Black Caribbean People Research Articles

Developing and testing Advance Choice Document implementation resources for Black African and Caribbean people with experience of compulsory psychiatric admission

BackgroundAdvance Choice Documents (ACDs) have been recommended for use in England and Wales based on evidence from trials that show that they can reduce involuntary hospitalisation, which disproportionately affects Black African and Caribbean people. Our aim was therefore to develop and test ACD implementation resources and processes for Black people who have previously been involuntarily hospitalised and the people that support them.MethodsResource co-production workshops were held to inform the development of the ACD template and two types of training for all stakeholders, comprising a Recovery College course and simulation training. An ACD facilitator then used the ACD template developed through the workshops to create personalised ACDs with service users and mental health staff over a series of meetings. Interviews were then conducted with service user and staff participants and analysed to document their experience of the process and opinions on ACDs. Other implementation strategies were also employed alongside to support and optimise the creation of ACDs.ResultsNine ACDs were completed and were largely reported as appropriate, acceptable, and feasible to service users and staff. Both reported it being an empowering process that encouraged hope for better future treatment and therefore better wellbeing. Uncertainty was also expressed about the confidence people had that ACDs would be adhered to/honoured, primarily due to staff workload. The information provision training and the skills training were generally considered to be informative by trainees.ConclusionsThe project has developed an ACD creation resource that was reported as agreeable to all stakeholders; however, the generalisability of the findings is limited due to the small sample size. The project also highlights the importance of staff and ACD facilitator capacity and good therapeutic relationships in ACD completion. Further research is needed to determine the adjustments needed for large scale use, including for those under age 18 and those under the care of forensic mental health services; and how to include carers/supporters more in the process.

Long term mortality trends in people with severe mental illnesses and how COVID-19, ethnicity and other chronic mental health comorbidities contributed: a retrospective cohort study.

People with schizophrenia-spectrum and bipolar disorders (severe mental illnesses; 'SMI') experience excess mortality. Our aim was to explore longer-term trends in mortality, including the COVID-19 pandemic period, with a focus on additional vulnerabilities (psychiatric comorbidities and race/ ethnicity) in SMI. Retrospective cohort study using electronic health records from secondary mental healthcare, covering a UK region of 1.3 million people. Mortality trends spanning fourteen years, including the COVID-19 pandemic, were assessed in adults with clinician-ascribed ICD-10 diagnoses for schizophrenia-spectrum and bipolar disorders. The sample comprised 22 361 people with SMI with median follow-up of 10.6 years. Standardized mortality ratios were more than double the population average pre-pandemic, increasing further during the pandemic, particularly in those with SMI and psychiatric comorbidities. Mortality risk increased steadily among people with SMI and comorbid depression, dementia, substance use disorders and anxiety over 13-years, increasing further during the pandemic. COVID-19 mortality was elevated in people with SMI and comorbid depression (sub-Hazard Ratio: 1.48 [95% CI 1.03-2.13]), dementia (sHR:1.96, 1.26-3.04) and learning disabilities (sHR:2.30, 1.30-4.06), compared to people with only SMI. COVID-19 mortality risk was similar for minority ethnic groups and White British people with SMI. Elevated all-cause mortality was evident in Black Caribbean (adjusted Rate Ratio: 1.40, 1.11-1.77) and Black African people with SMI (aRR: 1.59, 1.07-2.37) during the pandemic relative to earlier years. Mortality has increased over time in people with SMI. The pandemic exacerbated pre-existing trends. Actionable solutions are needed which address wider social determinants and address disease silos.

