On body economics and fitting in: upward mobility and obesity stigma in Jamaica.

Introduction: Jamaican culture is considered 'fat-loving,' and thus less likely to foster obesity stigma. However, the importance of tourism to Jamaica's economy, global trends toward a thinness aesthetic and extant ethos' of both bodily self-acceptance and status-based bodily critique suggest that obesity stigma may exist in Jamaica - particularly in the context of class status aspiration.Objective: This pilot study examined the relationship between upward mobility and fat stigma in Kingston, Jamaica in two samples.Design: The first sample - nineteen college-enrolled 18-25 year olds - completed an online survey. Responses were grouped by perceived wealth status.Results: No relationship was found between wealth status and obesity stigma. There was no association between wealth group and body ideal - whether slender or curvaceous. However, responses to questions concerning the value of having an ideal body differed by wealth grouping. Those with lower perceived wealth tended to cite 'fitting in to society' as a benefit of having an ideal body. Half (5 of 10) the lower wealth group ranked having an ideal body 'very important;' one person in the higher wealth group did so. Findings from twenty ethnographic interviews conducted in Kingston's public spaces with 18-25 year olds confirmed the obesity stigma/social aspiration relationship. Having an ideal body was associated with greater economic and social opportunity and a sense of 'fitting in.'Conclusion: These findings suggest that though (1) there seems to be no singular, size-related aesthetic in Jamaica; (2) obesity stigma does exist; and (3) experience of stigma may be affected by socio-economic status and socio-economic aspiration.

Exploring the psychometric properties of the CES-D-10 and its practicality in detecting depressive symptomatology in 27 low- and middle-income countries.

The Center for Epidemiological Studies Depression-10 (CES-D-10) scale is known for its good psychometric properties in measuring depressive symptoms, however, some researchers question its applicability across various settings. This study explored the factor structure of the CES-D-10 in low- and middle-income countries (LMICs). This cross-sectional survey consisted of 16,723 university students across 27 LMICs that completed self-report instruments assessing socio-demographic information and depressive symptoms using the CES-D-10. Data analysis included: exploratory factor analysis, item response theory and differential item functioning. Results indicate that a two-factor model (depressive affect and positive affect) had the best fit for this population and accounted for 52% of the total observed variance with an internal consistency, α = .77 for the depressive affect items and α = .57 for the positive affect items. The graded response model (GRM), however, indicated that the depressive affect factor had a good fit, unlike the positive affect factor. The depressive affect factor was found to consistently model depression for females better than males. Relative to their Asian counterparts, African, Caribbean and South American participants of similar depressive affect responded differently on all items of the depressive affect factor. The depressive affect factor seems most ideal for LMICs and shows gender and cross-cultural variability.

Differences in short and long sleep durations between blacks and whites attributed to emotional distress: analysis of the National Health Interview Survey in the United States.

OBJECTIVES: The current study examined the role of emotional distress in explaining racial/ethnic differences in unhealthy sleep duration. DESIGN: Data from the 2004-2013 National Health Interview Survey were analyzed using SPSS 20. SETTING: Data were collected through personal household interviews in the United States. PARTICIPANTS: Of the total 261,686 participants (age≥18 years), 17.0% were black, 83.0% were white, and the mean age was 48 years (SE=0.04). MEASUREMENTS: To ascertain total sleep duration, participants were asked, "How many hours of sleep do you get on average in a 24-hour period?" Sleep duration was coded as short sleep (<7hours), average sleep (7-8hours), or long sleep (>8hours). Emotional distress-feeling sad, nervous, restless, hopeless, worthless, and burdened over a 30-day period-was measured using Kessler-6, a 6-item screening scale. RESULTS: Of the participants reporting significant emotional distress (4.0% black, 3.5% white), χ2 analyses revealed that a higher percentage of blacks, compared with whites, reported unhealthy sleep durations. Relative to Whites, Blacks had increased prevalence of short sleep (prevalence ratio=1.32, P<.001) or long sleep (odds ratio =1.189, P<.001). The interaction between race/ethnicity and emotional distress was significantly associated with short (prevalence ratio=0.99, P<.001) and long sleep (odds ratio=0.98, P<.001) durations. CONCLUSIONS: Individuals of the black race/ethnicity or those reporting greater levels of emotional distress are more likely to report short or long sleep duration. Emotional distress might partially explain racial/ethnic differences in unhealthy sleep duration between blacks and whites.

Childhood Physical and Sexual Abuse in Caribbean Young Adults and Its Association with Depression, Post-Traumatic Stress, and Skin Bleaching.

