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Objectives: Studies suggest that living at high altitude decreases obesity risk, but this research is limited to single‐country analyses. We examine the relationship between altitude and body mass index (BMI) among women living in a diverse sample of low‐ and middle‐income countries. Materials and Methods: Using Demographic and Health Survey data from 1 583 456 reproductive age women (20–49 years) in 54 countries, we fit regression models predicting BMI and obesity by altitude controlling for a range of demographic factors—age, parity, breastfeeding status, wealth, and education. Results: A mixed‐effects model with country‐level random intercepts and slopes predicts an overall −0.162 kg/m2 (95% CI −0.220, −0.104) reduction in BMI and lower odds of obesity (OR 0.90, 95% CI 0.87, 0.95) for every 200 m increase in altitude. However, countries vary dramatically in whether they exhibit a negative or positive association between altitude and BMI (34 countries negative, 20 positive). Mixed findings also arise when examining odds of obesity. Discussion: We show that past findings of declining obesity risk with altitude are not universal. Increasing altitude predicts slightly lower BMIs at the global level, but the relationship within individual countries varies in both strength and direction. [ABSTRACT FROM AUTHOR]

This paper explores the impact of livelihood strategies and place on mental well‐being. Identifying different socioeconomic factors that impact mental well‐being across contexts is pressing given the global rise in mental health disorders. Numerous studies in the population and social sciences have emphasized the protective role of material wealth on human health and well‐being; however, scholars frequently assess wealth as a one‐dimensional variable, which may fail to capture diverse forms of wealth. Acknowledging different forms of wealth may be particularly important in settings where agricultural economies coexist with cash economies. Using data from the 2013 Namibia Demographic Health Survey (n = 13 377), we use a newly developed measure of success in agricultural activities, an agricultural wealth index, or AWI, generated by Hackman et al., (2021). To examine the role of different forms of wealth on mental health symptoms. We find mental well‐being, assessed through three survey questions, is lower among urban dwellers and females and shows varied associations with wealth type and sex/gender. In general, success in agricultural activities is associated with better mental well‐being, while the association with market success is null or and conditional upon sex/gender and place. This study adds to recent work on the value of using multidimensional measures of wealth and raises important questions about why wealth type and sex/gender differentially impact mental well‐being. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Although wealth is consistently found to be an important predictor of health and well-being, there remains debate as to the best way to conceptualize and operationalize wealth. In this article, we focus on the measurement of economic resources, which is one among many forms of wealth. We provide an overview of the process of measuring material wealth, including theoretical and conceptual considerations, a how-to guide based on the most common approach to measurement, and a review of important theoretical and empirical questions that remain to be resolved. Throughout, we emphasize considerations particular to the settings in which anthropologists work, and we include variations on common approaches to measuring material wealth that might be better suited to anthropologists' theoretical questions, methodological approaches, and fieldwork settings. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives To test the hypothesis that moderate iron deficiency among children is associated with lower likelihood of infection. Materials and Methods We use data from a population representative cross sectional study of 1164 Tanzanian children aged 6-59 months from the Tanzania Demographic and Health Survey. Respondents' iron levels were assessed through serum transferrin receptor (sTfR) and anemia was assessed using hemoglobin. C-reactive protein (CRP) was used as a marker of infection. Results Nearly 25% of the children were categorized as normal (iron replete, non-anemic); 45% were IDE (low iron, non-anemic), 24% were classified as IDA (low iron, anemic), and 69 children (5.9%) were anemic but had no evidence of iron deficiency. IDE was not associated with a lower likelihood of elevated CRP compared to iron replete, non-anemic children; 45% of normal children had elevated CRP compared to 51% of IDE children ( P = 0.10). IDA, by contrast, was associated with a higher likelihood of elevated CRP (68%, P < 0.001). These results were unchanged when child, maternal, and household controls were added to a logistic regression model. Discussion Our results do not support the optimal iron hypothesis as conventionally formulated. The fact that we did not find an effect where some other studies have may be due to differences in study design, sample (e.g., age), or the baseline pathogenic ecology. Alternatively, it may be more fruitful to investigate iron regulation as an allostatic system that responds to infections adaptively, rather than to expect an optimal pre-infection value. Am J Phys Anthropol 157:675-679, 2015. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

