Original Report| Volume 17, ISSUE 12, P1273-1280, December 2016

Does Caregiver Behavior Mediate the Relationship Between Cultural Individualism and Infant Pain at 12 Months of Age?

  • Monica C. O'Neill
    Department of Psychology, York University, Toronto, Ontario, Canada
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  • Rebecca Pillai Riddell
    Address reprint requests to Rebecca Pillai Riddell, PhD, CPsych, The Opportunities to Understand Childhood Hurt (OUCH) Laboratory, York University, Department of Psychology, Faculty of Health, Room 2038, Sherman Health Science Research Centre, 4700 Keele Street, Toronto, Ontario M3J 1P3, Canada.
    Department of Psychology, York University, Toronto, Ontario, Canada

    Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada

    Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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  • Hartley Garfield
    Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada

    Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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  • Saul Greenberg
    Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada

    Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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Published:August 30, 2016DOI:


      • Caregiver behavior is a mechanism by which culture affects infant acute pain.
      • Individualism is measured using a systematic continuous scale.
      • Emotional availability mediated caregiver culture and infant pain.


      This study aimed to understand the relationship between caregiver culture and infant pain expression at the 12-month immunization and discern if a mechanism subsuming this relationship was the quality of caregiver behaviors (emotional availability). Infants (N = 393) with immunization data at 12 months of age were examined. On the basis of the Development of Infant Acute Pain Responding model, a mediation model was developed to examine how caregiver behaviors mediate the relationship between caregiver heritage culture and infant pain. Culture was operationalized by an objectively derived quantification of caregivers' self-reported heritage culture's individualism. Two mediation models were estimated, examining infant pain expression at 1 and 2 minutes post-needle. Caregivers who self-reported heritage cultures that were more highly individualistic tended to show greater emotional availability, which in turn predicted decreased infant pain expression at 1 and 2 minutes post-needle. The present findings further our understanding of one mechanism by which caregiver culture affects infant acute pain expression.


      Adding to the literature examining direct relationships between culture and infant immunization pain, this article proposes the quality of caregiver behaviors as a mechanism by which culture affects infant acute pain expression at 12 months of age. Results support the proposed mechanism and inform our understanding of the role of caregiver culture in the infant pain context.

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