Cardiovascular Unit of Guatemala

Antigua Guatemala, Guatemala

Cardiovascular Unit of Guatemala

Antigua Guatemala, Guatemala
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Barnoya J.,Washington University in St. Louis | Barnoya J.,Cardiovascular Unit of Guatemala | Jin L.,Washington University in St. Louis | Hudmon K.S.,Purdue University | Schootman M.,Washington University in St. Louis
Journal of the American Pharmacists Association | Year: 2015

Objectives: To compare availability of nicotine replacement therapy (NRT), tobacco products, and electronic cigarettes (e-cigarettes) in pharmacies in St. Louis, MO. Design: Cross-sectional study, on-site store audits of 322 pharmacies. Setting: St. Louis, MO. Participants: 242 eligible community pharmacies located in the study area. Intervention: Pharmacies were visited by trained research assistants who conducted a 5- to 10-minute store audit using a paper-based data collection tool. Main outcome measures: Availability, accessibility, and pricing of NRT as a function of neighborhood poverty rate and proportion of black residents as well as availability of tobacco products and e-cigarettes. Results: NRT availability decreased as neighborhood poverty rate increased (P = 0.02). Availability without pharmacy personnel assistance also decreased with increasing poverty rate (r = -0.19; 95% CI = -0.06, -0.31) and higher percentage of black residents (r = -0.18; 95% CI = -0.06, -0.31). Prices were lower in neighborhoods with higher poverty rates (P = 0.02) and a higher percentage of black residents (P = 0.03). E-cigarettes were available in 43% of pharmacies, and their availability and price did not differ by poverty rate or percentage of black residents. Conclusion: Low access to NRT might perpetuate smoking disparities in disadvantaged and racially diverse neighborhoods. Study data support policies to ensure equal NRT access to reduce disparities.

Barnoya J.,Cardiovascular Unit of Guatemala | Barnoya J.,Washington University in St. Louis | Mejia R.,University of Buenos Aires | Szeinman D.,University of Buenos Aires | Kummerfeldt C.E.,Aldo Castan eda Foundation
Tobacco Control | Year: 2010

Objectives To determine tobacco point of sale advertising prevalence in Guatemala City, Guatemala and Buenos Aires, Argentina. Methods Convenience stores (120 per city) were chosen from randomly selected blocks in low, middle and high socioeconomic neighbourhoods. To assess tobacco point of sale advertising we used a checklist developed in Canada that was translated into Spanish and validated in both countries studied. Analysis was conducted by neighbourhood and store type. Results All stores sold cigarettes and most had tobacco products in close proximity to confectionery. In Guatemala, 60% of stores had cigarette ads. High and middle socioeconomic status neighbourhood stores had more indoor cigarette ads, but these differences were determined by store type: gas stations and supermarkets were more prevalent in high socioeconomic status neighbourhoods and had more indoor cigarette ads. In poorer areas, however, more ads could be seen from outside the stores, more stores were located within 100 metres of schools and fewer stores had 'No smoking' or 'No sales to minors' signs. In Argentina, 80% of stores had cigarette ads and few differences were observed by neighbourhood socioeconomic status. Compared to Guatemala, 'No sales to minors' signs were more prevalent in Argentina.&Conclusions Tobacco point of sale advertising is highly prevalent in these two cities of Guatemala and Argentina. An advertising ban should also include this type of advertising.

de Ojeda A.,Cardiovascular Unit of Guatemala | Barnoya J.,Cardiovascular Unit of Guatemala | Barnoya J.,Washington University in St. Louis | Thrasher J.F.,University of South Carolina | Thrasher J.F.,Instituto Nacional Of Salud Publica
Nicotine and Tobacco Research | Year: 2013