Singing Blackness

In this article I propose the exploration of racial discourse in recent Black Caribbean rap and hip-hop productions. Rap and hip-hop are often used as a sociopolitical tool that—through writing and language—achieve to create activist movements. Specifically, I study the work of the Cuban hip-hop group Obsesión [Obsession] and of Cuban rapper Robe L Ninho and the work of Dominican rappers Circuito Negro and JNoa. I particularly focus on some of their songs that make of the genre an opportunity to approach the racial topic in their communities and a way to celebrate Blackness. This way, these hip-hop and rap songs break the most commercial, common, and expected pattern of lyrics that focus on topics that oversexualize the female (Black) body, that often objectify women, and that reproduce a patriarchal and heteronormative discourse. Instead, these songs, through the topics that they explore, aim to create community and craft a space for social activism. They do so, for example, by singing about hair (Obsesión and Robe L Ninho) and by singing about their Afro-Caribbean communities and their existence as Black people in their neighborhoods (Circuito Negro, JNoa). Among a variety of tracks, I mainly focus on songs that are connected in topic and that represent a continuumin the production of approximately the last decade. So, for example I analyze the songs “Los pelos [Hair]” by Obsesión (2014) and “N.E.G.R.O. [N.E.G.R.O.]” by Robe L Ninho (2022) that focus on Afro hair, celebrate the beauty of it, and denounce the prejudices against it almost a decade apart from each other. Then, I focus on the song “Revolufunk” by Circuito Negro (2011) and the song “Qué fue[What Happened?]” (2022) by JNoa. In this case also there is a generational gap between the artists that symbolize both the evolution of the genre and the consistency of the topics that they cover and that are connected to Blackness. In addition to the racial discourse and the connection of topics across the last decade, these songs also create an inter-Caribbean discourse that transcends the concept of nation and nationality and instead identifies with and shapes a message for Black Spanish-speaking Caribbean people. These songs reveal a poetic that adds urban sounds to a spoken word tradition and that mixes writing, oral tradition, and language in lieu to create a sociopolitical activist movement for Afro-Caribbean people. Also, by focusing on race in countries where the Black communities are often made invisible, they shed light on minorities that usually are relegated to the lowest layers of society. Thus, through their music, these artists raise awareness on their Blackness and on their communities, but they also create a transversal Afro-Caribbean narrative that connects and creates a sense of community among Blacks in the Caribbean in their native Spanish language. This study, so, represents an opportunity to shift a US-centered discourse on Blackness and race and opens new ways of living and understanding the African diaspora in other geographies.

Ethnic inequalities in age-related patterns of multiple long-term conditions in England: Analysis of primary care and nationally representative survey data.

Little is known about the patterning of multiple long-term conditions (MLTCs) by age, ethnicity and across conceptualisations of MLTCs (e.g. MLTCs with/without mental health conditions [MHCs]). We examined ethnic inequalities in age-related patterns of MLTCs, and combinations of physical and MHCs using the English GP Patient Survey and Clinical Practice Research Datalink. We described the association between MLTCs and age using multilevel regression models adjusting for sex and area-level deprivation with patients nested within GP practices. Similar analyses were repeated for MLTCs that include MHCs. We observed ethnic inequalities from middle-age onwards such as older Pakistani, Indian, Black Caribbean and Other ethnic people had increased risk of MLTCs compared to white British people, even after adjusting for area-level deprivation. Compared to white British people, Gypsy and Irish Travellers had higher levels of MLTCs across the age groups, and Chinese people had lower levels. Pakistani and Bangladeshi people aged 50-74years were more likely than white people to report MLTCs that included MHCs. We find clear evidence of ethnic inequalities in MLTCs. The lower prevalence of MLTCs that include MHCs among some minoritised ethnic groups may be an underestimation due to underdiagnosis and/or inadequate primary care and requires further scrutiny.

Advance Statements for Black African and Caribbean people (AdStAC): protocol for an implementation study

BackgroundThe UK government committed to legislating for Advance Choice Documents/Advance Statements (ACD/AS) following their recommendation by the Independent Review of the MHA (2018). ACDs/AS are yet to be implemented in routine practice despite evidence and high demand; they are associated with improved therapeutic relationships and a reduction (25%, RR 0.75, CI 0.61–0.93) in compulsory psychiatric admission. Barriers to their implementation are well documented, ranging from low knowledge levels to logistical challenges in accessing the content during episodes of acute care. In the UK this is an issue for Black people, who experience detention rates disproportionately (over three times) higher than those of White British people and have poorer care experiences and outcomes. ACDs/AS allow for Black people to have their concerns heard by mental health professionals in a care system where they often feel their views are ignored. AdStAC aims to improve Black service users’ experiences in mental health services in South London by co-producing and testing an ACD/AS implementation resource with Black service users, mental health professionals and carers/supporters of Black service users.Methods/designThe study will take place in South London, England over three phases: 1) formative work through stakeholder workshops; 2) co-production of resources through a consensus development exercise and working groups; and 3) testing of the resources using quality improvement (QI) methods. A lived experience advisory group, staff advisory group and project steering committee will support the study throughout. The implementation resources will comprise: advance choice document/advance statement (ACD/AS) documentation, stakeholder trainings, a manual for mental health professionals to facilitate the processes of creating and revising advance statements, and informatics development.DiscussionThe implementation resources will help increase the likelihood of the new mental health legislation in England being implemented effectively; through aligning evidence-based medicine, policy and law to effectively provide positive clinical, social and financial outcomes for Black people, the National Health Service (NHS) and wider society. This study will likely benefit a wider group of people with severe mental illness, as when marginalised groups who are least engaged, can be supported with these strategies, then the strategies are likely to work for others.