While the global number of resettled refugees rises annually, the summaries of research on refugee health needs in countries of asylum remain sparse. We conducted a systematic review of published research on refugee health in Canada in order to: (i) identify studies addressing health outcomes among refugees recently resettled in Canada; (ii) identify general trends in health research conducted in Canada among refugee populations; (iii) identify significant gaps in current knowledge of health-related issues among refugees recently resettled in Canada; (iv) evaluate the quality and consistency of available information; (v) develop a summary of available research results; and (vi) identify priorities for future research. A search of several major citation indices resulted in the analysis of 196 research reports after reviewing more than 5,000 articles. This review is timely, systematic and inclusive; furthermore, potential biases in methodology are clearly assessed. The results indicate an immediate need to address specific gaps in health knowledge for refugee populations and lead us to draw five primary conclusions. First, mental health outcomes dominate the research landscape. Second, cross-sectional studies are most commonly the study design of choice. Third, studies examining some aspect of health among refugees from Asia dominate the literature. Fourth, there is a notable lack of information on cardiovascular diseases and its antecedents. Fifth, indications show that screenings for pre-existing conditions are biased towards communicable diseases. These findings have implications for health monitoring, evaluation and policy affecting the health of refugees resettled in Canada and elsewhere. [ABSTRACT FROM AUTHOR]

Food insecurity has traditionally been characterized as a driver of health disparities because of its potential impacts on nutritional status. Food, however, has important social and cultural valences that make it much more than a nutritional vehicle. Recent research that is sensitive to the social meanings of food has drawn attention to the complex and far-reaching mental and social health effects of food insecurity. In this article, we outline several theoretical pathways linking food insecurity to reduced physical and mental well-being, and then present results of a preliminary study in rural Brazil designed to test the relative importance of each of these pathways. Our results tentatively suggest that in this context, food insecurity is closely related to both mental and physical health disparities, but the pathways connecting food insecurity and mental health remain somewhat unclear. We present lessons learned and propose a set of research steps to further address the relationships between the social meaning of food and mental health. [ABSTRACT FROM AUTHOR]

Objectives There is increasing interest in the epidemiology of immune activation among young children because of the links with mortality and growth. We hypothesized that infant and child inflammation, as measured by elevated C-reactive protein (CRP), would be associated with household assets, household size, measures of sanitation, and food insecurity. We also hypothesized that children in the poorest households and with elevated CRP would show evidence of growth faltering. Methods A nationally representative cross-sectional study of Tanzania children 6-59 months of age. Survey data, anthropometrics, and dried blood spots were available for 1,387 children. Measures of elevated CRP (CRP ≥ 1.1 mg/l) were used to assess inflammation. Results Fifty-four percent of the sample had CRP ≥ 1.1 mg/l. In bivariate analyses, several measures of sanitation were associated with elevated CRP but in multiple regression models only age, sex, literacy, maternal reports of illness, household size, and living in the wealthiest households predicted CRP. There were no associations between elevated CRP and any measure of child growth. Conclusions Among children in Tanzania, a single elevated CRP does not predict poor growth functioning. Elevated CRP is associated with individual, caretaker, household, and community-level variables. Future work should strive to measure local biologies in more nuanced ways. Am. J. Hum. Biol. 26:523-529, 2014. © 2014 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

