Handbook of Diversity Issues in Health Psychology

452 Pages·1996·5.77 MB·English

by  Traci Mann

Handbook of Diversity
Issues in Health
Psychology
THE PLENUM SERIES IN CULTURE AND HEALTH
SERIES EDITORS:
Richard M. Eisler and Sigrid Gustafson
Virginia Polytechnic Institute and State University, Blacksburg, Virginia
HANDBOOK OF DIVERSITY ISSUES IN HEALTH PSYCHOLOGY
Edited by Pamela M. Kato and Traci Mann
Handbook of Diversity
Issues in Health
Psychology
Edited by
Pamela M. Kato and
Traci Mann
Stanford University
Stanford, California
Plenum Press • New York and London
Library of Congress Cataloging-ln-Pub1icatIon Data
Handbook of diversity issues in health psychology / edited by Pamela
M. Kato and Traci Mann.
p. cm. — (Plenum series in culture and health)
Includes bibliographical references and index.
ISBN 0-306-45325-8
1. Clinical health psychology. 2. Clinical health psychology-
-United States—Cross-cultural studies. 3. Minorities—United
States—Health and hygiene. 4. Minorities—United States—Medical
care. I. Kato, Pamela M. II. Mann, Traci. III. Series.
R726.7.H356 1996
610'.8*693—dc20 96-32564
CIP
ISBN 0-306-45325-8
© 1996 Plenum Press, New York
A Division of Plenum Publishing Corporation
233 Spring Street, New York, N. Y. 10013
All rights reserved
1098765432 1
No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any
means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written
permission from the Publisher
Printed in the United States of America
For my godfather, Joseph C. Mancuso
—PMK
For my brother, Dr. Barry Mann
—TM
Contributors
MARC H. BORNSTEIN, National Institute of Child Health and Human Devel
opment, 9000 Rockville Pike, Bethesda, Maryland 20892
FELIPE G. CASTRO, Department of Psychology and Hispanic Research Cen
ter, Arizona State University, Tempe, Arizona 85287
MARGARET A. CHESNEY, School of Medicine, University of California, San
Francisco, San Francisco, California 94061
CHI-AH CHUN, Department of Psychology, University of California at Los
Angeles, Los Angeles, California 90095
KATHRYN COE, Hispanic Research Center, Arizona State University,
Tempe, Arizona 85287
MICHAEL M. COPENHAVER, Department of Psychology, Virginia Polytechnic
Institute and State University, Blacksburg, Virginia 24060
RICHARD M. EISLER, Department of Psychology, Virginia Polytechnic Insti
tute and State University, Blacksburg, Virginia 24060
KANA ENOMOTO, Department of Psychology, University of California at Los
Angeles, Los Angeles, California 90095
TIFFANY M. FIELD, Touch Research Institute, University of Miami School of
Medicine, Miami, Florida 33101
GARY GROSSMAN, 2150 Sutter Street, San Francisco, California 94115
SARA GUTIERRES, Department of Social and Behavioral Sciences and His
panic Research Center, Arizona State University, Tempe, Arizona 85287
JAMES S. JACKSON, Institute for Social Research, University of Michigan,
Ann Arbor, Michigan 48106
vii
Vlll CONTRIBUTORS
BETTY R. KASSON, Departments of Nursing and Pediatric Surgery, Lucile
Salter Packard Children's Hospital at Stanford, Palo Alto, California
94304
PAMELA M. KATO, Department of Psychiatry and Behavioral Sciences,
Stanford University School of Medicine, Stanford, California 94305
HELENA CHMURA KRAEMER, Department of Psychiatry and Behavioral Sci
ences, Stanford University School of Medicine, Stanford, California
94305
ELLEN LANGER, Department of Psychology, Harvard University, Cam
bridge, Massachusetts 02138
NANCY LEFFERT, Search Institute, 700 South Third Street, Suite 210, Min
neapolis, Minnesota 55915
BECCA LEVY, Division on Aging, Harvard Medical School, Boston, Massa
chusetts 02115
PETER M. LEWINSOHN, Oregon Research Institute, 1715 Franklin Boule
vard, Eugene, Oregon 97403
KEH-MING LIN, Research Center on the Psychobiology of Ethnicity,
Harbor-UCLA Research and Education Institute, Torrance, California
90502
TRACI MANN, Health Risk Reduction Projects, UCLA Neuropsychiatric In
stitute, 10920 Wilshire Boulevard, Suite 1103, Los Angeles, California
90024
LINDA C. MAYES, Child Study Center, Yale University, New Haven, Con
necticut 06510
JILL B. NEALEY, Department of Psychology, University of Utah, Salt Lake
City, Utah 84112
KATHERINE A. O'HANLAN, Gynecologic Cancer Section, Stamford University
School of Medicine, Stanford, California 94305
MONISHA PASUPATHI, Department of Psychology, Stanford University,
Stanford, California 94305
ANNE C. PETERSEN, Institute of Child Development, University of Minne
sota, Minneapolis, Minnesota 55455
PAUL ROHDE, Oregon Research Institute, 1715 Franklin Boulevard, Eu
gene, Oregon 97403
CONTRIBUTORS ix
TONI RUCKER, Department of Sociology, University of Michigan, Ann Ar
bor, Michigan 48109
DELIA SAENZ, Department of Psychology and Hispanic Research Center,
Arizona State University, Tempe, Arizona 85287
STEVEN SCHINKE, Columbia University School of Social Work, New York,
New York 10025
SHERRILL L. SELLERS, Institute for Social Research, University of Michi
gan, Ann Arbor, Michigan 48106
SANDRA K. SENTIVANY, Departments of Nursing and Pain Management,
Lucile Salter Packard Children's Hospital at Stanford, Palo Alto, Califor
nia 94304
MICHAEL SMITH, Research Center on the Psychobiology of Ethnicity,
Harbor-UCLA Research and Education Institute, Torrance, California
90502
STANLEY SUE, Department of Psychology, University of California at Los
Angeles, Los Angeles, California 90095
DAVID R. WILLIAMS, Department of Sociology and Survey Research Center,
Institute for Social Research, University of Michigan, Ann Arbor, Michi