Transformation and representation in the clinical space

So a lot has transpired in the world. These last few years have highlighted the ways in which Black and Brown bodies are historically underrepresented, misunderstood and dismissed. As two Black Caribbean clinicians, we worked with various Black Caribbean people in an acute care setting over five years; this article focuses on how representation impacted their care. Black and Brown people often receive inadequate care, care that does not speak to the wholeness of their humanity. We sought to create a methodology that represented our patients’ cultural identities and allowed them to feel seen. We did this by transforming the clinical space into a culturally relevant play space and explored adaptive social skills in preparation for community reintegration and to build ego strength through creative reflection. This work breathed life into us as we explored what it means to be seen in an oppressive system.

Social network characteristics of Black African and Caribbean people with psychosis in the UK

Poorer social networks predict more coercive pathways to care and other adverse outcomes in people with psychosis. People from Black African and Caribbean backgrounds have more negative experiences within UK mental health care systems and family relationships often breakdown. This study aimed to examine the social network characteristics of Black African and Caribbean people experiencing psychosis and associations between network characteristics and severity of psychosis, negative symptoms, and general psychopathology. Fifty-one participants completed social network mapping interviews (a gold standard approach to assessing social network composition) and the Positive and Negative Syndrome Scale. This is the first study to explicitly measure social network size amongst Black people with psychosis living within the UK and results showed that participants’ social network size (mean = 12) was comparable to that of other psychosis samples. Networks were of moderate density and comprised disproportionately more relatives than other relationship types. Poor network quality was related to more severe psychosis symptoms suggesting that social network quality may be an important factor in influencing the severity of psychosis. Findings highlight the need for community-based interventions and family therapies to mobilise sources of social support for Black people with psychosis within the UK.

Differences in the risk of cardiovascular disease across ethnic groups: UK Biobank observational study

Background and aimsTo describe sociodemographic, lifestyle, environmental and traditional clinical risk factor differences between ethnic groups and to investigate the extent to which such differences confound the association between ethnic groups and the risk of cardiovascular disease (CVD) Methods and resultsA total of 440,693 white European (55.9% women), 7305 South Asian (48.6%) and 7628 black African or Caribbean (57.7%) people were included from UK Biobank. Associations between ethnicity and cardiovascular outcomes (composite of non-fatal stroke, non-fatal myocardial infarction and CVD death) were explored using Cox-proportional hazard models. Models were adjusted for sociodemographic, lifestyle, environmental and clinical risk factors. Over a median (IQR) of 12.6 (11.8, 13.3) follow-up years, there were 22,711 (5.15%) cardiovascular events in white European, 463 (6.34%) in South Asian and 302 (3.96%) in black African or Caribbean individuals. For South Asian people, the cardiovascular hazard ratio (HR) compared to white European people was 1.28 (99% CI [1.16, 1.43]). For black African or Caribbean people, the HR was 0.80 (0.66, 0.97). The elevated risk of CVD in South Asians remained after adjusting for differences in sociodemographic, lifestyle, environmental and clinical factors, whereas the lower risk in black African or Caribbean was largely attenuated. ConclusionsSouth Asian, but not black African or Caribbean individuals, have a higher risk of CVD compared to white European individuals. This higher risk in South Asians was independent of sociodemographic, lifestyle, environmental and clinical factors.

Engagement with services in Black African and Caribbean people with psychosis: The role of social networks, illness perceptions, internalized stigma, and perceived discrimination.

