Feasibility, Acceptability, and Design of a Mobile Ecological Momentary Assessment for High-Risk Men Who Have Sex With Men in Hanoi, Vietnam: Qualitative Study.

BACKGROUND: Men who have sex with men (MSM) are at a disproportionate risk for HIV infection and common mental disorders worldwide. In the context of HIV, common mental disorders are important and are frequent drivers of suboptimal prevention and treatment outcomes. Mobile ecological momentary assessments (EMAs), or the repeated sampling of people's behaviors and psychological states in their daily lives using mobile phones, can clarify the triggers and HIV-related sequelae of depressive-anxious symptoms and contribute toward the design of ecological momentary interventions (EMIs) that cater to the contextually varying needs of individuals to optimize prevention and treatment outcomes. OBJECTIVE: This study aims to characterize the feasibility and acceptability of mobile EMA among high-risk MSM in Hanoi, Vietnam. It aims to evaluate the perceived relevance, usability, and concerns of this group with regard to the content and delivery of mobile EMA and the potential of leveraging such platforms in the future to deliver EMIs. METHODS: Between January and April 2018, a total of 46 participants were recruited. The participants completed 6 to 8 mobile EMA surveys daily for 7 days. Surveys occurred once upon waking, 4 to 6 times throughout the day, and once before sleeping. All surveys queried participants' perceived safety, social interactions, psychological state, and mental health symptoms. The morning survey further queried on sleep and medication use within the past 24 hours, whereas the night survey queried on sexual activity and substance use and allowed participants to share an audio recording of a stressful experience they had that day. At the end of the week, participants were interviewed about their experiences with using the app. RESULTS: Participants completed an average of 21.7 (SD 12.7) prompts over the 7-day period. Excluding nonresponders, the average compliance rate was 61.8% (SD 26.6%). A thematic analysis of qualitative interviews suggested an overall positive reception of the app and 5 recurring themes, which were centered on the relevance of psychological and behavioral items to daily experiences (eg, mental health symptoms and audio recording), benefits of using the app (eg, increased self-understanding), worries and concerns (eg, privacy), usability (eg, confusion about the interface), and recommendations for future design (eg, integrating more open-ended questions). CONCLUSIONS: Mobile EMA is feasible and acceptable among young MSM in Vietnam; however, more research is needed to adapt EMA protocols to this context and enhance compliance. Most participants eagerly provided information about their mental health status and daily activities. As several participants looked toward the app for further mental health and psychosocial support, EMIs have the potential to reduce HIV and mental health comorbidity among MSM.

Cross-cultural gene- environment interactions in depression, post-traumatic stress disorder, and the cortisol awakening response: FKBP5 polymorphisms and childhood trauma in South Asia.

Despite increased attention to global mental health, psychiatric genetic research has been dominated by studies in high-income countries, especially with populations of European descent. The objective of this study was to assess single nucleotide polymorphisms (SNPs) in the FKBP5 gene in a population living in South Asia. Among adults in Nepal, depression was assessed with the Beck Depression Inventory (BDI), post-traumatic stress disorder (PTSD) with the PTSD Checklist-Civilian Version (PCL-C), and childhood maltreatment with the Childhood Trauma Questionnaire (CTQ). FKBP5 SNPs were genotyped for 682 participants. Cortisol awakening response (CAR) was assessed in a subsample of 118 participants over 3 days. The FKBP5 tag-SNP rs9296158 showed a main effect on depressive symptoms (p = 0.03). Interaction of rs9296158 and childhood maltreatment predicted adult depressive symptoms (p = 0.02) but not PTSD. Childhood maltreatment associated with endocrine response in individuals homozygous for the A allele, demonstrated by a negative CAR and overall hypocortisolaemia in the rs9296158 AA genotype and childhood maltreatment group (p < 0.001). This study replicated findings related to FKBP5 and depression but not PTSD. Gene-environment studies should take differences in prevalence and cultural significance of phenotypes and exposures into account when interpreting cross-cultural findings.

Sleep budgets in a globalizing world: biocultural interactions influence sleep sufficiency among Egyptian families.

