Assessing violence and injury surveillance in the Caribbean

OBJECTIVE: To determine the status of existing violence and injury prevention (VIP) efforts and surveillance systems in the Caribbean. SUBJECTS AND METHODS: The Caribbean Public Health Agency undertook a survey to gather evidence of VIP in 24 member Countries. The survey was administered to national epidemiologists and non-communicable disease focal points in October 2015 using an online tool, “Survey Monkey”. Questions were asked about the availability in each country of VIP representative surveys, policies,action plans, laws, victim support services and surveillance systems.RESULTS: Nineteen (79%) countries completed the VIP survey. Only three (16%) countries confirmed having undertaken a nationally representative survey. Twelve (63%) had not developed a national policy and 14 (74%) had not implemented an action plan on VIP. Each country reported the existence of VIP laws and offered victim support services, though average enforcement ranged from 40–79%. Nine (47%) countries indicated using an injury registry and 15 (79%) reported collecting injury data within patient records, mainly from public hospitals. All 19 countries confirmed that records of reported violent incidents were maintained by the police. Unique identifiers were generally lacking in registries and police systems. Only four (44%) countries with registries, ten (67%) countries with inpatient injury data and 12 (63%) countries with police records indicated sharing data with other organizations. CONCLUSION: Each country reported some level of injury surveillance system; however, such systems should be harmonized to produce more complete baseline data. The use of unique identifiers is required to reduce duplication and effectively link surveillance systems.

Analysis of intervention and counselling for at-risk youth to reduce crime, violence and improve outcomesfor the individual, the schools and the family

OBJECTIVES: In this study, we examined how counselling of students and their parents can change youth misbehavior and reduce school violence and crime. Our primary objective was to derive empirical data on successful counselling therapies for at-risk secondary school students within Trinidad and Tobago. SUBJECTS AND METHODS: Participants included 145 secondary school students from selected secondary schools in one school district in Trinidad and Tobago. Of these, 49(17.3%) participants were referred by the school principals as suspended or at risk of being suspended. Participants had to complete a 12-week counselling programme consisting of individual, group and parent guidance sessions. RESULTS: After controlling for demographic characteristics, results indicate that a 12-week counselling intervention and participation in multi-modal therapeutic counseling sessions was statistically significant in changing at-risk youth negative mood states and student misbehaviour and school violence. CONCLUSION: The results of this study show that the socioeconomic environmental factors present in high-risk communities contribute to hopelessness and depression which manifest themselves in physical and mental health problems. In our study, more than 50% of school youth involved in school crime and violence are afflicted with health problems. These health problems include maladies such as depression, emotional, verbal, or physical abuse, unresolved grief and loss. Research is needed to determine the potential causal nature of the relationships between mental health problems (ie hopelessness, depression) on youth violence and crime and its potential effects on health and well-being.

Injuries and violence in the Caribbean: how big is the problem?

OBJECTIVE: To quantify and characterize deaths from injuries and violence in the English- and Dutch-speaking Caribbean. DESIGN AND METHODS: The most recent year of available national cause-of-death data for each country for the period 2007-2013 was selected from the CARPHA regional mortality database. An analysis of regional causes of deaths by age and gender was completed. The crude injury death rate for each country, by gender, was also calculated followed by a descriptive analysis of the type of injuries contributing to death in each country. RESULTS: In the English- and Dutch-speaking Caribbean, annual deaths from injuries accounted for 11.5% of all deaths and four times as many men as women died from an injury. Among persons aged 15-44 years, 116,931 person-years of life was lost due to injuries. More males aged 1-44 years died from violence (one in four) than from any other cause. The injury death rate and the related causes varied substantially across countries within the region. CONCLUSIONS: Understanding the current mortality profile of injury and violence in the region is critical to the development of effective and efficient interventions to address this problem. Variability of these profiles across the region suggests that more research is needed to inform development of age, gender and country-specific programmes.

The risk factors to youth violence: findings from the CARICOM youth crime and violence school survey, Bahamas

OBJECTIVES: To determine the risk factors for in-school violence among Bahamas public school students. DESIGN AND METHODS: Self-administered questionnaires were completed by students in grades 6, 8, 10, and 12 from four public schools on New Providence island, Bahamas. Questionnaire focus was on school violence. Physical fighting, weapon carrying, and bullying were tested for associations for selected risk factors, including family structure, socioeconomic status, gang membership, attitudes toward school and delinquent behaviour, and delinquent peers. Bivariate associations were tested using Pearson chi-square and Fisher’s Exact Test (p <= .05). RESULTS: Five hundred and eighty eight students completed the survey (53% female); median age was 15 years (range 10 to 19). The average household size was 4. A third (34%) lived with both parents. Most parents had at least a high school education. More than half (55%) answered favourably for most school items. Forty six percent did not have friends who committed delinquent acts, and 68% felt most delinquent acts were morally wrong. Forty percent were in a gang, 7% carried weapons, 12% bullied, and 16% physically fought and/or injured someone. Students who were in gangs, had delinquent peers, and felt that delinquent acts were not wrong were more likely to bully, fight, carry weapons, and be in a gang. School connectedness was associated with all deviant activities except gang membership. Family make-up and socioeconomic status were not associated with delinquency. CONCLUSIONS: Schools should strongly monitor gang activity. Schools can also take advantage of students’ favourability toward school with after-school programs.

