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Trans Cultural

Trans Cultural

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Published by: kewlangot on Jan 12, 2013
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At the end of the 8-hour lecture, the students will be able to: 1. Define pertinent terms related to transcultural nursing 2. Understand important concepts that cover transcultural nursing care 3. Understand the importance of Transcultural nursing care 4. Understand the concepts & Principles of Transcultural Nursing care

1. 2.



Understand the theory of TN Explain the philosophical beliefs in TN theory Identify the principles of Culturalogical assessment Identify the transcultural communication mode


 Ethics The basic concepts & fundamental principles of right human conduct. also for the natural environment. obedience to the law of land. environment. person or stimulus. It includes study of universal values such as the essential equality of all men and women. increasingly. human or natural rights. Behavior a response of an individual or group to an action.  . concern for health and safety and.

doctrine or system of rules of what is right or wrong and to behave accordingly.  Morality conformance to a recognized code. Values exert major influence on the behaviour of an individual and serve as broad guidelines in all situations. Values important and enduring beliefs or ideals. shared by the members of a culture about what is good and desirable and what is not. It is NOT universal .

. Culture is also the result of acquired mechanisms that may have innate influences that are primarily affected by internal & external environmental stimuli.  Culture is a patterned behavioral response that develops over time as a result of imprinting the mind through social and religious structures and intellectual and artistic manifestations.

   Religion is a set of belief in a divine or super human power/s to be obeyed and worshipped as the creator and ruler of the universe. . Acculturation individuals who have taken on. Ethnicity a consciousness of belonging to a group. beliefs. practices of dominant society resulting in a blended cultural pattern. values. usually observable features of another culture. People of a minority group tend to assume the attitudes.

Sub Culture composed of people who have distinct identity but are related to a larger cultural group . art. Not all people of the same race have the same culture.    Race the classification of people according to shared biologic characteristics. Material Culture refers to objects (dress. social institutions. languages. religious artifacts) Non. customs. genetic markers or features.Material Culture refers to beliefs.

unfamiliarity. Ethnic identity refers to a subjective perspective of the person’s heritage and to a sense of belonging to a group that is distinguishable from other groups .  Culture Shock the state of being disoriented or unable to respond to a different cultural environment because of its sudden strangeness. and incompatibility to the stranger’s perception & expectations.

Diversity can occur between cultures and within a cultural group Bicultural a person who crosses two cultures.  Diversity refers to the fact or state of being different. lifestyles and sets of values .

.  Transcultural Nursing defined as a formal area of study and practice focused on comparative human-care differences and similarities of the beliefs. events. Beliefs assumptions and convictions that are held to be true. by an individual or a group. people. regarding concepts. & things. and patterned lifeways of cultures. values.



But she was able to study on anthropology and discovered that anthropological and related cultural information has a close relationship with nursing. graduate.A. .. There were no nursing theories or books on transcultural care. is considered to be the mother of Transcultural Nursing. It was in the mid 1950’s while working as the first. Madeleine Leininger discovered major cultural differences among the children and parents. Historical Development of TN Madeleine Leininger. PhD. child-psychiatric clinical nurse specialist in the US.

Thus. Leininger coined the phrase and began to study the concept after returning from a trip to New Guinea. . Leininger identified that nurses needed to understand their patients' backgrounds in order to provide care. On this trip in 1969.The former Dean of the University of Washington School of Nursing. she launched the Transcultural Nursing program at the university. and founded the Journal of Transcultural Nursing to support the Transcultural Nursing Society which she founded in 1974.

Rapid increase in the use of high technologies in caring or curing with different responses and effects on clients of diverse cultures. Marked increase in immigration and the migration of people within and between countries worldwide. 3. Scope of Transcultural Nursing & Factors Influencing Transcultural Nursing 1. 2. Implicit societal moral & professional expectation that nurses other health care providers need to know. understand. respond appropriately to care for people of diverse cultures. .B.

4. 5. Marked increase in the number of nurses who travel and work in different places in the world. Anticipated legal defense suits against nurses resulting from cultural negligence. Growing trend to care with & for people whether well or ill in their familiar or particular living & working environment. 7. The rise in gender and special groups issues & rights 8. & cultural imposition practices between nurses & clients of diverse cultures. 6. cultural ignorance. Increased signs of cultural conflicts. & cultural imposition practices in working with diverse cultures. cultural clashes. .

