Temporomandibular Disorder(s) (TMD), a common cause of chronic pain affecting the face and jaw, profoundly impacts interactions as fundamental to human existence as smiling, laughing, speaking, eating, and intimacy. Since landmark anthropological research on TMD in the 1990s, considerable changes have occurred in the way TMD is thought about and responded to. Knowledge about TMD among dentists and physicians has increased since publication of the Research Diagnostic Criteria (RDC-TMD), and a well-funded TMJ association now advocates for research and support of the condition. On the other hand, concerns in the medical world about increases in chronic pain and associated risks of misuse of pain medications have increased. Physicians are trained to perform a gatekeeper role, preventing those patients at-risk of becoming drug abusers from gaining access to opioid pain medications. These differing contextual factors and my focus on a group of participants drawn from a complementary and alternative medicine (CAM) trial, rather than from a pain clinic, provide an expanded and updated view of TMD. I present analyses of semi-structured, open-ended interviews with 44 participants interviewed multiple times over the course of their participation in an NIH-funded trial evaluating Traditional Chinese Medicine (TCM) for TMD. In contrast to earlier studies of participants who were consumed by an endless search for diagnosis and treatment, these participants were largely focused on coping and "just dealing with" the daily experience of severe pain. Three articles comprise the body of work presented in this dissertation. Topics include the Works of Illness, the Paradox of Hope, and the construction of moral identity through consumption of over-the-counter (OTC) medications. First, using a "works of illness" framework, I draw attention to the considerable work sufferers undertook to manage competing demands of social and physical risk imposed by chronic pain. I refer to these forms of work as the work of stoicism and the work of vigilance and identify double binds created in contexts that call for both. Multiple voices in the narratives of sufferers are highlighted as essential to the construction of a positive identity in the face of illness. In more in-depth exploration of the work of hope, hope is revealed as a fundamental and paradoxical aspect of autobiographical work. I describe multiple forms of hope in a typology of ways of hoping and raise as an issue the manner in which the paradox of hope--keeping hopes in check while also avoiding despair-- intersects with participant expectations in the trial. I suggest this may have an impact on the placebo effect. Trade-offs between physical harm reduction and reducing potential harm to one's identity produce narratives of harm justification as pain sufferers work to describe their use of OTC medications as minimal and responsible. Sufferers in this study, describing medications as "just over-the-counter" or "not real pain medication" distanced, themselves from association with the addictive potential of prescription pain medications. Participants avoided harm to their identities by consuming OTC pain medications as idioms of self-care. This case study provides important lessons about the experience of chronic pain in the USA. While much attention has been directed at overuse and addiction to pain medication, less has focused on the experience of those soldiering through pain and navigating paradoxes between social and physical demands. This study also directs attention to anthropology's potential contribution to drug trials, to the necessity of studying hope as well as expectations, and to how both impact the placebo response.

Polycystic ovary syndrome (PCOS), an endocrine disorder with no known cure that compromises fertility, is a lifestyle disease affecting a growing number of urban Indian women. Media accounts and medical practitioners have noted a recent rise in PCOS cases in urban India and attribute it to "Westernization," modernization, stress, and lifestyle changes following on the heels of economic liberalization in 1991, which opened up the country to processes of globalization. Discourse about PCOS has thus opened up a space for commentary indexing anxieties about larger social and political economic shifts in the country, and women with PCOS are individualized embodiments of the biosocial stresses caused by these shifts. Against the backdrop of a rapidly changing sociocultural landscape with potential for new opportunities for women, the syndrome also poses a challenge to women's traditional roles as wives and mothers, as its symptoms negatively affect reproduction and physical appearance. In this dissertation, I investigate aspects of public discourses about PCOS and lived realities of the syndrome in India as a lens into the interaction of processes of globalization with the local socioculturally embedded body.

This dissertation examines body image ideology within the larger context of adolescent social networks and the physical environment of a high school, specifically focusing on factors that may be contributing to the current overweight/obesity epidemic among youth. I explore the ways in which adolescents construct gendered identities through talk about body image as well as adolescent practices and discourses regarding exercise and food consumption, including how their perceptions of what it means to be athletic and healthy intersect with their perceptions about body image ideals and norms. I further discuss ways in which adolescents construct moral identities through 'othering' discourses about overweight and obese people, including teasing practices. A primary goal of this ethnographic research project is to integrate the study of body image, food consumption, exercise, and teasing practices among youth in order to contribute a contextualized understanding of how youth perceive and enact these behaviors in their daily lives.