Research and policies in the United Kingdom have repeatedly highlighted the need to reduce ethnic disparities and improve engagement with mental health services among Black African and Caribbean people with psychosis. The aim of this study was to examine the role of social network characteristics and psychological factors in engagement with services in Black people with psychosis. A cross-sectional study was conducted with 51 Black African and Caribbean adults with non-affective psychosis and currently receiving care from mental health services in England. Measures were completed to examine relationships between social networks, illness perceptions, perceived racial or ethnic discrimination in services, internalized stigma, and current engagement with services from service user and staff perspectives. Social network composition (ethnic homogeneity) moderately correlated with better service user and staff reported engagement. Greater perceived personal control over problems was associated with better staff reported engagement. Lower perceived ethnic or racial discrimination in services, and specific illness perceptions (higher perceived treatment control, greater self-identification with psychosis symptoms, more concern and greater emotional response related to problems) were associated with better service user reported engagement. Internalized stigma was not associated with service engagement. Multivariate regression analyses suggested that a more ethnically homogenous social network was the strongest predictor of better service user and staff reported engagement. Psychosocial interventions that target social networks, perceived ethnic and racial discrimination in services, and illness perceptions may facilitate better engagement and improve outcomes. Further longitudinal studies are required to examine causal mechanisms.

Analysis of incidence of motor neuron disease in England 1998–2019: use of three linked datasets

Objective: This study uses three linked datasets to provide an estimate of incidence of motor neuron disease (MND) in England from 1998 to 2019. Comparison is made to previous British studies. It examines age at diagnosis and ethnicity of those affected. Methods: The literature was searched for studies of MND incidence in Great Britain from 1995 to date. The QResearch and linked Hospital Episode Statistics and Death register databases were searched from 1998 to 2019 for cases of MND, and incidence calculated from 16.8 million adults and 112 million adult years of data. Results: We found 6437 adults with a diagnosis of MND giving an incidence of MND of 5.69/100,000 person years (95% CI 5.51–5.88); 6.57 (6.41–6.99) in men and 4.72 (4.49–4.97) in women when age-standardized to the 2011 UK population. The median age of diagnosis was 72 years. Peak incidence occurred in the 80–84 year age group in men and 75–79 in women. Age-standardized incidence was as high in Bangladeshi, Black Caribbean, Indian, other Asian and Pakistani people as in White people. Black African and Chinese people had a lower incidence. Conclusion: The use of three linked national datasets captured 33% more people than a primary care dataset alone. Patients were older than in previous studies and rates were high in all ethnic groups studied except Black African and Chinese people. We present the highest incidence of MND reported globally in the past 50 years. Methodological differences may in part explain differences with previous reports. The use of national datasets may have captured additional MND patients with serious comorbidities who have not seen a neurologist before death. A limitation of this approach is that unlike population registers, which minimize false positive diagnosis by neurologist review of each patient, we cannot review diagnosis for individuals as data are anonymized.

Mapping Black mixed-race Birmingham: Place, locality and identity

Utilizing narrations of urban space derived from interviews with 37 Mixed White and Black Caribbean people in the UK’s second-largest city, Birmingham, this article argues that place should be central to the theorization of mixed-race. Whilst Critical Mixed-Race Studies tends to privilege racial identity as the defining feature of the mixed-race experience, this article argues that mixed-race subjects identify with and through their respective localities to cultivate and perform their racialized identities. Drawing on personalized mental maps and routes through the city, the discussion sheds light on how conceptualizations of neighbourhood and territory are entangled with expressions of racial identity and belonging. By showing how the local histories, identities and characters of places come to be written on the bodies of mixed-race subjects, I demonstrate the power that place has in organizing social life and shaping identities. In doing so the article warns against the critical absence of place, and particularly the local, in empirical analyses of mixed-race identity. It suggests that for the development of de-essentialist understandings of mixedness which exist outside the realm of personal identifications, it is necessary to engage critically with place as an analytical framework.

Exploring the relationships between illness beliefs and psychosis symptoms among Black African and Caribbean people with non-affective psychosis

ABSTRACT Background Black African and Caribbean people in the UK have the highest rates of diagnosis with Psychosis. Compared with other ethnic groups, their contact with mental health services is characterised by inferior access, care experiences, and outcomes. Previous research suggests that beliefs about mental health problems may influence emotional responses, coping behaviours and outcomes in psychosis. Method The study examined the causal attributions and illness perceptions of 51 Black African and Caribbean people with non-affective psychosis and their associations with psychosis symptoms, using the Positive and Negative Syndrome S and the Brief Illness Perception Questionnaire. Results Black service users with non-affective psychosis most frequently attributed mental health problems to psychosocial factors, though spiritual, biological and substance abuse explanations were also provided. Endorsing a psychosocial explanation for psychosis was associated with less severe negative symptoms. More negative or threatening illness perceptions were correlated with greater negative, general and overall symptom severity in psychosis. Conclusions Psychological formulations and interventions for Black people experiencing psychosis should consider personalised beliefs about their mental health problems as this may facilitate improvements in symptoms. Further longitudinal research is warranted in larger samples to examine psychological causal mechanisms linking illness beliefs and psychosis outcomes.

