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Gary-Webb TL, Dyer H, Mckenzie J, Younger-Coleman N, Tulloch-Reid M, Blake A, Govia I, Bennett N, McFarlane S, Wilks RJ, Williams DR, Ferguson TS. Community stressors (violence, victimization, and neighborhood disorder) with cardiometabolic outcomes in urban Jamaica. Front Public Health 2023; 11:1130830. [PMID: 37346100 PMCID: PMC10280444 DOI: 10.3389/fpubh.2023.1130830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/11/2023] [Indexed: 06/23/2023] Open
Abstract
Background Despite limited data on neighborhood factors and health risk in Caribbean populations, previous analyses from Jamaica have shown that neighborhood and home disorder were associated with lower physical activity and higher cumulative biological risk among women, while poorer neighborhood infrastructure was associated with higher overweight/obesity among men. Design Cross-sectional survey design. Objectives In this study, we explored whether community stressors, as measured by community violence, victimization and neighborhood disorder scores, were associated with cardiometabolic outcomes (obesity, diabetes, hypertension and high cholesterol) in urban Jamaican communities. Sex-specific Poisson regression models were used to estimate prevalence ratios (PR) for these associations, adjusting for age, education, diet, physical activity and smoking. Participants Of the 849 participants (M = 282; F = 567), mean age was 48 ± 18.5 years and most had at least a high school education. Men were more likely to be current smokers (29.4 vs. 10.6%) and adequately physically active (53.2 vs. 42.0%); more women were obese (46.0 vs. 19.0%), more likely to have hypertension (52.9 vs. 45.4%) and had high cholesterol (34.2 vs. 21.6%) (all p < 0.05). Results We observed significant associations only for those in the middle tertile of neighborhood disorder with prevalence of higher cholesterol [PR:1.72 (1.20 to 2.47)] in women and lower prevalence of obesity [PR:0.24 (0.10 to 0.53)] in men. Conclusion Results suggest that higher, but not the highest level of neighborhood disorder was associated with higher cholesterol levels in women and lower obesity in men. Future work will explore additional approaches to measuring neighborhood characteristics in Jamaica and the mechanisms that may underlie any relationships that are identified.
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Affiliation(s)
- Tiffany L. Gary-Webb
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Harika Dyer
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Joette Mckenzie
- Caribbean Institute for Health Research (CAIHR), The University of the West Indies, Mona, Kingston, Jamaica
| | - Novie Younger-Coleman
- Caribbean Institute for Health Research (CAIHR), The University of the West Indies, Mona, Kingston, Jamaica
| | - Marshall Tulloch-Reid
- Caribbean Institute for Health Research (CAIHR), The University of the West Indies, Mona, Kingston, Jamaica
| | - Alphanso Blake
- Caribbean Institute for Health Research (CAIHR), The University of the West Indies, Mona, Kingston, Jamaica
| | - Ishtar Govia
- Caribbean Institute for Health Research (CAIHR), The University of the West Indies, Mona, Kingston, Jamaica
| | - Nadia Bennett
- Caribbean Institute for Health Research (CAIHR), The University of the West Indies, Mona, Kingston, Jamaica
| | - Shelly McFarlane
- Caribbean Institute for Health Research (CAIHR), The University of the West Indies, Mona, Kingston, Jamaica
| | - Rainford J. Wilks
- Caribbean Institute for Health Research (CAIHR), The University of the West Indies, Mona, Kingston, Jamaica
| | - David R. Williams
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Trevor S. Ferguson
- Caribbean Institute for Health Research (CAIHR), The University of the West Indies, Mona, Kingston, Jamaica
