OBJECTIVES:Around 11% of U.S. children are diagnosed with attention-deficit/hyperactivity disorder (ADHD). One hypothesis for ADHD's relatively high prevalence is that behaviors associated with ADHD were advantageous in past environments where they were positively selected for. A previous study showed that an allele associated with ADHD-the 7R allele of the gene encoding the D(4) dopamine receptor (DRD4)-had a positive effect on the nutritional status of nomadic adult Ariaal men and a negative effect on settled adult men. We attempted to replicate this finding by analyzing the impact of DRD4 7R on children's nutrition and other household metrics in the Rendille, a population closely related to the Ariaal. METHODS:We genotyped 259 Rendille children aged 5-10 years for DRD4 7R and analyzed this against previously collected anthropometric and household data from two Rendille towns. Analyses were pre-registered (https://osf.io/p8yv2/) before the addition of the 7R genotype to the dataset. RESULTS:DRD4 7R was not associated with iron nutrition, indicated by transferrin receptor (TfR) concentration, height-for-age (HAZ) or weight-for-height Z-scores (WHZ), or with maternal education status. However, DRD4 7R was positively associated with household economic status (p = 0.047). CONCLUSIONS:The failure to replicate an association between DRD4 7R and nutritional status might be due to this sample being of children who are not yet substantially provisioning themselves. Given that children's genotypes are correlated with parents' genotypes, it is likely that the effects of the parents' genotypes, rather than the participating children's, explain the association between children's DRD4 7R genotype and household economic success.

Abstract Objectives To examine the circumstances and needs of older adults who were “kinless,” defined as having no living spouse or children, when they developed dementia. Methods We conducted a secondary analysis of information from the Adult Changes in Thought study. Among 848 participants diagnosed with dementia between 1994 and 2016, we identified 64 who had no living spouse or child at dementia onset. We then conducted a qualitative analysis of administrative documents pertaining to these participants: handwritten comments recorded after each study visit, and medical history documents containing clinical chart notes from participants’ medical records. Results In this community-dwelling cohort of older adults diagnosed with dementia, 8.4% were kinless at dementia onset. Participants in this sample had an average age of 87 years old, half lived alone, and one third lived with unrelated persons. Through inductive content analysis, we identified 4 themes that describe their circumstances and needs: (1) life trajectories, (2) caregiving resources, (3) care needs and gaps, and (4) turning points in caregiving arrangements. Discussion Our qualitative analysis reveals that the life trajectories that led members of the analytic cohort to be kinless at dementia onset were quite varied. This research highlights the importance of nonfamily caregivers and participants’ own roles as caregivers. Our findings suggest that clinicians and health systems may need to work with other parties to directly provide dementia caregiving support rather than rely on family, and address factors such as neighborhood affordability that particularly affect older adults who have limited family support.

Literature on dynamics of change in female genital mutilation/cutting (FGM/C) portray two common but conflicting views. On one side, FGM/C is seen as static and deeply entrenched, with parents lacking agency to interpret culture, evaluate options and adopt changes. An alternative perspective focuses on the fluidity of social norms, influencing whether and how FGM/C is practised. This study asks: in counties where FGM/C persists at high rates, Kisii and Narok, are there changes in the way that FGM/C is performed? and what drives these changes? In-depth interviews and focus group discussions were conducted to illuminate these questions. Data showed five ways that FGM/C practices have changed: (1) reduction in severity of cutting, (2) medicalised cutting, (3) performing FGM/C at younger ages, (4) cutting in secret, and (5) occasionally, abandonment of FGM/C. Messaging on health risks of FGM/C and fear of criminal punishment have motivated less severe cutting and medicalisation. Legislation has also driven the practice underground. Programmes aimed at ending FGM/C should create a critical dialogue on changes in norms with the intent of reducing stigmatisation of uncut girls and their families, and the ways cutting practices are shifting, thereby building on change that is already underway.