Introduction: Single-cigarette sales have been associated with increased cigarette accessibility to less educated, lower-income populations, and minors; lower immediate cost, and increased smoking cues. Since 1997, Guatemalan Law bans the sale of single cigarettes and packs with fewer than 20 cigarettes. In 2005, Guatemala ratified the World Health Organization Framework Convention on Tobacco Control (WHO FCTC); it is therefore obliged to " prohibit sale of cigarettes individually or in small packets. " Methods: Blocks were numbered and randomly selected in Guatemala City and 3 neighboring towns. All stores in each block were surveyed. Single-cigarette and fewer than 20-cigarette pack sales were assessed by observation and purchase attempts. Cigarette brands and manufacturers (Philip Morris, PM or British American Tobacco, BAT) were also recorded. Percentages and means were used to describe data. Analyses were done using STATA 11.0. Results: Of 398 stores and street vendors surveyed, 75.6% (301) sold cigarettes. Of these, 91% (275) sold single cigarettes and none sold fewer than 20-cigarette packs. Only informal economic sectors sold singles. There was no difference on sales between Guatemala City and neighboring towns and by store type. Buying 20 single cigarettes was US$ 0.83 more expensive than buying a 20-cigarette pack. The most prevalent brands were Rubios (PM), Marlboro (PM), Payasos (BAT), and After Hours (BAT). Conclusions: Single-cigarettes sales are highly prevalent among informal economic sectors in Guatemala City and its neighboring towns. Our data should prove useful to advocate for FCTC Article 16 enforcement in Guatemala. © The Author 2012. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved.

Letona P.,Cardiovascular Unit of Guatemala | Letona P.,Incap Inc | Chacon V.,Cardiovascular Unit of Guatemala | Chacon V.,Incap Inc | And 3 more authors.
BMC Public Health | Year: 2014

Background: Food marketing is pervasive in high- and low/middle-income countries and is recognized as a significant risk factor for childhood obesity. Although food packaging is one of the most important marketing tools to persuade consumers at the point-of-sale, scant research has examined how it influences children's perceptions. This study was conducted in Guatemala and aimed to understand which snack foods are the most frequently purchased by children and how aspects of food packaging influence their product perceptions. Methods: Six activity-based focus groups were conducted in two elementary public schools with thirty-seven children (Grades 1 through 6, age range 7-12 years old). During each focus group, children participated in three activities: 1) list their most frequently purchased food products; 2) select the picture of their favorite product, the packaging they liked best, and the product they thought was the healthiest from eight choices; and 3) draw the package of a new snack. Results: Children reported purchasing salty snacks most frequently. Most children chose their favorite product based on taste perceptions, which can be influenced by food packaging. Visual elements influenced children's selection of favorite packaging (i.e., characters, colors) and healthiest product (i.e., images), and persuaded some children to incorrectly think certain foods contained healthy ingredients. When children generated their own drawings of a new product, the most frequently included packaging elements in the drawings were product name, price, product image and characters, suggesting those aspects of the food packaging were most significant to them. Conclusions: Policies regulating package content and design are required to discourage consumption of unhealthy snacks. This might be another public health strategy that can aid to halt the obesity epidemic. © 2014 Schäfer et al.

Barnoya J.,Washington University in St. Louis | Barnoya J.,Cardiovascular Unit of Guatemala | Navas-acien A.,Institute for Global Tobacco Control
Nicotine and Tobacco Research | Year: 2013

Introduction: Article 8 of the Framework Convention on Tobacco Control mandates all signatory countries to "protect citizens from exposure to tobacco smoke in workplaces, public transport and indoor public places "Even though there has been great progress in the implementation of Article 8, still most of the world population remains exposed to secondhand smoke (SHS). In this article, we sought to summarize the research that supports Article 8, where do we stand, and current research gaps and future directions. Discussion: Secondhand smoke is an established cause of heart disease and several types of cancer. Additional research is needed to reach final conclusions for diseases where evidence is only suggestive of causality. The only solution to SHS exposure in public places is banning smoking indoors. Research on the gaming industry and nightclubs, particularly in developing countries, needs to be disseminated to support their inclusion in smoke-free laws. Aside from indoor bans, additional research is needed for outdoor and multiunit housing bans and in support of measures that protect children and other vulnerable populations. The impact of smoke-free laws on other health outcomes, besides heart disease and respiratory outcomes, is another area where further research is needed. Thirdhand smoke assessment and health effects are also likely to be a topic of further research. As new tobacco products emerge, evaluating SHS exposure and effects will be vital. Conclusions: Furthering research in support of Article 8 can contribute to reach the final goal of protecting everyone from SHS exposure. © The Author 2012. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved.

