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Many researchers are currently studying the distribution of genetic variations among diverse groups, with particular interest in explaining racial/ethnic health disparities. However, the use of racial/ethnic categories as variables in biological research is controversial. Just how racial/ethnic categories are conceptualized, operationalized, and interpreted is a key consideration in determining the legitimacy of their use, but has received little attention. We conducted semi-structured, open-ended interviews with 30 human genetics scientists from the US and Canada who use racial/ethnic variables in their research. They discussed the types of classifications they use, the criteria upon which they are based, and their methods for classifying individual samples and subjects. We found definitions of racial/ethnic variables were often lacking or unclear, the specific categories they used were inconsistent and context specific, and classification practices were often implicit and unexamined. We conclude that such conceptual and practical problems are inherent to routinely used racial/ethnic categories themselves, and that they lack sufficient rigor to be used as key variables in biological research. It is our position that it is unacceptable to persist in the constructing of scientific arguments based on these highly ambiguous variables. Keywords: Race; Ethnic groups: Human genetics: Health disparities: Bioethics; USA: Canada

Acculturation has become a popular variable in research on health disparities among certain ethnic minorities, in the absence of serious reflection about its central concepts and assumptions. Key constructs such as what constitutes a culture, which traits pertain to the ethnic versus 'mainstream' culture, and what cultural adaptation entails have not been carefully defined. Using examples from a systematic review of recent articles, this paper critically reviews the development and application of the concept of acculturation in US health research on Hispanics. Multiple misconceptions and errors in the central assumptions underlying the concept of acculturation are examined, and it is concluded that acculturation as a variable in health research may be based more on ethnic stereotyping than on objective representations of cultural difference. Keywords: Acculturation; Research methods; Hispanic Americans; Ethnic groups; Health inequalities; Mexican-Americans

This article examines patient behavior towards treatment recommendations for chronic illness. The author, focusing type 2 diabetes patients, compares patient and care provider perspectives on treatment and discusses patient noncompliance, stating the provider is mostly concerned by bureaucratic standards and policies, whereas the patient has an individualized focus.

This paper examines the discourse of oncologists treating cancer in a provincial capital of southern Mexico. Based on an analysis of both formal interviews and observations of everyday clinical practice, it examines a set of narrative themes they used to maintain a sense of professionalism and possibility as they endeavored to apply a highly technologically dependent biomedical model in a resource-poor context. They moved between coexisting narrative frameworks as they addressed their formidable problems of translating between theory and practice. In a biomedical narrative frame, they drew on biomedical theory to produce a model of cellular dysfunction and of clinical intervention. However, limited availability of diagnostic and treatment techniques and patients inability or unwillingness to comply, presented serious constraints to the application of this model. They used a practical narrative frame to discuss the socio-economic issues they understood to be underlying these limitations to their clinical practice. They did not experience the incongruity between theory and practice as a continual challenge to their biomedical model, nor to their professional competency. Instead, through a reconciling narrative frame, they mediated this conflict. In this frame, they drew on culturally specific concepts of moral rightness and order to produce accounts that minimized the problem, exculpated themselves and cast blame for failed diagnosis and treatment. By invoking these multiple, coexisting narrative themes, the oncologists sustained an open vision of their work in which deficiencies and impotency were vindicated, and did not stand in the way of clinical practice.

A group of women were interviewed about their construction of their illness experiences before they saw a physician and subsequently over a period of several months following consultation. It was found that the physician's input was one of many components of their post-consultation understanding of their illnesses. The women built up their understandings in an interactive process, drawing significantly on their prior histories, ongoing experiences and social worlds. They continually tried out, adjusted and reworked the construction of their illnesses to adapt them to the exigencies of everyday life. We conclude that illness explanations are dynamic entities whose adequacy is determined by their usefulness within the extra-medical social environment. Key words--explantory models, doctor/patient relationships, social context of illness

Studies of self-care behaviors in the management of type 2 diabetes often focus on patient knowledge and motivation, without considering the role of practitioner orientations. Using an exploratory descriptive design, we conducted open-ended interviews with $1 type 2 diabetes patients and 35 practitioners from clinics in San Antonio and Laredo, Texas. We found critical differences between patient and practitioner goals, evaluations, and strategies in diabetes management, especially regarding such key concepts as 'control' and 'taking core of self.' Practitioners' perspectives are rooted in a clinical context, emphasizing technical considerations, whereas patients' perspectives exist within a life-world context and foreground practical and experiential considerations. These result in very different approaches to treatment. Practitioners, presuming failed treatment indicates uncooperativeness, try to inform and motivate patients. The patients we interviewed, however, understood and were committed to type 2 diabetes self-care, but lacked full access to behavioral options due to their poverty and limited social power., Non-Insulin Dependent Diabetes Mellitus (type 2 diabetes) is becoming alarmingly common among certain sectors of the population, particularly the ethnic and minority poor (Carter, Pugh, & Monterrosa, 1996; Flegal et [...]

This paper reports findings from an ethnographic study of self-care behaviors and illness concepts among Mexican-American non-insulin dependent diabetes mellitus (NIDDM) patients. Open-ended interviews were conducted with 49 NIDDM patients from two public hospital outpatient clinics in South Texas. They are self-identified Mexican-Americans who have had NIDDM for at least I yr, and have no major impairment due to NIDDM. Interviews focused on their concepts and experiences in managing their illness and their self-care behaviors. Clinical assessment of their glucose control was also extracted from their medical records. The texts of patient interviews were content analyzed through building and refining thematic matrixes focusing on their causal explanations and treatment behaviors. We found patients' causal explanations of their illness often are driven by an effort to connect the illness in a direct and specific way to their personal history and their past experience with treatments. While most cite biomedically accepted causes such as heredity and diet, they elaborate these concepts into personally relevant constructs by citing Provoking Factors, such as behaviors or events. Their causal models are thus both specific to their personal history and consistent with their experiences with treatment success or failure. based on these findings, we raise a critique of the Locus of Control Model of treatment behavior prevalent in the diabetes education literature. Our analysis suggests that a sense that one's own behavior is important to the disease onset may reflect patients' evaluation of their experience with treatment outcomes, rather than determining their level of activity in treatment. Key words - diabetes, Locus of Control, causal model, behavioral factors, patient perspective, Mexican Americans