Caribbean Adults Research Articles

Periodontal Health Knowledge and Oral Health-Related Quality of Life in Caribbean Adults.

To identify the relationship between periodontal health knowledge and oral health-related quality of life among Caribbean adults. A cross-sectional study was conducted in a representative sample from 3 Caribbean cities (weighted N = 1805). Participants completed a questionnaire on oral health knowledge, hygiene habits, and other practices, as well as the Oral Health Impact Profile-14 (OHIP-14) questionnaire. The associations between knowledge and habits and OHIP-14 score and its tertiles were evaluated using negative binomial and multinomial logistic regression models, respectively, adjusting for confounders. Odds ratios and regression coefficients were reported. Participants reporting none, little, and adequate knowledge about gum health had higher odds of being in the worst tertile for OHRQoL, compared to those reporting "good knowledge" (ORnone vs good = 2.38, 95% CI: 1.59-3.54; ORlittle vs good = 1.82, 95% CI: 1.19-2.78; ORadequate vs good = 1.68, 95% CI: 1.11-2.57). Participants reporting toothbrushing ≥ twice/day were less likely to be in the worst tertile for OHRQoL, compared to those brushing less often (OR = 0.67, 95% CI: 0.48-0.92). Self-reported gum bleeding was associated with double the odds of being in the worse tertile (OR = 2.03, 95% CI: 1.60-2.58). According to the findings of this study, periodontal health knowledge is associated with reduced OHRQoL in Caribbean Adults. In addition, the frequency of brushing and the self-reported gum bleeding was related to a worse quality of life (QoL) level.

Diet and Nutritional Status of West African and Caribbean Adults in the United Kingdom: Perspectives to Inform Community-Based Approaches to Healthy Eating

Diet and Nutritional Status of West African and Caribbean Adults in the United Kingdom: Perspectives to Inform Community-Based Approaches to Healthy Eating

Mixed-methods implementation study of a virtual culturally tailored diabetes self-management programme for African and Caribbean communities (HEAL-D) in south London and its scaling up across NHS regions in England: study protocol

IntroductionThe National Health Service Insight Prioritisation Programme was established to accelerate the implementation and evaluation of innovation that supports post-pandemic working. Supporting this, the Academic Health Science Network and National...

Implications for Self-Management among African Caribbean Adults with Noncommunicable Diseases and Mental Health Disorders: A Systematic Review.

Mental health problems are common among individuals suffering from chronic noncommunicable diseases (NCDs) such as type 2 diabetes mellitus and hypertension. Self-management is essential in preventing NCD progression. Mental health problems can impede the ability to self-manage one's NCDs. The African Caribbean population in the United States suffers from a high burden of NCDs and has unique societal factors that alter disease management. This systematic review aimed to better understand the burden of mental health problems among African Caribbean adults with one or more NCDs and explore the association between mental health disorders and the level of control of NCDs. A literature search was conducted for original research documenting the prevalence of mental illnesses in individuals with NCDs. Data were descriptively summarized. Fourteen studies met inclusion criteria. Three themes emerged: (1) prevalence of comorbid mental health problems and chronic NCDs; (2) factors that mitigate or mediate the association between mental health problems and chronic NCDs-(a) factors influencing self-management; (b) association between mental health and NCD outcome studies focused on (b1) risk factors and (b2) protective factors; and (3) varied results. Chronic disease self-management and disease outcomes are influenced by mental problems and the association is mitigated by complex factors in the African Caribbean population.

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.

Lifetime Trauma Exposure and Posttraumatic Stress Disorder Among African Americans and Black Caribbeans by Sex and Ethnicity.