Viteri E.,Cardiovascular Unit of Guatemala | Barnoya J.,Cardiovascular Unit of Guatemala | Barnoya J.,Washington University in St. Louis | Hudmon K.S.,Purdue University | Solorzano P.J.,Cardiovascular Unit of Guatemala
Tobacco Control | Year: 2012

Background: Guatemala, a party to the Framework Convention on Tobacco Control (FCTC), is obliged to promote the wider availability of smoking cessation treatment and to restrict tobacco advertising. Pharmacies are fundamental in providing smoking cessation medications but also might increase the availability of cigarettes. Purpose: To assess availability of cessation medications and cigarettes and their corresponding advertising in Guatemala pharmacies. Methods: In Guatemala City a representative sample was selected from a list of registered pharmacies classified by type (non-profit, chain, independent). In addition, all pharmacies in the neighbouring town of Antigua were included for comparison. Trained surveyors used a checklist to characterise each pharmacy with respect to availability and advertising of cessation medications and cigarettes. Results: A total of 505 pharmacies were evaluated. Cessation medications were available in 115 (22.8%), while cigarettes were available in 29 (5.7%) pharmacies. When available, medications were advertised in 1.7% (2) and cigarettes in 72.4% (21) of pharmacies. Chain pharmacies were significantly more likely to sell cessation medications and cigarettes, and to advertise cigarettes than were non-profit and independent pharmacies. Conclusion: Most pharmacies in Guatemala do not stock cessation medications or cigarettes. Cigarette advertising was more prevalent than advertising for cessation medications. FCTC provisions have not been implemented in Guatemala pharmacies.

Letona P.,Cardiovascular Unit of Guatemala | Letona P.,Incap Inc | Chacon V.,Cardiovascular Unit of Guatemala | Chacon V.,Incap Inc | And 3 more authors.
International Journal of Obesity | Year: 2014

BACKGROUND: Marketing of high-energy, low-nutrient foods is one of the contributing factors to the obesity-promoting environment. Licensed characters are typically used to market these foods to children because they increase brand recognition and sales, and data suggest that they affect the taste and snack preferences of children in high-income countries, but it has not yet been explored in low/middle income countries (LMICs). We sought to examine how licensed characters on food packaging influence children's taste and snack preferences in Guatemala, a LMIC. METHODS: One hundred twenty-one children (mean ± s.d. age, 7.4 ± 1.9 years) from four (two preschool and two elementary) public schools in Guatemala tasted three food types: potato chips, crackers and carrots. Each was presented in two identical packages, except that one had a licensed character and the other did not. Children tasted the foods (six total) in each package and answered whether they tasted the same or one tasted better. Snack preference was also evaluated. RESULTS: Children were significantly (P < 0.001) more likely to prefer the taste of the foods inside the package with the licensed character compared with the one with no character (mean ± s.d., 0.24 ± 0.54). Most (66%) chose the food in the package with the character for a snack. Younger children (P < 0.001) were more likely to prefer the taste of the food inside the package with the character. CONCLUSIONS: Licensed characters on food packaging influence Guatemalan children's taste and snack preferences. Given that these characters are typically used to promote high-energy, low-nutrient foods, their influence could contribute toward overconsumption of these foods and consequently increased risk of obesity in Guatemalan children. Therefore, public health advocates, in Guatemala and elsewhere, might explore restricting the use of licensed characters on food packaging as a public health strategy. © 2014 Macmillan Publishers Limited All rights reserved.

Corral J.E.,Cardiovascular Unit of Guatemala | Arnold L.D.,Washington University in St. Louis | Argueta E.E.,Cardiovascular Unit of Guatemala | Ganju A.,Washington University in St. Louis | And 2 more authors.
PLoS ONE | Year: 2012