ABSTRACT Many studies have linked measures of adult body shape and mass in ancient and contemporary populations to ecogeographical variables such as temperature and latitude. These results tend to support Bergmann's rule, which posits that bodies will be relatively less slender for their height in colder climates and more slender in warmer climates. Less well explored is the ontogeny of these population-level differences. Here we use data on infants and children from 46 low and lower income countries to test whether children's weight for height is associated with measures of temperature and latitude. We also test the hypothesis that children living in areas with greater pathogen prevalence will be lighter for their height because of life history trade-offs between investment in immune function and growth. Finally, we test whether population specific adult body mass predicts infant and child body mass, and whether this is independent of ecogeographical variables. Our results show that maximum monthly temperature explains 17% of children's weight for height while adult population-level body mass explains ∼44% (Table [Regression]). The measures of pathogen prevalence explain little of the variation in children's body shape (8%; P > 0.05). Our results suggest that population differences are consistent with Bergmann's rule but parental body shape explains more variance. Moreover, these population-level differences arise early in development, suggesting that any possible environmental influences occur in utero and/or result from epigenetic or population genetic differences. Am J Phys Anthropol 154:232-238, 2014. © 2014 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Measures of human body mass confound 1) well-established population differences in body form and 2) exposure to obesogenic environments, posing challenges for using body mass index (BMI) in cross-population studies of body form, energy reserves, and obesity-linked disease risk. We propose a method for decomposing population BMI by estimating basal BMI (bBMI) among young adults living in extremely poor, rural households where excess body mass accumulation is uncommon. We test this method with nationally representative, cross-sectional Demographic and Health Surveys (DHS) collected from 69,916 rural women (20-24 years) in 47 low-income countries. Predicting BMI by household wealth, we estimate country-level bBMI as the average BMI of young women (20-24 years) living in rural households with total assets <400 USD per capita. Above 400 USD per capita, BMI increases with both wealth and age. Below this point, BMI hits a baseline floor showing little effect of either age or wealth. Between-country variation in bBMI (range of 4.3 kg m−2) is reliable across decades and age groups ( R2 = 0.83-0.88). Country-level estimates of bBMI show no relation to diabetes prevalence or country-level GDP ( R2 < 0.05), supporting its independence from excess body mass. Residual BMI (average BMI minus bBMI) shows better fit with both country-level GDP ( R2 = 0.55 vs. 0.40) and diabetes prevalence ( R2 = 0.23 vs. 0.17) than does conventional BMI. This method produces reliable estimates of bBMI across a wide range of nationally representative samples, providing a new approach to investigating population variation in body mass. Am J Phys Anthropol 153:542-550, 2014. © 2013 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Introduction Worldwide, a shortage of skilled health workers has prompted a shift toward community-based health workers taking on greater responsibility in the provision of select maternal and newborn health services. Research in mid- and high-income settings suggests that coworker collaboration increases productivity and performance. A major gap in this research, however, is the exploration of factors that influence teamwork among diverse community health worker cadres in rural, low-resource settings. The purpose of this study is to examine how sociodemographic and structural factors shape teamwork among community-based maternal and newborn health workers in Ethiopia. Methods A cross-sectional survey was conducted with health extension workers, community health development agents, and traditional birth attendants in 3 districts of the West Gojam Zone in the Amhara region of Ethiopia. Communities were randomly selected from Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) sites; health worker participants were recruited using a snowball sampling strategy. Fractional logit modeling and average marginal effects analyses were carried out to identify the influential factors for frequency of work interactions with each cadre. Results One hundred and ninety-four health workers participated in the study. A core set of factors-trust in coworkers, gender, and cadre-were influential for teamwork across groups. Greater geographic distance and perception of self-interested motivations were barriers to interactions with health extension workers, while greater food insecurity (a proxy for wealth) was associated with increased interactions with traditional birth attendants. Discussion Interventions that promote trust and gender sensitivity and improve perceptions of health worker motivations may help bridge the gap in health services delivery between low- and high-resource settings. Inter-cadre training may be one mechanism to increase trust and respect among diverse health workers, thereby increasing collaboration. Large-scale, longitudinal research is needed to understand how changes in trust, gender norms, and perceptions of motivations influence teamwork over time. [ABSTRACT FROM AUTHOR]

Food security occurs when all members of a household have reliable access to food in sufficient quantity and quality to maintain an active and healthy lifestyle. Given the important biological and social value of food for humans, food and food sufficiency have been traditional topics of study among biological anthropolo-gists. The focus on food insecurity, however, has emerged within the past two decades and recent global events, including the food crisis of 2007/2008, have led to renewed interests in the topic of food insecurity and wellbeing. Here, we review current and novel threats to food security, current thinking on measurement and definitions, and then outline a model that links food insecurity to coping strategies and then to health out-comes. We suggest that coping strategies are typically context-specific and can be food and nonfood based. We further suggest that coping strategies may impact health quite broadly, not just through nutritional path-ways. We then review available data on the relation-ship between food insecurity and nutritional status, chronic diseases, infectious diseases, and mental health. Our review highlights the far reaching consequences of food insecurity for human wellbeing but also the consid-erable variability in its effect and our limited empirical knowledge of the pathways through which food insecur-ity impacts health. We conclude by offering thoughts on how biological anthropologists might contribute to grow-ing our understanding of food insecurity and human health and wellbeing [ABSTRACT FROM AUTHOR]

