University of the West Indies

Non-alcoholic fatty liver disease (NAFLD) is a potentially serious liver disease that affects approximately one-quarter of the global adult population, causing a substantial burden of ill health with wide-ranging social and economic implications. It is a multisystem disease and is considered the hepatic component of metabolic syndrome. Unlike other highly prevalent conditions, NAFLD has received little attention from the global public health community. Health system and public health responses to NAFLD have been weak and fragmented, and, despite its pervasiveness, NAFLD is largely unknown outside hepatology and gastroenterology. There is only a nascent global public health movement addressing NAFLD, and the disease is absent from nearly all national and international strategies and policies for non-communicable diseases, including obesity. In this global Delphi study, a multidisciplinary group of experts developed consensus statements and recommendations, which a larger group of collaborators reviewed over three rounds until consensus was achieved. The resulting consensus statements and recommendations address a broad range of topics - from epidemiology, awareness, care and treatment to public health policies and leadership - that have general relevance for policy-makers, health-care practitioners, civil society groups, research institutions and affected populations. These recommendations should provide a strong foundation for a comprehensive public health response to NAFLD.

Prostate cancer (CaP) is the leading cancer among men of African descent in the USA, Caribbean, and Sub-Saharan Africa (SSA). The estimated number of CaP deaths in SSA during 2008 was more than five times that among African Americans and is expected to double in Africa by 2030. We summarize publicly available CaP data and collected data from the men of African descent and Carcinoma of the Prostate (MADCaP) Consortium and the African Caribbean Cancer Consortium (AC3) to evaluate CaP incidence and mortality in men of African descent worldwide. CaP incidence and mortality are highest in men of African descent in the USA and the Caribbean. Tumor stage and grade were highest in SSA. We report a higher proportion of T1 stage prostate tumors in countries with greater percent gross domestic product spent on health care and physicians per 100,000 persons. We also observed that regions with a higher proportion of advanced tumors reported lower mortality rates. This finding suggests that CaP is underdiagnosed and/or underreported in SSA men. Nonetheless, CaP incidence and mortality represent a significant public health problem in men of African descent around the world.

Abstract This paper reviews the approach to forecasting based on the construction of ARIMA time series models. Recent developments in this area are surveyed, and the approach is related to other forecasting methodologies.

The Fair and Equitable Treatment Standard in International Investment Law and Practice Get access Stephen Vasciannie, BSc., MA, LL M, D Phil. Stephen Vasciannie, BSc., MA, LL M, D Phil. Senior Lecturer 1UWI; Oxon.; Cantab.; Oxon.; University of the West Indies , Mona Search for other works by this author on: Oxford Academic Google Scholar British Yearbook of International Law, Volume 70, Issue 1, 1999, Pages 99–164, https://doi.org/10.1093/bybil/70.1.99 Published: 01 November 2000

The blood in sickle cell anemia has a very low oxygen affinity and, although 2,3-diphosphoglycerate (2,3-DPG) is increased, there is doubt as to whether this is the only factor responsible. In this study of 15 patients with sickle cell anemia (Hb SS) no correlation was found between oxygen affinity (P(50) at pH 7.13) and 2,3-DPG in fresh venous blood. Whole populations of Hb SS erythrocytes were therefore separated, by an ultracentrifuge technique, into fractions of varying density. The packed red cell column was divided into three fractions; a bottom fraction rich in deformed cells or irreversibly sickled cells (ISC), with a very high mean corpuscular hemoglobin concentration (MCHC); a middle fraction containing cells with the highest content of fetal hemoglobin; and a top fraction containing reticulocytes and discoid cells but free of deformed cells. Oxygen affinity was shifted to the right in all layers (mean P(50) (pH 7.13)+/-1SD: top 46.3+/-2.9 mm Hg: middle 49.8+/-4.9 mm Hg; bottom 61.0+/-5.8 mm Hg) compared with normal blood (top 32.1+/-0.7 mm Hg: bottom 30.1+/-0.5 mm Hg). 2.3-DPG was increased in the top fraction, but was low or normal in the bottom fraction (top 21.8+/-3.4 mumol/g Hb: middle 17.7+/-2.2 mumol/g Hb; bottom 13.8+/-3.1 mumol/g Hb; normal whole blood 14.3+/-1.2 mumol/g Hb). The level of 2,3-DPG in top fractions could not account for the degree of right shift of P(50), and in the middle and bottom fractions the even greater right shifts were associated with lower levels of 2,3-DPG. Top fraction cells depleted of 2,3-DPG had a higher, but still abnormally low, oxygen affinity. A strong relationship was found between oxygen affinity and MCHC. The fractions with the greatest right shift in P(50) had the highest MCHC (top 32.4+/-2.0; middle 36.2+/-3.1; bottom 44.6+/-3.2 g/100 ml, respectively) and the plot of P(50) vs. MCHC showed a positive correlation (r = 0.90, P < 0.001). The red cell population in sickle cell anemia is not homogeneous but contains cells of widely varying Hb F content, 2,3-DPG, and hemoglobin concentration. Paradoxically, the cells with the lowest O(2) affinity have the lowest 2,3-DPG, but they also have the highest concentration of Hb S. The dense, deformed cell called the ISC is but the end stage in a process of membrane loss and consequent increase in hemoglobin concentration. The P(50) of Hb SS blood is, to a large extent, determined by the presence of these cells (r = 0.85, P < 0.001). Increased concentration of Hb S in the cell favors deoxygenation and crystallization even at relatively high P(o2). Lowered affinity for oxygen appears to be closely associated with Hb S concentration and not with 2,3-DPG content.

