Traditional and existential measures of wellbeing

Interestingly, recent studies on life satisfaction and happiness suggest that wellbeing plays a more significant role in health than previously understood [6–8]. Building from an initially incomplete definition and conceptualization of wellbeing, Forgeard and colleagues [9] have proposed broadening previous indices to include dimensions such as pleasure (subjective well-being), engagement, good relationships, meaning and purpose, and accomplishment, collectively known as PERMA. As such, combining both subjective and objective indicators, in this way, to construct this multidimensional construct of wellbeing creates a much more comprehensive and objective measure. Encouragingly, both national and international survey instruments have recently been incorporating these measures, reflecting a shift from a narrow focus on happiness to a multifaceted approach to well-being, providing a much richer index capable of capturing various dimensions of human flourishing [10].

On the one hand, traditional wellbeing encompasses quantifiable aspects of health and quality of life, including physical health, mental health, economic stability, and social well-being. Namely, physical health pertains to fitness and absence of disease, while mental health involves emotional stability and overall happiness [11,12]. On the other hand, economic stability denotes financial security and freedom from severe stress. For instance, economists have historically argued that positive wellbeing is a simple consequence of greater income. And indeed, this is undeniably true; especially on a global scale, higher incomes lead to reductions in extreme poverty and disease, improvements in food diversity and security, increases in school attendance, and increased health care expenditures [13]. Moreover, greater household income is typically associated with better health measures and outcomes such as normal height, waist-to-hip ratios, respiratory function, and malaise, thereby limiting the occurrence of acute or chronic illnesses [14]. Thus, poverty alleviation is associated with happier populations, and recent work has borne this out, in showing that high or volatile inflation is generally detrimental for a population’s wellbeing, especially among those with a right-wing political orientation within the United States [15,16].

Studies by economists Daniel Kahneman, Angus Deaton, and others have found that, once income has reached a basic subsistence level, namely, that of a pre-tax annual family income of around $75,000, such effects rapidly plateau [17]. From this research, one could conclude that although to a point, money does appear to buy happiness, this non-trivial effect on wellbeing appears to quickly diminish, once a basic income threshold has been reached [18]. Yet, more recent research complicates the picture. A large-scale experience-sampling study found that well-being continues to rise with income across the spectrum, including above $75,000, but in a logarithmic rather than linear fashion—meaning that proportional increases in income, not absolute gains, are consistently associated with higher well-being [19]. This suggests that while marginal returns may diminish, the positive relationship between income and subjective well-being remains robust and continuous at all income levels.

In contrast, existential wellbeing addresses deeper, less tangible aspects of life, such as meaning, purpose, and fulfillment [20]. It includes having meaningful goals, personal growth, community identity and strong community networks, living authentically according to one’s values, and existential security in understanding life and existence [21]. For instance, distinct from economic stability, social well-being refers to both the quality and quantity of social relationships and social networks [22]. In particular, social relationships have been shown to have a profound influence on wellbeing, health and human disease [23–25]. For example, among people with fewer sources of social and emotional support, such individuals typically have higher rates of mortality and morbidity, especially from angina and similar cardiovascular issues, likely related to higher blood pressure, cortisol levels, and overall difficulties coping with stress [25]. Indeed, research has shown the presence of a friend in a stressful situation can often be linked to lower blood pressure [26], while embraces from a loved one prior to a stressful situation commonly stimulates oxytocin production, acting as an endogenous analgesic. Beyond this, the influence of social networks on health and human disease can be even more profound, influencing the spread of a wide variety of behaviors and psychological states, including negative conditions such as obesity [27], smoking [28], and depression [29], as well as positive states, such as informing the prevention of social isolation and loneliness [30] and facilitating happiness [31].

From a less personal, more political perspective, additional studies have shown that federalism and democracy generally facilitate strong feelings of wellbeing in individuals [32]. Specifically, the more direct the political participation opportunities which have become available to citizens, the greater their wellbeing. Firstly, a more active role in politics by the citizenry allows for better monitoring of politicians and policy makers by average citizens, typically leading to greater approval of government outcomes. Secondly, the capacity for citizens to have control over and get involved in their own political decisions and outcomes – for example, by way of local public referendums – further raises wellbeing.

Fortunately, in recent years, these and various other similar wellbeing indicators have been increasingly measured through surveys and clinical assessments, and statistically evaluated across a wide array of populations. It stands to reason, then, that different geocultural locations throughout North America and the United States are characterized by different social norms and values that are associated with different levels of both traditional and existential wellbeing.

