Dr. Robert D. Baer (University of South Florida)will udnertake research on how the global pandemic of H1N1 influenza is understood in different cultural contexts, in this case, among laypeople and physicians in Mexico and the United States, as well as the responses people consider appropriate to this new illness. In the case of a pandemic, viruses move around the globe, carried by people and dispersed in the course of social interaction. Fears and anxieties, as well as vaccines, are also dispersed around the globe. This study will thus contribute to the anthropological literature on how macro global forces play out in different cultural contexts. The extent to which local interpretations differ may help to understand cultural responses to global patterns. Epidemics provide the opportunity to investigate how people use cultural knowledge to react to new kinds of social experiences; the new illness is interpreted in terms of the ethnomedical beliefs of the cultural group. As such, the project will explore how aspects of culture affect the impact of global forces.
This study is a cross-cultural comparative study describing the explanatory models of H1N1 among laypeople and physicians in the US and Mexico, comparing and contrasting individual and cultural themes in the models. The researcher will employ a two-step process for data collection. The first step uses qualitative, open-ended interviews to collect descriptive information on explanatory models of H1N1 in the US and Mexico. In the second step, themes from the descriptive interviews will be used to develop a structured interview, so that detailed comparisons can be made between laypeople and physicians, and across individuals, social classes, and cultural settings.
In addition to contributing to social scientific theory, the data from this study will be useful in our improving our understanding of how laypeople and physicians interpret H1N1 and its vaccine. Such information may be of great value in public health programs both in Mexico and the United States.
Introduction Our objective in this study was to examine how the global pandemic of H1N1 influenza was understood in different cultural contexts, in this case, among laypeople and physicians in Mexico and the United States, as well as the responses people considered appropriate to this new illness. Results: Research Question 1: 1. What are the models of H1N1 influenza among American and Mexican laypeople and physicians? How was the global pandemic H1N1 influenza understood? US vs. Mexican physicians: Conclusions: ¡ Overall—very high agreement ¡ Symptoms—US physicians recognize many more respiratory and gastrointestinal symptoms. ¡ Treatments—US physicians feel it will get better by itself and can be self treated. Mexican physicians disagree. US vs. Mexican Laypeople Differences between models: Causality--The role exposure to cold forces and dust and dirt is important in the Mexican model of H1N1 influenza causality, but not so in the US model. Symptoms--Mexican symptoms (not part of the US model) included coughing up blood, itchiness in the throat, chest pain, earache. US symptoms (not part of the Mexican model) included wheezing, nausea, stomachache, waking up at night soaked with sweat, and noise in the chest. Treatments—Only the US model included use of aspirin, vicks, and agreed that H1N1 influenza would get better by itself. Research Question 2. How are models of H1N1 influenza similar and different from those of similar illnesses (especially the common cold)? Mexican colds vs. H1N1 influenza: Conclusions We found class differences in beliefs about the common cold. In Mexico we found that middle class vs. working class/poor neighborhoods differed on 14 themes, but we did not find variation in beliefs about H1N1 influenza. When agreement was analyzed for patterns by neighborhood, educational level, age, gender, there were no significant correlations for beliefs about H1N1 influenza, but there were for the common cold. In general beliefs about H1N1 influenza and the common cold are highly similar with exceptions concerning more hot-cold issues and severity of symptoms--except for class differences. People from poorer neighborhoods in Guadalajara reported more symptoms for the common cold than did those from higher social class neighborhoods/educational levels. US colds vs. H1N1 influenza Conclusions We found strong class differences in the US between beliefs about the cold, patterned by higher education (greater than 13 yrs, vs. less than 13 years), while in Mexico these differences were patterned by neighborhood (middle class vs. poor/working class). No such differences were seen in models of H1N1 influenza in either country. Research Question 3. Are there systematic differences between the understandings of US and Mexican laypeople and physicians about H1N1 influenza? Overall, there was agreement among all four samples on most items. However, several patterns of disagreement were noted: Mexican lay vs. all of the other samples—The role of a lack of vitamins, drinking/eating icy things when sweating, exposure to drafts/wind/air, dirty air/air pollution, a change in the weather, living in an unclean house, dirt/dust, not being properly clothed in cold weather, and cold weather were noted as positive themes only by the Mexican lay sample. For symptoms, coughing up blood, and earache were only agreed upon by the Mexican lay sample. All Mexican vs. all Americans—The symptoms of nausea, and stomachache, vomiting, waking up at night soaked with sweat, and the treatments with aspirin and expecting H1N1 influenza to get better by itself were only agreed upon by the Americans. Lay vs. physician differences—The role of prayer and antibiotics were affirmed by both lay samples, and rejected by both physician samples. Overall conclusions: Physicians in both countries were similar. In both the US and Mexico, class differences were seen in models of the common cold, but not for H1N1 influenza. Cold causality (the belief that an illness is caused by exposure to cold forces) and a role for dirt and dust were important only in the Mexican lay model of H1N1 influenza. Prayer was an important treatment for both lay samples. Intellectual Merit: We found that in the case of H1N1 influenza, however, the similarities to the common cold seem to mean that the folk aspects of the cold (cold causality, the belief that an illness is caused by exposure to cold forces), are seen in the models of Mexican laypeople—even though this is a "new" illness. We hypothesize that models of new illnesses will differ relative to the extent to which they share similarities with "old" illnesses. We predict that for at least some lay groups, "folk" beliefs will be seen in these illnesses, particularly those related to causality. Broader Impacts: Our work has direct impact for the public health and medical spheres. These groups should be prepared to encounter folk beliefs even in "new illnesses," related to the extent of overlap with "old" illnesses. Health education approaches should be developed to accommodate these cultural beliefs.
