Substance use, age at migration, and length of residence among adult Caribbeans in the United States

OBJECTIVE: To examine the prevalence of substance use disorders and determine whether age at migration and time predict these behaviors using the National Survey of American Lives (n=1,370). DESIGN AND METHODS: Multivariable logistic regression analyses controlling for potential confounders were used. RESULTS: Individuals that immigrated to the US were less likely to be diagnosed with a substance use disorder compared to those that immigrated when they were less than 13 years old. On the other hand, migrants that spent 10-20 years in the US were less likely to be diagnosed with a substance use disorder compared to those that spend 1-10 years in the US; however, those migrants that spent more than 20 years in the US were 3-9 times more likely to be diagnosed with a substance use disorder. CONCLUSION: As suggested, age at migration and length of residence are important factors because they shape immigrants’ abilities to socialize and respond to the potentially conflicting demands of the host culture, and in this case, more likely to engage in problematic substance use patterns. Public health professionals must consider the heterogeneity among Blacks in the US as they attempt to reduce and/or eliminate racial/ethnic disparities in substance use.

Reducing health disparities and improving health equity in the United States and Saint Lucia

OBJECTIVE: To create a sustainable model for community health education, tracking and monitoring of selected health conditions (diabetes and mental health), research training, and health policy action in St. Lucia, which may be applicable to underserved African Americans in the U.S. DESIGN AND METHODS: Phase one of this pilot study included a mixed methods analytic approach. Adult clients at risk for or diagnosed with diabetes (n=157) and health care providers/clinic administrators (n=39) were recruited from 5 diverse healthcare facilities in St. Lucia to assess their views on health status, health care services and existing challenges/opportunities to improve health equity. Content analyses of the qualitative data were conducted. RESULTS: Preliminary analyses of qualitative data indicated an awareness of the relatively high prevalence of diabetes and other chronic illnesses. Patients generally acknowledged that one’s socioeconomic status (SES) has an overall impact on health outcomes, though anyone, regardless of SES, may be diagnosed with a chronic disease. Finally, participants indicated desire for better accessibility to healthcare services and improvements to existing healthcare infrastructures to provide better services. CONCLUSION: Findings from this pilot project could serve as a model to help advance health equity among diverse populations through evidence based, culturally tailored community education and prevention efforts. These activities may play a vital role in improving the health status and healthcare among St. Lucians with chronic health conditions and inform similar strategies that may be effective in the United States.

The mental and physical health of severely and non-severely abused U.S. Black Caribbean women

OBJECTIVE: The study examined the mental and physical health of U.S. Caribbean Black women using a nationally representative sample, with a special emphasis on the role of severe intimate partner violence. DESIGN AND METHODS: Data from the National Survey of American Life, the largest and the only known representative study on 1621 non- institutionalized Caribbeans residing in the United States, were used. The mental health (i.e., mood, substance, anxiety, eating) of participants was based on structured mental health assessments (DSM-IV) and physical health was based on self-report of physician-diagnosed conditions (i.e., arthritis, high blood pressure, liver problem, HIV or AIDS). Chi-square tests of independence were used to address differences in rates of mental and physical health conditions between severely abused and non-severely abused women. RESULTS: Rates of mental and physical health problems were generally higher among women experiencing severe intimate partner violence in comparison to women who had not experienced intimate partner violence. This was apparent for conditions such as bipolar disorder (12.4% vs. 1.3%), panic disorder (11.9% vs. 1.9%), alcohol abuse (5.5% vs. 1.8%), suicide attempts (12.7% vs 1.4%), kidney problem (6.0% vs. 1.8%), liver problem (3.7% vs. 0.8%), and HIV or AIDS (1.3% vs. 0.1%). CONCLUSIONS: The study had intervention and preventative implications for both detecting and addressing the health needs of women who are abused by an intimate partner.