BACKGROUND: The global prevalence of skin depigmentation/skin bleaching among blacks, estimated at 35%, is on the rise and is associated with a host of negative health and medical consequences. Current etiological approaches do not fully capture the emotional and psychological underpinnings of skin bleaching. The current study investigated the potential mediating role of depression, or post-traumatic stress symptoms (avoidance and hyperarousal) on the relationship between childhood physical and sexual abuse (CPSA) and skin bleaching. METHODS: A total of 1226 university participants (ages 18-30 years and 63.4% female) from three Caribbean countries (Jamaica, Barbados, and Grenada) provided data for the current analysis. They all completed self-reported measures of general demographic information along with the short screening scale for posttraumatic stress disorder (DSM-IV), childhood trauma, and skin bleaching questions. RESULTS: The prevalence of skin bleaching in our study was 25.4%. Our findings showed that individuals who bleached their skin were more likely to have been abused as children (21.6% versus 13.5%, p<0.001), were more likely to have significant symptoms of trauma (34.1% versus 24.0%, p=0.005), and were more likely to have significant depression (43.7% versus 35.1%, p=0.032). We found that trauma-related hyperarousal symptoms positively mediated the relationship between childhood physical and sexual abuse and skin bleaching (Indirect Effect=0.03, p<0.05), while avoidance (Indirect Effect=0.000, p>0.05) and depressive (Indirect Effect=0.005, p>0.05) symptoms did not. CONCLUSION: The presence of trauma symptoms and childhood physical and sexual abuse (CPSA) may increase the likelihood of skin bleaching. Findings suggest that further exploration is needed to ascertain if the presence of skin bleaching warrants being also screened for trauma.

The globalization of whitening: prevalence of skin lighteners (or bleachers) use and its social correlates among university students in 26 countries.

BACKGROUND: The aim of this study was to investigate the use of skin lighteners and its social correlates in university students from 26 low, middle income, and emerging economy countries. METHODS: Using anonymous questionnaires, data were collected from 19,624 undergraduate university students (mean age 20.8, SD 2.8) from 27 universities in 26 countries across Asia, Africa, and the Americas. Multivariate logistic regression analysis was used to identify associations between sociodemographic, social, health risk, mental health and abuse, and the use of skin lighteners. RESULTS: Overall, the prevalence of previous 12-month skin lightener use was 24.5, and 16.7% in male and 30.0% in female students. The use of skin lighteners varied by country, ranging from 0% in Turkey to 83.8% in Thailand. In multivariate logistic regression analysis among both men and women, social variables (highly-organized religious activity and lack of personal mastery) and health variables (inconsistent condom use) were associated with skin lightening use. In addition, male students from a lower income country, having a lack of social support, and a history of childhood sexual abuse were more likely to use skin lighteners, and women aged 20-21 years old, residing on the university campus, being a student of health and welfare, and having a lack of personal control, inadequate physical activity, and depressive symptoms were more likely users of skin-lightening products. CONCLUSION: A high prevalence of skin lightener use was found in this large sample of university students, and social and health-related risk factors were identified.

Linking emotional distress to unhealthy sleep duration: analysis of the 2009 National Health Interview Survey.

OBJECTIVE: The objective of the study was to examine the independent association of emotional distress with unhealthy sleep duration (defined as <7 or >8 hours). METHODS: Data from the 2009 National Health Interview Survey (NHIS), a cross-sectional household survey, were analyzed to investigate the associations of emotional distress with unhealthy sleep durations, adjusting for sociodemographic factors, health risks, and chronic diseases through hierarchical multiple logistic regression analysis. PARTICIPANTS: A total of 27,731 participants (age range 18-85 years) from the NHIS 2009 dataset were interviewed. MEASURES: Unhealthy sleep duration is defined as sleep duration <7 or >8 hours, whereas healthy sleep is defined as sleep duration lasting for 7-8 hours. Emotional distress is based on the Kessler 6 Non-Specific Distress Battery, which assesses the frequency of feeling sad, nervous, restless, hopeless, worthless, and burdened, over a 30-day period. RESULTS: Of the sample, 51.7% were female; 83.1% were white and 16.9% were black. Eleven percent experienced emotional distress and 37.6% reported unhealthy sleep. Adjusted logistic regression analysis revealed that individuals with emotional distress had 55% greater odds of reporting unhealthy sleep (odds ratio [OR] =1.55, 95% confidence interval [CI] =1.42, 1.68, P<0.001). CONCLUSION: Emotional distress, an important proxy for poor psychological health, was a significant predictor of unhealthy sleep, independent of the influences of several factors including demographic (age, education, sex, race/ethnicity, and family income), health risks (alcohol consumption and smoking status), and chronic diseases/conditions (diabetes, obesity, hypertension, heart disease, cancer, and arthritis).