First Settler Effects

Woodard [33] expanded upon the “Doctrine of First Effective Settlement” [34], which posits that the first successful settlers of a newly-colonized region have an outsized influence on the future trajectory of that society, including contemporary social, cultural, and ideological characteristics. Regional cultures can thus be discerned and mapped by tracking successful colonizer-settler patterns, an approach that has informed the work of historians [35,36], ethnographers [37], linguists [38], political scientists [39] and geographers [40–42]. Anthropologists have described how culture persists over long time periods, via intergenerational transmission, conducted through passive observation, imitation, shared participation, and formal teaching within families, schools, places and forms of worship, community organizations, ritualistic ceremonies and other social contexts [43–45]. Psychologists have shown how individual members of nations and other large social groups share collective – and often highly selective or invented – stories of the past; the individuals are the agents doing the remembering of these stories, but the content is shaped by their sociocultural environment [46–48].

The American Nations Model

Woodard’s American Nations framework delineates distinct cultures across North America north of the 25th parallel, including thirteen regional cultures or “nations” and the “anomalous” Federal Entity (the District of Columbia) [49]. Among these nations, some parallel regions identified by Fischer [35], such as Yankeedom, were originally settled by English Puritans who believed they had been tasked by God to create a more perfect society and, thus, strongly emphasized communal success over individual liberty, and Greater Appalachia, populated largely by Scots-Irish immigrants known for their fierce defense of individual autonomy and personal liberty and resistance to external control by government or most anyone else [50]. Similarly, Woodard’s El Norte aligns with Garreau’s MexAmerica [51], and his Left Coast mirrors Garreau’s Ecotopia, a concept initially inspired by literary works [52]. Empirical studies have demonstrated that Woodard’s nations exhibit distinct differences in various domains, including entrepreneurship [53], economic development [54], mortality rates [55], obesity, diabetes, and physical inactivity [56], social vulnerability [57], and voting patterns [58]. Like Fischer’s model, Woodard’s taxonomy is deeply rooted in historical settlement patterns, yet it also offers a comprehensive overview of contemporary societal structures. Fig 1 presents a map of Woodard’s model, with Table 1 providing brief descriptions of each nation. The methods Woodard used to trace the boundaries of these cultures have been described elsewhere [33,49], and the history and cultural characteristics of each region have been discussed in detail in four book-length treatments focused on their history [33], communitarian-individualistic orientation [59], relationship to competing narratives of United States nationhood [60], and specific contemporary policy issues [61].

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Table 1. Descriptions of Woodard’s American Nations with region and average MSA sample size.

https://doi.org/10.1371/journal.pone.0327972.t001

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Fig 1. This map illustrates the regional division of North America into distinct cultural nations as proposed by Colin Woodard in his 2011 book “American Nations: A History of the Eleven Rival Regional Cultures of North America”.

The model divides the continent into several “nations,” each with its own unique cultural identity shaped by the settlement patterns, historical events, and prevailing ideologies of the first settlers in those regions.

https://doi.org/10.1371/journal.pone.0327972.g001

Regional geocultural coalitions

When considering clusters of regional cultural characteristics among the nations, the Northeastern and Midwestern nations include Yankeedom, New Netherland, and the Midlands. These regions have been described as dignity cultures. Dignity cultures, which emerged from Enlightenment liberalism, prioritize the inherent worth of individuals regardless of their social standing. In dignity cultures, personal dignity is seen as an inalienable right, and individuals are encouraged to resolve disputes through legal and institutional channels rather than personal retribution. This fosters a more egalitarian social structure where respect is granted based on intrinsic human rights rather than external validation [62]. Conversely, the more southern regions (Greater Appalachia, Deep South, and Tidewater) are described as Honor cultures. Honor cultures, prevalent in societies where individuals must defend their reputation through personal bravery and adherence to communal norms, emphasize external recognition and social standing. In these cultures, respect and status are often maintained through displays of strength, loyalty, and the willingness to retaliate against insults or slights. This leads to a collective enforcement of social norms, where the community plays a significant role in regulating behavior and resolving conflicts.

Anthropologically, honor cultures have often arisen among herding societies, where the mobility and wealth associated with livestock necessitate a strong emphasis on reputation and communal enforcement of norms. The Sami of Northern Europe, the Tuva of Central Asia, and the Scottish Lowlanders (whom are the progenitors of a vast majority of the settlers of Greater Appalachia) all exemplify honor-based cultures shaped by their herding lifestyles. Among the Sami, herding reindeer in the harsh Arctic environment, and maintaining honor through bravery and communal solidarity is crucial for survival and protection against external threats [63]. Similarly, the Tuva, nomadic herders of Siberia, emphasize honor in their social structure, valuing personal bravery, loyalty, and the defense of their herds and territory [64]. The Scottish Lowlanders with their herding of cattle and sheep in contested and sometimes lawless border regions, developed a culture of honor that prized martial valor, kin loyalty, and the protection of clan reputation. These herding societies, including the Maasai of East Africa, who also prioritize honor through cattle raiding and warriorhood, showcase how the demands of pastoral life fostered cultures where honor is essential for social cohesion and survival [65].