ObjectivePosttraumatic stress disorder (PTSD) is a debilitating disorder requiring timely diagnosis and treatment, with special attention needed for Black populations in the U.S. Yet, stakeholders often fail to recognize Black communities' heterogeneous ethnic composition, thus not allowing diverse sociocultural realities to inform PTSD interventions. This study aims to characterize sex and ethnic differences in lifetime trauma exposure, lifetime PTSD diagnosis and symptoms, and help-seeking among the African Americans and Black Caribbeans in the U.S.MethodThis study relied on data from the National Survey of American Life 2001–2003 (NSAL) to investigate the lifetime exposure to traumatic events and prevalence of a clinical PTSD diagnosis based on the DSM-IV among African American (n = 3,570) and Black Caribbean (n = 1,623) adults. 44.5% of respondents were men and 55.5% were women. Logistic regression was utilized to investigate the impact of traumatic events on PTSD.ResultsSeveral ethnic and sex differences in exposure to potentially traumatic events were identified. African American respondents were more likely to experience spousal abuse and toxin exposure than their Black Caribbean counterparts. Black Caribbeans reported higher lifetime exposure to muggings, natural disasters, harsh parental discipline, being a civilian living in terror and/or being a refugee than African American respondents. Specific to sex, Black men reported more events of combat, a peacekeeper/relief worker, being mugged, toxin exposure, seeing atrocities, and/or injuring someone. Black women were more likely to have been rape/sexual assault and/or intimate partner violence victims. The assaultive violence trauma type was most predictive of lifetime PTSD diagnosis among Black Americans. African American women were more likely to report PTSD symptoms than men, with almost no significant differences in Black Caribbean men and women. Approximately half of Black Americans sought help for their worst traumatic event, commonly engaging family/friends, psychiatrists, and mental health professionals. Further, there were almost no ethnic and sex differences related to professional and non-professional help sought.ConclusionFuture PTSD-related research should aim to characterize the heterogenous experiences of potentially traumatic events within different Black communities. Clinicians working with Black clients should strive to understand the limitations within their tools/interventions in meeting the needs of diverse groups.

The Impact of Traumatic Events on Mental Health Among Older African American and Black Caribbean Adults.

Objectives: This study examined the frequency and impact of traumatic events on the mental health of older African American and Black Caribbean adults. Methods: The current study used data from the National Survey of American Life of 1,135 African American and 426 Black Caribbean adults aged 50 and older. Analysis examined the impact of traumatic events on both positive (i.e., happiness and life satisfaction) and negative (i.e., depressive symptoms, psychological distress, and 12-month anti-depressant use) domains of mental health. Results: Findings indicate that approximately 80% of older African Americans and Black Caribbeans reported experiencing a traumatic event at some point in their lifetime. Among African Americans assaultive violence was associated with more depressive symptoms, lower levels of life satisfaction, and lower levels of happiness. This was not the case among Black Caribbeans. Conclusions: These findings provide preliminary insight in mental health outcomes for older African American and Black Caribbean adults.

Nutrient intake of African and Caribbean adults in the United Kingdom. A cross- sectional study

Nutrient intake of African and Caribbean adults in the United Kingdom. A cross- sectional study

Remembering the Positive and Negative: Affective Themes as Predictors of Psychological Well-Being Across Adulthood.

The current study explored the link between psychological well-being (PWB; self-acceptance, personal growth, and purpose in life) and affective themes, including redemption (positive endings for negative events), contamination (negative endings for positive events), and positive and negative affect (no change in affect) in the life stories of Caribbean adults ranging in age from 19 to 78 (N = 105). How often the memory narrative was rehearsed, and whether or not the theme emerged after being cued in content-coded life story low, high, and turning point scenes were also considered. Affective theme alone did not predict PWB; however, when considering age, rehearsal, and cue, redemption and positive affect predicted personal growth. More work should cue meaning-making in specific ways for different age groups in order to understand why there were no associations for middle-aged adults. Efforts should also be made to understand cross-cultural differences in life stories and PWB.

Providing culturally sensitive diabetes self-management education and support for black African and Caribbean communities: a qualitative exploration of the challenges experienced by healthcare practitioners in inner London

IntroductionPoor access to, and engagement with, diabetes healthcare is a significant issue for black British communities who are disproportionately burdened by type 2 diabetes (T2D). Tackling these inequalities is a...

Abstract P463: Objectively Measured Moderate-to-Vigorous Physical Activity is Associated With Decreased Myosteatosis in African Caribbean Adults

