Cultural Differences Predict Palliative Care Development Across the United States: The Role of Cultural Tightness and Looseness.

Across the United States, some regions demonstrate greater readiness to adopt palliative care than others. This geographic variation in access and utilization may be due to cultural variation in "tightness" and "looseness," which can be understood as the relative strength and enforcement of social norms and behavioral constraint within a culture. The present study examined the influence of cultural tightness-looseness on access to palliative care (i.e., statewide percentage of hospitals with palliative care programs) across the 50 U.S. states while controlling for demographic covariates. Results of regression analyses demonstrated that states with looser cultures (i.e., less adherence to norms) had better palliative care access (β = .501, p = .012). Additionally, access was better in states with greater proportions of female (β = .455, p = .004) and white, non-Hispanic or Latino/a (β = .359, p = .002) residents. Strategies to improve utilization should consider the influence of culture and the relative strength of existing social norms within the region.