Latina immigrants' breast and colon cancer causal attributions: genetics is key.

Latinos in the US suffer health disparities including stage of disease at time of breast or colon cancer diagnosis. Understanding Latinas' causal attributions of breast and colon cancer may provide insight into some of the individual level determinants of cancer disparities in this population. Cultural consensus analysis (CCA) is one way to study causal beliefs. The objective of this study was to describe Latina immigrants' causal attributions of breast and colon cancer. We conducted Spanish-language interviews with 22 Latina immigrants using a qualitative exploratory design comprised of freelisting, ranking, and open-ended questions. Participants freelisted causes and risk factors for breast and colon cancer then ranked risk factors according to their perceived role in the development of each cancer. CCA was conducted on rank orders to identify whether a cultural consensus model was present. Participants answered semi-structured, open-ended questions regarding the risk factors and rankings. Interviews were transcribed and subjected to thematic analysis. CCA showed no consensus around rank of causes for either cancer, and residual agreement analysis suggested the presence of two subcultural groups. "Genetics" and "hereditary factors" ranked first and second on average across participants for both cancers. Based on interview data, participants were less aware of colon cancer than breast cancer. Participants' endorsement of heredity as a cause of breast and colon cancer was similar to beliefs reported in studies of primarily non-Latina populations.

Cultural Consensus Modeling to identify culturally relevant reasons for and against suicide among Black adolescents.

INTRODUCTION: The development of evidence-based treatments relies on accurate theoretical frameworks sensitive to the lived realities of the populations from which they are derived. Yet, the perspectives of Black youth are vastly underrepresented in extant theories of suicidal behavior. Cultural Consensus Modeling provides an evidence-based approach for developing a culturally informed understanding of suicide risk among Black youth. METHOD: Participants were 50 Black adolescents (Mage = 16.20 years; 76.0% male) who completed Phase 1 of a Cultural Consensus Modeling study. Participants freely listed reasons for suicide and reasons for living among similar peer Black youth. Responses were synthesized and coded for major themes. RESULTS: The most common reasons for suicide were racism (40%), depression (32%), poverty (26%), and bullying (22%). The most common reasons for living were family (58%), having a purpose or goals (36%), friends (30%), and hope for a better future (26%). CONCLUSION: Responses highlighted issues of racism and social justice, depression, and poverty, as well as the protective role of relationships, living for the future, and contributing to Black empowerment. Future research should utilize Cultural Consensus Modeling to elevate the voices of Black youth, improving extant theories of suicide, and identifying unique mechanisms or opportunities for prevention.

The impact of bilinguality and language context on the understanding of epistemic adverbs in health communication: the case of English and Russian.

Aim: To explore how English epistemic adverbs, as used in health communication, are understood by speakers depending on their first language (L1) and language context. Methods: We used an online dissimilarity rating task with paired doctors' opinions which differed only with respect to the embedded epistemic adverbs (e.g., This treatment definitely has side effects vs. This treatment possibly has side effects). In order to evaluate the possible effect of one's L1, we compared the ratings of English-speaking monolinguals and Russian-English bilinguals in Australia (Study 1). To evaluate the impact of language context, we compared the ratings of Russian-English bilinguals in Australia and Russia (Study 2). The data were interpreted using classical multidimensional scaling (C-MDS) analysis, complemented by cultural consensus analysis and hierarchical cluster analysis. Results: The C-MDS analyses returned statistically acceptable results. Intragroup consensus was evident for all speaker groups. They all clustered the high confidence adverbs (clearly, definitely, and obviously) and the hearsay adverbs (presumably and supposedly) similarly. Effects of L1 were seen: for example, unlike the monolinguals, the Russian bilinguals did not include evidently with the high confidence adverbs (Study 1). An effect of context was also evident: Russian-English bilinguals in Australia most resembled the monolinguals in their understanding of epistemic adverbs. The way Russian-based bilinguals clustered epistemic adverbs reflected a less nuanced understanding (Study 2). Conclusion: The subtle differences in how adverbs of likelihood and doubt are understood in health communication suggest extra care is needed when conveying risk and uncertainty to patients from diverse linguistic and/or cultural backgrounds to ensure mutual understanding and mitigate against miscommunication. The impact of L1 and language context on one's understanding highlights the need to explore more widely how epistemic adverbs are understood by diverse populations and, in doing so, improve healthcare communication practices.

