birth weight in African Americans, but not in non-Hispanic Whites. CONCLUSIONS: These findings provide further evidence that racism may play an important role in birth outcome disparities, and they are among the first to indicate the significance of psychosocial factors that occur early in the life course for these specific health outcomes.     

Psychological,sociocultural, and marital adaptation of Turkish immigrant couples in Canada

The study examined the acculturation and adaptation of 200 married Turkish immigrants in Toronto, Canada, using self‐report questionnaires. As an extension of research from sojourners to immigrants, and from individuals to married couples, marital adaptation was introduced and three facets of adaptation were differentiated: psychological, sociocultural, and marital. The findings support the contention that adaptation is multifaceted. Consistent with stress and coping models, psychological adaptation of married couples was associated with the personality variable of hardiness, social support, acculturation attitudes, and discrimination. On the other hand, in line with social learning perspectives, sociocultural adaptation was mostly related to the variables instrumental in acquiring social skills in the new culture, namely, language proficiency and contact with members of the dominant group. Marital adaptation was mostly associated with marital stressors and marital support. The lack of research on gender differences in the differentiation of adaptation was addressed. This differentiation was clearer in men than in women; there were also different variables associated with the facets of men's and women's adaptation. The effects of socioeconomic status and gender have also been examined. The findings made it evident that Turkish immigrants did not acculturate uniformly. Two groups of Turkish immigrants, working class and professionals were clearly distinguished in their acculturation experiences and adaptation. Gender differences were most apparent in the low socioeconomic status group. Women in general were psychologically more vulnerable than men; the group that faced more risk factors were those women of low socioeconomic status. In terms of acculturation attitudes, Turkish immigrant couples strongly endorsed separation; however, those of high socioeconomic status preferred integration and assimilation to a greater, and separation to a lesser extent than those of low socioeconomic status.     

Adolescents' orientation toward the future: Sex role differentiation in a sociocultural context

The present study examines sociocultural variations of gender differences reflected in the future orientation of Israeli Jews and Arabs as cases of modernity vs. transition to modernity, respectively. One hundred and twelve Jewish adolescents (61 males and 51 females) and 116 Arab adolescents (67 males and 49 females), all high school seniors in a college-bound program, responded to an open-ended future orientation questionnaire and listed their hopes and fears for the future. These responses were categorized into eight life domains (school and matriculation, military service, higher education, work and career, marriage and family, self, others, collective issues) and each domain was analyzed in terms of salience (i.e., importance and interest, assessed by number of pertinent statements) and specificity (i.e., extent of detail and concreteness, rated on a 1–3 scale). Results supported the hopothesized instrumental-expressive division between Jewish males and females and the primacy of higher education for Arab females. Analysis employing U. Bronfenbrenner's (The Ecology of Human Development: Experiments by Nature and Design, Cambridge, MA: Harvard University Press, 1979) ecological model of development suggests that these gender differences are sustained by the developmental settings of Jewish and Arab adolescents.     

The sociocultural movement in psychology,the role of theories in sociocultural inquiries,and the theory of sociocultural models

This special issue presents the theory of sociocultural models (TSCM) and its applications in diverse areas of psychology, including education, health care, clinical practice, gender relations, and general research. As many theories already exist in the social sciences, some readers may ask: “Why do cross‐cultural, cultural, and indigenous psychologists need another theory?” This question is comprised of two aspects: culture/cultural and theory/theoretical. Therefore, to answer it, it is important to clarify both issues. The first relates to cultural and its relation to psychological. The second, theory, considers its relation to cultural and psychological. These issues have long‐range implications for all culture and psychology disciplines as they pose many questions: What role does culture play in the mental functioning of people? How is culture constituted? Is cultural related to social? Does people’s mental functioning exert reciprocal influences on their cultural and social functioning? While working toward answering these questions, researchers quickly determine that more questions arise: What role should theories play in answering these questions? What constitutes theory in culture and psychology disciplines? How should such a theory (or such theories) address the triad of cultural, social, and mental? Consequently, in an effort to provide an overview of the TSCM and to begin to answer these questions, this introduction consists of two parts. The first part addresses the sociocultural turn in modern psychology; this part discusses its implications for research in culture and psychology disciplines. The second segment examines the topic of the theoretical backgrounds of cultural and cross‐cultural research and connects the philosophical paradigms of interpretivism and realism with the theory of sociocultural models. This introduction concludes with a brief overview of the articles included in this issue.     

