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).

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)

Trichuris trichiura infection and cognitive function in Jamaican school children

Trichuris trichiura is extremely prevalent worldwide and there is concern that this geohelminth may affect the cognitive function of children in developing countries. A random-controlled, double-blind, treatment trial was conducted in Jamaican children with light to moderate infections. This was part of a research programme involving several studies in Jamaica. Ninety-seven subjects, each with a minimum of 1200 T. trichiura eggs/g faeces, were randomly assigned to placebo (N = 48) or treatment (N = 49) groups. Each pair of infected children was matched with an uninfected classmate (N = 48). All children were given seven cognitive functions tests: French-learning; digit spans (forward and backwards), Corsi block span; fluency; picture search; and silly sentences. Albendazole was given to the treatment group and the other groups received a placebo. Three months later, these treatments were repeated, and the cognitive function battery was given again. On pre-test, the infected groups performed significantly poorer only in the silly-sentence test (analysis of variance F-value=8.17; two degrees of freedom; p<0.001). There was no significant improvement with treatment in any of the tests. Taking into account these findings and those of the other Jamaican studies, it is therefore probable that light to moderate Trichuris infections have little effect on cognitive functioning in school children who have adequate nutritional status.(AU)

Activity and behavioral development in stunted and nonstunted children and response to nutritional supplementation

It is frequently assumed that undernutrition in young children leads to poor development through reduced activity. Three groups of 26 1-year-old stunted children were studied: nutritional supplementation, supplementation with psychosocial stimulation, and controls. 26 nonstunted comparison children were also studied. Activity levels were measured by extensive observations in the homes, and development using 4 subscales of the Griffith's Mental Development Scales. Initially, stunted children were less active than nonstunted ones (p<.01), but after 6 months they caught up regardless of treatment. The mental ages of the stunted children were lower than those of the nonstunted children initially, and improved with either treatment. Initially activity levels made a significant contribution to the variance in the locomotor subscale only, but not 6 months later. Activity did not predict change in development over 6 or 12 months, nor did change in activity over 6 months predict change in development over 12 months (AU)

Cross-cultural cognition: developing tests for developing countries

The problems of adapting measures of cognitive performance to Third World conditions are described, and three novel adaptations are proposed, one based on speed of sentence comprehension, one on vocabulary acquisition, and a third on speed of visual search using pictorial material. These and other existing tests are applied to studying the cognitive performance of Jamaican children as part of an investigation into the effects on cognition of infection by the parasitic worm Trichuris trichiura. We demonstrate that the tests are usable under Third World field conditions, and give reliable results. The validity of our proposed test is indicated by their capacity to predict scholastic performance. Despite their brevity and avoidance of any demand on literacy, they yielded substantial correlations with the reading, spelling and arithmetic sales of the Wide Range Achievement Test.(AU)

The controversy of thin and thick porridges: does viscosity influence intake? - abstract

There is controversy concerning the best weaning foods for infants in developing countries with some promoting thick porridges while others claim viscosity reduction of thick porridges is necessary. We assessed the effects of viscosity and energy density on energy intake in fifteen children aged 7-15 months recovered from malnutrition. Three porridges were developed: thin-low energy (51 kcal/100gm viscosity 280-480 cP): thick-high energy (kcal/100gm viscosity 3000-4000 cP); and amylase-treated - high energy (97 kcal/100 gm viscosity 280-480 cP). Using a cross-over design, each porridge was fed ad lib four times daily for four days by specially trained feeders. The mean daily intake in grams of the thin porridge was significantly higher than that of the amylase-treated or thick porridges. However, the mean energy intake of the thin porridge was significantly lower than that of the amylase-treated or thick porridges. The mean daily energy intakes of the amylase-treated and thick porridges were similar and matched WHO/FAO recommended requirements. Meal duration was significantly longer for the thick porridge, which was fed by cup and spoon, than for the amylase-treated or the thin porridges. Feeding a thick porridge with an energy density of 100 kcal/100 gm four times daily therefore satisfied the recommended daily energy requirements for infants and young children. The only adventure of reducing the viscosity of the thick porridge was the shorter time spent feeding (AU)

Trichuris trichiura infection and working memory in Jamaican schoolchildren

Trichuris trichiura is extremely prevalent worldwide, and there is concern that this geohelminth may affect the school achievement of children in developing countries. However, the effects on cognition are unclear. Only one treatment trial has been reported in children with moderate to heavy infections, and treatment benefited several cognitive functions. We attempted to replicate that study in children with mild to moderate infections. Grade 5 children (9-12 yr) with minimum 1200EPG (eggs per gram of stool) were randomly assigned to placebo (n=48) or treatment (n=49) groups. Pairs of subjects were matched with uninfected classmates (n=48). On baseline, the test battery was administered and albendazole given to the treatment group while the other groups received a placebo. The test battery comprised 7 tests French Learning Task, Digit Span Forwards and Backwards, Corsi Block Span, Fluency, Picture Search, Silly Sentences. Three months later, the treatment was repeated and the children tested one to two weeks after this. On baseline the infected groups performed significantly more poorly than the non-infected only in the Silly Sentences test (ANOVA, p<0.001). Children with infections above 2000 EPG performed significantly worse than children with less intense infections in Picture Search (p<0.05) and in Silly Sentences (p<0.05). Treatment effects were examined in the infected groups only using multiple regression analyses of the final test scores. There were no significant treatment benefits. We were therefore unable to replicate the previous study. This may be explained by the lower intensity of infections in the children in this study. It is possible that the effect on working memory depends on a threshold level of infection.