Food-Focused Media Literacy for Remotely Acculturating Adolescents and Mothers: A Randomized Controlled Trial of the "JUS Media? Programme".

PURPOSE: Unhealthy eating is a major modifiable risk factor for noncommunicable diseases and obesity, and remote acculturation to U.S. culture is a recently identified cultural determinant of unhealthy eating among adolescents and families in low/middle-income countries. This small-scale randomized controlled trial evaluated the efficacy of the "JUS Media? Programme," a food-focused media literacy intervention promoting healthier eating among remotely acculturating adolescents and mothers in Jamaica. METHODS: Gender-stratified randomization of 184 eligible early adolescents and mothers in Kingston, Jamaica (i.e., 92 dyads: Madolescent.age = 12.79 years, 51% girls) determined 31 "Workshops-Only" dyads, 30 "Workshops + SMS/texting" dyads, and 31 "No-Intervention-Control" dyads. Nutrition knowledge (food group knowledge), nutrition attitudes (stage of nutritional change), and nutrition behavior (24-hour recall) were primary outcomes assessed at four time points (T1/baseline, T2, T3, T4) across 5 months using repeated measures analysis of covariances. RESULTS: Compared to control, families in one or both intervention groups demonstrated significantly higher nutrition knowledge (T3 adolescents, T4 mothers: mean differences .79-1.08 on a 0-6 scale, 95% confidence interval [CI] .12-1.95, Cohen's ds = .438-.630); were more prepared to eat fruit daily (T3 adolescents and mothers: .36-.41 on a 1-5 scale, 95% CI .02-.77, ds = .431-.493); and were eating more cooked vegetables (T4 adolescents and T2 and T4 mothers: .20-.26 on a 0-1 scale, 95% CI -.03-.50, ds = .406-.607). Postintervention focus groups (6-month-delay) revealed major positive impacts on participants' health and lives more broadly. CONCLUSIONS: A food-focused media literacy intervention for remotely acculturating adolescents and mothers can improve nutrition. Replication in Jamaica and extension to the Jamaican diaspora would be useful.

U.S. Media Enjoyment without Strong Media Literacy Undermines Adolescents' and Mothers' Reported Efforts to Reduce Unhealthy Eating in Jamaica.

We investigate whether media literacy and media use can moderate the association between U.S. media enjoyment and unhealthy eating among remotely acculturating "Americanized" adolescents and their mothers in Jamaica (n = 164 individuals/82 dyads; Madolescent.age  = 12.83, SD = 0.48, 48% female; Mmother_age  = 39.25, SD = 5.71). Socioeconomically diverse participants completed questionnaires reporting their degree of enjoyment of U.S. media (i.e., remote acculturation), media literacy (i.e., critical thinking about food media/advertising), and adherence to national dietary guidelines to reduce sugar/fat. Multilevel modeling showed that enjoying U.S. media and consuming high levels of U.S. TV plus Jamaican TV are associated with lower efforts to reduce sugar and fat. However, high media literacy, whether one's own or a close family member's, weakens or nullifies that association.

Transdisciplinary team science for global health: Case study of the JUS Media? Programme.

The world's most pressing health problems, such as the childhood obesity pandemic, demand creative new solutions. In this article it is argued that psychological theories, concepts, and methods are ripe for integration with those of other disciplines to synthesize innovative transdisciplinary global health solutions. As a model, the process of blending developmental and cross-cultural psychology with health and media sciences to develop a transdisciplinary intervention for youth and families in Jamaica-the J(amaican and) U(nited) S(tates) Media? Programme-is described. Jamaicans on the island are being inundated by the inflow of U.S. media, and those who have internalized U.S. culture and become "Americanized" via a process called remote acculturation are especially vulnerable to negative health habits promoted by U.S. media and advertising. In response, the JUS Media? Programme teaches critical thinking skills about food advertising (especially U.S.-produced) to decrease unhealthy eating among Americanized youth and families in Jamaica. In this article, first, transdisciplinarity is defined and distinguished from other scientific orientations (uni-, multi-, and interdisciplinarity) using the evolution of scholarship within JUS Media? Programme's transdisciplinary team as an example. Next, the application of transdisciplinary team science to global health problems is explained. As an example, the guiding transdisciplinary model for the JUS Media? Programme is described, and the cultural adaptation process used to design the JUS Media? Programme for Jamaican families is detailed. Finally, there is a reflection on best practices for transdisciplinary team leadership and collaboration. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Feel American, Watch American, Eat American? Remote Acculturation, TV, and Nutrition Among Adolescent-Mother Dyads in Jamaica.