Ethnicity and power in the mental health system: experiences of white British and black Caribbean people with psychosis.

Persistent inequalities exist in how individuals from minority ethnic groups access mental health care. A failure to investigate how these inequalities are experienced and what they mean to people with psychosis has privileged professional narratives and hindered our understanding of how they are sustained and what could be done to reduce them. The aim of this study was to investigate the long-term experience of living with psychosis and navigating mental health services within different ethnic groups. Our approach was informed by work on narrative analysis and prioritised the meaning that mental health services held for participants. In-depth interviews with 17 black Caribbean, 15 white British and 3 non-British white people with psychosis as part of AESOP-10, a 10-year follow-up of an ethnically diverse cohort of individuals with first-episode psychosis in the UK. Thematic narrative analysis was used to examine experiences at the personal level within and then across the individual accounts. Service users shared many defining experiences and narratives frequently returned to individuals' first contact with mental health services, first hospital admission, the experience of impatient wards, and the meaning of medication and diagnosis in their lives. We found that experiences of powerlessness punctuated the journey through mental health services and this appeared to dominate the accounts of black Caribbean, and to a lesser extent, white British participants. The findings reveal how negative expectations and experiences of mental health services are compounded over time, creating a vicious cycle of disempowerment and mistrust that manifests for many in resistance to - or at the best passive acceptance of - intervention by mental health services. High levels of need, coupled with alienation from services, contributed to negative patterns of service use among black Caribbean participants. White participants recounted substantial, though fewer, experiences of disempowerment and more instances of shared decision making that for some helped protect positive aspects of their lives. Against a background of entrenched social and economic disempowerment, services were experienced as disempowering by many black Caribbean people, compounding and perpetuating a sense of alienation. Concerted efforts by services to more systematically target social needs and to share power through partnership working may reduce the mistrust that many with psychosis feel when entering services and in turn reduce persistent inequalities across ethnic groups.

Ethnicity and impact on the receipt of cognitive–behavioural therapy in people with psychosis or bipolar disorder: an English cohort study

Objectives(1) To explore the role of ethnicity in receiving cognitive–behavioural therapy (CBT) for people with psychosis or bipolar disorder while adjusting for differences in risk profiles and symptom severity. (2)...

Ethnic, Religious and Gender Differences in Intragenerational Economic Mobility in England and Wales

This study uses data from consecutive England and Wales censuses to examine the intragenerational economic mobility of individuals with different ethnicities, religions and genders between 1971 and 2011, over time and across cohorts. The findings suggest more downward and less upward mobility among Black Caribbean, Indian Sikh and Muslim people with Bangladeshi, Indian and Pakistani ethnicities, relative to white British groups, and more positive relative progress among Indian Hindu people, but also some variation in the experiences of social mobility between individuals even in the same ethnic groups. For some groups, those becoming adults or migrating to the UK since 1971 occupy an improved position compared with older or longer resident people, but this is not universal. Findings suggest that these persistent inequalities will only be effectively addressed with attention to the structural factors which disadvantage particular ethnic and religious groups, and the specific ways in which these affect women.

The association between region of birth and sexually transmitted infections among people of black Caribbean ethnicity attending sexual health services in England, 2015.

