Social support, social networks and coping of parents of children with cancer

MISSING IMAGE

Material Information

Title:
Social support, social networks and coping of parents of children with cancer comparing white and African American parents
Physical Description:
xvi, 391 leaves : ; 29 cm.
Language:
English
Creator:
Williams, Holly Ann
Publication Date:

Subjects

Subjects / Keywords:
Anthropology thesis Ph. D
Dissertations, Academic -- Anthropology -- UF
Genre:
bibliography   ( marcgt )
non-fiction   ( marcgt )

Notes

Thesis:
Thesis (Ph. D.)--University of Florida, 1995.
Bibliography:
Includes bibliographical references (leaves 362-390)
Statement of Responsibility:
by Holly Ann Williams.
General Note:
Typescript.
General Note:
Vita.

Record Information

Source Institution:
University of Florida
Rights Management:
All applicable rights reserved by the source institution and holding location.
Resource Identifier:
aleph - 002054557
oclc - 33486703
notis - AKP2536
System ID:
AA00011762:00001


This item is only available as the following downloads:


Full Text










SOCIAL SUPPORT, SOCIAL NETWORKS AND COPING OF PARENTS OF
CHILDREN WITH CANCER: COMPARING WHITE AND AFRICAN AMERICAN
PARENTS

















By

HOLLY ANN WILLIAMS


A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
DOCTOR OF PHILOSOPHY

UNIVERSITY OF FLORIDA


1995































Copyright 1995

by

Holly Ann Williams













This dissertation is dedicated to the memory of Jodi

Michelle Lukacs, who was born on November 11, 1974, and died

on May 22, 1978, from aplastic anemia. Jodi was one of my

first patients that I cared for as a young staff nurse at Yale

University Hospital, New Haven, Conn. As only a young child

can, Jodi taught me that life is precious, and filled with

wonder and joy, even when one is faced with a life-threatening

illness. Jodi's influence on my personal and professional

life was profound, and she significantly altered my career

choices. My relationship with Jodi convinced me to work with

chronically and terminally ill children and their families.

I have never regretted that decision, and this dissertation is

a way of offering thanks to the memory of Jodi. This

dissertation is also dedicated with love to Jodi's family: her

mother Bonnie, her father Roy, and her baby sister Karie, who

all taught me that life can have meaning, in spite of

tremendous human tragedy.













ACKNOWLEDGMENTS


There are many people to whom I owe gratitude for

assisting me with this dissertation. First and foremost, I

would like to thank the parents and children for allowing me

to enter some very private moments in their lives. They

tolerated seeing me in the examination and hospital rooms,

they talked to me during periods of extreme stress, and they

stayed late on clinic days so that I could finish an

interview. This is their story and I deeply appreciate their

kindness, their humor, and their patience.

I also could not have done the interviewing without the

assistance of all the health care professionals. They are too

numerous to mention, but they include nurses, physicians,

social workers, aides, child life therapists, pharmacists,

etc. In spite of very busy days and, often grueling

schedules, they helped me in whatever ways I needed. For the

out-of-town sites, I was always made to feel welcome and part

of the staff. The staff humored me and often helped me to

decompress after difficult interviews. This is also a story

about the work that they do on an everyday basis.

This research would not have been possible without the

financial support that I received from various sources, most

notably a five-year pre-doctoral fellowship from the National

iv








Cancer Institute. I am deeply grateful to the following

sources of support: National Cancer Institute, Nurses'

Educational Funds, Inc., Transcultural Nursing Society,

Association of Pediatric Oncology Nurses, and the Alpha Theta

Tau chapter of Sigma Theta Tau, International Nursing Honorary

Society.

My research assistant, Ms. Karla Slocum, and my

transcriptionist, Ms. Monique Costantino, put in much time and

effort to assist me. Both were very interested in the

research and gave me much needed support during the times I

wondered if I would ever finish.

My committee members have been with me since the

beginning and have offered support, encouragement, and wisdom.

My outside committee members went far beyond the usual

commitments for committee members and gave willingly of their

time and efforts. Dr. Marjorie White was my nursing colleague

before she was a committee member. She gave me support and

empathetic understanding for the challenge of blending two

professional fields. Dr. Joe Feagin has been essential to my

beginning understanding of race relations. He not only

stimulated my thinking, but he made me challenge my own

preconceived notions about our society. He was always

generous with his time and was only a phone call away during

tough weekends of analysis and writing. Dr. Gary Lee has

nurtured my interest in family studies since the beginning of

my graduate career. He helped me to think like a sociologist,







as well as an anthropologist. He also spent much time just

being there for me.

The anthropologists on my committee helped to shape who

I am as an anthropologist. Dr. Otto von Mering taught me the

wonders and the perils of being a medical anthropologist. He

offered suggestions for making my daily life sane,

particularly during the last few months Dr. Tony Oliver-

Smith sharpened my thoughts concerning the place of human

tragedy in our lives. He stimulated me to understand personal

meanings that we use to contextualize events in our lives. My

chairperson, Dr. H. Russell Bernard, has been involved in my

career since the beginning of my doctoral program. He taught

me the importance of grantsmanship. He also worked hard over

the years to improve my writing skills. Whatever improvements

I have made, I owe to him. I deeply thank my committee

members.

I owe a large debt of gratitude to Dr. John Dixon,

Coordinator for Computer Applications, at the Center for

Instructional and Research Computing Activities (CIRCA) at the

University of Florida. Although not a committee member, he

patiently and consistently worked with me on my statistical

analyses. His mentoring skills are excellent, and he believed

in my abilities. From him, I learned statistics, data

analysis, and that I was capable of doing complex analyses.

Family and friends all across the country offered

listening ears, words of comfort, and laughter when it was








most needed. They understood how the process affected our

friendships, and were patient. My pediatric oncology nursing

colleagues reminded me how important this research was to our

practice.

Perhaps the hardest people to thank are my family

members. I am sorry that my father, Plummer H. Williams, did

not live long enough to see me finish the research. He and my

mother, Jane Williams, were always by my side. Many times

they did not understand the process, but they were there for

me. My sister, Dr. Susan Williams, knew from first-hand

experience how grueling doctoral studies were. She was a

critical support for me. She will never know how grateful I

am for the long-distant calls, the encouragement, the cheers,

and the constant belief in me as a person, as well as a future

scholar.

I offer much love and gratitude to my husband, Dr. Art

Hansen. He had to straddle two difficult positions, being a

faculty member in anthropology and being my husband. His

never ceasing love and words of support carried me through the

bleakest times. I could not have done this without his love.

My life was enriched during my doctoral studies by having two

children enter my life: my stepson, Akim Ben Hansen, and my

daughter, Kaitlin Williams Hansen. Akim challenged my

thinking on everything, but always made me laugh and look at

life from a less serious perspective. Kaitlin gave me the

gift of her precious little self and, with that gift, I


vii







understood my priorities. While education and research are

important, family ties are what really matter in the end.


viii
















TABLE OF CONTENTS


ACKNOWLEDGMENTS . .

ABSTRACT . . .


CHAPTERS


1 INTRODUCTION . .

Like a Blanket of Love .
Aims of the Study . .
Research Questions . .
Theoretical Framework .
Outline and Descriptions of Chapters

2 SOCIAL SUPPORT AND SOCIAL NETWORKS

Social Support . .


*. .. .. 1


Attempting to Define Social Support .
Social Support and Psychological Adaptation
Social Exchange Theory .. .....
Negative Aspects of Social Support .
Reciprocity and Social Support .


. 15
S18


Relationship Between Social Support and
Social Networks . .

Social Networks . .
Network Research Findings .
Personal Networks . .
Geographical Distances From Networks .
Density of Networks . .

Social Support, Social Networks and Cancer
The Role of Social Support in Parenting
an I11 Child . .

3 AFRICAN AMERICAN FAMILIES . .


r
Historical Review of the Social Forces Shaping
the African American Family .








r











The Period of Slavery . .
African Influence . .
Emancipation Through the Early Twentieth
Century . .

The Viability of the African American Family

Cultural Deviant or Pathological Model .
Cultural Relativity or Cultural Variant
School . . .
Adaptive Responses to Society .


Contemporary Family Organization .

Societal Trends Affecting Families .
Causative Factor for Family Structural
Changes . . .

Social Networks and the Provision of Support

Social Networks of African American Families


Extended Families . .
The Consequences of Support and the Need
for Reciprocity . .
Informal Ties .
Comparisons Between African American and
White Social Networks . .
Relationship Between Patterns of Support
and Family Structure . .
Helping Traditions in African American
Communities . .

Conclusions . . .

4 COPING . . .

Review of the Literature . .


Coping: Definitions in the Literature .
Anthropological Use of Coping .
Historical Approaches to the Study of Coping
Models of Coping . .
Empirical Testing of the Coping Process .
Family Stress and Coping . .
Coping with Childhood Cancer .

Limitations to the Literature . .

Cross-Sectional Design . .
The Use of Retrospective Data .
Lack of Multi-Variate Models .
Situation-Specific Studies . .


. 35
. 37

. 39


. 46
. 48


S 50

S 50

S 52

S 55


. 57


64

65

66

68

68

68
74
75
78
88
96
106

113

113
113
114
116


. .

. .


. .


. .







Cultural Influences to Coping .. 116
Demographic Characteristics That Have Been
Ignored . . 117
Unsolicited and/or Negative Sources of
Support . ........... 118
Measurement of the Coping Process and
Desired Outcomes . .. 118
Outcomes . . 119
Efficacy of Coping . .. 120

5 STUDY DESIGN AND METHODS . .. 122

Human Subjects Protection . 122
Sample and Settings .............. 124
Data Collection Schedule and Procedures .... .127
Instruments . . 129

The Interview . .. 129
Instruments Used to Measure the Outcome
Variables . . 130
Social Network Inventory . .. 131

Historical Influence on Sampling ... .132
Analysis . . 135

Social Networks . ..... 136
The Ways of Coping Questionnaire (WCQ) 137
Brief Symptom Inventory ... .. 155
Center for Epidemiological Studies
Depression Scale (CES-D) ... 157
Coping Health Inventory for Parents (CHIP) 157
Testing the Conceptual Model .. 158

6 PARENTS OF CHILDREN WITH CANCER: DEMOGRAPHICS .162

Pediatric Oncology Services in Three Research
Sites . . ... 163

Atlanta, Georgia . .. 165
Gainesville, Florida . .. 166
Jacksonville, Florida . .. 167

Parent Demographics. . .168

Socioeconomic Demographics . .. 170
Employment Status . .. 173
Marital Status . .. 176








Characteristics of the Ill Children .

Age of the Ill Child .. .
Gender of the Ill Child ...
Variables Pertaining to the Children's
Illnesses . .

Financial Costs and Burdens Caused by the
Child's Illness . ...

Gross Estimates of Out-of-Pocket Costs
of Child's Illness . .
Additional Jobs and Loans as a Way to
Supplement Income . .

7 THE PROVISION OF SOCIAL SUPPORT: WHAT IT IS
AND WHO PROVIDES IT . .

A Heart Feeling . .
Emic Definition of Support . .

Coding of Responses for the Definition of
Support . .
Definition of Support as Compared by Race

Provision of Social Support . .

Situational Types of Support .
Offers of Spontaneous Assistance .
Support During Periods of Hospitalizations
Financial Assistance with Costs of Illness

Social Networks: Membership and Structural
Aspects . .


. .


. 189


189
190


. 191
. 195

. 198


198
205
206
219


. 222


Network Membership Features .
Perception of Support from Alters .
Structural Characteristics of Social Networks
Relationships of Social Network Measures
to the Psychological Outcomes .
Concluding Discussion of Social Support .

8 THE PROCESS OF COPING AND ITS INFLUENCE ON
PSYCHOLOGICAL OUTCOMES . .


Types of Stressful Events Experienced by
by the Parents . .
Influence of Type of Stressful Event on
Coping Behaviors . .
Secondary Cognitive Appraisal of Stress .
Types of Coping Behaviors Used in Response
to Identified Stressful Events .


223
228
230

233
235


242


242

245
253


. 255


xii


178

178
178

179


182


183

186


* .


. .
. .







