The health and economic burden associated with sugar-sweetened beverage consumption in Trinidad and Tobago.

BACKGROUND: In Trinidad and Tobago, non-communicable diseases (NCDs) are the leading cause of death. Unhealthy diet is one modifiable NCD risk factor, which contributes to the NCD burden. The consumption of sugar-sweetened beverages (SSBs) has been associated with an increased risk of NCDs. AIM: The aim of this paper is to estimate the burden of disease and economic costs associated with the consumption of SSBs in Trinidad and Tobago as evidence to support the implementation of health and fiscal policies on SSB consumption. METHODS: The results of this study were obtained through the use of a mathematical model which used a comparative risk assessment approach to estimate the health and economic burden associated with SSB intake, by sex and age. RESULTS: Estimates for one year showed that SSB consumption was associated with approximately 15,000 cases of overweight and obesity in adults and 11,700 cases in children, 28% of all the cases of diabetes and overall, an estimated 387 deaths and 9000 years of healthy life were lost due to premature death and disability. Approximately US$23.1 million was spent in the public healthcare system to treat diseases associated with consumption of sugary beverages. CONCLUSIONS: The consumption of SSBs is associated with increases in diseases, deaths and rising healthcare costs in Trinidad and Tobago. It is hoped that the results of this study will provide an added rationale and impetus for the implementation of policies to reduce the consumption of SSBs.

Sociodemographic and dietary influences on perceptions of eating habits in Jamaica.

Objective: To evaluate how sociodemographic factors and food intake affect survey respondents' perceptions of the quality of their diet. Methods: This cross-sectional analysis is based on a nonprobability sample of 374 participants in Jamaica aged ≥18 years. The three-stage process used a simple random sample to select three parishes; the main commercial areas of each parish were chosen for sampling. To ensure the inclusion of a cross-section that was as representative as possible, the sample included both public and private sector businesses, such as those in retail, hospitality and tourism as well as nongovernmental organizations. Employees and patrons completed a questionnaire regarding their food consumption and their perception of their own diet. Multiple correspondence analysis was used to evaluate the nonlinear relationships among the variables. The results of the analysis guided the specification of a multivariate logistic regression model that was used to estimate the relationship between sociodemographic factors, food intake and perceived eating patterns. Results: The average predicted probability of perceiving a diet as unhealthy was reduced when the respondent was male, economically active, in good health, and married or in a common-law relationship. The probability of perceiving a diet as unhealthy was increased for respondents with a college degree and those living in a household that had a male as the sole head. Consuming healthful food and drink reduced the perception of having a poor diet and vice versa, indicating there are possibly connections between food intake, the perception of diet quality and actual diet quality. Conclusions: This exploratory analysis established links between perceived diet quality, eating habits and sociodemographic factors. The impact on the perception of diet quality can be negative or positive, depending on the variable under consideration.

Assessing the determinants of unhealthy dietary habits among a sample of survey participants in Jamaica.

Objective: To identify and assess the determinants of unhealthy dietary habits among a sample of survey participants in Jamaica. Methods: Because of resource constraints, this cross-sectional assessment is based on a three-stage non-probability sample of 374 survey respondents in Jamaica aged ≥18 years. Firstly, three administrative areas (parishes) were randomly selected. Secondly, the main commercial areas within the selected parishes were identified, from which a non-probability sample of establishments was drawn. A broad selection of establishments covering public, private, and nongovernmental organizations was chosen. This array of establishments was selected to capture a sample of respondents that was as representative as possible. Patrons and employees in the selected establishments were asked to complete a questionnaire. Results: Respondents' self-assessment of their general consumption revealed that 48.4% were unhealthy eaters. Among these, the top reasons for generally unhealthy dietary choices were greater accessibility of unhealthy foods (63.5%) and limited time to prepare healthy meals (61.3%). Additionally, 52.5% indicated "unhealthy foods cost less," and 47.0% identified affordability as the main factor in the food choice equation. Findings revealed that the determinants of eating unhealthily tended to vary across income, age, and gender. Female, younger, and lower-income respondents have a higher likelihood of being impacted by the factors. Conclusions: The largest proportions of the sample identified limited time to prepare healthy meals and the ease of access to unhealthy foods as the foremost determinants of unhealthy eating habits. These barriers to healthy eating are more likely to impact survey participants in the 18-34 age group.