The global view of transcultural nursing This logo has served as a cognitive image and philosophical guide to help nurses realize the large scope of transcultural nursing. .

their significance will be confusing to the nurse The 3rd millennium is challenging nurses and other health care professionals to think and act with a global perspective. .   Cultural assessment can give meaning to behaviors that might otherwise be judged negatively If culture behaviors are not appropriately identified.

sensitive. and healing patterns. beliefs. A major feature in the definition of transcultural nursing is the focus on comparative differences (diversities) and similarities among cultures in relation to humanistic care. . and safe to care for people with different or similar lifeways. illness.  The goal of transcultural nursing has been to prepare a new generation of nurses who would be knowledgeable. and practices. competent. health. values. wellness.

-Leininger .The ultimate goal of transcultural nursing is the use of relevant knowledge to provide culturally specific and culturally congruent nursing care to people.

and skills (including assessment. critical thinking. knowlede. decision making. . and evaluation) that enables the nurse to provide care in a culturally sensitive and appropriate manner. judgments. Culturally congruent care refers to the complex integration of attitudes.



decisions & actions. 2. Human cultures have material items or symbols such as artifacts. dress. 3. & actions that have special meaning in a culture. Non-material cultural symbols such as hand gestures or words when wanting to be cared for are important. . It reflects shared values. objects.Features of Culture: 1. ideals & meanings that are learned & that guide human thoughts. Have manifest (readily recognized) & implicit (covert & ideal) rules of behavior & expectations.

& other activities that are transmitted intergenerationally & reaffirm family or group ties & caring ways. food feasts.4. Cultures have traditional ceremonial practices such as religious rituals. .

5.Wayan traditional healing method in Bali - . Cultures have their local or emic (insider’s) views & knowledge about their culture that are extremely important for nurses to discover & understand for meaningful care practices. Etic (outsider’s/ nurse’s) views may be very different from emic views. .

Cultural variation is an important concept to keep in mind when studying individuals & different cultures.6.g African-Americans & ItalianAmericans show cultural variations in their daily lifeways regarding food & death. All human cultures have some intercultural variations between & within cultures. . E.

Cultural Imposition is the tendency to impose one’s cultural beliefs. and patterns of behavior on a person or persons from a different culture. forbidden. beliefs and practices and those of others because of strong ethnocentric tendencies (the tendency to view one’s own culture as superior to others).   Cultural blindness is the inability of a person to recognize his or her own values. or prohibited by a particular cultural group. . values. Cultural Taboos are those activities governed by rules of behavior that are avoided.

. or behave.   Ethnocentrism refers to the belief that one’s own ways are the best. believe. & helped according to their own particular values & standards. or preferred ways to act. Cultural relativism refers to the position that cultures are so unique & must be evaluated. most superior. Cultural Bias refers to a firm position or stance that one’s own values & beliefs must govern the situation or decisions. judged.

Multiculturalism refers to a perspective and reality that there are many different cultures & subcultures in the world that need to be recognized. cenetered upon. & functions from a oneculture perspective that reflects excessive ethnocentrism. & understood for their differences & similarities. . valued.  Uniculturalism refers to the belief that one’s universe is largely contituted.





which in effect limits the nurse’s effectiveness with clients.  These prejudices can be offensive and hurtful to clients and their families. . The first important principle in Transcultural nursing is to: “KNOW THYSELF”  Some nurses and students may have longstanding biases and prejudices about cultures that make it difficult for them to become effective transcultural nurses.


A. Goal of Culture care To discover, document, interpret, explain & even predict some of the multiple factors influencing care from an emic (inside the culture) & an etic ( outside the culture) view as related to culturally based care.  With the ethnonursing research method & theory, the reseracher was challenged to discover the similarities & diversities about human care in different cultures.  The goal of the Theory was to provide culturally congruent care that would contribute to the well-being of people or help them face disabilities or death.

