Male androphilia, fraternal birth order, and female fecundity in Samoa: A 10-y retrospective.

Two separate but related literatures have examined familial correlates of male androphilia (i.e., sexual attraction and arousal to masculine adult males). The fraternal birth order effect (FBOE) is a widely established finding that each biological older brother a male has increased the probability of androphilia 20-35% above baseline rates. Other family demographic variables, such as reproduction by mothers, maternal aunts, and grandmothers, have been used to test evolutionary hypotheses that sexually antagonistic genes lead to androphilia among males, lowering or eliminating reproduction, which is offset by greater reproductive output among their female relatives. These proposed female fecundity effects (FFEs), and the FBOE, have historically been treated as separate yet complementary ways to understand the development and evolution of male androphilia. However, this approach ignores a vital confound within the data. The high overall reproductive output indicative of an FFE results in similar statistical patterns as the FBOE, wherein women with high reproductive output subsequently produce later-born androphilic sons. Thus, examination of the FBOE requires analytic approaches capable of controlling for the FFE, and vice-versa. Here, we present data simultaneously examining the FBOE and FFE for male androphilia in a large dataset collected in Samoa across 10 y of fieldwork, which only shows evidence of the FBOE.

Functional genomics and metabolomics advance the ethnobotany of the Samoan traditional medicine "matalafi".

The leaf homogenate of Psychotria insularum is widely used in Samoan traditional medicine to treat inflammation associated with fever, body aches, swellings, wounds, elephantiasis, incontinence, skin infections, vomiting, respiratory infections, and abdominal distress. However, the bioactive components and underlying mechanisms of action are unknown. We used chemical genomic analyses in the model organism Saccharomyces cerevisiae (baker's yeast) to identify and characterize an iron homeostasis mechanism of action in the traditional medicine as an unfractionated entity to emulate its traditional use. Bioactivity-guided fractionation of the homogenate identified two flavonol glycosides, rutin and nicotiflorin, each binding iron in an ion-dependent molecular networking metabolomics analysis. Translating results to mammalian immune cells and traditional application, the iron chelator activity of the P. insularum homogenate or rutin decreased proinflammatory and enhanced anti-inflammatory cytokine responses in immune cells. Together, the synergistic power of combining traditional knowledge with chemical genomics, metabolomics, and bioassay-guided fractionation provided molecular insight into a relatively understudied Samoan traditional medicine and developed methodology to advance ethnobotany.

The impact of global and local Polynesian genetic ancestry on complex traits in Native Hawaiians.

Epidemiological studies of obesity, Type-2 diabetes (T2D), cardiovascular diseases and several common cancers have revealed an increased risk in Native Hawaiians compared to European- or Asian-Americans living in the Hawaiian islands. However, there remains a gap in our understanding of the genetic factors that affect the health of Native Hawaiians. To fill this gap, we studied the genetic risk factors at both the chromosomal and sub-chromosomal scales using genome-wide SNP array data on ~4,000 Native Hawaiians from the Multiethnic Cohort. We estimated the genomic proportion of Native Hawaiian ancestry ("global ancestry," which we presumed to be Polynesian in origin), as well as this ancestral component along each chromosome ("local ancestry") and tested their respective association with binary and quantitative cardiometabolic traits. After attempting to adjust for non-genetic covariates evaluated through questionnaires, we found that per 10% increase in global Polynesian genetic ancestry, there is a respective 8.6%, and 11.0% increase in the odds of being diabetic (P = 1.65×10-4) and having heart failure (P = 2.18×10-4), as well as a 0.059 s.d. increase in BMI (P = 1.04×10-10). When testing the association of local Polynesian ancestry with risk of disease or biomarkers, we identified a chr6 region associated with T2D. This association was driven by an uniquely prevalent variant in Polynesian ancestry individuals. However, we could not replicate this finding in an independent Polynesian cohort from Samoa due to the small sample size of the replication cohort. In conclusion, we showed that Polynesian ancestry, which likely capture both genetic and lifestyle risk factors, is associated with an increased risk of obesity, Type-2 diabetes, and heart failure, and that larger cohorts of Polynesian ancestry individuals will be needed to replicate the putative association on chr6 with T2D.

