The Proximate Causes of Waorani Warfare.

In response to recent work on the nature of human aggression, and to shed light on the proximate, as opposed to ultimate, causes of tribal warfare, we present a record of events leading to a fatal Waorani raid on a family from another tribe, followed by a detailed first-person observation of the behavior of the raiders as they prepared themselves for war, and upon their return. We contrast this attack with other Waorani aggressions and speculate on evidence regarding their hormonal underpinnings. On-the-ground ethnographic observations are examined in light of the neuroendocrinological literature. The evidence suggests a chain of causality in launching lethal violence, beginning with a perceived injury, culminating in a massacre, and terminating in rejoicing. Although no blood or saliva samples were taken at the time of this raid, the behaviors were consistent with a deliberate initiation of the hormonal cascade characterizing the "fight-or-flight" response, along with other hormonal changes. We conclude with observations on the stratified interrelationships of the cognitive, social, emotional, and neuroendocrinological causes of aggression leading to coalitional male homicide.

Bands of brothers and in-laws: Waorani warfare, marriage and alliance formation.

The root of modern human warfare lies in the lethal coalitionary violence of males in small-scale societies. However, there is a paucity of quantitative data concerning the form and function of coalitionary violence in this setting. Debates exist over how lethal coalitions are constituted, as well as the motivations and benefits for males to join such groups. Data from a lowland Amazonian population, the Waorani of Ecuador, illuminate three issues: (i) the degree to which raiding parties are composed of groups of fraternal kin as opposed to strategic alliances of actual or potential affinal kin; (ii) the extent to which individuals use pre-existing affinal ties to motivate others to participate in war or leverage warfare as a mechanism to create such ties; and (iii) the extent to which participation in raiding is driven by rewards associated with future marriage opportunities. Analyses demonstrate that Waorani raiding parties were composed of a mix of males who were potential affines, actual affines and fraternal kin, suggesting that men used pre-existing genetic, lineal and social kin ties for recruiting raid partners and used raiding as a venue to create novel social relationships. Furthermore, analyses demonstrate that males leveraged raiding alliances to achieve marriage opportunities for themselves as well as for their children. Overall, it appears that a complex set of motivations involving individual rewards, kin marriage opportunities, subtle coercion and the assessment of alliance strength promote violent intergroup conflict among the Waorani. These findings illustrate the complex inter-relationships among kin selection, coalition building and mating success in our species.

A culture of future planning: perceptions of sexual risk among educated young adults.

In this study we examined how social processes, specifically the acquisition of postsecondary education and capital, shaped perceptions of sexual risk and impacted sexual practices and sexual health among young adults. Using qualitative research methods we collected and analyzed data among students attending a 4-year university in the northeastern region of the United States over a 1-year period. By analyzing participants' narratives, we found that the reproduction of shared norms and values encouraged educated young adults to focus on educational and professional success, pressing many of them to be concerned about preventing pregnancy rather than preventing disease transmission, and increasing their risk for sexually transmitted infections, including HIV/AIDS. Sexual-health educators need to address how social processes shape sexual practices, encourage educated young adults to challenge unequal gender expectations, and consider how sexually transmitted infections might also interfere with life plans.

The social context and meaning of virginity loss among African American and Puerto Rican young adults in Hartford.

We describe virginity loss experiences of inner-city minority youth to understand the meaning attributed to first sex and the social and structural factors that contribute to early sexual debut. We interviewed 62 18-25-year-old African American and Puerto Rican Hartford men and women about their sexual and romantic life histories. Transcripts were coded in ATLAS.ti and analyzed for themes about virginity and sexual debut. We found different conceptions of virginity as a stigma to be lost, a normal part of growing up, and a gift to be given. The normative experience was consensual, early, and unplanned sexual debut. Inner-city minority youth have similar feelings, motivations, and experiences of sexual debut as non-ethnic youth reported in the literature except they are far younger. We discuss structural factors that affect inner-city sexual scripts for early sexual debut and identify it as a health inequity.

Condom use with serious and casual heterosexual partners: findings from a community venue-based survey of young adults.

