Economic change, family cohesion, and mental health in a rural Hawai'i community

ABSTRACT: Economic development in Hawai'i is generally based on a movement from agriculture (e.g., pineapple, sugar) to resorts and tourist-related activities. Tourism tends to change the complexion of rural communities and ultimately affects family structure and dynamics. The authors present a case study on the island of Lana'i, Hawai'i, which is undergoing economic changes that pose major challenges for agrarian families. The research findings indicated a clear relationship between family cohesion and mental health status. The results of this study provide a basis for designing preventive mental health strategies and making responsible policy decisions regarding future economic development.

RESORT DEVELOPMENT to diversify agriculture-based economies is viewed by economists and decision makers as a viable means for economic expansion in Hawai'i. Economic change in many agrarian communities is based primarily on an inverse relationship between a decline in agriculture and an increase in tourism development. The cumulative effects of resort development have led to dramatic environmental, economic, and sociocultural changes in Hawai'i (Matsuoka,1988).

Resorts tend to change the complexion of a community in numerous ways. The types of social changes typically associated with growth related to tourism and other economic development include economic changes, such as changes in types of employment, increased incomes, and increased cost of living (Liu, 1986; Liu & Var, 1983; Summers & Branch, 1984); changes in use patterns of natural resources, such as individuals' ability to subsist by reaping environmental resources (Matsuoka, McGregor, & Minerbi, 1994a, 1994b); changes in the infrastructure of the community, such as the need for increased human services and more schools (Matsuoka, 1992; Osbome, Boyle, & Borg, 1984); and overall changes in the economic and social organization of communities (Brown, Geertsen, & Krannich, 1989; Gill & Shera, 1990; Wilkinson, 1984). Other less tangible yet highly significant quality-of life variables include psychological adjustment (Husaini & Neff, 1987; Kamisasa, 1983) as well as values and spirituality issues (Olsen, Canan, & Hennessy, 1985).

A critical element in socioeconomic change is the way in which sudden and largescale industrial change affects community mental health conditions. Retrospective analysis of previous development projects helps us to forecast potential changes of current development projects. On the basis of previous research, one might predict that insular agrarian communities are vulnerable to sudden social shifts resulting from the in-migration of individuals whose values and cultural beliefs destabilize the values and beliefs of the indigenous population (Bowles, 1981).

An aspect of tourism that has received increasing attention is the complex relationship between economic development and family cohesion and dissolution. Results from Hawai'i-based studies suggested a correlation between tourism development and problems in marital relationships (e.g., divorce) resulting from changing gender roles such as higher employment rates for women (Cottington, 1969) and increased rates of child abuse and neglect (Abreu,1987).

The relationship among socioeconomic change, family cohesion, and mental health in rural communities has not been explored fully. Meanwhile, decisions promoting economic development are often based on the assumption that employment implies well-being. This assumption is narrow with respect to broader conception quality-of-life issues (e.g., family life, cultural practices). Also, little is known about the effects of changing work roles, activities, and schedules (e.g., standard weekday hours to weekends, nights, and holidays) on mental health. The extent to which persons are forced to contend with or adapt to changing socioeconomic circumstances may be a critical predictor of their well-being. Moos (1976) points out that people who attempt to function within an incompatible environment may suffer from poor health and distress. The concept of person-environment fit is germane to analyses of situations in which industrial development is overlaid on agrarian life-styles, especially when cultural change is a predominant factor.

Work Schedule and Family Welfare

Numerous studies have examined the relationship between parental work schedules and the psychological status of families (e.g., Bronfenbrenner & Crouter, 1982; Hoffman, 1983; Staines & Pleck, 1983). In summary, these studies found that irregular work patterns had a negative impact on the quality of family life, as reflected in reduced time spent in family activities, higher levels of perceived work-family interference, and family-adjustment problems. Other aspects of work schedules also influence family stress; for example, both the number of hours worked and shift work were associated with more job-family conflict.