Globalization prompts remote acculturation toward U.S. culture in Jamaica; this study used a bioecological systems approach to examine its proximal impact on nutrition through U.S. cable TV consumption, and maternal influences in the home. Overall, 330 randomly selected adolescent-mother dyads from schools in Kingston, Jamaica (Madolescent_age  = 13.8 years, SDadolescent_age  = 1.8) completed questionnaires reporting American identity and behavioral preferences, daily time spent watching U.S.-produced TV programs, and frequency of eating unhealthy foods. Actor-partner interdependence models revealed that girls' American identity/behavior directly predicted their unhealthy eating, whereas girls' mothers and boys' American identity/behavior indirectly predicted unhealthy eating as mediated by their U.S. TV hours. Additionally, mothers' American identity/behavior predicted daughters' unhealthy eating as mediated by mothers' U.S. TV hours. Remote acculturation theory may facilitate more targeted research and prevention/intervention.

Experiences of violence and deficits in academic achievement among urban primary school children in Jamaica.

OBJECTIVE: The aim of this study was to examine the relationship between children's experiences of three different types of violence and academic achievement among primary school children in Kingston, Jamaica. METHODS: A cross-sectional study of 1300 children in grade 5 [mean (S.D.) age: 11 (0.5) years] from 29 government primary schools in urban areas of Kingston and St. Andrew, Jamaica, was conducted. Academic achievement (mathematics, reading, and spelling) was assessed using the Wide Range Achievement Test. Children's experiences of three types of violence - exposure to aggression among peers at school, physical punishment at school, and exposure to community violence - were assessed by self-report using an interviewer administered questionnaire. RESULTS: Fifty-eight percent of the children experienced moderate or high levels of all three types of violence. Boys had poorer academic achievement and experienced higher levels of aggression among peers and physical punishment at school than girls. Children's experiences of the three types of violence were independently associated with all three indices of academic achievement. There was a dose-response relationship between children's experiences of violence and academic achievement with children experiencing higher levels of violence having the poorest academic achievement and children experiencing moderate levels having poorer achievement than those experiencing little or none. CONCLUSIONS: Exposure to three different types of violence was independently associated with poor school achievement among children attending government, urban schools in Jamaica. Programs are needed in schools to reduce the levels of aggression among students and the use of physical punishment by teachers and to provide support for children exposed to community violence. PRACTICE IMPLICATIONS: Children in Jamaica and the wider Caribbean experience significant amounts of violence in their homes, communities, and schools. In this study, we demonstrate a dose-response relationship between primary school children's experiences of three different types of violence and their academic achievement. The study points to the need for validated violence prevention programs to be introduced in Jamaican primary schools. Such programs need to train teachers in appropriate classroom management and discipline strategies and to promote children's social and emotional competence and prevent aggression.

Setting priorities in global child health research investments: guidelines for implementation of CHNRI method.