Background/IntroductionIn England, people of Black Caribbean (BC) ethnicity are disproportionately affected by sexually transmitted infections (STIs), but it is unclear whether this varies by their region of birth.Aim(s)/ObjectivesTo examine differences in STI diagnoses among UK- and Caribbean-born BC people.MethodsData on STI diagnoses in BC people attending specialist sexual health services (SHSs) during 2015 and living in England were obtained from the GUMCAD STI surveillance system, the national surveillance system for STIs in England. Associations between being UK- or Caribbean-born and each of several STI diagnoses were examined, using univariate and multivariable generalised estimated equations logistic regression models adjusted for sexual orientation, place of residence (London vs. non-London), HIV status, area-level deprivation, and STI diagnosis in the last year. All analyses were stratified by age (<25 vs. ≥25 years).ResultsIn 2015, 63,568 BC people made 108,881 attendances at specialist SHSs; 81.9% of these attendances were made by UK-born BCs. The median age (years) was 26 for UK-born and 35 for Caribbean-born people (p≤0.001). Chlamydia, gonorrhoea and non-specific genital infection (NSGI) were the most commonly diagnosed STIs among UK- (5.8%, 2.1% and 2.8%) and Caribbean-born people (4.5%, 1.7% and 3.5%) respectively. Among BCs aged under 25, no significant differences in STIs were found between UK- and Caribbean-born people. Among BCs aged ≥25, compared to Caribbean-born people, those who were UK-born were more likely to be diagnosed with chlamydia (AOR 1.15 [95%C.I. 1.04–1.27]); gonorrhoea (AOR 1.23 [95%C.I. 1.06–1.45]) and genital herpes (AOR 1.23 [95% C.I. 1.10–1.56]) and less likely to be diagnosed with NSGI (AOR 0.89 [95% C.I. 0.80–0.99]) and Trichomoniasis (AOR 0.84 [95% C.I. 0.71–0.99]).Discussion/ConclusionSTI diagnoses in BC people aged ≥25 attending specialist SHSs vary by region of birth. Country of birth may have an influence on social and sexual networks and therefore transmission of STIs.

Pathways to, and use of, sexual healthcare among Black Caribbean sexual health clinic attendees in England: evidence from cross-sectional bio-behavioural surveys

BackgroundIn England, people of Black Caribbean (BC) ethnicity are disproportionately affected by sexually transmitted infections (STI). We examined whether differences in sexual healthcare behaviours contribute to these inequalities.MethodsWe purposively selected 16 sexual health clinics across England with high proportions of attendees of BC ethnicity. During May–September 2016, attendees at these clinics (of all ethnicities) completed an online survey that collected data on health service use and sexual behaviour. We individually linked these data to routinely-collected surveillance data. We then used multivariable logistic regression to compare reported behaviours among BC and White British/Irish (WBI) attendees (n = 627, n = 1411 respectively) separately for women and men, and to make comparisons by gender within these ethnic groups.ResultsBC women’s sexual health clinic attendances were more commonly related to recent bacterial STI diagnoses, compared to WBI women’s attendances (adjusted odds ratio, AOR 3.54, 95% CI 1.45–8.64, p = 0.009; no gender difference among BC attendees), while BC men were more likely than WBI men (and BC women) to report attending because of a partner’s symptoms or diagnosis (AOR 1.82, 95% CI 1.14–2.90; AOR BC men compared with BC women: 4.36, 95% CI 1.42–13.34, p = 0.014). Among symptomatic attendees, BC women were less likely than WBI women to report care-seeking elsewhere before attending the sexual health clinic (AOR 0.60, 95% CI 0.38–0.97, p = 0.039). No ethnic differences, or gender differences among BC attendees, were observed in symptom duration, or reporting sex whilst symptomatic. Among those reporting previous diagnoses with or treatment for bacterial STI, no differences were observed in partner notification.ConclusionsDifferences in STI diagnosis rates observed between BC and WBI ethnic groups were not explained by the few ethnic differences which we identified in sexual healthcare-seeking and use. As changes take place in service delivery, prompt clinic access must be maintained – and indeed facilitated – for those at greatest risk of STI, regardless of ethnicity.

Nutritional factors and cardiovascular disease risk in Black African and Black Caribbean women: a cross-sectional study

People of Black African (BA) and Caribbean (BC) heritage form the third largest ethnic group in England and Wales. Evidence shows they experience higher rates of overweight/obesity, stroke and type 2 diabetes compared to the general population but lower risk of heart disease, which may be explained by the favourable lipid profile they exhibit (2,3). There are limited UK studies on their dietary habits and health. The aim of the current study was to assess nutritional intake and cardiovascular disease (CVD) risk factors in UK BA and BC women. A convenience sample of self-ascribed BA and BC women, aged 19-64 years, were recruited (n = 44) from the ATTITUdinal DEterminants of diet and lifestyle (ATTITUDE) study. Cholesterol was measured using a portable CardioChek Blood Analyser, blood pressure using a digital blood pressure monitor and dietary intake via triple pass 24hr recall. Ethical approval was obtained from London Metropolitan University, King’s College London and Westminster University. Percentage energy, total fat, saturated fat, carbohydrate, and fibre and salt intake were calculated and under-reporting was assessed using the Goldberg equation. A sensitivity analysis conducted on nutrient intakes with under-reporters removed. Nutritional intake and CVD risk factors are shown in Table 1. Sixty three percent of participants were overweight or obese. Analysis of the dietary data revealed higher intakes salt, free sugars, fat and saturated fat than recommendations and lower intake of carbohydrate. Sensitivity analysis was conducted to investigate the impact of under-reporting (n = 22). Reported data remained unchanged except for fibre intake, which was lower in the under-reporters (14.9g compared to 21.0g) (P = 0.004). Blood lipid profiles and blood pressure data were within recommendations. In conclusion, the anthropometric and certain dietary measures would indicate increased risk for developing CVD in BA and BC women, however, blood lipid profile and blood pressure measures were within healthy ranges.