Significant Differences in Types of Coping
Behaviors Used by Race and Gender 255
Significant Differences in Functions of Coping
by Race and Gender . .. 258
Perceived Satisfaction with Outcome of
Stressful Situation . .. 259

Does the Process of Coping Affect Psychological
Outcomes? . . 263
Comparison of Mean Scores of Outcome Variables
by Coping Type, Gender, and Race 270
Do Coping Patterns Predict Psychological
Outcomes? ... . ... 273

Influence of Type of Coping and Perception of
Control on Psychological Outcomes 276
Correlations of Independent Variables and
Dependent Variables . .. 280
Multiple Regression Results with the Full
Conceptual Model.. . 282
Comparison of Parents' Psychological Outcomes
to Other Populations .. . 285
Limitations and Discussion of Findings in
Regard to the Theoretical Framework .. 293

9 PARENTS' PERCEPTIONS OF RACISM AS A FACTOR IN
OBTAINING MEDICAL CARE FOR THEIR CHILDREN 298

Racism, Discrimination and Health Care .. 299
Interview Questions Pertaining to Racism
and Discrimination . .. 303
Parents' Perceptions of Racism in the Pediatric
Oncology Setting . .. 304
Differences in Care Based on Race ... 307

African Americans' Perceptions Regarding
Differences in Care Based on Race 308
White's Perceptions of Differences in Care
Based on Race . ... 308

Illness and Medical Treatments as Buffers
from Everyday Racism . .. 310
"I Didn't Notice It or Didn't Care to Notice
It . . 313
Personal Observations of Racism. .315

10 CONCLUSIONS .................. .319

Personal Reflections about the Research .. 319
Random Acts of Kindness. . .324
Summary of Research Questions and Hypotheses 325


xiii








Major Research Questions and Aim of the
Study . . 325
Summary of Findings Pertaining to Social
Networks . . .. 327
Summary of Findings Pertaining to Support 331
Summary of Findings Related to Coping 334
Summary of Research Hypotheses .. 335
Review of the Theoretical Base of
the Research ... ........ .. 339
Modification of the Conceptual Model .. 341

Implications for Applied Practice . 344
Suggestions for Family, Friends, and Others
in How to Assist Parents of Ill Children 347
Areas for Future Research . .. 352

APPENDIX A INTERVIEW SCHEDULE . .. 355

APPENDIX B SOCIAL NETWORK INVENTORY . .. 361

REFERENCES . .. 362

BIOGRAPHICAL SKETCH. .. . .391


xiv













Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy

SOCIAL SUPPORT, SOCIAL NETWORKS AND COPING OF PARENTS OF
CHILDREN WITH CANCER: COMPARING WHITE AND AFRICAN AMERICAN
PARENTS

By

Holly Ann Williams

May 1995

Chairperson: Dr. H. Russell Bernard
Major Department: Anthropology

Having a child diagnosed with cancer is an overwhelming

experience for parents. The goal of this research was to

understand why some parents do better with this situation than

do others. Research questions included the following: Who

provides support to the parents? What is provided? What do

parents do to cope? In addition, this research compared white

parents to African American parents in an effort to explicate

racial and cultural differences in experiencing childhood

cancer.

Two hundred two parents (150 white and 52 African

American) of children with cancer were interviewed in a

hospital or clinic setting in three southeastern US cities.

In addition, several standardized psychological instruments

were used to measure anxiety, depression, somatization, and







general level of psychological symptomatology. Qualitative

and quantitative analyses were performed on the data.

This was a story of courage and of incredible human

caring for others in distress. Overall, there were few

significant differences by race, gender, or site. These

parents had multiple sources of support. White parents had

larger social networks, but African Americans perceived

receiving more support from their network alters. Networks

were small, dense, kin-centered social networks of long

duration, with members living near to one another. Emic

definitions of support differed by race, with whites defining

support in emotional terms and African Americans defining it

more broadly, both in terms of emotional and instrumental

actions. Social network properties and characteristics did

not significantly correlate with or predict the psychological

outcomes.

Most parents used a combination of problem-focused and

emotion-focused coping behaviors to deal with stressful

situations. Only a small percentage of parents showed poor

psychological functioning. However, use of emotion-focused

coping behaviors, particularly escape-avoidance behaviors,

best predicted poorer psychological outcomes. Few of the

variables commonly thought to influence positive outcomes

(such as social support, income) predicted the psychological

variables. The experience of having a child with cancer was

so encompassing that nothing else mattered, not the amount of

support, or who provided it, or how much.


xvi













CHAPTER 1
INTRODUCTION


Like a Blanket of Love


This is a story about everyday people who are

experiencing one of the biggest, most demanding, and

frightening challenges of their lives. They all are parents

of children with cancer. The children are of different ages,

have different diseases, and have different prognoses.

However different these families may seem initially, the

experience of being told that your child has a potentially

fatal illness unites them in a myriad of ways. From hearing

the chilling words at diagnosis, "your child has cancer," to

traveling over and over again to the cancer clinics and

hospitals, to the days of waiting for lab test results, the

lives of these families are irreversibly changed. For some

families, this challenge heightens their spirit of life and is

turned into a positive challenge to be met together. For

others, the days become a vast wasteland from which nothing

good could ever spring, filled with pain and isolation.

Family becomes a metaphor for broken spirits and failed

promises.








2
While the specific details may vary as to the physical

environment or the people involved in the actions, the daily

drama of childhood cancer is repeated hundreds of times in

clinics and hospitals across the country. In some settings,

there is an attempt to make the surroundings as pleasant and

conducive to normal childhood activities as possible. One

sees volunteers assisting children with fun things to do;

furniture is bright and child-sized; examination rooms are

painted with murals and motifs and come with hanging mobiles

so that the children may concentrate on fantasies, and not on

medical procedures.

Other clinics look like any standard hospital area. The

walls are a drab green or gray, there is never enough room for

everyone to sit down, equipment is scattered around the

hallway, and there is a sense of chaos that permeates

throughout. Children and families appear to get lost in the

vast machinery that is called the "medical system."

Yet appearances can be misleading. It only takes a few

moments of sitting with the children and families to realize

that something intangible occurs in these spaces. An

overwhelming sense of caring for these children and a profound

respect for the resilience within each child are seen over and

over again in many different ways. Although cluttered, the

hallways and the examination rooms are filled with photos of

the children and the children's hand-drawn pictures. People

stop whatever they are doing to give or get a hug from the







3
children, and to take time to listen about the latest school

adventure or a new pet in the family.

Families learn about each other and become "friends" in

a very special way that is circumscribed by events and the

clinic or hospital surroundings. They share in the joy of

good news, in the fear when their children come off treatment,

and in the grief of a relapse or death. Their silent language

of shared understanding is so well communicated that words are

often inconsequential.

The research presented here focused primarily on the

parents of the children. The story would not be complete,

however, without recognizing the efforts of others. For many

of the families, help comes from the health care staff, family

members, co-workers, and neighbors. Perhaps most striking was

the kind assistance I saw being given by strangers who reached

out to touch the lives of children and parents with whom they

had never met. As one mother described the support, it was

"like a blanket of love that surrounds you and protects you

from what you are going through at the time."

I have been a pediatric nurse specializing in pediatric

thanatology for 18 years. These months of research have, once

again, filled me with awe and wonder of the human spirit. I

watched these families cope with incredible circumstances that

made me shudder at times. Yet, they maintained a sense of

humor and an awareness of others, and they survived in the

truest sense of the word.









Aims of the Study

My research was motivated by these questions: Who

provides support to the parents? What is provided? What do

parents do to cope? The goal was to understand why some

parents do better with this situation than do others.

Historically, studies on coping and social support of parents

of children with cancer used white parents for subjects. Yet

the pediatric oncology population is racially and culturally

diverse. This research compared white parents to African

American parents in a effort to explicate racial and cultural

differences in families experiencing childhood cancer.

The specific aims of the study were a) to describe and

understand the differences for African American and white

parents in the experience of parenting a child with cancer,

2) to understand why some families experiencing childhood

cancer seem to have more social support than others, and 3) to

ask whether African American parents experience problems,

based on race, in receiving care for their children.


Research Questions

The research questions were as follows:

1) Are there racial or gender differences in the

characteristics of the social networks of parents of children

with cancer?








5
2) During the period of the child's illness, how do

social network members function to exacerbate or alleviate the

stress of having a child with cancer?

3) Are certain network properties associated with the

perception of being supported?

4) Are certain network properties associated with better

or worse levels of psychological symptoms?

5) How much support is given to parents of children with

cancer? Does this vary by race or gender?

6) What types of support are given to parents of children

with cancer?

7) Do different ways of coping predict better

psychological outcomes for these parents?


Theoretical Framework


Lazarus and Folkman's (1984) transactional model of

stress, appraisal, and coping is the theoretical base of the

research. Coping is examined in detail and is tested in a

theoretical model to see if it predicts psychological outcomes

in the parents. Coping is defined as "constantly changing

cognitive and behavioral efforts to manage specific external

and/or internal demands that are appraised as taxing or

exceeding the resources of the person (Lazarus & Folkman 1984:

141). Coping is further differentiated into problem-focused

coping and emotion-focused coping. Problem-focused coping is

defined as "coping that is directed at managing or altering








6
the problem causing the distress," while emotion-focused

coping is "coping that is directed at regulating emotional

response to the problem" (Lazarus & Folkman 1984: 150).

A conceptual framework built on the stress, appraisal,

coping model of Lazarus and Folkman (1984) guided my research

questions (see Figure 1.1). Personal factors, such as race,

gender, education, marital status, and social network

characteristics combined with situational/environmental

factors (income, total amount of government assistance

received, length of child's illness, and social support) to

influence the primary appraisal of a stressful situation.

Secondary appraisal was thought to be influenced by social

support, degree of perceived control over the stressful

situation, as well as the personal and situational factors

that influenced primary appraisal. Coping behaviors included

emotion-focused coping and problem-focused coping. An

immediate outcome from the coping process was the perception

of satisfaction with the outcome of the stressful event.

Longer-term psychological outcomes included anxiety,

depression, somatization, and global level of psychological

symptomatology. At any point in this process, feedback

mechanisms could influence prior variables in the model.

This study also tests the applicability of previous

social support findings for African American families in

crisis. It compares coping across racial and gender


















o0

- 0
(D


-o -0
1 0
'
0I

0 c E
m 5
E E



t


E
a.
C,


c


0
0 o
L,-
o -o 0--
_0_

m a ra v)


00
o 0
, N


a "
1 U E 0


/











0
)
L "
0


0

> o
-0
o0-

.o E
0 0
a
f o


E0 v
" E u

E > >
c o5 ." 0
*L5 !E o c
.2 o
._ E "

0 o ,c o -

O -


00
Ch


0













04
a)



S"









0
*0
m

44
N1









"0






0
a,


-4



0) 4
iO0


Ha)
MA >
,-)
to r-4
m
wo
Uom
o..4

0 *4





(0
4)0



4 0
41

0







O.O
4.- 0
2O4


$4 -4 0


,- 0 0












manI
0 04 1O




O a
r::





04
0) 4J r







S- 0 *0
OOC



0 0C
H) U M
, u




E0)
.,-I
4 a X





<<^l
u ><
(0 *PO




Z tn IT








8
categories. In addition, it examines whether racism is an

additional burden to African American families.

Based on a literature review and two pilot studies

conducted prior to the dissertation (Williams 1992, 1993) the

following hypotheses guided my work:

1) In situations characterized by a perceived minimum of

control, parents who use emotion-focused coping strategies

will demonstrate positive adaptational outcomes (e.g. lower

levels of psychological symptoms, less depression and

anxiety);

2) in situations characterized by a perceived sense of

control or changeability, parents who use problem-focused

coping will demonstrate positive adaptational outcomes;

3) social network characteristics (e.g. size, density,

length of time members have known one another) will not

predict perception of support;

4) white parents will define support primarily as

emotional interactions;

5) African American parents will define support primarily

as instrumental actions;

6) married parents will perceive and receive greater

levels of support than single parents, irrespective of race;

7) parents with higher incomes and education will

demonstrate a higher level of perceived support and will

receive greater levels of enacted support;








9
8) higher incomes will be associated with larger social

networks;

9) parents with lower incomes will demonstrate greater

psychological symptomatology, with single poor parents having

the worst adaptational outcomes; and

10) the shared experience of parenting a child with

cancer will diminish racial and cultural differences between

the African American and the white parents.


Outline and Descriptions of Chapters

The dissertation will present selected aspects of the

entire research process. Research findings that are not

presented in the dissertation will be completed at a later

date in the form of manuscripts submitted for publication. As

usual, I have far too much data to ever include in one

dissertation. Although much of the dissertation focuses on

the quantitative analyses that I completed, qualitative

analyses were also performed. Whenever appropriate, the

qualitative material will be combined with the quantitative

findings for better illustration of a point or concept.

Verbatim quotes will be used throughout the text to portray

the sentiments of the informants in their own words. Names,

institutions and locations will be disguised as needed to

preserve the confidentiality of the informants.

Chapters 2 through 4 review pertinent bodies of litera-

ture. Chapter 2 reviews social support, Chapter 3 discusses







10
the African American family, and Chapter 4 details coping.

Chapter 5 outlines the study design and the methods that I

used. Chapter 6 provides demographic information on the

informants, the ill children, and the research sites. In

addition, information pertaining to the financial status of

the parents is presented, as finances were a major worry for

these parents. Chapter 7 presents the findings related to

social support and social networks. Support is defined

emically by the parents. The types of support offered to the

parents are discussed, as well as identifying the support

providers. Structural aspects of the social networks are

detailed. The chapter concludes with a discussion of whether

social network attributes contributed to the psychological

outcomes of the parents. Chapter 8 focuses on coping. It

looks at which coping behaviors are used to manage a

particular stressful event using data from the Ways of Coping

Questionnaire (Folkman & Lazarus 1988a). For the sake of

brevity, the second coping instrument used, the Coping Health

Inventory for Parents (McCubbin & Thompson 1983), will not be

discussed in the dissertation. Data regarding whether coping

predicts psychological outcomes will be presented as well as

the results of multiple regression analyses based on the

conceptual model. Selected social network variables, demo-

graphic variables, social support variables, and coping

variables were all entered into the conceptual model. Chap-

ter 9 presents the results of whether African American parents







11
perceived racism and discrimination as problems in obtaining

care for their children. Chapter 10 summarizes the major

results of the research. Personal insights gleaned from the

research are shared. Each research question and study

hypothesis is reviewed. The theoretical base of the research

is highlighted, and modifications to the conceptual model,

based on the findings, are discussed. Lastly, clinical

interventions and lay suggestions for offering assistance in

this type of situation are outlined. Areas for future

research are presented.