Time in the United States and diabetes among Mexican immigrant women: The moderating role of culture.

Mexican immigrants in the U.S. show high incidence of type 2 diabetes, and increased risk is associated with longer duration of residency. This study considers the impact of culture over time for Mexican immigrant women in a southern U.S. city. Using cultural consensus analysis to empirically derive the substance and structure of a cultural model for la buena vida (the good life) among Mexican immigrant women in Birmingham, Alabama, we assess the extent to which respondents are aligned with the model in their everyday lives. This measure of 'cultural consonance' is explored as a moderating variable between length of time living in the U.S. and level of Hemoglobin A1c. Results demonstrate that for those with more time in the U.S., those with lower consonance are more likely to have diabetes, while those who are more aligned with la buena vida are at lower risk.

Context Matters for Food Security: Multi-Sited Evidence of Shared Cultural Models of Food Consumption.

Anthropologists have long emphasized the social significance of foods and the contexts in which they are consumed. Expanding on this idea, we define the context of consumption as the non-eating behaviors that surround eating, such as the manner of food preparation, food sharing, and dietary patterns. In this study, we used cultural consensus analysis to assess whether there exist consistently shared, normative ideas about preferable context of food consumption in three diverse research sites: urban Ethiopia, rural Brazil, and rural Haiti. Our analysis demonstrates that in all three communities, there are distinct sets of behaviors that people identified as non-preferable because they reliably associate them with poverty and food insecurity, and behaviors that people identify as preferable because they reliably associate them with wealth and food security. Across the settings, there was little variation in agreement about behaviors across household composition, age, gender, and food security status. These findings suggest that people do indeed share culturally specific ideas about the context in which foods should be prepared and consumed, beyond the actual content of one's diet. Exploring these cultural models elucidates the social consequences of food insecurity, enabling researchers to better examine the relationship between food insecurity, social context, and well-being.

Re-examining Norms of Disrespect and Abuse in the Second Stage of Labor in Tanzanian Maternity Care.

Globally, the widespread occurrence of disrespect and abuse (D&A) on maternity wards is well-documented. Using ethnography and cultural consensus analysis we explore how the practice of midwives hitting women who are in the second stage of labor (pushing) has become a locally accepted form of care in Tanzania if a baby's life appears to be at risk. This analysis interrogates the deep uncertainty of birth outcomes in this setting that may motivate abuse during this time. Seriously engaging with local discourses on abuse and care sheds light on hegemonic norms and power dynamics and is critical for improving maternity services.

Concepciones culturales de hemofilia en padres que son miembros de una asociación civil en México / Cultural conceptions on hemophilia in parents who are members of a civil association in Mexico

Introducción: La hemofilia es un padecimiento crónico y existen actividades que, en dependencia de la persona, pueden mejorar la salud del paciente. Para poder entender estas acciones se necesita un acercamiento a las concepciones culturales que tienen las familias sobre la hemofilia. Objetivo: Describir las concepciones culturales respecto a la hemofilia que tienen los padres con hijos que padecen esta enfermedad y radican en la República Mexicana. Métodos: Se realizó un estudio cualitativo de investigación antropología cognitiva. Se les aplicaron dos entrevistas estructuradas a 64 padres, que pertenecían a la asociación civil. Se buscaron significados de hemofilia a partir del uso de cinco palabras y después se identificó si existía o no consenso entre los participantes. Resultados: Las principales categorías que se derivaron de las dimensiones culturales fueron: consecuencias derivadas del padecimiento y cómo se vive. Las principales dimensiones culturales responsabilidad y vivir. Dentro de la responsabilidad se encontró lo que el tratamiento implica, lo que debe superar la persona, lo no deseado y lo que debe aprender. En la dimensión vivir estuvo la afectación familiar, las repercusiones, los temores, su realidad y los conocimientos. Conclusiones: Aunque los informantes viven en diferentes partes del país tienen un alto consenso cultural sobre la hemofilia, su percepción, en general, muestra un panorama adverso para sus hijos en el contexto mexicano en el que se encuentran. Sienten responsabilidad compartida con el personal de salud, lo que debe ser aprovechado para que, tanto médicos como personas con el padecimiento y sus familias aprendan sobre las limitaciones de los tratamientos, miedos, experiencias de vida y las oportunidades de medicamentos oportunos que se pueden tomar como alternativas para mejorar la atención y adherencia al tratamiento(AU)