Objectives: There is considerable interest in the link between household food insecurity and child wellbeing, and the extent to which caregiver wellbeing mediates the relationship between food insecurity and child wellbeing. The aim of this was to assess these relationships among a rural population in Ethiopia. Methods: We used existing survey data from a maximum of 1,006 children under 5 years of age with matched data on household-level data on food insecurity, caregiver distress, and asset ownership, along with other sociodemographic information. All respondents lived in a predominately rural, primarily subsistence-based area in southwest Ethiopia. Multivariable regression models were used to test hypothesized associations. Results: Household food insecurity, distress, and socioeconomic status predicted children's weight for age and undernutrition, defined as weight for age Z (WAZ) less than −2SD from the reference median. A small portion of the household food insecurity effect was mediated by caregiver distress but these were largely independent effects. Maternal distress was associated with greater odds of a child having any illness, and any illness was associated with lower WAZ and higher odds of being undernourished. The effect of maternal distress on undernutrition was mediated by diarrhea. Conclusions: This study suggests that household food insecurity, maternal distress, and household SES are independent contributors to children's undernutrition. Our results are consistent with others but are not generally consistent with the hypothesis that maternal distress is a primary pathway through which food insecurity impacts on child nutritional wellbeing. Am. J. Hum. Biol. 2012. © 2011 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

This report describes preliminary findings about the connections between type 2 diabetes, mental health, and normative social roles among women living in Delhi, India. We conducted freelist interviews with 62 diabetic and nondiabetic women about women's roles, perceptions of diabetes, and 'tension,' a common Hindi-language idiom used to express stress. Using the freelist results, we produced and then administered a questionnaire to a pilot sample of 33 diabetic women. Among the diabetic women, physical symptoms of diabetes predicted higher biomedical anxiety and 'tension,' whereas difficulties achieving gender-specific social roles predicted higher biomedical depression. We conclude that both physical symptoms of diabetes and difficulties achieving socially important roles contribute to poor mental health among these diabetic women; further research will clarify the relationships among depression, anxiety, 'tension,' and women's physically and socially mediated experiences of diabetes. [ABSTRACT FROM AUTHOR]

It is not known to what extent food insecurity may underlie the continued high rates of maternal to child transmission of HIV and AIDS (MTCT) in sub-Saharan Africa, where most cases of pediatric HIV and AIDS are reported to occur. However, a number of plausible conceptual models and a growing evidence base drawn from both qualitative and empirical studies suggest that food insecurity contributes significantly to the epidemic of pediatric HIV infection. Specifically, food insecurity puts women at risk of HIV infection and weakens the ability of infected women and the health systems to which they may have access to prevent secondary infection of their children. Applied anthropologists have played a role in understanding some of the pathways through which food insecurity mediates biological and social risks of maternal to child transmission of HIV and AIDS. Efforts to understand and address the biocultural pathways through which food insecurity increases transmission of HIV from mothers to children can raise awareness of the importance of food and nutrition security among policy makers and program planners. Applied research on food insecurity by anthropologists can inform communities and contribute to the design of improved programs to prevent of MTCT. [ABSTRACT FROM AUTHOR]

Several related demographic trends are occurring in developing countries: youth comprise a large portion of populations, fertility rates are declining, and urban dwellers are increasing. As fertility rates decline and populations age, the decline in the ratio of young dependents to working age adults is expected to free up household resources, which can be invested in human capital, including youth nutritional wellbeing. We test this hypothesis in a sample of youth ( n = 1,934) in Southwestern Ethiopia. Multiple measures of achieved growth and nutritional status are explored (weight, height, mid-upper arm circumference (MUAC), body mass index (BMI) and body mass index for age z-score (BMIZ), weight for age z-score (WAZ), and height for age z-score (HAZ)). In multivariable models controlling for the effects of income, age, gender, and youth workloads, youth living in rural settings had significantly lower weight (1.24 kg lighter), MUAC (0.67 cm lower), BMI (0.45 BMI lower), BMIZ (0.27 lower), HAZ (0.14 HAZ lower), and WAZ (0.3 WAZ lower) than urban youth (all P < 0.01). Compared with youth in the lowest dependency ratio households, results show that youth in households with the highest dependency ratios were estimated to be 1.3 kg lighter, have 0.67 cm smaller MUAC, and BMI that was 0.59 lower (all P<0.01). Similar results were found for WAZ (0.21 lower) and BMIZ (0.36 lower). Youth height and HAZ were not associated with household dependency. These results may point toward increasing levels of human capital investments in Ethiopian youth as fertility levels decline and populations urbanize. Am J Phys Anthropol, 2011. © 2011 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