EQ-5D self-reported health in Barbados and Jamaica with EQ-5D-5L population norms for the English-speaking Caribbean.

BACKGROUND: The EQ-5D instrument is increasingly used in clinical and resource allocation decision making in developed and developing countries. EQ-5D valuation and population norms studies have been undertaken for Trinidad and Tobago, however no population norms or value sets have been generated for the other Caribbean countries. The aims of this study were to provide population norms for Barbados and Jamaica, and to develop a set of population norms that could be used by the other English-speaking Caribbean countries. METHODS: The EQ-5D-5L self-reported health questionnaire was included in surveys of representative samples of adults in Barbados and adults in Jamaica in 2013. EQ-5D health states, mean EQ VAS scores and mean EQ-5D-5L index values (using the Trinidad and Tobago value set) were calculated for demographic groups in both countries based on 2347 respondents from Barbados and 1423 from Jamaica. A set of 'Caribbean' norms were developed by combining the Barbados and Jamaica data with norms recently published for Trinidad and Tobago. RESULTS: Data were obtained for 2347 and 1423 respondents in Barbados and Jamaica respectively. The mean index and EQ VAS values were 0.943 and 81.9 for Barbados, and 0.948 and 87.8 for Jamaica. The health states most commonly observed in the two countries were similar. Generally the demographic patterns of self-reported health were consistent with those found in other studies. Some differences between the countries were observed in the patterns of rates of reporting problems on the EQ-5D dimensions among age-gender groups specifically for anxiety/depression and pain/discomfort CONCLUSION: This study has produced a set of EQ-5D population norms that can be used as base-line values in clinical and clinico-economic analyses for Barbados and Jamaica and for the English-Speaking Caribbean region.

An empirically validated framework for measuring patient's acceptability of health care in Multi-Island Micro States.

Measuring health-care acceptability presents conceptual and contextual challenges, particularly in data-poor Multi-Island Micro States (MIMSs). Thus, there has been limited evidence on the acceptability of health care in MIMS and scarce use of acceptability metrics in policy design and health system evaluation. In the present study, we developed and empirically validated a theoretical framework for measuring users' acceptability of health care in a MIMS in the Caribbean. Using a minimum-data approach, we used a synoptic review of health-care literature and consultations with experts and health system stakeholders to define, scope and select constructs for the theoretical framework of health-care acceptability. Empirical validation of the modelled framework was performed using data collected from household expenditure and health-care utilization surveys in Carriacou and Petite Martinique (n = 226), island dependents of Grenada in the Caribbean. Data were used to create health utilization profiles and analyse measurement scales of the health-care acceptability framework using non-linear partial least square structural equation modelling. The modelled framework included 17 items integrating economic and psychosocial concepts, with 1 dependent construct (utilization) and 3 independent constructs (users' perception, experience and knowledge of health facility). Model analysis and validation indicated that the framework was significant, explaining 19% of the variation in health-care acceptability. Users' experience construct was influenced by perception and knowledge of health facility and was the only construct with a significant negative relationship with acceptability. Health-care acceptability declined with increased waiting and travel times and unsuitable opening hours. We conclude that acceptability comprises a complex multidimensional concept, which is highly dependent on various interacting variables and contextual characteristics of the health system. Therefore, policies and actions to improve acceptability should be context specific and focused on evaluating factors infringing health-care acceptability. Routine acceptability and/or satisfaction studies represent baseline evidence towards understanding and integrating acceptability in health-care assessment.

Health and economic burden of disease of sugar-sweetened beverage consumption in four Latin American and Caribbean countries: a modelling study.