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.

Heavy drinking and violent behaviour in youths in Guyana

OBJECTIVE: To investigate the problem of alcohol among Guyanese youths and its gender implications. DESIGN AND METHODS: The Global School-based Student Health Survey (GSHS) was reviewed since there is a dearth of statistics on the consumption of alcohol in youths and violent behaviour. In all, 2,392 students participated in the GSHS. The focus was on early youth. RESULTS: There was a high prevalence of violence in girls. This was reflected by 33.8% having been physically attacked in a 12 month period, 36.6% were bullied in one month and 25% were involved in physical fights in a 12 month period. This indicates that bullying is a serious problem among adolescents in schools. CONCLUSION: This issue is one of particular concern because early initiation of alcohol use is associated with an increased risk of alcoholism in adults. The age at first drink and the regular consumption of alcoholic beverages during adolescence are strongly influenced by social, economic, and environmental factors as indicated in WHO Facts on Alcohol and Violence. There appears to be no surveillance system that captures data on gender based violence in Guyana. Thus, a system should be established to examine gender-based violence in the wider context of other forms of violence including childhood abuse, sexual victimizations, and self-harm and suicide.

Exploring perceptions and impact of violence as experienced by the emergency department staff of the Princess Margaret Hospital in The Bahamas

OBJECTIVE: To explore the perceptions and impact of violence experienced by Emergengy Department (ED) staff of the Princess Margaret Hospital in The Commonwealth of The Bahamas in order to inform administrative managers’ awareness and ED staff behavioural changes. DESIGN AND METHODS: A qualitative research design and interpretative epistemological view point was adopted. Purposive sampling method was utilized and 12 participants were recruited for the study. Data collected from semi-structured interviews were transcribed and thematically analysed to identify common themes. RESULTS: Five major themes were common to all interviews. Firstly, the overwhelming perception of violence was seen as an innate and inevitable ED occurrence. Secondly, facilitating elements were viewed multifactorially with verbal abuse perceived as the most common form experienced. Thirdly, personal and professional impact of ED violence was seen as having the potential to negatively affect patient care. Fourthly, support and coping measures viewed as post-incident essentials were considered lacking. Finally, suggested measures to decrease ED violence related to areas of patient, staff and ED improvements. However doubt was voiced as to the efficacy of such measures being adequately implemented. CONCLUSION: The study provided a useful insight into the perceptions and impacts of violence experienced by staff in the ED. The negative impact on staff personally was seen as having consequential negative effect on professional performance in the ED, with patient quality care ultimately being compromised. In sharing the results of this and the highlighted public health concern, awareness and behavioural changes were encouraged, along with the need for further research into this emotive issue.

Workplace violence against medical staff in public primary healthcare facilities in Barbados

OBJECTIVE: To determine the prevalence of physical and psychological violence amongst the medical staff in the eight public polyclinics of Barbados. DESIGN AND METHODS: A cross sectional study was conducted utilising a modified version of the standard Workplace Violence Questionnaire by the World Health Organisation, designed to assess the prevalence, types and features of workplace violence. All nursing and physician staff on duty at the island’s eight polyclinics during the study period (June-July 2014) were invited to participate. Statistical analysis was performed using Epi info 7. RESULTS: Of the 102 respondents (72% response rate), a total of 63% (95% CI 53.0%-72.4%) of nursing and physician staff at the polyclinics in Barbados reported having suffered at least one incident of violence in the past 12 months. Verbal abuse was the most frequent (60%; 95% CI 50.1%- 69.7%). The one-year prevalence rates of physical violence, bullying, sexual harassment, and racial harassment were 2.9%, 18.8%, 6.9% and 2.9%, respectively. Logistic regression showed that females were more likely to experience verbal abuse than males (OR=11; 95% CI 2.8-43.1) and nurses more likely than physicians (OR=1.9; 95% CI 1.1-4.7). The client accounted for 64% of the incidents. CONCLUSIONS: More than half of all staff surveyed reported experiencing some type of violence in the past year, female gender being a significant predictor of abuse. This initial process of characterising the extent and type of violence present, can serve as a foundation for further qualitative research exploring reasons for violence experienced.

Patterns of violence related injuries presenting to the Cornwall Regional Hospital

OBJECTIVES: Determine the factors associated with violence related injuries (VRI) presenting the Cornwall Regional Hospital (CRH). DESIGN AND METHODS: Data were collected from the Jamaica Injury Surveillance System (JISS) on all patients presenting to the CRH during April and May 2014. This information was collected at hospital registration from all patients with VRIs after triage in the hospital emergency room. RESULTS: A total of 438 patients presented to the Cornwall Regional Hospital during April and May 2014. Complete data were located for 407 of these patients (93%). Of these 58% (237) were males and 42% (170) were female. The most common age group presented in the data was 18-29 years (37%) and blunt trauma was the most common method of injury (34%). The most common circumstance surrounding VRIs was a fight (77%) and 43% of persons were injured by an acquaintance. Gang and drug related VRIs accounted for less than 1% of injuries. CONCLUSIONS: The JISS represents an excellent source of data on VRIs in Montego Bay and Jamaica. It allows the creation of a profile of those injured during violence and the surrounding circumstances. Violence might be a common part of interaction between friends and family.

