Characterizing patterns of seasonal drought stress for use in common bean breeding in East Africa under present and future climates.

Common bean (Phaseolus vulgaris L.) is the second most important source of dietary protein and the third most important source of calories in Africa, especially for the poor. In East Africa, drought is an important constraint to bean production. Therefore, breeding programs in East Africa have been trying to develop drought resistant varieties of common bean. To do this, breeders need information about seasonal drought stress patterns including their onset, intensity, and duration in the target area of the breeding program, so that they can mimic this pattern during field trials. Using the Decision Support for Agrotechnology Transfer (DSSAT) v4.7 model together with historical and future (Coupled Model Inter-comparison Project 6, CMIP6) climate data, this study categorized Ethiopia, Tanzania, and Uganda into different target population of environments (TPEs) based on historical and future seasonal drought stress patterns. We find that stress-free conditions generally dominate across the three countries under historical conditions (50-80% frequency). These conditions are projected to increase in frequency in Ethiopia by 2-10% but the converse is true for Tanzania (2-8% reduction) and Uganda (17-20% reduction) by 2050 depending on the Shared Socioeconomic Pathway (SSP). Accordingly, by 2050, terminal drought stresses of various intensities (moderate, severe, extreme) are prevalent in 34% of Uganda, around a quarter of Ethiopia, and 40% of the bean growing environments in Tanzania. The TPEs identified in each country serve as a basis for prioritizing breeding activities in national programs. However, to optimize resource use in international breeding programs to develop genotypes that are resilient to future projected stress patterns, we argue that common bean breeding programs should focus primarily on identifying genotypes with tolerance to severe terminal drought, with co-benefits in relation to adaptation to moderate and extreme terminal drought. Little to no emphasis on heat stress is warranted by 2050s.

A Constituição do Público-Alvo na Política de Educação Especial Brasileira: Movimentos e Disputas no Interior do Estado Integral / The Constitution of the Target Population in the Brazilian Special Education Policy: Movements and Disputes Within the Integral State

RESUMO: Este trabalho objetiva evidenciar os movimentos políticos e sua participação na constituição do público-alvo das políticas de Educação Especial no Brasil. Com os pressupostos do materialismo histórico dialético, compreendem-se a política como relação de forças. Analisaram-se fontes documentais que demarcaram mudanças relativas ao público-alvo, bem como literatura acadêmica. Apoiadas no conceito de Estado Integral, verificam-se que as instituições privadas e assistenciais, como aparelhos privados, marcaram posição nas definições das políticas de Educação Especial. Ressaltam-se a criação de dois tipos de movimento: de e para pessoas que demandam políticas públicas de Educação Especial - o primeiro representado por instituições privadas e assistenciais; e o segundo, formado pelos próprios sujeitos com condições específicas, cada qual com demandas particulares. Constataram-se que a participação dos movimentos na constituição do público-alvo da Educação Especial acontece em níveis diferentes, com os movimentos de e para pessoas com deficiências adotando a estratégia de participação em cargos públicos na esfera do aparelho de Estado para que seus interesses sejam incorporados às políticas educacionais, evidenciando a articulação das organizações da sociedade civil como elemento constituidor do Estado Integral. Por fim, destacam-se a forma de atuação política fragmentária dos movimentos com vistas a demandas específicas.

ABSTRACT: This paper aims to highlight the political movements and their participation in the constitution of the target population of the policies of Special Education in Brazil. With the assumptions of dialectical historical materialism, we understand the policy as a relation of forces. Thus, we analyzed documentary sources that marked changes related to the target population, as well as academic literature. Supported by the concept of Integral State, we verified that private and welfare institutions, as private apparatus, marked their position in the definitions of Special Education policies. We emphasize the creation of two types of movement: of and for people who demand Special Education public policies - the first represented by private and welfare institutions; and the second, formed by the subjects themselves with specific conditions, each with particular demands. We noted that the participation of movements in the constitution of the target population of Special Education happens at different levels, with movements of and for people with disabilities adopting the strategy of participation in public positions in the State apparatus so that their interests are incorporated into education policies, highlighting the articulation of Civil Society organizations as a constituent element of the Integral State. Finally, we highlight the form of fragmentary political action of the movements with a view to specific demands.