OBJECTIVE: Overweight and obesity are important contributors to the non-communicable disease burden. The consumption of sugar-sweetened beverages (SSBs) has been associated with an increased risk of type 2 diabetes mellitus (T2DM), cardiovascular disease, cancer and other conditions. The objective of this study was to estimate the burden of disease attributable to the consumption of SSBs and the costs to the healthcare systems in Argentina, Brazil, El Salvador, and Trinidad and Tobago. DESIGN: Following a systematic review of models, a comparative risk assessment framework was developed to estimate the health and economic impact associated with the consumption of SSBs. SETTING: Argentina, Brazil, El Salvador, and Trinidad and Tobago. PARTICIPANTS: Overall population. PRIMARY AND SECONDARY OUTCOME MEASURES: The model estimated the effects of SSB consumption on health through two causal pathways: one mediated by body mass index (BMI) and health conditions associated with BMI and another that reflected the independent effects of SSB consumption on T2DM and cardiovascular diseases. RESULTS: The model results indicated that for all four countries, in 1 year, SSB consumption was associated with 18 000 deaths (3.2% of the total disease-related deaths), seven million disease events (3.3% of the total disease-related events), a half-million DALYs and US$2 billion in direct medical costs. This included 1.5 million cases of overweight and obesity in children/adolescents (12% of the excess weight cases) and 2.8 million cases in adults (2.8%); 2.2 million cases of type 2 diabetes (19%); 200 000 cases of heart disease (3.8%); 124 000 strokes (3.9%); 116 000 cases of musculoskeletal disease (0.2%); 102 000 cases of kidney disease (0.9%); and 45 000 episodes of asthma (0.4%). The Trinidad and Tobago population were the most affected by disease events. CONCLUSIONS: The study results indicate that the consumption of SSBs is associated with a significant burden of disease and death in Latin America and the Caribbean.

Health-Related Quality of Life Population Norms for Belize Using EQ-5D-5L.

OBJECTIVES: There has been a growing interest in the use of EQ-5D health outcomes measures in Latin America and the Caribbean. Population norms data provide a benchmark against which clinicians, researchers, and policy makers can compare the health status of patient, treatment, or demographic groups. This study aimed to provide EQ-5D-5L population norms for Belize. METHODS: The EQ-5D-5L questionnaire was included in a national survey in Belize in 2014. The survey also captured key demographic variables. EQ-5D-5L health states, EQ-5D visual analog scale (EQ VAS) scores, and EQ-5D-5L index values (based on the Trinidad and Tobago value set) were obtained for key demographic groups in Belize. RESULTS: A representative sample of 2078 respondents completed the survey. The mean index value, EQ VAS score, and ceiling level for Belize were 0.947, 82.6, and 67.8%, respectively. Similar to other Caribbean countries, Belizeans self-reported relatively high EQ VAS scores and ceiling levels compared with non-Caribbean regions. Men reported generally higher health status than women, health status declined as age rises, and the dimensions with the highest burden were pain/discomfort and mobility. CONCLUSIONS: This study provides researchers and practitioners in Belize with tools to use EQ-5D-5L. Users can apply the EQ VAS scores and EQ-5D-5L states presented herein as reference values. Until an EQ-5D-5L value set is created for Belize, the Trinidad and Tobago index values can be applied to Belizean-reported EQ-5D-5L states, which can then be compared with the index values presented in this study.

Evaluating Health Inequality in Five Caribbean Basin Countries Using EQ-5D-5L.

BACKGROUND: EQ-5D-5L is a standardized health outcomes instrument that can be added to national surveys to measure inequality in health outcomes. The aim of this study was to produce baseline values of health inequality using EQ-5D-5L for five countries in the Caribbean Basin region based on national surveys in 2012-2014. METHODS: The EQ-5D-5L questionnaire was included in adult population surveys of Barbados, Belize, Colombia, Jamaica and Trinidad and Tobago. EQ-5D-5L measures were calculated for demographic groups using stratifiers from the World Health Organization's PROGRESS-Plus framework, and generalized linear models were used to test for association between EQ-5D-5L and the PROGRESS-Plus variables. Ordered logit models were used to obtain odds ratios for the effect of the PROGRESS-Plus variables on reporting problems on the EQ-5D-5L dimensions. The Kakwani index was calculated for each country. RESULTS: Data were obtained for representative samples in each country, giving a combined total of 11,284 respondents. Different patterns of inequality were observed among the five countries. The biggest drivers of inequality were age and gender, and the biggest EQ-5D factors were self-care in Belize and pain/discomfort in the other four countries. CONCLUSION: This study demonstrated that the EQ-5D-5L instrument can easily be added to national surveys. Inequality measures from this study can be used as baseline values for comparisons with future similar surveys in these five countries to infer changes in health inequality as measured by EQ-5D outcomes. These can be used to track the performance of policy initiatives aimed at specific demographic groups.