Ethnographic research - is a qualitative method

aimed to learn and understand cultural phenomena which reflect the knowledge and system of meanings guiding the life of a cultural group

B. Philosophical Beliefs, Assumptions, Hunches with the Culture Care Theory

Traditional nursing needed to shift to global transcultural nursing in the immediate future to serve people in meaningful ways. Nursing was far to local, national & parochial in the mid century and needed a theory to expand its research, knowledge, & practice focus, Hence, the development of Culture Care Theory.

charms worn on a string or chain around the neck. or waist to protect the wearer from the evil eye or evil spirits.  Amulets are objects with magical powers.TRADITIONAL PRACTICES 1. wrist. USE OF PROTECTIVE OBJECTS  Protective objects can be worn or carried or hung in the home. . for all walks of life and cultural and ethnic backgrounds is example.

placenta. USE OF SUBSTANCES  Substances are ingested in certain ways or amounts regimen. snake oil. 1947) mind. For example. an effort must be made to determine if they are worn or hung in the home.  Jews also believe that milk and meat must never be mixed or eaten at the same meal (Steinberg.2. and spirit.  This practice uses diet and consists of many different observances. or the restoration of holistic health . lizard. It is believed that the body is kept in balance or harmony by the type of food eaten so many food taboos and combinations exist in traditional belief systems.

RELIGIOUS PRACTICES  Another traditional approach to illness prevention.  Religion dictates social.  Religion strongly affects the way people attempt to prevent illness. and it plays a strong role in rituals associated with health protection. female centers around religion and includes practices such as from a divine source the burning of candles. rituals of redemption. moral. and dietary practices designed to keep a traditional healer (Kaptchuk and Croucherl987) .3. and In many instances a heritage consistent person may prayer.

roots.  Often. flowers. seeds. . Traditional Remedies  The admitted use of folk or traditional medicine increasing. must be made to determine properties of vegetation-plants.  The pharmaceutical. these ingredients can be antagonistic or synergistic to prescribed medications.4. tested stems. and herbs-have been studied tested. and used for countless centuries. Many of the remedies have been used and passed on for generations. Over dose may occur. cataloged. and the practice is seen among people from all walks of life and cultural ethnic back ground.

. or in conjunction with a modern health care provider.5. instead of. Healers  The healer may be male or and is thought to have received the gift of healing In many instances a heritage consistent person may consult a traditional healer before.

.g. . Nurses giving tours or making brief visits . Culture encounter or contact refers to a situation in which a person from one culture meets or briefly interacts with a person from another culture.E.5 Basic Interactional Phenomena: 1.A nurse having brief encounters with people from another culture or a cleint seldom grasps & understands strangers & their cultural lifeways.

beliefs & practices .g. nurses become enculturated into local hospitals. beliefs & actions .A child becomes enculturated when he or she shows acceptable behavior of the cultural values. Enculturation refers to the process by which one learns to take on or live by a particular culture with its specific values.2.E. community agencies & other health services to accept & maintain practice expectation .

Acculturation refers to the process by which an individual or group from cultura A learns how to take on many values. . behaviors. Vietnamese refugee who migrates to the US initially retains their own traditional values but after 10 years had become acculturated and took on the anglo-american lifeways . norms & lifeways of culture B.g.3.It is therefore important for nurses to determine if they are living by traditional or new cultural values for quality care outcomes .E.

. Socialization process whereby an individual or group from a particular culture learns how to function within the larger society that is to know how to interact appropriately with others & how to survive.4. work & live in relative harmony within a society.It is different from acculturation because the goal of socialization is to learn how to adapt to & function in a large society with its dominant values. ethos or national lifeways. .

E. Assimilation refers to the way an individual or group from one culture very selectively & & usually intentionally selects certain features of another culture without necessarily taking on many or all attributes of lifeways that would declare one to be acculturated. . . and vice versa.g. An american nurse may handle differently the placenta & umbilical cord after delivery from that of an Arab nurse. Both nurses may assimilate some practices of Arab nurse in handling the placenta but not all.5.