Same-visit HIV testing in Trinidad and Tobago

BACKGROUND: The Ministry of Health (hereafter, Ministry) of Trinidad and Tobago is responsible for delivery of all health services in the country. The Ministry takes responsibility for direct delivery of care in the public sector and has initiated a process whereby those seeking HIV test results could obtain confidential reports during a single-visit to a testing location. The Ministry requested technical assistance with this process from the Caribbean Epidemiology Centre (CAREC). The United States Centers for Disease Control and Prevention (CDC) played an important role in this process through its partnership with CAREC. METHODS: Under the technical guidance of CAREC and CDC, the Ministry organized a technical working group which included representatives from key national HIV program services and technical assistance partners. This working group reviewed internationally-recognized best practices for HIV rapid testing and proposed a program that could be integrated into the national HIV programs of Trinidad and Tobago. The working group wrote a consensus protocol, defined certification criteria, prepared training materials and oversaw implementation of "same-visit" HIV testing at two pilot sites. RESULTS: A Ministry-of-Health-supported program of "same-visit" HIV testing has been established in Trinidad and Tobago. This program provides confidential testing that is independent of laboratory confirmation. The program allows clients who want to know their HIV status to obtain this information during a single-visit to a testing location. Testers who are certified to provide testing on behalf of the Ministry are also counselors. Non-laboratory personnel have been trained to provide HIV testing in non-laboratory locations. The program includes procedures to assure uniform quality of testing across multiple testing sites. Several procedural and training documents were developed during implementation of this program. This report contains links to those documents. CONCLUSIONS: The Ministry of Health has implemented a program of "same-visit" HIV testing in Trinidad and Tobago. This program provides clients confidential HIV test reports during a single visit to a testing location. The program is staffed by non-laboratory personnel who are trained to provide both testing and counseling in decentralized (non-laboratory) settings. This approach may serve as a model for other small countries.

Neutropenia in 6 ethnic groups from the Caribbean and the U.S.

BACKGROUND: Low white blood cell counts (WBC) or absolute neutrophil counts (ANC) may delay or prevent the completion of appropriate chemotherapy, especially among women receiving adjuvant therapy for breast and colon cancer, and affect cancer survival. Because race/ethnicity is also associated with survival, the authors compared WBC and ANC in healthy American-born women of African descent and European descent, and women from Barbados/Trinidad-Tobago, the Dominican Republic, Haiti, and Jamaica. METHODS: Blood samples from 261 healthy women ages 20 to 70 years were tested for WBC with differential, cytokine and growth factor levels, and ancestry informative and neutrophil elastase polymorphisms. The authors analyzed the association between neutropenia and serum WBC growth factor levels, cytokine levels, and neutrophil elastase c199a polymorphism. RESULTS: The median WBC and ANC differed among the 6 groups (P < .01 for WBC and P < .0001 for ANC). Dominicans were found to have higher median WBC and ANC than all other groups (P < .03). Neutropenia (ANC < 1500 cu/mm) was observed among 2.7% to 12.5% of the groups of predominantly African descent; no other groups were found to have neutropenia (P < .05). Granulocyte-colony-stimulating factor was found to be lower in white women, but tumor necrosis factor-alpha and C-reactive protein were not found to be correlated with ethnicity. Women of African origin were more likely to have polymorphisms of African ancestry (P < .001) and c199a alleles (P < .0001), which were also associated with low ANC levels. CONCLUSIONS: In the current study, the authors observed a strong association between neutropenia and African descent among asymptomatic women from the U.S. and the Caribbean. Among women of African descent who develop a malignancy, this association may contribute to racial disparities in treatment and outcomes.

HIV risk behaviors of Latin American and Caribbean men who have sex with men in Miami, Florida, USA

