Cultural Values, Disease, and Self-Rated Health Among Mexican American Injection Heroin Users

Background and Purpose. The relationship between self-rated health and mortality is a well-established inverse relationship: lower self-rated health is linked to higher mortality and vice versa. Thus, improving self-rated health, especially in the presence of disease, can have beneficial outcomes. However, which factors impact this relationship is lesser known. There is some evidence that cultural values may moderate the relationship between presence of disease and subjective self-rated health status, which could be of potentially critical importance. We examine this relationship in a sample of 227 male Mexican American injection heroin users. We hypothesized that respondents who scored high on cultural values that have a “positive” connotation (i.e., familismo or family centeredness and personalismo or preference for close and warm interpersonal transactions) would have higher self-rated health in the presence of disease. Respondents who scored high on cultural values with a “negative” connotation (i.e., fatalismo or belief in fate and machismo or male chauvinism) would have lower self-rated health in the presence of disease.

Methods. For this analysis, self-reported diseases were grouped into 6 categories: Cardiovascular, Liver, Sexually-Transmitted Infections (STIs), Metabolic Syndrome, IDU-Lifestyle-Related Conditions (i.e., Bacterial Endocarditis, Skin Abscesses or Cellulitis, and HIV), and Other Health Conditions (i.e., Arthritis, Cancer, and Tuberculosis). Self-Rated Health was dichotomized as “Poor/Fair” and “Good/Excellent”. Four cultural values present in Mexican American communities (familismo, fatalismo, machismo, and personalismo) were measured using the Multiphasic Assessment of Cultural Constructs-Short Form (MACC-SF) and then dichotomized as low (below the mean) or high (above the mean). Chi square analyses are reported.  

Results. Frequencies of diseases were 132 (58.1%) for Liver Diseases; 102 (44.9%) for Metabolic Syndrome; 71 (31.3%) for STIs; 62 (27.3%) for Cardiovascular Diseases; 38 (16.7%) for Other Conditions; and 22 (9.7%) for IDU-Lifestyle-Related Conditions. Cultural Values Measures were low across the board but consistent with other samples of primarily bicultural and acculturated Mexican Americans: Familismo (M=3.26, SD=1.79); Fatalismo (M=3.74, SD=2.34); Personalismo (M=4.6, SD=2.0); and Machismo (M=6.0, SD=2.9). Bivariate analyses yielded mixed results. As hypothesized, familismo played a protective role on IDU-Related Conditions (p=.031), but a risk role for Metabolic Syndrome (p=.018). Fatalismo was protective for both Cardiovascular (p=.021) and Metabolic (p=.021) Diseases. Machismo was also protective for Cardiovascular (p=.010) and Metabolic (p=.011) Diseases, while Personalismo was a risk factor for both Cardiovascular (p=.037) and Metabolic (p=.042) Diseases.

Conclusions. Cultural values do appear to moderate the relationship between disease presence and self-rated health, although the effect is nuanced and complex. These four cultural values, which are present in many Mexican American communities, may sometimes play a protective role and other times a risk role. This relationship needs to be further disentangled using both multivariate statistical methods and qualitative approaches as well. Further clarifying these relationships may contribute to reducing Hispanic health disparities by maximizing the protective value of these ubiquitous cultural values and minimizing their risk impact.