Evolutionary history of modern Samoans.

Archaeological studies estimate the initial settlement of Samoa at 2,750 to 2,880 y ago and identify only limited settlement and human modification to the landscape until about 1,000 to 1,500 y ago. At this point, a complex history of migration is thought to have begun with the arrival of people sharing ancestry with Near Oceanic groups (i.e., Austronesian-speaking and Papuan-speaking groups), and was then followed by the arrival of non-Oceanic groups during European colonialism. However, the specifics of this peopling are not entirely clear from the archaeological and anthropological records, and is therefore a focus of continued debate. To shed additional light on the Samoan population history that this peopling reflects, we employ a population genetic approach to analyze 1,197 Samoan high-coverage whole genomes. We identify population splits between the major Samoan islands and detect asymmetrical gene flow to the capital city. We also find an extreme bottleneck until about 1,000 y ago, which is followed by distinct expansions across the islands and subsequent bottlenecks consistent with European colonization. These results provide for an increased understanding of Samoan population history and the dynamics that inform it, and also demonstrate how rapid demographic processes can shape modern genomes.

The Vave campaign: impact evaluation of a cancer awareness raising multi-media campaign in Samoa.

Cancer is a leading cause of premature death and disability in Samoa. Recognizing the importance of symptom awareness and early detection, the Samoa Cancer Society (SCS) developed the 'Vave' (quickly) campaign as the first multi-media cancer awareness campaign in Samoa. The campaign adopted a three-pronged community engagement approach including mass media; printed resources; and community outreach at culturally appropriate locations including churches, villages and schools. The campaign promoted three key messages: detect signs and symptoms quickly; quickly see a doctor; and quickly call SCS. To measure impact, data were collected using several methods around the outreach education sessions (pre- and post-surveys), campaign recall (survey) and Vave-related enquiries received by SCS. The findings revealed the campaign was effective in increasing awareness of cancer and importance of early detection demonstrated through community recall of campaign messages, increased enquiries to SCS and improved knowledge. However, it is of note that almost 30% of campaign recall respondents stated they were unsure or would not see a doctor if concerned about a sign of cancer. The reasons given being a lack of knowledge, lack of trust in hospitals and preference for traditional healing. This suggests more targeted culturally sensitive strategies are needed including partnering with traditional healers. Further, advocacy efforts are needed to address the structural barriers to cancer detection and treatment together with continuing education around causes and symptoms of cancer targeting the hard-to-reach communities in Samoa.

Cancer is a number one killer and cause of disability in Samoa. Identifying cancer early can lead to better health outcomes. Ability to understand signs and symptoms of cancer among community members is crucial in facilitating early detection. Recognizing this, the Samoa Cancer Society (SCS) developed the first ever multi-media cancer awareness campaign in Samoa­the 'Vave' which means 'quickly'. The campaign used mass media; printed resources; and community outreach to spread three key messages: detect signs and symptoms quickly; quickly see a doctor; and quickly call SCS. To understand how effective the campaign was, data were collected through surveys and statistics on Vave-related calls to SCS. The campaign was effective in increasing awareness of cancer and importance of early detection demonstrated through community recall of campaign messages, increased enquiries to SCS and improved knowledge. Efforts are needed to address the structural barriers to cancer early detection and continuing education targeting the hard-to-reach communities in Samoa.

Gearing to success with national breastfeeding programmes: The Becoming Breastfeeding Friendly (BBF) initiative experience.