Sleep matters for adolescents. It matters for physical and mental health, for success in the classroom and in extracurricular activities, for safety while driving and for protection against potential future psychological problems and substance abuse. Although the recommended nightly amount of sleep for adolescents is over nine hours, many factors interact to preclude teens from getting the sleep they need. This study uses a biocultural, multi-method approach to examine how biological, cultural, and environmental factors interact to affect adolescent sleep behavior in a cohort of 50 high school freshmen in the United States. High school is a place where adolescents learn social and academic skills that will carry them into adult life, but it also provides a space where they are socialized into "how to sleep." By exploring sleep and related behaviors, including ways to cope with inadequate sleep, in a group of teens who were 14 or 15 years old and evenly divided between White and Hispanic and male and female participants, this research explores how sleep is embedded within webs of individual, household-level, school-specific and societal factors. Beyond examining how advice about sleep and teens' experience of sleep behavior is internalized and embodied by adolescents, special attention is paid to the relationships between personal technology use and sleep, and also to the relationships among sleep and food and caffeine intake.

In the United States, a growing proportion of the population is aged 65 and older. Associated with this demographic transition is a rise in the number of people who are aging with chronic disease. While there is a cultural ideal for older adults to remain in the community and out of institutional settings ("aging in place"), there is little recognition of the work and experience of trying to accomplish this. In the following papers, I draw on 12 months of ethnographic research in the Southwest US to describe the work of "aging in place." As a starting point, I use Medicare-funded home health care (HHC), which stands at the crossroads of acute-based institutional care and custodial, long-term care. In the first paper, using definitions of place from cultural geography, I explore the work of aging from the perspective of chronically ill older adult HHC users. I illustrate how bodies, practices, and places shift as processes of disease and medicalization inscribe them with risk, and the ways in which people accept, resist, and negotiate these changes. The second paper extends the work on audit culture to describe how Medicare's audit system has structured the organization and practice of HHC, and how this has reinforced the commodification of patients. I note how HHC nurses can draw on personal and professional logics in their documentation practices as a means of resisting rationalizing forces and opening up eligibility for care. The third paper uses case studies to push the literature on family caregiver burden to include the fraught, yet highly meaning-filled experience of caregiving. The cases show the difficulties and ambivalence in providing care to a chronically ill family member. Throughout these articles, underlying the tensions, uncertainties, and gaps I explore questions about what type of care is needed, who is worthy of care, and how responsibilities are distributed. I focus on how people's worlds and work are structured by larger scale social, cultural, and economic forces, and attend to the ways in which they reproduce, contend, and negotiate these forces from their unique positions, in effort to protect what they value.

In this dissertation, I use separation and divorce as the lens through which I examine the impact of modernization and globalization on the intimate lives and the health and well-being of low income women of African descent in rural Northeast Brazil. I argue that trends such as shifts in the gendered division of labor in a growing eco-tourism economy, and the spread of the modern notion of romantic love and companionate marriage through popular telenovelas, are directly related to dramatic increases in separation and divorce in Brazil. I further argue that social inequality affects individual perceptions and experiences of divorce, and the embodied distress low-income Afro Brazilian women endure with marital failure is also an expression of social suffering.

Reducing racial and ethnic disparities in healthcare are ongoing concerns. A paucity of data on healthcare seeking behavior among older Black women has hampered efforts to make culturally responsive healthcare services available to this population. Little is known about how older Black women's expectations and perceptions of care affect their patterns of health behavior.This study explored sociocultural contexts of health behavior with fifty Black women, aged 40 and older, in Tucson, Arizona by examining what prompts these women to seek services, identifying key factors affecting their access to and utilization of healthcare, documenting their experiences in healthcare settings and how these interactions influence their healthcare-seeking behavior. If effective healthcare service access and utilization are to be encouraged among older Black women, an informed understanding of the role cultural difference plays is essential.This research has three purposes: to provide a forum for discussion of culturally relevant strategies and models for prevention of disease and promotion of wellness in Black communities; to provide perspectives on older Black women's health issues for policymakers and administrators in public health sciences; and to gain insight and document reasons for selected health behaviors among this population. Research funding from the NIH/ NIA has helped to establish this small multi-disciplinary data set on a specific race, gender and age sub-population group for future research and development of community resource partnerships; including public health education and effective healthcare service delivery with intervention / promotion efforts targeting older Black women.Findings: Older Black women's poorer health status reflects the cumulative effects of inadequate health care due to various discriminatory experiences and their mistrust of the health care system. Mistrust, expectations of racial bias, perceived cultural insensitivity, and lack of effective communication within healthcare settings were found to be barriers to their healthcare-seeking behavior. Neither healthcare providers nor older Black women can address these issues alone. Working towards more trusting relationships within healthcare settings is critical in beginning to address avoidable inequities in health status experienced by older Black women.This research is applicable to such disciplines as Sociocultural/Medical Anthropology, Health Education, Public Health, and Africana/Ethnic Studies.

