Prevalence of risk factors for coronary heart disease among Dominicans in the Dominican Republic: comparison with Japanese and Americans using existing data

Blood cholesterol level and prevalence of hypercholesterolaemia in developing countries: a review of population-based studies carried out from 1979 to 2002

BACKGROUND

While the age-specific rates of cardiovascular diseases (CVD) are declining in many developed countries, the epidemic is accelerating in most developing countries. Elevated serum total cholesterol (TC) is one of the major risk factors for atherosclerotic CVD. This review was carried out to describe the current situation in mean TC and in the prevalence of hypercholesterolaemia in developing countries.

DESIGN AND METHODS

A search for papers published in medical journals from 1990 to 2002 was performed using the MEDLINE database. A total of 37 articles were selected according to previously defined criteria containing information on mean blood total cholesterol and/or hypercholesterolaemia from 38 developing countries.

RESULTS

Hypercholesterolaemia is a public health problem in most of the developing countries reviewed. A positive association between the population mean TC and the GNP per capita was evidenced.

CONCLUSIONS

Differences in methodology between national surveys make international comparisons difficult. Nevertheless, low-cost dietary interventions and the development of primary prevention strategies are needed to reduce the already existing public health problem of elevated TC in developing countries.

Tobacco use and exposure to secondhand smoke among pregnant women in the Dominican Republic: an exploratory look into attitudes, beliefs, perceptions, and practices

INTRODUCTION

The purpose of this study is to assess the attitudes, beliefs, perceptions, and practices regarding tobacco use and exposure among pregnant women in the Dominican Republic.

METHODS

The survey was conducted in two public health hospitals in Santiago, Dominican Republic, and was administered to a convenience sample of 192 women during prenatal care visits. Analyses examined pregnant women's tobacco use, secondhand smoke exposure (SHS), knowledge about risks of smoking and benefits of quitting, and attitudes toward women's tobacco use. All data were collected between April and August 2009.

RESULTS

Respondents' age ranged from 18 to 41 years, with a mean age of 25 years (SD = 4.59), a high literacy level (82%), low educational levels (48% less than high school education), and a high unemployment rate (65%). Levels of ever having experimented with cigarettes were 14%, and 5% had ever been a regular smoker. Among all respondents, 3% of women reported being current smokers. When respondents were asked if they would try smoking next year, 7% responded yes, maybe, or don't know. Rates of self-reported SHS among pregnant women were 16%, and 14% reported their young children being exposed to secondhand smoke. More than half of the pregnant women in this study allowed smoking in their home (76%).

CONCLUSIONS

This study provides a preliminary understanding of tobacco use and exposure among pregnant women and its potential impact on the Dominican Republic's public health efforts that include improving maternal and child health.

Health care workers in the Dominican Republic: self-perceived role in smoking cessation

A Dominican Republic (DR)-based multi-community trial of smoking cessation viewed health care workers (HCWs) as potential interventionists. Effectively engaging them requires a clear understanding of their attitudes and practices regarding smoking. A Rapid Assessment Procedure, conducted among HCWs in six economically disadvantaged communities, included physicians, nurses, other health professionals, paraprofessionals, and lay workers. Attitudes and practices about smoking were consistent across the 82 HCWs and mostly reflected community views. HCWs lacked proactiveness related to smoking cessation and had a limited view of their role, attributing clients' quitting successes to personal will. Prior cessation training was limited, although interest was generally high. Material resources about smoking cessation were virtually absent. DR HCWs' views represented features both distinct from and common to HCWs elsewhere. Any intervention with HCWs must first raise awareness before addressing their role in smoking cessation, discussing implementation barriers, and include training and materials about risks and effective interventions.

Tobacco use in six economically disadvantaged communities in the Dominican Republic

The Dominican Republic is a tobacco-growing country, and tobacco control efforts there have been virtually nonexistent. This study provides a first systematic surveillance of tobacco use in six economically disadvantaged Dominican Republic communities (two small urban, two peri-urban, two rural; half were tobacco growing). Approximately 175 households were randomly selected in each community (total N = 1,048), and an adult household member reported on household demographics and resources (e.g., electricity), tobacco use and health conditions of household members, and household policies on tobacco use. Poverty and unemployment were high in all communities, and significant gaps in access to basic resources such as electricity, running water, telephones/cell phones, and secondary education were present. Exposure to tobacco smoke was high, with 38.4% of households reporting at least one tobacco user, and 75.5% allowing smoking in the home. Overall, 22.5% reported using tobacco, with commercial cigarettes (58.0%) or self-rolled cigarettes (20.1%) the most commonly used types. Considerable variability in prevalence and type of use was found across communities. Overall, tobacco use was higher in males, illiterate groups, those aged 45 or older, rural dwellers, and tobacco-growing communities. Based on reported health conditions, tobacco attributable risks, and World Health Organization mortality data, it is estimated that at least 2,254 lives could potentially be saved each year in the Dominican Republic with tobacco cessation. Although it is expected that the reported prevalence of tobacco use and health conditions represent underestimates, these figures provide a starting point for understanding tobacco use and its prevalence in the Dominican Republic.