Crucially, while herding itself has largely declined in many of these regions, the underlying cultural patterns persist due to well-established processes of cultural transmission. Through vertical (parent-to-child), horizontal (peer-to-peer), and oblique (institutional) mechanisms, honor-based values continue to be passed down and reinforced. Local institutions—such as churches, schools, and community organizations—serve as cultural vectors that embed and perpetuate these norms, even in the absence of the original subsistence ecology. An agent-based model supports this, showing that honor cultures thrive where formal authority is weak, reinforcing norms of self-reliance and group protection [66]. These insights help explain why Western “dignity” strategies often falter in honor-based regions: the psychological and institutional legacy of early settlement patterns continues to shape regional wellness outcomes today.

Hypotheses and predictions

In this study, we investigate three primary hypotheses related to cultural geography and its impact on wellbeing. The Settler Wellness Effect hypothesis posits that cultural geography and first settler effects significantly influence an individual’s form of wellbeing, encompassing not only traditional metrics (physical, social, and financial wellbeing) but also existential wellbeing, which includes a sense of purpose, meaning, and community identification. We predict that the American Nations regions, based on their cultural norms and differences, will exhibit distinct wellbeing outcomes. The Honor-Based Wellness hypothesis asserts that American Nations with honor-based cultural norms will demonstrate greater existential wellbeing but lower traditional wellbeing and life satisfaction.

The Minority Identity Disparity Hypothesis suggests that non-majority racial out-groups will experience lower levels of wellness and life satisfaction compared to majority in-groups across the various cultural regions of the American Nations. In the Northeastern and Midwestern nations, we anticipate disparities in wellbeing between White and non-White populations, with particularly pronounced gaps for Black populations. In the Southern nations, we predict significant disparities, with non-White populations facing markedly lower wellness due to the region’s historical racial hierarchies. In the Western nations, the dynamics are more complex: in El Norte, Hispanic populations are expected to experience higher wellness, while non-Hispanic groups may face lower levels; in The Left Coast and The Far West, White populations are likely to maintain higher wellness, with potential disparities for non-White groups. This framework provides a nuanced understanding of how regional, cultural and historical contexts shape contemporary disparities in wellbeing.

Participants and data collection

The data for this study were derived from the Gallup-Healthways Well-Being Index, which has been tracking the well-being of U.S. adults since 2008 through a comprehensive survey methodology. This index provides a nearly real-time view of Americans’ well-being, offering insights into five interrelated elements: sense of purpose, social relationships, financial security, community relationships, and physical health [66]. This research was conducted in accordance with the ethical standards of the University of Toronto’s Research Ethics Board, following guidelines for human participant research and data confidentiality.

Gallup-Healthways interviews U.S. adults aged 18 and older living in all 50 states and the District of Columbia using a dual-frame design that includes both landline and cellular telephone numbers [67]. The survey employs random-digit-dial methods to sample landline and cellphone numbers. Within households, Gallup selects respondents at random based on the member who had the most recent birthday. Each national sample includes a minimum quota of 50% cellphone respondents and 50% landline respondents, with additional minimum quotas by time zone within each region. Interviews are conducted in Spanish for respondents who are primarily Spanish-speaking. Gallup conducts interviews with at least 500 U.S. adults daily, accumulating over 175,000 interviews annually. Since its inception in 2008, the survey has conducted more than 2 million interviews. These extensive data collection efforts ensure that the analysis captures a wide range of factors affecting well-being, allowing for an in-depth examination of how cultural geography and settlement patterns influence individual and community well-being across the United States.

In addition to wellness data, the study incorporates various demographic and socioeconomic variables from public datasets, such as racial diversity, educational attainment, political leanings, religious diversity, and income levels, to provide a comprehensive understanding of the factors influencing well-being across different American Nations. The dataset for this study includes yearly measures of wellness for Metropolitan Statistical Areas (MSAs) from 2009 to 2016, providing a robust longitudinal dataset for analysis.