Increased skeletal muscle fat infiltration (i.e. myosteatosis) is now recognized as a major risk factor for cardio-metabolic diseases. Therefore, a lifestyle modification that reduces myosteatosis would be of great public health importance. However, studies examining the association of relevant lifestyle factors with this ectopic fat depot are lacking, particularly in African ancestry populations who have a very high burden of cardio-metabolic diseases. The aim of this study was to examine the relation between objectively measured physical activity and sedentary behavior with computed tomography measured calf muscle attenuation among middle-aged and elderly African-Caribbeans from the population-based Tobago Health Study. Preliminary analyses were conducted among 134 women (mean age 59 yrs, mean BMI 31.6 kg/m 2 ) and 355 men (mean age 62 yrs, mean BMI 28 kg/m 2 ). Physical activity was measured using the SenseWear Pro armband worn for 4-7 days. We calculated the mean duration of waking time engaged in light physical activity (LPA), moderate to vigorous activity (MVPA), and sedentary behavior (SB) per day. Skeletal muscle attenuation (mg/cm 3 ) reflects the fat content of the muscle such that greater skeletal muscle fat infiltration is reflected by lower attenuation. Women spent less time in LPA (146 vs. 270 min/day) and MVPA (15 vs. 41 min/day), but more time in SB (789 vs. 647 min/day) than men (all p<0.0001) after adjustments for gender differences in age. Muscle attenuation was lower among women compared with men (70.5 vs. 72.7 mg/cm3; age and BMI adjusted p<0.0001). In both women and men, muscle attenuation was positively correlated with the LPA and MVPA, and inversely with time spent in SB (spearman correlation coefficients (r) ranged from 0.21 to 0.39, all p<0.006 adjusted for age). Upon additional adjustment for BMI, in both women and men, the association of muscle attenuation with MVPA remained significant (r=0.21 and r=0.18, respectively, both p<0.03), but there was no association with LPA. Percent time spent in SB was associated with muscle attenuation only among women after additional adjustment for BMI (women: -0.16, p=0.052), and we also found a significant sex interaction effect of SB on muscle attenuation (p=0.035). Our preliminary findings suggest that there is significant association between MVPA and myosteatosis among middle-aged and elderly African Caribbeans. However, SB may only be relevant for myosteatosis among women. Future analyses will be conducted in a larger sample from this cohort to confirm our findings and to test for independence from other potential confounding factors, such as diet, sleep patterns, adiposity distribution, and diabetes.

Desarrollo y Validación de la Escala de Ansiedad por Enfermedad en Puerto Rico

El presente estudio analiza las propiedades psicométricas de la Escala de Ansiedad por Enfermedad en una muestra de adultos puertorriqueños. Un total de 300 puertorriqueños participaron en este estudio de carácter exploratorio y psicométrico. Los resultados confirmaron que la escala posee una estructura unidimensional. Los 10 ítems de la escala cumplieron con los criterios de discriminación. El índice de confiabilidad alfa de Cronbach de la escala fue .95. Estos resultados sugieren que el instrumento tiene el potencial para medir este constructo en adultos puertorriqueños. Además, la escala permitirá el avance de nuevas investigaciones sobre la ansiedad por enfermedad en adultos puertorriqueños, caribeños y latinoamericanos.

Association between gingival parameters and Oral health\u2013related quality of life in Caribbean adults: a population-based cross-sectional study

BackgroundGood oral health has been associated with better quality of life and general health. In the Caribbean, there have been no studies regarding the association between oral health conditions and the quality of life of the population. The main purpose of this study was to investigate the association between gingival parameters and oral health–related quality of life (OHRQoL) in Caribbean adults. A secondary aim of the study was to gain more information on factors that impact OHRQoL in this population.MethodsThis cross-sectional, epidemiological, population-based study was conducted in community settings. After the participants with missing Oral Health Impact Profile (OHIP) data were excluded, the sample size was 1821 (weighted according to the age and gender distribution in each target population). OHIP-14 standardized questionnaires were used to collect information. In addition, a medical/oral health questionnaire including sociodemographics, general health, dental visits, oral hygiene habits and knowledge, the frequency of dental visits, prosthesis use/hygiene, and smoking was administered. A multivariate model included predictors that showed significant associations in the univariate models. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported; statistical significance was set at 0.05.ResultsIn the multivariate analysis, current smokers (OR = 2.34, 95% CI: 1.74–3.14 vs. never smokers), those who visited the dentist only when problems arose (OR = 1.65, 95% CI: 1.13–2.40 vs. those visiting once a year), and participants with any chronic disease/condition (OR = 1.38, 95% CI: 1.06–1.78) had higher odds of being in the highest tertile for OHIP score (poorer health).ConclusionsThe present multicenter study identified potential modifiable risk factors for poor OHRQoL among adults in three Caribbean cities.

Obesity and weight misperception among adults in the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study.