Introduction: Hemophilia is a chronic condition and there are activities that, depending on the person, can improve the patient's health. To be able to understand these actions it is needed an approach to the cultural conceptions that families have about hemophilia. Objectives: Describe the cultural conceptions regarding hemophilia that parents have with children who suffer from this disease and reside in the Mexican Republic. Methods: A qualitative study of cognitive anthropology research was conducted. Two structured interviews were applied to 64 parents, who belonged to the civil association. Hemophilia meanings were sought from the use of five words and then it was identified if existed or not consensus among participants. Results: The main categories that derived from cultural dimensions were: consequences derived from the condition and how it is lived. The main cultural dimensions were responsibility and living. Within responsibility it was found what the treatment implies, what the person must overcome, the unwanted and what the person must learn. In the living dimension were family affectation, repercussions, fears, reality and knowledge. Conclusions: Although informants live in different parts of the country, they have a high cultural consensus on hemophilia; their perception generally shows an adverse picture for their children in the Mexican context in which they find themselves. They feel shared responsibility with the health personnel, which should be leveraged so that both doctors and people with the condition and their families learn about treatment limitations, fears, life experiences and timely drugs that can be taken as alternatives to improve the care and adherence to treatment(AU)

Cultural Conceptions of Teachers on the Educational Model of a Public University of Ecuador / Concepciones culturales de los docentes sobre el modelo educativo de una universidad pública de ecuador

RESUMEN El objetivo del estudio fue indagar los significados culturales del concepto "modelo educativo" con la exploración de dimensiones cognitivas y el consenso cultural en docentes de una universidad pública ecuatoriana. Se aplicaron el diseño cualitativo, descriptivo y exploratorio enmarcados en la antropología cognitiva, así como las técnicas listados libres y sorteo por montones en fases sucesivas, la primera de 20 docentes y la segunda de 18 docentes cada vez, basados en el modelo de Romney, Weller y Batchelder. Se obtuvieron niveles del consenso cultural a razón de 5,213 y promedio de competencia cultural de 3,196, que demostraron acuerdo grupal. Se identificaron componentes principales, intermedios y secundarios. La jerarquización temática del discurso permitió agrupar en un modelo epistemológico, curricular y pedagógico. Se concluye que los participantes piensan en forma homogénea y los significados culturales del modelo educativo se ajustaron al consenso, sin variación cultural entre docentes.

ABSTRACT The objective of the study was to investigate the cultural meanings of the Educational Model concept, through the exploration of cognitive dimensions and the cultural consensus in teachers at an Ecuadorian public university. Methodology: Qualitative, descriptive, exploratory design; framed in Cognitive Anthropology. Free listing techniques were applied, and lots were drawn in successive phases; the first of 20 teachers, and the second of 18 teachers each time; based on the Romney, Weller, and Batchelder Model. Results: Cultural consensus levels in a ratio of 5,213, and cultural competence average of 3,196, showed agreement within the group. Main, intermediate, and secondary components were identified. The Thematic hierarchization of the discourse allowed for grouping in an epistemological, curricular, and pedagogical model. Conclusions: The participants think homogeneously, the cultural meanings of the educational model were adjusted to consensus, without cultural variation among teachers.

Cultural Consensus Modeling to Understand South African Adolescent Girls' Attitudes, Awareness, and Uptake of Dual Protection Strategies.