Evidence-based policy toolboxes are essential for decision makers to effectively invest in and scale up maternal-child health and nutrition programs, and breastfeeding is no exception. This special issue focuses on the experiences implementing the Becoming Breastfeeding Friendly (BBF) toolbox in England, Scotland, and Wales. BBF is an initiative that includes a toolbox for decision making based on the Complex Adaptive System-based Breastfeeding Gear Model. The BBF initiative experience in Great Britain presented in this special issue illustrates how versatile BBF is as it can be readily adapted to the specific application context. In this instance one country, England was trained by the Yale School of Public Health team that developed BBF. England, in turn, trained and assisted Scotland and Wales with the implementation and oversight of BBF in those countries. The positive experience implementing BBF in Great Britain is fully consistent with findings related to this initiative in other countries with contrasting economic, social, political and health care systems; including Germany, Ghana, Mexico, Myanmar, and Samoa. In all instances BBF has led to breastfeeding policy improvements with strong implications for enabling breastfeeding environments including maternity benefits, workforce development, the Baby Friendly Hospital Initiative and behavior change communication campaigns. In conclusion, BBF is a powerful tool to help guide the effective scaling up of evidence-based programmes to advance breastfeeding protection, promotion and support globally.

The prevalence of chronic kidney disease in Samoans living in Auckland, New Zealand.

AIMS: Pacific peoples have higher rates of chronic kidney disease (CKD) and are five times more likely to commence kidney replacement therapy compared with New Zealand (NZ) Europeans. As the majority live Auckland, this study looked at the prevalence of CKD in two Auckland Pacific Island health providers caring for a large proportion of Pacific peoples, of which almost 50% are Samoan, as well as NZ Europeans. METHODS: De-identified information was requested on individuals who had two or more CKD tests (serum creatinine and urinary albumin creatinine ratios) more than 3 months apart. CKD prevalence across different demographic groups was determined. Logistic regression was used to look at associations of known risk factors and CKD. RESULTS: Data from 25 127 patients was evaluated. Of the total sample, 7451 individuals identified as Samoans. The prevalence of CKD amongst all Samoans in this sample was 17.8% increasing to 36.3% in those Samoans that had been tested for CKD. The prevalence of CKD in this total sample was 13% increasing to 27.5% considering only those who had CKD testing. The odds of Samoans having CKD (adjOR: 1.9 [95%CI 1.7, 2.2]), all other Pacific Island ethnicities identified and NZ Maori (adjOR:1.5 [95%CI 1.3, 1.8]), were increased compared with non-Maori-non-Pacific (likelihood p value <.001). CONCLUSION: We report the high prevalence of CKD (15.9%-33.4%) in Samoans living in New Zealand. This reveals an urgent need for further studies to develop strategies to prevent or reduce the development of kidney failure and premature death.

'When they do that kind of bad things to me, I feel that they encourage me to be strong and be who I am': How transfeminine people in Samoa, Tonga and the Cook Islands experience discrimination, acceptance and a sense of place.

Data on transfeminine participants from a 2016 Pacific Multi-Country Mapping and Behavioural Study evidence high levels of verbal, physical and sexual abuse, as well as discrimination. In interviews from the same study, accounts of hardship were frequently countered with assertions of happiness and talk of acceptance. This paper analyses these accounts and, in particular, the ways in which interviewees viewed and managed their place in society. Data provide insights into the factors that support transfeminine occupation of a positive place in some contemporary Pacific settings, highlighting negotiation between modern and traditional, and local and global, cultures and values.

A missense variant in CREBRF, rs373863828, is associated with fat-free mass, not fat mass in Samoan infants.