. E.Terms related to TN Concept: Cultural Backlash – refers to negative feedback or unfavorable outcomes after nurses have been working or consulting with cultures for brief periods.g. Host country being served by foreign nurse feels their efforts failed to help the people in meaningful or beneficial ways. the host country expresses negative views & feelings to the consultant. As a result.

or being greatly offended by an individual or group who shows a great lack of sensitivity toward another’s cultural experience. or too compassionate with the people.Cultural Overidentification – refers to nurses who become too involved. situation. overly sympathetic. . Resulting to nontherapeutic action. Cultural Pain – refers to suffering. discomfort. or a human condition.

beliefs & patterned lifeways that are used to assist. quite unique. & disease conditions that are particular. . & usually specific to a designated culture or geographical area.Culture bound – refers to specific care. Cultural Universals – refer to commonalities among human beings or humanity that reveal the similarities or dominant features of humans. facilitate or enable another individual or group to maintain their well-being or health. health. illness. Culture Care – cognitively learned & transmitted professional & indegenous folk values.

when certain activities occur each day. present & future periods that guides one’s thinking & actions. beliefs.refers to time for leisurely interactions & activities in which exact time is of less importance Cyclic time . Social time . values & lifeways. Regulate activities as a cyclic rhythm of life . night. Culture time – refers to the dominant orientation of an individual or group to different past. concern & nonhelpful nursing care practices that fail to meet a client’s cultural expectations.Cultural care conflicts – refers to signs of distress. month or during the year.

many things are left unsaid. a. Body Touching– how different cultures touch same/ opposite sexes in public. Intimate zone 0-18 inches b. territorial & interpersonal distance to others. high context culture.Cultural space – variations of cultures in the use of body. personal zone  18 in. social/ public  3-6 ft. visual. letting the culture explain .3ft c.

Korean. American. Irish.g. Italian Low Context Culture . Japanese. Many things are left unsaid.people are deeply involved. African. Filipinos. Brazilian. Australian. High Context Culture . & patterns of living. Finnish. Indian.g. English. thinking. knowing each other & the situation. cultural & physical environments that influence attitudes. Greek. French. making it difficult to quickly understand strangers. German . E.Cultural context – totality of shared meanings & life experiences in particular social. E. sharing & respecting values & beliefs almost instantly. letting the culture explain.people having less commonly shared meanings of life experiences or values.

refers to formally & cognitively learned etic knowledge & practice skills that have been taught & used by faculty & clinical services. Professional care . 2.Kinds of Care: 1. indigenous (traditional). & largely emic folk knowledge & skills used by cultures. Generic care .refers to culturally learned & transmitted lay. .

Generic (Emic)-Humanistically oriented -People based with practical & familiar referents -Holistic & integrated approach with focus on social relationship. diagnosis. & lifeways -Focus largely on caring Professional (Etic) -Scientifically oriented -Clients to be acted on with unfamiliar techniques & strangers -Fragmented & nonintegrated services with focusing on physical body & mind -Focus is largely on curing. disability & maintaining disabilities. & treatments -Largely non-technological using -Largely technological with many folk remedies & personal diagnostic tests & scientific relationships treatments -Focuses on prevention of -Focuses on treating diseases. & pathologies lifeways -Using high-context -Uses low-context communication communication -Relies on traditional & familiar folk caring & healing -Relies on biophysical emotional factors to be assessed & treated . illnesses. language.

social structure factors such as religion. kinship (social). & patterns in different cultures. & generic & professional care factors would greatly influence cultural care meanings. technology. environment. Care Diversities (differences) & universalities (commonalities) existed among & between cultures in the world 2. education.THEORETICAL TENETS 1. expressions. ethnohistory. Worldview. language. . economics. politics.

Culture care restructuring & or re-patterning . Three major care actions and decisions to arrive at culturally congruent care for the general health and well-being of clients or to help them face death or disabilities.THEORETICAL TENETS 3. 3 Theoretical Practice modes/ care actions: a. Culture care accommodation & or negotiation c. Culture care preservation/ maintenance b.

a. or face handicaps and/or death. or greatly modify client’s life ways for a new. recover from illness. Culture care accommodation & or negotiation  Adapt or negotiate with the others for a beneficial or satisfying health outcome c. Culture care restructuring & or re-patterning  Records. Culture care preservation/ maintenance  Retain and or preserve relevant care values so that clients can maintain their well-being. different and beneficial health care pattern . change. b.


.“Let the sun shine and rise”  Figuratively means to have nurses open their minds to informants to discover many different factors influencing care in their culture with their meeaning & the ways they influence the health & well-being of people.

& life experiences as they bear on actual or potential nursing care phenomena. . describe. open discovery & largely inductive (emic) modes to document. explain & interpret informant’s worldview. meanings.Ethnonursing Research  Refers to a qualitative nursing research method focused on naturalistic. symbols.