Weight stigma, defined as pervasive misconceptions and stereotypes associated with higher body weight, is both a social determinant of health and a human rights issue. It is imperative to consider how weight stigma may be impeding health promotion efforts on a global scale. The World Obesity Federation (WOF) convened a global working group of practitioners, researchers, policymakers, youth advocates, and individuals with lived experience of obesity to consider the ways that global obesity narratives may contribute to weight stigma. Specifically, the working group focused on how overall obesity narratives, food and physical activity narratives, and scientific and public-facing language may contribute to weight stigma. The impact of weight stigma across the lifespan was also considered. Taking a global perspective, nine recommendations resulted from this work for global health research and health promotion efforts that can help to reduce harmful obesity narratives, both inside and outside health contexts.

Peoples of the Caribbean in general, and Jamaicans in particular, have always been a migratory people. However, over the last 30 years, the emigration rates have increased substantially, with alarming rates in particular, of highly skilled individuals. There are four major factors which emerged in this study and influence this phenomenon: 1. Crime, violence, lawlessness and general societal indiscipline, 2. Occupation and skill mismatch, 3. Lack of economic opportunities, and 4. Lack of social opportunities. This study suggests that both the direct and indirect effects of crime in general and violent crimes in particular, combined with suitable employment for the migrant’s skill set, have forced some members of Jamaica’s professional class to gravitate towards First World countries, taking their skill set which their home country has financed. This places their host country in an advantageous position as these skills contribute to that country’s development and growth. In return, such countries offer migrants secure economic (e.g., skill-career match and ability to afford their desired lifestyle) and social opportunities (e.g., desired health care) currently unavailable in the country of origin.

OBJECTIVES: To assess the feasibility of integrating early psychosocial stimulation into primary care for undernourished children and to determine the effect on children's development and mothers' knowledge and practices of childrearing. DESIGN: Cluster randomised controlled trial. SETTING: 18 clinics in three Jamaican parishes. PARTICIPANTS: 139 undernourished children aged 9 to 30 months and their mothers enrolled in intervention or control clinics. INTERVENTIONS: Weekly home visits by community health aides for one year in addition to usual duties. Parenting issues were discussed with the mothers and play activities were demonstrated with the children using homemade materials. MAIN OUTCOME MEASURES: Children's scores on the Griffiths mental development scales and mothers' knowledge and practices of childrearing measured by questionnaires. RESULTS: Children from the intervention group showed significant improvements in development: developmental quotient, 7.8 points (95% confidence interval 4.5 to 11.1); hearing and speech, 10.7 (5.9 to 15.4 points); hand and eye coordination, 6.8 (3.4 to 10.1 points); and performance subscale, 11.0 (5.6 to 16.4 points). No improvements were shown on the locomotor subscale. The mothers from the intervention group showed improved knowledge and practices of childrearing. Change in children's body mass index and height independently affected change in development. CONCLUSION: Integrating parenting skills and early psychosocial stimulation for undernourished children into primary care was feasible and effective in improving the children's development and mothers' knowledge and practices of childrearing.