Explaining disproportionately high rates of adverse birth outcomes among African Americans: the impact of stress, racism, and related factors in pregnancy

Compared with European Americans, African American infants experience disproportionately high rates of low birth weight and preterm delivery and are more than twice as likely to die during their 1st year of life. The authors examine 5 explanations for these differences in rates of adverse birth outcomes: (a) ethnic differences in health behaviors and socioeconomic status; (b) higher levels of stress in African American women; (c) greater susceptibility to stress in African Americans; (d) the impact of racism acting either as a contributor to stress or as a factor that exacerbates stress effects; and (e) ethnic differences in stress-related neuroendocrine, vascular, and immunological processes. The review of literature indicates that each explanation has some merit, although none is sufficient to explain ethnic disparities in adverse birth outcomes. There is a lack of studies examining the impact of such factors jointly and interactively. Recommendations and cautions for future research are offered.     

Pregnancy-specific stress, prenatal health behaviors, and birth outcomes

OBJECTIVE: Stress in pregnancy predicts earlier birth and lower birth weight. The authors investigated whether pregnancy-specific stress contributes uniquely to birth outcomes compared with general stress, and whether prenatal health behaviors explain this association. DESIGN: Three structured prenatal interviews (N = 279) assessing state anxiety, perceived stress, life events, pregnancy-specific stress, and health behaviors. MAIN OUTCOME MEASURES: Gestational age at delivery, birth weight, preterm delivery (<37 weeks), and low birth weight (<2,500 g). RESULTS: A latent pregnancy-specific stress factor predicted birth outcomes better than latent factors representing state anxiety, perceived stress, or life event stress, and than a latent factor constructed from all stress measures. Controlling for obstetric risk, pregnancy-specific stress was associated with smoking, caffeine consumption, and unhealthy eating, and inversely associated with healthy eating, vitamin use, exercise, and gestational age at delivery. Cigarette smoking predicted lower birth weight. Clinically-defined birth outcomes were predicted by cigarette smoking and pregnancy-specific stress. CONCLUSION: Pregnancy-specific stress contributed directly to preterm delivery and indirectly to low birth weight through its association with smoking. Pregnancy-specific stress may be a more powerful contributor to birth outcomes than general stress.     

Coping in context: the role of stress, social support, and personality in coping

Personality and social relationships play an important role in almost every aspect of stress and coping. Daily process methods are particularly useful in elucidating how these factors might influence both responses to and outcomes of stress. Our work has linked both dimensions of personality, particularly the Big Five, and aspects of social relationships, particularly social support, to the likelihood of engaging in certain coping strategies and the effectiveness or outcomes of these coping strategies. In addition, we have found the effect of personality on coping and stress outcomes to vary by the situational context in which stress occurs. We review findings from our recent daily process studies of stress, coping, and social support. Further, we discuss the costs and benefits of the daily process methodology for addressing these questions, highlighting the clinical utility of findings gleaned with the use of this approach. Finally, we discuss future directions and applications of daily process methods to the study of stress and coping.     

Pattern of perceived stress and anxiety in pregnancy predicts preterm birth.