Countries around the world have passed laws specifically banning female genital mutilation/cutting. Legal restrictions vary as to whether they apply to both girls and adult women or to minors only, and few address a second set of genital cutting procedures known as 'female genital cosmetic surgeries'. Different legal framings reflect variation in views regarding women's autonomy and their ability to provide meaningful consent. Social norms theory has drawn attention to the fact that in societies where customary female genital mutilation/cutting is common, women can be under intense pressure to conform lest risking social inclusion, support and possibly marriage prospects. Hence, protectionist measures by the state have been invited. Much less attention has been directed towards the broader circumstances that can shape and constrain women's autonomy, including economic instability, limited access to resources and services, political marginalisation and discrimination, and global factors such as climate change. In this article, I highlight the promise of intersectional analyses of factors influencing female genital mutilation/cutting and suggest that in moving beyond the problematic distinction of 'modern' and 'traditional' societies, it is more fruitful to understand the multiple and combined factors that influence women's empowerment. Drawing on case studies from Senegal, Kenya and the US, I illustrate that the logic to perform female genital mutilation/cutting or to resist engaging in community outreach on female genital mutilation/cutting may not only emanate from community norms, but also include broader conditions that influence people's ability to cope with precarious livelihoods. A more comprehensive understanding of spheres of influence on women's choices can be gained by examining how structural, material, social and individual domains overlap in a woman's life. Programmes that aim to address female genital mutilation/cutting may be enhanced by expanding beyond a focus on legal reform and social norms to also address the broader structural and global factors that influence women's agency.

Anthropogenic carbon emissions have the potential to trigger changes in climate and ecosystems that would be catastrophic for the well-being of humans and other species. Widespread shifts in production and consumption patterns are urgently needed to address climate change. Although transnational agreements and national policy are necessary for a transition to a fully decarbonized global economy, fluctuating political priorities and lobbying by vested interests have slowed these efforts. Against this backdrop, bottom-up pressure from social movements and shifting social norms may offer a complementary path to a more sustainable economy. Furthermore, norm change may be an important component of decarbonization policies by accelerating or strengthening the impacts of other demand-side measures. Individual actions and policy support are social processes-they are intimately linked to expectations about the actions and beliefs of others. Although prevailing social norms often reinforce the status quo and unsustainable development pathways, social dynamics can also create widespread and rapid shifts in cultural values and practices, including increasing pressure on politicians to enact ambitious policy. We synthesize literature on social-norm influence, measurement, and change from the perspectives of psychology, anthropology, sociology, and economics. We discuss the opportunities and challenges for the use of social-norm and social-tipping interventions to promote climate action. Social-norm interventions aimed at addressing climate change or other social dilemmas are promising but no panacea. They require in-depth contextual knowledge, ethical consideration, and situation-specific tailoring and testing to understand whether they can be effectively implemented at scale. Our review aims to provide practitioners with insights and tools to reflect on the promises and pitfalls of such interventions in diverse contexts.

Female genital mutilation derails efforts to achieve gender equality and the empowerment of girls and women. In Kenya, national estimates show a steady decline in prevalence, although there is considerable variation at the sub-national level. There is a need to better understand female genital mutilation-related norms and meanings and whether there have been changes in these given long-term and diverse efforts to promote abandonment. Focusing on Narok and Kisii counties, we conducted a cross-sectional qualitative study to identify social norms surrounding the practice of female genital mutilation, as well as consensus or contestation with respect to these norms. Ten focus group discussions were held with men and women aged 18 years and older from the Maasai and Abagusii communities that have traditionally practised female genital mutilation. Study findings showed that norms associated with female genital mutilation such as sexuality and marriageability were actively contested by community members. This change may provide a useful starting point for programmes that seek to create dialogue and critical reflection on female genital mutilation to accelerate its abandonment.

There exist two dominant but conflicting views on the role of men in the perpetuation female genital mutilation/cutting (FGM/C). One paints men as culprits, with FGM/C viewed as a manifestation of patriarchal oppression of women. An alternative portrays men as relatively uninvolved in a practice described as 'women's business'. These two perspectives lead to divergent predictions: if FGM/C underpins patriarchal structures, men should be expected to be ardent supporters of FGM/C as it bolsters their power and status; if FGM/C is a women's affair, men should have little involvement. We test these predictions using data from a mixed-method study of norms and social networks in two regions of Senegal. Data show that men comprise 50% of core network members, although they exert influence in different ways in each study site. In South Senegal excision is upheld by men, as well as older women, through a constellation of norms that define FGM/C as prerequisite to marriage and social inclusion. In Central Senegal these gender norms have eroded, opening possibilities for abandonment of FGM/C, and men, particularly fathers, at times successfully advocate this change. This suggests that men can play an important role in ending FGM/C, and should be involved in intervention efforts.