SummaryObjectivePrior studies have suggested that weight misperception – underestimating one's actual weight – may be associated with reduced engagement in weight loss programmes, decreasing the success of initiatives to address obesity and obesity‐related diseases. The purpose of this study was to examine the factors associated with weight misperception among Eastern Caribbean adults and its influence on engagement in weight control behaviour.MethodsData from the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study were analysed (adults aged 40 and older, residing in the US Virgin Islands, Puerto Rico, Barbados and Trinidad). Weight misperception is defined as participants who under‐assess their weight measured by body mass index (BMI). Multivariable logistic regression (n = 1,803 participants) was used to examine the association of weight misperception with BMI category, age, gender, education, history of non‐communicable disease and attempt to lose weight.ResultsWeight misperception was common, with 54% of overweight (BMI 25–29 kg m−2), and 23% of obese class I (BMI 30–34.9 kg m−2) participants under‐assessing their actual weight. Participants with higher levels of education, versus lower, had decreased odds of weight misperception (OR 0.5, p < 0.001). There were no significantly reduced odds of weight misperception in women versus men (OR 1.13, p = 0.367) or in individuals with history of diabetes versus none (OR 0.88, p = 0.418). Participants with weight misperception had 85% (p < 0.0001) lower odds of attempting weight loss than those with accurate weight perception.ConclusionWeight misperception is common among adults with overweight and obesity in the Eastern Caribbean and is associated with lower likelihood of attempting weight loss. Obesity interventions, targeting similar populations, should incorporate approaches for addressing weight misperception to achieve measurable success.

Diabetes mellitus and obesity in the French Caribbean: A special vulnerability for women?

ABSTRACTThe objective of this study was to analyze the prevalence, awareness, treatment, and control of diabetes and its risk factors among French Caribbean adults. This cross-sectional study included 18–74-year olds (N = 2252; 56.5 percent women) who underwent a heath examination in Guadeloupe during July–December 2014. Diabetes was defined as using antidiabetic treatment, or fasting glucose ≥7 mmol/l, and glycated hemoglobin (HbA1c) ≥6.5 percent; diabetes control was defined as HbA1c < 7 percent. Multilevel logistic regression was used. Diabetes prevalence was 8.2 percent for women and 5 percent for men (age-adjusted odds ratio [aOR] for women = 2.0; 95 percent confidence interval [CI]: 1.4–2.9). The proportion of women with diabetes who were aware of it was 84.5 versus 67.3 percent in men (aOR = 2.7; 95 percent CI: 1.2–6.2). Nearly, all diagnosed participants were being treated. In less than a third of diabetics in both sexes was diabetes control obtained. Most women (55.3 percent) had a waist circumference at or above the National Cholesterol Education Program thresholds versus 14 percent of men (aOR = 9.3; 95 percent CI: 7.5–11.7), which wholly accounted for excess diabetes in women. In women, obesity and diabetes were associated with low education and income. In this French Caribbean sample, abdominal obesity and diabetes affected more women. Diabetes was rarely controlled. A comprehensive women’s health policy for the prevention of abdominal obesity and diabetes is needed.

Family and friendship informal support networks and social anxiety disorder among African Americans and Black Caribbeans.

This study explores relationships between Social Anxiety Disorder (SAD) and quality and frequency of involvement with family and friends. Data are from a nationally representative sample of African American and Black Caribbean adults (n=5191), the National Survey of American Life. SAD was assessed using the DSM-IV World Mental Health Composite International Diagnostic Interview. Findings indicated that among both populations, close supportive ties with family members and friends are protective against meeting criteria for SAD. Negative interactions with family (e.g., conflicts), however, are a risk factor for SAD among both African Americans and Black Caribbeans. For African Americans, an interaction indicates that the relationship between negative interaction and social anxiety is much stronger among African Americans who are not emotionally close to their families. For Caribbean Blacks, an interaction suggests that the odds of meeting criteria for SAD were higher among Black Caribbeans who had high negative interaction with family as well as low levels of friendship closeness. The cross-sectional nature of the study does not allow for causal attributions for findings. This study demonstrates that SAD may impact black ethnic subgroups differently, which has important implications for understanding the nature, etiology, and treatment of this disorder.

Extended family and friendship support networks are both protective and risk factors for major depressive disorder and depressive symptoms among African-Americans and black Caribbeans.