CHAPTER 2
SOCIAL SUPPORT AND SOCIAL NETWORKS




The experience of parenting a sick child can be likened

to riding a roller-coaster. Throughout the time of the

illness, there are many emotional ups and downs and sharp

corners to be turned without knowing what lies ahead. How-

ever, what is missing in this simile is the thrill and fun-

seeking aspects that one normally associates with riding a

roller-coaster. The events and experiences that cause the ups

and downs differ as the illness progresses, and parents'

abilities to withstand the tensions alter as time goes by.

But unlike riding a carnival ride, parents can not simply get

up and leave when the ride is finished. The course of the

illness varies and may last for years, requiring combined

modalities of treatments.

Diagnosis is an especially frightening time. For some

families, it represents the first time their child has been

seriously ill. Some parents and children may have to travel

to obtain care at a distant, specialized pediatric oncology

center. In an amazingly short period of time, parents are

asked to make decisions regarding the care of their child, and

to consent to treatment protocols that appear to be written in








13
foreign languages. Hospital routines and a new vocabulary of

medical terms and abbreviations must be learned.

Hospital and clinic bureaucracies present mazes that, at

times, entangle parents in their webs. Parents are confronted

with answering never-ending lists of questions, giving medical

histories over and over to new members of the health care

team, and filling out piles of insurance forms and/or

applications for much needed social services. Particularly

during the first year of treatment, the out-of-pocket

financial costs may exceed the family's expected budget. Few

health care professionals remember that parents are expected

to perform all these tasks at the same time that they are

exhausted from caring for their child and worried about the

short and long-term consequences of their child's illness.

For many children, their cancer goes into remission and

the stresses alter for the parents and children. Although the

child appears to be much healthier, the family is still

confronted with unexpected emergencies and must plan their

daily lives around a series of in-patient hospitalizations and

clinic visits. Whatever was deemed as "normal daily life" is

now altered due to the child's illness and treatment

requirements. New ways of interacting with friends and family

are incorporated so that the immune suppressed child is

protected. Sibling needs become more apparent and demand

parental attention. Parents must deal also with work

responsibilities that often were ignored during the initial








14
phases of the illness. Throughout the time of remission, the

fear remains that the child has relapsed, and the disease has

returned.

As the illness trajectory continues, some children are

cured, some remain chronically ill for years, and some

children die. Each scenario has its own stresses and demands,

even for the "cured" child. Years go by and parents worry

whether the cancer will eventually return.

Social support from a network of family, friends,

neighbors, acquaintances, and sometimes even strangers is

thought to lessen some of the intensity of the stress in this

situation. This chapter reviews the literature on social

support and social networks. The term "social support"

encompasses both perceived support and received or enacted

support. Perception of support refers to the belief that

support is available if needed, as compared to support that is

actually received. Social networks, the set of relationships

from which the support is provided, are also discussed. In

addition, the literature pertinent to support for parents of

ill children, especially children with cancer, is highlighted.

The literature on social support is vast and, at times,

unwieldy. This literature review concentrates only on the

aspects of support that are most relevant to my research.

Recent literature regarding social support and social networks

will also be incorporated into the discussion sections of the

results.









Social Support

Attempting to Define Social Support


Social support is a complex and multi-dimensional con-

struct. It has been studied in a myriad of ways to determine

types of support provided, categories of support providers,

mechanisms by which support protects people against the

negative effects of stress, and even what the best definition

is for support. Bruhn and Philips (1984: 152-53) suggest that

environmental, physical, social, interpersonal and cultural

facets of social support should be considered in any

definition of the concept. Classical definitions, such as

Caplan (1974) and Cobb (1976), stress the affective component

of support. An often used definition of social support notes

that it consists of interpersonal transactions that have at

least one of three characteristics: affect, affirmation, and

aid (Kahn & Antonucci 1980). Gottleib and Wagner (1991: 166)

stress the processual nature of support defining it as "a

social process that is shaped by the commerce occurring

between people in particular relationships who are attempting

to maintain their equilibrium in the face of conditions that

are personally and socially destabilizing."

Social support can also be conceptualized into the

dimensions of perception of support, enacted support, and

social embeddedness (Barrera 1986). Barrera notes that these

concepts were only mildly related and should be treated as







16
separate components of the construct social support. He

defines social embeddedness as ". the connections that

individuals have to significant others in their social

environments" (p. 415); perceived support as the ". the

cognitive appraisal of being reliably connected to others"

(p. 416); and enacted support as ". actions that others

perform when they render assistance to a focal person"

(p. 417) (Barrera 1986). I am modifying Barrera's concept of

social embeddedness for this research. Consistent with the

extant literature, I refer to social embeddedness as simply

the parents' social support networks. Social networks are

viewed as the source from which social support arises.

A consistent and major criticism of social support

research is the absence or inadequate conceptualization and

operationalization of the construct (Antonucci & Depner 1982;

Brownell & Shumaker 1984; Heller & Swindle 1983; LaRocco,

House & French 1980; Ryan & Austin 1989; Thoits 1982; Wortman

& Dunkel-Schetter 1987). Different aspects of support (i.e.,

enacted support and perceived support) have been discussed as

if they were equivalent (Heller & Swindle 1983). However,

research results from the past fifteen years demonstrate that

social support can not be conceptualized adequately as a soli-

tary dimension. Critics of the early work on support urged

for disaggregating the construct into separate components,

each of which could then be defined clearly and operation-

alized (Rook 1984; Lieberman 1986).








17
Reviewing the literature on social support, Wortman and

Dunkle-Schetter (1987: 70-71) suggest that support can be

distinguished into the following types: a) expressing agree-

ment of a person's beliefs, b) encouraging open expression of

feelings and beliefs, c) expressing of positive affect,

d) offering material aid, e) offering information or advice,

f) instrumental assistance with tasks, and g) acknowledging

that the person is part of a system of mutual obligation or

reciprocal help. Dunkel-Schetter and Bennett (1990) urge the

differentiation of support into cognitive and behavioral

aspects. They conceptualize support as either available or

activated. Once activated, there are differences in the

extent to which people seek support, the need or desire for

support in certain circumstances, and the actual receipt of

specific types of support from particular persons (Dunkel-

Schetter & Bennett 1990: 268).

Support has been measured generally in two ways:

perceptual appraisal and structural network measures (Ryan &

Austin 1989). Both measurement approaches need to be included

in research. It should be noted that support changes circum-

stantially and temporally and these changes can cause discre-

pancies in individual answers versus objective counts of

support (Singer & Lord 1984). The relationship between the

support provider and the support recipient and how this

affects the outcome of the stressful situation is a component







18
of social support research that is sorely lacking (Coyne &

DeLongis 1986).


Social Support and Psychological Adaptation


Since Cassel's (1974) classic paper on the relationship

between stress and social support, researchers have been

studying if and how social support protects people from the

effects of stress. Numerous papers have summarized the

beneficial effects of support in a variety of situations

(Bloom 1982; Broadhead & Kaplan 1991; Brownell & Shumaker

1984; Dean and Lin 1977; Lin, Woelfel & Light 1985; Wortman &

Dunkel-Schetter 1987). Assuming this to be so, the center-

piece of prevention and intervention programs has been to

strengthen systems of social support to enhance human

adaptation in a variety of circumstances. Whether or not

social support is consequential for mental health in any

causal sense is now being questioned (Coyne & DeLongis 1986:

454). While well-being may be tied to supportive relation-

ships, the linkages are thought to be complex, reciprocal, and

contingent. The contextual situations that govern the

relationship between perception of support and its supposed

adaptational consequences need attention (Coyne & DeLongis

1986).









Social Exchange Theory


Aspects of social support can be conceptualized using

social exchange theory. This theory stresses the mutual

interdependency of people and proposes that one strives to

maintain equity of exchanges in relationships (Blau 1964;

Chadwick-Jones 1976; Gouldner 1960). Although equity is

desired, there is a tendency toward imbalance (Chadwick-Jones

1976). Inequitable relationships over time will cause

distress, and individuals will seek to restore equity in

unbalanced relationships. Both the overbenefitted and the

underbenefitted will feel stress (Stewart 1989; Tilden &

Galyen 1987).

While this theory may have some applicability in studying

social support exchanges, there are additional considerations

that need to be examined. The costs of receiving assistance

need to be studied in closer detail. As well, the desire for

equitable exchange may be differentiated on the basis of the

type of social relationship, the timing of the assistance,

and/or the specific type of assistance given (Rook 1987).

Much of this work has been done in experimental laboratory

settings and needs to be tested in field settings (Antonucci

& Jackson 1990). How reciprocity operates within the context

of specific situation needs to be further studied.









Negative Aspects of Social Support


Confounding the problem of inadequate conceptualization

has been the implicit understanding that social support is, by

its very nature, "good" or positive (Coyne & DeLongis 1986;

Coyne, Wortman & Lehman 1988; Rook 1984; Wellman 1981; Wortman

& Dunkel-Schetter 1987). Quantity of contact with others has

been equated with high levels of social support, yet few

studies look at the problems found in such contacts (Rook

1984). By focusing solely on the positive aspects of

relationships, the negative elements of support and the

uncertain and/or unsuccessful attempts to obtain support have

been overlooked.

In order for social support to be effective, it must meet

the needs of the support recipient by decreasing the demands

placed on the recipient, increasing resources or altering the

consequences of failing to manage such demands (Woods, Yates,

& Primomo 1989). Recent findings indicate that "supportive"

interactions can result in significant stress and problems

concurrently with providing much needed assistance (Cramer,

Riley & Kiger 1991; Fisher et al. 1988; Tilden & Galyen 1987;

Wellman 1981; Wortman & Dunkel-Schetter 1987). Problematic

areas include a) differing perceptions of efficacy between the

provider and the recipient, b) availability of social network

members during a crisis, c) level of satisfaction (adequacy)

with received support, and d) activation of support, the

extent to which support is desired, needed, sought, or







21
received (Bloom 1982; Wortman & Dunkel-Schetter 1987). Social

support can be seen as unhelpful when it serves to undermine

self-esteem (Stewart 1989). In addition, the process of

support is affected by contingencies that arise during the

stressful event that precipitated the need for support. These

contingencies include a) the amount of distress communicated;

b) the nature of the topic and the help expected; c) both

parties' responses to the stressor; d) and the restraints that

each person's coping strategies place on the other's receipt

of support (Gottleib & Wagner 1991:171).


Reciprocity and Social Support


Reciprocity involves the processes of giving, receiving,

and repaying. Giving and receiving are essential elements of

social support. In everyday social relationships reciprocity

plays an important role by balancing obligations among members

of social groups. Relationships characterized by either

excessive giving or receiving (i.e., the situation of the

parents of ill children) can be detrimental to the support

process (Ingersoll-Dayton & Antonucci 1988).

Wentowski (1981) studied exchanges among older people and

found that the nature of the relationship was more important

than age. Both equivalency of exchange and time of exchange

were important factors. She also delineated types of recipro-

city: immediate, deferred, and generalized. Superficial

relationships used stricter rules of exchange and expected the








22
return of equivalent gifts in a shorter period of time.

Intimate and longer term relationships allowed for non-

equivalent exchanges over a longer span of time. Wentowski's

work did not ask what happened if the recipient was unable to

return the assistance.

Similarly, Clark (1984) distinguished social relation-

ships as either communal or exchange relationships. Communal

relationships are closer relationships that have an implicit

assumption that the parties in the relationship will be

responsive to each other's needs in a general way. Exchange

relationships are based on a pragmatic relationship in which

assistance is offered in response to specific benefits

received.

Bruhn and Philips (1984: 155) hypothesize that the

relationship between a person's level of functioning and the

social support received is related to the degree to which the

individual reciprocates social support. If support recipients

feel that they are unable to return the benefit then social

relationships can become strained. Perhaps more importantly,

those in need of help may then be unwilling to seek help or

accept offered support (Antonucci & Israel 1986; Stewart 1989;

Woods, Yates, & Primomo 1989).

There are some gaps in the conceptualization of

reciprocal relationships when one considers a crisis

situation, such as parenting a child with cancer. First, it

is not solely a dyadic exchange. As noted before, it may








23
involve both kin and non-kin, as well as others outside the

social network. Patterns of exchange occur that reflect both

communal and exchange relationships. Therefore, long held

expectations about the balance of support over a life-time in

intimate relationships are pertinent to only some of the

support providers.

Support is an interactional process and recipients simply

do not passively accept such assistance. But as Silver,

Wortman, and Crofton (1990: 398) note, little attention has

been paid to the recipient variable that may influence the

provision of support. Rarely has the recipient been asked if

they feel a need to reciprocate, and, if so, how would they do

that?

Reciprocity is difficult, if not impossible, to practice

in the situation of parenting a seriously ill child. The time

demands created by the illness and treatments are immense.

Most parents have conflicting pressures between managing the

illness and managing work responsibilities. Emotionally, many

parents talk about being depleted of any extra energy with

which they could do other things. In addition, siblings

frequently require special assistance during this time.


Relationship Between Social Support and Social Networks


The source from which support is provided, i.e., the

social network, is important in understanding how social

support operates. Analysis of social network ties may be used







24
to describe characteristics and variables that constitute the

opportunity for social support (Bloom 1982; Israel 1982;

Maxwell 1982).