Understanding the burden of bacterial sexually transmitted infections and Trichomonas vaginalis among black Caribbeans in the United Kingdom: Findings from a systematic review.

BackgroundIn the UK, people of black Caribbean (BC) ethnicity continue to be disproportionately affected by bacterial sexually transmitted infections (STIs) and Trichomonas vaginalis (TV). We systematically reviewed evidence on the association between bacterial STIs/TV and ethnicity (BC compared to white/white British (WB)) accounting for other risk factors; and differences between these two ethnic groups in the prevalence of risk factors associated with these STIs, sexual healthcare seeking behaviours, and contextual factors influencing STI risk.MethodsStudies presenting relevant evidence for participants aged ≥14 years and living in the UK were eligible for inclusion. A pre-defined search strategy informed by the inclusion criteria was developed. Eleven electronic databases were searched from the start date to September-October 2016. Two researchers independently screened articles, extracted data using a standardised proforma and resolved discrepancies in discussion with a third researcher. Descriptive summaries of evidence are presented. Meta-analyses were not conducted due to variation in study designs. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed.ResultsOf 3815 abstracts identified, 15 articles reporting quantitative data were eligible and included in the review. No qualitative studies examining contextual drivers of STI risk among people of BC ethnicity were identified. Compared to the white/WB ethnic group, the greater STI/TV risk among BCs was partially explained by variations in socio-demographic factors, sexual behaviours, and recreational drug use. The prevalence of reporting early sexual debut (<16 years), concurrency, and multiple partners was higher among BC men compared to white/WB men; however, no such differences were observed for women. People of BC ethnicity were more likely to access sexual health services than those of white/WB ethnicity.ConclusionsFurther research is needed to explore other drivers of the sustained higher STI/TV prevalence among people of BC ethnicity. Developing holistic, tailored interventions that address STI risk and target people of BC ethnicity, especially men, could enhance STI prevention.

Ethnic variations in the risk of hypoglycaemia among people with Type 2 diabetes prescribed insulins and/or sulfonylureas: a historical cohort study using general practice-recorded data.

To identify ethnic differences in hypoglycaemic risk among people with Type 2 diabetes prescribed insulins and/or sulfonylureas in community settings. Using routine general practice-recorded data, two cohorts of adults with Type 2 diabetes from east London were studied between January 2013 and December 2015: (1) adults prescribed insulins ± other antidiabetes medications (n=7269) and (2) adults prescribed sulfonylureas ± other antidiabetes medications excluding insulins (n=12 502). Incidence rate ratios of hypoglycaemia by ethnicity, adjusting for age, sex, socio-economic status and clustering within Clinical Commissioning Groups, were estimated using random effects Poisson regression. Compared with white British people prescribed insulins, those of black Caribbean ethnicity were at increased hypoglycaemic risk [adjusted incidence rate ratio 1.56 (95% CI 1.21,2.01)], while Bangladeshi people had a lower risk [adjusted incidence rate ratio 0.49 (95% CI, 0.38,0.64)]. In the sulfonylurea cohort, black Caribbean, black African and Indian people all had increased risks of hypoglycaemia compared with white British people [adjusted incidence rate ratios 1.63 (95% CI 1.15,2.29), 1.90 (95% CI 1.32,2.75) and 1.93 (95% CI 1.39,2.69), respectively]. The differences in hypoglycaemic risk among people with Type 2 diabetes prescribed insulin and/or sulfonylureas warrant further investigation of any differing biological responses and/or cultural attitudes to antidiabetes therapy among ethnic groups, and should be considered by clinicians evaluating the treatment goals of people with Type 2 diabetes using insulins or sulfonylureas.