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To describe Latino beliefs about AIDS (SIDA), Latino adults were sampled at two U.S. sites (Connecticut and Texas) and two international sites (Mexico and Guatemala). A 125-item questionnaire covered risk factors, symptoms, treatments, and sequellae of AIDS. The cultural consensus model was used to determine the cultural beliefs for each sample. Responses from 161 people indicated that a single set of beliefs was present at each site and that beliefs were shared across sites. Comparison of answers between samples indicated high agreement (p < .0007). The proportion of shared beliefs, however, decreased significantly between samples: .68 in Connecticut, .60 in Texas, .51 in Mexico, and .41 in Guatemala (p < .05). The proportion of positive answers similarly decreased from Connecticut to Guatemala (p < .001). Beliefs were stronger and more detailed in the higher prevalence areas. Furthermore, Latino beliefs tended to converge on biomedical beliefs about the disease.

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Before carrying out a breastfeeding promotion programme in a periurban area of Mexico City, we conducted a rapid ethnographic study to determine the factors associated with absence of exclusive breastfeeding. The responses to pilot interviews were used to develop a standardized questionnaire regarding reasons for infant feeding choice, sources of advice, and barriers to breastfeeding. We interviewed a random sample of 150 mothers with a child < 5 years of age; 136 (91%) of them had initiated breastfeeding; but only 2% exclusively breastfed up to 4 months. The mothers consistently stated that the child's nutrition, health, growth, and hygiene were the main reasons for the type of feeding selected; cost, comfort, and the husband's opinion were less important. Physicians were ranked as the most important source of advice. Reduction or cessation of breastfeeding occurred on the doctor's advice (68%); or when the mothers encountered local folk illnesses such as "coraje" (52%) or "susto" (54%), which are associated with anger or fright; or had "not enough milk" (62%) or "bad milk" (56%); or because of illness of the mother (56%) or child (43%). During childhood illnesses and conditions, breastfeeding was reduced and the use of supplementary foods was increased. This study emphasizes the importance of cultural values in infant feeding choices, defines specific barriers to breastfeeding, and provides a basis for interventions to promote exclusive breastfeeding in the study population.

PIP: Prior to initiating a community-based intervention program to promote exclusive breast feeding in San Pedro Martir, Mexico, a 2-month (1994) rapid ethnographic assessment was conducted. 150 mothers whose youngest child was under 5 years of age were interviewed. 136 mothers (91%) had breast-fed their infant, for a median duration of 6 months, but only 2% exclusively breast-fed for up to 4 months. Mothers consistently described breast feeding as the best nutrition for their infant. However, the dominant feeding pattern was mixed breast and bottle-feeding. Formula, tea, and water were introduced during the first postpartum day. By the end of the third month, 63% of mothers had introduced solid food to promote growth. It was common practice to reduce breast feeding and increase feeding of supplementary foods when a child was ill. Physicians were the most respected source of knowledge on breast feeding. 42% of mothers reported that, at some point when they were breast feeding, a doctor had advised them to stop and half these mothers complied. The data collected in this rapid survey were used to guide a peer counseling program to promote exclusive breast feeding in the community.

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OBJECTIVE: To describe Latino beliefs about diabetes and assess heterogeneity in beliefs across different groups. RESEARCH DESIGN AND METHODS: This study comprised a survey of 161 representative Latino adults from four diverse communities: Hartford, Connecticut; Edinburg, Texas; Guadalajara, Mexico; and rural Guatemala. A 130-item questionnaire covered causes symptoms, and treatments for diabetes. Information on demographics and acquaintanceship with someone with diabetes was also collected. The cultural consensus model was used to analyze the variation in responses to determine whether the degree of consistency within and between samples was sufficient to warrant aggregation and description as a single set of beliefs. RESULTS: Homogeneous beliefs were present within each of the four samples. Although variability in responses increased significantly from Connecticut to Guatemala (P < 0.00005), there was significant agreement between samples on the answers (P < 0.0005). Answers tended to be concordant with the biomedical description of diabetes. Greater acculturation, higher educational attainment, and higher diabetes prevalence were associated with greater cultural knowledge about diabetes. In Connecticut, greater knowledge correlated with longer mainland U.S. residency (P < 0.05). In Mexico, those with average educational attainment knew more (P < 0.05). Finally, average knowledge levels were higher in communities with greater diabetes prevalence. CONCLUSIONS: The cultural consensus model facilitated assessment of cultural beliefs regarding diabetes and diabetes management. Overall, Latino cultural beliefs about diabetes were concordant with the biomedical model. Variation in responses tended to characterize less knowledge or experience with diabetes and not different beliefs.