Early Childhood Disadvantage for Sons of Mexican Immigrants: Body Mass Index Across Ages 2-5.

PURPOSE: To distinguish the origins of higher weight status and determine when and why intra- and interracial/ethnic disparities emerge. DESIGN: The study used a longitudinal analysis of the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B). SETTING: The study was conducted in the United States. SUBJECTS: Participants were children of non-Hispanic white mothers and children of U.S.- and foreign-born mothers of Mexican origin from a nationally representative sample of children born in the year 2001 (N ≈ 3700). MEASURES: The Centers for Disease Control and Prevention growth charts determined sex- and age-specific weight status. Covariates were obtained from birth certificate records and parent interviews. ANALYSIS: Frequencies, growth curve trajectories, and ordinary least squares regression examined body mass index (BMI) and obesity across survey waves. RESULTS: Compared to their peers with non-Hispanic white mothers, children of Mexican-heritage mothers have higher average BMI and greater rates of obesity. The BMI of boys with Mexican-born mothers is higher relative to whites and children of U.S.-born Mexican mothers across early childhood, increasing sharply at about age 4.5 years. This divergence is driven by increases in the BMI of boys, as girls do not show the same growth. A number of measures, including descriptors of children's nutritional intake, lifestyle factors, and acculturation, do not explain the increased obesity rates among sons of Mexican mothers. CONCLUSION: Despite favorable perinatal health and weight, Mexican-American sons of foreign-born mothers show disadvantages in BMI that emerge close to the start of kindergarten.

The Role of Physical Activity and Sedentary Behaviors in Explaining the Association Between Acculturation and Obesity Among Mexican-American Adults.

PURPOSE: We investigated associations of acculturation with various types of activity (moderate-vigorous leisure-time physical activity [LTPA], moderate-vigorous work- and transportation-related physical activity, and sedentary activity), and whether these activities mediated the acculturation-obesity association among Mexican-Americans. DESIGN: Cross-sectional. SETTING: National Health and Nutrition Examination Survey (NHANES) 2007-2010. SUBJECTS: Mexican-American NHANES participants aged ≥20 years (n = 1902). MEASURES: Demographic characteristics, physical activity, sedentary behavior, acculturation, and body mass index. ANALYSIS: Multinomial logistic regression was used to estimate associations of acculturation with categories of self-reported activity. Path analysis was used to test whether the activity measures mediated acculturation-obesity associations. RESULTS: In adjusted models, compared to U.S.-born Mexican-Americans, foreign-born Mexican-Americans living in the United States for less than 10 years were significantly less likely to be in the highest LTPA and sedentary activity categories, and more likely to be in the highest total and transportation activity categories. Foreign-born Mexican-Americans living in the United States for 10 years or more were significantly less likely to engage in high sedentary activity but more likely to engage in high transportation activity. Sedentary behavior was the strongest mediator of the acculturation-obesity association, accounting for 40.7% and 57.1% of the total effect of acculturation on obesity among foreign-born Mexican-Americans living in the United States for less than 10 years and for 10 years or more, respectively, compared to U.S.-born Mexican-Americans. CONCLUSION: Reducing sedentary behavior may lower the negative impact of acculturation on obesity.

A physical-cognitive intervention to enhance gait speed in older Mexican adults.