Ethics statement

This research was conducted in accordance with the ethical standards of the University of Toronto’s Research Ethics Board. The study adhered to all institutional and national guidelines for research involving human participants, including the principles outlined in the Tri-Council Policy Statement on Ethical Conduct for Research Involving Humans. All data were anonymized and aggregated prior to analysis, ensuring participant confidentiality and data protection. No identifiable information was used, and ethical approval was obtained where required for secondary data analysis.

American Nations Model

MSA’s were coded into their respective American Nations Model geography [33]. Table 1 describes geo-cultural characteristics, as well as the associated average respondent number for each nation. In order to assess the characteristics of communities, we initially aggregated individuals into MSAs. However, the number of respondents in most MSAs varied: Of the 110 MSAs represented in the data, several had smaller sample sizes. These small MSAs, however, included only a minor portion of the total sample. This led to a more robust dataset which included a total of 325,777 individuals. These averages were derived from the responses collected over the years from 2013 to 2016, providing a comprehensive overview of the sample distribution across different American Nations.

Data, factors, & variable transformation

The response variables for this study were derived from components of wellbeing as measured by respondents in the U.S. Dailies Gallup survey, reported as aggregate averages across MSAs. These variables encompass both traditional and existential dimensions of wellbeing. As defined by Gallup-Sharecare, traditional wellness variables, encompassing physical, social, and financial wellbeing, are represented by indices that capture the more measurable aspects of an individual’s health and quality of life. Although social well-being could reasonably be associated with existential dimensions, we classified it within the Traditional Wellness Index, due to extensive evidence linking the quality of social relationships—particularly loneliness and social isolation—to concrete physical health outcomes, such as cardiovascular disease, immune function, and mortality risk, aligning it more closely with other material and physiological dimensions of wellness.

1. Physical wellbeing includes metrics related to having good health and sufficient energy to perform daily tasks.
2. Social wellbeing reflects the presence of supportive relationships and love in one’s life.
3. Financial wellbeing involves managing one’s economic life to minimize stress and enhance security.

In contrast, existential wellness addresses deeper, philosophical aspects of human life.

1. Community wellbeing measures the extent to which individuals like where they live, feel safe, and take pride in their community, capturing a sense of belonging and security.
2. Purpose wellbeing relates to having meaningful goals and feeling motivated to achieve them, reflecting a sense of direction and personal fulfillment.

The Traditional Wellbeing Index is calculated as the Z-score of physical, social, and financial wellbeing, integrating these elements to provide a comprehensive measure of traditional health and quality of life. The Existential Wellness Index is calculated as the Z-score of community and purpose wellbeing, capturing the more intangible aspects of meaning, purpose, and community identification. Together, these indices provide a holistic view of wellbeing, encompassing both the quantifiable and philosophical dimensions of human experience.

The Regions factor categorizes the American Nations into broader geographical regions as outlined in Table 1. This classification helps to contextualize the diverse cultural and social dynamics within each American Nation. Specifically, the Regions factor groups these nations into the following categories: Northeastern and Midwestern Nations – which for the purposes of testing the second hypothesis – are labeled as Dignity Culture, Southern Nations are labeled as Honor Culture, and remaining regions including the Western and Small Nations. This regional classification reflects the historical and cultural contexts that shape the wellbeing outcomes within these distinct areas.

The Racial Diversity (Entropy Index) was computed from demographic data detailing the racial composition within multiple MSAs in the United States. This process involved converting racial percentages into proportions. The racial composition was calculated proportionally, reflecting the distribution of Non-Hispanic Whites, Blacks, Hispanics, Asians, and others within each MSA. For the Entropy Index, we then utilized Shannon’s entropy formula [51]. The entropy index is a measure of uncertainty or randomness in the racial distribution within an MSA, with higher values indicating greater diversity (more even distribution across racial groups) and lower values suggesting less diversity (dominance by one or a few groups). This index provides a nuanced understanding of racial diversity, facilitating comparative analyses across different urban settings and offering insights into the dynamics of racial composition.

The Education Index was derived by first converting survey response percentages into numeric values. Educational categories were assigned specific values reflective of their perceived educational duration: “High school or less” was given a value of 3, “Some college” a value of 6, “College graduate” a value of 9, and “Post graduate” a value of 14, as representative of the years put towards educational attainment. These values were then aggregated, providing a composite score that quantified educational attainment for each observation in the dataset.

The Political Party Continuum serves as a quantitative measure to assess the relative balance between conservative and liberal political orientations within MSAs or regional contexts. This index typically ranges from negative to positive, with negative values indicating a conservative-leaning sentiment and positive values reflecting a liberal-leaning sentiment (where zero equals perfectly moderate political orientation). The index provides insight into the predominant political affiliation within the region and the intensity of these leanings, with higher positive values suggesting a more pronounced liberal-leaning population and lower values indicating a stronger conservative orientation. For example, the presence of a significant number of independents would moderate the index, resulting in a more balanced or centrist political landscape.