This article provides detailed guidelines for the implementation of systematic method for setting priorities in health research investments that was recently developed by Child Health and Nutrition Research Initiative (CHNRI). The target audience for the proposed method are international agencies, large research funding donors, and national governments and policy-makers. The process has the following steps: (i) selecting the managers of the process; (ii) specifying the context and risk management preferences; (iii) discussing criteria for setting health research priorities; (iv) choosing a limited set of the most useful and important criteria; (v) developing means to assess the likelihood that proposed health research options will satisfy the selected criteria; (vi) systematic listing of a large number of proposed health research options; (vii) pre-scoring check of all competing health research options; (viii) scoring of health research options using the chosen set of criteria; (ix) calculating intermediate scores for each health research option; (x) obtaining further input from the stakeholders; (xi) adjusting intermediate scores taking into account the values of stakeholders; (xii) calculating overall priority scores and assigning ranks; (xiii) performing an analysis of agreement between the scorers; (xiv) linking computed research priority scores with investment decisions; (xv) feedback and revision. The CHNRI method is a flexible process that enables prioritizing health research investments at any level: institutional, regional, national, international, or global.

Perceptions and experiences of violence among secondary school students in urban Jamaica

Objective. To obtain information on the perceptions and experiences of violence among secondary school students in Kingston, Jamaica, and its environs. Methods. Data collection was carried out from September through December 1998. Two researchers administered questionnaires in 11 randomly selected secondary schools, to a total of 1,710 students who were in either grade 7 or grade 9 and who were aged 9-17 years old (mean of 13.2 years). Frequency distributions of the responses were compared by gender, age, grade level, socioeconomic status, and school type. Results. Seventy-five percent of the students thought that someone who was reluctant to fight would be "picked on" more, 89 percent thought it generally wrong to hit other people, and 91 percent thought it wrong to insult other people. Eighty-four percent knew of students who carried knives or blades from such items as a scalpel or a utility knife to school, and 89 percent were worried about violence at school. Thirty-three percent had been victims of violence, and 60 percent had a family member who had been a victim of violence. Eighty-two percent thought that violent television shows could increase aggressive behavior. Factor analysis of selected responses was carried out, yielding five factors: neighbourhood violence, school violence, perceptions of acceptable behaviors, level of concern about violence, school violence, and general experiences and perceptions of violence. The factors varied with gender, age, grade level, socioeconomic status, and school type. Conclusions. These results will help focus interventions aimed at reducing violence, provide a baseline for later comparisons of perceptions and experiences of violence, and offer a basis for comparing the experiences of young people in urban Jamaica with those of young persons elsewhere (AU)

Presence of Anorexia Nervosa and Bulimia Nervosa in Jamaica

We could find no previous data describing the extent to which eating disorders are a public health problem in Jamaica, and so we carried out two exercises to assess this. We investigated the number of cases of anorexia nervosa (AN) and bulimia nervosa (BN) presenting at the University Hospital of the West Indies (UHWI) between 1985 and 1988, using case records, and carried out a survey among health professionals (psychiatrists, clinical psychologists, paediatricians and nutritionists/dietitians) to determine the number of patients with eating disorders seen by them between 1996 and 1998. We also examined the diagnostic criteria used and correlates of eating disorders. Only two cases of AN were treated at UHWI. Eleven cases each of AN and BN (two males) had presented to the health professionals surveyed, chiefly the psychiatrists. The AN patients ranged in age from 14 to 28 years (mean 20.9 years), and the BN patients from 11 to 35 years (mean 22.2 years). Eating disorders were reported primarily among urban dwellers (76 percent), and half of the cases were among students. Limiting food intake, excessive exercise and vomiting were the most frequently used metdods of weight control. Nine eating disorder patients (41 percent) were also diagnosed with depression, and five (23 percent) patients reported previous emotional trauma. The occurrence of eating disorders in Jamaica appears to be very low. (AU)

