Shelly R. McFarlane

Fast-food and sweetened beverage consumption: association with overweight and high waist circumference in adolescents

OBJECTIVE Overweight and obesity have increased to epidemic proportions among adolescents and are associated with chronic non-communicable diseases and excess mortality in adulthood. The association of overweight/obesity with poor dietary habits has not been studied in adolescents in middle-income developing countries. The present study aimed to estimate the prevalence of overweight, obesity and high waist circumference (WC) in 15-19-year-old Jamaican adolescents and to investigate the association with fast-food and sweetened beverage consumption. DESIGN The study enrolled 1317 (598 male, 719 female) adolescents aged 15-19 years using multistage, nationally representative sampling. Age-specific prevalence calculation used internal Z-score lines connecting with the WHO adult cut-off points. Logistic regression was used to examine the association of overweight or high WC with fast-food and sweetened beverage consumption, adjusting for potential confounders. RESULTS The overall prevalence of overweight, obesity and high WC was approximately 15 %, 6 % and 10 %, respectively. Prevalence estimated using internal Z-scores was similar to that using the International Obesity Taskforce cut-off points. Obesity (8.0 % in females, 3.3 % in males) and high WC (16.2 % in females, 1.7 % in males) were significantly more prevalent in females when using internal Z-score cut-offs. High WC was associated with the absence of fruit consumption (P = 0.043) and overweight with high sweetened beverage consumption (P = 0.018). CONCLUSION Overweight occurs frequently among Jamaican 15-19-year-olds and is associated with increased consumption of sweetened beverages. High WC is more prevalent among females and is related to low consumption of fruits and vegetables. Measures to reduce the consumption of sweetened beverages and increase fruit intake may reduce the prevalence of excess body fat among adolescents.

Diabetes mellitus in Jamaica: sex differences in burden, risk factors, awareness, treatment and control in a developing country

The objective of this study was to provide valid estimates of the burden of and risk factors for diabetes mellitus by sex in Jamaica, a predominantly Black, middle‐income and developing country.

Excess Cardiovascular Risk Burden in Jamaican Women Does Not Influence Predicted 10-Year CVD Risk Profiles of Jamaica Adults: An Analysis of the 2007/08 Jamaica Health and Lifestyle Survey.

Background Black Caribbean women have a higher burden of cardiovascular disease (CVD) risk factors than their male counterparts. Whether this results in a difference in incident cardiovascular events is unknown. The aim of this study was to estimate the 10 year World Health Organization/International Society for Hypertension (WHO/ISH) CVD risk score for Jamaica and explore the effect of sex as well as obesity, physical activity and socioeconomic status on these estimates. Methods and Findings Data from 40–74 year old participants in the 2007/08 Jamaica Health and Lifestyle Survey were used. Trained interviewers administered questionnaires and measured anthropometrics, blood pressure, fasting glucose and cholesterol. Education and occupation were used to assess socioeconomic status. The Americas B tables were used to estimate the WHO/ISH 10 year CVD risk scores for the population. Weighted prevalence estimates were calculated. Data from 1,432 (450 men, 982 women) participants were analysed, after excluding those with self-reported heart attack and stroke. The women had a higher prevalence of diabetes (19%W;12%M), hypertension (49%W;47%M), hypercholesterolemia (25%W;11%M), obesity (46%W;15%M) and physical inactivity (59%W;29%M). More men smoked (6%W;31%M). There was good agreement between the 10-year cardiovascular risk estimates whether or not cholesterol measurements were utilized for calculation (kappa –0.61). While 90% had a 10 year WHO/ISH CVD risk of less than 10%, approximately 2% of the population or 14,000 persons had a 10 year WHO/ISH CVD risk of ≥30%. As expected CVD risk increased with age but there was no sex difference in CVD risk distribution despite women having a greater risk factor burden. Women with low socioeconomic status had the most adverse CVD risk profile. Conclusion Despite women having a higher prevalence of CVD risk factors there was no sex difference in 10-year WHO/ISH CVD risk in Jamaican adults.