OBJECTIVE: The goal of this study is to describe the sexual practices, drug use behaviors, psychosocial factors, and predictors of unprotected anal intercourse (UAI) in a sample of Hispanic men who have sex with men (MSM) born in Latin American and Caribbean (LAC) countries who currently reside in Miami-Dade County, Florida. METHODS: Hispanic MSM (N = 566) recruited from community and Internet venues completed a computer-assisted self-interview assessing sociodemographic factors, drug use, sexual behaviors, and psychosocial factors. We focused on the 470 men who were born in LAC countries, including Puerto Rico. We first examined separately, by country of origin, the sexual practices, drug use behaviors, and psychosocial factors of the sample. We then collapsed the groups and examined the factors associated with UAI in the previous 6 months for the entire sample of Hispanic MSM from LAC countries. RESULTS: In the previous 6 months, 44 percent of the sample engaged in UAI, and 41 percent used club drugs. At the multivariate level, psychological distress, higher number of sexual partners, club drug use, HIV-positive status at the time of immigration, and greater orientation to American culture were significantly associated with UAI in the previous 6 months. CONCLUSIONS: Many MSM born in LAC countries engage in HIV-related risk behaviors in the AIDS epicenter of Miami-Dade County, Florida. Culturally appropriate interventions should address these risk behaviors in this underserved population.

Confidence intervals for biomarker-based human immunodeficiency virus incidence estimates and differences using prevalent data

Prevalent biologic specimens can be used to estimate human immunodeficiency virus (HIV) incidence using a two-stage immunologic testing algorithm that hinges on the average time, T, between testing HIV-positive on highly sensitive enzyme immunoassays and testing HIV-positive on less sensitive enzyme immunoassays. Common approaches to confidence interval (CI) estimation for this incidence measure have included 1) ignoring the random error in T or 2) employing a Bonferroni adjustment of the box method. The authors present alternative Monte Carlo-based CIs for this incidence measure, as well as CIs for the biomarker-based incidence difference; standard approaches to CIs are typically appropriate for the incidence ratio. Using American Red Cross blood donor data as an example, the authors found that ignoring the random error in T provides a 95% CI for incidence as much as 0.26 times the width of the Monte Carlo CI, while the Bonferroni-box method provides a 95% CI as much as 1.57 times the width of the Monte Carlo CI. Further research is needed to understand under what circumstances the proposed Monte Carlo methods fail to provide valid CIs. The Monte Carlo-based CI may be preferable to competing methods because of the ease of extension to the incidence difference or to exploration of departures from assumptions.

IOP by Goldman Applanation Tonometry and the Tono-Pen in Afro-Americans

One hundred subjects attending the Preventative-Community Opthalmology Service in a community-based primary care center (Southside Healthcare, SW Atlanta, GA) were examined between January 24, 1996 and April 26, 1996. Ninety-nine African Americans and one Hispanic subject contributed 113 patient visits, hence there were 226 eye pairs for analysis. The mean age (n=100) was 55.8ñ16.8 years (x+sd). There were 62 females (54.2ñ17.8 years) and 38 males (58.3ñ14.9 years). The Kowa (portable) applanation tonometer and Tono-Pen (Mentor) were employed to measure the intraocular pressure in subjects at high risk for severe visual loss from either hypertension (glaucoma), diabetes (retinopathy), or HIV-related ocular syndromes. Assignment to order of measurement device was done randomly by coin-flip. The mean IOP for Kowa was 19.56ñ4.55mmHg and Tono-Pen was 19.53ñ4.63mmHg. Data from scatter plot with regression line indicate that an increase of 1mmHg for Kowa applanation tonometer was associated with 0.73mmHg for the Tono-Pen; hence the correlation factor r=0.58. Both tonometers are virtually comparable at 16-24mmHg range. The Tono-Pen demonstrated significant error at both the high (IOP>25mmHg) and low (IOP<12mmHg) ranges. Our data indicate that for low IOP range (10-15mmHg) the Tono-Pen read 2.6mmHg higher than the Kowa tonometer; similarly within the high IOP range (>25mmHg) the Tono-Pen read 4.2mmHg lower than the Applanation tonometer. The clinical caveats to primary care doctors screening emergency room patients are to ensure that ocular hypotony, a pertinent physical finding in penetrating eye injuries, is not overlooked with Tono-Pen tonometry. Studies comparing Goldman slit lamp mounted Applanation tonometers and Tono-Pen devices indicate that consistencies exist at both the high (>24) and low (<12) IOP ranges. (AU)

The important concepts in the management of microbial keratitis

Eye practitioners in the Caribbean must be aware of the issues involved in the management of microbial keratitis. A comprehensive literature review is presented in order to outline appropriate management strategies and to identify when referral may be indicated. (AU)