Concepts of obesity among outpatients of a Jamaican hospital

Obesity is an important risk factor for the development of chronic non-communicable diseases such as diabetes and hypertension, which affects large numbers of Caribbean people. There is a perception that Caribbean culture is not only tolerant of obesity but actually encourages this state, especially among women. We carried out a survey among normal-weight and overweight adults in order to investigate their attitudes to obesity. Three hundred adults (245 women and 55 men) present at the Casualty department at the University Hospital during the study period were asked to participate. A questionnaire was given, and heights and weights were measured to determine Body Mass Index (BMI). The relation between BMI and attitudes to obesity was explored. Forty percent of the respondents agreed that fatness was a sign of happiness, 15 percent thought it represented wealth, and 10 percent thought it represented health. Just over half (58 percent) of the women who were overweight perceived themselves to be fat, while of the overweight men (42 percent) thought themselves fat. Fifty-six percent of the men, and 38 percent of the women preferred a slim partner. Most respondents were aware of the diseases associated with obesity and could name foods which contributed to obesity e.g. fried foods and sweets. These data suggest that obesity is viewed favourably, or not unfavourably, by nearly half of the sample, or the converse, over half of the respondents did not view obesity favourably. Although the problems of obesity are recognized, overweight people are not necessarily aware that they are in fact overweight and at risk. Health promotion efforts should take this into account. (AU)

Concepts of obesity among outpatients of a Jamaican hospital

Obesity is an important risk factor for the development of chronic non-communicable diseases such as diabetes and hypertension, which affects large numbers of Caribbean people. There is a perception that Caribbean culture is not only tolerant of obesity but actually encourages this state, especially among women. We carried out a survey among normal-weight and overweight adults in order to investigate their attitudes to obesity. Three hundred adults (245 women and 55 men) present at the Casualty department at the University Hospital during the study period were asked to participate. A questionnaire was given, and heights and weights were measured to determine Body Mass Index (BMI). The relation between BMI and attitudes to obesity was explored. Forty percent of the respondents agreed that fatness was a sign of happiness, 15 percent thought it represented wealth, and 10 percent thought it represented health. Just over half (58 percent) of the women who were overweight perceived themselves to be fat, while of the overweight men (42 percent) thought themselves fat. Fifty-six percent of the men, and 38 percent of the women preferred a slim partner. Most respondents were aware of the diseases associated with obesity and could name foods which contributed to obesity e.g. fried foods and sweets. These data suggest that obesity is viewed favourably, or not unfavourably, by nearly half of the sample, or the converse, over half of the respondents did not view obesity favourably. Although the problems of obesity are recognized, overweight people are not necessarily aware that they are in fact overweight and at risk. Health promotion efforts should take this into account.

The use of herbal teas and remedies in Jamaica

We investigated the prevalence of the use of herbs among adults and children in Jamaica in 1996. Two concurrent surveys were conducted in randomly selected urban and rural area; among the adults and among caretakers of young children. From over 90 percent of the selected households, all caretakers of children under 6 years and one randomly selected adult (18 years or older) were interviewed using structured questionnaires. The 457 adults reportedly used 156 types of herbs: a mean of 6ñ3 (mean ñ standard deviation) by the urban adults, and 10ñ6 by the rural adults (t-test, p < 0.001). Almost 100 percent of respondents had at some time used herbs for teas or for treating illnesses. The most common methods of preparation was by infusion or boiling in water, then adding sugar. Urban respondents, women and those who were employed were more likely to buy medicines than to use herbal remedies. One hundred and sixty-seven caretakers of 203 children under 6 years were interviewed. The mean number of herbs given to each child was between 2 and 3. The most common herbs were introduced within the first 6 months of life. Many caretakers factors were associated with herbal use. Public health implications include the potential toxicity of some herbs, the possibilty that herbal teas given to young children may displace more nutritious foods and delay presentation to health care facilities. The findings will allow policy makers to target those most likely to use herbal preparations or to give them to young children, and target herbs to be analyzed for toxic or beneficial properties.(Au)