A measure of Religious Diversity was calculated by synthesizing data which detailed religious affiliations across various geographic regions. This process involved converting percentage representations of religious affiliations into numeric values and applying a custom function to calculate the entropy index. The index measures the diversity and distribution of religious affiliations, with higher values indicating greater diversity (more even distribution among different religious categories) and lower values suggesting lower diversity (dominance by one or a few categories).

The Income Index was developed to provide a comprehensive ordinal measure of income distribution. Each income bracket was assigned an ordinal value: < $3,000 per month = 1, $3,000 – < $7,500 per month = 2, and $7,500+ per month = 3. Percentages for each income bracket were converted to proportions and used to compute the ordinal index through a weighted summation approach. This index captures the distribution of income within the dataset and serves as a nuanced metric for examining income effects in quantitative analyses. Population Data reflects the average number of respondents for wellness surveys per MSA, providing a proxy for MSA population size. Religious Importance was measured by the proportion of respondents who indicated that religion is important to them. This variable was derived from responses categorized as “yes,” “no,” or “don’t know (DK).”

Modeling

To assess the predictors of the five response variables—Physical, Social, Financial, Community, and Purpose wellbeing—within the American Nations Model, where the American Nations (or regions) served as the factor of analysis, we employed a linear model in R 4.4.0 [68]. To normalize response variables, all continuous variables were scaled. Statistical inferences were made using a combination of standardized coefficients, confidence intervals, and p-values.

For Hypothesis 1, our primary factor of analysis was the fixed effects of American nations. The American nation of Yankeedom was used as the reference category, serving as the point of comparison for other groups in the statistical analysis. Consequently, estimates for each population represent predicted differences in wellness response counts compared to this reference sample. To explicitly assess whether cultural regions differentially influence traditional versus existential well‐being, we conducted a within‐subjects linear mixed‐effects analysis. In this framework, the two wellness indices (Traditional and Existential) were concatenated into a single outcome variable, accompanied by a binary indicator for wellness type. The model included fixed effects for wellness type, American Nation, and their interaction—thereby testing whether the effect of each nation on well‐being depends on whether one considers material (traditional) or meaning‐oriented (existential) dimensions—while controlling for education and income. A random intercept for each metropolitan area accounted for non‐independence of observations. For hypothesis 2, our primary factor of analysis was the fixed effects of American nations grouped into Regions (see Table 1). The Dignity culture of the Northeastern and Midwestern nations is the reference group. For hypothesis 3, we performed a linear mixed-effects model where MSA was a repeated measure. Our primary factor of analysis was the fixed effects of American nations and Racial demographics, while controlling for Income.

Model fitting was performed to assess multicollinearity. The correlation matrix highlighted significant associations among key variables in the wellbeing assessment. Political orientation and Religious diversity showed a strong positive correlation (r = 0.71), while Racial diversity had a moderate positive correlation with Political orientation (r = 0.35). Education and MSA population size exhibited a weaker correlation (r = 0.28). Variance Inflation Factors (VIF) were computed to assess multicollinearity among predictors in each Wellness Index regression model. The American Nations displayed a high GVIF of 8.996, indicating substantial multicollinearity among its categories, suggesting overlapping effects on the wellness index. Religious diversity and Religious importance also showed high GVIF values around 7. To address these concerns, religious importance was removed from the final model, and the Racial diversity was excluded to focus on race (categories) in subsequent analyses. With these adjustments, no remaining predictors exhibited high GVIF values, enhancing the model’s stability and interpretability. This underscores the American Nations Model’s robustness in predicting wellness.

The models to test hypothesis 1 were specified as follows:

1. Model 0: Wellness response ~ American Nations Wellness
2. Model 1: Wellness response ~ Wellness type * American Nation + EducationIndex + IncomeIndex + (1 | MSA)
3. Model 2: Wellness response ~ Racial diversity + Political orientation + Education + Religious Diversity + Income

The models to test hypothesis 2 were specified as follows:

1. Model 3: Wellness response ~ Region Wellness
2. Model 4: Wellness response ~ Racial diversity + Political orientation + Education + Religious Diversity + Income

The models to test hypothesis 3 were specified as follows:

1. Model 5: Wellness response ~ Racial demographic + Income + Region + (1 | MSA)

The full dataset, along with all meta-data and detailed descriptions of each variable, is available in the Open Science Framework (OSF) data repository: https://osf.io/jxsz8/?viewonly=968233c39a594d14bed3f201b24ec0f8.