The changing spectrum of childhood poisoning in the Caribbean - Poster abstract

OBJECTIVE: To determine the incidence of accidental poisoning in children, types of ingested substances, age of victims and outcome and compare data from Antigua with those from the United States and other Caribbean countries. DESIGN AND METHODS: A retrospective review of the records of all patients admitted to Children's Ward, Holberton Hospital, Antigua from March 1989 to March 1999 was performed. Data were compared with previous reports form Jamaica (1977), Barbados (1978), Guyana (1988) and the United States (1990). RESULTS: In Antigua there were 255 ingestions in children less than 13 years, with 45 percent in 1-year old, 27 percent in 2 year old and 10 percent in 3 year old children; 57 percent boys, similar in all countries. Two percent (2 percent) of poisonings in Jamaica were fatal and 0.3 percent in Antigua (kerosene). Fatality rate was 6 per 100,000 in Antigua, 0.5 per 100,000 in USA. Per capita GDP was US$995 in Guyana, US$2,079 in Jamaica, US$3,700 in Barbados, US$5,377 in Antigua and US$18,448 in United States. CONCLUSIONS: A comparison of poisonings seen in the Caribbean suggest that, with economic advance, ingestates change from hydrocarbon to medications and households products.(AU)

Seroprevalence of human herpesvirus-8 (HHV-8) in countries of Southeast Asia compared to the USA, the Caribbean and Africa

Seroprevalence of HHV-8 has been studied in Malaysia, India, Sri Lanka, Thailand, Trinidad, Jamaica and the USA, in both healthy individuals and those infected with HIV. Seroprevalence was found to be low in these countries. In contrast, the African countries of Ghana, Uganda and Zambia showed high seroprevalences in both healthy and HIV-infected populations. This suggests that human herpes virus-8 (HHV-8) may be either a recently introduced virus or one that has extremely low infectivity. Nasopharyngeal and oral carcinoma patients from Malaysia, Hong Kong and Sri Lanka who have very high EBV titres to show that only 3/82 (3.7 percent) have antibody to HHV-8, demonstrating that there is little, if any, cross-relativity between antibodies to these two gamma viruses. (AU)

Population data on the thirteen CODIS core short tandem repeat loci in African Americans, U.S. Caucasians, Hispanics, Bahamians, Jamaicans, and Trinidadians

Allele distributions for 13 tetrameric short tandem repeat (STR) loci, CSF1PO, FGA, TH01, TPOX, VWA, D3S1358, D5S818, D7S820, D8S1179, D13S317, D16S539, D18S51, and D21S11, were determined in African-American, United States Caucasian, Hispanic, Bahamian, Jamaican, and Trinidadian sample populations. There was little evidence for departure from Hardy-Weinberg expectations (HWE) in any of the populations. Based on the exact test, the loci that departed significantly from HWE are: D21S11 (p=0.010, Bahamians); CSF1PO (p=0.014, Trinidadians); TPOX (p=0.011, Jamaicans and p= 0.035, U.S. Caucasians); and D16S539 (p=0.043, Bahamians). After employing the Bonferroni correction for the number of loci analyzed (i.e., 13 loci per database), these observations are not likely to be significant. There is little evidence for association of alleles between the loci in these databases. The allelic frequency data are similar to other comparable data within the same major population group. (AU)

Filariasis of the ankle: magnetic resonance imaging

Filariasis is a world health problem that is frequently seen in tropical and subtropical countries. In endemic areas, the clinical spectrum of extremity swelling, lymphangitis, or elephantiasis is usually recognized as filariasis. In the United States, diagnosis of the disease may be more difficult because of lack of familiarity with this infection. We present a case of filaremic anthropathy of the ankle joint and the magnetic resonance imaging (MRI) findings of this disease. It is the first reported case of MRI findings in a human patient. MRI has been done on animal models with filariasis, and the findings are similar. (AU)

Relationships of fasting and postload glucose levels to sex and biased against detection of diabetes in women?