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Sharma SK, Nambiar D, Joseph J. Hidden educational inequalities in high blood pressure and high blood glucose levels in Kerala: evidence from the National Family Health Survey (2019-2021). BMJ Open 2023; 13:e068553. [PMID: 37015784 PMCID: PMC10083770 DOI: 10.1136/bmjopen-2022-068553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVE This study assesses educational inequalities in measured as well as self-reported high blood pressure (BP) and high blood glucose (BG) in the southern Indian state of Kerala, which is known to have high chronic disease morbidity. DESIGN The present findings are drawn from a large-scale, nationally representative cross-sectional study. SETTINGS AND PARTICIPANTS India's Demographic and Health Survey (conducted in 2019-2021) had data on 36 526 individuals aged 15 years and above in the state of Kerala, India. PRIMARY AND SECONDARY OUTCOMES MEASURES Measured high BP and BG; self-reported high BP and BG; as well as self-reported BP and BG testing. Descriptive statistics, bivariate analysis, along with multivariate statistics, were used. Educational inequalities were assessed through absolute and relative complex measures of inequality, namely the Slope Index of Inequality (SII) and Relative Concentration Index (RCI), respectively, with 95% CIs. RESULTS The largest margin of inequality in Kerala, between the least and the most educated groups, was observed for measured high BP (57.7% and 17.6%). Measured high BP (SII -45.4% (95% CI -47.3% to -43.4%); RCI -26.6% (95% CI -27.9% to -25.3%)), self-reported high BP (SII -34.5% (95% CI -36.3% to -32.7%); RCI -19.0% (95% CI -20.1% to -17.9%)). High BG levels were concentrated among those with lower educational attainment (SII -26.6% (95% CI -28.6% to -24.7%); RCI -15.7% (95% CI -16.9% to -14.5%)), represented by negative SII and RCI values. CONCLUSIONS The study findings suggest that research and programme efforts need to be redoubled to determine what is driving greater vulnerability to non-communicable diseases among population with lower educational attainment on the one hand and the possible role that improving education access can be on health outcomes, on the other hand. Further research should explore relevant intersections with low education.
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Affiliation(s)
- Santosh Kumar Sharma
- Healthier Societies, The George Institute for Global Health India, New Delhi, Delhi, India
| | - Devaki Nambiar
- Healthier Societies, The George Institute for Global Health India, New Delhi, Delhi, India
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Jaison Joseph
- Healthier Societies, The George Institute for Global Health India, New Delhi, Delhi, India
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Khosla L, Bhat S, Fullington LA, Horlyck-Romanovsky MF. HbA 1c Performance in African Descent Populations in the United States With Normal Glucose Tolerance, Prediabetes, or Diabetes: A Scoping Review. Prev Chronic Dis 2021; 18:E22. [PMID: 33705304 PMCID: PMC7986971 DOI: 10.5888/pcd18.200365] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction African descent populations in the United States have high rates of type 2 diabetes and are incorrectly represented as a single group. Current glycated hemoglobin A1c (HbA1c) cutoffs (5.7% to <6.5% for prediabetes; ≥6.5% for type 2 diabetes) may perform suboptimally in evaluating glycemic status among African descent groups. We conducted a scoping review of US-based evidence documenting HbA1c performance to assess glycemic status among African American, Afro-Caribbean, and African people. Methods A PubMed, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) search (January 2020) yielded 3,238 articles published from January 2000 through January 2020. After review of titles, abstracts, and full texts, 12 met our criteria. HbA1c results were compared with other ethnic groups or validated against the oral glucose tolerance test (OGTT), fasting plasma glucose (FPG), or previous diagnosis. We classified study results by the risk of false positives and risk of false negatives in assessing glycemic status. Results In 5 studies of African American people, the HbA1c test increased risk of false positives compared with White populations, regardless of glycemic status. Three studies of African Americans found that HbA1c of 5.7% to less than 6.5% or HbA1c of 6.5% or higher generally increased risk of overdiagnosis compared with OGTT or previous diagnosis. In one study of Afro-Caribbean people, HbA1c of 6.5% or higher detected fewer type 2 diabetes cases because of a greater risk of false negatives. Compared with OGTT, HbA1c tests in 4 studies of Africans found that HbA1c of 5.7% to less than 6.5% or HbA1c of 6.5% or higher leads to underdiagnosis. Conclusion HbA1c criteria inadequately characterizes glycemic status among heterogeneous African descent populations. Research is needed to determine optimal HbA1c cutoffs or other test strategies that account for risk profiles unique to African American, Afro-Caribbean, and African people living in the United States.