BACKGROUND/OBJECTIVES: In Samoa, where 80% of the adult population is living with obesity, understanding the determinants of adiposity and growth during infancy may inform prevention efforts. We examined the association of a missense variant, rs373863828, in the CREBRF gene with body composition in Samoan infants. Adults with one or more copies of the rs373863828 minor allele (A) have higher odds of obesity, based on body-mass index (BMI), but paradoxically decreased odds of diabetes compared to those without the allele. Our study may offer novel insight into the natural history and pathogenesis of this unexpected relationship. SUBJECTS/METHODS: In a prospective study, we measured body composition in early infancy, and at 2- and 4-months of age using anthropometry and dual-energy x-ray absorptiometry (DXA). We genotyped subjects at the CREBRF rs373863828 locus and compared infants with (AA/AG) and without (GG) the variant. In longitudinal analyses, we calculated the absolute change in each outcome from the early infant to the 4-month assessment, adjusting for baseline and other covariates. RESULTS: In cross-sectional analyses, there was no significant difference in infant BMI or fat mass by genotype. After adjusting for covariates, infants with the variant had 4.0 ± 1.8 g more bone mass (p = 0.026) and 210.9 ± 79.6 g more lean mass (p = 0.009) at 4-months and accumulated 176.9 ± 73.0 g more lean mass between the early infant and 4-month assessment (p = 0.017). CONCLUSIONS: The CREBRF rs373863828 minor allele (A) was not associated with increased BMI or adiposity in Samoan infants, but instead with increased lean and bone mass. Our findings suggest that lean (i.e., muscle) and bone mass accretion should be explored as pathways to explain the "protective" effect of the CREBRF variant against diabetes.

Genome-wide association studies in Samoans give insight into the genetic architecture of fasting serum lipid levels.

The current understanding of the genetic architecture of lipids has largely come from genome-wide association studies (GWAS). To date, few GWAS have examined the genetic architecture of lipids in Polynesians, and none have in Samoans, whose unique population history, including many population bottlenecks, may provide insight into the biological foundations of variation in lipid levels. Here we performed a GWAS of four fasting serum lipid levels: total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides (TG) in a sample of 2849 Samoans, with validation genotyping for associations in a replication cohort comprising 1798 Samoans and American Samoans. We identified multiple genome-wide significant associations (P < 5 × 10-8) previously seen in other populations-APOA1 with TG, CETP with HDL, and APOE with TC and LDL-and several suggestive associations (P < 1 × 10-5), including an association of variants downstream of MGAT1 and RAB21 with HDL. However, we observed different association signals for variants near APOE than what has been previously reported in non-Polynesian populations. The association with several known lipid loci combined with the newly identified associations with variants near MGAT1 and RAB21 suggest that while some of the genetic architecture of lipids is shared between Samoans and other populations, part of the genetic architecture may be Polynesian-specific.

ECHS1 disease in two unrelated families of Samoan descent: Common variant - rare disorder.

Mutations in the short-chain enoyl-CoA hydratase (SCEH) gene, ECHS1, cause a rare autosomal recessive disorder of valine catabolism. Patients usually present with developmental delay, regression, dystonia, feeding difficulties, and abnormal MRI with bilateral basal ganglia involvement. We present clinical, biochemical, molecular, and functional data for four affected patients from two unrelated families of Samoan descent with identical novel compound heterozygous mutations. Family 1 has three affected boys while Family 2 has an affected daughter, all with clinical and MRI findings of Leigh syndrome and intermittent episodes of acidosis and ketosis. WES identified a single heterozygous variant in ECHS1 at position c.832G > A (p.Ala278Thr). However, western blot revealed significantly reduced ECHS1 protein for all affected family members. Decreased SCEH activity in fibroblasts and a mild increase in marker metabolites in urine further supported ECHS1 as the underlying gene defect. Additional investigations at the DNA (aCGH, WGS) and RNA (qPCR, RT-PCR, RNA-Seq, RNA-Array) level identified a silent, common variant at position c.489G > A (p.Pro163=) as the second mutation. This substitution, present at high frequency in the Samoan population, is associated with decreased levels of normally spliced mRNA. To our understanding, this is the first report of a novel, hypomorphic allele c.489G > A (p.Pro163=), associated with SCEH deficiency.

Samoan Men's Sexual Attraction and Viewing Time Response to Male-to-Feminine Transgender and Cisgender Adults.

