ACCULTURATION AS A RISK FACTOR FOR CHRONIC DISEASE AMONG CAMBODIAN REFUGEES IN THE UNITED-STATES

Although the concept of acculturation originated within anthropology, in recent years it has assumed a prominent role within epidemiology as a risk factor for chronic disease. However, these studies often consi der acculturation in structural terms, reflected in differences betwee n groups assumed to lie along the same continuum, all moving in the sa me direction toward greater acculturation to the values and behaviors of the dominant society. This paper addresses how acculturation should be conceptualized when examining it as a potential risk factor for ch ronic disease and how it should be measured so that it becomes both th eoretically and clinically meaningful. Four case studies of Cambodian refugees of San Diego, California are used to illustrate the following : (1) the importance of integrating an acculturation-as-process perspe ctive with an acculturation-as-structure perspective; (2) viewing accu lturation as both individual and group experience of conflict and nego tiation between two systems of behavior and belief; (3) measuring it l ongitudinally and as narrative; and (4) understanding that rather than being an inherent health risk, it may also promote health by creating access to certain forms of health care unavailable in the country of origin and by contributing to the abandonment of risky health-related behaviors and the adoption of behaviors that promote goad health.