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Affiliation(s)
- Lakshay Khosla
- Department of Health and Nutrition Sciences, Brooklyn College, City University of New York, Brooklyn, New York.,College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Sonali Bhat
- Department of Health and Nutrition Sciences, Brooklyn College, City University of New York, Brooklyn, New York.,College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Lee Ann Fullington
- Library Department, Brooklyn College, City University of New York, Brooklyn, New York
| | - Margrethe F Horlyck-Romanovsky
- Department of Health and Nutrition Sciences, Brooklyn College, City University of New York, Brooklyn, New York.,Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, New York.,City University of New York, Brooklyn College, 2900 Bedford Ave, Brooklyn, NY 11210.
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4
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Samuels TA, Unwin N. The 2007 Caribbean Community Port-of-Spain Declaration on noncommunicable diseases: an overview of a multidisciplinary evaluation. Rev Panam Salud Publica 2018; 42:e193. [PMID: 31093220 PMCID: PMC6385896 DOI: 10.26633/rpsp.2018.193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 09/26/2018] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Noncommunicable diseases (NCDs) are a threat to social and economic development, including in the Caribbean. In 2007 the Caribbean Community (CARICOM) held the world's first-ever summit of heads of government on NCD prevention and control and issued the landmark Declaration of Port-of-Spain: Uniting to Stop the Epidemic of Chronic NCDs. The objectives of this paper are to provide an overview of a formal evaluation of the Declaration and to highlight key findings that could inform further implementation of the Declaration's 15 mandates. METHODS The evaluation's six research objectives were decided through stakeholder engagement and assessed by concurrent quantitative and qualitative research methods, using the following four themes: 1) trends in risk factors, morbidity, and mortality; 2) national and Caribbean-wide policy responses, and factors associated with policy successes and difficulties; 3) the international impact of the Declaration; and 4) the potential for raising revenue from tobacco and alcohol taxation in order to support NCD prevention and control. RESULTS There are marked disparities in NCD mortality and trends among the 20 CARICOM member countries and territories. No CARICOM member had fully implemented all of the Declaration's 15 mandates (which were monitored by 26 indicators), with 10 CARICOM members implementing fewer than half of the indicators, and with most members lacking a well-functioning multisectoral NCD Commission. Larger CARICOM members tended to have higher levels of implementation than did smaller members. Mandates that received active support from regional institutions tended to be better implemented by the CARICOM members than did mandates that lacked that kind of support. Feasible national tobacco and alcohol tax increases could more than cover the cost of implementing the World Health Organization NCD "best buy" interventions in the CARICOM member countries and territories. CONCLUSIONS Priorities for further implementation of the mandates from the Port-of-Spain Declaration include establishing throughout the CARICOM member countries and territories fully functioning national bodies to support multisectoral action for NCD prevention; greater regional support in policy development and implementation for smaller countries; and greater targeted use of taxes on tobacco and alcohol to support NCD control and prevention.
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Affiliation(s)
- T. Alafia Samuels
- George Alleyne Chronic Disease Research Centre, University of the West Indies, Bridgetown, Barbados.
| | - Nigel Unwin
- George Alleyne Chronic Disease Research Centre, University of the West Indies, Bridgetown, Barbados.
