Maureen Samms-Vaughan

Interpersonal violence in three Caribbean countries: Barbados, Jamaica, and Trinidad and Tobago

OBJECTIVES This article reports the prevalence of two types of interpersonal violence (IPV) (sexual and physical) and one type of aggression (psychological) in three low-to-middle-income Caribbean countries. It examines IPV among adolescents and young adults as both victims and perpetrators. METHOD This population-based study compares the experiences of 15-30 year olds in countries at different levels of socioeconomic development. The Revised Conflict Tactics Scales (CTS2) and other behavioral instruments were used to assess the level and characteristics of IPV. RESULTS Out of 3 401 respondents, 70.9% reported victimization by some form of violence, which was most commonly perpetrated by a relationship partner (62.8%). Sexual violence victimization was reported more commonly by women, and was highest in Jamaica. Significant between-country differences in overall levels of reported physical violence, and psychological aggression, were evident when stratifying by perpetrator type. CONCLUSIONS The very high levels of reported IPV indicate very high levels of tolerance among victims, and suggest a culture of violence and of adversarial intimate relationships may be well entrenched. The findings support the view that co-occurrence of general interpersonal violence and partner violence may be limited, and that one may not necessarily be a predictor of the other. They also reveal that, among partners, not only are there no gender differentials in victimization by physical violence, but more women than men are self-reporting as perpetrators of this type of IPV.

Is it prudent to administer all items for each Child Behavior Checklist cross-informant syndrome? Evaluating the psychometric properties of the Youth Self-Report dimensions with confirmatory factor analysis and item response theory

Through surveying of children in 10 nations with parent, teacher, and Youth Self-Report (YSR) forms of the Child Behavior Checklist (CBCL), cross-informant syndromes (CISs) were derived and cross-validated by sample-dependent methodology. Generalizing CBCL syndromes and norms to nations excluded from its normative sample is problematic. This study used confirmatory factor analyses (CFAs) to test factor model fit for CISs on the YSR responses of 625 Jamaican children ages 11 to 18 years. Item response theory (IRT), a sample-independent methodology, was used to estimate the psychometric properties of individual items on each dimension. CFAs indicated poor to moderate model-to-data fit. Across all syndromes, IRT analyses revealed that more than 3/4 of the cross-informant items yielded little information. Eliminating such items could be cost effective in terms of administration time yet improve the measures discrimination across syndrome severity levels.

Prevalence of the metabolic syndrome and its components in relation to socioeconomic status among Jamaican young adults: a cross-sectional study.

BackgroundThe metabolic syndrome has a high prevalence in many countries and has been associated with socioeconomic status (SES). This study aimed to estimate the prevalence of the metabolic syndrome and its components among Jamaican young adults and evaluate its association with parental SES.MethodsA subset of the participants from the 1986 Jamaica Birth Cohort was evaluated at ages 18-20 years between 2005 and 2007. Trained research nurses obtained blood pressure and anthropometric measurements and collected a venous blood sample for measurement of lipids and glucose. Prevalence of the metabolic syndrome and its components were estimated using the 2009 Consensus Criteria from the International Diabetes Federation, National Heart Lung and Blood Institute, American Heart Association, World Heart Federation, International Atherosclerosis Society, and International Association for the Study of Obesity. SES was assessed by questionnaire using occupation of household head, highest education of parent/guardian, and housing tenure of parent/guardian. Analysis yielded means and proportions for metabolic syndrome variables and covariates. Associations with levels of SES variables were obtained using analysis of variance. Multivariable analysis was conducted using logistic regression models.ResultsData from 839 participants (378 males; 461 females) were analyzed. Prevalence of the metabolic syndrome was 1.2% (95% confidence interval [95%CI] 0.5%-1.9%). Prevalence was higher in females (1.7% vs. 0.5%). Prevalence of the components [male: female] were: central obesity, 16.0% [5.3:24.7]; elevated blood pressure, 6.7% [10.8:3.3]; elevated glucose, 1.2% [2.1:0.4]; low HDL, 46.8% [28.8:61.6]; high triglycerides, 0.6% [0.5:0.6]. There were no significant differences in the prevalence of the metabolic syndrome for any of the SES measures used possibly due to lack of statistical power. Prevalence of central obesity was inversely associated with occupation (highly skilled 12.4%, skilled 13.5%, semi-skilled/unskilled 21.8%, p = 0.013) and education (tertiary 12.5%, secondary 14.1%, primary/all-age 28.4%, p = 0.002). In sex-specific multivariate logistic regression adjusted for hip circumference, central obesity remained associated with occupation and education for women only.ConclusionPrevalence of the metabolic syndrome is low, but central obesity and low HDL are present in 16% and 47% of Jamaican youth, respectively. Central obesity is inversely associated with occupation and education in females.