Reported Hours of Sleep, Diabetes Prevalence and Glucose Control in Jamaican Adults: Analysis from the Jamaica Lifestyle Survey 2007-2008

Background. There are limited data on sleep duration and diabetes from developing countries. We therefore examined the relationship between reported hours of sleep, diabetes prevalence and glucose control in Jamaican adults. Methods. Data on reported hours of sleep and diabetes (based on glucose measurement and medication use) from a national survey of 15–74-year-old Jamaicans were analyzed. Results. The 2,432 participants (31% M, Age 42 ± 16 years, BMI 27.6 ± 6.6 kg/m2, diabetes prevalence 12%) reported sleeping 8.2 ± 1.8 hours. In men, sleeping less than 6 hours (OR (95% CI) = 2.65 (1.09–6.48)) or more than 10 hours (OR (95% CI) = 4.36 (1.56–12.19)) was associated with diabetes when adjusted for age, BMI, and family history of diabetes. In women sleeping less than 6 hours was associated with a reduced likelihood of diabetes after adjusting for the same confounders ((OR (95% CI) = 0.43 (0.23–0.78)). There was no significant association between sleep and glucose control. Conclusion. Insufficient and excessive sleep was associated with increased diabetes prevalence in Jamaican men but not women.

Associations between neighborhood effects and physical activity, obesity, and diabetes: The Jamaica Health and Lifestyle Survey 2008

OBJECTIVE To examine the impact of neighborhood disorder, perceived neighborhood safety, and availability of recreational facilities on prevalence of physical activity (PA), obesity, and diabetes mellitus (DM). STUDY DESIGN AND SETTING Multilevel analyses were conducted among 2,848 respondents from the 2007-08 Jamaica Health and Lifestyle Survey. Neighborhood effects were based on aggregated interviewer responses to systematic social observation questions. Mixed-effect logistic regression models were created to assess the relationship between neighborhood indicators and DM and the modifiable risk factors PA and overweight/obesity. RESULTS There was significant clustering in PA levels of 20 minutes at least once per week (intraclass correlation coefficient [ICC] = 10.7%), low/no PA (ICC = 7.22%), diabetes (ICC = 5.44%), and obesity (ICC = 3.33%) across neighborhoods. Greater levels of neighborhood disorder, home disorder, and counterintuitively recreational space availability were associated with higher levels of low/no PA among women. There was significant interaction by sex between neighborhood infrastructure and overweight/obesity with a significant association in men (odds ratio [OR] = 1.16; 95% confidence interval [CI] = 1.05, 1.28) but not women (OR = 1.01; 95% CI = 0.95, 1.07). CONCLUSION Differences in PA and obesity-related outcomes among Jamaicans may be partially explained by characteristics of the neighborhood environment and differ by sex. Future studies must be conducted to determine the mechanistic pathways through which the neighborhood environment may impact such outcomes to better inform prevention efforts.

Risky behaviours of Jamaican adolescents with sickle cell disease

Abstract Objectives To describe the risky behaviours of Jamaican teens with sickle cell disease (SCD) and compare them to a national sample of Jamaican youth. Methods One hundred twenty two SCD adolescents, 15–19 years old, completed the standardized questionnaire used in the Jamaican Youth Risk and Resiliency Behaviour Survey (JYRRBS), which was a nationally representative survey of 1317 Jamaican youths. Information was obtained on socio-demographics, smoking, alcohol use, and sexual activity. Secondary data from the JYRRBS were extracted to measure the difference in risky behaviours between the groups. Results Almost 50% of SCD and 58% of national teens reported having had sexual intercourse. More SCD teens used alcohol (77.7% vs. 60.7%; P value = 0.001). Risky behaviours tended to coexist and living with a parent (odds ratio: 0.62, P value <0.01) and currently attending school (odds ratio: 0.43, P value <0.001) lowered the likelihood of having had sex. Discussion SCD teens engage in many risky behaviours and health care professionals should screen and counsel them at each visit.