PURPOSE: To test the effects of a physical-cognitive exercise intervention on gait parameters under dual-task conditions in community-dwelling older adults. DESIGN: A repeated-measures quasi-experimental design, with control and exercise groups, was used. SETTING: Study participants consist of a convenience sample recruited from senior citizens' centers in Monterrey, Mexico. SUBJECTS: A total of 143 sedentary participants ages 65 to 92 years per group participated. INTERVENTION: A combined 45- to 60-minute program of physical and cognitive exercises was conducted in three weekly sessions during 12 weeks for the exercise group. Measures . The spatial gait parameters of speed (cm/s), step width, and stride length (cm); and the temporal parameters of single and double support time, cadence (steps per minute), and swing time(s) were measured using the GaitRite. Counting backwards or naming animals represented cognitive performance. ANALYSIS: Two (groups: exercise group vs. control group) by three (time: baseline, week 6, and week 12) repeated-measures multivariate analysis of variance (MANOVA) was applied. RESULTS: Repeated-measures multivariate analysis of variance revealed a significant group effect (Wilks lambda F4,279 = 6.78, p < .001); univariate analysis showed significant differences for gait speed (m/s), stride length, cadence, step width, and double support time. Time-by-group interaction showed significance in gait speed and stride length. CONCLUSION: The exercise group participants showed increased gait speed, cadence, and stride length, and reduced their step width and time spent with both feet on the ground. Walking while simultaneously performing a cognitive task might prepare older adults for competing/interfering demands from their environments. The protective health benefits of this intervention remain to be investigated.

The influence of gender stereotypes on eating habits among Costa Rican adolescents.

PURPOSE: To identify the influence of gender stereotypes on eating habits among Costa Rican adolescents. DESIGN: Qualitative, descriptive research was used in this study. SETTING: Adolescents and parents were recruited from socioeconomically diverse populations in rural and urban areas of San José, Costa Rica. SUBJECTS: Subjects were 92 adolescents (14 to 17 years old) and 48 parents. METHODS: Focus group data were transcribed and entered into the qualitative data analysis software Atlas.ti version 5.0. Analyses were grounded on the social cognitive theory. RESULTS: Five themes emerged from the focus group discussions: (1) Costa Rican adolescents associate the consumption of moderate quantities of healthy foods with femininity and male homosexuality. (2) The consumption of hearty portions of nonhealthy foods was associated with masculinity and male heterosexuality. (3) There is an emerging view that it is acceptable for heterosexual male adolescents to take care of their bodies through healthy eating. (4) Body care among female adolescents is an element of femininity and body image. (5) Parents reinforce their daughters' persistent concern with weight control because they perceive it as feminine behavior. CONCLUSION: Health promoters should be aware of the existing and changing food stereotypes around gender as an avenue for the promotion of healthy eating.

Household food insecurity and dietary intake among Mexican-American women participating in federal food assistance programs.

PURPOSE: To explore the association between food insecurity and dietary intake among Mexican-American women after controlling for sociocultural and economic factors including participation in federal food assistance programs. DESIGN: Cross-sectional. SETTING: Three cities in Texas. SUBJECTS: Seven hundred seven Mexican-American women (26-44 years). MEASURES: Demographics, anthropometrics, acculturation, and food security status were obtained using validated measures. Dietary intake was assessed by a 24-hour dietary food record. ANALYSIS: Logistic regression was used to examine the association between individual and household characteristics on food security status. One-way analysis of covariance tested the association between food security status and dietary intake after adjusting for socio-demographic variables, acculturation, body mass index, participation in federal food assistance programs, and energy intake. RESULTS: About 77% of food-insecure women participated in at least one federal food assistance program. Each additional child in the household increased the odds of being food insecure by 25%. A higher proportion of obese women was found in the food-insecure group. No significant differences in dietary intake were found by food security status. CONCLUSION: Food insecurity did not negatively influence dietary intake independently of women's participation in federal food assistance programs. Food security did not ensure consumption of nutritionally adequate foods. Educational and food assistance programs need to be optimized to facilitate enrollment and improve the nutritional status of this ethnic group, food secure or not.

Using existing health care systems to respond to the AIDS epidemic: research and recommendations for Chile.