Nutritional status of 11-12-year-old Jamaican children: coexistence of under- and overnutrition in early adolescence

OBJECTIVE To determine the nutritional status of a cohort of 11-12 year olds and ascertain social and demographic factors associated with under- and overweight in early adolescence. DESIGN Cross-sectional. SUBJECTS Subgroup (n = 1698) of the birth cohort (September-October 1986) of the Jamaican Perinatal Survey enrolled in schools in the Kingston Metropolitan area. One thousand and sixty-three parents or caregivers provided social and demographic information. RESULTS Undernutrition and overnutrition are of public health significance among adolescent Jamaican children. Ten per cent of 11-12 year olds had body mass index (BMI) values below the 5th percentile (boys, 10.6%; girls, 7.1%) but this prevalence is relatively low compared with other developing countries. The prevalence of stunting was low (3%). The prevalence of overweight (BMI > or = 85th percentile) (19.3%) was approaching prevalence rates found in the USA. Similar social and demographic variables were associated with thinness and fatness in males. Birth weight predicted overweight in girls. CONCLUSIONS Under- and overnutrition in early adolescence are important problems in Jamaica. There is a need to address both under- and overnutrition in adolescence in preventive and rehabilitative intervention programmes.

Are the indicators for the Language and Reasoning Subscale of the Early Childhood Environment Rating Scale-Revised psychometrically appropriate for Caribbean classrooms?

Evaluating the psychometric properties of the indicators that comprise the Early Childhood Environment Rating Scale‐Revised (ECERS‐R) language‐reasoning scale from an item response theory (IRT) perspective on a sample of observations from 334 Caribbean classrooms, Stout’s procedure revealed that all indicators on this dimension are not part of a single essentially unidimensional construct. IRT‐based factor analyses on the indicator scores yielded two factors – named Language‐Reasoning Activities and Language‐Reasoning Materials. IRT analyses conducted on these two factors revealed that their indicators provide adequate psychometric information and have no floor effects – although they demonstrate evidence for ceiling effects. IRT also revealed that at least within the Caribbean context: (a) the ECERS‐R authors have ordered the indicators inappropriately; (b) administration of all indicators is unnecessary; and (c) equally weighting indicators might yield spurious results. IRT‐based scoring might improve the psychometric soundness of indicators on this ECERS‐R scale.

The status of early identification and early intervention in autism spectrum disorders in lower- and middle-income countries.

Abstract There is limited information on autism spectrum disorders from lower- and middle-income countries (LMIC). This paper reviews the status of early identification and early intervention for autism spectrum disorders in response to the article by 4. The PubMed database was searched to identify relevant epidemiological studies from LMIC. Seven studies from five countries were identified: Colombia, India, Jamaica, Jordan, and Mexico. The mean age of parental concern, at 21–24 months, and mean age of diagnosis, at 45–57 months, were similar in LMIC, but later than in high-income countries. Both country groups reported language disorder to be the symptom of initial concern. Similarities in biological aspects of the disorders were noted across LMIC and high-income countries. Comparable ages of identification and diagnosis across vastly different LMIC suggest limited resources to be the underlying contributory factor. Recommendations for improving early identification and intervention made by researchers in the LMIC are reported.

Are oral contraceptive use and pregnancy complications risk factors for atopic disorders among offspring

In utero programming of atopic manifestations has been suggested. We investigated the association between oral contraceptive (OC) use before, and complications during pregnancy (CDP) and asthma, along with other atopic manifestations. The study is based on neonates from Kingston and St Andrew, a geographic subcohort from the Jamaican Perinatal Morbidity, Mortality Survey conducted in 1986–1987. Information on OC use and CDP was extracted from maternal interviews and medical records. In a follow up in 1997–1998, via interviews with mothers, trained nurses collected information on asthma/wheezing, coughing, eczema, and hay fever. Data, specific to this paper, from birth and 11–12 yr of age was available for a total of 1040 of the 1720 members of the geographic subcohort. Using logistic regression, controlling for confounders, we estimated adjusted odds ratio (aOR) and corresponding 95% confidence intervals (CI). For asthma or wheezing, and coughing, aOR for OC use were 1.81 (95% CI: 1.25–2.61), and 2.72 (95% CI: 1.41–5.24), respectively. CDP was only shown to be a significant risk factor for hay fever. Additionally, a higher number of older siblings were protective for hay fever. The results suggest that asthma in childhood may be programmed in utero.