With its oil wealth and an environment of abundant rivers, lakes, and the largest coastline in the United States, Alaska is one of the last places one would expect to find water insecurity. Yet approximately one third of households in remote Alaska Native villages lack in-home piped water and suffer the health consequences of poor sanitation and inadequate treated water. This problem has become particularly acute in the wake of surging energy prices and a concomitant shift in policies that increasingly require demonstrated economic sustainability before funding will be allocated for village water and sanitation projects. In response to increasing costs of living and the failure of development projects to foster the conditions under which they would be able to provide for their needs, many Iñupiat assert the importance of traditional values, practices and values that from their view constitute a path out of insecurity and into self-sufficiency. These Iñupiat point to modern technology as the source of what they call the spoiling of their communities. In this dissertation, I explore the disjuncture between how the state and the Iñupiat signify historical and contemporary issues and solutions around water, energy, and development. I suggest that the unintended consequences of decades of interventions to improve Iñupiaq health and well-being have been manufactured insecurity that is exacerbated by weakened social networks of reciprocity (the Iñupiaq traditional value of sharing), and rendered invisible by sustainability policies. I argue that these multifaceted processes of domination and suffering are all part of what many Iñupiat describe spoiling. In other words, when the Iñupiat talk about being spoiled by technology, they are talking about the historical domination by the state over their social reproduction in ways that produce and exacerbate the insecurities characterizing daily life in these remote villages.

By now scholars, practitioners, government officials and others in the global community have witnessed a number of countries and their populations going through extreme destruction and trying to rebuild in the aftermath. Country case studies are invaluable for their in-depth, continuous look at how a nation-state collective and the individuals who make up that collective recover, regroup, develop, but also remain very harmed for a long time. They must live among and beside their former enemies. Studies of the resettlement of refugees in a third country offer a different view: there are varied populations arriving with different socio-cultural and economic histories and experiences, and different definitions of a normalcy to which they aspire. They are in a setting that is much different than what characterized their pre-war experiences, and they do not have to rebuild out of ashes in the place that they were born. Refugees from various countries resettling in a third country have so much in common with each other from the experience of extreme violence and having to resettle in a foreign land that one key informant suggested that we think about a "refugee ethnicity." Though they would not have wished for them, they have gained numerous new identification possibilities not available to those in the country of origin: U.S. citizen, hybrid, diaspora, cosmopolitan global citizen; refugee/former refugee survivors. But the "fit" of these identities vary, because the receiving society may perceive individuals and families along a continuum of belonging vs. "othering." In the post-9-11 era in the U.S., the "belonging" as a citizen and member of the imagined community of the nation that a refugee or former refugee is able to achieve may be precarious. Will refugees resettling turn out to be vectors of socio-political disease, infecting the new host? Or will they be vectors of development and agents of host revitalization as they realize adversity-activated development in a new environment? The U.S. "host environment" has changed considerably since the modern era of resettlement began in the 1970s and then passed through the dramatic incidents of 9-11. The "hosts" have now also undergone an experience of extreme political violence. U.S. institutions are responding to the events and subsequent wars, and have themselves been changed as they adjust practices and policies in response to the trauma experienced by the people they are meant to serve. Much is in play. The times beg for a better understanding of refugees' social experiences of resettlement in a new country, the forms of suffering and marginalization they face, and the healing processes in which they engage. We need a far better understanding of what it takes to assist refugees as they work to re-constitute social networks, recover economically, find opportunity and meaning, pursue goals, and - with receiving communities--express solidarity across social dividing lines. This dissertation calls out this problematic; and analyzes it at the multi-stakeholder site of refugee resettlement.

In this dissertation, I use the ethnographic case study of the United Arab Emirates to illustrate a much larger phenomenon that involves young women worldwide in the throes of identity negotiation at a time of accelerated global flows of information, foods, fashion, media images, fashions, health information, and health and self-enhancement products. My research utilizes ethnographic and anthropometric information as a means of investigating the ways in which these global flows are affecting the physical bodies, attitudes, behaviors, perceptions of self, and perceptions of community in a sample of young, female, Emiratis living in the UAE in the Arab Gulf in the twenty-first century. I employ biocultural methods and perspectives to examine bodies-as-products and bodies-as-projects in this cohort, focusing on health, beauty, and self-presentation projects. I also focus on the uncertainty and accompanying psychosocial stress that these women are subject to as a result of juggling globalized, "modern" opportunities and lifestyles on the one hand with local expectations and regulations on the other. Key to these analyses is the acknowledgment of the synergy between biology and culture, and the effects of both local and global factors on this synergy.