Given the racial/ethnic disparities that characterize STI trends and recent increases in heterosexually transmitted HIV infection in the US, an understanding of factors underlying condom use among young adults in minority communities is vitally important. To this end, this paper presents findings from a community venue-based survey examining the influence of motivations, heuristics, and relationship factors on condom behaviors with serious and casual heterosexual partners in a sample of urban African American and Puerto Rican males and females ages 18-25 (n = 380). Condom use rates at time of last sex were considerably higher with casual partners (n = 87) than with serious (n = 313) partners, 77.9% vs. 38.7%. While dual pregnancy/STI prevention was the most frequently cited reason for use at last sex with casual partners, pregnancy prevention was the most frequently cited reason for use with serious partners. Bivariate conditional logistic regression analyses found two factors to be associated with condom use at last sex with casual partners: use at first sex with the partner and belief that neighborhood peers worried some/a lot about HIV. In contrast, such factors as condom heuristics (e.g., nonuse symbolizes trust), contraceptive status, and markers of emotional intimacy were associated with condom use with serious partners in both bivariate and multivariable analyses.

A cultural model of infidelity among African American and Puerto Rican young adults.

Having concurrent sexual partners is a risk factor for STIs and HIV/AIDS, yet few studies have investigated the cultural meanings and functions of concurrency. A multi-method qualitative/quantitative study of sexual ideas, attitudes, and behaviors among inner-city Puerto Rican and African American emergent adults (age 18-25) in Hartford, Connecticut, USA, suggests that having concurrent partners is common in this population. Using data from 12 focus groups and 40 participants in systematic data collection techniques (e.g., pile sorts), the underlying cognitive structure of concurrency and cheating/infidelity are explored. Results suggest that participants are less tolerant of multiple partners in more committed relationships, but that very few relationships can be considered committed. Furthermore, participants see cheating as inevitable even in committed relationships. Sexual transgressions are considered the most severe form of cheating. Having an outside partner for emotional reasons or to have access to one's child were seen as more acceptable/forgivable than doing so for sexual satisfaction, social status or material goods. Multiple partnerships must be seen in the context of the inner city where resources and opportunities are scarce and young adults attempt to protect themselves from emotional injury. Documenting new and changing social constructions of infidelity is important for understanding the social context of sexual behavior in our global world and for designing culturally appropriate health interventions.

Long-term Lyme disease antibiotic therapy beliefs among New England residents.

Most physicians prescribe Lyme disease antibiotic therapy regimens that are recommended by the Centers for Disease Control and Prevention, the Infectious Disease Society of America, and the National Institutes of Health. An alternative approach by some physicians consists of prolonged antibiotic treatment for >2 months because they believe that Lyme disease often results in persistent Borrelia burgdorferi infection. Understanding how patients perceive the disease is important for effective doctor-patient communication. We conducted interviews and surveys on Block Island, Rhode Island, and Storrs, Connecticut, to explore the public perception of persistent symptoms following Lyme disease and the need for long-term treatment. Most of our participants believed that symptoms and the Lyme disease bacteria can persist after antimicrobial therapy for Lyme disease. When asked about the value of continuing antibiotic treatment for >2 months, about half thought that it was sometimes useful and about a quarter thought it was always useful. Almost all of the respondents stated that they knew people who had experienced Lyme disease, and these personal observations were more frequently cited as an important source of Lyme disease information than official sources such as medical professionals. We conclude that healthcare workers should review the scientific literature regarding appropriate therapy for Lyme disease, discuss such information with their patients, and identify sources of information that their patients can review. Medical societies, private foundations, and State and Federal Health agencies should increase efforts to educate physicians and the general public about the standard diagnosis and treatment of Lyme disease and provide additional funding to determine why some people experience persistent symptoms following this infection.

"And let me see them damn papers!" The role of STI/AIDS screening among urban African American and Puerto Rican youth in the transition to sex without a condom.

Common strategies employed in preventing STI/AIDS transmission among young adults in America include abstinence, monogamy and safer sex. These strategies require a high level of vigilance and responsibility and, according to inner city participants in Project PHRESH.comm, neither option is always desirable, available, or rational in the context of their lived experiences. This article reports findings from Project PHRESH.comm, a mixed-method, ethnographic study incorporating data from focus group discussions, semi-structured interviews, coital diaries, systematic cultural assessments and a structured survey designed to explore concepts of risk and decision making about condom use among at risk African American and Puerto Rican young adults aged 18-25 years in Hartford, CT. We found that many young adults from our study population rely on a strategy of using clinic-sponsored STI/AIDS screening when wanting to discontinue condom use with a partner. While our data suggest that screening is a common strategy used by many couples to transition to having sex without a condom, the data also show that most youth do not maintain monogamy even in long-term, serious relationships. Thus, sharing test results may provide a false sense of security in the sexual culture of inner city, minority youth.

Ceremonial tobacco use in the Andes: implications for smoking prevention among indigenous youth.