BACKGROUND: School-based interventions involving teacher and/or child training have been shown to benefit teacher practices and to prevent conduct problems and improve children's social and emotional competence in developed countries; however, we are aware of no reports from a developing country. We conducted a pilot study of the Incredible Years Teacher Training programme and a curriculum unit on social and emotional skills based on concepts and activities drawn from the Incredible Years Dina Dinosaur Classroom Curriculum to determine if this approach is appropriate for use with Jamaican pre-school teachers and children. METHODS: Five pre-schools in Kingston, Jamaica were randomly assigned to an intervention (3 pre-schools with 15 classrooms) or control (2 pre-schools with 12 classrooms) condition. Intervention involved seven whole-day teacher workshops using the Incredible Years Teacher Training programme supplemented by 14 child lessons in each class. The project was evaluated through structured observations of four categories of teacher behaviour and four observer ratings: two rating scales of child behaviour and two rating scales of classroom atmosphere. RESULTS: Significant intervention benefits were found to teachers' behaviour with increased positive behaviour [b = 7.9; 95% confidence interval (CI): 3.5, 12.3], reduced negative behaviour (b =-3.5; 95% CI: -6.6, -0.2) and increases in the extent to which teachers promoted children's social and emotional skills (b = 46.4; 95% CI: 11.0, 81.7). The number of teacher commands was not significantly reduced (b =-2.71; 95% CI: -6.01, 0.59). Significant intervention benefits were found to ratings of child behaviour with an increase in children's appropriate behaviour (b = 5.7, 95% CI: 1.0, 10.8) and in children's interest and enthusiasm (b = 7.2, 95% CI: 0.9, 13.5). Intervention also benefited classroom atmosphere with increases in opportunities provided for children to share and help each other (b = 1.3, 95% CI: 0.5, 2.1) and in teacher warmth (b = 1.3, 95% CI: 0.9, 1.8). CONCLUSION: This is a promising approach for improving the emotional climate of Jamaican pre-school classrooms and for improving child behaviour and participation.

Non-carious cervical lesions (NCCLs) are often encountered in clinical practice and their aetiology attributed to toothbrush abrasion, erosion and tooth flexure. This paper aims to determine the prevalence and severity of NCCLs in a sample of patients attending a university clinic in Trinidad and to investigate the relationship with medical and dental histories, oral hygiene practices, dietary habits and occlusion. Data were collected via a questionnaire and clinical examination. Odds ratios were used to determine the association of the presence of lesions and the factors examined. One hundred and fifty-six patients with a mean age of 40.6 years were examined of whom 62.2% had one or more NCCLs. Forty five per cent of the lesions were sensitive to compressed air. Younger age groups had a significantly lower correlation with the presence of NCCLs than older age groups. Other significant factors included patients who reported heartburn, gastric reflux, headaches, bruxism, sensitive teeth and swimming or had a history of broken restorations in the last year. There was also significant correlation of NCCLs in patients who brushed more than once a day or used a medium or hard toothbrush. Patients with vegetarian diets and those who reported consuming citrus fruits, soft drinks, alcohol, yoghurt and vitamin C drinks were associated with the presence of lesions. Significant associations were also found in patients with group function, faceting, clicking joints or those who wore occlusal splints.

Monocyte activation during HIV-1 infection is associated with increased plasma levels of inflammatory markers and increased risk for premature development of age-related diseases. Because activated monocytes primarily use glucose to support cellular metabolism, we hypothesized that chronic monocyte activation during HIV-1 infection induces a hypermetabolic response with increased glucose uptake. To test this hypothesis, we evaluated glucose transporter 1 (Glut1) expression and glucose uptake by monocyte subpopulations in HIV-seropositive (HIV(+)) treatment-naive individuals (n = 17), HIV(+) individuals on combination antiretroviral therapy with viral loads below detection (n = 11), and HIV-seronegative (HIV(-)) individuals (n = 16). Surface expression of Glut1 and cellular uptake of the fluorescent glucose analog 2-(N-(7-nitrobenz-2-oxa-1, 3-diazol-4-yl) amino)-2 deoxyglucose were analyzed by flow cytometry on monocyte subpopulations. Irrespective of treatment status, monocytes from HIV(+) persons had significantly increased surface expression of Glut1 compared with those from HIV(-) controls. Nonclassical (CD14(+)CD16(++)) and intermediate (CD14(++)CD16(+)) monocyte subpopulations showed higher Glut1 expression than did classical (CD14(++)CD16(-)) monocytes. Intermediate monocytes from treatment-naive HIV(+) individuals also showed increased uptake of 2-(N-(7-nitrobenz-2-oxa-1, 3-diazol-4-yl) amino)-2 deoxyglucose compared with those from HIV(-) controls. Our results show that HIV infection is associated with increased glucose metabolism in monocytes and that Glut1 expression by proinflammatory monocytes is a potential marker of inflammation in HIV-infected subjects. However, the possibility exists whereby other Gluts such as Glut3 and Glut4 may also support the influx of glucose into activated and inflammatory monocyte populations.