Staines and Pleck (1983) found that the degree of control that a person had over his or her work schedule was a critical factor in moderating individual and family stress. A measure of control over one's work schedule tended to reduce the negative impact of irregular and excessive working hours. They also explored the joint effects of both parents' work schedules and found that a wife's conflicts were exacerbated when her husband worked weekends, whereas the husband's conflicts were exacerbated when she worked an irregular shift during the week. The results of this study suggest differential effects of employment according to the type and level of one's position. In singleindustry communities in which the majority of workers are employed by one company, workers were generally confined to working-class jobs and had little control over their work schedule and pay rates. Obviously, a low to moderate salary paired with a high-cost economic environment encourages dual-worker households.

Impacts of Economic Transition On Children

The relationship between family cohesion and the socioemotional adjustment of youth has been explored in numerous studies (e.g., Koopmans, 1993; Novv, 1992; Smart, Chibucos, & Didier, 1990). These studies generally found that adolescents were at risk when family cohesion was low. Measures of low family cohesion were correlated with socioemotional problems, juvenile offenses, and drug and alcohol abuse among adolescents. Economics is a primary factor contributing to low family cohesion. Financial hardship (e.g., unemployment, welfare assistance) creates family instability. Among families living in communities undergoing economic transition (e.g., agriculture to tourism), it is important to recognize the effects of employment factors such as workshift changes, working multiple jobs, cost-ofliving increases, and other factors not necessarily tied to financial hardship. These factors may affect family welfare and the mental health status of family members.

Purpose of the Study

Economic changes in Hawai'i have spurred social changes that have had prevailing effects on families and communities; disempowered and economically disadvantaged ethnic minorities may be especially vulnerable to stressors generated by such changes. Persons subjected to a changing physical environment, interpersonal relationships, and job and work patterns must adopt new patterns of coping with and adapting to stress in order to avoid physical and mental health problems (Moos, 1976). Persons are exposed to social changes when they move to a new community setting or when change occurs in the community in which they reside. The latter condition is perhaps more stressful, especially when changes are involuntary, undesirable, or based on unilateral decision making.

The purpose of the present study was to determine the degree to which family cohesion accounted for different outcome measures of mental health. Hypothetically, socioeconomic changes have negative effects on the mental health of the general community, thus affecting family functioning and well-being. For example, the radical shift in employment opportunities from agriculture to resorts is likely to result in stress-induced mental health problems among adults and ultimately the entire family system-especially children. This study examines the relationship between levels of family cohesion and adaptability and outcome measures on various mental health indicators. Quantitative and qualitative methods were used to provide a comprehensive picture of the dynamics of change in a rural, multiethnic community.

Study Setting

The island of Lana'i is poised for a major transition. This rural, plantation-style community of approximately 2,700 has for many years existed apart from modern-day Hawai'i. A unique subculture has evolved from a multiracial Pacific and Asian American island population and its single-crop economy of pineapple. In 1985, the transnational Californiabased Flexi-van Corporation merged with the island's existing owner, Castle and Cooke, Inc., and assumed ownership of 98% of the island. Soon after the merger, the corporation announced plans to phase out pineapple production and develop tourism.

The development of two world-class resorts are part of a large project. The project includes two golf courses, 350 acres (775 units) of luxury residential development, and new commercial areas. The island's population is projected to triple in the next decade-with newcomers from markedly different cultural and socioeconomic backgrounds settling on Lana'i. The current situation provides an ideal natural laboratory setting to study the impact of major economic development on a rural Hawai'i community. Since pineapple was introduced in 1920, Lana'i has been an extremely stable community with little cultural or environmental change.

Not long after the announcement that Castle and Cooke, Inc. (now under the name Dole Foods, Inc.), was planning to proceed with the resort development, agricultural activity began phasing down, and pineapple workers were retrained in hotel operations. The first resort opened in 1988 and the second in late 1990. Golf courses have also been developed in areas adjacent to the two hotels. The corporation has received approval to develop 350 luxury housing units and is seeking approval for an additional 425 luxury housing units. If these units are approved, housing on the island will increase by approximately 80%. There has been a large influx of workers from off-island, and the majority of managerial positions have been offered to individuals from the continental United States.