Tobacco use in the Dominican Republic: understanding the culture first

OBJECTIVE

To conduct formative research on the landscape of tobacco use to guide survey and subsequent intervention development in the Dominican Republic (DR).

DESIGN

Rapid Assessment Procedures, systematic qualitative methods (participant-observations, in-depth interviewing, focus groups) using bilingual mixed age and gendered teams from the United States and DR.

SUBJECTS

Over 160 adults (men and women), ages 18 to 90 years, current, former and never smokers, community members and leaders from six underserved, economically disadvantaged DR communities.

MAIN OUTCOME MEASURES

Key domains: tobacco use patterns and attitudes; factors affecting smoking initiation, continuation, quitting; perceived risks/benefits/effects of smoking; and awareness/effects of advertising/regulations.

RESULTS

Perceptions of prevalence varied widely. While "everybody" smokes, smokers or ex-smokers were sometimes difficult to find. Knowledge of health risks was limited to the newly mandated statement "Fumar es prejudicial para la salud" [Smoking is harmful to your health]. Smokers started due to parents, peers, learned lifestyle, fashion or as something to do. Smoking served as an escape, relaxation or diversion. Quit attempts relied on personal will, primarily for religious or medical reasons. Social smoking (custom or habit) (< 10 cigarettes per day) was viewed as a lifestyle choice rather than a vice or addiction. Out of respect, smokers selected where they smoked and around whom. Health care providers typically were reactive relative to tobacco cessation, focusing on individuals with smoking related conditions. Tobacco advertising was virtually ubiquitous. Anti-tobacco messages were effectively absent. Cultures of smoking and not smoking coexisted absent a culture of quitting.

CONCLUSIONS

Systematic qualitative methods provided pertinent information about tobacco attitudes and use to guide subsequent project steps. Integrating qualitative then quantitative research can be replicated in similar countries that lack empirical data on the cultural dimensions of tobacco use.

Socioeconomic differences in behavioural and biological risk factors: a comparison of a Japanese and an English cohort of employed men

BACKGROUND

To compare socioeconomic differences in behavioural and biological risk factors in Japanese and English 39-59-year-old employed men.

METHODS

We measured systolic and diastolic blood pressure, total and high density lipoprotein (HDL) cholesterol, body mass index (BMI), waist-to-hip ratio and fibrinogen at medical screenings and smoking and alcohol consumption in health questionnaires among Japanese non-manual and manual employees of a steel products company and among English non-manual employees working in Civil Service departments.

RESULTS

In England, higher employment grades were advantaged with regard to most risk factors studied. In Japan the picture was different in that higher grades had higher BMI, waist-to-hip-ratio and lower HDL cholesterol. In Japan employment grade differences in these three risk factors are clearly larger among younger men than among older men, while in England age differentials in the grade differences are small. Similar results were obtained for education.

CONCLUSIONS

Important differences in the social patterning of risk factors were observed in our cohorts of employed Japanese and English men. The contribution that these risk factors make in explaining social differences in health may vary accordingly. Studies that identify the common and unique determinants of socioeconomic health differences in different populations are needed.

Lipoprotein(a) concentrations in healthy subjects in the Dominican Republic. Comparison with Japanese

Previous studies have shown that serum concentrations of lipoprotein(a) [Lp(a)] are markedly different among different ethnic groups. We examined the serum levels of total cholesterol, high density lipoprotein (HDL) cholesterol and Lp(a) in apparently healthy subjects aged 20-69 years in Japan (n = 865) and the Dominican Republic (n = 1,893). Dominicans had significantly lower levels of total cholesterol and HDL cholesterol than Japanese. The distribution of Lp(a) concentrations were markedly skewed towards low levels in both Japanese and Dominicans. However, the mean Lp(a) concentration in Dominicans was approximately 2 times higher than in Japanese (21.7 +/- 23.7 vs 12.3 +/- 15.9 mg/dl, p < 0.001). This is possibly because the majority of Dominicans are of mixed Negroid and European blood.

Food intake and food consumption patterns of hospital workers in the dominican republic

Coronary heart disease (CHD) is the leading cause of death according to official mortality statistics in the Dominican Republic. The purpose of this study was to assess food intake and food consumption patterns of Dominicans and to discuss CHD risks related to nutrient intake. The subjects were 22 men and 81 women voluntarily recruited among 230 hospital workers in Santo Domingo. The mean nutrient intake and food consumption were estimated from a single 24-hour recall method administered by trained persons who elicited each subject's previous day's intake from midnight to midnight. The mean energy intake was 2030 kcal. The mean intake of total protein, total fat and carbohydrates were 66.3g, 89.1 g and 248g, respectively. Percentage of energy from total fat was 39.5%, which was higher than WHO recommendations. But, the percentage of animal fat per total fat was 46.8%. Especially, the value in the low income group was 31.7%. Moreover, we analyzed the food consumption structure in order to understand the Dominican dietary pattern, and three factors were found to explain the characteristics on the basis of factor analysis.The low percentage of animal fat was due to the diets rich in vegetable oil. Our results suggested that it was difficult to assume that CHD risks increased as a result of the Dominican dietary pattern. This was consistent with our previous findings that the average serum cholesterol level of Dominicans was generally low.