PURPOSE: This study used cultural consensus modeling to elucidate culturally relevant factors associated with dual protection use (strategies to prevent both pregnancy and sexually transmitted infection [STI]/HIV) among South African adolescent girls aged 14-17 years. METHODS: In Phase 1, participants (N = 50) completed a free-listing survey assessing pregnancy and STI/HIV methods used by peers. In Phase 2, participants (N = 100) completed a rating survey to examine perceived peer acceptability of Phase 1 pregnancy and STI/HIV prevention methods. In Phase 3, qualitative individual interviews (N = 25) gathered in-depth information regarding the cultural acceptability of pregnancy and STI/HIV prevention strategies. In Phase 4, participants (N = 300) completed the Phase 2 rating survey for individual beliefs regarding the acceptability of pregnancy and STI/HIV prevention methods. RESULTS: In Phase 1, 41 pregnancy and 29 STI/HIV prevention strategies, along with 16 factors influencing pregnancy prevention method acceptability were endorsed; male condoms were the most commonly endorsed pregnancy and STI/HIV prevention method. In Phase 2, using cultural consensus analysis, participants were consistent in the perceived acceptability of pregnancy and STI/HIV prevention methods (73.4% variance accounted for in single cultural model). In Phase 3, qualitative findings provided in-depth information regarding factors influencing commonly used pregnancy (e.g., injectable contraception) and STI/HIV (e.g., condoms) prevention methods. In Phase 4, a single cultural model was identified (56.3% variance accounted for), with similar acceptability ratings as Phase 2. CONCLUSIONS: A singular cultural model of pregnancy and STI/HIV prevention method acceptability was observed, with little awareness of dual protection. The findings highlight cultural factors for future culturally tailored dual protection interventions for South African adolescent girls.

Using paired cultural modelling and cultural consensus analysis to maximize programme suitability in local contexts.

Cultural consensus analysis (CCA) is a quantitative method for determining cohesion in a specified cultural domain and cultural modelling (CM) is a method for designing and testing connections within a cultural domain based on qualitative data collection. After a description of the methods, and examples of their application, we provide a description of three main points in the programme planning, implementation and evaluation cycle at which the method can best be utilized to plan, contextualize or evaluate programmes and policies. In addition, the use of CCA and CM is not constrained to one point in time though, in order to maximize its ability to help with programme design or evaluation, it ought to be done as early as possible in the process. Through examples from research, and a broader description of the methods of CM and analysis, we provide another tool for global public health practitioners, planners and policymakers. We argue these tools can be used to great effect in a short period of time to maximize the local suitability, acceptability and quality of proposed and implemented interventions, building on existing local strengths, not just in maternal health but, more broadly.

Social Values and Determinants of Cultural Fit in Quebec: The Roles of Ancestry, Linguistic Group, and Mental Health Status.

Many quantitative cross-cultural research studies assume that cultural groups consist of anyone born and raised in the same country. Applying these criteria to the formation of study samples may produce cohorts that share a country but are heterogeneous in relevant domains of culture. For example, in Canada, Franco- and Anglo-Canadians are generally assumed to represent different linguistic groups but the same cultural group. However, speaking a different first language also can mean exposure to different media, information, and conventions, which are known to shape certain cultural domains, such as social values. Other factors may also produce cultural heterogeneity. For example, ancestral origins and recency of familial migration may influence endorsed social values after exposure to diverse cultures or norms. Mental health status or psychiatric conditions may also influence subscription of social values due to different lifestyle demands. Understanding the nuanced contributions of diverse backgrounds to cultural membership and fit (i.e., the degree to which an individual behaves like other cultural members) is useful when performing quantitative cross-cultural studies to minimize alternative explanations for statistical outcomes. This study used Cultural Consensus Analysis (CCA) to assess the cultural fit of social values for 222 Canadians, who had participated in cross-cultural neuropsychological experiments. CCA is an anthropological statistical method for evaluating cultural agreement of a sample. Participants were systematically evaluated by linguistic groups (French and English), migratory generation (1st-3rd+), and mental health status (healthy and patient). Group and individual variances were statistically interrogated. Results demonstrated that Franco- and Anglo-Canadians represent different cultural groups cohabitating in Quebec. Social values dividing Franco- and Anglo-Canadians were also identified. Second and third generation Canadians held more heterogeneous social values than Canadians, whose families had migrated earlier. Second generation Canadians with psychiatric disorders showed notably reduced cultural fit with other Canadians, which supports other literature reporting difficulties experienced by second generation migrants. However, third and later generations of Canadians with psychiatric disorders held a greater range of social values compared to healthy Canadians but still were good fits for Canadian culture. This study concluded that linguistic group and migratory generation partially determines cultural group for the social values domain while mental health status does not, contrary to theories proposed by previous literature.