The accurate assessment of risky sexual behaviors and barriers to condom use is essential to reduce the spread of HIV/AIDS. This study tests a new nonverbal response-card method for obtaining more accurate responses to sensitive questions in the context of face-to-face interviewer-administered questionnaires in a survey of 1,269 Ethiopian young people aged 13-24. Comparisons of responses between a control group that provided verbal responses and an experimental group that used the card indicate that the prevalence of nonmarital sexual intercourse may be two times higher and knowledge of condom access may be 22 percent lower in the study than typical population-survey methods suggest. These results suggest that our nonverbal response-card method yields less biased estimates of risky adolescent sexual behavior and perceived access to condoms than those derived from conventional face-to-face interviewer-administered surveys, and that this method provides an effective, easy-to-use, low-cost alternative. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discuss various reports within the issue on topics including health and socioeconomic status among Hispanics, prevalence of child hunger among Somali refugees in Maine, and impact of food choices in cultural communities.

Each year the United States accepts 40,000-70,000 refugees. Refugees face many unique challenges and opportunities as they, very often, transition from nonindustrialized contexts (low-income, low-reliance on processed foods, high mortality rate) to industrialized settings (high-income, high-reliance on processed foods, low mortality rate). This article contributes to the existing literature on migration health and acculturation by underscoring how refugees' daily life interactions and activities are at work in the social production of health inequalities in the United States. In the voice of refugee participants, we present and summarize the numerous individual and structural factors that directly or indirectly relate to refugee diet and mental and physical well-being after resettlement. [ABSTRACT FROM AUTHOR]

The article presents a study that investigates female autonomy and women's health relationship. The study assessed measures of women autonomy such as ownership, control over buying and decision making through extensive questionnaires. Results show that freedom-related and control autonomy has lower depression levels and systolic blood pressure, while decision making autonomy has higher depressive and diastolic blood pressure. Moreover, autonomy and health relation was suggested to be complex.

The global food crisis has led to increased interest in food insecurity and its causes and consequences. Much of the focus however has been on mothers and young children, with little attention paid to the possible impacts on the large population of youth in developing countries. The objectives of this paper are to (1) draw attention to the food insecurity experience of a forgotten population, youth; (2) test whether the prevalence of food insecurity among Ethiopian adolescents is increasing with the rising cost of foods; and (3) to identify some individual, household, temporal, and spatial predictors of vulnerability. Data are drawn from a baseline survey in 2006 and a follow-up survey round conducted in 2007 of an ongoing population-based longitudinal study of approximately 2,100 youth living in southwestern Ethiopia. Results show high levels of food insecurity among youth, a marked increase in the experience of food insecurity among youth, and a bias in vulnerability toward youth in the poorest households and in rural households. During the intersurvey period boys were also more likely than girls to become food insecure. This latter finding effectively eliminates the gender bias in food insecurity observed in the baseline survey. Youth who became food insecure between survey rounds were also more likely to report worse health in 2007 than in 2006. Collectively our results suggest that youth are not being adequately buffered from food insecurity, and that generalizations about the current food crisis may be too broad and, thus, misrepresent vulnerable groups. Future research should focus on how to best protect vulnerable youth from the experience of food insecurity and its consequences. [ABSTRACT FROM AUTHOR]

The article discusses the symptoms of anxiety and depression in relation to seasonal changes in household food insecurity. The author explains that burdens of disease in developing countries are caused by common mental health disorders. He mentions that seasonal changes in food insecurity are correlated with concomitant changes in measures of anxiety symptoms.