Declines in self-reported sleep quotas with globalizing lifestyle changes have focused attention on their possible role in rising global health problems such as obesity or depression. Cultural factors that act across the life course and support sleep sufficiency have received scant attention, nor have the potential interactions of cultural and biological factors in age-related changes in sleep behavior been systematically investigated. This study examines the effects of cultural norms for napping and sleeping arrangements along with sleep schedules, age, and gender on sleep budgets among Egyptian households. Data were collected in 2000 from 16 households with 78 members aged 3-56 years at two sites in Egypt (Cairo and an agrarian village). Each participant provided one week of continuous activity records and details of each sleep event. Records showed that nighttime sleep onsets were late and highly variable. Napping was common and, along with wake time flexibility, played a key role in maintaining sleep sufficiency throughout the life course into later middle age. Cosleeping was prevalent and exhibited contrasting associations with reduced duration and sufficiency of both nocturnal and total sleep, and with earlier, more regular, and less disrupted sleep. Daily sleep quotas met published guidelines and showed age-related changes similar to existing reports, but differed in how they were achieved. Cultural norms organizing sleep practices by age and gender appear to tap their intrinsic biological properties as well. Moreover, flexibility in how sleep was achieved contributed to sleep sufficiency. The findings suggest how biocultural dynamics can play key roles in sleep patterns that sustain favorable sleep quotas from infancy onwards in populations pursuing globalizing contemporary lifestyles.

Sex differences in child nutritional and immunological status 5-9 years post contact in fringe highland Papua New Guinea.

OBJECTIVES: This study examines sex differences in vulnerability among children experiencing rapid culture change that may reflect distinct microecologies driven by differential parental investment and/or sex-specific life history strategies. Apparent female growth canalization may be a life history strategy favoring growth over maintenance but also may reflect sex-differentiated selection for resilience based on unequal treatment during early life. METHODS: Stature, weight, and serum measures of C-reactive protein (CRP, an inflammation marker) and Epstein-Barr Virus antibodies (EBV, a humoral immune response marker) were collected longitudinally among children/adolescents ages 5-20 years (N = 65), 5-9 years after sustained contact in a fringe highland hunter-horticulturalist group from the Schrader Range in Papua New Guinea exhibiting male preference and sex-biased survival. It was hypothesized that girls would exhibit canalization, with better nutritional status than boys; lower maintenance investment would yield lower female immune activation; and because of differential survivorship, females would appear increasingly canalized as early conditions for girls worsened relative to boys. RESULTS: Girls had greater arm circumference z-scores than boys, less frequent stunting, and lower CRP despite high pathogen load. Average nutritional status for girls improved over time as the sex ratio became increasingly male biased and the condition of female infants reportedly worsened. CONCLUSIONS: Both canalization and survivorship effects were found. Although a life history perspective on female canalization can help explain developmental outcomes in populations undergoing rapid culture change amid adversity, possible sex differences in the strength of survivorship effects that select for resiliency should not be ignored.

Culture in psychiatric epidemiology: using ethnography and multiple mediator models to assess the relationship of caste with depression and anxiety in Nepal.

BACKGROUND: The causes of ethnic and caste-based disparities in mental health are poorly understood. AIM: The study aimed to identify mediators underlying caste-based disparities in mental health in Nepal. SUBJECTS AND METHODS: A mixed methods ethnographic and epidemiological study of 307 adults (Dalit/Nepali, n=75; high caste Brahman and Chhetri, n=232) was assessed with Nepali versions of Beck Depression (BDI) and Anxiety (BAI) Inventories. RESULTS: One-third (33.7%) of participants were classified as depressed: Dalit/Nepali 50.0%, high caste 28.4%. One quarter (27.7%) of participants were classified as anxious: Dalit/Nepali 50.7%, high caste 20.3%. Ethnographic research identified four potential mediators: Stressful life events, owning few livestock, no household income, and lack of social support. The direct effect of caste was 1.08 (95% CI -1.10-3.27) on depression score and 4.76 (95% CI 2.33-7.19) on anxiety score. All four variables had significant indirect (mediation) effects on anxiety, and all but social support had significant indirect effects on depression. CONCLUSION: Caste-based disparities in mental health in rural Nepal are statistically mediated by poverty, lack of social support, and stressful life events. Interventions should target these areas to alleviate the excess mental health burden born by Dalit/Nepali women and men.