Results from this study offer us a clearer understanding of the relationship between interdependent systems (e.g., economy and family). A decline or increase in mental health may be determined through composite examination of economic development and social change and subsequent changes in family conditions. In an era during which modernization and industrialization are impinging upon rural areas at unprecedented rates, we need to be able to predict accurately the environmental and human impact of these activities. Such knowledge will allow us to design preventive mental health strategies and make responsible policy decisions regarding the course and rate of future economic development.

Methods

The purpose of this cross-sectional, oneyear study was to establish a mental health baseline and to conduct an examination of the relationship between socioeconomic change and specific mental health factors.(1) The intent of the study was to isolate those factors (e.g., family cohesion) associated with changing mental health conditions.

A simple random sample of households was collected from the Lana'i community. Tax Map Keys representing all of the occupied households on the island and Lana'i Company maps were used to develop a sampling scheme. Many households on Lana'i consist of multigenerational families. To avoid potential bias in the selection of heads of households, interviews were conducted with a randomly selected adult (21 years of age or older) in each household. Efforts were made to obtain a balance of male and female respondents. However, male respondents were generally unavailable (many were working multiple jobs) or refused to be interviewed. Of the 201 persons in the final sample, the ratio of women to men in the sample was approximately 2 to 1. The total response rate based on the number of residents who consented and refused to participate and those who were unavailable was 89%. Study methods involved gathering qualitative data to corroborate and explain the quantitative results. A series of focus groups elicited qualitative information to fill in conceptual gaps and explain causal relationships between family cohesion and mental-health-related outcomes. The focus group discussions most relevant to family issues were those held with human service professionals (social workers and public health nurses), public service professionals (police, legal aid), school teachers, and church leaders. Participants were led through a semistructured format that sought to gather reliable information across groups. Data derived from focus groups provided a deeper understanding of phenomena related to family cohesion and change. The following section presents information gathered from the focus groups.

Questionnaire

Instruments with demonstrated psychometric properties were used to measure mental health and family cohesion and adaptability. The Brief Symptom Inventory (BSI) is a 53item self-report symptom inventory designed to measure the psychological symptom patterns of both patients and nonpatients (Derogatis & Spencer, 1982). Each item of the BSI is rated on a five-point scale of distress, ranging from "not at all" (0) to "extremely" (4). The BSI is scored and profiled in terms of nine primary symptom dimensions: (1) somatization, (2) obsessive-compulsive, (3) interpersonal sensitivity, (4) depression, (5) anxiety, (6) hostility, (7) phobic anxiety, (8) paranoid ideation, and (9) psychoticism. The BSI also yields a General Symptom Index (GSI) as a gross measure of mental health status.

The FACES II instrument integrates primary dimensions of family behavior incorporated into the Circumplex Model formulated by Olson, Sprenkle, and Russell (1979). The dimensions are cohesion and adaptability (change). The 30-item instrument contains 16 cohesion and 14 adaptability items.

Family cohesion assesses the degree to which family members are separated from or connected with their family. Family cohesion is defined as the emotional bonding that family members have toward one another. Specific concepts used to diagnose and measure the cohesion dimension include emotional bonding, boundaries, time, space, decision making, and interests. Family adaptability (change) refers to the extent to which the family system is flexible and able to change and is defined as the ability of a family system to change its power structure, role relationships, and relationship rules in response to situational and developmental stress.

Results

The family cohesion and adaptability scores were divided into two subgroups representing low and high cohesion and adaptability. Subgroups were created by identifying the midpoint in the total range of responses and dividing respondents into two groups. These subgroups were compared on all of the mental health index scores (e.g., depression, anxiety) and the cumulative mental health score (GSI). Statistical analysis using analysis of variance (ANOVA) was used to investigate whether the means of the dependent variables related to mental health differed compared with means of the independent variables (family cohesion and adaptability).