Chile is a country with a relatively low prevalence of HIV infection, where successful prevention has the potential to change the future course of the epidemic. A controversial national prevention strategy based upon public education has emerged in response to characterizations of the epidemic as well-dispersed with a growing involvement of heterosexuals. This characterization is not consistent with the observed facts. There is a comparatively well-organized health care system in Santiago that is doing a good job of detecting HIV infection and already has in place the elements of a targeted intervention scheme. Chile should place priority on the use of the existing health care infrastructure for implementing both the traditional public health interventions for sexually transmitted diseases (contact tracing and partner notification) and the AIDS-necessitated strategy of focused counseling and education.

PIP: 93% of the 1016 cumulative AIDS cases reported through June 1994 in Chile have been among men. People aged 20-49 years comprise 85% of cases. The cases are concentrated in the Santiago metropolitan area with a second cluster in the urban sea coast region which includes Valparaiso and Vina-del-Mar. An additional 1627 people have been confirmed HIV seropositive. 86% of AIDS cases are the result of sexual intercourse. Of the 815 adult males diagnosed with AIDS as of the middle of 1994, 58% were homosexual, 24% were bisexual, and 18% were heterosexual. These figures suggested that HIV infection was spreading into the general heterosexual population of the country and prompted the government to implement a mass media HIV/AIDS campaign as the cornerstone of its AIDS prevention plan. However, interview findings suggest that the extent of bisexual- and heterosexual-related HIV transmission reflected in official statistics could be high by as much as 50%. Many men who have sex with men do not identify themselves as homosexual. HIV/AIDS route of infection statistics based upon self-identified sexual categories are therefore inaccurate. The AIDS epidemic in Chile to date is more like the largely homosexual epidemic in San Francisco during the 1980s than that occurring in the countries of the Caribbean or elsewhere with a heterosexual transmission pattern. A highly focused AIDS prevention program effectively slowed the spread of HIV in San Francisco. Rather than continue with the mass media prevention campaign, Chile should use its existing blood donor system combined with partner tracing and case investigation to capture a manageable number of HIV-positive people and identify nascent localized epidemics.

AIDS prevention research in Chile and implications for the United States.

PIP: Chile holds interest for researchers due to the relatively low but increasing prevalence of human immunodeficiency virus (HIV) and existence of an extensive infrastructure for implementing an affordable acquired immunodeficiency syndrome (AIDS) prevention strategy. To facilitate the development of a pragmatic, affordable AIDS intervention plan for Chile, the following data sources were reviewed: mandatory case reporting data collected by the Chilean Ministry of Health, findings of the Chilean version of the World Health Organization AIDS general population survey, studies of the validity of the official HIV transmission classification system used for national planning purposes, interviews with people with AIDS, and a study of HIV testing in Santiago's health care system. By June 1994, 1016 cases of AIDS had been reported and 1627 people had been identified as HIV-positive. 93% of those with AIDS were men; homosexual/bisexual transmission accounted for 66.2% of cases and heterosexual transmission another 19.4%. In-depth interviews with AIDS patients revealed they were a well-defined population subgroup with few linkages to other sectors. This finding calls into question the current government strategy of broad-based mass media campaigns. Preferable would be campaigns that target homosexual men. A strength of the Chilean primary health care system is its effective utilization of nurses. Nurses manage about 1/3 of clinic visits, with no input from physicians, and their involvement in AIDS prevention should be strengthened.^ieng

On the limited utility of KAP-style survey data in the practical epidemiology of AIDS, with reference to the AIDS epidemic in Chile.

Population surveys concerning 'risk behaviours' thought to be related to the AIDS epidemic are many. Nevertheless, unfocused inquiry into diffuse behaviours in undifferentiated populations is not productive in low-seroprevalence populations, especially when the point is to design some form of intervention that might actually avert further infection. This is because of a failure to distinguish conceptually between the relevance of AIDS-related behavioural data for individuals and for populations. An illustration is drawn from the AIDS epidemic in Santiago, Chile, and an alternative perspective, based on extensive interviews with persons with AIDS and a survey of current HIV-surveillance and blood-screening programs, is described.

