Acculturation is the process whereby the attitudes and/or behaviors of people from one culture are modified as a result of contact with a different culture. Acculturation implies a mutual influence in which elements of two cultures mingle and merge. It has been hypothesized that in order for acculturation to occur, some relative cultural equality has to exist between the giving and the receiving culture. In contrast, assimilation is a process of cultural absorption of a minority group into the main cultural body. In assimilation, the tendency is for the ruling cultural group to enforce the adoption of their values rather than the blending of values. From a practical point of view it may be hard to differentiate between acculturation and assimilation, for it is difficult to judge whether people are free or not free to choose one or another aspect of a culture. The term "ethnic identity" has sometimes been used in association with acculturation, but the two terms should be distinguished. The concept of acculturation deals broadly with changes in cultural attitudes between two distinct cultures. The focus is on the group rather than the individual, and on how minority or immigrant groups relate to the dominant or host society. Ethnic identity may be thought of as an aspect of acculturation in which the concern is with individuals and how they relate to their own group as a subgroup of the larger society.
Acculturation is a complex concept, and two distinct models have guided its definition: a linear model and a two-dimensional model. The linear model is based on the assumption that a strong ethnic identity is not possible among those who become involved in the mainstream society and that acculturation is inevitably accompanied by a weakening of ethnic identity. Alternatively, the two-dimensional model suggests that both the relationship with the traditional or ethnic culture and the relationship with the new or dominant culture play important roles in the process. Using the two-dimensional model, J. W. Berry has suggested that there are four possible outcomes of the acculturation process: assimilation (movement toward the dominant culture), integration (synthesis of the two cultures), rejection (reaffirmation of the traditional culture), or marginalization (alienation from both cultures). Similarly, Sodowsky and Plake have defined three dimensions of acculturation: assimilation, biculturalism (the ability to live in both worlds, with denial of neither), and observance of traditionality (rejection of the dominant culture).
The term "acculturation" was first used in anthropology in the late 1800s. Early studies dealt with the patterns in Indian-Spanish assimilation and acculturation in Central and South America, the consequences of contact between Native American tribes and whites, and the study of the culture of Haiti as a derivative of West African and French patterns. Increasingly, the importance of acculturation has been recognized in the social sciences, sociology, psychology, epidemiology, and public health.
MEASURES OF ACCULTURATION
It has long been known that race, ethnicity, and socioeconomic status are interrelated, and that there are marked variations in health status among racial, ethnic, and socioeconomic groups. There are many factors that can contribute to these variations, including the level of acculturation of a particular group. It is therefore important to have a method of measurement of acculturation.
The acculturation process affects a range of behaviors, values, and beliefs. All of the scales used to measure acculturation include items on second-language proficiency, because being able to communicate in the language of the host culture is a prerequisite to learning about it. Some scales also assess patterns of language use, friendship choices, food, music or movie preferences, cultural awareness, ethnic pride, place of birth, and contact with one's homeland. Acculturation scales have been developed for different ethnic groups, including Hispanics, Filipinos, Asian Americans, and Southeast Asian immigrants to the United States.
For immigrants, the percentage of one's lifetime spent in the host country and one's age at the time of immigration have been shown to correlate with more extensive and detailed measures of acculturation, and are therefore good indicators of an individual's level of acculturation when more detailed information is unavailable.
RELEVANCE TO PUBLIC HEALTH
Level of acculturation has been shown to be associated with many aspects of health behavior in the United States. High levels of acculturation have been shown to be associated with greater use of mental health services among female Chinese immigrants, increased alcohol intake among Mexican-American women and Southeast Asian immigrants, and increased smoking prevalence among Asian-American youth and Mexican-American women. In contrast, a study among African Americans showed a lower prevalence of smoking among men and women with higher levels of acculturation. Dietary patterns have been shown to change with acculturation. For example, among Hispanics, those with a higher level of acculturation are less likely to consume rice, beans, fruits, meat, fried foods, and whole milk than those with lower levels of acculturation. Many studies have shown high levels of acculturation to be associated with increased cervical and breast cancer screening among Latinos and Asian Americans, and with increased cervical, breast, and colorectal cancer screening among Filipino and Korean immigrants. Such studies show that while acculturation can increase one's health risk in some cases, it can also promote health by creating access to certain forms of health care and by contributing to the abandonment of risky health-related behaviors and the adoption of behaviors that promote good health.
Acculturation has also been shown to influence knowledge and attitudes that shape and influence health behaviors. For example, several theoretical models postulate that knowledge of cancer screening guidelines, perceived severity of cancer, perceived susceptibility to contracting cancer, perceived group norms regarding cancer screening, and perceived barriers to cancer screening will influence whether or not a person will get screened. Many studies have demonstrated that these underlying beliefs differ between individuals with high and low levels of acculturation. A 1996 study showed that Latino women with lower acculturation levels were less knowledgeable about breast cancer risk factors and symptoms and had less favorable attitudes about breast cancer compared to their more acculturated peers. Another study showed that unacculturated Korean-American women were less likely to have friends who had mammograms, were less likely to receive a doctor's recommendation to get screened, and were more likely to state that it was difficult for them to go to a mammography facility than were their more acculturated peers. A study among Hispanic women found that the members of the more acculturated group were more confident in their abilities to acquire health-related information and to seek assistance than the less acculturated group. Still another study among first-and second-generation Japanese-American women found differences in general knowledge of osteoporosis, attributions of its causes, anticipated and preferred support mechanisms for care, treatment compliance, and feelings toward physicians.
These studies show the importance of considering acculturation in developing health-education messages and interventions that are culturally appropriate in terms of language and content, and in terms of psychological factors related to health behavior change. Program planners, researchers, and health educators who understand and take into account the level of acculturation in a target population will be better able to design effective programs of health intervention.
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