FEATURE — Fall 2003

Investigating How Culture Impacts Health

Professor Wendy Auslander's interdisciplinary research identifies risk factors that affect the health of marginalized populations as well as creates interventions for preventing and managing disease.

by Nancy Mays

As a nation, Americans may recognize that disease occurs as a result of faulty genetics or of bad lifestyle choices. What many may not recognize is that other social, psychological, and cultural factors contribute to health and illness.

As one of social work's leading health behavior researchers, Wendy Auslander delves into these environmental and cultural factors. Auslander, professor of social work at the George Warren Brown School of Social Work (GWB), understands that disease stems also from a tangle of family, race, gender, and class.

"It's always more complicated than we think," says Auslander.

For more than 15 years, Auslander has carved out a niche as a social worker whose research has vast and important implications in the clinical field of medicine. Her work focuses primarily on two diseases—diabetes and HIV—and how these diseases affect society's marginalized populations: specifically, the poor, minorities, and teens in foster care.

For many of the people she studies, the question isn't "if" they'll develop a chronic disease, but "when." In fact, Auslander's research reveals a system where health care is seen as a middle-class right—and disease a lower-class rite of passage.

"You can't modify behaviors or help people lead healthy lives unless you also take into account cultural issues like race and gender—and how those issues influence their daily lives," she says.

One of Auslander's early, career-defining studies looked at the environmental factors influencing how children control their diabetes.

Auslander's findings were deceptively simple. Children with diabetes from single-parent families, for example, are more likely to manage the disease poorly than children from two-parent families. Why? Single parents are more likely to miss doctor appointments, struggle to pay for blood glucose tests—and have less time to manage their child's illness, monitoring quantity and quality of food intake and encouraging exercise.

Auslander's mentor, Barbara Anderson, a professor at the Baylor College of Medicine in Texas, says it's that kind of research—creative, life-changing—that sets Auslander apart from her peers.

"She was the first researcher to identify the risk factors for children who will have a tough course of diabetes," Anderson says. "Now clinicians know that when a child, say, from a single-parent family is diagnosed, he or she is going to need some extra help along the way."

In fact, it is that kind of interdisciplinary work that makes Shanti Khinduka, dean of GWB and the George Warren Brown Distinguished University Professor, beam. Khinduka regards Auslander as one of the leading intervention researchers in the profession of social work.

"Few social work researchers have engaged in a systematic program of interdisciplinary studies and have come up with culturally specific, community-based interventions for preventing and managing disease as well as for promoting health-enhancing behaviors," he says. "Whether it is with the African-American community in North St. Louis or an American Indian tribe in Arizona, Auslander forms fruitful partnerships with community groups in conducting her studies."


For many of the people she studies, the question isn't "if" they'll develop a chronic disease, but "when." In fact, Auslander's research reveals a system where health care is seen as a middle-class right—and disease a lower-class rite of passage.


Auslander's insight into health-based lifestyle changes isn't purely academic. At 13, she was diagnosed with insulin-dependent, Type I diabetes. The experience of managing a chronic disease guides her research today by providing valuable insight into asking important questions.

In one study, Auslander and researchers from the School of Medicine looked at the kinds of emotional support teens with diabetes need to best manage their disease. The findings? Friends and family perform distinctly different roles. Friends provide diabetic teens with tremendous emotional support, while the family is best at helping teens manage the day-to-day tasks associated with the disease.

Auslander's creative research has led her to the top of her field. Her most notable academic accomplishments include leading more than 10 studies funded by the National Institutes of Health; publishing in top academic journals like Diabetes Care; fostering interdisciplinary relationships with researchers from medicine; serving on editorial boards of leading journals; and serving as associate director of the Comorbidity and Addictions Center at GWB.

Still, Auslander is most proud of the impact her research has.

In one pioneering study, Auslander looked at HIV prevention among teens in foster care—an ignored but highly vulnerable group. The study had fascinating implications. Most prevention tactics focus on teaching teens how to properly use a condom.

"A narrow target," says Auslander.

Instead, her team looked at why teens engage in risky sexual acts. Teens in foster care have an understandably bleak view of the future so to ask them to protect it is, by all accounts, naïve.

"It's common sense," says Auslander. "If you have nothing to look forward to, then what are you protecting? Many of these kids don't come from families who talk about the future and recognize goals."

So Auslander's study gave teens a future. For every "life skills" session they attended, they earned money. If they saved the money, they received a one-to-one match. Nine months later, savings were matched again—thanks to a collaborative effort with the Annie E. Casey Foundation.

In the meantime, the "life skills" classes showed teens attainable goals: job training, attending community colleges, and such. Auslander is still processing the data—the study just finished—but initial findings are promising. So far, her team has found that among those teens that saved, about 40 percent of the teens saved at the highest level. The study also revealed a troubling but interesting fact: A host of complex factors influence risky behaviors in teens, from a history of sexual abuse to an underlying mental health problem.
Professor Wendy Auslander (left) meets with Marcia Ollie, a doctoral student in Auslander's course on intervention research.

In yet another study, Auslander has looked at how to teach healthy eating habits to African-American women at risk for diabetes. Because food is such an integral part of the culture, getting women to change their diet is not easy. What would be the best way to do it? With peers, Auslander found.

The study, called "Eat Well, Live Well," showed that women respond best when learning about diet from a neighbor, not from an outsider. Training inner-city women to be nutrition counselors is effective on many levels, because, usually, they have well-developed networks—church, family, schools—and can spread the word more efficiently.

As is the case with many of Auslander's studies, the research revealed other interesting facts as well. Women who participated in the study were less likely to suffer from depression than women in similar living circumstances.

"We're not sure why," says Auslander. "It could be that when you get women together in a supportive environment doing something fun like cooking and taking control of their health, it feels empowering."

Another possibility: Changing dietary patterns could diminish depression.

"That's what we want to find out next," she says. "Then we can really make an impact in the community."

Nancy Mays is a free-lance writer based in Lenexa, Kansas.