A review of the health risk behaviours among adolescents in the Englishspeaking Caribbean: 2006 to 2020

• Adolescents comprise around 25% of the Caribbean population. Past studies report that the challenges faced by this target group include substance use, mental health, violence, high risk sexual behaviours such as HIV, juvenile delinquency, obesity, accidents and injuries, among others. • Through the understanding of the adolescent health risk behaviours, challenges, their health risks and protective factors, can we then comprehend and generate solutions to the challenges faced by youth in the Caribbean. This review will focus on the years 2006-2020, where we will determine what has or has not changed from the last review (from 1985-2005) and what solutions can be implemented.

Violence among adolescents in 13 Caribbean islands

OBJECTIVE: To determine the prevalence of violence and examine associations between violence and risk factors among 12 –15 year-old adolescents in the Caribbean. DESIGN AND METHODS: Cross national data from 13 Caribbean countries that participated in the Global School-Based Student Health Survey between 2007 and 2010 were analyzed. Adolescents who reported physical violence were compared with those who did not in relation to the reported risk factors. Odds ratios (ORs) and their 95% confidence intervals (CIs) for the risk factors were estimated. RESULTS: Being in a physical fight and being physically attacked during the 12 months preceding the survey was reported by 39.7% and 36.6% of the adolescents studied in the 13 countries, respectively. Moderate to strong associations were observed between exposure to physical violence and gender, loneliness, suicidal ideation, school truancy, substance use (alcohol, tobacco and drugs), lack of parental supervision and close friends (p ≤ 0.05 for all associations). The study found that Grenadians were 1.17 (95% CI: 1.02 – 1.34, p = 0.03) more likely to be physically attacked than those in Trinidad and Tobago. Physical violence varied significantly between countries and gender. CONCLUSION: Violence related behaviors in childhood and adolescence were common in the Caribbean and were associated with risky behaviors such as smoking, drug use and truancy. The potential for poor health outcomes and continued violence in adulthood was high and therefore violence in childhood and adolescence requires urgent attention. There is a critical need for interventions targeting high-risk adolescents at the school and community levels.

Disordered eating behaviours and attitudes in Jamaican adolescents: does the media play a role?

OBJECTIVE: The purpose of this study was to identify the prevalence of disordered eating behaviours and attitudes in Jamaican high school students and to determine the impact of media exposure. DESIGN AND METHODS: A cross-sectional survey of 524 Jamaican adolescents aged 11-19 years, identified using stratified random sampling, was conducted. Data was collected on sociodemographic factors, eating behaviours and attitudes (Eating Attitudes Test: EAT-26) self-esteem and media influence and anthropometric measurements were taken. Descriptive and inferential statistical analyses were performed at the 5% significance level. RESULTS: Most participants were normal weight (n=385, 76.7%) and males had lower mean body mass index (BMI) than females (females 20.7 ñ 4.2, males 19.4 ñ 3.2; p<0.01) with more females being overweight or obese (females n=46, 16.2%; males 21, 9.6%; p<0.05). Females had higher mean EAT-26 scores than males (females 15.0 ñ9.3, males 12.4 ñ 9.4; p<0.01). The mean media impact score (MIS) was higher in females (females 22.6, CI 21.7, 23.4; males 21.0, CI 20.1, 21.9; p=0.02) and in late adolescence (early adolescence 21.0, CI 20.1, 21.9, late adolescence 22.6, CI 21.7, 23.5; p=0.01). The MIS correlated positively with the EAT 26 score (p<0.001), the negative affect score (p<0.05) and BMI (p<0.05) and negatively with the self-esteem score (p<0.05). CONCLUSION: One in 5 Jamaican adolescents were deemed at risk of developing an eating disorder with an increasing prevalence of more severe disordered eating behaviours such as self-induced vomiting. There is a positive relationship between media influence and disordered eating behaviours and negative affect and a negative relationship with self-esteem.

Adolescent suicide in Trinidad and Tobago

Previous research in Trinidad and Tobago has been limited in examining suicidal behavior through psychological autopsy, secondary data and psychiatric populations. To date there has been no community survey with an emphasis on causation and prevention. A total of 1.845 respondents age 14-20 were selected in 24 schools across the country. Data were collected on socio demographic variables and suicidal behavior. Gender differences existed for both suicidal ideation and attempts (p<0.001). Respondents from reconstituted families had higher suicidal ideation compared to other family structures (p<0.001), while intact families had the lowest rate if suicide attempts (p<0.001). Attendance to religious institutions lowered only suicide ideation (p<0.05), while prayer with the family lowered both suicidal ideation (p<0.01) and suicidal attempts (p<0.001). Individual with alcohol abuse in the family had a higher suicidal ideation (p<0.001) and attempts (p<0.001). Significant social predictors of suicidal behaviour in Trinidad and Tobago are gender, attendance to religious institution, prayer with family, family structure and alcohol abuse in the family. It is essential to consider these predictors in planning public health policies.