The association of nutrition behaviors and physical activity with general and central obesity in Caribbean undergraduate students / Asociación de los comportamientos nutricionales y la actividad física con la obesidad general y central en estudiantes de pregrado del Caribe

OBJECTIVE: To quantify the prevalence of obesity and obesity-related factors in a crosssectional, observational study of Caribbean students using the results of three recent surveys of health behavior among undergraduates in Barbados, Grenada, and Jamaica. METHODS: A total of1 578 Caribbean undergraduate students from Barbados, Grenada, and Jamaica (ages 18-30 years) completed questionnaires and had physical measurements recorded. Multivariable logistic regression was used to estimate odds ratios (ORs) for the association of nutrition behaviors with prevalence of obesity (body mass index > 30 kg/m² ); elevated waist-to-height ratio (W/ht) (> 0.50); and high waist circumference (WC) (> 88 cm in females, > 102 cm in males). Models were adjusted for age, year in university, socioeconomic status, and sex. RESULTS: There was a higher prevalence of obesity (13% versus 10%), high WC (21% versus 7%), and high W/ht (35% versus 25%) in females relative to males. Compared to females, males had reduced odds of obesity (OR 0.46), high WC (OR 0.22), and high W/ht (OR 0.61) (P < 0.05 for all). Both females (46%) and males (24%) reported high levels of physical inactivity. Fruit and vegetable consumption was low (approximately two servings per day). Many students reported avoiding fatty foods (40%); this behavior was associated with high W/ht (OR 1.68), obesity (OR 1.90), and high WC (OR 1.82) (P < 0.05 for all). Irregular breakfast consumption, age, and year of study were also positively associated with obesity. Physical activity was not significantly associated with any obesity measure. CONCLUSIONS: There was a low prevalence of healthy behaviors and a high prevalence of obesity in this sample of Caribbean young adults.

OBJETIVO: Cuantificar la prevalencia de la obesidad y los factores relacionados con esta mediante un estudio transversal y de observación de estudiantes del Caribe, que utilizó los resultados de tres encuestas recientes sobre comportamientos con respecto a la salud en estudiantes de pregrado de Barbados, Granada y Jamaica. MÉTODOS: Un total de 1 578 estudiantes de pregrado caribeños de Barbados, Granada y Jamaica, de 18 a 30 años de edad, completaron cuestionarios y se sometieron a una serie de mediciones antropométricas, que fueron registradas. Se utilizó un modelo de regresión logística multivariable para calcular las razones de posibilidades (OR) de las asociaciones de los comportamientos nutricionales con la prevalencia de obesidad (índice de masa corporal > 30 kg/m²); índice cintura-talla (ICT) elevado (> 0,5); y circunferencia de la cintura (CC) elevada (> 88 cm en mujeres, > 102 cm en hombres). Los modelos se ajustaron para la edad, el número ordinal del curso universitario, la situación socioeconómica y el sexo. RESULTADOS: Se observó una mayor prevalencia de obesidad (13 frente a 10%), CC más elevada (21 frente a 7%) e ICT más elevado (35 frente a 25%) en las mujeres que en los hombres. En comparación con las mujeres, los hombres mostraron menores probabilidades de obesidad (OR 0,46), CC elevada (OR 0,22) e ICT elevado (OR 0,61) (P < 0,05 para todos ellos). Tanto las mujeres (46%) como los hombres (24%) notificaron altos niveles de inactividad física. El consumo de frutas y verduras era bajo (aproximadamente de dos raciones por día). Muchos estudiantes notificaron que evitaban los alimentos grasos (40%); este comportamiento se asoció con ICT elevado (OR 1,68), obesidad (OR 1,90) y CC elevada (OR 1,82) (P < 0,05 para todos ellos). El consumo irregular en el desayuno, la edad y el número ordinal del curso universitario también se asociaron positivamente con la obesidad. La actividad física no se asoció significativamente con ninguna medición de obesidad. CONCLUSIONES: En esta muestra de adultos jóvenes del Caribe se observó una baja prevalencia de comportamientos saludables y una alta prevalencia de obesidad.