Background Female Genital Mutilation (FGM) is recognized internationally as an issue of global health concern and a violation of human rights. Changing climactic conditions are argued to put a strain on Maasai livelihoods making women and girls more susceptible to harmful practices. Therefore, this study sought to elucidate the effect of climate change on changing social, gender norms and FGM practice among the Maasai of Kajiado County. Methods The study employed a descriptive cross-sectional study design, employing qualitative methodologies. The study purposively selected 12 key-informants and 8 participants for a focus group discussion. A thematic framework analysis was utilized to examine and interpret data and findings were presented in narrative form. Results The study revealed that climate change eroded the Maasai social and economic fabric and in particular, the dwindling of their livelihoods whose mainstay has been livestock thereby sunk these communities into abject poverty. These changes have resulted in widening of gender inequalities and further disempowerment of women and girls, through the loss of education, perpetuation of FGM, and increasing child marriages. These practices are an adaptive strategy to survive climactic changes but detrimental to girls and women. Conclusions In conclusion, the study points to the intersecting axes of climate change on gender norms and FGM. The study portends that broader socio-ecological factors pose as barriers to social norms change among the Maasai of Kajiado. Therefore, there is need to adopt a multilevel intersectional approach when designing programmes to end FGM. The contextual social, economic and environmental factors should not be overlooked when tailoring FGM intervention programs.

Background To our knowledge, no studies exist on the influence of nomadic pastoralist women’s networks on their reproductive and sexual health (RSH), including uptake of modern family planning (FP). Methods Using name generator questions, we carried out qualitative egocentric social network analysis (SNA) to explore the networks of four women. Networks were analyzed in R, visuals created in Visone and a framework approach used for the qualitative data. Results Women named 10–12 individuals. Husbands were key in RSH decisions and never supported modern FP use. Women were unsure who supported their use of modern FP and we found evidence for a norm against it within their networks. Conclusions Egocentric SNA proves valuable to exploring RSH reference groups, particularly where there exists little prior research. Pastoralist women’s networks likely change as a result of migration and conflict; however, husbands make RSH decisions and mothers and female neighbors provide key support in broader RSH issues. Interventions to increase awareness of modern FP should engage with women’s wider networks.

More than 200 million girls and women alive today have undergone FGM/C across 30 countries in Africa, Asia, and the Middle East. While most affected countries have adopted legal frameworks prohibiting FGM/C, these have been varyingly effective in preventing the practice or significantly accelerating its abandonment. The success of programmatic interventions to address FGM/C has also been variable. One possible reason for the limited success of these initiatives is the neglect of the collectively held social norms underpinning the practice’s continuation. This study, conducted in 30 villages in Somaliland, aimed to investigate: 1) if the norms associated with FGM/C are consistent with a social coordination norm; 2) which norms—if any—are associated with different stages of readiness to change; 3) how, to what extent, and by whom the norms and practices are being contested or altered; and 4) if the stages of readiness to change are associated with gender, location (rural/urban), and generational differences.

Tracing change in female genital mutilation/cutting through social Tracing change in female genital mutilation

Background: Female genital cutting (FGC), which poses risks to the health of girls, has proved remarkably persistent in many communities in Africa, despite decades of efforts to discourage it. The social coordination norm model of FGC attributes this persistence to high social costs for uncut women, such as exclusion from marriage markets or social support networks. Objective/methods: To test the social coordination model of FGC decision-making in Senegambia, we examined variation in FGC across communities, attitudes toward FGC, and how attitudes affected readiness to change (abandon) FGC. We used an ethnographically-grounded survey to assess valuation of FGC and readiness to change FGC. We used factor analysis to identify constructs in valuation of FGC and logistic regression models to evaluate hypothesized predictors of cut status and readiness to change FGC drawn from the social coordination norm model. Results: 1220 women with at least one daughter completed the survey; FGC valuation and readiness to change were characterized in 820 of these women. Findings were generally consistent with the social coordination norm hypothesis: Both locality and ethnicity were associated with cut status, and the prevalence of cutting across communities clustered at high and low levels. Factor analysis identified two distinct concerns in valuation of FGC-social advantages and health costs-and these were distributed differently for cut and uncut women, reflecting distinct normative schema. Further, readiness to change FGC differed in predicted ways with valuation of FGC. Conclusions: These findings support the social coordination norm model, and reveal distinct normative schema among cut and uncut women. Furthermore, our findings point to a dynamic reassessment of social benefits and health costs underlying FGC decision-making and readiness to change FGC. The reappraisal of social benefits may be an unrecognized opportunity for programs aiming to discourage FGC.