Health risk behaviours among adolescents in the English-speaking Caribbean: a review.

ABSTRACT: BACKGROUND: The aim of this paper was to review and summarize research on prevalence of health risk behaviours, their outcomes as well as risk and protective factors among adolescents in the English-speaking Caribbean. METHODS: Searching of online databases and the World Wide Web as well as hand searching of the West Indian Medical Journal were conducted. Papers on research done on adolescents aged 10 - 19 years old and published during the period 1980 - 2005 were included. RESULTS: Ninety-five relevant papers were located. Five papers were published in the 1980s, 47 in the 1990s, and from 2000-2005, 43 papers. Health risk behaviours and outcomes were divided into seven themes. Prevalence data obtained for these, included lifetime prevalence of substance use: cigarettes-24 per cent and marijuana-17 per cent; high risk sexual behaviour: initiation of sexual activity

Violence among youth in Jamaica: a growing public health risk and challenge

Although the overwhelming majority of Jamaican children and adolescents are well adjusted, a substantial group exhibits high levels of maladjustment and deficient functioning (1). A perfunctory review of Jamaican newspapers and television talk-shows reveals that violence, particularly violence perpetrated by youths, is of major concern in every sector of Jamaican society. Although aggressive and violent behaviors are not new in Jamaica, the recent escalation of criminal violence among the adolescent population has become a major public policy issue and a serious public health problem. Violent activities have become more vicious and the perpetrators more ruthless than what the typical Jamaican over 40 years of age is used to (M. Jones, Social Scientist, personal communication, 8 March 2006). The purpose of this article is to review the relevant literature, describe the existing knowledge regarding aggression and violence among children and youth in the Jamaican context, and evaluate the plausibility of popular assumptions regarding the correlates of aggressive and violent outcomes in Jamaican children and youth. This article assesses the relationship between ecological processes and youth outcomes in Jamaica and is organized in the following manner: the first section addresses the incidence of violence and its impact on society; the next section focuses on the overall conceptual framework and its usefulness in assessing child outcomes in the Jamaican context. Pursuant to that, the individual attributes of violent outcomes are addressed, as well as two levels of the ecological environment: the proximal (near) environment and the distal (far) environment. In the proximal context, the issue of parental involvement is addressed as two separate issues: father absence and mother absence. This is because a substantial number of Jamaican children, historically, have not had "involved" fathers ... final section summarizes, discusses implications for policy decision making

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)

Behavioral problems and tobacco use among adolescents in Central America and the Dominican Republic

Objectives: The purpose of this study was to examine the association between behavioral problems and tobacco use among adolescent students in six countries of Central America and in the Dominican Republic. Methods: Data were drawn from a multinational collaborative study that included questionnaire surveys of between 451 and 1 170 school-attending adolescents in each of the seven countries studied. Assessments were based on an adapted, Spanish-language version of the Drug Use Screening Inventory (DUSI). The conditional form of logistic regression was employed for analysis, matching students on type of school and area, with further statistical adjustments for sex, age, and selected risk factors. Results: Occurrence of tobacco use was observed to vary dramatically from country to country. Nevertheless, for the combined group of countries, the estimated odds of tobacco use in youths at the highest levels of behavioral problems was more than five times that for youths at the lowest levels, after controlling for sex, age, lack of participation in recreational activities, level of irritability, and levels of problems with school, family, and mental health. Country-specific analyses show that youths at the highest levels of behavioral problems have a consistently greater occurrence of tobacco use as compared to youths at the lowest levels of behavioral problems. Conclusions: These findings are concordant with prior studies on tobacco use among adolescents with behavioral problems. Although the magnitude of observed associations varied according to the country of residence, the strength of these associations and their significance by conventional standards were observed in nearly all the countries sampled. This is the first study in these seven countries on potentially causal relationships such as these. More research is needed to augment our knowledge regarding the observed cross-country differences and ultimately to develop, implement, and evaluate effective tobacco preventative intervention programs (AU)

Risky behaviour in Jamaican adolescent patients attending a sexually transmitted disease clinic