Hypothesis 1

Model 0 regression analysis for the Traditional Wellness Index reveals significant and nuanced relationships between American Nations and wellness outcomes. The within‐subjects mixed‐effects model revealed a significant interaction between wellness type and American Nation (χ²₁₀ = 77.99, p < .001), indicating that the balance of traditional versus existential well‐being varies markedly by nation. Pairwise contrasts showed that in Yankeedom, traditional well‐being significantly exceeded existential well‐being (β ± SE = 0.845 ± 0.176, 95% CI [0.500, 1.190], t₁₂₁ = 4.80, p < .0001), whereas in the Deep South, existential well‐being surpassed traditional by 0.459 ± 0.176 (95% CI [–0.803, –0.115], t₁₂₁ = –2.61, p = .010). Greater Appalachia exhibited the largest reversal, with existential exceeding traditional by 0.999 ± 0.191 (95% CI [–1.374, –0.624], t₁₂₁ = –5.24, p < .0001). The Left Coast also showed higher traditional scores relative to existential (β ± SE = 0.704 ± 0.321, 95% CI [0.077, 1.331], t₁₂₁ = 2.19, p = .030). In contrast, El Norte, the Far West, the Midlands, New France, New Netherland, the Spanish Caribbean, and Tidewater did not exhibit significant differences (all p > .05) (Fig 2).

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Fig 2. Within‐Nation Mixed‐Effects Model.

Nation‐specific contrasts with 95% confidence intervals. This pattern indicates that several American Nations—particularly those with honor‐based or frontier legacies—display proportionally greater existential versus traditional wellness compared to Yankeedom, highlighting nation‐specific tradeoffs.

https://doi.org/10.1371/journal.pone.0327972.g002

Notably, the Greater Polynesia (GP) shows a significant positive effect on traditional wellness (β ± SE = 2.271 ± 0.911, CI = 0.474 to 4.068, p = 0.014), suggesting higher wellness compared to the reference category, Yankeedom (YK). Conversely, Greater Appalachia (GA) has a significant negative association with traditional wellness (β ± SE = −0.987 ± 0.293, CI = −1.569 to −0.405, p = 0.001), indicating lower traditional wellness in this region. The Deep South (DS) also approaches significance with a negative effect (β ± SE = −0.547 ± 0.281, CI = −1.103 to 0.009, p = 0.055). Other regions such as El Norte (EN), Far West (FW), and the Left Coast (LC) do not show significant differences from Yankeedom in terms of traditional wellness (Fig 3). Overall, this model highlights the variability in traditional wellness across different American Nations, underscoring the influence of regional cultural and historical contexts. The regression analysis for the Existential Wellness Index highlights several significant predictors among the American Nations and other variables. The Deep South (DS) demonstrates a positive effect on existential wellness (β ± SE = 0.792 ± 0.350, CI = 0.100 to 1.484, p = 0.026), indicating higher wellness compared to the reference category, Yankeedom (YK). El Norte (EN) shows a highly significant positive effect (β ± SE = 1.781 ± 0.375, CI = 1.035 to 2.527, p < 0.001), suggesting that individuals in this region report higher existential wellness. The Far West (FW) also exhibits a significant positive association (β ± SE = 0.938 ± 0.349, CI = 0.245 to 1.631, p = 0.009), as does Greater Appalachia (GA) (β ± SE = 0.749 ± 0.327, CI = 0.099 to 1.399, p = 0.024). The Spanish Caribbean (SC) stands out with a notably high positive effect on existential wellness (β ± SE = 2.096 ± 0.651, CI = 0.803 to 3.389, p = 0.002) (Fig 3).

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Fig 3. Fixed Effects Plot for Drivers of Traditional and Existential Wellness: This figure displays fixed effects estimates from a linear model, showing the influence of various factors on traditional wellness (top) and existential wellness (bottom) across the American Nations.