Statistical results for family cohesion are presented in Table 1. Comparisons between the two levels of cohesion indicated that low cohesion resulted in significantly higher levels of somatization, interpersonal sensitivity, depression, anxiety, psychoticism, and the GSI consisting of all mental health categories. The same pattern occurred in all of the other comparisons that were not statistically significant.

Similar analysis was conducted for family adaptability, which also was divided into two subgroups. Comparisons between the two levels of adaptability indicated that low adaptability resulted in significantly higher levels of depression and psychoticism (Table 2). Interestingly, the pattern of results was the same for all indices except hostility, for which high adaptability resulted in higher hostility.

These findings point clearly to the relationship between family dynamics and conditions and the mental health status of individual members. Members of families with low cohesion and adaptability were prone to experience more mental health problems. These results show that the construct of family cohesion is a more critical predictor of mental health status than is family adaptability. In the following discussion, data derived from focus groups is used to illustrate how economic change has resulted in changes in the family. Economic changes leading to the destabilization of agrarian families has implications for the mental health of individual members and the overall functioning of the family unit.

Discussion

Family cohesion and adaptability were critical factors with regard to the mental health status of respondents. This finding pointed to the significance of family as a determinant or predictor of various mental health outcomes. A discussion attempting to relate family cohesion and adaptability to specific mental health outcomes (e.g., somatization, anxiety) would be questionable because of the empirical limitations of the study (corroborating clinical assessment measures were not used). Yet, on the basis of our results, we can assume in general that family predispositions buffer individuals against or contribute to mental health problems and that family dynamics and/or supports are critical to individuals' ability to cope with stressors associated with socioeconomic changes.

Families on Lana'i have undergone extreme shifts in behavioral norms, dynamics, and even composition. Economic change has subjected the labor force to stressors associated with retraining, developing interpersonal styles and skills conducive to working in a luxury hotel, and changes in work schedule associated with moving from plantation work to service work. Virtually every family in the community was affected by this economic shift.

Adults had to make the change from extremely regimented work and adapt to work in a new and relatively unpredictable setting. Under the plantation system, the island residents' schedule and life-style were regulated by loud sirens that woke residents at 4:30 A.M. and signaled bedtime at 8:00 P.M. For most residents, the workday ended at 3:15 P.M. Parents did not work weekends-the time when families engaged in recreational, community, and church activities that cultivated family cohesion.

Many of the family-oriented activities were tied to cultural events and celebrations (e.g., Filipino Barrio Fiesta, Hawaiian Hula, Japanese Bon Dance). Such activities reinforced cultural identities and provided role prescriptions for persons of all ages. These cultural activities supported a system of networking and information exchange vital to community cohesion and mutual support. The changing economy has led to an infusion of new residents and a loss of discretionary time that was used to plan and organize these events. These changes threaten the vitality of the community and inhibit transmission of cultural practices affecting family integrity and welfare.

Work at the new resorts has been relatively tenuous and sporadic. Economic recession has had a major impact on tourism in Hawai`i, especially for luxury hotels. Regular work schedules are difficult to maintain as a result of fluctuations in the number of tourists. Many workers have had to take second and even third jobs. Irregular work schedules and working multiple jobs have also contributed to family instability and conflict. These results, although qualitative in nature, clearly parallel findings from the literature (see Staines & Pleck, 1983).

The radical shift in work environment and culture has also contributed to work stress. The majority of resort service personnel were retrained field laborers who had to undergo intense training courses designed to teach them appropriate behavioral and language skills for resort work. Numerous reports of worker dissatisfaction with managers' cultural insensitivity were made. Most of the managers were brought over from the continental United States. Workers lamented the loss of autonomy. Work roles in the pineapple fields were highly circumscribed and predictable, and little supervision was required. With resort work, however, work roles are relatively undefined and unpredictable, and many workers perceive management as overbearing in its efforts to control worker behaviors. An authoritarian management style has reduced opportunities for camaraderie in the workplace, which many workers believe is essential to worker morale and productivity. All of these factors have contributed to work stress, which in turn has detracted from quality family life.