In many different cultures, some men express sexual interest in male-to-feminine (MtF) transgender individuals, but others do not. We examined whether, in Samoa, men who are sexually interested in fa'afafine (Samoan MtF transgender individuals) (MSF; N = 40) differed from men who were exclusively sexually interested in women (MSW; N = 41) in terms of their self-reported sexual attraction and viewing times responses to images of MtF transgender individuals who were feminine (e.g., had feminine hairstyles, makeup) but had not undergone gender-affirming surgeries (e.g., breast augmentation), cisgender women, and cisgender men. MSF reported that images of MtF transgender individuals were sexually attractive, although somewhat less attractive than images of cisgender women. In contrast, MSW reported that images of cisgender women were sexually attractive, but images of MtF transgender individuals were not. The groups did not differ in their sexual attraction ratings of men, which were uniformly low. MSF viewed MtF transgender individuals and cisgender women for a similar length of time and viewed both longer than cisgender men. In contrast, MSW viewed cisgender women longer than MtF transgender individuals and they viewed MtF transgender individuals longer than cisgender men. The present study indicates that responses to MtF transgender individuals vary among Samoan men who share a sexual preference for women.

Identifying opportunities to strengthen school food environments in the Pacific: a case study in Samoa.

BACKGROUND: Despite global recommendations to prioritise policies that create healthy food environments within education institutions, the implementation of effective healthy school food policies has proved challenging for many countries. This study examined the experience of Samoa subsequent to the 2012 introduction of a stronger policy to improve the healthiness of school food environments. Our aim was to identify opportunities to strengthen healthy school food policy implementation in Samoa and other comparable contexts. METHODS: We used a qualitative case study approach, underpinned by policy science theory. In 2018, we conducted in-depth semi-structured interviews with 30 informants, coupled with analysis of relevant documents, to generate a detailed understanding of the relevant policy implementation processes in Samoa, and the perspectives and capacities of key implementation actors. Data collection and analysis were guided by the Health Policy Analysis Triangle, supplemented by other policy theories relevant to policy process. RESULTS: Samoa's school food policy operationalizes international 'best practice' recommendations. We found health policymakers and leaders in Samoa to be strongly committed to improving school food environments. Despite this, there continued to be challenges in ensuring compliance with the school nutrition standards. Key issues that negatively impacted the policy's effectiveness were the lack of priority given to school food by stakeholders outside of health, the high prevalence of unhealthy food in the areas immediately surrounding schools, vendor knowledge and capacity, and the high degree of agency exercised by actors in and around the school. We noted several opportunities for policies to be effectively implemented and sustained. Respondents identified community-level leaders as potentially pivotal stakeholders, particularly where school governance arrangements draw heavily on community representation. CONCLUSIONS: Sustained and effective implementation of healthy school food policies requires continued engagement from political and community leaders, beyond initial commitment. There is potential to capitalize on political will for diet-related NCD prevention by more clearly demonstrating the institutional and operational requirements for effective and sustained implementation. Strong incentives for compliance and effective enforcement mechanisms are also likely to be crucial to success.

Decolonising violence against women research: a study design for co-developing violence prevention interventions with communities in low and middle income countries (LMICs).

BACKGROUND: There has been substantial progress in research on preventing violence against women and girls (VAWG) in the last 20 years. While the evidence suggests the potential of well-designed curriculum-based interventions that target known risk factors of violence at the community level, this has certain limitations for working in partnership with communities in low- and middle-income (LMIC) countries, particularly when it comes to addressing the power dynamics embedded within north-south research relationships. METHODS: As an alternative approach, we outline the study design for the EVE Project: a formative research project implemented in partnership with community-based researchers in Samoa and Amantaní (Peru) using a participatory co-design approach to VAWG prevention research. We detail the methods we will use to overcome the power dynamics that have been historically embedded in Western research practices, including: collaboratively defining and agreeing research guidelines before the start of the project, co-creating theories of change with community stakeholders, identifying local understandings of violence to inform the selection and measurement of potential outcomes, and co-designing VAWG prevention interventions with communities. DISCUSSION: Indigenous knowledge and ways of thinking have often been undermined historically by Western research practices, contributing to repeated calls for better recognition of Southern epistemologies. The EVE Project design outlines our collective thinking on how to address this gap and to further VAWG prevention through the meaningful participation of communities affected by violence in the research and design of their own interventions. We also discuss the significant impact of the COVID-19 pandemic on the project in ways that have both disrupted and expanded the potential for a better transfer of power to the communities involved. This article offers specific strategies for integrating Southern epistemologies into VAWG research practices in four domains: ethics, theories of change, measurement, and intervention design. Our aim is to create new spaces for engagement between indigenous ways of thinking and the evidence that has been established from the past two decades of VAWG prevention research and practice.