The results indicate that regions like Greater Polynesia and Spanish Caribbean exhibit higher traditional wellness, while regions like the Deep South and El Norte show elevated existential wellness.

https://doi.org/10.1371/journal.pone.0327972.g003

In Fig 4, the Model 1 regression analysis examining the Traditional Wellness Index using the American Nations Model reveals several key insights. The coefficient for the Spanish Caribbean (AN: SC) is significant and positive (β ± SE = 1.305 ± 0.636, CI = 0.056 to 2.555, p = 0.043), indicating that individuals in this region report higher traditional wellness compared to the reference category, Yankeedom. Conversely, the coefficient for the Deep South (AN: DS) is negative and approaches significance (β ± SE = −0.603 ± 0.319, CI = −1.236 to 0.030, p = 0.062), suggesting lower traditional wellness, though the confidence interval includes zero. The Education Index is also a significant positive predictor (β ± SE = 0.371 ± 0.117, CI = 0.140 to 0.602, p = 0.002), indicating that higher education levels are associated with increased traditional wellness. Other predictors, such as the Entropy Index, Political Index, Religion Entropy Index, and Income Index, do not exhibit significant relationships with traditional wellness, as their confidence intervals overlap zero.

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Fig 4. Fixed Effects Plot for Honor vs. Dignity Cultures on Wellness: This figure displays fixed effects estimates from a linear model, comparing the impact of Honor and Dignity cultures on traditional wellness (top) and existential wellness (bottom) across the American Nations.

The analysis reveals that Honor cultures, particularly in the Southern nations, are associated with higher existential wellness, while Dignity cultures in the Northeastern and Midwestern nations show no significant advantage in either wellness dimension.

https://doi.org/10.1371/journal.pone.0327972.g004

In Fig 4, the regression analysis for the Existential Wellness Index using the American Nations Model highlights several significant predictors. The Spanish Caribbean (AN: SC) has a notably positive effect on existential wellness (β ± SE = 2.096 ± 0.651, CI = 0.803 to 3.389, p = 0.002), indicating higher wellness compared to the reference category, Yankeedom. Similarly, El Norte (AN: EN) shows a significant positive effect (β ± SE = 1.781 ± 0.375, CI = 1.035 to 2.527, p < 0.001), suggesting that individuals in this region report higher existential wellness. Other regions, including the Far West (AN: FW), Deep South (AN: DS), and Greater Appalachia (AN: GA), also demonstrate positive and significant associations with existential wellness. However, the coefficients for factors like Entropy Index, Political Index, Religion Entropy Index, and Income Index are not significant, indicating no substantial effect on existential wellness. The Education Index is a significant positive predictor (β ± SE = 0.505 ± 0.120, CI = 0.267 to 0.743, p < 0.001), underscoring the role of education in enhancing existential wellness.

Hypothesis 2

The regression for the regional analysis of the Traditional Wellness Index identifies significant and non-significant predictors related to different regions (Table 2). The model explains about 36% of the variance in traditional wellness (R-squared = 0.359) and has a significant overall fit (F(8, 100) = 6.993, p < 0.001). The Education Index stands out as a significant positive predictor (β ± SE = 0.403 ± 0.117, CI = 0.171 to 0.634, p = 0.001), indicating higher education levels are associated with increased traditional wellness. However, other predictors, where groups of nations compared against the Northeastern and Midwestern Nations, such as the Southern region (β ± SE = −0.214 ± 0.227, CI = −0.664 to 0.236, p = 0.348), Western region (β ± SE = 0.365 ± 0.228, CI = −0.087 to 0.818, p = 0.112), and Small regions (β ± SE = 1.305 ± 0.620, CI = 0.073 to 2.538, p = 0.038), do not show significant effects on traditional wellness. Additionally, variables such as Entropy Index (β ± SE = −0.007 ± 0.100, CI = −0.205 to 0.191, p = 0.947), Political Index (β ± SE = −0.045 ± 0.118, CI = −0.278 to 0.188, p = 0.704), Religious Entropy Index (β ± SE = 0.121 ± 0.130, CI = −0.137 to 0.379, p = 0.352), and Income Index (β ± SE = 0.059 ± 0.098, CI = −0.135 to 0.253, p = 0.549) also do not show significant associations with traditional wellness.

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Table 2. Linear regression model summary for the regional comparison of the Traditional Wellness Index. The model includes the predictors: Region (with Northeastern and Midwestern nations as the reference category). The table presents the estimated coefficients, standard errors (S.E.), 95% confidence intervals, and p-values for each predictor.