This study explores relationships between lifetime and 12-month Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) major depressive disorder (MDD), depressive symptoms, and involvement with family and friends within a national sample of African-American and Black Caribbean adults (n = 5191). MDD was assessed using the DSM-IV World Mental Health Composite International Diagnostic Interview and depressive symptoms were assessed using the Center for Epidemiologic Studies-Depression subscale and the K6. Findings indicated that among both populations, close supportive ties with family members and friends are associated with lower rates of depression and MDD. For African-Americans, closeness to family members was important for both 12-month and lifetime MDD, and both family and friend closeness were important for depressive symptoms. For Caribbean Blacks, family closeness had more limited associations with outcomes and was directly associated with psychological distress only. Negative interactions with family (conflict, criticisms), however, were associated with higher MDD and depressive symptoms among both African-Americans and Black Caribbeans.

Establishing a System for Health Professional Training and Certification in Diabetes Self-Management Education in the Caribbean

The Caribbean includes not only the islands in the Caribbean Sea, but also South and Central American countries (e.g., Guyana, Suriname, and Belize) as well as islands in the Atlantic (e.g., The Turks and Caicos Islands), which have strong historical, political, and social links. The region, predominantly comprising low- to middle-income countries, has been adopting a more “westernized” lifestyle, which has resulted in an increase in the prevalence of chronic noncommunicable diseases, including diabetes. Diabetes is estimated to affect ~ 9% of Caribbean adults, disproportionately affecting women and occurring at an earlier age than in many developed countries.1 The region has also reported some of the highest rates of diabetes-related amputations.2 In Jamaica, the prevalence of diabetes ranges from 65 years of age.3 Type 2 diabetes is the most common form of diabetes in adults. Although type 1 diabetes remains the most common form of diabetes in young people, a recent study4 found that type 2 diabetes affected 16% of adolescents. With an aging population and a high prevalence of obesity in women, the Caribbean is expected to see one of the largest increases in diabetes prevalence in the next 20 years.5 Diabetes self-management education (DSME) is crucial in addressing the coming epidemic. DSME equips patients with the skills to become active participants in their care and make informed choices that can improve outcomes and prevent complications. Although DSME is a well-established clinical skill in developed countries, there have been few efforts in the Caribbean and Latin America to develop this area of expertise and incorporate it as part of standard clinical practice.6–8 Clinicians receive much of their diabetes education while in training. Although conferences and continuing medical education opportunities …

The Caribbean's HIV/AIDS Epidemic: Theory, Research and Interventions

The Caribbean is the second leading region worldwide in HIV/AIDS infections behind Sub-Saharan Africa, and AIDS is the leading cause of death among young Caribbean adults. This paper addresses the research findings on the spread of the HIV virus in the adult population of English-speaking Caribbean countries (ESC). There is an examination of the primary drivers of the virus such as risky sexual behaviors, economic deprivation, illiteracy, stigmatization, inadequate HIV/AIDS health care facilities, among other factors. A related discussion is on the feminization of the HIV/AIDS epidemic. Discrimination experienced by Caribbean persons infected and affected by HIV/AIDS is addressed. Theoretical perspectives on HIV/AIDS and research findings on HIV/AIDS care and antiretroviral treatment are discussed. The paper concludes with recommendations for the prevention and control of the epidemic in the Caribbean. Abstract

Perceived Discrimination and DSM-IV–Based Alcohol and Illicit Drug Use Disorders

We examined the relationship between everyday and major discrimination and alcohol and drug use disorders in a nationally representative sample of African Americans and Black Caribbeans. With data from the National Survey of American Life Study, we employed multivariable logistic regression analyses--while controlling for potential confounders--to examine the relationship between everyday and major discrimination and substance use disorders on the basis of Diagnostic and Statistical Manual of Mental Disorders criteria. Every 1 unit increase in the everyday discrimination scale positively predicted alcohol (odds ratio [OR] = 1.02; P < .01) and drug use (OR = 1.02; P < .05) disorders. Similarly, each additional major discrimination event positively predicted alcohol (OR = 1.10; P < .05) and drug use (OR = 1.15; P < .01) disorders. To our knowledge, this study is the first to examine problematic usage patterns rather than infrequent use of alcohol and drugs in a national sample of African American and Black Caribbean adults and the first to examine this particular relationship in a national sample of Black Caribbeans.