The socio-economic determinants of multimorbidity among the elderly population in Trinidad and Tobago.

OBJECTIVE: To estimate the prevalence of multimorbidity and investigate the socioeconomic factors that are associated with multimorbidity among persons 70 years and older in Trinidad and Tobago. DESIGN AND METHODS: The data were obtained from a nationally representative comprehensive cross-sectional survey conducted in 2014 among elderly persons in the targeted age group. The prevalence of multimorbidity among the elderly population was estimated. A logit model was utilized to determine the socioeconomic characteristics that are associated with multimorbidity in the elderly. RESULTS: The results of the study show that multimorbidity in the elderly population is strongly associated with age, ethnicity, lower education, smoking history, no physical activity and being female. An interesting finding is that elderly persons in the richest quintile are in general, more prone to multimorbidity. CONCLUSION: The findings suggest that interventions to reduce multimorbidity among the elderly population must encourage greater levels of physical activity, provide education on the risk factors of multimorbidity, and discourage smoking.

EQ-5D-5L population norms and health inequalities for Trinidad and Tobago.

The EQ-5D instrument is now used in many health systems as a health outcomes measure. Recently an EQ-5D valuation study was conducted for Trinidad and Tobago, but thus far there have been no population norms published for Trinidad and Tobago or for any Caribbean country. The objective of this study is to provide a set of population norms, and to investigate inequalities in health in Trinidad and Tobago. The EQ-5D-5L questionnaire was included in the 2012/2013 Adult Population Survey of the Global Entrepreneurship Monitor for Trinidad and Tobago. This survey covered a representative sample of 2,036 adults aged 18 and over. Demographic data and self-reported health using EQ-5D-5L were collected. The Trinidad and Tobago value set was used to obtain EQ-5D index values. The Kakwani index and logistic regression models were used to evaluate inequalities in health. Mean EQ-5D index values and EQ-VAS values were calculated by age group, ethnicity, gender, income, educational attainment, employment status and place of residence. The 10 most commonly observed EQ-5D-5L states accounted for 90% of the respondents. The mean VAS value for the sample was 83.6 and the mean EQ-5D-5L index value was 0.95. Pain/discomfort was found to be the EQ-5D dimension with the highest prevalence of reported problems with 22% of the population reporting pain at any level. Self-care was the dimension with the lowest prevalence of problems reported at any level (3%). Health declines with increasing age, and men reported fewer problems and higher levels of self-reported health than women. Age, gender and education level were found to be important drivers of health status as measured by the EQ-5D instrument. Being in a very low income group was also observed to affect EQ-VAS values among younger respondents. The population norms provided in this study can be used by clinicians, academics and policy makers in several ways. They can be used in comparing different demographic groups or patient groups, or as a basis for tracking the progress of patients through a treatment regimen. They can also provide a baseline for cost utility analysis of health interventions for Trinidad and Tobago.

Austerity, and funding cuts: Implications for sustainability of the response to the Caribbean HIV/AIDS epidemic.

The Caribbean, accessed significant external funding over the first three decades of the epidemic, which provided local authorities the opportunity to defer their responsibility in leading or matching the support provided from the external agencies. The reduction in external support has placed increased pressure on the response to the epidemic, with some countries more likely to be affected than others. This paper undertakes a review of the expenditure and funding landscape for HIV programs in the Caribbean. The findings confirm that despite the dwindling number of funding sources, some countries continue to display a significant degree of dependency on external funding sources. It is noteworthy that Treatment and Care accounted for the largest share of HIV expenditure in those countries, which displayed the highest degree of dependency on external funding. While, HIV spending was a relatively small percentage of both total health expenditure and gross domestic product, expenditure levels were noticeably higher in Haiti. These averages however conceal significant differences across countries, which should inform the magnitude and direction of any spending expansion by these countries if they are to achieve financial sustainability. Some recommendations are provided on the way forward to facilitate building a sustainable response to the epidemic.

