Male genital hygiene beliefs and practices in Nairobi, Kenya.

OBJECTIVES: Attitudes and practices concerning genital hygiene may influence topical microbicide use by men. This study examines knowledge and behaviours related to hygiene, genital hygiene, circumcision and hygiene, and to genital hygiene before and after sex among men in Nairobi, Kenya. METHODS: We conducted 463 interviews of men recruited by respondent driven sampling techniques and 10 focus group discussions with a subsample of 100 volunteers from this group. Men were asked individual quantitative survey and qualitative group discussion questions about general hygiene behaviours, genital hygiene, and the temporal relation of genital hygiene behaviours to sexual encounters. RESULTS: Bathing once daily was associated with education, income, and inside tap water. Genital washing aside from regular bathing and washing before sex ever were negatively associated with bathroom crowding. Genital hygiene before the most recent sexual encounter was uncommon and negatively associated with HIV risk perception, bathroom crowding, and ethnicity. Men believed genital hygiene before sex would arouse suspicions of infidelity or cool sexual ardour. Genital hygiene after sex was associated with education, religion, and having inside tap water. Genital hygiene after the most recent sexual encounter was associated with age, income, and with men having at least one child. CONCLUSIONS: Genital hygiene behaviours were associated with resource access factors and group discussions suggest that they are modulated by interactions in sexual partnerships. Topical microbicides may improve hygiene before and after sex.

Analysis of birth intervals in a non-contracepting Indian population: an evolutionary ecological approach.

Reproductive strategies are related to ecological constraints. This paper examines data on early birth spacing in a scheduled caste, Bengali-speaking, non-contracepting population of the Karimganj district of southern Assam, India, taking an evolutionary ecological perspective. It is found that on average birth intervals closed by boy-boy are longer than those closed by girl-girl. Birth spacing tends to be longer among upper-income and Craftsman sub-caste mothers. The presence of a 'grandmother' in the household shortens spacing. These findings are compatible with an evolutionary-based reproductive decision-making process.

Longitudinal association of cardiovascular reactivity and blood pressure in Samoan adolescents.

OBJECTIVE: The longitudinal association between blood pressure (BP) reactivity to a video game and resting BP 3 to 4 years later was investigated in 83 Samoan adolescents from American and (Western) Samoa as part of a multidisciplinary study of cardiovascular disease (CVD) risk in modern Samoans. METHODS: Participants ranged in age from 11 to 14 years at baseline, in 1992 to 1993, and 14 to 18 years at follow-up in 1996. Video game BP reactivity was defined as the residual score of the regression of the maximum BP during the video game on the minimum resting BP before the video game. The predictive effect of baseline video game BP reactivity on follow-up resting BP was tested using regression models with baseline resting BP, baseline body mass index (BMI), and age as covariates. RESULTS: Systolic BP reactivity to the video game at baseline was significantly, p=.04, and independently associated with resting systolic BP 3 to 4 years later. Samoan adolescents who had higher systolic BP reactivity scores at baseline had significantly higher resting systolic BP at follow-up after adjustment for the significant effects of baseline resting systolic BP, age, and BMI. There were no interactions between sex and reactivity or between residence, American Samoa or (Western) Samoa, and reactivity in the models, indicating that the effects of systolic BP reactivity in early adolescence on later adolescent resting systolic BP were similar in the entire study sample. CONCLUSIONS: Video game cardiovascular reactivity seems to assess aspects of psychophysiological arousal and prospective CVD risk in Samoan adolescents of both sexes residing in both Samoas, and may be useful for understanding the role of psychosocial stress and health in modernizing societies.

Anger expression, age, and blood pressure in modernizing Samoan adults.

OBJECTIVE: Relationships among anger expression, age, and blood pressure (BP) were studied in a cross-sectional sample of 593 American and Western Samoan adult men and women, 25 to 55 years of age. Prior studies indicated that anger coping is an important psychosocial domain in modernizing Samoans. METHODS: Anger expression was assessed using a modified 24-item version of the State-Trait Anxiety Inventory composed of anger-in, anger-out, and anger-control, along with 4 Samoan culture-specific anger items. Age and sex stratified analyses were performed. Body-mass adjusted BP was regressed on the anger expression subscales and age. RESULTS: In women < or = 40 years of age, anger-out was significantly (p < 0.01) and negatively related to adjusted diastolic BP. Young women from American and Western Samoa who outwardly expressed anger least frequently had higher adjusted diastolic BP. CONCLUSION: The significant influence of anger expression on BP in young modernizing Samoan women may be because: a) increased stress from the interaction of traditional gender role-related domestic demands and more opportunities for individual socioeconomic activities; and b) the culturally normative pattern of suppressed emotional expression.

Expression of anger by Samoan adults.

A modified version of Spielberger's 1988 Anger Expression Inventory including four Samoan culture-specific anger terms was administered to 593 adult American and Western Samoans, 25 to 55 years, to assess intrasample age, sex, and location differences and to examine its cross-cultural utility by an exploratory factor analysis. American Samoans men's and women's scores showed greater difficulty controlling anger than Western Samoan men and women, American Samoan males scored higher on Anger-Out and Samoan anger expression than Western Samoan men, and Western Samoan women scored higher on Anger-Out and higher on Samoan anger expression than Western Samoan men. Factor analysis showed that Spielberger's original factor structure was replicated in all subpopulations except American Samoan women. Control of anger, a Samoan cultural core value, appears to be more difficult in modern American Samoans of both sexes compared with the more traditional Western Samoans. Among American Samoan women, we speculate that role expansion may be responsible for their heterogeneous factor structure of anger expression.

Introducing preclinical students to primary care through a community preceptorship program.

In the 1980-81 academic year, the Morehouse School of Medicine implemented a preceptorship program designed to introduce preclinical students to primary care. The program is unique in that it is required for all first- and second-year students; it is continuous throughout the first two years of medical school; it exposes students to a variety of primary care specialties, settings, and practice modes; and it enables students to follow a family for one to two years. A preliminary evaluation of the program's first year indicates that it has had an impact on the students' attitudes, knowledge, and career plans. The objectives and operation of the program are described.