Zinc supplementation, morbidity and growth in stunted Jamaican children

We investigated whether there was a morbidity or growth response to zinc supplementation of nutrition clinic attenders in Kingston, which would indicate zinc deficiency. Children selected were singletons aged 6 to 24 months and stunted (<2.0 sd length for age, NCHS references). They were stratified by gender and age (6-11, 12-17, 18-24 mo.) and randomly assigned to receive zinc supplementation (n=31) (5mg elemental zinc), or placebo (n=30) daily for 12 weeks. Adequately nourished comparison children (n=24) were recruited from a well-baby clinic. Caretakers were interviewed to obtain social background data. Anthropometric measurements were done on enrolment and after 6 weeks, 12 weeks and 12 months. A weekly questionnaire to determine the stunted children's health was given to the caretakers during the supplementation period. The zinc supplemented and placebo groups were very similar on enrolment. The adequately nourished children were significantly better socio-economic circumstances. Five placebo children, but no zinc supplemented children, were hospitalized during the supplemented period (Fisher's exact test, two-tailed, p=0.02), indicating reduced severity of illness with supplementation, which suggests a response to zinc deficiency. There were no significant differences in hair zinc content among the three groups. Regression analyses showed that there were no significant effects of supplementation of length, height or head circumference, or on the incidence of any symptom. Mean duration of the episodes were significantly shorter for skin rashes in the supplemented group compared with the placebo group (ANCOVA, P=0.02), and longer for vomiting (ANCOVA, p=0.02).(AU)

A case-control study of aggressive and pro-social Jamaican school boys

We examined the correlates of behaviour of 102 aggressive and 103 pro-social boys, selected by peer and teacher ratings, from grades 5 and 6 in 10 primary schools in urban Kingston and St. Andrew. The children were given in-depth questionnaires, school achievement test (WRAT) and verbal ability tests (Peabody Picture Vocabulary Test). Their parents were also given questionnaires. Interobserver and test retest reliabilities were established for all questionnaires and tests. Interviewers were unaware of the boys' groups. The aggressive group was significantly older (mean 11.1 years; t-test p<0.1). The aggressive group had significantly lower scores on both the number of possessions and the housing rating (proxies for socio-economic status); they showed significantly lower scores on spelling, arithmetic, reading and verbal IQ, and considered themselves less bright than the pro-social boys. Preliminary analyses indicate that, as expected, the aggressive boys fought more and used knives more compared with the pro-social boys. They reported receiving significantly more punishment at home. The aggressive group indicated that they saw significantly more family fights. All differences remained significant when socio-economic status was controlled in analyses of covariance except that the difference in the arithmetic scores was no longer significant. Many of these patterns are similar to those reported elsewhere.(AU)

Zinc supplementation: effects on the growth and morbidity of undernourished Jamaican children

OBJECTIVE: We investigated whether there was a growth or morbidity response to zinc supplementation. DESIGN: The study was randomized, placebo-controlled, and double-blind. SETTING: Children were recruited at clinics in Kingston, Jamaica, and supplemented at home. SUBJECTS: Children selected were singletons aged 6-24 months, and stunted (< -2.0 s.d. length for age, NCHS references). They were stratified by sex and age and randomly assigned to receive zinc supplement (n = 31) or placebo (n = 30). Four children were excluded because of hospitalization; all others had all measurements. Adequately nourished children (n = 24) were recruited from a well-baby clinic. INTERVENTIONS: The supplement provided 5 mg elemental zinc in a syrup daily for 12 weeks; the placebo comprised the syrup only. MAIN OUTCOME MEASURES: Caretakers were interviewed to obtain social background data, number of clinic visits and hospitalizations. Anthropometric measurements were done on enrolment, and after 6 weeks, 12 weeks and 12 months. Children's health was determined by weekly questionnaire to caretakers of the undernourished groups during the supplementation period. RESULTS: The supplemented and placebo groups were similar on enrolment. The adequately nourished children were from significantly better socio-economic circumstances. Mean initial hair zinc content was 5.5 +/- 4.8 mumol/g (supplemented group) and 6.7 +/1 12.1 mumol/g (placebo) (n.s.). Regression analyses showed that there were no significant effects of supplementation on length, height or head circumference, nor on the incidence of any morbidity symptom. Mean duration of the episodes was significantly shorter for skin rashes in the supplemented group compared with the control group (ANCOVA, P = 0.02), and longer for vomiting (P = 0.02). The incidence of hospitalization was significantly greater in the control group (Fisher's exact test, P = 0.02). CONCLUSIONS: Zinc supplementation reduced the hospitalizations which probably reflect severity of morbidity, but did not improve growth.(Au)