Sociodemographic and dietary influences on perceptions of eating habits in Jamaica / Influencias sociodemográficas y alimentarias en las percepciones de los hábitos de alimentación en Jamaica / Influências sociodemográficas e dietéticas na percepção dos hábitos alimentares na Jamaica

ABSTRACT Objective. To evaluate how sociodemographic factors and food intake affect survey respondents' perceptions of the quality of their diet. Methods. This cross-sectional analysis is based on a nonprobability sample of 374 participants in Jamaica aged ≥18 years. The three-stage process used a simple random sample to select three parishes; the main commercial areas of each parish were chosen for sampling. To ensure the inclusion of a cross-section that was as representative as possible, the sample included both public and private sector businesses, such as those in retail, hospitality and tourism as well as nongovernmental organizations. Employees and patrons completed a questionnaire regarding their food consumption and their perception of their own diet. Multiple correspondence analysis was used to evaluate the nonlinear relationships among the variables. The results of the analysis guided the specification of a multivariate logistic regression model that was used to estimate the relationship between sociodemographic factors, food intake and perceived eating patterns. Results. The average predicted probability of perceiving a diet as unhealthy was reduced when the respondent was male, economically active, in good health, and married or in a common-law relationship. The probability of perceiving a diet as unhealthy was increased for respondents with a college degree and those living in a household that had a male as the sole head. Consuming healthful food and drink reduced the perception of having a poor diet and vice versa, indicating there are possibly connections between food intake, the perception of diet quality and actual diet quality. Conclusions. This exploratory analysis established links between perceived diet quality, eating habits and sociodemographic factors. The impact on the perception of diet quality can be negative or positive, depending on the variable under consideration.

RESUMEN Objetivo. Evaluar cómo los factores sociodemográficos y la ingesta de alimentos afectan las percepciones de las personas encuestadas sobre la calidad de su alimentación. Métodos. Este análisis transversal se basa en una muestra no probabilística de 374 participantes mayores de 18 años en Jamaica. En el proceso, de tres etapas, se utilizó una muestra aleatoria simple para seleccionar tres distritos; para el muestreo, se eligieron las principales áreas comerciales de cada distrito. Para garantizar la inclusión de una sección transversal lo más representativa posible, la muestra incluyó a empresas de los sectores público y privado, como las del comercio minorista, hotelería y turismo, así como a organizaciones no gubernamentales. Tanto empleados como clientes llenaron un cuestionario sobre su consumo de alimentos y su percepción sobre su alimentación. Para evaluar las relaciones no lineales entre las variables se utilizó el análisis de correspondencia múltiple. Los resultados del análisis se usaron como guía para las especificaciones de un modelo de regresión logística multivariante, utilizado para estimar la relación entre los factores sociodemográficos, la ingesta de alimentos y los patrones de alimentación percibidos. Resultados. La probabilidad promedio predicha de percibir que un régimen alimentario es poco saludable era menor cuando el encuestado era de sexo masculino y económicamente activo, tenía buena salud y estaba casado o en una unión de hecho. La probabilidad de percibir un régimen alimentario como poco saludable era mayor en el caso de los encuestados con título universitario y de los que vivían en un hogar con un hombre como único cabeza de familia. El consumo de alimentos y bebidas saludables redujo la percepción de tener una mala alimentación y viceversa, lo que indica la posible existencia de una relación entre la ingesta de alimentos, la percepción de la calidad del régimen alimentario y la calidad real del régimen alimentario. Conclusiones. En este análisis exploratorio se estableció una relación entre la percepción de la calidad del régimen alimentario, los hábitos alimentarios y los factores sociodemográficos. El impacto sobre la percepción de la calidad del régimen alimentario puede ser negativo o positivo, según la variable considerada.

