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
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,"
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 diseasesdiabetes and HIVand 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 rightand 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 genderand how those issues influence their daily
lives," she says.
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 testsand
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 researchcreative, life-changingthat 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 rightand disease a lower-class rite
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
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 carean 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
"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 againthanks 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 datathe study
just finishedbut 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
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 networkschurch, family, schoolsand 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."