OBJECTIVE: To determine whether the pattern of prenatal stress, as compared to prenatal stress assessed at a single gestational time point, predicts preterm delivery (PTD). DESIGN: Perceived stress and anxiety were assessed in 415 pregnant women at 18-20 and 30-32 weeks' gestation. MAIN OUTCOME MEASURES: Gestational length was determined by last menstrual period and confirmed by early pregnancy ultrasound. Births were categorized as preterm (< 37 weeks) or term. RESULTS: At neither assessment did levels of anxiety or perceived stress predict PTD. However, patterns of anxiety and stress were associated with gestational length. Although the majority of women who delivered at term exhibited declines in stress and anxiety, those who delivered preterm exhibited increases. The elevated risk for PTD associated with an increase in stress or anxiety persisted when adjusting statistically for obstetric risk, pregnancy-related anxiety, ethnicity, parity, and prenatal life events. CONCLUSIONS: These data suggest that the pattern of prenatal stress is an important predictor of PTD. More generally, the findings support the possibility that a decline in stress responses during pregnancy may help to protect mother and fetus from adverse influences associated with PTD.     

The role of auditory context in action-effect-related motor adaptation

Previous research indicates that adding auditory effects to a (silent) action can lead to substantial efficiency gains in the performance of the action, while compromising the connection between the motor and the auditory event (e.g., by removing, or by delaying the auditory effects), leads the agent to compensate for the loss of auditory feedback by executing actions in a way which increases the probability of success or enhances feedback in other modalities, thus departing from the optimal action performance. The current study explored how this motor adaptation was affected when the quality of auditory feedback was reduced by contextual factors, while keeping the physical link between the action and auditory effect intact. In two experiments, participants elicited pure tones by pinching a force sensitive resistor (FSR). In some of the conditions action-effect contingency was reduced by intermixing externally initiated tones with the self-induced ones. Pinch-force measurements indicated that action optimization was affected by contextual factors. The influence of auditory context was the most pronounced when the discrimination of self-induced and external tones was made difficult by the similarity and temporal proximity of the self-induced and external tones. In these conditions, tone eliciting actions were more forceful in comparison to conditions in which no external tones were presented, and in comparison to conditions in which the external tones were easily distinguishable from self-induced ones. This suggests that contextual factors can induce similar motor adjustments as manipulating the physical connection between the action and its sensory consequences.     

Psychological resilience, positive emotions, and successful adaptation to stress in later life

In 3 studies, the authors investigated the functional role of psychological resilience and positive emotions in the stress process. Studies 1a and 1b explored naturally occurring daily stressors. Study 2 examined data from a sample of recently bereaved widows. Across studies, multilevel random coefficient modeling analyses revealed that the occurrence of daily positive emotions serves to moderate stress reactivity and mediate stress recovery. Findings also indicated that differences in psychological resilience accounted for meaningful variation in daily emotional responses to stress. Higher levels of trait resilience predicted a weaker association between positive and negative emotions, particularly on days characterized by heightened stress. Finally, findings indicated that over time, the experience of positive emotions functions to assist high-resilient individuals in their ability to recover effectively from daily stress. Implications for research into protective factors that serve to inhibit the scope, severity, and diffusion of daily stressors in later adulthood are discussed.     

Negative work reflection,personal resources,and work engagement: the moderating role of perceived organizational support

This day-level study examined the role of perceived organizational support (POS) in the context of employees’ negative work reflection during off-job time. We hypothesized that negative work reflection during off-job time should be indirectly related to reduced work engagement on the next workday through personal resources (i.e., vigour and self-efficacy) in the morning. In addition, we hypothesized that POS moderated the relationships between negative work reflection and personal resources and between personal resources and work engagement. In total, 100 employees completed one general survey and three daily surveys (in the morning, after work, and at bedtime) over five workdays. Results of multilevel path analyses showed that negative work reflection was neither directly associated with personal resources nor indirectly with work engagement via personal resources, although vigour and self-efficacy positively predicted increased work engagement. However, negative work reflection was negatively associated with self-efficacy when POS was low. POS did not predict work engagement, but moderated the relationships between personal resources and work engagement: Consistent with the resource substitution hypothesis, high levels of POS compensated for low levels of vigour and self-efficacy. Negative work reflection had a significant negative indirect effect on work engagement through self-efficacy only when POS was low.     