Purpose This conceptual paper examines the Caribbean tourism sector, its growth, performance, importance and its vulnerability to climate change. The purpose of this paper is to serve as an introduction to the on-going conversation around climate change and the socioeconomic impacts likely to be experienced in tourism-dependent Caribbean territories. Design/methodology/approach The Caribbean is used as the context of this work. A broad perspective was adopted to paint a picture of the wider implications. The region is represented by a multiplicity of country profiles, both in physical and socio-economic characteristics; this warrants a broad assessment of the issues examined here. Findings This work shows that the Caribbean tourism sectors face significant future threats related to both competitiveness and climate change impacts. For a region so heavily dependent on coastal- and marine-related tourism attractions, adaptation and resilience are critical issues facing Caribbean tourism. An effective approach to building resilience to climate change requires extensive regional cooperation. Research limitations/implications While there is much published on the matter of climate change implications in the general global context, there is considerably less published work specifically examining the likely effects climate change will have on the special socio-economic features of the Caribbean and on the tourism industry in particular. Practical implications The lack of extensive and ongoing research dedicated to climate change implications for Caribbean tourism, while limiting the scope of this work, does highlight a gap and open the door for future work that examines, in greater detail both collectively and on an individual country basis, the climate change implications for tourism industries throughout the region. Social implications Climate change vulnerabilities in the region present a significant threat to economic development, employment and food security among others. Coastal flooding, infrastructural damage and the potential displacement of coastal communities present significant impediments to the quality of life of Caribbean nationals. The social implications necessitate further in-depth study to inform the development of adaptation strategies that may secure the tourism industry and the livelihoods and lifestyles of the people. Originality/value This work is original in its evaluation of the viewpoints of climate change vulnerability specific to the Caribbean tourism sector.

OBJECTIVE: To examine the distribution and impact of diabetes, glycaemic status, and related factors, in a predominantly black adult Caribbean population. METHODS: The study included 4709 people, or 84% of a simple random sample of Barbadian-born citizens aged 40-84 years, examined between 1988 and 1992 and re-assessed 4 years later. Diabetes was evaluated according to physician-diagnosis and glycosylated haemoglobin (GHb). Associations were assessed by logistic regression analyses, cumulative mortality by product-limit methods and death-rate ratios by Cox proportional hazards regression. RESULTS: Among the 4314 black participants, the prevalence of known diabetes, predominantly type 2, was 9.1% at 40-49 years of age and increased to 24.0% at 70-79 years. The overall prevalence was 17.5%, while it was 12.5% in mixed (black/ white; n = 184) and 6.0% in white/other participants (n = 133), only 0.3% had younger-onset. Additionally, 2% had GHb >10% (>2 SD over the mean) without diabetes history. Sulphonylureas were the most frequent treatment, while insulin use was infrequent. In black participants, diabetes was positively associated with age (OR = 1.03 per year; 95% CI : 1.02-1.04), diabetes family history (OR = 2.85, 95% CI : 2.39-3.40), hypertension (OR = 1.71, 95% CI : 1.42-2.05), obesity (BMI > or = 25 kg/m(2); OR = 1.74, 95% CI : 1.44-2.10), and high waist-hip ratio (WHR > or = 0.92; OR = 1.29, 95% CI : 1.09-1.53). Ocular co-morbidities were increased among people with diabetes, as was 4-year-mortality (death rate ratio = 1.42, 95% CI : 1.10-1.83). There was a 9% increase in mortality for each 1% increase in GHb (death rate ratio = 1.09, 95% CI : 1.04-1.15). CONCLUSIONS: A markedly high prevalence of diabetes existed in the adult black population, affecting almost one in five people and increasing morbidity and mortality. Prevention strategies are urgently needed to reduce the adverse implications of diabetes in this and similar populations.

Five species of lucinid clams from Bermuda (Codakia costata, Ctena orbiculata, Parvilucina multilineata, Lucina radians, Anodontiaphilippiana) had ribulose-1.5-bisphosphate carboxylase activity in the gills. Presence of this enzyme of the Calvin-Benson cycle along with dark coloration of gills and morphologically simplified digestive tract strongly suggests presence of chemoautotrophic bacteria living symbiotically with the clams. Natural history is described for these 5 lucinids and several others not studied biochemically All inhabit reduced sediments rich in organic matter, where hydrogen sulfide is detectable. Results, along wlth previously published studies, indlcate that most clams of the family Lucinidae live symbiotically with chemoautotrophic bacteria in their gills and inhabit sulfide-rich environments.