Do People Agree on What Foods are Prestigious? Evidence of a Single, Shared Cultural Model of Food in Urban Ethiopia and Rural Brazil.

To what extent do people agree on the meaning of foods, and does this vary by socioeconomic status, demographics, or household type? Addressing this question is critical for testing hypotheses about the relationship between food insecurity, food meaning, and mental well-being because it speaks directly to the social implications of food behaviors. In this study, we test for a shared cultural model of food meaning in two diverse settings: urban Ethiopia and rural Brazil. Using freelist and pile sort data from 63 respondents in Ethiopia and 62 from Brazil, we show strong consensus on the prestige value of various key food items in each context. Further, consensus varies little across household composition, food security status, and age and gender. This suggests that, in these two settings, consumption of widely available foods is an act that has both biological and social consequences.

Blood, Sweat, and/or Tears: Comparing Nervios Symptom Descriptions in Honduras.

With the aim of advancing the cross-cultural investigation of the folk illness nervios, I conducted a dual-sited comparative study of symptom descriptions among two diverse research settings in Honduras. Baer et al. (Cult Med Psychiatry 27(3):315-337, 2003) used cultural consensus modeling (CCM) to confirm a core description of nervios among four Latino groups in the US, Mexico, and Guatemala, but observed that overall agreement and average competence in a shared illness model decreased along a gradient from presumably more-to-less economically developed sites. This has left unresolved whether such variation extends to other Latin American regions. This paper is an exploratory analysis of inter- and intracultural variation in nervios symptom descriptions by 50 Hondurans from the market town of Copán Ruinas (n = 25) and city of San Pedro Sula (n = 25). I performed CCM using a combination of free-listing, pile-sorting, and rating activities to establish if respondents across sites share a single model of nervios. I found consensus for the San Pedro Sula subsample, but not for Copán Ruinas or for the overall sample. Results suggest nervios is constitutive of differing forms of distress ranging from chronic illness to acute suffering, as well as anger- and panic-based manifestations that overlap with biomedical ideas about depression, anxiety, and panic disorder. This variation derives in part from demographic factors such as age, gender, and residence, but may also result from ethnic and regional diversity among subsamples. However, consensus only being present among San Pedro Sula respondents suggests their greater awareness of cultural distinctions between biomedical and folk medical knowledge, which is likely due to their exposure to manifold health frameworks in those settings.

Measuring community norms around women's empowerment in the West Bank: Opportunities and challenges of a novel approach using cultural consensus.

Understanding cultural norms is essential to achieving results in development interventions and preventing interventions from causing unintended negative consequences. However, capturing norms within everyday contexts in ways that can be monitored and evaluated can be expensive and time consuming and is not always feasible. We tested a novel method, the cultural consensus analysis (CCA), in the context of monitoring and evaluating a United States Agency for International Development (USAID) justice project in the West Bank, Palestine. We conducted 392 survey interviews with men and women, using 60 true or false questions in the knowledge domains of women's empowerment and gender-based violence (GBV), and tested three gender propositions using CCA. We found no singular cultural understanding of women's empowerment and GBV across West Bank Palestinians (proposition 1). Distinctive cultural models for women and other subgroups (e.g., those living in villages, women who identified as discriminated against within Palestinian society) exist, although there were no shared cultural models among men of any subgroup (proposition 2). Program assumptions regarding structural barriers to women's empowerment conformed to the women's cultural models (proposition 3). To our knowledge, this is the first application of CCA as an approach for describing gender norms in international development programming. CCA was able to distinguish subtle cultural patterns, including between population subgroups, and to identify how those are associated with specific risks, such as GBV. We conclude that CCA is a potentially useful approach for development practice, to ground-truth program assumptions and, potentially, to track program impacts.