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5
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Cherfan M, Blacher J, Asmar R, Chahine MN, Zeidan RK, Farah R, Salameh P. Prevalence and risk factors of hypertension: A nationwide cross-sectional study in Lebanon. J Clin Hypertens (Greenwich) 2018; 20:867-879. [PMID: 29604167 DOI: 10.1111/jch.13268] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/21/2018] [Accepted: 02/28/2018] [Indexed: 11/26/2022]
Abstract
There is limited epidemiologic data on hypertension (HTN) in Lebanon. This study aimed to determine the prevalence and associated risk factors of HTN in the adult Lebanese population and evaluate the association between dietary and psychological factors on systolic blood pressure (SBP). Cross-sectional analyses were conducted using a multistage cluster sample across Lebanon. A total of 2014 participants were included. The prevalence and control rates of HTN were 31.2% and 28.7%, respectively. In women, educational level and physical activity were negatively associated with HTN (P < .05 for both) and adherence to the Lebanese Mediterranean diet was associated with a lower SBP. Other factors were associated with HTN in men. There was no relationship with SBP and psychological distress. Of the modifiable risk factors, body mass index persisted as the only contributory factor in both sexes (P < .01). Accordingly, prevention of HTN at the population level should focus mainly on overweight prevention.
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Affiliation(s)
- Michelle Cherfan
- Nutritional Epidemiology Research Unit (EREN), Galilee Doctoral School of Sciences, Technology and Health, Centre of Research in Epidemiology and Biostatistics (CRESS), Inserm U1153, Inra U1125, Cnam, Paris 13 University Sorbonne Paris Cite, Bobibny, France.,Faculty of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Jacques Blacher
- Nutritional Epidemiology Research Unit (EREN), Galilee Doctoral School of Sciences, Technology and Health, Centre of Research in Epidemiology and Biostatistics (CRESS), Inserm U1153, Inra U1125, Cnam, Paris 13 University Sorbonne Paris Cite, Bobibny, France.,Faculty of Medicine, Diagnosis and Therapeutic Center, Hôtel-Dieu Hospital, Paris-Descartes University, AP-HP, Paris, France
| | - Roland Asmar
- Foundation-Medical Research Institutes, F-MRI®, Geneva, Switzerland
| | - Mirna N Chahine
- Foundation-Medical Research Institutes, F-MRI®, Beirut, Lebanon.,Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Rouba K Zeidan
- Faculty of Public Health, Lebanese University, Fanar, Lebanon
| | - Rita Farah
- Faculty of Pharmacy, Lebanese University, Hadath, Lebanon
| | - Pascale Salameh
- Faculty of Public Health, Lebanese University, Fanar, Lebanon.,Faculty of Pharmacy, Lebanese University, Hadath, Lebanon
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Burns J, Polus S, Brereton L, Chilcott J, Ward SE, Pfadenhauer LM, Rehfuess EA. Looking beyond the forest: Using harvest plots, gap analysis, and expert consultations to assess effectiveness, engage stakeholders, and inform policy. Res Synth Methods 2017; 9:132-140. [PMID: 29106058 DOI: 10.1002/jrsm.1284] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 10/04/2017] [Accepted: 10/23/2017] [Indexed: 11/09/2022]
Abstract
We describe a combination of methods for assessing the effectiveness of complex interventions, especially where substantial heterogeneity with regard to the population, intervention, comparison, outcomes, and study design of interest is expected. We applied these methods in a recent systematic review of the effectiveness of reinforced home-based palliative care (rHBPC) interventions, which included home-based care with an additional and explicit component of lay caregiver support. We first summarized the identified evidence, deemed inappropriate for statistical pooling, graphically by creating harvest plots. Although very useful as a tool for summary and presentation of overall effectiveness, such graphical summary approaches may obscure relevant differences between studies. Thus, we then used a gap analysis and conducted expert consultations to look beyond the aggregate level at how the identified evidence of effectiveness may be explained. The goal of these supplemental methods was to step outside of the conventional systematic review and explore this heterogeneity from a broader perspective, based on the experience of palliative care researchers and practitioners. The gap analysis and expert consultations provided valuable input into possible underlying explanations in the evidence, which could be helpful in the further adaptation and testing of existing rHBPC interventions or the development and evaluation of new ones. We feel that such a combination of methods could prove accessible, understandable, and useful in informing decisions and could thus help increase the relevance of systematic reviews to the decision-making process.