There is limited information on autism spectrum disorders from lower- and middle-income countries (LMIC). This paper reviews the status of early identification and early intervention for autism spectrum disorders in response to the article by Camarata (2014) . The PubMed database was searched to identify relevant epidemiological studies from LMIC. Seven studies from five countries were identified: Colombia, India, Jamaica, Jordan, and Mexico. The mean age of parental concern, at 21-24 months, and mean age of diagnosis, at 45-57 months, were similar in LMIC, but later than in high-income countries. Both country groups reported language disorder to be the symptom of initial concern. Similarities in biological aspects of the disorders were noted across LMIC and high-income countries. Comparable ages of identification and diagnosis across vastly different LMIC suggest limited resources to be the underlying contributory factor. Recommendations for improving early identification and intervention made by researchers in the LMIC are reported.

Abstract While it is generally recognized that the projected changes in the global climate will have serious negative consequences for the Caribbean as a whole, it is becoming more and more evident that the impacts of climate change will not be uniformly felt across the region. The primary aim of this paper is to provide a review of the Caribbean climate change literature. The paper begins with a brief discussion on the shifting nature of Caribbean vulnerability within the context of the region's longstanding and continued exposure to forces of global economic and environmental change. Particular attention is paid to both the practical and discursive dimensions of vulnerability, and the specific ways the term has been understood and framed in relation to other crosscutting themes such as adaptation and resilience in the broader academic literature. In addition to providing an overview of the regional climate change science literature, the paper offers a critical review of the existing climate change impacts literature for the Caribbean. By drawing on, and taking stock of this growing body of impact studies, the paper seeks to shed light on the differential and multi‐scalar drivers of social and economic vulnerabilities to climate variability and change in the Caribbean as well as highlight some of the existing knowledge gaps that need to be addressed. The paper ends by providing some brief reflections on the emerging themes arising from the discussion and highlights a few key areas for future academic research for the Caribbean in light of existing knowledge gaps observed in the regional climate change impact literature.

To characterize the extent and impact of ancestry-related biases in precision genomic medicine, we use 642 whole-genome sequences from the Consortium on Asthma among African-ancestry Populations in the Americas (CAAPA) project to evaluate typical filters and databases. We find significant correlations between estimated African ancestry proportions and the number of variants per individual in all variant classification sets but one. The source of these correlations is highlighted in more detail by looking at the interaction between filtering criteria and the ClinVar and Human Gene Mutation databases. ClinVar's correlation, representing African ancestry-related bias, has changed over time amidst monthly updates, with the most extreme switch happening between March and April of 2014 (r=0.733 to r=-0.683). We identify 68 SNPs as the major drivers of this change in correlation. As long as ancestry-related bias when using these clinical databases is minimally recognized, the genetics community will face challenges with implementation, interpretation and cost-effectiveness when treating minority populations.

BACKGROUND: The strategies that parents use to guide and discipline their children may influence their emotional health. Relatively little research has been conducted examining the association of parenting practices to depressive symptoms among Caribbean adolescents. This project examines the association of parenting styles to levels of depressive symptoms among adolescents in Jamaica, the Bahamas, St. Kitts and Nevis, and St. Vincent. METHODS: Adolescents attending grade ten of academic year 2006/2007 in Jamaica, the Bahamas, St. Vincent, and St. Kitts and Nevis were administered the Parenting Practices Scale along with the BDI-II. Authoritative, Authoritarian, Permissive and Neglectful parenting styles were created using a median split procedure of the monitoring and nurturance subscales of the Parenting Practices Scale. Multiple regression analyses were used to examine the relationships of parenting styles to depressive symptoms. RESULTS: A wide cross-section of tenth grade students in each nation was sampled (n = 1955; 278 from Jamaica, 217 from the Bahamas, 737 St. Kitts and Nevis, 716 from St. Vincent; 52.1% females, 45.6% males and 2.3% no gender reported; age 12 to 19 years, mean = 15.3 yrs, sd = .95 yrs). Nearly half (52.1%) of all adolescents reported mild to severe symptoms of depression with 29.1% reporting moderate to severe symptoms of depression. In general, authoritative and permissive parenting styles were both associated with lower levels of depressive symptoms in adolescents. However, the relationship of parenting styles to depression scores was not consistent across countries (p < .05). In contrast to previous research on Caribbean parenting, caregivers in this study used a mixture of different parenting styles with the two most popular styles being authoritative and neglectful parenting. CONCLUSIONS: There appears to be an association between parenting styles and depressive symptoms that is differentially manifested across the islands of Jamaica, the Bahamas, St. Kitts and Nevis and St. Vincent.