Social Networks


Social support does not occur as an isolated entity but

rather it is derived from relations with members of one's

social network. Social networks are a series of ties or

social connections between individuals that vary in terms of

structure and function (Heller & Swindle 1983; Mitchell 1986).

Theoretically, social networks are representative of social

structure and the web of ties of different sorts can link

people throughout society, however remotely (Mitchell 1986).

It is important to remember that social network boundaries are

not fixed and static but, rather, fluid in response to situ-

ational contexts, perceptions of one's social relationships,

and even geographical distances and time (Jacobsen 1986). How

the alteration of such boundaries affect the provision and

receipt of support needs to be examined.

For the purpose of this research I concentrated on a

subset of the parent's total social network. The network has

been defined narrowly as a personal (ego-centered) social

support network. The network represents the ties between the

parents of children with cancer and the individuals whom the

parents identified as being helpful or important to them

during the course of their child's illness.







25
Social network analysis has emerged from the study of

sociometric analysis, British "Structural-Functionalism," and

crisis theory (Moos & Mitchell 1982). Network analysts study

social structure by analyzing patterns of ties linking its

members and describing how these patterns influence or

constrain social behavior (Mitchell 1969a; Wellman 1985). The

emphasis of study is on examining the concept of ties linking

nodes (i.e., persons, groups, organizations), the properties

of such ties (density, dispersion, content, duration, etc.),

and how resources flow across ties. Individual charac-

teristics of persons (such as the ability to ask for help,

degree of empathy, feelings of fear) may affect the flow of

resources. Culturally specific beliefs and values also shape

how resources are given and received within a network. How a

network is defined (i.e., who is included in the network) may

also be shaped by cultural beliefs (Jacobsen 1986).

Differences in the features of social networks have been

described as having structural, functional and interactional

characteristics (Rounds & Israel 1985). Functional charac-

teristics may include access to social contacts, maintenance

of social identity, and the provision of affective, affirma-

tional, and material aid (Rounds & Israel 1985). Structural

components are size or range, network density, and degree of

connection. Intensity, durability, multi-dimensionality,

directedness and reciprocity, relationship diversity,







26
dispersion, frequency and homogenicity describe the interac

tional elements (Mitchell & Trickett 1980).


Network Research Findings


The studies of social support and social networks are

closely interwoven in the research literature. For a person

experiencing stress, the existence and use of a social network

hedges against the collapse of a single relationship. In

addition, network members can offer consensual information and

validation (Gottleib 1988). Networks that are diverse in

nature and capable of providing multi-faceted support appear

to enhance perception of support and social adaptation in

various situations.


Personal Networks


Wellman (1985) studied a large community sample of

working-class adults to discern the kinds of supportive

resources flowing through a naturally occurring sample of ties

and networks. His data showed a complex, multi-dimensional

array of specific resource transfers with the most common

categories of support being companionship, emotional aid and

small services. The complex ties and resource transfers

suggested variation in the type, extent, and breadth of social

support available.

Fisher et al. (1988) reviewed the literature and found

that studies indicate that family members are chosen for







27
longer-term serious problems, while friends are chosen for

short-term everyday problems. Friends may be seen as

supplemental to the family, but not as a substitute. Other

data suggest that one source of support does not compensate

for another that is lacking (Coyne & DeLongis 1986).

In an intensive ethnographic analysis of unmarried

teen mothers, the better adapted teens displayed a more

differentiated view of their social networks' taxonomic

structure and perceived network members as more diverse in

their capacity to offer various types of support. The results

also suggested that support was best received from network

members who are perceived to be permanent and enduring

components of their social world (Boyce, Kay, & Uitti 88).


Geographical Distances From Networks


Sociological studies focused on the question of urban

isolation have demonstrated that due to communication and

transportation advances, urbanites are embedded in networks of

supportive others that fall disproportionately outside

boundaries of the immediate neighborhoods (Fischer 1982;

Wellman 1979). Significant others may be a component of

personal networks and yet live away from the contact person.

While this paper is not a study of urbanites, an understanding

of environmental determinants of networks can assist in

interpreting whether geographical isolation from a network







28
(such as being away from home in the hospital) affects network

response.


Density of Networks


Findings regarding density appear to be situation-

specific, and somewhat contradictory. Some argue that dense

networks are able to offer emotional support to a person in

distress (Simmons 1994). For example, in family crises

involving death of a parent, children cope better in high-

density, close networks (Hammer 1981). Contrasting this,

Granovetter (1973) notes that weak ties may be more useful in

situations where linkages are needed outside the primary

group, such as moving or job-seeking. Hirsch (1980) studied

the adjustment of women in college and has found that dense

networks were significantly related to greater symptomatology,

poorer mood, and lower self-esteem.

A series of studies was recently completed that compared

parents of handicapped or chronically ill children to parents

of healthy children (Kazak 1987a; Kazak & Marvin 1984; Kazak,

Reber, & Carter 1988). Personal stress, marital satisfaction,

and network size and density were compared across sets of

parents. Stress was consistently found to be higher in the

parents of handicapped children, especially for the mothers.

Mothers of handicapped children were found to have higher

density measures of their social networks, but when compared

statistically, there were few significant differences between







29
groups with regard to the size and density of the parent

networks. However, for both sets of parents, larger, less

dense networks were associated with decreased experiences of

psychological distress, particularly for the mothers. How-

ever, the causal direction of this relationship is not known.

While these studies did not focus on the experience of child-

hood cancer, hypothetically these findings are applicable to

the issue of dealing with chronic illness, such as cancer.

The last section of this chapter focuses on the role of

social support and social networks for parents of children

with cancer. Although there is a vast array of literature

pertaining to social support and adult cancer patients it will

not be reviewed here. The support issues pertinent to adults

experiencing cancer are vastly different from the issues

confronting parents of children with cancer.



Social Support, Social Networks and Cancer


There is ample documentation of the turmoil and suffering

experienced by a family when a child has been diagnosed with

cancer (Bakke & Pomietto 1986; Binger et al. 1969; Chesler &

Barbarin 1984, 1987; Fife, Norton, & Groom 1987; Futterman &

Hoffman 1973; Moore, Kramer, & Perin 1986). Social support is

just one component of people's lives (Jacobsen 1986) but there

is broad agreement that social support is important in coping

with this turmoil and suffering.








30
There has been limited attention to the role of support

for pediatric oncology patients and their families, as

compared with studies of adult patients with cancer.

Perception of adequacy of support and satisfaction with

support has not been discussed (Hamlett, Pellegrini, & Katz

1992: 36). Findings indicate that support plays a role in

mitigating the stress of childhood cancer, although the

studies suffer from a lack of attention to the social networks

or other factors that might influence how support works (Fife,

Norton, & Groom 1987; Lynam 1987; Magni et al. 1986; McCubbin

et al. 1983).


The Role of Social Support in Parenting an Ill Child


As described previously, serious childhood illnesses,

such as cancer, pose multiple cognitive, emotional, and

physical demands on the entire family. Families cope not only

with the stress of caring for their ill child, but also with

life events such as illnesses/hospitalizations of other family

members, occupational changes, financial concerns, moving,

planning vacations, and deaths of other ill children or family

members (Kalnins, Churchill, & Terry 1980).

In response to this situation, members of the parent's

social networks offer assistance. Networks expand to include

strangers and communities who become involved in making the

life of the family easier in a myriad of ways. In fact,

family growth and survival during the period of treatment may








31
be determined by the family's abilities to mobilize and

maintain their resources (Thoma, Hockenberry-Eaton, & Kemp

1993).

Social support, both perceived and actual, is thus seen

as an important coping resource for the parents (Huang 1991-

1992; Tunali & Power 1993). Parents seek support from a

variety of sources and employ a broad range of coping stra-

tegies to deal with childhood cancer (Chesler, Barbarin, &

Lebo-Stein, 1984). Psychosocial adjustment in parents has

been positively correlated with the amount of support received

(Morrow, Hoagland, & Morse 1982). Kazak and Marvin (1984)

suggest that informal sources of support are more critical to

family well-being than are formal sources of support. Find-

ings from other studies indicate that spouses, the medical

community, and other parents from self-help groups are

valuable sources of support (Barbarin, Hughes, & Chesler 1985;

Lynam 1987; Morrow, Hoagland, & Morse 1982).

Chesler and Barbarin (1984) note that parents' abilities

to identify their need for help correlates positively with

success in receiving help. Families with higher socioeconomic

status (SES) used friends for support, while families with

lower SES used health professionals. Other factors

influencing family adjustment to childhood illness include

economic resources, family communication patterns, marital

adjustment, access to medical care, and parental perceptions

of the child's illness (Clements, Copeland, & Loftus 1990).








32
Perceived social support continues to have a positive

effect for parents of childhood cancer survivors. Parents

experiencing low levels of perceived social support were

significantly more depressed and anxious than parents of

healthy children in one study. For mothers, the generalized

perception of support is most important to psychological well-

being. For fathers, a combination of the specific support

offered by marriage and the generalized perception of social

support is most conducive to well-being (Speechley & Noh 1992:

19).

This chapter examines the role that social support plays

in helping families deal with the experience of childhood

cancer. It questions whether social support and assistance

are always helpful processes. It delineates the differences

between social support and social networks, and concludes with

a review of social support specific to parents of ill

children. The next chapter reviews the African American

family, paying particular attention to the role of support in

these families.













CHAPTER 3
AFRICAN AMERICAN FAMILIES



The subject of the African American family has

received tremendous attention during the past six decades.

Various theoretical paradigms have argued the origins and

variability of the African American family. Some writers said

that the African American family evolved into a unique

cultural form as a response to racism, while others argued

whether the African American family was a pathological

institution. Still others argued whether the African American

family was a variant on the white family.

The literature remains weak in some areas regarding the

study of African American families. In-depth ethnographies of

African American families have not been written since the

1970s (e.g., Aschenbrenner 1975; Stack 1974). Recently, a few

large, randomized studies have been completed which examine

diverse phenomena affecting African American family life

(Taylor, Chatters, & May 1988; Taylor 1990). It is not known

whether contemporary societal conditions have overwhelmed the

African American family to the point that years of tradition

of extended assistance npw fall short. Are problems so severe

now that available help has been depleted? If so, what

happens when a catastrophic event, such as childhood cancer,

33








34
faces a family? To whom do they turn? Is there a difference

between African American and white families facing this issue?

I argue in this chapter that the African American family

survives as a viable institution with its own norms and expec-

tations. Family structure and the family's ability to provide

assistance have altered in the face of years of racism, denied

social and economic opportunities, and a deteriorating social

environment affecting both the dominant white culture and the

African American culture.

This chapter examines the African American family from a

variety of perspectives. The literature on the African Amer-

ican family is voluminous. The chapter concentrates on those

topics most relevant to the dissertation research. First, it

is necessary to determine historically the social forces that

shaped the family organization before one can question the

viability of the family. Therefore, the history of the

African American family as an institution from slavery to

modern times is briefly described. Major theoretical para-

digms are discussed regarding the structure and viability of

African American family life. The final section of the paper

focuses on African American family social network research.

Extended family support is seen as a strength of the African

American family. Extant literature is reviewed regarding how

and if social support is received from members of the extended

African American family and others. Intra-cultural variation

regarding social support and characteristics of social








35
networks for both African American and for white families is

a crucial component of the dissertation.


Historical Review of the Social Forces Shaping
the African American Family


The Period Of Slavery


Slavery challenged the resilience of both individuals and

families. Individuals suffered multiple losses loss of

a homeland, customs, and emotional attachments to the land and

to people left behind; loss of freedom and dignity; and, for

some, loss of life.

Scholastic arguments developed regarding how African

American men, women, and families responded to the conditions

of slavery. A prominent argument stated that the demise and

disorganization of the African American family began in the

wretched conditions of slavery. Families disbanded; sexual

mores did not exist; and women ruled the slave family with

little need for or regard to the slave man. Proponents of

this argument held that slavery was the first step in a long

process of family disintegration (Frazier 1939; Harris 1979).

Not only did slavery destroy the family, according to

this argument, slavery also served to strip African American

families of all their cultural heritage and customs. Frazier

(1939) argued that enslavement erased any perpetuation of

African kinship and family relations. Conditions of life in

America destroyed the significance of an African heritage, and








36
new habits and attitudes formed to meet the new situations

(Frazier 1957). Family life during slavery was portrayed as

non-existent due to the selling of children, the separation of

kin as slaves arrived in America, and the emasculation of the

African American male. The African American woman was seen as

the most dependable and most important member of the family.

Frazier's description of slave life was harsh and focused

attention and blame on the slaves. He described a loss of

morals and wanton sexual behavior of the slaves, particularly

men.

Contrasting the belief that slavery eroded the family,

others argued that the family as an institution survived.

Family life was important; attachment between slaves was real;

and thousands of slaves fled in search of missing family

members (Franklin 1988a). Gutman (1976) destroyed the myth of

the dissolution of the African American family during slavery.

He studied records from enslaved African Americans, their

children and grandchildren, and showed how they adapted to

enslavement by developing distinctive domestic arrangements

and kin networks. Those networks fostered a new Afro-American

culture.

Using census data from various cities (1880-1925), Gutman

demonstrated most African Americans lived in nuclear families,

regardless of social class, and that the two-parent family was

the dominant form. He further argued that current family and

kinship patterns originated during slavery, and that these







37
practices reflected an African heritage. Slave conceptions

regarding marital, familial, and kin obligations were passed

from generation to generation by slaves in marriages of long

duration. Extended kin networks revealed one aspect of the

adaptive capacities of the slaves and their offspring. This

study was critically important in addressing the question of

whether the institution of the African American family had

survived.