Wife abuse and battering in the sociocultural context of Arab society

Despite increasing public, professional, and scientific interest in the problem of wife abuse and battering, little has been written about the importance of sociocultural sensitivity in intervention with abused and battered women in Arab society. In this article, I describe central family values in that society and discuss their relevance to wife abuse and battering. Specifically, the discussion focuses on values such as mutual family support and interdependence, family reputation, women's inferiority and male supremacy, and family cohesion and the relevance of those values to wife abuse and battering. In addition, I present Arab women's perspectives on this problem, as revealed in their responses to open-ended questions that were part of larger studies conducted by me. In this regard, five dimensions of their perspectives are considered: (1) Women's definitions of violence against women; (2) their awareness of the problem; (3) their justification or condemnation of violence against women; (4) their awareness of the risk encountered by battered women; and (5) their approach toward coping with the problem. The results are discussed from the perspective of the sociocultural context of Arab society. The article concludes with recommendations for socioculturally sensitive intervention with battered women in this society.     

Coping in context: sociocultural determinants of responses to sexual harassment

The authors investigated coping responses to sexual harassment across 4 samples of working women from 3 cultures and 2 occupational classes. Complete-link cluster analyses provide preliminary support for D. E. Knapp, R. H. Faley, S. E. Ekeberg, and C. L. Z. Dubois's (1997) coping framework, suggesting that avoidance, denial, negotiation, advocacy seeking, and social coping are universal responses to sexual harassment. Further, L. F. Fitzgerald's (1990) internal-external dichotomy appears to capture higher order relationships among coping responses. In addition, regression analyses suggest that Turkish and Hispanic American women engage in more avoidance than Anglo American women, and Hispanic women also use more denial but less advocacy seeking. No differences emerged in social coping. The authors discuss these results in the context of coping theory, individualism-collectivism, power distance, and patriarchal gender norms.     

War zone stress, personal and environmental resources, and PTSD symptoms in Gulf War veterans: a longitudinal perspective

Cross-sectional research has demonstrated a link between personal and environmental resources and development of emotional distress after war zone service. Less is known about the longitudinal relationship between resources and distress. The authors addressed this issue in a study of 348 Gulf War returnees tested at 2 time points. Resources decreased and posttraumatic stress disorder (PTSD) symptoms increased over time. Time 1 avoidance and family cohesion predicted PTSD symptoms at Time 2. Regression analyses revealed a bidirectional relationship over time between resources and PTSD symptoms. Time 1 resources predicted Time 2 psychopathology after accounting for Time 1 emotional distress. PTSD symptoms at Time 1 also predicted changes in coping and family relationships, even after accounting for Time 1 resources. Findings are consistent with the concept of a loss spiral (Hobfoll, 1989), in which resource factors and emotional sequelae to war stress exert reciprocal effects.     

Work engagement and financial returns: A diary study on the role of job and personal resources

This study investigates how daily fluctuations in job resources (autonomy, coaching, and team climate) are related to employees' levels of personal resources (self‐efficacy, self‐esteem, and optimism), work engagement, and financial returns. Forty‐two employees working in three branches of a fast‐food company completed a questionnaire and a diary booklet over 5 consecutive workdays. Consistent with hypotheses, multi‐level analyses revealed that day‐level job resources had an effect on work engagement through day‐level personal resources, after controlling for general levels of personal resources and engagement. Day‐level coaching had a direct positive relationship with day‐level work engagement, which, in‐turn, predicted daily financial returns. Additionally, previous days' coaching had a positive, lagged effect on next days' work engagement (through next days' optimism), and on next days' financial returns.     