The prevalence of sexually transmitted diseases (STD) and risky behaviour patterns were studied in 165 adolescents attending a STD clinic in Jamaica. A standardised structured questionnaire, clinical algorithms for STD and serological tests for HIV and syphilitic infection were applied. High prevalences of risky behaviour including young age at onset of sexual activity, especially in boys, (mean age 12.5 ñ 2.5 years); unprotected sexual intercourse (only 4 percent used condoms consistently); multiple sexual partners (mean 3.8 ñ 2.4 and 1.8 ñ 1.2 for boys and girls, respectively were found. Marijuana, used by 60 percent of the boys, was an independent risk factor for dysuria (adjusted Odds Ratio (OR), 2.0; 95 prcent CI, 1.6 - 3.4). Repeated episodes of STD (33 percent), coinfection with HIV (1.2 percent), syphilis (1.2 percent) and teenage pregnancy (13 percent) were prominent findings. Educational strategies which promote behaviour intervention at an early age, frequent and consistent use of condoms, abstinence or delayed onset of sexual activity are essential to reducing the HIV/AIDS and STD risk in adolescents in Jamaica.(Au)

Physical activity in Barbadian secondary school attenders - results from the Adolescent Health and Fitness study (AHFIT)

OBJECTIVE: To study the physical activity habits of adolescent school attenders in Barbados. DESIGN AND METHODS: Four hundred and sixty-two students, randomly selected by school class, attending four schools at different points of the "academic rank ladder", were invited to complete a knowledge, attitudes and practices questionnaire, to be measured, and to have blood drawn. RESULTS: Fifteen percent of these 10-18-year-old students, (males 8 percent, females 20 percent, p<0.001) did not participate in any form of physical activity on a regular basis. The males participated in cycling (54 percent), cricket (52 percent), jogging (50 percent) and football (45 percent), while the females participated in dancing (47 percent) and brisk walking (36 percent). Generally the males were more active than the females. Competing with the physical activity as leisure time activities were more sedentary activities like television viewing, computer and video games, while these adolescents had also experimented with alcohol (60 percent) and cigarettes (9.5 percent). CONCLUSIONS: The role for the health promotion team is clear: to promote increased physical activity in adolescents, to discourage other inappropriate behaviour patterns, and to monitor the influence of adolescent physical activity habits on adult physical activity and ultimately adult disease.(Au)

Evaluation of a sexuality education program for young adolescents in Jamaica

Despite their increasing numbers, few of the sexuallity education and pregnancy preventative programs in developing countries have been evaluated. This study, conducted in 1995-1997, assesses the impact of a school-based sexuality education program, the Grade 7 Project, on 945 Jamaican seventh graders (aged 11-14) and their initiation of sexual activity and the use of contraception at first intercourse, as well as the knowledge and attitudes that influence their behaviors. Using a quasi-experimental design, the study measured the effects of the Grade 7 Project when the nine-month intervention was completed (short term) and one year after that (long term). Multivariate logistic regression analysis indicated that the project had no effect on initiation of sexual activity, but it had a positive short-term impact on use of contraception at first intercourse (P=.08); adolescents in the intervention group were more than twice as likely to use contraception. The project also had a positive short-term influence on several aspects of the adolescents' knowledge of and attitudes about sexuality and pregnancy. The modest impact of the Grade 7 project is encouraging, as school-based sexuality education programs of limited duration rarely have a long-term impact. Moreover, competing socioeconomic and cultural forces in Jamaica encourage early sexuality and parenthood among adolescents. The use of more participatory teaching methods and smaller class sizes might strengthen the Grade 7 Project and enhance its impact (AU)

Peer influence and its health implications for adolescents in selected high schools in Jamaica

The aim of this study was to examine the extent to which peer pressure influences the behaviour of adolescents and the implications of such behaviours for health. The study, a cross-sectional one, was conducted at the Clan Carthy and Donald Quarry Comprehensive High Schools with 133 adolescents, and employed a muti-stage sampling process - a combination of random and stratified techniques. Subjects for the sample were selected from one class/stream each from grades 7-11, making a total of 5 classes in the study sample. A focus group study, involving 2 groups each of 6 students, was conducted to supplement the quantitative findings. Results showed that male adolescents were more involved in gangs/posses, than females. In relation to drug/substance abuse it was shown that the prevalence for males was much higher than that of females except for the use of inhalants, the majority was encouraged by friends to use ganja and alochol, males were more likely than females to be influenced or encouraged by their friends to use drugs, and males were 3 times more likely than females to meet with friends to drink alcohol. In relation to sexual behaviour, it was shown that approximately 76 percent of adolescents met with friends to discuss sexual matters 70 percent of the times, and that male adolescents were 11 times more likely than females to be encouraged by friends to have sexual intercourse, 14 times more likely to be encouraged to fondle a girl and 10 times more likely to be encouraged to have more than one lover. In relation to violence it was found that a knife was the most prevalent weapon carried or encouraged to be carried by adolescents; pencils/pens/divider were the most prevalent weapons encouraged to be used in fights at school and males were 3 times more likely than females to fight at school. It was concluded that males were more at risk than females to be influenced by their peers, and it was recommended that Family Life Education programmes in schools be intensified and specifically targeting the male adolescent (AU)

