Dressler W W, Bindon J R
Department of Anthropology, University of Alabama, Tuscaloosa 35487-0210, USA.
Am J Phys Anthropol. 1997 Jan;102(1):55-66. doi: 10.1002/(SICI)1096-8644(199701)102:1<55::AID-AJPA5>3.0.CO;2-C.
As social change and economic development have proceeded, the prevalence of chronic diseases, especially cardiovascular diseases, has increased in the developing world. In part this is due to the adoption of diets and other health behaviors characteristics of industrialized nations; in part it is a function of changing social and economic circumstances. In this paper, we describe the development and testing of a model designed to account for social and economic effects on cardiovascular disease risk. The model incorporates the fact that global economic processes have made a lifestyle characterized by the consumption of Euroamerican material goods and information a basis for the assignment of social status in local communities. But economic change at the local level is rarely sufficient to provide a foundation for individuals' status aspirations. Hence, many individuals attempt to maintain lifestyle inconsistent with their economic standing, a variable we term lifestyle incongruity. Here we described how this factor is associated with higher blood pressure in a variety of settings and also how the effects of lifestyle incongruity can be modified in local contexts by social class and social role processes. This latter process, contextual modification, is illustrated by data from American Samoa. In this example, the association of lifestyle incongruity with blood pressure is examined in 30 male household heads and 26 spouses. After an examination of Samoan ethnography focused attention on the importance of age and gender differences as defining social contexts of intracultural variation, the model was modified to assess interactions between age and gender as they affect the association of lifestyle incongruity and blood pressure. Lifestyle incongruity is strongly associated with higher systolic and diastolic blood pressure for the younger household heads, minimally associated with blood pressure for older household heads, and only slightly associated with blood pressure of their spouses. The regression coefficients for the lifestyle incongruity by age by sex interaction term was significant at P < or = 0.01 for both systolic and diastolic blood pressure. The consistency of these results with expectations based on the ethnographic record is emphasized in the interpretation. We feel that the lifestyle incongruity model represents and empirically successful attempt to link global political-economic processes, local social structure, and biological outcomes.
随着社会变革和经济发展的推进，慢性病尤其是心血管疾病在发展中世界的患病率有所上升。部分原因在于采用了工业化国家特有的饮食及其他健康行为方式；部分原因则是社会和经济环境的变化。在本文中，我们描述了一个旨在解释社会和经济因素对心血管疾病风险影响的模型的开发与测试过程。该模型纳入了这样一个事实，即全球经济进程已使以消费欧美物质商品和信息为特征的生活方式成为当地社区社会地位分配的基础。但地方层面的经济变化很少足以成为个人地位期望的基础。因此，许多人试图维持与其经济状况不符的生活方式，我们将这一变量称为生活方式不一致。在此，我们描述了这一因素在各种情况下如何与高血压相关联，以及生活方式不一致的影响如何在当地背景下通过社会阶层和社会角色过程得到调节。后一过程即情境调节，通过美属萨摩亚的数据得以说明。在这个例子中，对30名男性户主和26名配偶进行了生活方式不一致与血压关联的研究。在对萨摩亚人种志进行考察，聚焦于年龄和性别差异作为界定文化内部变异社会背景的重要性之后，对模型进行了修改，以评估年龄和性别之间的相互作用对生活方式不一致与血压关联的影响。生活方式不一致与年轻户主的收缩压和舒张压显著相关，与年长户主的血压关联极小，与他们配偶的血压仅有轻微关联。生活方式不一致、年龄和性别交互项的回归系数在收缩压和舒张压方面均在P≤0.01时具有显著性。在解释中强调了这些结果与基于人种志记录的预期的一致性。我们认为，生活方式不一致模型是将全球政治经济进程、地方社会结构和生物学结果联系起来的一次实证性成功尝试。