The association of nutrition behaviors and physical activity with general and central obesity in Caribbean undergraduate students / Asociación de los comportamientos nutricionales y la actividad física con la obesidad general y central en estudiantes de pregrado del Caribe

Objective. To quantify the prevalence of obesity and obesity-related factors in a crosssectional,observational study of Caribbean students using the results of three recent surveys of health behavior among undergraduates in Barbados, Grenada, and Jamaica. Methods. A total of 1 578 Caribbean undergraduate students from Barbados, Grenada, and Jamaica (ages 18–30 years) completed questionnaires and had physical measurements recorded. Multivariable logistic regression was used to estimate odds ratios (ORs) for the association of nutrition behaviors with prevalence of obesity (body mass index ≥ 30 kg/m2); elevated waist-toheight ratio (W/ht) (> 0.50); and high waist circumference (WC) (> 88 cm in females, > 102 cm in males). Models were adjusted for age, year in university, socioeconomic status, and sex. Results. There was a higher prevalence of obesity (13% versus 10%), high WC (21% versus 7%), and high W/ht (35% versus 25%) in females relative to males. Compared to females, males had reduced odds of obesity (OR 0.46), high WC (OR 0.22), and high W/ht (OR 0.61) (P < 0.05 for all). Both females (46%) and males (24%) reported high levels of physical inactivity. Fruit and vegetable consumption was low (approximately two servings per day). Many students reported avoiding fatty foods (40%); this behavior was associated with high W/ht (OR 1.68), obesity (OR 1.90), and high WC (OR 1.82) (P < 0.05 for all). Irregular breakfast consumption, age, and year of study were also positively associated with obesity. Physical activity was not significantly associated with any obesity measure. Conclusions. There was a low prevalence of healthy behaviors and a high prevalence of obesity in this sample of Caribbean young adults.

Objetivo. Cuantificar la prevalencia de la obesidad y los factores relacionados con esta mediante un estudio transversal y de observación de estudiantes del Caribe, que utilizó los resultados de tres encuestas recientes sobre comportamientos con respecto a la salud en estudiantes de pregrado de Barbados, Granada y Jamaica. Métodos. Un total de 1 578 estudiantes de pregrado caribeños de Barbados, Granada y Jamaica, de 18 a 30 años de edad, completaron cuestionarios y se sometieron a una serie de mediciones antropométricas, que fueron registradas. Se utilizó un modelo de regresión logística multivariable para calcular las razones de posibilidades (OR) de las asociaciones de los comportamientos nutricionales con la prevalencia de obesidad (índice de masa corporal ≥ 30 kg/m2); índice cintura-talla (ICT) elevado (> 0,5); y circunferencia de la cintura (CC) elevada (> 88 cm en mujeres, > 102 cm en hombres). Los modelos se ajustaron para la edad, el número ordinal del curso universitario, la situación socioeconómica y el sexo. Resultados. Se observó una mayor prevalencia de obesidad (13 frente a 10%), CC más elevada (21 frente a 7%) e ICT más elevado (35 frente a 25%) en las mujeres que en los hombres. En comparación con las mujeres, los hombres mostraron menores probabilidades de obesidad (OR 0,46), CC elevada (OR 0,22) e ICT elevado (OR 0,61) (P < 0,05 para todos ellos). Tanto las mujeres (46%) como los hombres (24%) notificaron altos niveles de inactividad física. El consumo de frutas y verduras era bajo (aproximadamente de dos raciones por día). Muchos estudiantes notificaron que evitaban los alimentos grasos (40%); este comportamiento se asoció con ICT elevado (OR 1,68), obesidad (OR 1,90) y CC elevada (OR 1,82) (P < 0,05 para todos ellos). El consume irregular en el desayuno, la edad y el número ordinal del curso universitario también se asociaron positivamente con la obesidad. La actividad física no se asoció significativamente con ninguna medición de obesidad. Conclusiones. En esta muestra de adultos jóvenes del Caribe se observó una Baja prevalencia de comportamientos saludables y una alta prevalencia de obesidad.

The association of nutrition behaviors and physical activity with general and central obesity in Caribbean undergraduate students.

OBJECTIVE: To quantify the prevalence of obesity and obesity-related factors in a crosssectional, observational study of Caribbean students using the results of three recent surveys of health behavior among undergraduates in Barbados, Grenada, and Jamaica. METHODS: A total of1 578 Caribbean undergraduate students from Barbados, Grenada, and Jamaica (ages 18-30 years) completed questionnaires and had physical measurements recorded. Multivariable logistic regression was used to estimate odds ratios (ORs) for the association of nutrition behaviors with prevalence of obesity (body mass index > 30 kg/m² ); elevated waist-to-height ratio (W/ht) (> 0.50); and high waist circumference (WC) (> 88 cm in females, > 102 cm in males). Models were adjusted for age, year in university, socioeconomic status, and sex. RESULTS: There was a higher prevalence of obesity (13% versus 10%), high WC (21% versus 7%), and high W/ht (35% versus 25%) in females relative to males. Compared to females, males had reduced odds of obesity (OR 0.46), high WC (OR 0.22), and high W/ht (OR 0.61) (P < 0.05 for all). Both females (46%) and males (24%) reported high levels of physical inactivity. Fruit and vegetable consumption was low (approximately two servings per day). Many students reported avoiding fatty foods (40%); this behavior was associated with high W/ht (OR 1.68), obesity (OR 1.90), and high WC (OR 1.82) (P < 0.05 for all). Irregular breakfast consumption, age, and year of study were also positively associated with obesity. Physical activity was not significantly associated with any obesity measure. CONCLUSIONS: There was a low prevalence of healthy behaviors and a high prevalence of obesity in this sample of Caribbean young adults.