PIP: The AIDS epidemic and the associated discovery of HIV brought attention to the dearth of knowledge among social scientists about homosexuality, bisexuality, injectable drug use, and other behaviors which may place participating individuals at risk of contracting and/or transmitting HIV. To redress these gaps in their knowledge, researchers have recently tended to gather attitudinal and behavioral data through population-based KAP-style surveys and to make inferences from such data to the current prevalence and future course of the AIDS epidemic. While survey data may help expand our knowledge on the distribution of practices in a variety of populations, it is not clear that they help us understand the epidemiology of AIDS in a given population. The author argues that these unfocused inquiries into diffuse behaviors in undifferentiated populations are not productive in low-seroprevalence populations, especially when the objective is to design interventions to avert further infection. The failure of KAP surveys to distinguish conceptually between the relevance of AIDS-related behavioral data for individuals and for populations makes them fundamentally flawed for such purposes. An illustration of the AIDS epidemic in Santiago, Chile, is used to substantiate this argument and an alternative perspective is presented based upon interviews with people with AIDS and a survey of current HIV-surveillance and blood screening programs. KAP survey findings generally lead to prescriptions for mass behavior modification. Individuals infected with HIV who remain sexually active and their partners should instead be targeted by interventions to change their behavior. This approach would focus on actual social and sexual networks and the true etiology of viral contagion. In closing, the author acknowledges that his proposed approach may unjustly stigmatize or blame certain groups; contribute to a lack of unity in the fight against the virus and jeopardize supportive funding and legislation; and create a false sense of security for individuals not in the targeted risk groups.

Prevention of STDs -- the challenge of changing behaviors.

PIP: STD prevention efforts in Latin America, particularly in the Dominican Republic, have begun to stress the need for behavioral changes. Traditionally, the professional public health community has focused on secondary prevention of STDs -- detection and treatment of the disease in order to prevent complications from developing. But in light of the AIDS epidemic, greater attention has been paid to primary prevention. Hoping to prevent the disease from occurring, primary prevention efforts target high risk groups (prostitutes and their clients and young people) with health education and promotion of behavioral change. Such changes include using condoms, seeking medical care for STDs, and decreasing the number of sex partners. An example of primary prevention programs is the Avancemos Project in the Dominican Republic. Launched in 1989 by the country's Ministry of Health and Family Health International's AIDSTECH Division, the project targets sex workers with several intervention measures. Initially, the Avancemos Project trained 16 sex workers to serve as peer educators to distribute condoms and educational materials. These 16 volunteers have in turn trained more than 300 other peer educators. Among the educational materials distributed by the peer educators are 2 comic books entitled "Martiza's Advice" and "The Triumphs of Maritza." A handsome, well dressed, and street-wise sex worker, the title character in these comic books instructs on a range of issues, including how to negotiate with clients how to use a condom. As those involved with the project attest, the comic books have become extremely popular among the target group, tapping into the women's buried feelings of self-worth.^ieng

Where have all the children gone? PROJIMO.

PIP: Few children now frequent the facilities of PROJIMO, initiated as a rehabilitation program for disabled rural children in Mexico, ever since the organization begun accepting physically disabled and socially troubled young adults. PROJIMO (the Program of Rehabilitation Organized by Disabled Youth of Western Mexico) began in 1981 as a community-based rehabilitation program run by disabled villagers. In its first years of operation, the program served primarily children suffering from disabilities caused by polio or cerebral palsy. PROJIMO quickly gained international recognition and became an inspirational model for similar programs throughout the Third World. But in 1983, PROJIMO took a decision that would transform the character of the organization. That year, after much debate, members agreed to take in Julio, a 15-year-old quadriplegic whose spinal cord injury was the result of an accidental shooting. In taking care of Julio, the team of disabled villagers had to learn an entirely new set of skills: treatment and prevention of pressure sores, the use of catheters, bowel programs, exercise activities, etc. They also had to develop ways of treating Julio's depression, giving him a sense of self-worth. Julio was followed by an influx of other young adults with spinal cord injuries. Many of these young adults came from troubled and violent backgrounds, such as Juan, an orphan who had made his way out of poverty by trafficking drugs. Juan was left paralyzed in a shootout with enemies. The new patrons have scared away PROJIMO's original audience. Parents fear bringing their disabled children to a center frequented by people raised in a culture of violence. The solution appears to be splitting PROJIMO into 2 organizations: one for disabled children and one for socially troubled adults.^ieng

[Profamilia: immense unknown contribution]. / Profamilia: inmenso aporte desconocido.