The purpose of this study was to identify Andean youth's beliefs regarding ceremonial tobacco use and to discuss potential applications of findings in tobacco control interventions. The study was conducted in the Province of Jujuy, Argentina among 202 boys and girls, 10 to 20 years of age, living in rural and urban areas. The world of beliefs and meanings became accessible by asking youth to focus on tangible experiences regarding the Pachamama ceremony, a ritual honoring Mother Earth. Concepts such as reciprocity, the unity of material and spiritual realms, and the complementary nature of opposite forces were linked to beliefs about ceremonial tobacco use. Three domains for understanding smoking behaviour beliefs and norms were identified including mechanisms of production, conceptual tenants and behavioural expressions. These findings suggest that tobacco control interventions based on solidarity, reciprocity, and non-rational ways of learning are more culturally appropriate for native populations in the Andes than the current individual behaviour change models and have the potential applications with other indigenous populations. The research methods also have the potential for generalized application in cross-cultural studies of health behaviours in understudied populations in middle and low-income countries.

Life histories, blood revenge, and reproductive success among the Waorani of Ecuador.

The Waorani may have the highest rate of homicide of any society known to anthropology. We interviewed 121 Waorani elders of both sexes to obtain genealogical information and recollections of raids in which they and their relatives participated. We also obtained complete raiding histories of 95 warriors. An analysis of the raiding histories, marital trajectories, and reproductive histories of these men reveals that more aggressive warriors have lower indices of reproductive success than their milder brethren. This result contrasts the findings of Chagnon [Chagnon N (1988) Science 239:985-992] for the Yanomamo. We suggest that the spacing of revenge raids may be involved in the explanation of why the consequences of aggressiveness differ between these 2 warlike lowland South American peoples.

Syndemics, sex and the city: understanding sexually transmitted diseases in social and cultural context.

This paper employs syndemics theory to explain high rates of sexually transmitted disease among inner city African American and Puerto Rican heterosexual young adults in Hartford, CT, USA. Syndemic theory helps to elucidate the tendency for multiple co-terminus and interacting epidemics to develop under conditions of health and social disparity. Based on enhanced focus group and in-depth interview data, the paper argues that respondents employed a cultural logic of risk assessment which put them at high risk for STD infection. This cultural logic was shaped by their experiences of growing up in the inner city which included: coming of age in an impoverished family, living in a broken home, experiencing domestic violence, limited expectations of the future, limited exposure to positive role models, lack of expectation of the dependency of others, and fear of intimacy.

Barriers to breast abnormality follow-up: minority, low-income patients' and their providers' view.

Little is known about the factors associated with delayed or incomplete adherence to recommendations for follow-up when breast abnormalities are seen in minority women. This study examines barriers to follow-up in a cohort of predominantly minority women, with input from providers, using quantitative and qualitative methods. We conducted telephone interviews with 535 women and inperson, unstructured interviews with 31 providers from three medical facilities in the Los Angeles area. Most patient respondents were <50 years old (59.6%), Latina (84.2%), and unmarried (60.9%); half (49.1%) had six or fewer years of education, and most were foreign-born (83.4%). Data from patient and provider groups identified race/ethnicity, country of birth, financial issues, fear of pain, and difficulty navigating the healthcare system as barriers to follow-up, though certain provider-identified barriers did predict adherence among women. System barriers, not individual patient characteristics, were more salient factors in the follow-up of breast abnormalities.

Should a mucoadhesive patch (DentiPatch) be used for gingival anesthesia in children?

A local anesthetic-impregnated mucosal adhesive patch (DentiPatch) was compared with topical anesthetic (Hurricaine Dry Handle Swab) for gingival anesthesia before rubber dam clamp placement in children. Twenty-eight children needing sealants on their posterior teeth were enrolled in this study. Topical anesthesia was provided using either the mucoadhesive patch (20% lidocaine) or topical anesthetic (20% benzocaine). Subjects were randomized using a split mouth model. Either the patch or topical anesthetic was applied to the gingiva for 5 minutes or 1 minute, respectively. Subjects used a visual analog scale to describe their pain during the procedure. Linear regression and mixed linear models were used for data analysis. The visual analog scale results (pain scores) showed no significant difference between treatments. The mean per-child patch-sticking fraction was 29.7%. Patch adherence to oral mucosa increased with age in girls (P = .0045), but not in boys. The DentiPatch is as effective as, although not superior to, the Hurricaine Dry Handle Swab for gingival anesthesia before rubber dam clamp placement in children. These study results would not support the use of the DentiPatch for gingival anesthesia in children because of poor adherence to oral mucosa and the extra time necessary to apply and retain the device.