Ethnic differences in sexual behaviour among unmarried adolescents and young adults in Zimbabwe.

Understanding the social and cultural contextual determinants of sexual behaviour of adolescents and young adults is an essential step towards curtailing the spread of HIV. This study examined the effects of one cultural factor, ethnicity, on sexual abstinence, faithfulness, condom use at last sex, and risky sex among young people in Zimbabwe. Data from the cross-sectional, population-based 2005-06 Zimbabwe Demographic and Health Survey were used. Net of the effect of sociodemographic and social-cognitive factors, and using multinomial logistic regression, ethnicity was found to have a strong and consistent effect on sexual behaviour among youth. In addition, the study found that there were ethnic-specific and within-gender differences in sexual behaviour, for both men and women. Shona youth were more likely to be abstinent than Ndebele youth. Compared with Shona youth, Ndebele youth were more likely to have engaged in risky sex. However, Ndebele men were more likely have used condoms at last sex, compared with Shona men. For both men and women, sexual behaviour was more socially controlled. School attendance and religion exerted protective effects on sexual abstinence. For men only, those living in rural areas were less likely to be faithful and more likely to have engaged in risky sexual behaviour than those living in urban areas. The study attests to the fact that ethnic norms and ideologies of sexuality need to be identified and more thoroughly understood. In addition, the study provides evidence that in order to promote safe and healthy sexuality among young people in Zimbabwe, cultural, social and gender-specific approaches to the development of HIV prevention strategies should be seriously considered. Current success in the Abstinence, Being faithful and Condom use (ABC) approach could be strengthened by recognizing and responding to cultural forces that reproduce and perpetuate risky sexual behaviours.

Differential neonatal and postneonatal infant mortality rates across US counties: the role of socioeconomic conditions and rurality.

PURPOSE: To examine differences in correlates of neonatal and postneonatal infant mortality rates, across counties, by degree of rurality. METHODS: Neonatal and postneonatal mortality rates were calculated from the 1998 to 2002 Compressed Mortality Files from the National Center for Health Statistics. Bivariate analyses assessed the relationship between neonatal and postneonatal mortality by Urban Influence (UI) codes. Multivariable, weighted least-squares regression models included measures of county socioeconomic conditions, health services and environmental risks. FINDINGS: The bivariate analysis indicated neonatal and postneonatal mortality was significantly higher in the most nonmetropolitan counties compared to the most metropolitan counties. However the relationship was not linear across the Urban Influence codes. In the multivariable models, a nonmetropolitan advantage was observed for counties not adjacent to metropolitan areas for neonatal mortality. However, postneonatal mortality rates were higher in the most rural nonmetropolitan counties. CONCLUSIONS: Certain characteristics of nonmetropolitan counties not adjacent to metropolitan counties and with an urban area of 2,500 population or more are protective against neonatal mortality (UI = 7, UI = 8). This may indicate that just having access to health services is more important to creating a protective effect for these nonmetropolitan counties than having a high concentration of medical facilities. The nonmetropolitan, not adjacent (UI = 9) disadvantage observed for postneonatal mortality supports the idea that the isolation of these areas combined with the combination of risk factors across the most nonmetropolitan counties leads to poorer postneonatal health outcomes in these areas.

Income inequality and mortality in US counties: does minority racial concentration matter?

UNLABELLED: This study examined (1) the relationship between income inequality and mortality among all counties in the contiguous United States to ascertain whether the relationships found for states and metropolitan areas extend to smaller geographic units and (2) the influence of minority racial concentration on the inequality-mortality linkage. METHODS: This county-level ecologic analysis used data from the Compressed Mortality Files and the US Census. Weighted least squares regression models of age-, sex-, and race-adjusted county mortality rates were estimated to examine the additive and interactive effects of income inequality and minority racial concentration. RESULTS: Higher income inequality at the county level was significantly associated with higher total mortality. Higher minority racial concentration also was significantly related to higher mortality and interacted with income inequality. CONCLUSIONS: The relationship between income inequality and mortality is robust for counties in the United States. Minority concentration interacts with income inequality, resulting in higher mortality in counties with low inequality and a high percentage of Blacks than in counties with high inequality and a high percentage of Blacks.