Development of a Risk-Factor Questionnaire for the Infant Ear and Hearing Program in Samoa.

PURPOSE: Congenital hearing loss is the most common sensory disorder present at birth. While universal newborn hearing screening is the standard for most high-income countries, alternative models are under consideration for most low and middle-income countries. The Pacific Islands have among the highest rates of paediatric ear disease and deafness in the world, and an interim Infant Ear and Hearing Program is currently being developed for the Polynesian nation of Samoa. The inclusion of a routine risk-factor questionnaire for childhood deafness in the Infant Ear and Hearing Program package is a feasible alternative for well-baby clinics in Samoa. DESCRIPTION: The World Health Organisation advocates that all member states should implement newborn and infant hearing screening. This includes a risk-factor questionnaire developed from the joint committee on infant hearing risk-factors, as well as additional risk-factors unique to low and middle income countries. The present paper examines all known risk-factors for childhood deafness to develop an appropriate and evidence-based questionnaire for inclusion in the Samoan Child Health Book and Infant Ear and Hearing Program package. ASSESSMENT: From a starting point of 19 risk-factors, 11 risk-factors were included with no changes; 5 risk-factors were modified to align with current health service availability in Samoa; 2 risk-factors were excluded due to cultural inappropriateness and irrelevance for Samoa; and 1 risk-factor was added for our Samoan and Pacific Island context. CONCLUSION: There are 17 items on the final risk-factor questionnaire for childhood deafness developed for Samoa. The Infant Ear and Hearing Program package will also include ear examinations and monitoring of hearing developmental milestones. The risk-factor questionnaire will be reviewed again in 5 years' time for the next edition of the Samoan Child Health Book.

Beliefs about cancer causation in Samoa: results from an awareness campaign recall survey.

INTRODUCTION: Cancer is a leading cause of death in Samoa. Cultural beliefs shape attitudes towards disease and disease prevention in Pacific countries, and are a barrier to engaging in cancer screening services. METHODS: A survey of 205 Samoan adults conducted as part of the evaluation of the first cancer awareness campaign implemented in Samoa explored beliefs about cancer causation. RESULTS: Lifestyle factors associated with a departure from fa'aSamoa (traditional lifestyle) were most commonly cited as causing cancer. Cancer was also attributed to pathogens and person-to-person transmission, and, to a lesser extent, cultural beliefs including supernatural agency (spirits, God). CONCLUSION: Addressing misconceptions while integrating certain aspects of fa'aSamoa into cancer control strategies could support greater engagement in health promotion practices and screening initiatives.

Tenacious Endemic Typhoid Fever in Samoa.

BACKGROUND: Typhoid fever has been endemic on the island nation of Samoa (2016 population, 195 979) since the 1960s and has persisted through 2019, despite economic development and improvements in water supply and sanitation. METHODS: Salmonella enterica serovar Typhi isolates from the 2 hospitals with blood culture capability and matched patient demographic and clinical data from January 2008 through December 2019 were analyzed. Denominators to calculate incidence by island, region, and district came from 2011 and 2016 censuses and from 2017-2019 projections from Samoa's Bureau of Statistics. Data were analyzed to describe typhoid case burden and incidence from 2008 to 2019 by time, place, and person. RESULTS: In sum, 53-193 blood culture-confirmed typhoid cases occurred annually from 2008 to 2019, without apparent seasonality. Typhoid incidence was low among children age < 48 months (17.6-27.8/105), rose progressively in ages 5-9 years (54.0/105), 10-19 years (60.7-63.4/105), and 20-34 years (61.0-79.3/105), and then tapered off; 93.6% of cases occurred among Samoans < 50 years of age. Most typhoid cases and the highest incidence occurred in Northwest Upolu, but Apia Urban Area (served by treated water supplies) also exhibited moderate incidence. The proportion of cases from short-cycle versus long-cycle transmission is unknown. Samoan S. Typhi are pansusceptible to traditional first-line antibiotics. Nevertheless, enhanced surveillance in 2019 detected 4 (2.9%) deaths among 140 cases. CONCLUSIONS: Typhoid has been endemic in Samoa in the period 2008-2019. Interventions, including mass vaccination with a Vi-conjugate vaccine coadministered with measles vaccine are planned.