PIP: In late 1965, when he presented himself to the International Planned Parenthood Federation headquarters in London weeks after founding the Profamilia Foundation, Dr. Fernando Tamayo was an unknown Colombian physician with a mission to modify Colombia's very rapid rate of population growth. Colombia in 1964 has a population of 17.5 million growing at an annual rate of 3.4%. By 1973, the population was 22.9 million and growing at 2.7%. Cultural, religious, and moral obstacles precluded an aggressive family planning campaign, which would have aroused violent resistance. Profamilia personnel worked discreetly but persistently, convinced that they would see few short term results but that their effect would be immense in the long run. Family planning is partly a process of educating families in the health, socioeconomic, and psychological benefits of smaller families. Profamilia has a centralized organization which administers 3 main programs, the clinical program with 40 traditional clinics in major cities and 8 well-accepted male clinics, the sterilization program in clinics and mobile units, and the community-based distribution program which distributes pills, condoms, and IUDs through 3000 community posts under the direction of 120 instructors. Between 1964-90, Colombia's total fertility rate declined from 9.2 to 4.4 in rural areas, from 5.2 to 2.2 in urban areas, and from 7.0 to 2.8 overall. The rate of population growth declined from 3.4 to 1.8%. It has been estimated that over half the decline is due to Profamilia services. The total investment by Profamilia during its history was US $100 million. The average cost of protecting a couple against unwanted pregnancy is US $5.26 per year. Colombia's population is projected to increase from 30 to 54 million between 1985 and 2025 even if the growth rate declines from 1.8% in 1990 to 1.3% in 2025. The most worrisome aspect of the projected growth is its concentration in urban areas, which are already beset by poverty, inadequate basic services, and a limited potential water supply already threatened by deforestation. It is clear that the work of family planning in Colombia is not done and that much remains to be accomplished.^ieng

Incorporating AIDS prevention activities into a family planning organization in Colombia.

Three AIDS prevention activities were incorporated into the services offered by PROFAMILIA in two operations research projects. The activities included: (1) informative talks given both to the general public and to members of target groups by PROFAMILIA's community marketing (CM) program field workers (or instructors); (2) the establishment of condom distribution posts in meeting places of target groups; and (3) mass-media information campaigns on AIDS prevention. Community-based distributors were able to successfully provide information on AIDS to their regular audiences as well as to deliver information and condoms to special target groups without negatively affecting family planning information/education/communication activities and contraceptive sales. A radio campaign that promoted condom use for AIDS prevention did not affect public perceptions about the condom and did not jeopardize PROFAMILIA's image.

PIP: PROFAMILIA, a private family planning agency in Colombia, conducted an operations research (OR) project designed to explore the use of 3 AIDS prevention activities. The 3 activities includes the use family planning workers to deliver informative talks on AIDS, the establishment of condom distribution posts in places frequented by high-risk groups (homosexuals, prostitutes, soldiers, and prison inmates), and the use of mass-media educational campaigns. A total of 59 in June of 1987, the number of reported AIDS cases in Colombia increased to 474 by 1988. Recognizing the lack of activity on AIDS prevention, PROFAMILIA decided to explore education strategies. Some of the questions and concerns included: 1) How much need is there for AIDS and STD information among typical PROFAMILIA clients (mostly women of reproductive age and adolescents)? 2) How much effort would AIDS-related activities demand from field workers? 3) Would these activities disrupt contraceptive sales? 4) Would field workers be accepted by the target groups, and would they be able to convey the message and establish condom distribution posts? And 5) would a mass media campaign be effective? The study revealed that a great demand for AIDS information exists among PROFAMILIA's typical clients, as well as the fact that these services do not disrupt field workers' other activities, including condom sales. Although field workers were able to deliver the information to the target groups, they had difficulty attracting many members of high-risk groups to the informative talks. Furthermore, the sales of condoms at distribution posts were low. But the mass media campaigns were found to be highly effective in disseminating AIDS information.