Narrative self-appropriation: embodiment,alienness, and personal responsibility in the context of borderline personality disorder

It is often emphasised that persons diagnosed with borderline personality disorder (BPD) show difficulties in understanding their own psychological states. In this article, I argue that from a phenomenological perspective, BPD can be understood as an existential modality in which the embodied self is profoundly saturated by an alienness regarding the person’s own affects and responses. However, the balance of familiarity and alienness is not static, but can be cultivated through, e.g., psychotherapy. Following this line of thought, I present the idea that narrativising experiences can play an important role in processes of appropriating such embodied self-alienness. Importantly, the notion of narrative used is that of a scalar conception of narrativity as a variable quality of experience that comes in degrees. From this perspective, narrative appropriation is a process of gradually attributing the quality of narrativity to experiences, thereby familiarising the moods, affects, and responses that otherwise govern ‘from behind’. Finally, I propose that the idea of a narrative appropriation of embodied self-alienness is also relevant to the much-debated question of personal responsibility in BPD, particularly as this question plays out in psychotherapeutic contexts where a narrative self-appropriation may facilitate an increase in sense of autonomy and reduce emotions of guilt and shame.     

The role of sociocultural context for culture competence and depressive symptoms among ethnic minority youths in junior high school

The aim of the study was to examine whether school sociocultural context affects culture competence and its relationship to depressive symptoms. As part of the Youth, Culture and Competence study conducted in the Norwegian Institute of Public Health, questionnaire data was collected from 373 immigrant students in two junior high schools within Oslo. The school contexts were represented in terms of proportion of ethnic minority students, 90% versus 60% referred to as the concentrated and balanced context, respectively. Results showed a relatively low level of depressive symptoms and high level of ethnic and host culture competence regardless of context. Ethnic culture competence showed an inverse relationship to depression in both contexts. Host culture competence was also negatively correlated with depression, but only in the balanced context. In the concentrated context this correlation was unsubstantial. Thus, the sociocultural context was found to moderate this correlation.     

Prolonging life and delaying death: The role of physicians in the context of limited intensive care resources

Critical care is in an emerging crisis of conflict between what individuals expect and the economic burden society and government are prepared to provide. The goal of critical care support is to prevent suffering and premature death by intensive therapy of reversible illnesses within a reasonable timeframe. Recently, it has become apparent that early support in an intensive care environment can improve patient outcomes. However, life support technology has advanced, allowing physicians to prolong life (and postpone death) in circumstances that were not possible in the recent past. This has been recognized by not only the medical community, but also by society at large. One corollary may be that expectations for recovery from critical illness have also become extremely high. In addition, greater numbers of patients are dying in intensive care units after having receiving prolonged durations of life-sustaining therapy. Herein lies the emerging crisis – critical care therapy must be available in a timely fashion for those who require it urgently, yet its provision is largely dependent on a finite availability of both capital and human resources. Physicians are often placed in a troubling conflict of interest by pressures to use health resources prudently while also promoting the equitable and timely access to critical care therapy. In this commentary, these issues are broadly discussed from the perspective of the individual clinician as well as that of society as a whole. The intent is to generate dialogue on the dynamic between individual clinicians navigating the complexities of how and when to use critical care support in the context of end-of-life issues, the increasing demands placed on finite critical care capacity, and the reasonable expectations of society.     

Prolonging life and delaying death: The role of physicians in the context of limited intensive care resources

In the past decade donor commitments to health have increased by 200 percent. Correspondingly, there has been a swell of new players in the global health landscape. The unprecedented, global response to a single disease, HIV/AIDS, has been responsible for a substantial portion of this boon. Numerous health success have followed this windfall of funding and attention, yet the food, fuel, and economic crises of 2008 have shown the vulnerabilities of health and development initiatives focused on short term wins and reliant on a constant flow of foreign funding. For too long, the international community has responded to global health and development challenges with emergency solutions that often reflect the donor's priorities, values, and political leanings, rather than funding durable health systems that can withstand crises. Progress towards achieving the Millennium Development Goals has stalled in many countries. Disease specific initiatives have weakened health systems and limited efforts to improve maternal and child health. As we enter this era of scarce resources, there is a need to return to the foundations of the Alma Ata Declaration signed thirty years ago with the goal of providing universal access to primary healthcare. The global health community must now objectively evaluate how we can most effectively respond to the crises of 2008 and take advantage of this moment of extraordinary attention for global health and translate it into long term, sustainable health improvements for all.