A SOUTHERN EXPOSURE: CROSS-CULTURAL FACTORS AFFECTING HEALTH SERVICES UTILIZATION, PSYCHOSOMATIC ILLNESS AND PRE-DEPARTURE, SOJOURN AND RE-ENTRY EXPERIENCES OF FOREIGN STUDENTS IN NORTH CAROLINA (ADJUSTMENT, NETWORK, MENTAL HEALTH)

International students at the University of North Carolina at Chapel Hill and at Duke University in Durham were studied before leaving their home countries, in the U.S.A. and just prior to completing their studies. Problems during the pre-departure phase included lack of information and uncertainty about their prospective educational careers. Students interviewed during the sojourn phase reported that their social networks consisted of individuals who were similar in age, student status and educational goals. They had experienced housing problems, had made few intimate friendships and felt that their social status in the US was often low. Toward the end of their educational careers they reported they had been given insufficient opportunity to teach or use their foreign or professional skills and had received little encouragement to attend conferences or publish papers. They demonstrated ambivalence toward returning, and they cited continuation of studies, uncertainty of the job market and indecisiveness as reasons for remaining in the United States.; A seven-year survey of medical records showed foreign students used Mental Health Services approximately one-third as frequently as did US students. They presented with adjustment reaction to adult life, depression, anxiety and marital maladjustments. Differences were also found between US and foreign groups concerning injuries, eye problems, skin problems, infections, gastrointestinal disorders and psychosomatic illness. Students from Africa, Turkey and Iran made most visits to Student Health Services and students from Thailand and Korea the fewest.; The findings are discussed using literature from medical anthropology, social psychology and social epidemiology. Foreign students assemble a social network, of which part--the Transitory Action Set (TAS)--is instrumental during their transitory affiliation to US culture. In the discussion of utilization behavior the influence of social support, somatization, cultural distance and diagnostic relevance is appraised.; Orientation programs are recommended in all phases of the foreign student experience and must respond to the needs of the target population as dictated by age and nationality, and address role and status shock and social relations among other factors. Health professionals should be made aware of ethnocentric health and counseling services and adapt these to the needs of international students.