Sexual Attitudes and Behaviour among young adolescents in Jamaica

Describes the attitudes and behaviour among low-income adolescents in Jamaica. Contributing factors to early sexual activity and pregnancy; Social pressure and encouragement among boys to be sexually active; Branding of young girls who become pregnant as having loose morals; Motivations for engaging in sex among girls and boys.(AU)

Peer influence and its health implications for adolescents in selected high schools in Jamaica

The aim of this study was to examine the extent to which peer pressure influences the behaviour of adolescents and the implications of such behaviours for health. The study, a cross-sectional one, was conducted at the Clan Carthy and Donald Quarry Comprehensive High Schools with 133 adolescents, and employed a multi-stage sampling process - a combination of random and stratified techniques. Subjects for the sample were selected from one class/stream each from grades 7 - 11, making a total of 5 classes in the study sample. A focus group study, involving 2 groups each of 6 students, was conducted to supplement the quantitative findings. Results showed that male adolescents were more involved in gangs/posses, than females. In relation to drug/substance abuse it was shown that the prevalence for males was much higher than that of females except for the use of inhalants, the majority was encouraged by friends to use ganja and alcohol, males were more likely than females to be influenced or encouraged by their friends to use drugs, and males were 3 times more likely than females to meet with friends to drink alcohol. In relation to sexual behaviour, it was shown that approximately 76 percent of adolescents met with friends to discuss sexual matters 70 percent of the times, and that male adolescents were 11 times more likely than females to be encouraged by friends to have sexual intercourse, 14 times more likely to be encouraged to fondle a girl and 10 times more likely to be encouraged to have more than one lover. In relation to violence it was found that a knife was the most prevalent weapon carried or encouraged to be carried by adolescents; pencils/pens/divider were the most prevalent weapons encouraged to be used in fights at school and males were 3 times more likely than females to fight at school. It was concluded that males were more at risk than females to be influenced by their peers, and it was recommended that Family Life Education programmes in schools be intensified and specifically targetting the male adolescent.(Au)

Behavioral and Emotional problems among adolescents of Jamaica and the United States: Parent, Teacher and self-reports for ages 12 to 18

Compares nonreferred adolescent samples for ages 12 to 18 from Jamaica and the United States via syndromes; syndrome groupings and total problem scores on the Child Behavioral Checklist (CBCL), Teacher's report form and Youth Self-report. Reporting of more problems by adolescents in both societies than their parents or teachers.(AU)

Behaviour and emotional problems of clinic referred children of the African diaspora

Several factors determine behaviour problem types children exhibit, and actions adults (eg, parents) subsequently take. Factors include children's sociocultural background and clinicians' professional training. Cross-national research on children of similar heritage (eg, the African Diaspora) living in different cultures can address sociocultural issues associated with child psychopathology, but few cross-cultural studies focus on children of African descent. This study begins addressing these issues by surveying clinic records of 696 African American and Jamaican children aged 4-18 years. Trained recorders reviewed clinic records and recorded youngsters' presenting problems. By matching youngsters' problem to the widely used Child Behavior Checklist (CBCL) items, recorders coded and summed problems according to eight CBCL syndromes, internalising, externalising problems, other CBCL-, and non-CBCL problems. Stepwise regression revealed that African American youngsters scored higher on the Somatization syndrome only, a child problem type the Jamaican culture seems to tolerate.(AU)

Popular music and associated health responses among female adolescents 15-19 years in three parishes of Jamaica

The many health risks faced by adolescents place them high on the list of priorities for family health services. The inculcation of values and sound decision making skills among adolescents are factors which facilitate their resilence. The alleged negative influence of Jamaica's popular dance hall music has been an issue of much public debate. Even as the lyrical content of some dance hall music get more sexually explicit, a sizeable proportion of our population seem to enjoy them. Recognizing the powre of music, this study was undertaken to explore the relationship between music and adolescents' emotions, self-concept and gender perception. The preference for, use and effects of dance hall and other music was analysed among fifty sexually active (cases) and fifty, reportedly, non-sexually active (control) female adolescents in three parishes. It was statistically significant (p<0.05) that sexual activity was associated with the kinds of feelings evoked by music. There was no conclusive evidence however, that exposure to dance hall or other types of music is associated with early sexual involvement, or that they contribute to negative feelings about self, men and women. Soul music was the most valued by both cases and controls and significantly elicited feelings of love, intimancy and loneliness among those who were sexually active. Dance hall music was the preference among adolescents for fun and excitement while reggae music was seen as an instrument for building consciousness and for reflection. Gospel music was more for spirtuality. The words of songs were the major reasons for liking selected songs and this was significantly so for soul music among sexually active and non-sexually active adolescents. Although more detailed research is required, it can be concluded that music is vital to the lives of adolescents and offers scope for use in educational programmes.(Au)