Urban Jamaican children's exposure to community violence

Exposure to violence in childhood is associated with aggression in adulthood. The high level of community violence in Jamaica is likely to expose Jamaican children to violence. There has been no detailed study of the exposure of Jamaican children to violence in their daily lives. Some 1674 urban 11-12-year-old children, previously part of a national birth cohort study, completed a questionnaire detailing their exposure to violence as witnesses, victims and aggressors. Their parents completed a socio-economic questionnaire. Jamaican children had high levels of exposure to physical violence. A quarter of the children had witnessed severe acts of physical violence such as robbery, shooting and gang wars, a fifth had been victims of serious threats or robbery and one in every twelve had been stabbed. Children reported being least exposed to sexual violence and to being shot at. Robbery was an almost universal experience affecting children from all schools and socio-economic groups. The single commonest experience as a victim of violence was the loss of a family member or close friend to murder, affecting 36.8% of children. Childrens experiences of witnessing violence occurred chiefly in their communities but their personal experiences of violence occurred at school. Boys and children attending primary school had greater exposure to violence as witnesses and victims. Socio-economic status discriminated exposure to physical violence as witnesses but not as victims. Intervention strategies to reduce childrens exposure to violence should include community education on the impact of exposure to violence on children, particularly the loss of a significant person, and the development of a range of school-based violence prevention programmes.

Role of metabolic genes in blood arsenic concentrations of Jamaican children with and without autism spectrum disorder

Arsenic is a toxic metalloid with known adverse effects on human health. Glutathione-S-transferase (GST) genes, including GSTT1, GSTP1, and GSTM1, play a major role in detoxification and metabolism of xenobiotics. We investigated the association between GST genotypes and whole blood arsenic concentrations (BASC) in Jamaican children with and without autism spectrum disorder (ASD). We used data from 100 ASD cases and their 1:1 age- and sex-matched typically developing (TD) controls (age 2–8 years) from Jamaica. Using log-transformed BASC as the dependent variable in a General Linear Model, we observed a significant interaction between GSTP1 and ASD case status while controlling for several confounding variables. However, for GSTT1 and GSTM1 we did not observe any significant associations with BASC. Our findings indicate that TD children who had the Ile/Ile or Ile/Val genotype for GSTP1 had a significantly higher geometric mean BASC than those with genotype Val/Val (3.67 µg/L vs. 2.69 µg/L, p < 0.01). Although, among the ASD cases, this difference was not statistically significant, the direction of the observed difference was consistent with that of the TD control children. These findings suggest a possible role of GSTP1 in the detoxification of arsenic.

The role of early childhood professionals in the early identification of autistic disorder

Autism is a pervasive developmental disorder defined by impaired social skills, impaired language development and stereotyped or repetitive behaviours. The increasing prevalence of autism worldwide has made this an important condition among professionals working with young children, including those in Jamaica. Early identification and intervention improves the outcome for autistic children. This article investigates the role of professionals working with young children in the early identification and intervention by reviewing the diagnostic process. A cross‐sectional survey of 117 children diagnosed with autism at the University Hospital of the West Indies (UHWI) in Jamaica over a five‐year period was undertaken. Data were collected retrospectively from hospital records on demographic characteristics, presenting features, professionals recommending referral, age of maternal concern and age at diagnosis. The mean age of maternal concern was 21.3 ± 10.9 months, but the mean age at diagnosis was 43.8 ± 17.8 months. The main behaviour resulting in parental concern was language development, occurring in some 85% of children. The majority of children (76.2%) were referred to the UHWI diagnostic centre by specialist medical personnel. First contact education and health sector professionals referred only 5.6% and 4.6% of children, respectively. Low socio‐economic status was a significant factor affecting delay in diagnosis. The study has shown significant delays in diagnosis of autism, despite early concern by mothers. The study recommends general public education on the features of autism, as well as education targeted at first‐contact health and education professionals. Professionals should also be educated on the use of simple screening tools and the referral process to the diagnostic centre, to reduce diagnostic delay.