RESUMO Objetivo. Avaliar como fatores sociodemográficos e a ingestão de alimentos influenciam a percepção dos participantes da pesquisa sobre a qualidade de sua alimentação. Métodos. Trata-se de uma análise transversal realizada em uma amostra não probabilística com 374 participantes maiores de 18 anos na Jamaica. Três localidades no país foram selecionadas por meio de um processo de amostragem aleatória simples em três etapas, com amostragem da população nas áreas comerciais centrais de cada localidade. Para garantir uma boa amostra transversal representativa da população, foram incluídos estabelecimentos comerciais dos setores público e privado, como varejistas, hotelaria e turismo e organizações não governamentais. Clientes e empregados responderam um questionário sobre seu consumo de alimentos e percepção sobre a própria alimentação. Uma análise de correspondência múltipla foi realizada para avaliar as relações não lineares entre as variáveis e, a partir dos resultados desta análise, foi construído um modelo de regressão logística multivariada para estimar a relação entre fatores sociodemográficos, consumo de alimentos e padrões alimentares percebidos. Resultados. A probabilidade prevista média de perceber a alimentação como pouco saudável foi menor entre os participantes do sexo masculino, economicamente ativos, com boa saúde e casados ou em união estável. A probabilidade de perceber a alimentação como pouco saudável foi maior entre os participantes com nível superior de escolaridade e que residiam em um ambiente familiar com uma pessoa do sexo masculino como chefe de família. Consumir alimentos e bebidas saudáveis foi associado a uma percepção menor de má alimentação, e vice-versa, o que indica um possível vínculo entre o consumo de alimentos, a percepção da qualidade da alimentação e a qualidade efetiva da alimentação. Conclusões. Esta análise exploratória demonstrou existir um vínculo entre qualidade percebida da alimentação, hábitos alimentares e fatores sociodemográficos. A influência na percepção da qualidade da alimentação é negativa ou positiva dependendo da variável considerada.

Assessing the determinants of unhealthy dietary habits among a sample of survey participants in Jamaica / Evaluación de los determinantes de los hábitos alimentarios poco saludables en una muestra de encuestados en Jamaica / Uma análise dos determinantes de hábitos alimentares não saudáveis em uma amostra de participantes de pesquisa na Jamaica

ABSTRACT Objective. To identify and assess the determinants of unhealthy dietary habits among a sample of survey participants in Jamaica. Methods. Because of resource constraints, this cross-sectional assessment is based on a three-stage non-probability sample of 374 survey respondents in Jamaica aged ≥18 years. Firstly, three administrative areas (parishes) were randomly selected. Secondly, the main commercial areas within the selected parishes were identified, from which a non-probability sample of establishments was drawn. A broad selection of establishments covering public, private, and nongovernmental organizations was chosen. This array of establishments was selected to capture a sample of respondents that was as representative as possible. Patrons and employees in the selected establishments were asked to complete a questionnaire. Results. Respondents' self-assessment of their general consumption revealed that 48.4% were unhealthy eaters. Among these, the top reasons for generally unhealthy dietary choices were greater accessibility of unhealthy foods (63.5%) and limited time to prepare healthy meals (61.3%). Additionally, 52.5% indicated "unhealthy foods cost less," and 47.0% identified affordability as the main factor in the food choice equation. Findings revealed that the determinants of eating unhealthily tended to vary across income, age, and gender. Female, younger, and lower-income respondents have a higher likelihood of being impacted by the factors. Conclusions. The largest proportions of the sample identified limited time to prepare healthy meals and the ease of access to unhealthy foods as the foremost determinants of unhealthy eating habits. These barriers to healthy eating are more likely to impact survey participants in the 18-34 age group.

RESUMEN Objetivo. Identificar y evaluar los determinantes de los hábitos alimentarios poco saludables en una muestra de encuestados en Jamaica. Métodos. Debido a las limitaciones de recursos, esta evaluación transversal se basa en una muestra no probabilística de tres etapas de 374 encuestados en Jamaica de edad igual o superior a los 18 años. Primero, se seleccionaron al azar tres parroquias (áreas administrativas). Luego, se identificaron las principales áreas comerciales dentro de las parroquias seleccionadas, y se extrajo una muestra no probabilística de establecimientos de esas áreas comerciales. Se escogió una amplia selección de establecimientos que abarcaban organizaciones públicas, privadas y no gubernamentales. Se seleccionó este rango de establecimientos para reunir una muestra de encuestados que fuera lo más representativa posible. Se pidió a los clientes y empleados de los establecimientos seleccionados que llenaran un cuestionario. Resultados. La autoevaluación de los encuestados sobre su consumo general reveló que 48,4 % tenían una alimentación poco saludable. Entre estos, las principales razones tras estas decisiones alimentarias generalmente poco saludables fueron un mayor acceso a alimentos poco saludables (63,5 %) y limitaciones en el tiempo para preparar comidas saludables (61,3 %). Además, 52,5 % indicó que "los alimentos poco saludables cuestan menos", y 47,0 % identificó la asequibilidad como el factor principal en la ecuación relativa a la selección de alimentos. Los resultados revelaron que los determinantes de una alimentación poco saludable tendían a variar según los ingresos, la edad y el sexo. Entre los encuestados, las mujeres más jóvenes y con menores ingresos tenían una mayor probabilidad de verse afectadas por los factores. Conclusiones. La mayoría de los encuestados identificó las limitaciones con el tiempo necesario para preparar comidas saludables y la facilidad de acceso a alimentos poco saludables como los principales determinantes de hábitos alimentarios poco saludables. Es más probable que estas barreras para una alimentación saludable afecten a los encuestados del grupo etario de 18 a 34 años.