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Affiliation(s)
- J Burns
- Institute for Medical Informatics, Biometry and Epidemiology, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - S Polus
- Institute for Medical Informatics, Biometry and Epidemiology, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - L Brereton
- The School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.,College of Health and Social Sciences, University of Lincoln, Lincoln, UK
| | - J Chilcott
- The School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - S E Ward
- The School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - L M Pfadenhauer
- Institute for Medical Informatics, Biometry and Epidemiology, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - E A Rehfuess
- Institute for Medical Informatics, Biometry and Epidemiology, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
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Ferguson TS, Younger-Coleman NOM, Tulloch-Reid MK, Hambleton IR, Francis DK, Bennett NR, McFarlane SR, Bidulescu A, MacLeish MY, Hennis AJM, Wilks RJ, Harris EN, Sullivan LW. Educational Health Disparities in Cardiovascular Disease Risk Factors: Findings from Jamaica Health and Lifestyle Survey 2007-2008. Front Cardiovasc Med 2017; 4:28. [PMID: 28555188 PMCID: PMC5430054 DOI: 10.3389/fcvm.2017.00028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 04/24/2017] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES Socioeconomic disparities in health have emerged as an important area in public health, but studies from Afro-Caribbean populations are uncommon. In this study, we report on educational health disparities in cardiovascular disease (CVD) risk factors (hypertension, diabetes mellitus, hypercholesterolemia, and obesity), among Jamaican adults. METHODS We analyzed data from the Jamaica Health and Lifestyle Survey 2007-2008. Trained research staff administered questionnaires and obtained measurements of blood pressure, anthropometrics, glucose and cholesterol. CVD risk factors were defined by internationally accepted cut-points. Educational level was classified as primary or lower, junior secondary, full secondary, and post-secondary. Educational disparities were assessed using age-adjusted or age-specific prevalence ratios and prevalence differences obtained from Poisson regression models. Post-secondary education was used as the reference category for all comparisons. Analyses were weighted for complex survey design to yield nationally representative estimates. RESULTS The sample included 678 men and 1,553 women with mean age of 39.4 years. The effect of education on CVD risk factors differed between men and women and by age group among women. Age-adjusted prevalence of diabetes mellitus was higher among men with less education, with prevalence differences ranging from 6.9 to 7.4 percentage points (p < 0.05 for each group). Prevalence ratios for diabetes among men ranged from 3.3 to 3.5 but were not statistically significant. Age-specific prevalence of hypertension was generally higher among the less educated women, with statistically significant prevalence differences ranging from 6.0 to 45.6 percentage points and prevalence ratios ranging from 2.5 to 4.3. Similarly, estimates for obesity and hypercholesterolemia suggested that prevalence was higher among the less educated younger women (25-39 years) and among more educated older women (40-59 and 60-74 years). There were no statistically significant associations for diabetes among women, or for hypertension, high cholesterol, or obesity among men. CONCLUSION Educational health disparities were demonstrated for diabetes mellitus among men, and for obesity, hypertension, and hypercholesterolemia among women in Jamaica. Prevalence of diabetes was higher among less educated men, while among younger women the prevalence of hypertension, hypercholesterolemia, and obesity was higher among those with less education.
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Affiliation(s)
- Trevor S. Ferguson
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Novie O. M. Younger-Coleman
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Marshall K. Tulloch-Reid
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Ian R. Hambleton
- Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
| | - Damian K. Francis
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Nadia R. Bennett
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Shelly R. McFarlane
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Aurelian Bidulescu
- Indiana University School of Public Health – Bloomington, Bloomington, IN, USA
| | - Marlene Y. MacLeish
- Department of Medical Education, Morehouse School of Medicine, Atlanta, GA, USA
| | - Anselm J. M. Hennis
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Rainford J. Wilks
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
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