African Influence


According to many authors, African heritage played a

prominent role in the survival and adaptation of the African

American family during slavery and afterward as well (Foster

1983; Herskovits 1958; Martin & Martin 1985; Sudarkasa 1988).

However, this view is not universally accepted. In the 1957

revision of Frazier's book (1939), he continued to espouse

that it was difficult to establish any factual linkage between

the African family system and the African American family.

More recently, Martin & Martin (1985) said that the brutality

of slavery was, in itself, a force against the perpetuation of

former cultural traits. African slaves came from diverse

tribal backgrounds and did not share a common language. Slave

masters fought against the retention of cultural traits, and

mere survival, at times, forced slaves to forego their efforts

to maintain their culture.







38
Yet, in spite of the forces that militated against

retaining African traditions, aspects of slavery worked to

foster humanistic values and patterns of assistance (Martin &

Martin 1985). Helping traditions were deeply rooted in

African culture, and non-institutionalized aspects of culture

were maintained more easily than other cultural ways. The

slave system demanded cooperation to ensure survival. Slaves

established their own community structures in the slave

quarters during the few hours when they were not working for

the masters. Leaders arose and attempted to maintain the

spirit of life as previously known in Africa. In short,

oppression led to patterns of assistance necessary for day-to-

day existence (McCray 1980).

DuBois (1908) was the first scholar to urge the study of

the African American American family against the background of

its African origins (Sudarkasa 1988). African cultural

traditions that were carried to America and transformed by

subsequent years of slavery and oppression included fictive

kin, extended family networks, marriage rules and rituals,

consanguineal kin groupings, husband-wife relations with

complementary and egalitarian roles, patterns of respect and

deference, socialization practices, and corporate identity

(Foster 1983; Martin & Martin 1985; Rodgers-Rose 1980;

Sudarkasa 1988).

Although enslaved Africans came from different West

African tribal groups, some features of kinship organization








39
and social institutions were commonly held (Sudarkasa 1988).

Patriarchy and polygyny figured prominently in African life,

and an individual could not place his or her personal

interests above those of the group. In many groups, lineage

membership was passed through women and women held important

instrumental and economic roles, particularly in regards to

bearing and raising children.' The universality of African

practices, values, and institutional arrangements aided

American slaves in establishing family organization during

slavery (Foster 1983; Sudarkasa 1988). The African principles

of respect, restraint, responsibility, reciprocity, and a

commitment to the collectivity provided a basis from which

African Americans would establish extended family networks

during slavery. The specific forms the networks took

reflected the political and economic circumstances of the

enslaved populations, as well as the influence of European-

derived institutions (Sudarkasa 1988).


Emancipation Through the Early Twentieth Century


The Civil War and Reconstruction presented new problems

and challenges for the African American family.2 Free African

Americans assisted in the freedom fight for others by their


'For more in-depth discussions of African practices and
their integration into African American life, see Foster
(1983) and Sudarkasa (1986).

2For a historical review of African American life in
American society, see Franklin and Moss (1988).








40
efforts in the Underground Railroad. Kin consciousness

extended to racial consciousness with the awareness of the

plight of all African Americans. Free African Americans

normalized the natural helping traditions of the slaves

(extended family and fictive kin) establishing churches,

benevolent societies, fraternal orders, and schools (Franklin

& Moss 1988; Martin & Martin 1985).

The resiliency of African American families was shown

through their efforts during Reconstruction to unite with lost

family members, to establish legitimate marriages with legal

marriage contracts, and to foster and adopt orphaned African

American children (Franklin & Moss 1988; Gutman 1976).

Sharecropping perpetuated poverty. Though mired in debt,

subsequent generations were tied to family land, and forced to

depend on relatives for survival (Martin & Martin 1985;

Rodgers-Rose 1980).

Sweeping social changes occurred at the turn of the

century with the transition from agriculture to urban indus-

trialism. European peasant immigrants competed for jobs; the

Great Depression hit; and, hoping to find better oppor-

tunities, southern African Americans migrated by the thousands

to the northern urban centers.

The agrarian system of the rural South was exploitative

and limited the opportunities for advancement of African

American families. Large extended families were an economic

necessity. As the migration took hold, families continued to







41
extend as they adjusted to social and economic conditions in

the cities. Although social welfare programs were introduced

in the New Deal, African Americans continued to face

overwhelming social injustice and lack of opportunity (Harris

1979; Foster 1983; Franklin & Moss 1988; Martin & Martin

1985).

The brief historical review is important for several

reasons. First, the family as a social institution cannot be

understood in isolation. From slavery to contemporary times

the political, economic, and social climate of the country has

alienated African Americans and hindered opportunities.

Racist ideologies and discriminatory practices, such as

segregation, are simple examples of the many forces affecting

the African American family. Second, the historical sequence

provides insight on the establishment and importance of

African American family organization, in spite of tremendous

outside pressures against its formation. From the beginning

of African American family life in America it is clear that

mutual support from established extended networks has been a

core tradition and value. Environmental conditions mitigated

against individualism and fostered cooperative patterns to

insure group survival. The collective, extended nature of

family life would later haunt the African American family as

critics argued that such a form was counter to the norm and,

thus, pathological. Third, understanding the impoverishment

of the African American community, the effects of rural-urban







42
migration, and the limited economic opportunities for African

American families sets the stage for reviewing the conflicting

models of the contemporary African American family.

Families everywhere--African American or white, national

or international--must adapt continuously to changes in the

larger society and its institutions by modifying their

structures and functions (Berardo 1990). A key issue that has

been fought, and continues to be fought, is whether African

American families are adaptable and resilient, or whether

external forces have weakened the family to the point of

collapse. I believe that history shows the adaptability of

the African American family. The next section presents the

contemporary arguments between the paradigms of the cultural-

deviance model versus the resilient-adaptive model. The

resilient-adaptive model is the stronger. The last section of

the chapter on African American networks and social support

exemplifies the adaptability of the African American family.


The Viability of the African American Family


Many writers have questioned the very existence of the

African American family as an institution over the past 50-60

years. The issue raised was ". is family and household

structure in the African American community indicative of

'social disorganization,' or are distinctive features of Afro-

American domestic groups adaptations to economic marginality

and oppression?" (Dressler, Hoeppner, & Pitts 1985: 853).







43
As the debate raged, more subtle questions emerged regarding

the extent to which the African American family and community

life reflected traditional African values and practices;

whether the issue of African American family structure

pertained more to class differences than racial differences;

and what the causes were for apparent racial differences

regarding family functioning.

The two major paradigms that emerged were the following:

a) African American family life is disorganized and patho-

logical (the mainstream view); and b) African American family

life is an organized, logical approach to oppression (the

dissenting view). The models will be discussed separately.


Cultural Deviant or Pathological Model


The pathological model (also referred to as the "cultural

ethnocentric school," Dodson 1988) saw the family as unable to

provide the social and psychological support necessary for

full assimilation into the dominant society. White middle-

class family values were considered the societal norm.

African American marriages were seen as the most fragile of

conjugal units, and the African American woman/mother was

depicted as the core of a matrifocal society.

E. Franklin Frazier (1939) studied race relations and the

process of how African American families were culturally

assimilated into white society. He attributed variations in

sexual and marital practices to a) matriarchal characteristics







44
of the family, whereby males were marginal; b) the lack of

legal marriages in slavery and casual sex as a norm causing

later marital instability patterns; and c) urbanization as a

force in the dissolution of family life (Staples 1986; Stewart

1990). He believed that contemporary family organization

traced back to slavery and to the influence of American

culture, not to African cultural transfers (Dodson 1988).

Contemporary with Frazier, African American

intellectuals, such as W.E. DuBois, urged assimilation and

stressed the need for the African American family to adopt

norms held by white, middle-class families. The model applied

to writers of this persuasion was called the "Cultural

Equivalent" model. This model depicted African Americans as

legitimate when they adopted the lifestyle and norms of

middle-class whites (Johnson 1988). (This was also the time

that the Structural/Functionalism ideology was popular.

Conservatism was accepted social patterns were

identified and reasons were created to justify those patterns.

Process, change and individual responses that were outside of

the mainstream were not valued in this paradigm.) However,

writers during the 1940s-50s challenged the idea that the

African American middle-class was economically secure and

better assimilated (Harris 1979). This period led to the more

scathing studies of the 1960s .the period of the African

American family seen in negative, pathological terms.







45
Best known of this genre is Moynihan's report (March

1965), The Negro Family--The Case for National Action. The

same themes as discussed earlier were repeated; the African

American community was characterized by matriarchy, broken

families, economic dependency, and delinquency and crime.

Moynihan described the African American community as a "tangle

of pathology" and identified the fundamental problem as the

crumbling family structure. The matriarchal structure was

inconsistent with American society, and African Americans were

disadvantaged as their values were not in line with the

dominant societal values. Moynihan's report was linked to the

"Culture of Poverty" thesis (Lewis 1966). The "culture of

poverty" described the lower-class poor as having limited

ability to defer gratification, having high incidence of

material deprivation, weak ego structure, and lack of impulse

control. African Americans were both the victims of and were

blamed for their misfortunes. Moynihan's central recommen-

dation urged the national government to set a goal of

establishing a stable Negro family structure. This implied

structural changes in the family, replacing African American

familial features with characteristics emulating the white

middle-class the so-called "functional normative model

family" (Dodson 1988). (The prevailing social climate during

this period was one of unrest, challenging the status quo, and

resisting the established societal structures. The Civil







46
Rights movement had gained momentum and was seen as

challenging and frightening in much of the dominant society.)


Cultural Relativity or Cultural Variant School


Responding sharply to the negative, victim-blaming stance

of the previous work, critics of the pathological model lauded

the African American family as a functioning entity in its own

right. The cultural relativity model proposed that the

African American family was a culturally different family

form, nondeviant, with values and family patterns instrumental

for combating oppressive racial, political, and economic

conditions of American society (Billingsley 1968; Dodson 1988;

Herskovits 1958; Hill 1972; Johnson 1988; Shimkin, Shimkin, &

Frate 1978; Stack 1974). Aschenbrenner (1975) described the

African American family as a cultural institution with a long

tradition whose social organization was created in the face of

adversity, and not merely adjustment to contemporary urban

conditions.

Focusing on family strengths, this framework proposed

that the African American extended family and domestic units

adapted to economic marginality. Historical forces were

inimical to family formation and maintenance. Judged against

alien norms, social roles in America demanded variability from

the African American family in order to survive (McCray 1980;

Staples 1985). Structural transformation of the economy from

industrialization to a service oriented market, with an







47

emphasis on high technology, and a dismantling of a welfare

state were seen as responsible for African American family

problems--rather than blaming the victims (Ladner 1986).

Collins (1989) sharply criticized Moynihan's report

implicating the African American family as the source for

creating deviant societal values that ". in turn, collec-

tively shape African American cultural deficiency" (p. 877).

She and others contended that Moynihan neglected the manner in

which racism and political and economic factors shape indi-

vidual and/or group accomplishment (Collins 1989; Ladner

1986).3

Countering the earlier importance placed on attitudes and

values as primary predictors of economic achievement, contem-

porary family scholars place environmental restraints on

mobility and achievement as a primary problem. Analyzing

census data, Farley & Allen (1987) claim that the majority of

African Americans in the United States remain separate and

unequal because a legacy of African American subjugation

remains. The subjugation is seen in persistent racial

inequalities in educational achievement, family structure,

occupational attainment, patterns of unemployment, income

levels, residential segregation, and distribution of wealth.

While declamations of the dominant society are assimila-

tionist, political/economic/social structures remain committed


3Rainwater and Yancy (1967) provide a more complete
analysis of the events leading to and after the publication of
the Moynihan report.








48
to exclusionary practices and continued subordination of

African Americans (Jaynes & Williams 1989; Young 1989).


Adaptive Responses to Society


The question becomes "what are the strengths and coping

strategies used by the African American family to counter such

obstacles?" The most discussed strength is the strong sense

of obligation to kin and the extended family structure

(Aschenbrenner 1975; McAdoo 1978; Stack 1974). Consanguinity

assumes primacy over affinal ties. As compared to white

middle-class families, the marital tie does not hold the same

status for African Americans. This is not to imply that

marriage is unimportant. The importance of marriage ties has

been shown from historical data. The statement is meant to

imply a cultural difference surrounding the meaning of

marriage. Commitment to motherhood is strong, whether or not

the mother is married, and there is a recognition that

children may not be raised necessarily in an intact family

(Aschenbrenner 1975; Peters & Massey 1983). Role flexibility

may allow for stability in the one-parent family by having

extended relatives play the role of the absent parent (Foster

1983). Extended kin ties are reinforced and maintained

through space and time by participation in rituals such as

funerals, family reunions, and regular visiting patterns

(Aschenbrenner 1975; Barnes 1981; Foster 1983; Stack 1974).







49
Contrary to the popular, stereotypic image of African

American men as absent from the family, African American men

are an important aspect of family life playing different roles

in the family organization. Women have participated in the

labor force since slavery, and gender roles have evolved in a

more egalitarian fashion (Foster 1983; McCray 1980; Taylor,

Chatters, Tucker, & Lewis 1990). Men may not support children

as a matter of course but are generous if asked (Aschenbrenner

1975). A review of recent literature indicates that African

American men are highly involved in parental and childrearing

roles (Taylor, Chatters, Tucker, & Lewis 1990).