The Mediating Effects of Social Support and Locus of Control on the Relationship between Post-Traumatic Stress and Depressive Symptoms in a Jamaican University Sample.

BACKGROUND: The increasing rate of comorbid posttraumatic stress and depressive symptoms among young adults presents a unique symptom presentation and challenges to treatment. The current study examined psychosocial barriers--external locus of control-- and facilitators-- social support-- in the posttraumatic stress and depressive symptoms association. METHODS: The current cross-sectional study was conducted among 701 Jamaican university participants, ages 18-30 years. Participants completed self-report measures of general demographic information as well as target variables which include the CES-D-10, Sense of control (external and internal locus of control), Short screening scale for DSM-IV posttraumatic stress disorder and social support measures. RESULTS: Majority of the sample was female (76.2%; n=534); and slightly more than half of the sample self-identified as Black/African ancestry (59.7%). External locus of control (LOC) partially mediated the relationship between posttraumatic stress and depressive symptoms, external locus of control (LOC) had a greater mediation magnitude than social support in the posttraumatic stress-depressive symptoms association (Indirect Effect=0.133, 95% CI-0.075-0.211). In post-hoc analyses women appeared more highly traumatized than their male counterparts (14.3%, χ2 =8.032, p=0.005). The sub-sample of highly traumatized individuals reported higher levels of depression, posttraumatic stress symptoms, external LOC, and lower levels of social support and internal LOC than did individuals with lower levels of trauma. CONCLUSION: Contrary to previous research, our findings indicate that external LOC partially mediated the relationship between posttraumatic stress and depressive symptoms among a Jamaica university sample more so than social support. These findings therefore suggest that psychosocial treatments should consider locus of control focused interventions or skill building for young adults who suffer from posttraumatic stress and depressive symptoms.

Valuing psychiatric patients' stories: belief in and use of the supernatural in the Jamaican psychiatric setting.

The aim of this study was to examine illness presentation and understand how psychiatric patients make meaning of the causes of their mental illnesses. Six Jamaican psychiatric patients were interviewed using the McGill Illness Narrative Interview Schedule. Of the 6, 3 representative case studies were chosen. The hermeneutic phenomenological approach and the common sense model were used in the formulation of patients' explanatory models. Results indicate that psychiatric patients actively conceptualized the causes and resultant treatment of their mental illnesses. Patients' satisfaction and compliance with treatment were dependent on the extent to which practitioners' conceptualization matched their own, as well as practitioners' acknowledgement of patients' concerns about causation, prognosis, and treatment.

Traditional and alternative therapy for mental illness in Jamaica: patients' conceptions and practitioners' attitudes.

The aim of this study was to investigate traditional and alternative therapy for mental illness in Jamaica: patients' conceptions and practitioners' attitudes. The sample included 60 psychiatric patients selected from Ward 21 at the University of the West Indies, Kingston as well as Princess Margaret outpatient clinic, and 30 Afro-centric psychiatric nurses, psychiatrist and clinical psychologists from Kingston and St. Thomas, Jamaica. Patients were interviewed with the Short Explanatory Model Interview (SEMI) and practitioners completed a self administered questionnaire on attitudes towards traditional and alternative medicine. Results indicate that among psychiatric patients more than a third expressed the belief that the overall cause of their mental illness was as a result of supernatural factors. In general, the majority of patients felt that their perception of their problems did not concur with the western practitioner, which in turn caused distress for these patients. In case for those who also sought traditional medicine, they were more inclined to feel pleased about their interaction and the treatment they received. Results from western trained practitioners found that although they acknowledged that traditional medicine plays a major role in the treatment of mental illness among psychiatric patients the treatment was not advantageous. For the most part when all three traditional approaches were examined alternative medicine seemed more favourable than traditional healing and traditional herbal treatment. There is a need to develop models of collaboration that promote a workable relationship between the two healing systems in treating mental illness.