Jamaican Creole is one of the major Atlantic English-lexifier creoles spoken in the Caribbean. In Jamaica, this creole is popularly labelled as ‘Patwa’ (Devonish &amp; Harry 2004: 441). There is a widely-held view in Jamaica that a post-creole continuum exists. The continuum is between Jamaican English and Jamaican Creole (Meade 2001: 19). Many scholars holding this view find it necessary to distinguish among acrolectal, mesolectal and basilectal varieties (Irvine 1994, Beckford-Wassink 1999, Patrick 1999, Meade 2001, among others). Major phonological differences are found between the two extremes. However, a discussion of the phonological differences in the continuum and problems with the theoretical notion of a ‘post-creole continuum’ is beyond the scope of this paper. The aim of this paper is to provide an adequate description of some salient aspects of the synchronic phonetics and phonology of Jamaican Creole based on the speech forms of two native Jamaican Creole speakers, Stacy-Ann Watt, a post-graduate female student at the University of West Indies, Mona, and Racquel Sims, 22 year old female from the parish of St Catherine. Both come from the Eastern parishes of the island.

Importance: Rates of breast and ovarian cancer are high in the Caribbean; however, to date, few published data quantify the prevalence of inherited cancer in the Caribbean population. Objective: To determine whether deleterious variants in genes that characterize the hereditary breast and ovarian cancer syndrome are associated with the development of breast and ovarian cancer in the English- and Creole-speaking Caribbean populations. Design, Setting, and Participants: This multisite genetic association study used data from germline genetic test results between June 2010 and June 2018 in the Bahamas, Cayman Islands, Barbados, Dominica, Jamaica, Haiti, and Trinidad and Tobago. Next-generation sequencing on a panel of 30 genes and multiplex ligation-dependent probe amplification (BRCA1 and BRCA2) were performed. Medical records were reviewed at time of study enrollment. Women and men diagnosed with breast and ovarian cancer with at least 1 grandparent born in the participating study sites were included; 1018 individuals were eligible and consented to participate in this study. Data were analyzed from November 4, 2019, to May 6, 2020. Exposures: Breast and/or ovarian cancer diagnosis. Main Outcomes and Measures: Rate of inherited breast and ovarian cancer syndrome and spectrum and types of variants. Results: Of 1018 participants, 999 (98.1%) had breast cancer (mean [SD] age, 46.6 [10.8] years) and 21 (2.1%) had ovarian cancer (mean [SD] age, 47.6 [13.5] years). Three individuals declined to have their results reported. A total of 144 of 1015 (14.2%) had a pathogenic or likely pathogenic (P/LP) variant in a hereditary breast and ovarian cancer syndrome gene. A total of 64% of variant carriers had P/LP variant in BRCA1, 23% in BRCA2, 9% in PALB2 and 4% in RAD51C, CHEK2, ATM, STK11 and NBN. The mean (SD) age of variant carriers was 40.7 (9.2) compared with 47.5 (10.7) years in noncarriers. Individuals in the Bahamas had the highest proportion of hereditary breast and ovarian cancer (23%), followed by Barbados (17.9%), Trinidad (12%), Dominica (8.8%), Haiti (6.7%), Cayman Islands (6.3%), and Jamaica (4.9%). In Caribbean-born women and men with breast cancer, having a first- or second-degree family member with breast cancer was associated with having any BRCA1 or BRCA2 germline variant (odds ratio, 1.58; 95% CI, 1.24-2.01; P < .001). A BRCA1 vs BRCA2 variant was more strongly associated with triple negative breast cancer (odds ratio, 6.33; 95% CI, 2.05-19.54; P = .001). Conclusions and Relevance: In this study, among Caribbean-born individuals with breast and ovarian cancer, 1 in 7 had hereditary breast and ovarian cancer. The proportion of hereditary breast and ovarian cancer varied by island and ranged from 23% in the Bahamas to 4.9% in Jamaica. Each island had a distinctive set of variants.