gan 48106
ANTONETTE M. ZEISS, Geriatric Research Education and Clinical Center,
Veterans Affairs Palo Alto Health Care System, Palo Alto, California 94304
Foreword
The field of health psychology has grown dramatically in the last decade,
with exciting new developments in the study of how psychological and
psychosocial processes contribute to risk for and disease sequelae for a
variety of medical problems. In addition, the quality and effectiveness of
many of our treatments, and health promotion and disease prevention
efforts, have been significantly enhanced by the contributions of health
psychologists (Taylor, 1995). Unfortunately, however, much of the theo
rizing in health psychology and the empirical research that derives from
it continue to reflect the mainstream bias of psychology and medicine,
both of which have a primary focus on white, heterosexual, middle-class
American men. This bias pervades our thinking despite the demographic
heterogeneity of American society (U.S. Bureau of the Census, 1992) and
the substantial body of epidemiologic evidence that indicates significant
group differences in health status, burden of morbidity and mortality, life
expectancy, quality of life, and the risk and protective factors that con
tribute to these differences in health outcomes (National Center for
Health Statistics, 1994; Myers, Kagawa-Singer, Kumanyika, Lex, & Mar-
kides, 1995). There is also substantial evidence that many of the health
promotion and disease prevention efforts that have proven effective with
more affluent, educated whites, on whom they were developed, may not
yield comparable results when used with populations that differ by eth
nicity, social class, gender, or sexual orientation (Cochran & Mays, 1991;
Castro, Coe, Gutierres, & Saenz, this volume; Chesney & Nealey, this
volume).
The Handbook of Diversity Issues in Health Psychology makes a
strong case for the need for more systematic research that investigates
possible differences in health between and within groups along the di
mensions of age, gender, social class, race/ethnicity, and sexual orienta
tion. The chapters provide the reader with critical, scholarly reviews of the
extant knowledge about differences as a function of each of these dimen
sions, and point out some of the major lacunae as a guide to future
research. Three strong themes emerge throughout the book that aire
XI
Xll FOREWORD
important to highlight and to reiterate. First, a number of differences
between the groups are identified and discussed. Group differences are
salient for some disorders and not for others, and not all differences are
disadvantageous to the socially marginalized group (e.g., lesbians are at
lower risk for HIV/AIDS than heterosexual women; Latinas have compa
rable or better obstetrical outcomes than white women when SES differ
ences are controlled; very old African Americans are often healthier than
their white counterparts). Authors also note that these differences are not
attributable to any single set of factors, but are more likely the result of
the interplay of biological, sociocultural, and psychological factors. Fur
ther, these factors exert their effects through social class, life stresses,
health beliefs and behaviors, and access to and utilization of quality
health services.
Second, it is important to note, however, that the merits of between-
group comparisons should be tempered by an appreciation of the sub
stantial heterogeneity and behavioral variability that characterizes these
groups. For example, in arguing for ethnic group differences in health
behaviors, some investigators have erroneously treated sociopolitical de
scriptors such as "racial/ethnic minorities" as if they were scientifically
meaningful groups that differ in meaningful and systematic ways from
whites. While it is true that people of color do differ in important ways
from whites, the groups that are usually subsumed under this heading
are extremely heterogeneous on a number of important dimensions, and
often differ as much from each other as they do from whites. Similarly,
even meaningful groups such as Hispanics/Latinos and Asian/Pacific
Islanders evidence significant within-group differences on a number of
health-relevant factors as a function of national origin, language, and
level of acculturation.
Appreciation of these within-group differences also adds a second
level of complexity to our analysis. For example, while it is clear that there
are significant differences in health status and related predictors between
African Americans and white Americans, there is also substantial evi
dence of health differentials among the subgroups that differ by social
class, gender, and sexual orientation. Thus, low-SES African American
gay and bisexual men evidence different health-risk profiles than African
American heterosexuals and than white gay and heterosexual men (Co
chran & Mays, 1988; Johnson, 1993). As in other cases of cross-ethnic
comparisons, social class is an important contributor to these differences
(Kessler & Neighbors, 1986; Williams & Collins, 1995). There is also grow
ing evidence that similar differences may be observed between subgroups
of women (Wyatt, 1991; Nyamathi, Bennett, Leake, Lewis, & Flaskerud,
1993).
The research on diversity issues in health psychology is still in its
infancy, and formal theoretical models that integrate the findings and
give them conceptual coherence are still not available. This is the next