Hill (1972) summarized the following characteristics as

strengths common to African American families: strong kinship

bonds, strong work orientation, adaptability of family roles,

strong achievement orientation, and strong religious orien-

tation. While also seen in white families, Hill argued that

these traits are manifested differently in African American

families due to their history of racial oppression. Other

values cited as strengths include a belief in the institution

of the family, motherhood, and childrearing; an emphasis on

strict discipline and respect for elders; and the necessity

for caring roles and mutual aid systems (Aschenbrenner 1975;

McCray 1980; Staples 1985). In a recent study focused on

middle-class African Americans, core characteristics and

values included an implicit or explicit embracing of the

dominant culture; delay of gratification; a strong sense of







50
self and empowerment; a sense of importance in the fact of

their Blackness; and quality of life pursuits (Coner-Edwards

& Edwards 1988).


Contemporary Family Organization

Societal Trends Affecting Families


In spite of the strength of African American families,

family organization and structure have changed over the past

20-30 years. It is important to remember that larger societal

trends, such as an increased rate of divorces and a shifting

of emphasis away from familism toward individualism affected

both African American and white families. In a decade review

of family research in the 1980s, Berardo (1990) noted a

renewed concern that family and marriage institutions were

being severely weakened and threatened from accelerated and

pervasive social change. The African American family was at

double risk exposure to those societal threats shared by

whites and African Americans coupled with continued oppression

and racism.

Major demographic trends identified in the literature

include higher divorce rates, declining rates of marriage,

later ages at first marriage, larger percentages of children

living in female-headed families, higher percentages of

children living in poverty, an increase in female-headed

families, and a higher proportion of births to unmarried

mothers (Jaynes & Williams 1989; Wilson 1987). African







51
American families, particularly the growing African American

underclass, have disproportionately suffered from these trends

(Jaynes & Williams 1989; Taylor, Chatters, Tucker, & Lewis

1990; Wilson 1987). For example, African American female

heads of family are less likely to marry if single, or to

remarry if divorced or widowed. Female-headed white families

are of shorter duration than African American female-headed

families (Wilson 1987). Between 1969 and 1987, the jobless

rate of African American husbands more than doubled (from 2.9%

to 7.0%). During the same period of time, the number of

unemployed African American husbands almost tripled (from

84,000 to 209,000) (Hill 1990: 87).

There are vast economic differences by race with African

Americans disproportionately over-represented among the poor.

Female-headed families are at the most profound economic

disadvantage, with African American female-headed families

being twice as likely to have poverty-level incomes than white

female-headed families (Jaynes & Williams 1989). In 1992, 13%

of all families had incomes below the poverty level. For

white families the poverty rate was 9.8%, compared to 32.7%

for African American families (US Department of Commerce

1993a: 2-3, Table 2). Female-headed families with related

children under 18 years of age below the poverty level

differed sharply by race: 42% were white and, 68% were African

American families (US Department of Commerce 1993: 93-94,

Tables 93-94). The 1993 figures showed an even greater







52
disparity, with 30.9% of African American families below the

poverty level, compared to 8.9% of white families (US Bureau

of the Census 1994: 48, Table 49) (Based on constant 1992

dollars).

Poverty rate for all children under 18 in 1992 was 21.9%,

with African American children representing 34.6% of all poor

related children under 6 years of age. For children living in

female-householder families, 73.1% were African American,

compared to 60.5% white and 71.8% Hispanic-origin (US

Department of Commerce 1993b: x).


Causative Factor for Family Structural Changes


Throughout this chapter, I argue that social forces

directly impinge on the functioning of the family. The

contemporary African American family is also subject to these

forces. One must ask: What accounts for racial differences

between African American and white family patterns?

Two major explanations have been offered: a) systematic

and persistent differences exist because of differing cultural

norms; and b) differences are due to economic factors (Farley

& Allen 1987). Arguments pertaining to the cultural norm

explanation were presented earlier in the section describing

different values held by African Americans, particularly in

regards to marriage and gender roles.

Additional support for the cultural explanation arose

from an analysis of the 1980 census data. Independent of







53
household income, race was related to household extendedness.

This patterns was seen for African Americans, Hispanics and

Asians. A proposed explanation was that benefits from

extendedness may go beyond economic benefits to include

childcare, household help, and companionship (Farley & Allen

1987). However, due to the type of data used in the study, it

was impossible to verify values and attitudes regarding

extendedness that might play a role in this finding.

Economic and structural factors have been strongly

implicated in several studies. In an extensive study on the

position of African Americans in American society since the

eve of WWII, the most salient factors explaining racial

differences in family structure were differences in income and

employment, greater (relative) economic independence of

African American women, and a more limited pool of African

American men who are good marriage prospects (Jaynes &

Williams 1989). Staples (1985) agreed with the premise that

for African American women, the quality of potential mates was

poor due to fewer African American men obtaining gainful

employment. Higher rates of male unemployment were due to

a) changes in the work setting (i.e., service orientation,

less industry), b) greater competition with white women for

jobs, c) increased functional illiteracy in men secondary to

the reality of blocked opportunities, and d) less access to

the personal networks used by white men to secure employment.

Using a "male marriageable pool index" (MMPI), Wilson (1987)







54
argued that the sharp rise of African American female-headed

families directly related to increasing African American male

joblessness.

Additional factors cited in the literature as contri-

buting to alterations in family structure have included:

a) increased societal acceptance of non-marital sex,

b) increased use of abortion and birth control, c) a welfare

system that requires men to be absent, d) decreased self-

esteem of African American men related to economic/psycho-

logical alienation, e) longer duration in poverty for African

American families, f) increased incarceration of African

American men in prison and mental institutions, g) a long-

standing African American male shortage resulting from

differential mortality rates, and h) fewer opportunities to

create stable African American family homes due to decreased

economic opportunities (Jaynes & Williams 1989; Ladner 1986;

Taylor, Chatters, Tucker, & Lewis 1990).

The question regarding African American/white differences

in family structure is not answered solely by the cultural or

the economic explanations. Rather, both explanations appear

to contribute to the observed differences (Tienda & Angel

1982; Farley & Allen 1987). Analysis of the 1980 census data

indicates that race differences in family organization

diminished as economic differences by race lessened. "African

American-white differences in economic well-being, political

power, and social standing--more so than differences in values







55
and predispositions--explain the observed race differences in

family organization and process" (Farley & Allen 1987: 187).

Clearly, African American family organization reflects

differing historical circumstances, cultural values and

practices that are suggestive of African heritage, and current

socio/economic/political forces that have created multiple

barriers to opportunities. The resources and strengths of the

African American family is seen in its survival and

resilience. The last section of the chapter specifically

addresses the topics of social networks and patterns of

support for African American families.


Social Networks and the Provision of Support


Social network analysis developed with Elizabeth Bott's

work in England (1957) and J. Clyde Mitchell's work in Africa

(1969b). How network members provide support to others has

continued to be a topic of interest for anthropologists and

sociologists. Much of the work on network composition and the

provision of support has focused on kin ties. However, two

distinct research agendas emerged one concentrating on

the white family and one concentrating on the African American

family. The African American literature concentrated on

patterns of assistance from kin, and support was viewed for

the most part as instrumental (Aschenbrenner 1973; Ball 1983;

Stack 1974). Existence of mutual help was considered from the

perspective of extended kin buffering the family from economic







56
disparities, and from the perspective that there was a greater

cultural emphasis on kinship among African Americans (Malson

1982). Therefore, stronger kin ties should be found at all

socioeconomic levels.

The literature that focused on whites took a broader

perspective, looking at support provision in a variety of

situations (Antonucci & Depner 1982; Bott 1969; Fiore, Becker,

& Coppel 1983; Hammer 1981; LaRocco, House, & French 1980).

For both races, few studies have examined the different

aspects of support (such as emotional support, instrumental

support, and perception of support from network members)

concurrently. Until recently, even fewer studies compared

differences between African American and white networks.


Social Networks of African American Families


Attention has turned again recently to the "demise" of

the African American family with much emphasis being placed on

the trends of single-parent families, poverty (particularly in

regards to the effects on children), absent fathers, and

environmental deprivation that may be weakening the extended

family's ability to assist others (Billingsley 1990; Jaynes &

Williams 1989). Yet there is minimal research that

investigates whether support is adequate or available to

families facing unexpected, long-term crisis situations, such

as in the case of chronic childhood illness.








57
Social network research with African American families

has focused predominantly on urban, lower class, extended

families (Aschenbrenner 1973; Hays & Mindel 1973; Lindblad-

Goldberg, & Dukes 1985; Martineau 1977; Stack 1974). An

occasional study used rural populations (Dressler 1985; Gaudin

& Davis 1985; Hofferth 1984) or middle-class African American

families (Barnes 1981; McAdoo 1978). Research questions asked

whether African American family life existed in urban, ghetto

areas and whether the ties between members of extended

families served to buffer individuals against the severe

effects of racism and poverty.


Extended Families


There has been a strong emphasis on the value of extended

families for African Americans. It has been believed gener-

ally that African American families have supportive extended

families and kin ties that are lacking in white families.

Ethnographic research has documented the strength of these

extended families, and detailed the extensive exchange

patterns between kin and friends in which members of extended

households shared economic aid and other forms of instrumental

assistance, such as housing, resources, and household tasks

(Aschenbrenner 1973; Stack 1974). Fictive kin were as

important as blood kin in the provision of support (Johnson &

Barer 1990; Scott & Black 1989; Stack 1974; Ulbrich & Warheit

1989).








58
Stack (1974) interpreted these exchange networks as a

resilient response to the socioeconomic conditions of poverty

and unemployment. Economic deprivation mitigated against the

maintenance of nuclear families. Extended families were

described as having expanded units of reciprocity, thereby

being more flexible economic units (Aschenbrenner 1973).

Extendedness is recognized as an effective mechanism for

pooling limited resources, hence increasing economic benefits

(such as stability, access to a wider pool of resources).

"Doubling up" in extended households is generally a less

expensive method of providing for needy relatives, as compared

to direct cash transfers (Taylor, Chatters, Tucker, & Lewis

1990).

McAdoo (1978) found similar behavior in a study of

African American middle-income, urban and suburban families.

Her research indicated that extended help patterns are

culturally rather than solely economically based. She

extended the study in 1980 to ascertain whether the mother's

differential involvement within her wider family was based on

whether she was head of the household or if she was married.

Her findings indicated that both single and married mothers

were deeply involved in the kin-help exchange networks,

including the use of fictive kin. Additional research

confirmed that marital status did not alter sources of support

or satisfaction with support (Brown & Gary 1985; Taylor 1986).







59
Family members and extended kin remained major sources of

support after divorce (Brown & Gary 1985).

Later and larger, representative studies also indicated

the importance of kin ties to receiving support (Hatchett &

Jackson 1993). Frequent interactions with family members,

close familial relationships, and having an available pool of

relatives predicted the probability of receiving support,

regardless of gender (Taylor 1986). A more recent study

compared the level of familial involvement between adults

labeled as support-deficients (those who had never received

assistance) and self-reliants (those reporting they had never

needed help). Findings from multivariate analysis indicated

the self-reliants reported significantly higher familial

involvement (Taylor 1990). Findings from the representative

National Survey of Black Americans (NSBA) indicated that there

was an overwhelming perception of family solidarity among

African Americans. Geographical distances to both immediate

and other kin members were fairly close, and frequented aid

from kin was reported, Women reported more receiving more aid

than did men, as well as having more frequent interactions

with kin. Summary of the findings indicated that subjective

closeness with kin was the most influential predictor of

frequency of interaction with kin, and aid received from kin

(Hatchett & Jackson 1993).









The Consequences of Support and the Need for Reciprocity


Although aspects of support were beneficial, there were

negative consequences to receiving assistance. Failure to

reciprocate harmed kin and non-kin relationships and sometimes

resulted in shunning or ostracism (Scott & Black 1989).' Help

obligated the individual to a pattern of reciprocal assistance

which, at times, had the negative effect of limiting potential

opportunities for upward mobility (Stack 1974). Belle (1982)

found that although mutual aid networks were critical survival

strategies against poverty, the networks were not voluntarily

chosen by those who could find other means for escaping the

effects of poverty. Increased emotional distress and stress

have been reported in women participating in networks with

extensive social ties (Belle 1982; Lindblad-Goldberg & Dukes

1985).


Informal Ties


Findings from network studies of African American

families documented active networks of informal ties to non-

residential kin, friends, and neighbors (Ball 1983; Belle

1982; Martineau 1977). Ball (1983) found that requests for

assistance with a real problem were as frequent to friends as

to kin outside the family. Higher levels of SES were



4Reciprocity and its relationship to the receipt of
support is detailed in "There Are No Free Gifts! Social
Support and the Need for Reciprocity" (Williams, In press).







61
associated with larger networks and the probability of

receiving support (Campbell & Lee 1990; Taylor 1986, 1990).

Network studies began to use representative, national

survey data to re-evaluate the importance of extended kin and

friend ties. During times of crisis, immediate family members

were heavily relied upon (Taylor, Chatters, & May 1988).