The Sukuma ethnic group appears to be expanding across Tanzania at a rate far greater than other ethnic groups in the area. In this paper, the household-level dynamics that may be fueling this expansion are explored by comparing measures of infant mortality and child health with another Tanzanian ethnic group, the Pimbwe. Consistent with expectations, the Sukuma appear to have comparable levels of fertility but lower child mortality. As predicted, compared to the Pimbwe, Sukuma children are also heavier and taller for their age, suggesting better nutritional status. Four hypotheses about why the Sukuma are so successful in this area are addressed. Surprisingly, the results show that household food security and wealth are not related to children's nutritional status, nor can maternal effects account for the observed health differences. Several lines of evidence suggest that different patterns of infant feeding practices may underlie the differences in children's nutritional status. [ABSTRACT FROM AUTHOR]

ABSTRACT Anthropologists and demographers have devoted considerable attention to testing the fertility-polygyny hypothesis, which posits that polygynously married women have lower fertility than their monogamously married counterparts. Much less attention has been paid to the potential impact of polygynous marriages on the health and well-being of children. The objective of this paper was to assess whether polygynous marital status is a risk factor for poor nutritional status and growth performance among a cohort of young Tanzanian children. Using data collected from both wet and dry season periods, we tested for an association from both cross-sectional and longitudinal perspectives. Despite relatively high nutritional status compared to other agropastoralists and horticultural populations, as well as the presence of various socioecological factors that were expected to mitigate any "costs" to polygynous marriage, we found that among our target population, polygynous marital status is a risk factor for poor growth performance. This association is most pronounced in the wet season, and maintains even after allowing for the potential influences of child age and sex, and household characteristics. These results counter our original expectation, and suggest that polygyny is costly to children in this population; this does not appear to be the result of difference in early child environment or household wealth. [ABSTRACT FROM AUTHOR]

The article presents a study on the relationship between measures of psychosocial stress and marital status in mothers in two Tanzanian communities. Results indicated that there is no connection between psychosocial stress and marital type. It suggests that women in polygynous marriages in these communities are not at significantly increased risk of experiencing common mental health disorders.

Purpose: To build a new measure of trust from the ground up that is valid and locally relevant. Background: Little is known about the influence of trust among health workers in low-resource settings. Trust may be particularly salient among health workers in developing countries such as Ethiopia where skilled health worker shortages have led to reliance on lower-skilled community-level health workers to provide services. Methods: Ethnographic data on the conceptualization of trust were collected through semi-structured interviews with 30 health workers in Amhara region, Ethiopia. Transcripts underwent thematic analysis to identify characteristics of trustworthiness. Respondents' own words were used to build a 25-item trust scale which was subsequently pilot tested with 92 health workers. Cultural consensus analysis and Quadratic Assignment Procedure (QAP) assessed the level of shared cultural knowledge within and between cadres of health workers. Results: Psychometric testing of the trust scale reveals strong internal consistency. Cultural consensus analysis and QAP provide preliminary evidence for the existence of divergent models of trust among health worker cadres. Conclusions: This represents a case example of how rapid formative work can lead to the development of a scale that is both valid and locally relevant. Next steps in the research involve assessing the association between trust and teamwork, and linking trust and teamwork with delivery of health services and outcomes. Funding: Bill and Melinda Gates Foundation [ABSTRACT FROM AUTHOR]

Food insecurity is a major health problem that has pervasive effects on many human biological outcomes. In particular, there are compelling theoretical and empirical reasons to expect that the relationship between food insecurity may be directly related to mental health morbidities, and may be quantifiable in developing country settings. This preliminary study examined whether caretaker reports of food insecurity were associated with anxiety and depression among four ethnic groups in two communities of rural Tanzania. In-home interviews were conducted in June-August of 2005 among female caretakers (n = 449). In addition to collecting household and demographic data, modified versions of the USDA's food security module and Hopkins Symptom Checklist (HSCL) were used to measure food insecurity and anxiety and depression. Consistent with predictions, the results showed a strong positive correlation between a caretaker's score on the food insecurity instrument and her summed response on the HSCL (P < 0.0001). This association was maintained in all four ethnic groups, even when controlling for individual-level covariates such as caretaker's age and marital status. Issues of causality and hypotheses that might explain this robust finding are discussed, as are methodological and theoretical implications.