View From the Canoe: Co-Designing Research Pacific Style.

In 2016, Rose Lamont and Tana Fishman were the first patient-clinician dyad from outside North America to attend the North American Primary Care Research Group (NAPCRG) Patient and Clinician Engagement Program workshop. They returned to New Zealand inspired and formed the Pacific People's Health Advisory Group and a Pacific practice-based research network (PBRN). They are guided by the principles of co-design, and the Samoan research framework fa'afaletui, which emphasizes a collective approach and importance of reciprocity and relationships. Their collective inquiry aims to reduce health inequalities experienced by Pacific people in South Auckland. Their community group members and PBRN are generating research questions being answered by university-based graduate students. When they embarked, they knew not the direction in which they headed. With guidance, their community members and clinicians have led the way. By giving everyone a say in where they are going and how they get there, they are modeling what they wish to achieve-an egalitarian approach which decreases disparities for Pacific people.

The potential impact of a recent measles epidemic on COVID-19 in Samoa.

BACKGROUND: The pandemic of COVID-19 has occurred close on the heels of a global resurgence of measles. In 2019, an unprecedented epidemic of measles affected Samoa, requiring a state of emergency to be declared. Measles causes an immune amnesia which can persist for over 2 years after acute infection and increases the risk of a range of other infections. METHODS: We modelled the potential impact of measles-induced immune amnesia on a COVID-19 epidemic in Samoa using data on measles incidence in 2018-2019, population data and a hypothetical COVID-19 epidemic. RESULTS: The young population structure and contact matrix in Samoa results in the most transmission occurring in young people < 20 years old. The highest rate of death is the 60+ years old, but a smaller peak in death may occur in younger people, with more than 15% of total deaths in the age group under 20 years old. Measles induced immune amnesia could increase the total number of cases by 8% and deaths by more than 2%. CONCLUSIONS: Samoa, which had large measles epidemics in 2019-2020 should focus on rapidly achieving high rates of measles vaccination and enhanced surveillance for COVID-19, as the impact may be more severe due to measles-induced immune paresis. This applies to other severely measles-affected countries in the Pacific, Europe and elsewhere.

Heterogeneity in the Sexual Orientations of Men Who Have Sex with Fa'afafine in Samoa.

In Samoa, feminine natal males who possess male-typical genitalia are known locally as fa'afafine. Some Samoan men express sexual interest in fa'afafine, whereas others do not. To assess the sexual orientation of men who are sexually interested in fa'afafine, we collected sexual attraction ratings and viewing times of Samoan men's and women's faces. Study 1 (N = 130) focused on men who were insertive or versatile during anal sex with fa'afafine partners. These men were compared to each other, as well as to males (i.e., men and fa'afafine) who were exclusively sexually interested in either women or men. Study 2 (N = 180) compared men who had sex with fa'afafine and women; men who had sex with fa'afafine, women, and men; and men who had sex with fa'afafine and men. These men were compared to each other, as well as to males who were exclusively sexually interested in either women or men. These studies suggest that men who have sex with fa'afafine are a heterogeneous group. A small portion of the men who are sexually interested in fa'afafine shows a relatively bisexual pattern of sexual attraction ratings and viewing times, namely men who have sex with fa'afafine, men, and women. In contrast, a larger number of men who were sexually interested in fa'afafine responded in a manner similar to men who were exclusively sexually interested in either women or men. The present research suggests that additional insights into male sexual orientation can be garnered by focusing on how sexuality is expressed in non-Western cultural contexts.