A survey of providers’ knowledge, opinions, and practices regarding induced abortion in Jamaica

To determine the stance of providers in Jamaica regarding the suggested change in abortion law and proposal to train providers.

Risk behaviours and adolescent depression in Jamaica

The objective of this study was to assess the prevalence of depression and the associated risk factors in Jamaican youth aged 15–19 years. A nationally represented sample of youth aged 15–19 years was surveyed using multistage cluster sampling. Risk behaviours such as sexual activity, alcohol and marijuana use were obtained by interviewer-administered questionnaire; depression was assessed using the Ministry of Health screening tool. Multivariate logistic regression was used to obtain the odds of depression for any given risk factor. Data showed that 15.5% (males = 596, females = 716), of the youth recruited were classified as depressed (males = 9.7%, females = 21.3%, p < 0.001). Approximately12.5% had planned, considered or attempted suicide in the past year. More than one-half of youth had unsafe sexual practices (males = 68.2%, females = 48.7%, p < 0.001). One-fifth were involved in violent acts (males = 27.2%, females = 12.5%, p < 0.001) or substance abuse (males = 22.6%, females = 17.4%, p = 0.008). Unsafe sexual practices and substance abuse doubled the likelihood of being depressed (odds ratio = 1.76, 95% confidence interval [1.21, 2.54]; and odds ratio = 2.31, 95% confidence interval [1.67, 3.21], respectively). Youth who were involved in violence were three times more likely to be depressed (odds ratio = 2.77, 95% confidence interval [1.90, 4.04]). Gender-specific multivariable models showed that pregnancy and violence increased the likelihood for depression in males whilst violence, drunkenness, smoking and more than one sexual partner were significant for females. Youth who engage in high-risk behaviours are at increased odds for depression. Programmes to involve youth in positive behaviours should be given priority in order to reduce the prevalence of depression.

Cardiovascular disease among patients attending a specialist diabetes clinic in Jamaica

Correspondence: Trevor Ferguson epidemiology Research Unit, Tropical Medicine Research institute, The University of the West indies, Mona, Kingston, Jamaica Tel +1 876 927 2471 Fax +1 876 927 2984 email trevor.ferguson02@uwimona.edu.jm Background: This study aimed to estimate the prevalence of cardiovascular disease (CVD) among patients attending The University Hospital of the West Indies diabetes clinic and to examine the relationship between prevalent CVD and its risk factors. Methods: We analyzed data from 174 patients selected from the University Hospital of the West Indies diabetes clinic using gender-stratified random sampling. An intervieweradministered questionnaire was used to obtain data on self-reported CVD (coronary heart disease [CHD], cerebrovascular disease, and peripheral vascular disease [PVD]), physical activity, alcohol consumption, and smoking. Trained nurses performed blood pressure and anthropometric measurements. A capillary blood sample was collected to measure glycosylated hemoglobin, and urine was tested for protein and microalbumin. Means and proportions for patient characteristics, CVD outcomes, and risk factors were calculated. Logistic regression was used to identify factors independently associated with CVD. Results: Data from 129 women and 45 men (mean age 55.7 ± 14.7 years) were analyzed. The prevalence of any self-reported CVD (CHD, cerebrovascular disease, or PVD) was 34.5% (95% confidence interval [CI] 27.4–41.6). PVD had the highest prevalence (25.9%), compared with CHD (6.9%) and cerebrovascular disease (16.1%). There were no gender differences in the prevalence of CVD. Prevalence of CVD was higher among people

Self-reported prevalence of heart attacks and strokes in Jamaica: a cross-sectional study. The Jamaica Health and Lifestyle Survey 2007–2008

50 years, and those with high blood pressure, central obesity, high total cholesterol, and duration of diabetes