HIV/AIDS in Mexico.

PIP: The 1st case of the acquired immunodeficiency syndrome (AIDS) in Mexico was found in 1981. By February, 1990 3944 cases were registered. The exact number of cases is unknown. The government AIDS program estimates that at least 26% of AIDS cases are not registered. Around 36.7% are registered in the last stages. It is estimated that there are 6429 cases; 1.2 of the affected people have died. The World Health Organization estimates that there are between 50-100 human immunodeficiency virus (HIV)-infected people for each person with AIDS. Therefore, there should be between 321, 450, and 642,900 people infected with HIV. The figure for people with AIDS should be close to 65,000 by the latter 1.2 of 1992. HIV-infected people should number several hundreds of thousands. The male-female ratio is 7:1. Transmission of AIDS through blood and blood products accounts for about 17.5% of the total cases. 69.7% of the 468 women's registered cases are associated with blood transfusions. Preventive campaigns should be stepped up. The recent government campaign on the Mexico City underground has not been successful. There is a need for more involvement from the public sector and intersectorial coordination. However, there is a funding problem.^ieng

"Integration"--finding the way in Belize.

PIP: This paper highlights the challenges involved in integrating AIDS control programs into existing health care services. The Belize Red Cross Association has integrated its AIDS control program into its extensive child survival programs in Belize. The program involved training of volunteers who would provide AIDS related information at the household level. Trained traditional birth attendant and community leaders were also well represented in the program. On evaluation of the year's field experience, it was concluded that integration had worked, since a large percentage of the target population used condoms and 74% of the female population sought it as their responsibility to initiate the use of condoms. The success of this project was primarily attributed to the determination of the participants, and to the fact that the existing health services had already established a target population which was accessible to the health workers.^ieng

Gente Joven: a community program for Mexico's young people.

PIP: Mexfam, the Mexican Foundation for Family Planning, came to the conclusion that for family planning programs to succeed, the emphasis had to be shifted from adults to young people. The 1st community youth program, Gente Joven, began operations in 1985 in San Berabe, a very poor community south of Mexico City. Mexfam established the age group of 11-20 as the target group and adopted the slogan "It is not safe for you to have children before the age of 20." This message was aimed at the poor sector, about 70% of the population of Mexico. A long-term goal is for the sex education program to reach every young boy and girl between the ages of 11 and 12. It should cover the topics of 1) communication between family members, 2) whether or not to have sex before marriage, 3) the anatomy and physiology of female and male sex organs, 4) sexually transmitted diseases, and 5) contraceptive methods. Films on communication between family members, early sexual relations, male and female sex roles, and juvenile drug addiction were produced. Case studies on Mexfam's programs in Colima and Armeria are described, as are educational materials including drama and rock. A brief history of Mexfam is also include.^ieng

[The preoccupation with goals]. / La preocupacion por las metas

PIP: Contraception has become the principle factor in Mexico's fertility drop during the past 15 years. Between 1976-82, 47.7% of married women in the population used contraception. The national policy established a growth rate of 1.9% for 1988 implying a global fertility rate of 3.1, with a 58% utilization rate; results of the 1987 Demographic and Health Survey demonstrated that Mexico achieved a fertility rate of 3.8 and a 52.7% utilization rate. In Mexico fertility is perceived as the key variable that can change the demographic profile of the country with family planning as the means of changing people's value systems and controlling the growth of the population. In Mexico, regional characteristics determine the number of children couples decide to have. There are 4 groups of behavior: 1) the Northeast (63%) and Northwest (70%) which have accurate statistical data, share borders with the US and are economically developed; 2) the North Zone of the Isthmus of Tehuantepec and the 3 regions on the coast (Gulf 54%; South Center 51%; and Center 55%); 3) the North Center (46%); and 4) the Southeastern region (32%) with the lowest prevalence rates in the country. There is a need to modify the demographic rationale of determining targets towards a more social/historical perspective that acknowledges regional differences in a country and allows new interest in understanding the reproductive behavior of women and couples.^ieng

[Women with high fertility in Mexico: orientations for a population policy]. / Las mujeres de alta fecundidad en Mexico: orientaciones para una politica de poblacion.