https://doi.org/10.1371/journal.pone.0327972.t002

The regression for regional analysis of the Existential Wellness Index reveals several significant predictors among the regions of nations (Table 3). The model explains about 36% of the variance in existential wellness (R-squared = 0.358) and has a significant overall fit (F(8, 100) = 6.963, p < 0.001). The Southern region Honor Cultures (β ± SE = 0.590 ± 0.229, CI = 0.137 to 1.043, p = 0.011) and the Western region (β ± SE = 1.048 ± 0.230, CI = 0.594 to 1.502, p < 0.001) show positive associations with existential wellness indicating higher existential wellness in these regions compared to the reference category of the Northeastern and Midwestern nations associated with Dignity Cultures. The Small regions also exhibit a significant positive effect (β ± SE = 1.901 ± 0.625, CI = 0.663 to 3.139, p = 0.003). Education is a significant positive predictor (β ± SE = 0.517 ± 0.118, CI = 0.284 to 0.751, p < 0.001), highlighting the importance of education in enhancing existential wellness. Political orientation exhibits a marginally significant negative effect (β ± SE = −0.229 ± 0.119, CI = −0.464 to 0.005, p = 0.057), suggesting that increased political conservatism correlates with lower existential wellness. Variables such as Entropy Index (β ± SE = −0.107 ± 0.101, CI = −0.307 to 0.093, p = 0.289), Religious Entropy Index (β ± SE = −0.254 ± 0.131, CI = −0.513 to 0.005, p = 0.055), and Income Index (β ± SE = −0.058 ± 0.099, CI = −0.254 to 0.138, p = 0.562) do not show significant associations with existential wellness.

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Table 3. Linear regression model summary for the regional comparison of the Existential Wellness Index. The model includes the predictors: Region (with Northeastern and Midwestern nations as the reference category). The table presents the estimated coefficients, standard errors (S.E.), 95% confidence intervals, and p-values for each predictor.

https://doi.org/10.1371/journal.pone.0327972.t003

Hypothesis 3

The linear mixed model analysis assessing traditional wellness included race, region, their interaction, and the income index as predictors, with MSA as a random effect (Fig 5). Black residents exhibited significantly lower traditional wellness compared to White residents (β ± SE = −1.745 ± 0.399, p < 0.001). However, the interactions between race and region did not reveal substantial differences. The interaction between Black race and the Southern region was positive but not statistically significant (β ± SE = 0.760 ± 0.500, p = 0.131), suggesting no significant regional mitigation of racial disparities in traditional wellness. Interestingly, Hispanic residents in the Western region showed a significant positive interaction effect, indicating higher traditional wellness in this group compared to their counterparts in other regions (β ± SE = 1.154 ± 0.562, p = 0.044).

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Fig 5. Fixed Effects Plot for Racial Disparities in Wellness: This figure illustrates the fixed effects estimates from a linear mixed effects model, highlighting the influence of race on traditional wellness (top) and existential wellness (bottom) across the American Nations. The analysis reveals significant disparities, with Black residents generally reporting lower wellness levels. However, regional interactions indicate that Black and Hispanic residents in Southern and Small Nations experience relatively higher existential wellness, challenging the expected regional disparities.

https://doi.org/10.1371/journal.pone.0327972.g005

The Small nations region exhibited an overall positive effect on traditional wellness (β ± SE = 1.493 ± 0.470, p = 0.002), suggesting that residents in these areas, regardless of race, experience higher traditional wellness compared to the reference region. The income index remained a significant positive predictor of traditional wellness (β ± SE = 0.646 ± 0.114, p < 0.001), underscoring the critical role of economic stability in overall wellbeing. These results suggest that, after controlling for income, regional cultural factors, whether Honor versus Dignity cultures, do not significantly drive differences in wellness among racial groups within their respective regions, except for the noted positive effect in the Western region for Hispanics and the generally higher wellness in the Small nations. The linear mixed model analysis assessing the Existential Wellness Index offered detailed insights into the Minority Identity Disparity hypothesis. The model included race, region, their interaction, and the income index as predictors, with MSA as a random effect. Black residents exhibited significantly lower existential wellness compared to White residents (β ± SE = −2.541 ± 0.381, p < 0.001). Notably, the interaction between Black race and the Southern region showed a significant positive effect (β ± SE = 1.864 ± 0.408, p < 0.001), suggesting that Black residents in the Southern nations experience higher existential wellness compared to those in the Northeastern and Midwestern nations. Similarly, the interaction for Hispanic residents in the Southern region was also significant (β ± SE = 1.630 ± 0.492, p = 0.001), indicating that Hispanics in the Southern nations report better existential wellness compared to their counterparts in the Northeastern and Midwestern regions. Additionally, Black residents in the Small nations region showed a significant positive interaction, reflecting higher existential wellness in these areas (β ± SE = 1.447 ± 0.651, p = 0.027). Interactions for Hispanic and Black residents in the Western region were positive but did not reach statistical significance. Interestingly, the income index was not a significant predictor of existential wellness (β ± SE = 0.001 ± 0.125, p = 0.998), highlighting the prominent role of regional and cultural factors over economic stability in shaping existential wellness outcomes.