RESUMO Objetivo. Identificar e analisar os determinantes de hábitos alimentares não saudáveis em uma amostra de participantes de pesquisa na Jamaica. Métodos. Por limitação de recursos, esta análise transversal foi realizada a partir de uma amostra não probabilística com 374 participantes maiores de 18 anos na Jamaica. A amostragem seguiu um processo de três estágios. Primeiro, três áreas administrativas (localidades) foram selecionadas de forma aleatória e, em seguida, foram identificadas as áreas comerciais centrais em cada localidade selecionada. Para garantir a representatividade da população, uma amostra não probabilística de estabelecimentos comerciais em setores variados (público e privado e organizações não governamentais) foi obtida, com a aplicação do questionário da pesquisa aos seus clientes e funcionários. Resultados. Os participantes avaliaram o próprio consumo alimentar em geral, o que demonstrou que 48,4% consumiam alimentos não saudáveis. Os principais fatores para escolhas alimentares pouco saudáveis foram maior acesso a alimentos não saudáveis (63,5%) e falta de tempo para o preparo de refeições saudáveis (61,3%), sendo que 52,5% indicaram que "os alimentos pouco saudáveis são mais baratos" e 47,0% citaram os preços acessíveis como o principal fator na escolha dos alimentos. Os determinantes da alimentação pouco saudável tenderam a variar de acordo com o gênero, idade e o nível de renda, afetando mais as mulheres, os jovens e pessoas de baixa renda. Conclusões. Uma grande parcela da amostra estudada apontou a falta de tempo para o preparo de refeições saudáveis e a facilidade de acesso a alimentos pouco saudáveis como determinantes de hábitos alimentares não saudáveis. Os obstáculos à alimentação saudável repercutem mais entre os participantes jovens de 18 a 34 anos de idade.

Results from an exploratory study to test the performance of EQ-5D-3L valuation subsets based on orthogonal designs, and an investigation into some modeling and transformation alternatives for the utility function.

BACKGROUND: EQ-5D-3L valuation studies continue to employ the MVH protocol or variants of MVH. One issue that has received attention is the selection of the states for direct valuation by respondents. Changes in the valuation subset have been found to change the coefficients of the utility function. The purpose of this study was to test the performance of valuation subsets based on orthogonal experiment designs. The design of the study also allowed a comparison of models based on raw or untransformed VAS values with values transformed at the level of the respondent and at the aggregate level. METHODS: Two different valuation subsets were developed based on orthogonal arrays. A VAS elicitation was undertaken with two groups of similar respondents and the resulting utility functions based on the valuations of the two different valuation subsets were compared using mean absolute errors between model and observed values, and by correlation with values in and out of sample. The impact of using untransformed versus VAS values transformed at the level of the individual and at aggregate level and the inclusion of a constant term in the utility functions were also investigated. RESULTS: The utility functions obtained from the two valuation subsets were very similar. The models that included a constant and based on raw VAS values from the two valuation studies returned rank correlation coefficients of 0.994 and 0.995 when compared with respective observed values. MAEs of model values with observed values were 2.4% or lower for all models that included a constant term. Several models were developed and evaluated for the combined data (from both valuation subsets). The model that included the N3 term performed best. CONCLUSIONS: The finding that two very different valuation subsets can produce strikingly similar utility functions suggests that orthogonal designs should be given some attention in further studies. The impact of rescaling VAS values at the level of the individual versus at aggregate level had minimal impact on the performance of the models when compared to models based on the raw VAS values.