1993; Harwood et al., 1999). Similarly, culture also provides a framework for the use of home remedies. There are studies on the use of cupping and coining, traditional practices in some cultures that have been confused with child abuse (Moy, 2003; Bullock, 2000; Hansen, 1998). Cupping, a practice used by various cultures including Chinese, Arabic, and Jewish, involves attaching cups on one’s back and creating a vacuum to evacuate a malady and increase blood flow to the region, leaving marks that can be confused with the result of trauma to the area. Similarly, coining is the practice of rubbing the edge of a coin on one’s skin as a treatment for an illness. Other examples of the importance of cultural meaning of health and disease definitions are the “empacho” theory used by Latin Americans (food is claimed to be “stuck” to the intestines causing vomiting, diarrhea, or early satiety—many families seek the help of folk healers or home remedies consisting of such dangerous substances as lead and mercury) and the use of “hot-cold” remedies, which were mentioned in Chapter 1 (Nuñez and Taft, 1985; Risser and Mazur, 1995).

In the United States, variables such as language proficiency, acculturation level, and recency of migration have all been identified as important sources of variability within cultures (Gutierrez et al., 1988) with significant impact on health. Biculturalism (identifying simultaneously with two cultures) rather than linear acculturation (adopting a single cultural identification over time) has been found to be related to better outcomes (Gil et al., 1994; Szaponick et al., 1981).

An interesting finding in the health literature is what has been termed the “Latino epidemiological paradox” (Markides and Coreil, 1986) or “the immigrant paradox” (Fuligni, 1997; Portes and Rumbaut, 2001), whereby recent immigrants who tend to be more economically deprived and less acculturated, or individuals from Hispanic backgrounds in general, tend to have better health outcomes than other groups from the same ethnic backgrounds or non-Hispanics (Hayes-Bautista et al., 2002; Hayes-Baustista, 2003). The mechanisms behind these surprising findings are not well understood. One possibility is that of selection bias; that is, first-generation immigrants to the United States may be the healthiest and most motivated subset of potential immigrant families. But it has also been hypothesized that traditional cultural practices serve as protective factors.

These and other findings have led investigators to posit cultural differences as sources of both risk and resilience (García Coll et al., 1996; García Coll and Magnuson, 2000). In other words, culture does not constitute a source of vulnerability or risk per se, but cultural differences can become a source of risk when (1) cultural differences are seen as deficits that need to be remedied or fixed, (2) cultural differences lead to mismatches between caregivers or the child themselves and members of dominant institutions, and (3) cultural differences lead to experiences of discrimination and diminished life opportunities due to segregation. There is evidence that these sources of stress are not limited to low-income



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