Culural Care Assessments  Refer to the systematic identification & documentation of culture care beliefs. environmental context. . ehtnohistory. & practices of individuals or groups within a holistic prespective. life experiences. values. symbols. language. meanings. & diverse social structure influences. which includes the worldview.

& interpersonal space. Give attention to gender or class differences. Show genuine & sincere interest in the client as one listens to and learns from the client. 3. Study the Sunrise model before doing the assessment . communication modes (with special language terms). Principles for Cultaroligical Assessment (Guide) 1. 2.A.

Be aware that clients may belong to subcultures or special groups such as the homeless. gays. fixed ways with prejudged views about them & their lifeways . deaf & the mentally retarded. lesbians. AIDS infected. Remain fully aware of one’s own cultural biases & prejudices 5.4. drug users. Avoid Stereotyping Stereotyping – refers to seeing people in rigid.

Nurses need to know their own culture & areas of competencies along with their deficits to become culturally competent practitioners. or group the focus & purpose of the assessment. family.6. including times to visit with them about their health care beliefs & practices. 7. Clarify & explain at the outset to the individual. .

Create a trusting climate. Seek holistic view of the client’s world within his or her environmental context by focusing on familiar & multiple factors depicted in the Sunrise Model that influence care. & values as well as etic professional ways.8. Reflect on learned transcultural holding knowledge about the client’s culture & research-based care & health knowledge available today. illness. 10. beliefs. . or well-being 9. Remain an active listener & to discover the client’s emic lifeways.


Special Author Insights 1. technologies & highly personal life & illness experiences. Real secret for an effective culturalogical care assessment is to remain an active learner & reflector 3. 2. whereas Western cultures like to talk initially about medical treatments. Clients from non-western cultures like to talk first about their family & their caring values & health beliefs. medications. tests. . Reason is to be sure one is trusted. Negative experiences or stories are usually told at the end of the sessions along with valuable & sacred cultural secrets.

The nurse will have a better opportunity to assess a client at home since the nurse is able to see first hand the naturalistic environment & material culture items & often to meet family members. .Special Author Insights 4.

.  Proxemics – use & perception of interpersonal or personal space in sociocultural interactions. facial expressions (smile/anger). eye contact & other body features. Transcultural Communication Modes  Requires understanding the verbal & non-verbal modes. which include posture. gestures.  Kinesics – body movements’s communciation modes.B.


4. Write out terms in both languages to check when you are in doubt about the terms spoken or the interpreter’s interpretation.Pointers when utilizing Interpreters: 1. Be sure the interpreter knows the client’s cultural language & knows the culture 2. not the interpreter’s views of a desired response. . Discuss in advance what you are doing in the assessment & its purposes to the client 3. Insist on an exact interpretation from the client.

Always thank the interpreter afterward. & recheck ideas or observations that are unclear to you. Try to get an interpreter of the relatively same age as younger clients. as children & teenagers may often communicate different integrational knowledge leading to errors in the data 6. .5. Try to know a few words or phrases in the language being interpreted to occasionally check if the interpreter is sharing ideas accurately & completely 7.

beliefs. body condition features.Leininger’s short Cultralogical Assessment Guide (Model B) Phase I Record observations of what you see. hear or experience with clients (dress. heard or experienced Phase II Phase III . language. mannerisms & general behavior. Give attention to generic (folk) practices & professional nursing practices Identify & Document recurrent client patterns & narratives (stories) with client meanings of what has been seen. appearance. attitudes & cultural features Listen to & learn from the client about cultural values. daily & nightly practices related to care & health in the client’s environmental context.

Phase IV Synthesize themes & patterns of care derived from the information obtained in phases I. & III Phase V Develop culturally-based client-nurse care plan as co-participants for decisions & actions for culturally congruent care . II.

talks to others) 3. Arabs ( direct & Indirect) 6. Mexican (Kept with extended family) . Russians (Indirect) 5. Southeast Asians (Circular. English – Anglo American (Direct) A B 2.1. Europeans (Through several persons) 4.

withdraw at times from researchers. Signs of being comfortable & enjoying friendship Wants research truths to be accurate regarding beliefs. values & lifeways. Tends to offer inaccurate data More signs of accepting Signs of working with & helping the researcher as a friend. be absent. values & interpretations spontaneously or without probes. Uncomfortable to become friend or to confide in stranger. Reluctant to share cultural secrets & views as private knowledge. Attentive to what researchers does & says Skeptical about researchers motives & works. May come late.Indicators of Stranger Active to protect self & others. Suspicious & Questioning Indicators of Trusted Friend Less active to protect self. people. Offers mostly local views. Willing to share. . May question how findings will be used by the researcher or stranger.