Female genital mutilation/cutting (FGM/C), also known as female circumcision, is a global public health and human rights problem affecting women and girls. Several concerted efforts to eliminate the practice are underway in several sub-Saharan African countries where the practice is most prevalent. Studies have reported variations in the practice with some countries experiencing relatively slow decline in prevalence. This study investigates the roles of normative influences and related risk factors (e.g., geographic location) on the persistence of FGM/C among 0-14 years old girls in Kenya. The key objective is to identify and map hotspots (high risk regions). We fitted spatial and spatio-temporal models in a Bayesian hierarchical regression framework on two datasets extracted from successive Kenya Demographic and Health Surveys (KDHS) from 1998 to 2014. The models were implemented in R statistical software using Markov Chain Monte Carlo (MCMC) techniques for parameters estimation, while model fit and assessment employed deviance information criterion (DIC) and effective sample size (ESS). Results showed that daughters of cut women were highly likely to be cut. Also, the likelihood of a girl being cut increased with the proportion of women in the community (1) who were cut (2) who supported FGM/C continuation, and (3) who believed FGM/C was a religious obligation. Other key risk factors included living in the northeastern region; belonging to the Kisii or Somali ethnic groups and being of Muslim background. These findings offered a clearer picture of the dynamics of FGM/C in Kenya and will aid targeted interventions through bespoke policymaking and implementations.

The factorial focus group methodology described in this guide provides a powerful means of illuminating the social norms that uphold female genital mutilation/cutting (FGM/C), and the ways in which meanings have at times become contested or rejected. The methods described here can be applied to the study of a wide range of behaviors influenced by social norms, such as early marriage, adoption of contraception, and more.

Over the last several decades, global efforts to end female genital mutilation/cutting (FGM/C) have intensified through combined efforts of international and non-governmental organizations, governments, and religious and civil society groups. One question asked by donors, program implementers and observers alike is whether there is any evidence that FGM/C is declining. In the last two decades, reliable data have been generated in numerous countries through major household surveys, including repeat cross-sectional surveys. What can we learn from these data? We explore this question by analyzing data on FGM/C obtained from women aged 15–49 in two successive household surveys in Senegal (2005 and 2010–11). The aggregate national-level statistics suggest that there has been no significant change in the prevalence of FGM/C among adult women. These figures are, however, unadjusted for potentially confounding factors, and potentially mask important variation in the practice. This paper aims to provide a deeper understanding of trends in FGM/C across regions, and possibly across generations, providing evidence as to when and where the practice of FGM/C is changing. We aim to answer the following questions: 1. What are the trends in FGM/C among women across Senegal and within regions? 2. Are individual characteristics, such as education, wealth and ethnicity, associated with a likelihood of FGM/C? 3. Are community-level factors, captured by covariate-adjusted geographic estimates, important predictors of a likelihood of FGM/C, as predicted by social convention theory?4. After adjusting for individual- and community-level factors, do we see a decrease in the prevalence of FGM/C across generations of women in Senegal? Participants were 14,602 and 14,228 respondents from two consecutive Senegal Demographic and Health Surveys from 2005 to 2010 (FGM/C prevalence 30.1% in 2005 and 28.1% in 2010). A Bayesian geo-additive mixed model based on Markov Chain Monte Carlo techniques was used to map the change in the spatial distribution of FGM/C prevalence at the regional level during the five-year period, while simultaneously examining the effect of individual-level risk factors. Overall, the prevalence of FGM/C at that national level changed little over the 5-year period, but the fully-adjusted model and map of trends in residual spatial effects at the regional level reveal important spatial patterns. Across both survey periods, several high prevalence regions remained “hot spots,” bearing a consistently high FGM/C prevalence. These include Kolda (along with the newly subdivided region of Sédhiou in 2010), Tambacounda (along with the newly subdivided region of Kédougou in 2010), and Matam. At the same time, risk remained not significant in the high prevalence regions of Saint Louis and Zinguinchor and was attenuated between 2005 and 2010–11 in Kaolack (including the newly subdivided region of Kaffrine in 2010), shifting from not significant risk in 2005 to a very low FGM/C prevalence in 2010–11. In both surveys, unadjusted estimates of the effect of age show no significant difference in risk of FGM across age cohorts. However, non-parametric covariate-adjusted estimates show that in both surveys age is a significant risk factor for FGM/C, although not in the anticipated direction. The effect of age on prevalence of FGM/C is highest in women aged 15–20, and declines with increasing age. Other significant factors are socio-demographic variables, particularly ethnicity. Findings from two consecutive surveys reveal that while no significant changes in FGM/C prevalence are found at the national level, mixed changes are visible at the regional level, as well as at the individual level. The modelled covariate results confirmed that the patterns of FGM/C differ markedly with region of residence and age remaining significant risk factors in both surveys, suggesting that community factors (convention theory), above and beyond individual factors, play a crucial role in the perpetuation, spread or decline of the practice of FGM/C. There is a clear pattern of regions with higher prevalence of FGM/C, mostly the south-eastern region of Tambacounda, Kolda and Matam in 2005, including the eastern region of Kédougou and the southern region of Sédhiou in 2010, which were associated with a higher prevalence of FGM/C, while regions  such as Louga, Thiès, Diourbel, Kaolack and Fatick in 2005 and Louga, Thiès, Diourbel, Fatick, Kaolack and Kaffrine in 2010 were associated with a lower prevalence of FGM/C. However, the total spatial residuals in both surveys also indicate that much of the variation in FGM/C likelihood remains to be explained. The spatial effects of the Kaolack region in 2005 was greatly attenuated after multiple adjustments of other risk factors indicating that perhaps the higher number of FGM/C affected women living in the region was inflated by other factors such as ethnicity, socio-economic status and education. Overall, the results indicate that across surveys, certain high prevalence regions remain “hot spots” regarding FGM/C prevalence. These novel findings fit with predictions of theory on social norms and conventions which suggest that the practice is upheld by interdependent expectations regarding the practice, and when such expectations are challenged within a community, the possibility for abandonment is opened.