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This study attempts to identify and describe factors associated with the choice of a health care source in rural Guatemala. Because of limited choice options, rural Guatemala makes an excellent location for studying the factors that affect utilization patterns. Illness case histories were collected from a random sample of 270 households in six villages. Then, two different methodological approaches were used to predict treatment actions. First, a sociobehavioral model, which encompasses enabling, predisposing, and need factors, was used to predict treatment choices. Using discriminant analysis we identified factors associated with the use of home remedies, a pharmacy, the health post, a physician, or folk healer. In a second, parallel study, descriptive interviews were used to identify important factors in choosing a treatment strategy. From these interviews, and from responses to hypothetical illness cases, we developed a decision model of treatment actions. Both models were tested against the set of illness cases. Results indicate that both approaches identify similar variables (especially, severity), although selection of variables through the multivariate analysis was much more successful in predicting treatment actions.

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As part of an effort to involve community members in malaria control activities, we studied knowledge, beliefs, and practices of residents of both the Pacific coastal plain and northeastern Guatemala related to malaria transmission and Anopheles albimanus control. Most residents recognized the role of mosquitoes in malaria transmission, but few knew how mosquitoes acquired their infections or understood the risk of having an untreated person in their midst. If this were more widely known, residents might put greater pressure on infected patients to seek timely and appropriate antimalarial treatment. Seventy-three percent of families owned one or more bed nets; however, even though most informants believed that bed nets help protect against malaria, the major reason for using them was to prevent nuisance mosquito bites. It is concluded that efforts should be made to promote bed net use by seeking ways to make them more affordable and by emphasizing their effectiveness as a barrier to nuisance mosquitoes. Although residents have a very positive opinion of the National Malaria Service spray teams, it is proposed that cooperation might be improved if malaria workers would emphasize the fact that house spraying reduces the numbers of nuisance mosquitoes and other pest insects, rather than focusing solely on malaria prevention, which most informants believed was less important. This study emphasizes the importance of understanding community beliefs and practices when planning or evaluating vector control activities.

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Since the late 1950s, most malaria surveillance and treatment in rural areas of Latin America has been carried out by networks of unpaid community malaria workers, known as Volunteer Collaborators, who are selected and supervised by staff of the national malaria services (NMSs) in each country. In spite of the free and readily accessible antimalarial treatment available at these Volunteer Collaborator posts, many residents continue to seek treatment elsewhere and in most cases take doses of antimalarials that are insufficient to cure their infections. To identify ways in which the Volunteer Collaborator Network could be made more attractive to residents and to improve the process of selection of new workers, we asked community residents and Guatemalan NMS workers to rank order, according to their importance, 11 qualities or characteristics of an 'ideal' volunteer malaria worker. Community residents preferred someone who is available to take care of patients at all times of the day, is a responsible person, and has a general knowledge of medicine. No significant differences were noted in the rank orders of male and female residents or literate and illiterate residents. National Malaria Service workers also preferred someone who takes care of patients at all times of the day, even when busy. In addition, they wanted individuals who recognize the importance of their work as a Volunteer Collaborator, but choosing volunteers who had a general knowledge of medicine was not important. By modifying the procedures used to select Volunteer Collaborators so as to identify candidates with the qualities preferred by residents, it should be possible to increase acceptance and improve the performance of these volunteer workers.

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Lack of compliance with medical therapy is a major clinical problem. We undertook a study to determine whether degree of acculturation to mainland U.S. culture was predictive of compliance in Puerto Rican families having a child with asthma. A questionnaire was administered to parents of Puerto Rican asthmatic children attending an asthma clinic and taking oral theophylline as part of their medical management. The questionnaire included items concerning medical, socioeconomic, and cultural variables, as well as a standardized instrument devised to measure degree of acculturation. Compliance was measured by a serum theophylline level obtained at the time of the visit. Families were divided into compliant (n = 15) and noncompliant (n = 13) groups based on their child's serum theophylline determination. There was a significant difference in mean acculturation scores between compliant and noncompliant groups (p = .008). Those in the complaint group had scores indicative of a style of acculturation that integrated aspects of both "Anglo" and Puerto Rican lifestyles. Those in the noncompliant group had scores indicative of a less acculturated lifestyle. The findings of this study show that degree of acculturation is a predictor of compliance with medical therapy in mainland Puerto Ricans. Additional studies with other cultural groups are needed, as well as other studies incorporating acculturation into a multivariate model of compliance.

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It is usually impossible to know if reported differences between cultures are due to cultural differences or due to a difference in the methods used to study the cultures. This paper describes a collaborative, multisite study using a shared methodology to study intra- and inter-cultural variation in beliefs. A series of standard interview schedules were used to study Latin American beliefs about empacho in Guatemala, Mexico, and in the United States (Mexican-Americans and Puerto Ricans). Results showed consistency in beliefs about empacho both within and between the four samples.