A case-control study of aggressive and pro-social Jamaican school boys

The study examined the correlates of behavior of 102 aggressive and 103 prosocial boys, selected by peer and teacher ratings, from grades 5 and 6 in 10 schools in urban Kingston and St. Andrew. The children were given in-depth questionnaires, school achievement tests (WRAT) and verbal ability tests (Peabody Picture Vocabulary Test). Their parents were also given questionnaires. Interobserver and test-retest reliabilities were established for all questionnaires and tests. Interviewers were unaware of the boys' group. The aggressive group was significantly older (mean 11.4 years) than the pro-social boys (mean 11.1 years; t-test p,0.01). The aggressive group had significantly lower scores on both the number of possessions and the housing rating (proxies for socio-economic status), they showed significantly lower scores on spelling, arithmetic, reading and verbal IQ, and considered themselves less bright than the pro-social boys. Preliminary analyses indicate that, as expected, the aggressive boys fought more and used knives in fights more compared with the pro-social boys. They reported receiving significantly more punishments at home. The aggressive group indicated that they saw significantly more family quarrels, threats between family members and family fights. All differences remained significant when socio-economic status was controlled in analyses of covariance except that the differences in the arithmetic scores was no longer significant. Many of these patterns are similar to those reported elsewhere. (AU)

A case-control study of aggressive and pro-social Jamaican school boys

The study examined the correlates of behaviour of 102 aggressive and 103 prosocial boys, selected by peer and teacher ratings, from grades 5 and 6 in 10 schools in urban Kingston and St. Andrew. The children were given in-depth questionnaires, school achievement tests (WRAT) and verbal ability tests (Peabody Picture Vocabulary Test). Their parents were also given questionnaires. Interobserver and test-retest reliabilities were established for all questionnaires and tests. Interviewers were unaware of the boys' group. The aggressive group was significantly older (mean 11.4 years) than the pro-social boys (mean 11.1 years; t-test p,0.01). The aggressive group had significantly lower scores on both the number of possessions and the housing rating (proxies for socio-economic status), they showed significantly lower scores on spelling, arithmetic, reading and verbal IQ, and considered themselves less bright than the pro-social boys. Preliminary analyses indicate that, as expected, the aggressive boys fought more and used knives in fights more compared with the pro-social boys. They reported receiving significantly more punishments at home. The aggressive group indicated that they saw significantly more family quarrels, threats between family members and family fights. All differences remained significant when socio-economic status was controlled in analyses of covariance except that the differences in the arithmetic scores was no longer significant. Many of these patterns are similar to those reported elsewhere.

Activity levels and maternal-child behavior in undernutrition: studies in Jamaica

It has been well established that children suffering from severe or moderate protein energy malnutrition in early childhood show delayed development, but the mechanisms linking undernutrition to poor development are not well understood. One holds that undernutrition causes irreversible central nervous system changes that affect function... The authors have recently reviewed, in detail, studies on activity and undernutrition n children. This work will briefly review the literature on activity levels and behavior in undernourished children and then describe two Jamaican studies that addresses aspects of the functional isolation hypothesis. Activity levels will be discussed first, then, other behaviors

Aggressive behaviour in children and adolescents. Part 1: a review of the effects of child and family characteristics

Interpersonal violence is a major public health concern throughout the West Indies, particularly in Jamaica. Many factors contribute to a youth's violent or aggressive behaviour, ranging from individual temperamemt, to family structure, to large sociocultural influences. In Part 1. we review the incidence and severity of violence, and discuss the effects of individual characteristics, and of family structure and discipline. In Part 11, the reported effects of school structure, peer relationships and interaction, corporal punishment and the media on violenct behaviour in children and adolescents are reviewed, and potential policy implication are discussed.(AU)