Is there a "complementary feeding cultural core" in rural Kenya? Results from ethnographic research in five counties.

This investigation used data from focused ethnographic studies in five rural counties in Kenya to determine whether the concept of "special foods for infants and young children" exists in the different ethnic groups in these areas as an identifiable component of cultural beliefs and knowledge, as well as in practice, and whether they can be characterized as a "complementary feeding cultural core." The concept of "cultural core foods" refers to the set of foods that have a central role in diets of a population and, as a consequence, also have significant social and emotional components. We used the ethnographic cognitive mapping technique of "free listing" and a qualitative 24-hr recall of infants and young children (IYC) intake, with probing, to obtain data on caregivers' beliefs and behaviours. The results show that an IYC cultural food core can be identified in all of the counties. A related finding that supports the argument for an "IYC cultural core" with respect to appropriate foods for IYC is the clear cognitive consensus within sites about its content, although in practice, food insecurity and food shortage constrain household abilities to put their beliefs into practice. We conclude that interventions to improve IYC feeding in rural Kenya that build on the concept of "IYC cultural core foods" will be congruent with basic cultural ideas about managing IYC feeding and could take advantage of this cultural feature.

Physician professionalism: definition from a generation perspective.

OBJECTIVES: The primary objective of this study was to determine whether consensuses on the definition of emergency physician professionalism exist within and among four different generations. Our secondary objective was to describe the most important characteristic related to emergency physician professionalism that each generation values. METHODS: We performed a cross-sectional survey study, using a card-sorting technique, at the emergency departments of two university-based medical centers in the United States. The study was conducted with 288 participants from February to November 2017. Participants included adult emergency department patients, emergency medicine supervising physicians, emergency medicine residents, emergency department nurses, and fourth- and second-year medical students who independently ranked 39 cards that represent qualities related to emergency physician professionalism. We used descriptive statistics, quantitative cultural consensuses and Spearman's correlation coefficients to analyze the data. RESULTS: We found cultural consensuses on emergency physician professionalism in Millennials and Generation X overall, with respect for patients named the most important quality (eigenratio 5.94, negative competency 0%; eigenratio 3.87, negative competency 1.64%, respectively). There were consensuses on emergency physician professionalism in healthcare providers throughout all generations, but no consensuses were found across generations in the patient groups. CONCLUSIONS: While younger generations and healthcare providers had consensuses on emergency physician professionalism, we found that patients had no consensuses on this matter. Medical professionalism curricula should be designed with an understanding of each generation's values concerning professionalism. Future studies using qualitative methods across specialties, to assess definitions of medical professionalism in each generation, should be pursued.

Self-managing HIV/AIDS: cultural competence and health among women in Nairobi, Kenya.

Despite recent efforts to supply antiretroviral therapy, many in Africa are not receiving medication, instead relying on self-management in their attempts to remain healthy. In Kenya, the majority of those infected are women who are below the extreme poverty level. Building on research demonstrating a link between knowledge of HIV/AIDS management and the length of time HIV-positive women have lived in Nairobi, this article uses a cognitive anthropological approach that conceives of culture as shared models and explores the relationship between how well women know a cultural model of self-managing HIV/AIDS and health among women who are not receiving biomedical treatment. Outcomes include reported perceived stress, depressive symptoms, and recent illness episodes. Here, this association of competence in the shared cultural model and health among women living in extremely marginal economic conditions is explored from a biocultural perspective to better understand this relationship. Knowledge of the model is a significant predictor of better overall health even after controlling for age, education, income, marital status, internal locus of control, and how long women have known that they are HIV-positive. This article adds to the HIV/AIDS literature by quantitatively linking health to cultural knowledge among an HIV-positive population. It also contributes to the cultural consensus literature by demonstrating health benefits of cultural knowledge.

A novel application of cultural consensus models to evaluate conservation education programs.