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Surveys of residents of the Pacific coast of Guatemala revealed a lack of knowledge and many misconceptions about the transmission and treatment of malaria, which could adversely affect malaria control measures and antimalarial therapy. Although mosquitoes are known to play an important role in malaria transmission and are thought to become infected by biting individuals with malaria, 75% of people interviewed believe that the mosquitoes can also acquire infections from contaminated water or by biting snakes and frogs. Furthermore, most residents believe that malaria can be acquired in other ways, such as by bathing too frequently or by drinking unboiled water. Although self-treatment of malaria with oral and injectable drugs purchased at stores and pharmacies is very common, less than 10% of the respondents were aware of the correct curative dose of chloroquine. Chloroquine injections are preferred to tablets and believed to be approximately three times as potent as tablets of the same concentration. Nearly two-thirds of the interviewees believed that pregnant and lactating women with malaria should avoid the use of chloroquine because it may cause a spontaneous abortion or dry up breast milk. Similar surveys of National Malaria Service workers and village malaria workers revealed higher levels of knowledge, although the village workers had many misconceptions about malaria transmission. An educational campaign directed at correcting some of these misconceptions should result in more appropriate self-treatment of malaria and greater acceptance by residents of personal protection methods and vector control and drug treatment programs.

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Although anthropologists have provided descriptions of many folk illnesses, few have systematically evaluated their prevalence and determined who is at greatest risk for acquiring them. This report attempts to provide a systematic description of the folk illness empacho including the symptoms that define it. Illness prevalence was estimated and subpopulations at greatest risk were identified from illness histories collected from a random sample of households in rural Guatemala. Empacho was found to constitute a distinct cluster of symptoms: diarrhea, vomiting, headache, and lack of appetite. It differed from other gastrointestinal illnesses in that headaches were more likely and stomachaches were less likely to be reported. Empacho was highly prevalent and occurred in adults and children. Further, results showed that although empacho was frequently diagnosed by residents, folk healers were rarely consulted for any illness. Nevertheless, a strong association exists between a household diagnosis of empacho and the use of folk healers by those households (p less than .001).

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To determine if calcium status is associated with blood lead levels and behavior, 64 black urban children aged 18 to 47 months were studied. Twenty-seven controls (blood lead levels, less than 1.45 mumol/L) were compared with 37 cases (blood lead levels, greater than or equal to 1.45 mumol/L) with respect to four calcium measures (calcium intake, serum calcium level, 1,25-dihydroxyvitamin D level, and bone densitometric findings) and three behavioral scores. Levels of 25-hydroxyvitamin D provided a measure of vitamin D sufficiency. As expected, blood lead level was associated with pica scores. However, none of the calcium measures differed between cases and controls. Controlling for four confounders (season, pica score, maternal education, and sex), yielded no significant differences between the two groups in the mean values of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D level. There was no interaction between blood lead level and the four covariates. No relationship could be demonstrated between calcium status and the pica scores.

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An assessment of health cognition and health locus of control (HLOC) was obtained in 85 healthy and 81 chronically ill children, using instruments adapted from Piaget's work and standard HLOC measures. A relationship between HLOC and compliance was sought in a subset of children with spina bifida taught self-catheterization. Evidence of the developmental nature of health cognition and HLOC was documented. Contrary to the effect of experience in formal learning, experience with chronic disease did not alter developmental progression in these health-related areas. Our results suggest that in communicating with children about illness, the pediatrician's approach should not be altered by an appearance of superficial sophistication that some children may acquire as part of their experience with chronic disease.

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The preferences of Spanish-speaking Hispanics and English-speaking Anglos for breast and bottle feeding were evaluated using marketing research techniques. Preliminary interviews with 55 mothers conducted within the first 48 hr post-partum elicited a list of verbatim responses regarding the positive and negative aspects of both feeding methods. An additional 195 women rank-ordered the most frequently mentioned statements in terms of their preference for each. Socio-demographic data on the mothers were analyzed with chi-square analysis and discriminant analysis. Multidimensional scaling was used to assess the preferred characteristics of breast and bottle feeding. Results indicated that most mothers prefer a method of infant feeding that allows the mother to be 'closer to her baby' and allows the baby to 'grow up healthier.' Bottle feeders perceived bottle feeding to be superior because it insured that baby would be 'full and satisfied' and would 'get all the vitamins and nutrients it needed,' especially when 'mother was not eating right" or was 'on medications.' Analysis of cultural preference patterns revealed that there exists a strong culture pattern or preference for breast feeding and its characteristics among Anglos. In contrast, the Hispanics show no clear preference for either breast or bottle feeding.

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One hundred forty-four young adults and adolescents representative of an upstate New York community were studied on two occasions to identify relationships between chronic illness and psychosocial well-being. In the 8 years since the original survey, the health status of 62 of the 106 with a chronic medical condition improved, remained unchanged in 27, and worsened in 17. Subjects whose chronic medical problem persisted and was associated with at least mild impairment in daily living demonstrated significantly more psychosocial problems, centering around future plans, perceptions of family life, and having a driver's license. Those who had recovered from their illness or did not have any associated impairment appeared no different from the controls. Multidimensional scaling confirmed that chronic illness and poor psychosocial functioning are related, as are physical wellness and better psychosocial function. These results confirm the contention that chronic illness persisting into adolescence has a small but measurable effect on psychosocial adjustment.

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