Other studies noted the importance of both formal and informal

helpers (non-professional helpers, notably non-kin, immediate

and extended kin), with the mother being the most utilized

category of informal helper (Neighbors and Jackson 1984;

Chatters, Taylor, & Neighbors 1989).

These findings contrasted with the earlier ethnographic

work of Aschenbrenner (1975) and Stack (1974). The unrepre-

sentativeness of the ethnographic accounts might account for

the discrepancy. The ethnographic studies also focused more

on everyday life rather than on serious personal problems.

Definitions of what constitutes a "serious problem" may also

account for variation.


Comparisons Between African American and White Social Networks


Findings in the literature are inconsistent regarding the

differences between provision of support for African American

and white families. Some studies documented larger kin

networks for African Americans as compared to whites, (Ball,

Warheit, Vandiver, & Holzer 1979; Cross 1990; Gaudia & Davies

1985; Hays & Mindel 1973; Hogan, Hao, & Parrish 1990). The








62
larger kin networks appeared to provide greater amounts of

assistance (Hays & Mindel 1973; Hogan, Hao, & Parrish 1990;

Johnson & Barer 1990). Compared to elderly whites, elderly

inner-city African Americans expanded their networks by

mobilizing relatives on the periphery of the kinship network

(nieces, nephews and cousins), and created fictional kin

(Johnson & Barer 1990). For some situations, the greater

amount of help was associated with a more pronounced tendency

for African Americans to be living with adult kin (Hogan, Hao,

& Parrish 1990). Constrained social opportunities and unequal

access to resources were cited as factors related to stronger

helping African American neighbor networks (Lee & Campbell

1990; Lee, Campbell, & Miller, 1989).

However, the assumptions that African Americans receive

more support than whites and have larger kin networks have not

been universally reported. Silverstein and Waite (1993)

failed to confirm previous studies that suggested a support

advantage for African Americans with economic and social

variables controlled. Using representative data from the 1985

General Social Survey, Marsden (1987) looked at the aspects of

interpersonal networks in which Americans discuss "important

matters." Overall findings indicated that the networks are

small, kin-centered, relatively dense, and homogeneous.

Whites had the largest networks (mean size 3.1), African

Americans the smallest (mean size 2.25), and Hispanics and

others fell in between. Cross (1990) compared the social







63

networks of a national sample of African American, white, and

ethnic-white mothers. Ethnic-white mothers had the highest

number of kin in their networks overall, followed by white

mothers, and then African American mothers. This held for

both one-parent and two-parent families in all three groups.

In a study of parents of chronically ill children, Williams

(1993) compiled social network inventories of those

individuals important or helpful to the parents during the

time of their children' illnesses. The networks of white

parents were twice as large as those of the African American

parents, although the African American parents perceived the

individuals in their networks to be slightly more supportive.

In a national sample of rural, low SES mothers, African

American mothers had greater numbers of kin in their networks,

and the networks were more durable, but those networks

provided less help and fewer persons to call on than did white

networks. These African American mothers perceived and

received less support from informal social networks (Gaudin &

Davies 1985). Similar results were found in another

nationally representative sample of African American and white

American mothers (Hogan, Hao, & Parish 1990). Matching

African American and white samples on marital status and kin

proximity, African Americans received less substantial income

support than whites. Although African American mothers

received free child care from co-residential kin, only 1/3 of

African American mothers, compared to 2/3 of white mothers,







64
reported adequate access to child care. In another study,

requests for assistance with major problem resolution were

seen more in whites than African Americans, although African

Americans were more likely to have a geographically proximate

close relative than were whites (Ball, Warheit, Vandiver, &

Holzer 1979). A possible explanation was that whites may have

perceived greater resource availability for them than did

African Americans.


Relationship Between Patterns of Support and Family Structure


The variable of family structure appeared to play a

determining role in the provision of support for African

Americans and whites. Cross (1990) found that African Ameri-

can two-parent mothers were similar to ethnic white two-parent

mothers in the areas of financial, emotional, and work-related

support. In the areas of practical, financial, and emotional

support, white two-parent mothers received the most support.

In contrast, African American single mothers were the most

disadvantaged of the three groups in all functional areas of

support. For African American single mothers, the level of

need outstripped the level of support.

Hofferth (1984) argued that the apparent relationship

between race and extendedness was due to family structure

differences between African American and white female family

heads. Using a national sample, she defined kin participation

narrowly on the basis of exchange of finances and/or extended







65
living arrangements. White single parents participated in kin

networks more than African American single parents, but the

relationship was weak. African American two-parent families

were more likely to participate in kin networks than white

two-parent families. White families were more likely than

African American families to receive money from kin, regard-

less of marital status. African American female-headed

families were less likely to receive financial assistance than

white female-headed families. Thus, they appeared to benefit

less from a kin network than white female-headed families.


Helping Traditions in African American Communities


As has been seen throughout this chapter, the practice of

mutual aid has been an integral component of African American

lives from slavery to modern times. The helping tradition has

extended historically from the family through a religious

consciousness, fictive kin, and a racial consciousness to

permeate all areas of life in the African American community.

This is now under scrutiny. Martin and Martin (1985) cite the

following factors as contributing to the demise of mutual aid:

a) decreased male/female cooperation, b) a lack of reinforce-

ment of helping values by the schools or wider community,

c) bourgeoisie (individualistic, social-status seeking) and

street ideologies fighting against the values of helping, d) a

decline in racial consciousness making it difficult to trans-

fer helping values, and e) a historical decline of self-help







66
traditions after the initiation of social welfare programs

started in the New Deal era.

Their argument runs counter to much of the previously

cited work that shows the existence of the helping tradition.

Further studies are needed to identify if, given the contem-

porary social problems, mutual aid patterns are effective in

protecting individuals from institutional assaults beyond

their control. Assistance continues to exist, but to what

degree? Additional data are also needed to determine whether

patterns of support occur within each social class and for

each household type. Income appears to assume a primary role

in determining patterns of support, but this area of consi-

deration is new and needs further study.


Conclusions

Research on African American families is difficult to

summarize. Studies have used different methods and different

data bases. Only recently have studies begun to use large

representative samples. The problem is that, for many of

those studies, the data were collected for purposes other than

the intent of the subsequent analysis. For example, census

data do not answer questions regarding attitudes or need. Few

studies have combined quantitative and qualitative methods for

a broader perspective on issues such as network functions and

importance of network ties.







67

The African American family as an institution cannot be

studied in isolation. Macro and micro level influences must

be examined together. In spite of the problems and historical

challenges addressed in this chapter, the African American

family is alive and viable. There is great diversity in the

family unit and such diversity as social class status and

household type must be considered while examining any

phenomena pertinent to family life. Research must concentrate

on individuals in all social strata and not be lured into

focusing on the problems most visible, such as the extreme

poverty of the underclass. To do so would imply that there is

a "standard" African American family.

This chapter focuses on describing the contemporary

African American family. It reviewed historical social forces

that impacted family life, described theoretical paradigms

regarding the structure and viability of African American

family life, and summarized research concerning the provision

of support from social networks. Whenever pertinent, it

compared the African American family to white families. The

next chapter concludes the literature review section. It

reviews the literature on coping and offers a detailed

description of the theoretical framework used for the

dissertation research.













CHAPTER 4
COPING



Although the term "coping" is used a lot, few people

agree on what it is, how it works, and particularly, how to

measure it. In this chapter I review part of the litera-

ture--the part most germane to my research. I follow the

transactional model of stress and coping proposed by Lazarus

and Folkman (1984). In their model, coping is a process

separate from its outcomes. I argue against the traditional

stance in anthropology that defines coping implicitly as a

successful outcome.

First, I present Lazarus and Folkman's model and findings

pertinent to the model. Next, I summarize research on how

families experiencing childhood chronic illness appear to

cope. In the final section I offer a critique of the

literature.


Review of the Literature


Coping: Definitions in the Literature


It is an understatement to say that coping is poorly

defined in the literature. Social support, another

frequently-used construct, suffers from a plethora of








69
definitions and typologies, while studies of coping often lack

any definition at all (see Table 4.1). It is assumed that the

reader knows what coping is and which dimensions of the

construct are being measured.

There are notable exceptions. Table 4.2, "Comparisons of

Coping Definitions," shows examples of how coping has been

defined. The most frequently cited definition is that offered

by Lazarus and his colleagues (Folkman 1984; Folkman et al.

1986; Folkman & Lazarus 1980; Lazarus 1982; Lazarus & Folkman

1984). They define coping as "constantly changing cognitive

and behavioral efforts to manage specific external and/or

internal demands that are appraised as taxing or exceeding the

resources of the person" (Lazarus & Folkman 1984, p. 141). As

seen in Table 4.2, many of the definitions are similar to or

evolve from the model proposed by Lazarus and Folkman (1984).

There are several key concepts in the definition. First,

coping is a process. The process involves conscious psycholo-

gical cognitions and behaviors, presumed to have protective

qualities. The process begins with appraisal. Coping arises

from a situation of psychological stress stress arising

from an observed stimulus--response relationship (as opposed

to either a stimulus or a response uniquely defining stress).

Coping is different from its outcomes. Coping implies

efforts to manage demands, whether or not those efforts are

deemed "successful" (Folkman 1984). Previous research efforts

confounded coping with effective outcomes (Folkman 1984; Klein












Table 4.1

Examples of Coping Literature That Fail to Define Coping


Authors

Baskin, Forehand, & Saylor 1985

Brickman et al. 1982

Commerford et al. 1990

Fife, Norton, & Groom 1987

McCubbin & Figley, Vol. 1, 1983;
Figley & McCubbin, Vol. II, 1983


Comments


Two series volume with multiple
contributors.


Hansen 1986

Heller & Swindle 1983


Hirsch 1980


Kazak 1989


Interchanges coping
adaptation/adjustment


Kupst et al. 1982
Kupst & Schulman 1988

Lavee, McCubbin, & Olson 1987


with


Longitudinal studies of parental
coping

Refers to Lazarus & Folkman model
(1984), labels "sense of
coherence" as a coping resource
and measures coping by a family
coping instrument. Never clearly
defines coping.


Levental, Nerenz, & Steele 1984


Presents a
interact
threats.
coping.
separated
executing


model of how people
and cope with health
No clear definition of
Coping conceptually
into planning and
responses.


Mattlin, Wethington, & Kessler 1990


McCubbin et al. 1983


Peterson 1989
Series editor


Uses the model of Lazarus/Folkman
but does not offer a definition.

Discusses coping patterns but does
not offer a definition of coping.

Special series to integrate the
progress made in coping process
research with the challenges of
behavioral research. Most
articles did not define coping,
e.g.:
Miller, Leinbach & Brody
Vitaliano, Katon, Jaiuro & Russo
Johnson, Lauver & Nail
Leventhal, Leventhal, Shacham &
Easterling
Revenson & Fulton












Table 4.1 continued


Authors

Reiss & Oliveri 1983

Spinetta et al. 1988

Tolsdorf 1976

Van Dongen-Melman, Pruyn, Van
Zanen, & Sanders-Woudstra 1986

Wentowski 1981

Wheaton 1983
Wheaton 1985



Wills 1987a
Wills 1987b

Wortman & Silver 1989

Wyckoff & Erickson 1987


Comments












Differentiates between environ-
mental and personal coping
resources but does not define
coping.






Used a self-report measure of
coping: "how one coped"












Table 4.2

Comparisons of Coping Definitions


Author/Date

Chesler & Barbarin 1987



Davis & Nakeo 1990




Kupst et al. 1984




Lazarus & Folkman 1984






McCubbin et al. 1980





Menaghan 1983b







Murphy & Moriarty 1976







Pearlin & Schooler 1978
(also used in Pearlin
Aneshensel 1986; Pearlin 1989)


Rowland 1989


Definitions

". people's efforts to meet the
challenge present by stressful life
situations" (p. 91).

". the degree to which a person
is able to deal with the hardships
of his/her life circumstances"
(P. 7)

"Coping meant both what people did
in their attempts to master the
situation and the adequacy of their
coping" (p. 151).

"Constantly changing cognitive and
behavioral efforts to manage
specific external and/or internal
demands that are appraised as
taxing or exceeding the resources
of the person" (p. 141).

". process of achieving a
balance in the family system which
facilitates organization and unity
and promotes individual growth and
development" (p. 865).

"To cope is to manage stress
successfully, and coping responses
are presumed to reduce distress
and/or improve one's situation"
(p. 114). [Distinguishes between
coping resources, styles, and
efforts.]

". a general term to include
defense mechanisms, active ways of
solving problems, and methods for
handling stress that do not come
under the heading of defense
mechanisms and problem-solving
methods" (p. 5).

". behavior that protects
& people from being psychologically
harmed by problematic social
experience" (p. 2).

"Adaptation under very difficult
situations" (p. 44). [Per White
1974.]











Table 4.2 continued


Author/Date


Rutter 1981


Singer 1984


Stone & Neale 1984


Venters 1981


White 1974


Definitions


". what the person does about
the stress situation. Coping
mechanisms include an individual's
attempts to directly alter the
threatening conditions themselves
and the attempts to change only his
appraisals of them so that he need
not feel threatened" (p. 345).

Summarizes two classical approaches
to the coping literature:
a) "In the context of such a
physiologic/endocrinologic view of
stress, coping is a process that
modulates the neuro-endocrinologic
functioning" (p. 2303). [Per the
model of Hans Selye.]

b) "In the interactionist view
S. coping is any action or
belief that modifies some aspect of
the appraisal and evaluation
process" (p. 2303). [Per the model
of Richard Lazarus.]