Generic (Emic)-Humanistically oriented -People based with practical & familiar referents -Holistic & integrated approach with focus on social relationship. diagnosis. language. illnesses. & lifeways -Focus largely on caring Professional (Etic) -Scientifically oriented -Clients to be acted on with unfamiliar techniques & strangers -Fragmented & nonintegrated services with focusing on physical body & mind -Focus is largely on curing. & pathologies lifeways -Using high-context -Uses low-context communication communication -Relies on traditional & familiar folk caring & healing -Relies on biophysical emotional factors to be assessed & treated . & treatments -Largely non-technological using -Largely technological with many folk remedies & personal diagnostic tests & scientific relationships treatments -Focuses on prevention of -Focuses on treating diseases. disability & maintaining disabilities.

Hospital culture .Client’s culture . Understanding Cultures & Tribes of Nursing.Health agency culture .Nursing culture .Other cultures .Medical culture . Hospitals & Medical Culture The nurse & other cultures: Nurse’s Culture (Center) .A.Community cultures .

B. Moral & Legal Aspects of TN Principles that guide moral action: 1. Are expected to be applicable across all such cases or situations 3. Ethical. Principle or rules considered more than the interests of the individual 2. Provide culturally shared reasons to support or defend the decision or action .

Deontological – focuses on the importance of duty & the inherent rightness or wrongness of a moral action 2.Approaches: 1. Teleological or consequentialist – focuses on the value (good or bad) of anticipated consequences .

Principles of Bioethics: Non-maleficence – to act so as not to inflict harm Beneficence – to act to benefit another Justice .to act fairly Respect for autonomy – to act in respect of another as an autonomous person .

& actions prevent ethical dilemmas that lead to cultural imposition practices & ethical conflicts? . What are my ethical beliefs & practices. How can nurses with strong ethnocentric values.Self Examination Questions to avoid Cultural Imposition: 1. biases. & how can they influence the client’s health & well-being? 2.

In what ways can nurses prevent cultural imposition or pain & best handle ethical or moral dilemmas? 5. In what kinds of clinical illnesses or contexts do nurses tend to impose their professional & personal ethical beliefs or values on clients. or groups? 4. families.3. What are the potential legal consequences associated with the nurse who violates a client’s ethical values? .

values.to justify & support shared resources for the betterment of human beings & sociocultural justice . beliefs & lifeways 3. Principle of benefits of the common good .UNIVERSAL PRINCIPLES: (western/ nonwestern) 1. Principle of Moral Justice – to redress the gap between the rich & poor worldwide 2. Principle of cultural respect & human rights – to preserve human cultural heritage.

to strengthen ethical & moral decisions in beneficial ways in diverse & similar cultures. Principle of frequent ethical & moral assessments . Principle to serve & protect others from destructive acts 5.4. .

& social & ecological factors influence food uses & consumption transculturally? 3. emotions.Questions to be considered: 1. What are the basic nutritional needs of people transculturally? 2. worldview. Are there common foods that tend to be eaten or avoided in different cultures when well or sick? . How do religion. education.

4. What foods tend to support wellness patterns over time in different cultures? 5. What factors often lead to changes in food patterns of production, consumption & usage? 6. What foods tend to be most beneficial throughout the lifecycle for infants, children, & adults transculturally?

C. Transcultural Food Functions, Beliefs & Practices Universal Functions & Uses of Food: 1. Food for biophysical needs 2. Food for human relationships – establishing & maintaining social & cultural relationships with friends, kinfolk, strangers & others 3. Food to assess interpersonal distance – assess social relationships or interpersonal closeness or distance between people

4. Food to cope with stress – symbolic use of food is to cope with emotional stresses, conflicts & traumatic life events 5. Food for rewards & punishments 6. Food to influence status 7. Food to treat & prevent illness

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