Conservation professionals recognize the need to evaluate education initiatives with a flexible approach that is culturally appropriate. Cultural-consensus theory (CCT) provides a framework for measuring the extent to which beliefs are communally held and has long been applied by social scientists. In a conservation-education context, we applied CCT and used free lists (i.e., a list of items on a topic stated in order of cultural importance) and domain analysis (analysis of how free lists go together within a cultural group) to evaluate a conservation education program in which we used a children's picture book to increase knowledge about and empathy for a critically endangered mammal, the Javan slow loris (Nycticebus javanicus). We extracted free lists of keywords generated by students (n = 580 in 18 schools) from essays they wrote before and after the education program. In 2 classroom sessions conducted approximately 18 weeks apart, we asked students to write an essay about their knowledge of the target species and then presented a book and several activities about slow loris ecology. Prior to the second session, we asked students to write a second essay. We generated free lists from both essays, quantified salience of terms used, and conducted minimal residuals factor analysis to determine presence of cultural domains surrounding slow lorises in each session. Students increased their use of words accurately associated with slow loris ecology and conservation from 43% in initial essays to 76% in final essays. Domain coherence increased from 22% to 47% across schools. Fifteen factors contributed to the domain slow loris. Between the first and second essays, factors that showed the greatest change were feeding ecology and slow loris as a forest protector, which increased 7-fold, and the humancentric factor, which decreased 5-fold. As demonstrated by knowledge retention and creation of unique stories and conservation opinions, children achieved all six levels of Bloom's taxonomy of learning domains. Free from the constraints of questionnaires and surveys, CCT methods provide a promising avenue to evaluate conservation education programs.

Agency as a mediator in the pathway from transactional sex to HIV among pregnant women in Swaziland: a multigroup path analysis.

INTRODUCTION: Transactional sex is a structural driver of HIV for women and girls in sub-Saharan Africa. In transactional relationships, sexual and economic obligations intertwine and may have positive and negative effects on women's financial standing and social status. We conducted a clinic-based survey with pregnant women in Swaziland using a locally validated transactional sex scale to measure the association between subjective social status, transactional sex, and HIV status, and to assess whether this association differed according to a woman's agency within her relationship. METHODS: We recruited a convenience sample of 406 pregnant women at one rural and one urban public antenatal clinic in Swaziland and administered a behavioural survey that was linked to participant HIV status using clinic records. We then conducted a multigroup path analysis to test three hypotheses: (1) that more engagement in transactional sex is associated with decreased condom use and increased subjective social status; (2) that subjective social status mediates the relationship between transactional sex and HIV status; and (3) that these relationships are different across groups according to whether or not a woman reported any indicator of constrained agency within her relationship. RESULTS: The amount and value of material goods received from a sexual partner was significantly and positively associated with higher subjective social status among all participants. As the amount of material goods received from a partner increased, women who reported no indicators of constrained agency were less likely to use condoms. Conversely, there was no relationship between transactional sex and condom use among women who reported any indicator of constrained relationship agency. Among women who reported any indicator of constrained agency, HIV was significantly associated with lower subjective social status. CONCLUSIONS: Relationship agency likely plays a key role in determining which mechanisms create HIV risk for women in transactional relationships. Interventions to mitigate these risks must address social forces that penalize women who engage in sexual relationships as well as structural drivers of gendered economic disparity that reduce women's agency within their sexual and romantic relationships.

Medical Disease or Moral Defect? Stigma Attribution and Cultural Models of Addiction Causality in a University Population.

This study examines the knowledge individuals use to make judgments about persons with substance use disorder. First, we show that there is a cultural model of addiction causality that is both shared and contested. Second, we examine how individuals' understanding of that model is associated with stigma attribution. Research was conducted among undergraduate students at the University of Alabama. College students in the 18-25 age range are especially at risk for developing substance use disorder, and they are, perhaps more than any other population group, intensely targeted by drug education. The elicited cultural model includes different types of causes distributed across five distinct themes: Biological, Self-Medication, Familial, Social, and Hedonistic. Though there was cultural consensus among respondents overall, residual agreement analysis showed that the cultural model of addiction causality is a multicentric domain. Two centers of the model, the moral and the medical, were discovered. Differing adherence to these centers is associated with the level of stigma attributed towards individuals with substance use disorder. The results suggest that current approaches to substance use education could contribute to stigma attribution, which may or may not be inadvertent. The significance of these results for both theory and the treatment of addiction are discussed.