OBJECTIVE: To compare, in men and women, the prevalence of undiagnosed type 2 diabetes assessed using criteria from the American Diabetes Association (ADA) and the World Health Organization (WHO) and to investigate risk factors associated with fasting and 2-h postload plasma glucose. RESEARCH DESIGN AND METHOD: Data from two companion surveys of Europeans, South Asians, and Afro-Caribbean in west London were used. A total of 4,367 men and women aged 40-64 years who were not known to have diabetes underwent an oral glucose tolerance test after an overnight fast. The prevalence of undiagnosed diabetes was estimated using the ADA (fasting plasma glucose > or = 7.0 mmol/l) and WHO (2-h postload glucose > or = 11.1 mmol/l) criteria for epidemiologic studies. The association of body fat and usual alcohol intake with plasma glucose and diabetes prevalence was assessed. RESULTS: Compared with the WHO criterion, the ADA criterion gave a higher prevalence of diabetes in men (6.4 vs 4.7 percent) but a lower prevalence in women (3.3 vs. 4.2 percent). In Afro-Caribbeans, the sex difference in diabetes prevalence was reversed. Women had significantly lower fasting glucose than men despite higher 2-h glucose levels. Alcohol intake was positively associated with fasting glucose in men and women but not with 2-h glucose levels. CONCLUSIONS: The new ADA criterion, based on fasting glucose alone, does not take account of sex differences in metabolic response to fasting or possible artifactual effects on fasting glucose. With ADA criterion, alcohol intake was significant risk factor for diabetes in our study population; this was not the case with the WHO criterion.(AU)

HDV 16 antibody prevalence in Jamaica and the United States reflects differences in cervical cancer rates

Human papillomavirus (HPV) is widely accepted as the primary etiologic agent in the development of cervical cancer. DNA of a particular HPV type, HPV 16, is found in about half of tumors tested. Inconsistent with this causal relationship, however, population-based studies of HPV DNA prevalence have often failed to find high rates of anogenital HPV infection in countries with high cervical cancer rates. To examine this issue, we used serology to compare HPV 16 exposure in healthy volunteer blood donors in the United States (n = 278) and similar subjects from a country with 3-fold higher cervical cancer rates, Jamaica (n = 257). Jamaican sexually transmitted disease (STD) patients (n = 831) were also studied to examine in detail the relation of HPV 16 antibodies with sexual history. Serology was conducted using an ELISA employing HPV 16 virus-like particles (VLPs). Age-adjusted seroprevalence rates were greatest among male (29 percent) and female (42 percent) STD patients, intermediate in male (19 percent) and female (24 percent) Jamaican blood donors and lowest among male (3 percent) and female (12 percent) U.S. blood donors. The higher seroprevalence in women was significant, and prevalence tended to increase with age. In multivariate logistic regression, controlling for age and gender, Jamaican blood donors were 4.2-fold (95 percent CI 2.4 - 7.2) and STD patients 8.1-fold (95 percent CI 5.0 - 13.2) more likely to have HPV 16 VLP antibodies than U.S. blood donors. Among STD patients, HPV 16 antibodies were associated with lifetime number of sex partners and years of sexual activity, as well as other factors. Our data suggest that HPV 16 VLP antibodies are strongly associated with sexual behavior. Moreover, exposure to HPV 16 appears to be much greater in Jamaica than in the United States, consistent with the high rate of cervical cancer in Jamaica (Au)

Prevalence of diabetes and impaired glucose tolerance in Nigerians, Jamaicans and US blacks

The prevalence of type 2 diabetes, impaired glucose tolerance and associated risk factors were compared in sample surveys in Africa and the Caribbean with the Third National Health and Nutrition Survey (NHANES-III) from the United States. A total of 856 Nigerians, 1286 Jamaicans, and 1827 US blacks were included in the study. Body mass index (BMI) increased in a stepwise fashion across the three population groups, ie, 23 kg/m2 in Nigerians, 26 kg/m2 in Jamaicans, and 28 kg/m2 in US blacks. The persons aged 25-74, were 1 percent, 12 percent, 13 percent. Jamaican women were found to have the same prevalence of type 2 diabetes as US women (14 vs 13 percent, respectively); mean BMI was likewise very similar (28 kg/m2 in Jamaican and 29 kg/m2 in US women). BMI and waist-to-hip ratio were both associated with type 2 diabetes prevalence. Findings of this study confirm the marked gradient in type 2 diabetes risk among these genetically related populations and suggest that the blacks in the island nations of the Caribbean and the United States are at particularly high risk. Nigerians exhibited remarkably well-preserved glucose tolerance. Understanding the factors that limit the risk of type 2 diabetes in West Africa, beyond relative absence of obesity, would have considerable public health significance.(Au)

