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In societies that have been historically stratified by class, interclass communication is frequently hampered by behaviors of higher status people that lower status people interpret as denigrating. To escape what they perceive as denigration, lower status people may attempt to avoid interclass interaction, and, when it is unavoidable, adopt such strategies as not making direct eye contact, saying very little except what they think the higher status people want to hear (including flattery), and using a lower status peer as an intermediary. Such behavioral patterns have important implications for the design of health services programs.

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