"Those behaviors and thoughts which
are consciously used by an
individual to handle or control the
effects of anticipating or
experiencing a stressful situation"
(p. 893).

". sum total of all strategies
and patterns employed to deal with
a significant threat to the
family's stability" (p. 290).
Focuses specifically on the family.

"Adaptation under relatively
difficult conditions" (p. 49).









74
1983). For example, if a person drank alcohol to excess in

response to a loss, then that person would have been evaluated

as "not coping well."


Anthropological Use of Coping


The concepts of coping and adaptation are used widely in

anthropology. In general, adaptation is associated with day

to day adjustments, while coping implies responses to a cri-

sis--something beyond the ordinary, like disasters, migration,

and famine.

Still, coping is not defined clearly by anthropologists

and is generally discussed as a strategy rather than as a

process (Colson 1979; Colson 1991; Downing, Gitu, & Kamau

1989; Huss-Ashmore 1989). Hansen (1986) referred to coping

strategies as conscious plans. Coping strategies, tactics

(behavior), and buffering mechanisms (relationships or factors

that function to promote adaptation and human survival) he

said are ways that people react to and adapt to crisis.

Implicit in the use of coping and adaptation is the idea

of a successful outcome some positive adjustment to the

environment. Colson (1991), for example, says that people who

survive displacement prove that they have coping abilities.

There is a value-ladened linkage between survival and coping

in this statement. The person who migrates to another

location is thus successful with coping; the refugee who turns








75
back then is not seen as a survivor. The efforts are not as

important as the outcome.

Consistent with the conflating of coping and outcomes,

anthropologists also lump the coping process with components

of that process, such as cognitive appraisal. Colson (1979)

is an exception. In discussing how self-reliant societies

deal with changing environmental conditions, she notes that

the first coping device is an assessment of those conditions.

Although she linked coping behaviors and appraisal as the same

process, she recognized the importance of some type of

appraisal.

Efficacy of coping behaviors has not been evaluated in

terms of outcomes. Nor has efficacy been linked to specific

functions of coping by anthropologists, who tend to deal with

society or community-level aggregate measures and not with

individual differences in response to the environment over

time. The model proposed by Lazarus and Folkman offers the

best alternative approach.


Historical Approaches to the Study of Coping


The first studies of coping were done by physiologists,

concentrating on stress responses.' Selye (1956) pioneered


'In Chapter 1 of their book, Lazarus & Folkman (1984)
review the concept of stress and how it has been
systematically conceptualized over the years. Pearlin (1989)
reviews stress from a sociological perspective. He urges for
a critical analysis of stress and coping that includes the
"structural contexts of stress" (e.g. social institutions and
statues, gender, race, and ethnicity).








76
the study of bodily defenses against noxious stimuli. His

theoretical model, "The General Adaptation Syndrome," was

widely used for years. Interest in stress shifted to interest

in coping with stress. Animal models focused on the concepts

of arousal, activation, or "drive" and the relationship to

coping. Coping was defined as acts that control aversive

environmental conditions, resulting in lowered psychophysio-

logical disturbance (usually acts of avoidance and escape

behavior). Minimal attention was paid to the complexities in

human cognitive-emotional functioning (Lazarus & Folkman

1984).

Studies of human coping were grounded in the psycho-

analytic ego psychology model where cognition played a major

role. In this model, coping was defined as processes

(acts/thoughts) that individuals used to solve problems

(Lazarus & Folkman 1984). The processes were differentiated

into a hierarchy of strategies that went from the lowest ego

processes (psychotic levels of functioning), to ego defenses

(neurotic modes of adaptation), to the highest level of mature

ego processes (Lazarus & Folkman 1984). For example, in a

much cited study, Vaillant (1977) used a hierarchy of ego

defenses to classify coping styles of male college students

who were followed longitudinally. Unfortunately, defining

coping to cognition ignores the importance of behaviors and

situational factors.









77
Another intrapsychic approach to coping has been to

conceptualize it as a personality trait (Billings & Moos

1981). Emphasis is placed primarily on the properties of the

person, with little notice given to the context of the

situation (Folkman et al. 1986). The assumption of this

approach is that personality traits or styles dispose

individuals to cope in predictable ways over the life course.

Wheaton (1983) investigated psychiatric outcomes using

personality traits. Kobasa, Maddi, and Courington (1981)

studied personality characteristics as mediators of the

stress-illness relationship.

The use of personality traits or styles has been widely

criticized. Attributional styles and traits influence how a

person responds to life events and may be related to coping,

yet they do not describe the coping process (Stone & Neale

1984). Additionally, data are lacking on how traits mediate

an outcome with respect to stressors (Rutter 1981).

Traits have had very modest predictive value with respect

to actual coping behavior. Surgical patients were interviewed

pre-operatively about specific behaviors toward the threat of

surgery and were also administered a standard trait assessment

test. No correlations were found between the traits and the

behaviors. The behavior process measure alone predicted the

outcome variables of speed and ease of surgical recovery

better than either the trait measure alone or in combination

with the behavior measure (Cohen & Lazarus 1973).









78
The unidimensional qualities of traits ignores the

complexity and variability in coping (Lazarus & Folkman 1984).

Limiting coping to an analysis of traits reduces the idea of

coping to the maintenance of psychological equilibrium and

does not include active problem-solving behavior directed at

avoiding or changing the situation (Billings & Moos 1981).


Models of Coping


research efforts expanded to view coping as a multi-

dimensional construct. Cognitions, behaviors, and contextual

factors became important variables. Conceptually there was a

shift towards thinking that change per se may not be suffi-

cient or necessary for the experience of stress (Menaghan

1983a). Research moved from naturalistic observation

(Mechanic 1962) to process oriented research based on larger,

representative samples (Folkman et al. 1986; Mattlin,

Wethington, & Kessler 1990). However, most studies continued

to be cross-sectional and to ignore outcome variables.


The Lazarus/Folkman model of stress, appraisal and coping


In this model, coping and cognitive appraisal are two

processes that mediate stressful person-environmental

relations and adaptational outcomes (Folkman, Lazarus, Dunkle-

Schetter, De Longis, & Gruen 1986). Psychological stress is

defined as "a particular relationship between the person and

the environment that is appraised by the person as taxing or









79
exceeding his or her resources and endangering his or her

well-being" (Lazarus & Folkman 1984: 19)(see Figure 4.1).

There are three main features in this process approach to

coping. Actual behavior is observed and assessed, not what

the individual says he or she would usually do or should do.

Coping occurs within a specific context--that is, under

particular conditions to which coping thoughts and actions are

directed. Lastly, the process model indicates change. Coping

thoughts and actions alter over time as the contextual circum-

stances shift.

Coping does not occur randomly. It occurs in direct

response to continuous appraisals and reappraisals of the

changing person-environmental relationships. Cognitive

appraisal is a process that determines why and to what extent

interactions between a person and the environment are relevant

to his or her well-being or are stressful (Folkman et al.

1986). Understanding cognitive appraisal is a step toward

explaining the processes between the encounter and the

reaction.

Primary appraisal is an evaluative process to determine

whether the person has anything at stake in the encounter. An

irrelevant appraisal implies that the encounter carries no

implication for a person's well-being. If the outcome of an

encounter is construed as positive then it is seen as a be-

nign/positive appraisal. Stress appraisals include harm/loss,















Person-Environment Interaction


SSituation Foctors

Primary Appraisal
I


I
Irrelevant
(no action needed)


I
Stressful


Harm/Loss
Threat
Challenge


Action


I
Benign/Positive
(no action needed)


Thoughts


Secondary Appraisal

I
Coping Resources
Physical (health, energy, stamina)
Social (social support from social network)
Psychological (beliefs, morale, problem-solving skills)

1

Coping Efforts
Emotion-Focused Information Seeking Problem-Focused


Direct Action
Inhibition of Action
Infrapsychic Processes

1
Outcomes


Social
Social


Psychological


Figure 4.1

Schematic Representation of
Lazarus and Folkman Model (1984)


Person Factors


Behavioral








81
threat, and challenge. Harm/loss situations are those in

which some damage (physical and/or psychological) has

occurred. Threat implies harms or losses that are anticipated

in the future, thus allowing for anticipatory coping.

Contrasting threat, with its associated negative emotions such

as loss and fear, are challenge appraisals. Challenge

appraisals focus on positive emotions and on the potential for

gain/growth in an encounter. Challenge also initiates

anticipatory coping (Lazarus & Folkman 1984).

Lazarus and Folkman emphasize that challenge and threat

appraisals are not opposite ends of a continuum. They can

occur simultaneously (ex. job promotion) even though their

cognitive components (potential harm vs. potential mastery)

and their affective components (positive vs. negative

emotions) differ. Appraisals can shift from challenge to

threat and vice versa. Marris (1974) argues that meaning is

a crucial organizing principle of human behavior and as such,

makes sense of action by providing reasons for it. Meaning is

"a structure which relates purposes to expectations so as to

organize actions--whether the actions are taken or only

thought about" (Marris 1974: vii). Clearly, meaning is

essential to appraisal and to coping efforts.

The benign/positive appraisal is the least well-developed

aspect of primary appraisal. The distinction between

benign/positive and challenge appraisal is whether or not the

situation (person-environmental transaction) will tax the








82
resources of the individual (Folkman 1984). I believe that

challenge appraisals implicitly reflect a sense of motivation

and immediacy in action. Challenge and threat indicate that

some degree of vulnerability or jeopardy is present, and

something needs to be done to manage the situation.

Secondary appraisal includes the evaluative process that

looks at available coping strategies, the likelihood that any

given coping option will accomplish what it is supposed to,

and the possibility that one could apply a particular strategy

effectively. Primary appraisals of what is at stake and

secondary appraisal of coping options jointly determine the

significance of the stress, as well as the strength and

quality or content of the emotional reaction. Reappraisal

follows an earlier appraisal and refers to a changed appraisal

based on new information from the environmental and/or the

person (Lazarus & Folkman 1984).

Both personal and situational factors influence

appraisal. Two important person factors are beliefs and

commitments. Beliefs can be generalized (such as with

religion) or specific (such as belief in one person). Beliefs

color the individual's perception of an event. Beliefs

regarding control (i.e., can the individual control outcomes

of importance) influence primary appraisal (Folkman 1986).

Rotter's theory of locus of control (1966) is applicable to

Lazarus and Folkman's model. Under conditions of ambiguity or

novelty, these generalized control expectancies are thought to









83
have their greatest influences (Folkman 1986). In situations

of environmental ambiguity, situational cues are minimal;

inference is needed to understand the situation; and, hence,

person factors have more influence in determining the meaning

of the situation (Folkman 1986). Conversely, in situations

with minimal ambiguity, situational factors play a more

important role than beliefs/person factors. "One's belief in

one's ability to control an event influences how that event is

appraised and, through appraisal, subsequent coping activity"

(Lazarus & Folkman 1984: 77).

Sims and Baumann (1972) used the locus of control theory

to compare coping with tornado threats in two different

sections of the country (Illinois and Alabama). People living

in the area of highest frequencies of tornado-caused deaths

(Alabama) internalized their sense of control over events,

exhibited fatalism and passivity, and were inattentive to

organized warning systems. Illinoisans were more action-

oriented, objective, rational, and displayed features of an

external locus of control. While psychological attitudes are

only one factor in the outcome of the number of deaths due to

tornados, this study was an interesting application of the

model discussed above.

Commitments refer to values, choices, and/or goals and

serve to determine what is at stake in a stressful encounter,

thus underlying choices people make. Together commitments and

beliefs influence appraisal by a) determining how an encounter








84
will influence well-being, b) shaping a person's understanding

of the event, subsequently affecting the person's emotions and

coping efforts, and c) providing the basis for evaluating

outcomes (Lazarus & Folkman 1984).

Situational factors work in concert with person factors

to determine the extent to which any event is stressful.

Situational factors include novelty, predictability, event

uncertainty, and the temporal factors of imminence, duration,

and temporal uncertainty. Coping is determined both by

resources and by constraints that mitigate the use of

resources (Lazarus & Folkman 1984).

The coping model used by Lazarus and Folkman distin-

guishes two functions of coping: problem-focused coping and

emotion-focused coping. Problem-focused coping is defined as

"coping that is directed at managing or altering the problem

causing the distress," while emotion-focused coping is "coping

that is directed at regulating emotional response to the

problem" (Lazarus & Folkman 1984: 150). In most stressful

situations, both forms of coping are used, and the appraisal

of the encounter (e.g., whether one has the potential for

control) determines the relative proportion of each form used.

Situations that are appraised as unchangeable favor emotion-

focused coping, while problem-focused forms of coping are more

apparent when encounters are appraised as amenable to change

(Folkman & Lazarus 1980; Lazarus & Folkman 1984; Folkman 1986;

Folkman et al. 1986).




Full Text
xml version 1.0 encoding UTF-8
REPORT xmlns http:www.fcla.edudlsmddaitss xmlns:xsi http:www.w3.org2001XMLSchema-instance xsi:schemaLocation http:www.fcla.edudlsmddaitssdaitssReport.xsd
INGEST IEID EK3C0CEAU_YTTQWW INGEST_TIME 2012-08-13T15:33:00Z PACKAGE AA00011762_00001
AGREEMENT_INFO ACCOUNT UF PROJECT UFDC
FILES