Beyond ethnicity as risk factor: Biocultural context and correlates of type 2 diabetes in a Cambodian American community.

摘要

Clinicians and community leaders report diabetes as a substantial health threat within Cambodian American communities 25 years after resettlement. While ethnic minorities disproportionately suffer from diabetes, there is little research investigating the socio-cultural context of diabetes within refugee communities. While genetics may predispose an individual to a particular disease, the physical and social environments lead to its embodiment. Given a history of trauma and migration, this biocultural research uses a multi-theoretical framework to explore diabetes embedded in the larger experiences of Cambodian Americans in southern New England. In addition to established risk factors, the research investigates the contribution of mental health, the status syndrome (those with lower status are at risk due to limited control and decreased social integration) and cultural consonance (the ability to live according to the standards of a culture) to diabetes risk. Data were elicited from adults in semi-structured interviews on explanatory models of diabetes, and in structured interviews targeting the experience of established and additional culturally mediated risk factors for diabetes. Cambodian American cultural models of diabetes are compared to a general American sample. Grounded theory was used to elicit themes for semi-structured interview data. Correlation and logistic regression analyses were used for structured interview data.;Both the Cambodian and general American samples drew on biomedically accepted causes and symptoms of diabetes; yet, Cambodians discussed mental health associations, while the general American sample focused on physical symptoms. Cambodian Americans experience a variety of health concerns in the context of past experiences in Cambodia and current experiences in urban America. Family history and symptoms of depression are key predictive variables of diabetes status for this sample of Cambodian Americans. As an adaptation to the reality of life in the United States, diabetes may be used as an idiom of distress. The findings suggest target areas for the long-term health of refugees with overlapping, chronic physical and mental health concerns. The research contributes to an understanding of socio-cultural factors in chronic disease and health disparities.