Background: Guatemala is currently undergoing an epidemiologic transition. Preventive services are key to reducing the burden of non-communicable diseases, and smoking counseling and cessation are among the most cost-effective and wide-reaching strategies. Internal medicine physicians are fundamental to providing such services, and their knowledge is a cornerstone of non-communicable disease control. Methods: A national cross-sectional survey was conducted in 2011 to evaluate knowledge of clinical preventive services for non-communicable diseases. Interns, residents, and attending physicians of the internal medicine departments of all teaching hospitals in Guatemala completed a self-administered questionnaire. Participants' responses were contrasted with the Guatemalan Ministry of Health (MoH) prevention guidelines and the US Preventive Services Task Force (USPSTF) recommendations. Analysis compared knowledge of recommendations within and between hospitals. Results: In response to simulated patient scenarios, all services were recommended by more than half of physicians regardless of MoH or USPSTF recommendations. Prioritization was adequate according to the MoH guidelines but not including other potentially effective services (e.g. colorectal cancer and lipid disorder screenings). With the exception of colorectal and prostate cancer screening, less frequently recommended by interns, there was no difference in recommendation rates by level. Conclusion: Guatemalan internal medicine physicians' knowledge on preventive services recommendations for non-communicable diseases is limited, and prioritization did not reflect cost-effectiveness. Based on these data we recommend that preventive medicine training be strengthened and development of evidence-based guidelines for low-middle income countries be a priority. © 2012 Corral et al.

Barnoya J.,Cardiovascular Unit of Guatemala | Barnoya J.,University of Washington | Arvizu M.,Cardiovascular Unit of Guatemala | Jones M.R.,Johns Hopkins University | And 3 more authors.
Cancer Causes and Control | Year: 2011

Objective: In February 2009, Guatemala implemented a comprehensive smoking ban. We assessed air nicotine levels in bars and restaurants 6 months after the ban (post-ban) and compared them with levels found in 2006 (pre-ban). Methods: Exposure was estimated by passive sampling of vapor-phase nicotine using samplers (n = 50) placed for 7 working days in 10 bars and 11 restaurants in Guatemala City. Air nicotine was measured by gas chromatography, and the time-weighted average concentration in μg/m3 was estimated. Employees answered a survey about smoke-free workplaces (n = 32) and compared with pre-ban (n = 37) results. Results: Nicotine was detectable in all bars pre- and post-ban. In restaurants, it was detectable in all pre- and 73% post-ban. Median nicotine concentrations in bars significantly decreased from 4.58 μg/m3 (IQR, 1.71, 6.45) pre-ban to 0.28 μg/m3 (IQR 0.17, 0.66) post-ban (87% decrease). In restaurants, concentrations significantly decreased from 0.58 μg/m3 (IQR, 0.44, 0.71) to 0.04 μg/m3 (IQR 0.01, 0.11) (95% decrease). Employees' support for a smoke-free workplace increased in the post-ban survey (from 32 to 81%, p < 0.001). Conclusion: Six months after the implementation of a smoke-free law in Guatemala, nicotine levels were significantly decreased in bars and restaurants and workers' support for the law substantially increased. © 2010 Springer Science+Business Media B.V.

PubMed | Harvard University and Cardiovascular Unit of Guatemala
Type: Journal Article | Journal: International journal of obesity (2005) | Year: 2016

Food marketing has been implicated as an important driver of obesity. However, few studies have examined food marketing in low- and middle-income countries (LMICs). This study documents the prevalence of advertising on cereal boxes in Guatemala and examines associations between various marketing strategies and nutritional quality.One box from all available cereals was purchased from a supermarket located in an urban area in Guatemala City, Guatemala. A content analysis was performed to document child-oriented marketing practices, product claims and health-evoking images. The Nutrient Profile Model (NPM) was used to calculate an overall nutrition score for each cereal (the higher the score, the lower the nutritional quality).In all, 106 cereals were purchased, and half of the cereals featured child-oriented marketing (54, 50.9%). Cereals had a mean (s.d.) of 5.102.83 product claims per cereal, and most cereals (102, 96.2%) contained health-evoking images. Child-oriented cereals had, on average, higher NPM scores (13.00.55 versus 7.900.74, P<0.001) and sugar content (10.10.48 versus 6.190.50g/30g, P<0.001) compared with non-child oriented cereals. Cereals with health claims were not significantly healthier than those without claims.In Guatemala, cereals targeting children were generally of poor nutritional quality. Cereals displaying health claims were also not healthier than those without such claims. Our findings support the need for regulations restricting the use of child-oriented marketing and health claims for certain products.

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