Evenings, weekends, and holidays are no longer sacrosanct for families. Children, particularly adolescents, must negotiate changing family patterns and absentee parents who are preoccupied with working multiple jobs and making ends meet. A decline in family life and parental supervision is inversely related to increases in extracurricular activities, antisocial behaviors, and substance abuse among adolescents (Shilts, 1991; Smart et al., 1990). Human service professionals reported increases in suicide attempts among teenagers (five attempts within a four-month period following the resort development), and school teachers reported having to expand their roles and serve as surrogate parents to meet students' increased psychoemotional needs caused by family stress.

A general decline in parenting is evident by increases in juvenile crime and domestic violence. Police informants reported increases in property crime, substance abuse, and gang-like activities among juveniles. Increased incidents of domestic violence have been explained by a decline in the quality of marital relationships, parents compensating for loss of control over children's behavior by resorting to corporal punishment, and increased work-related stress paired with a lack of appropriate strategies for stress reduction.

Two interesting phenomena were also reported. The divorce and separation rates as well as fertility rates have increased. Many women left their male companions. The infusion of new people on the island expanded the pool of available partners, and women who found themselves in unfulfilling or abusive relationships had new options for partners. Some human service professionals (e.g., public health nurses) explained the increased fertility rate in terms of men impregnating women to discourage them from seeking new partners.

Economic change has not affected all families in the same way. Against the backdrop of changing family dynamics and roles, close, tight-knit families able to maintain their integrity buffered members against the stress of change. Cohesive families may also serve other functions that enhance individual coping. For example, Voydanoff and Donnelly (1989) noted that families whose members are emotionally close serve as a resource for social support as well as a model for appropriate problem-solving skills. Because of the degree of change, family cohesion has been difficult to maintain and has required stronger commitment among members. Parents who are better at time management have resources that enable them to provide activities for their children that compensate for reduced parental involvement. Others do not work for resorts and therefore are less effected by the changing economy. These groups generally have fared better. Premorbid family conditions that were exacerbated by economic stressors were not examined. It is possible that pathologies existed in some families well before socioeconomic changes occurred.

Conclusion

The results of this study offer a clearer understanding of the relationships among interdependent systems. A decline or increase in mental health may be analyzed through a composite examination of variables related to economic development and family cohesion. In an era in which modernization and industrialization impinge upon rural areas, social workers need to be able to predict accurately the environmental and human impact of socioeconomic change.

Decisions allowing or regulating economic development radically different from existing economies should be contingent upon creation of human service programs that can address anticipated negative impacts. The loss of larger institutional supports (e.g., work regimen, church) that traditionally supported family bonds must be replaced by new activities that maintain the family. For example, programs aimed at teaching parents new skills such as time management, stress reduction, and child-discipline skills can help parents make up for deficits in the amount of time they have available for family life.

To compensate for family stresses, institutional alternatives must be developed to provide social structures critical to the well-being of youth. For example, development-impact fees can be used to underwrite programs aimed at child care, youth recreational activities, youth counseling, school or communitybased educational programs and activities, and the like. Approval of future development projects should be contingent upon the allocation of funds based on human service professionals' human-impact cost estimations. Time series analysis and case studies of communities that have experienced similar development can be used to anticipate and estimate the sociocultural impact of economic change and to exact tolls to finance program development.

Finally, more research on the impact of economic development on community and family well-being is needed. The present study suggests that the degree of dissimilarity between past and present economies is tied to level of family cohesion-a predisposing mental health factor. Our understanding of the dynamics and outcomes of economic development and family cohesion will allow for more conscientious planning and decision making.

1. This study is based on a comparative prospective panel design. It represents phase one of a longitudinal study planned over multiple phases.

Jon K. Matsuoka is Associate Professor and Melanie Benson is graduate research assistant, School of Social Work, University of Hawai'i, Honolulu, Hawai'i. This article is based on research supported by National Institute of Mental Health grant 5R 24 MH 49387 01-02-03.

Copyright Family Service America Feb 1996
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