Tracking biocultural pathways in population health: the value of biomarkers.

BACKGROUND: Cultural factors and biomarkers are emerging emphases in social epidemiology that readily ally with human biology and anthropology. Persistent health challenges and disparities have established biocultural roots, and environment plays an integral role in physical development and function that form the bases of population health. Biomarkers have proven to be valuable tools for investigating biocultural bases of health disparities. AIMS: We apply recent insights from biology to consider how culture gets under the skin and evaluate the construct of embodiment. We analyse contrasting biomarker models and applications, and propose an integrated model for biomarkers. Three examples from the Great Smoky Mountains Study (GSMS) illustrate these points. SUBJECTS AND METHODS: The longitudinal developmental epidemiological GSMS comprises a population-based sample of 1420 children with repeated measures including mental and physical health, life events, household conditions, and biomarkers for pubertal development and allostatic load. RESULTS: Analyses using biomarkers resolved competing explanations for links between puberty and depression, identified gender differences in stress at puberty, and revealed interactive effects of birthweight and postnatal adversity on risk for depression at puberty in girls. CONCLUSION: An integrated biomarker model can both enrich epidemiology and illuminate biocultural pathways in population health.

Cultural and community determinants of subjective social status among Cherokee and White youth.

BACKGROUND: . Subjective social status (SSS) is associated with physical and mental health in diverse samples. However, community, cultural, and ethnic influences on SSS are poorly understood, especially among rural and American Indian populations. OBJECTIVE: We aimed to examine similarities and differences in how community poverty, family context, and life course attainment predict SSS among Cherokee and White youth in Appalachia. DESIGN: We assessed culturally and developmentally appropriate aspects of life course attainment among 344 Cherokee and White youth (age 19-24) using the Life Trajectory Interview for Youth (Brown et al. 2006. International Journal of Methods in Psychiatric Research, 15, 192-206). Combined with information regarding community context and family history, these data were used to examine common patterns and ethnic differences in community, family, and cultural influences on SSS. RESULTS: Overall, both Cherokee and White youth rank their families lower in SSS than previously studied US youth. Family poverty during childhood and low parental education negatively influence family SSS, Cherokee youth rank higher on subjective socioeconomic status (SES) than Whites, as do participants in high poverty areas. However, White youth rank higher on peer SSS. Ethnographically generated items perform better than standard demographic markers in predicting SSS. Educational attainment is associated with peer SSS among Cherokee (but not White) youths. CONCLUSIONS: Cultural identity, community context, and local reference groups are crucial determinants of SSS. Both White and Cherokee youth in Appalachia exhibit SSS rankings consistent with socioeconomic and cultural marginalization. On a local scale, however, living in high poverty areas or minority communities may buffer individuals from some negative social comparisons regarding subjectively perceived SES. Meanwhile, social monitoring in small minority communities may constrain optimistic bias in assessments of peer popularity and status. Social ecology, family context, and individual attainment appear to exert distinctive influences on SSS across different cultural and ethnic groups.

Receding horizons of health: biocultural approaches to public health paradoxes.

Worldwide challenges to health reflect a "paradox of success," whereby both the strengths and the weaknesses of current approaches in public health, epidemiology, and biomedicine have determined the nature of the health problems we now face. In detail, we analyze and illustrate five constituent paradoxes that fuel continued health risk even in the face of success, including: (1) unmasking, (2) local biology, (3) socialization, (4) emerging and reemerging disease, and (5) savage inequity. We trace the pathways behind the paradoxes and their effects on health, and demonstrate that biocultural dynamics are involved in each. Furthermore, we track the roots of health paradox to changes that divert or disrupt pathways for production of health. These analyses contribute to an emerging literature of research and praxis on integrative biocultural models of health.