Seroprevalence of HTLV-I and HTLV-II among a cohort of HIV-infected women and women at risk for HIV infection. Women's Interagency HIV Study

OBJECTIVES: To determine the seroprevalence of, and risk factors for, HTLV-I and HTLV-II infection among HIV-infected women and women at high risk for HIV infection. DESIGN: Cross-sectional analysis of baseline data for women enrolled in the prospective Women's Interagency HIV Study (WIHS). METHODS: From October 1994 through November 1995, 2657 women from five metropolitan areas in the United States (Chicago, Los Angeles, New York City [two sites], Northern California, and Washington DC) were enrolled in WIHS. An interview-based survey collected data on demographics, behavior, and medical history. HTLV-I and HTLV-II determinations were made using a combined HTLV-I/HTLV-II indirect immunofluorescent antibody (IFA) screening test, an IFA titration specificity test, and individual HTLV-I and HTLV-II confirmatory Western blots. Fisher's exact tests and logistic regression were used to determine univariate and multi variate independent predictors for HTLV-II infection. RESULTS: Of 2625 women enrolled in WIHS with confirmed HIV results, 2487 (95 percent) were tested for HTLV-I and HTLV-II. Of these, 241 (10 percent) HTLV-II-seropositive and 13 (0.5 percent) were HTLV-I-seropositive. On multivariate analysis, independent predictors of HTLV-II infection included injection drug use (OR = 5.2; p < .001), black race (OR = 3.6; p < 0.001), age > 35 years (OR = 3.3; p < .001) and a history of sex with a male injecting drug user (OR = 1.9; p < .001). Among women injected with HIV, the seroprevalence of HTLV-II was 11 percent compared infected with HIV, the seroprevalence of HTLV-II was 11 percent compared with 6 percent for women at risk for HIV but not infected (p < .001). However, HIV was not an independent predictor of HTLV-II infection in multivariate analysis. CONCLUSIONS: This cross sectional analysis confirms that HTLV-II is found commonly in HIV-infected women at risk for HIV in major urban areas throughout the United States and that HTLV-II is far more common than HTLV-I in these populations. Although injecting drug use is most strongly associated with HTLV-II infection, sexual transmission likely contributes to the high HTLV-II seroprevalence in this cohort.(AU)

Estimating African American admixture proportions by use of population-specific alleles

We analyzed the European genetic contribution to 10 populations of Africans descent in the United States (Maywood, Illinois; Detroit; New York; Philadelphia; Pittsburgh; Baltimore; Charleston, South Carolina; New Orleans; and Houston) and in Jamaica, using nine autosomal DNA markers. These markers either are population-specific or show frequency differences >45 percent between the parental populations and are thus especially informative for admixture. European genetic ancestry ranged from 6.8 percent (Jamaica) to 22.5 percent (New Orleans). The unique utility of these markers is reflected in the low variance associated with these admixture estimates (SEM 1.3 percent -2.7 percent). We also estimated the male and female European contribution to African Americans. on the basis of informative mtDNA (haplogroups H and L) and Y Alu polymorphic markers. Results indicate a sex-biased gene flow from Europeans, the male contribution being substantially greater that the female contribution. mtDNA haplogroups analysis shows no evidence of a significant maternal Amerindian contribution to any of the 10 populations. We detected significant nonrandom association between two markers located 22 cM apart (FY-null and AT3), most likely due to admixture linkage disequilibrium created in the interbreeding of the two parental populations. The strength of this association and the substantial genetic distance between FY and AT3 emphasize the importance of admixed populations as a useful resources for mapping traits with different prevalence in two parental populations (AU)