PIP: The characteristics and correlates of high fertility women in Mexico were assessed for different age and residential groups with data from the National Demographic Survey of 1982. This survey included information on rural, urban and metropolitan Mexican women aged 15-49 years who had ever been in union. Rural areas were defined as those with fewer than 20,000 inhabitants. Metropolitan areas were Guadalajara, Monterrey, and Mexico City. High fertility was defined for the purpose of this study as at least 2 live births for women 15-19, 3 for women 20-24, 4 for those 25-29, 5 for those 30-34, 6 for those 35-39, and 7 for those 40-49. According to this definition about 40% of Mexican women are high fertility, with proportions ranging from about 1/3 of those 20-29 to half of those 35-49 years old. High fertility is about twice as common in women 15-19 in rural areas as in urban and metropolitan areas of Mexico. 10% of rural women aged 20-24 already have 5 children, compared to less than 1% of metropolitan women and under 3% of women in other urban areas. By age 45-49, 31% of rural women, 20% of other urban women, and 15% of metropolitan women have 10 or more children. 13% in all areas have 2 or 3. Large proportions of rural women in all age groups are high fertility, with the difference especially marked at young ages. The data on contraceptive usage indicate that high fertility women are among the increasing numbers of Mexican women attempting to control their family size. 10% of high fertility women in rural areas are sterilized and another 10% use oral contraceptives. Injectables and traditional methods share 3rd place. IUDs are almost nonexistent in rural areas. In urban and metropolitan zones about 1/4 of high fertility women have been sterilized. About 10% use pills. Traditional methods and IUDs are in 3rd place for urban women while injectables occupy 3rd place for metropolitan women. Except among women 30-34, about 70% of sterilizations in rural areas are in high fertility women. The data demonstrate the growing acceptance of family planning in rural as well as in urban areas. In 1969, only 10% of rural women in union had ever used a contraceptive method. The 43.1% of Mexican women with little or no schooling contribute 63% of the high fertility. High fertility women are overrepresented in the lowest educational stratum in all age groups. Methodological difficulties arise in comparing the fertility performance of different social groups. It appears however that agricultural workers and unsalaried self-employed workers contribute a disproportionate share of high fertility.^ieng

Targeting AIDS through information, education, and communications programs: implications for Africa and the Caribbean.

PIP: IEC campaigns targeted at acquired immunodeficiency syndrome (AIDS) must seek to achieve the maximum impact within a contest of extremely limited resources. This implies a careful assessment of population groups and behaviors that carry the highest risk. Rather than expending large sums of money on mass media campaigns, the approach should be to target IEC activities at the social networks of those most at risk. This may include, for example, prostitutes, homosexual men, hotel and tourist employees, students, and military personnel. Once epidemiologic studies have identified the at-risk population, volunteers form these groups should be recruited and trained to reach their peers through the networks available to them. This education component of IEC work takes priority. The second step involves information diffusion to health providers who are likely to come into contact with human immunodeficiency virus (HIV)-infected individuals, especially those who have access to pregnant women and mothers. Some of these providers are not aware of the risks involved in the reuse of immunization needles. The third step--communication with the general public--is aimed at making the population aware of the factors that place people at risk of HIV infection. Radio seems to be the media capable of reaching the greatest numbers, although traditional means of communication should not be neglected. The IEC effort should consider options at the community, institutional, and individual levels and address those factors that enable, reinforce, and predispose appropriate health behaviors.^ieng