This policy brief summarizes key findings from a study that examined whether there are shifts in norms and practices related to FGM/C among communities in Narok (predominantly inhabited by Maasai) and Kisii (predominantly inhabited by Abagusii) counties in Kenya. Although Kisii and Narok are FGM/C hotspots, practicing communities in these counties are reassessing norms and traditions in light of the current social and legal climate. These changes may provide a useful starting point for intervention programs that seek to create dialogue and critical reflection on the practice of FGM/C in an effort to accelerate its abandonment. Programmatic recommendations include: engaging community members in values deliberation to facilitate community-wide abandonment, addressing human rights issues and gender norms, allocating sufficient resources to local grassroots organizations, and a long-term commitment to ensure successful and sustainable change.

The purpose of this document is to guide researchers who plan to use qualitative social network methods drawing on our experiences implementing a qualitative study entitled, “The End of Female Genital Mutilation/Cutting in Senegal: Tracing Social Networks, Investigating the Role of Gender and Intergenerational Influence.” Qualitative fieldwork was carried out in two contrasting settings in Senegal: 1) a region with a low prevalence of female genital mutilation/cutting (FGM/C) characterized by ethnic heterogeneity, and 2) a region with a high prevalence of FGM/C characterized by relative ethnic homogeneity. The goal of this research was to investigate the ways in which social interactions and social influence vary along dimensions including gender, class, and generation, and how they influence the dynamics of decisionmaking regarding FGM/C.

Purpose of Review Female genital cutting/mutilation (FGM/C) performed by health care professionals (medicalization) and reduced severity of cutting have been advanced as strategies for minimizing health risks, sparking acrimonious ongoing debates. This study summarizes key debates and critically assesses supporting evidence. Recent Findings While medicalization is concentrated in Africa, health professionals worldwide have faced requests to perform FGM/C. Whether medicalization is hindering the decline of FGM/C is unclear. Factors motivating medicalization include, but are not limited to, safety concerns. Involvement of health professionals in advocacy to end FGM/C can address both the supply and demand side of medicalization, but raises ethical concerns regarding dual loyalty. Ongoing debates need to address competing rights claims. Summary Polarizing debates have brought little resolution. We call for a focus on common goals of protecting the health and welfare of girls living in communities where FGM/C is upheld and encourage more informed and open dialog.