Fear of violence increases risk behaviours of persons living with HIV (PLHIV) in Guyana

OBJECTIVE: To assess if fear of violence among PLHIV in Guyana affects sexual risk behaviours. DESIGN AND METHODS: In 2011 a cross sectional survey was conducted of the sexual risk behaviours of 271 PLHIV enrolled in a Prevention with Positives (PwP) project promoting risk reduction behaviours at seven non-governmental organizations (NGOs). Quantitative data was analyzed using STATA. Seventeen PLHIV and partners were interviewed using a semi-structured guide. Transcripts were analyzed for themes and data triangulated to understand the prevalence of risk behaviours and the barriers to risk reduction among PLHIV. RESULTS: Domestic violence was experienced by 25.9% of enrollees. HIV positive women were more likely to have fears of violence (OR, 3.6; 95% CI 0.58, 5.48) and to be in a sexual relationship with an HIV negative partner (OR 4.1; 95% CI 0.5, 49.4) than males though these were not statistically significant when adjusted for disclosure and having sex for things. PLHIV who were not afraid of violence were more likely to disclose (P=0.03 Fisher exact). When controlling for gender, having sex for things, and HIV status of partner, PLHIV who were not afraid of violence were significantly more likely to use family planning (OR= 10.7: 95% CI 1.9, 61.4). HIV positive women experienced discrimination when seeking social services. CONCLUSIONS: Fear of violence was a barrier to disclosure and use of family planning. Gender differences in experiences of violence should be catered for and discrimination against PLHIV by staff at social services addressed.

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

Physical and psychological violence in Jamaica's health sector

OBJECTIVE: To determine the prevalence of experiences with physical violence and psychological violence that health staff have had in the workplace in Jamaica, and to identify factors associated with those experiences of violence. DESIGN and METHODS: A total of 832 health staff answered the standardized questionnaire that was used in this cross-sectional study. Sampling was done at public facilities, including specialist, tertiary, and secondary hospitals in the Kingston Metropolitan Area; general hospitals in the rural parishes; and primary care centers in urban and rural areas. Sampling was also done in private hospitals and private medical centers. RESULTS: Psychological violence was more prevalent than was physical violence. Verbal abuse had been experienced in the preceding year by 38.6 percent of the questionnaire respondents, bullying was reported by 12.4 percent, and physical violence was reported by 7.7 percent. In multivariate analyses there was a lower risk of physical violence for health staff who were 55 years or older, worked during the night, or worked mostly with mentally disabled patients, geriatric patients or HIV/AIDS patients. Staff members working mostly with psychiatric patients faced a higher risk of physical assaults than did other health staff. Of the various health occupations, nurses were the ones most likely to be verbally abused. In terms of age ranges, bullying was more commonly experieced by health staff 40-54 years old. CONCLUSIONS: Violence in the health sector workplace in Jamaica is an occupational hazard that is of public health concern. Evaluation of the environment that creates risks for violence is necessary to guide the formulation of meaningful interventions for the country (AU)

Physical and psychological violence in Jamaica's health sector

OBJECTIVE: To determine the prevalence of experiences with physical violence and psychological violence that health staff had in the workplace in Jamaica, and to identify factors associated with those experiences of violence. DESIGN AND METHODS: A total of 832 health staff answered the standardized questionnaire that was used in this cross-sectional study. Sampling was done at public facilities, including specialist, tertiary, and secondary hospitals in the Kingston Metropolitan Area; general hospitals in the rural parishes; and primary care centres in urban and rural areas. Sampling was also done in private hospitals and private medical centres. RESULTS: Psychological violence was more prevalant than was physical violence. Verbal abuse has been experienced in the prceeding year by 38.6 percent of the questionnaire respondents, bullying was reported by 12.4 percent, and physical violence was reported by 7.7 percent. In multivariate analyses there was a lower risk of physical violence for health staff who were 55 years or older, worked during the night, or worked mostly with mentally disbled patients, geriatric patients, or HIV/AIDS patients. Staff members working mostly with psychiatric patients faced a higher risk of physical assaults that did other health staff. Of the various health occupations, nurses were the ones mostly likely to be verbally abused. In terms of age ranges, bullying was more commonly experienced by health staff 40-54 years old. CONCLUSION: Violence in the health sector workplace in Jamaica is an occupational hazard that is of public health concern. Evaluation of the environment that creates risks for violence is necessary to guide the formulation of meaningful interventions for the country(AU)

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)

Non-fatal violence-related injuries (VRIs) at the Kingston Regional Hospital (KRH): a preventable drain on resources [Abstract]

OBJECTIVE: We used data for a one-year period from the Violence-related Injury (VRI) Surveillance System at the Kingston Regional Hospital (KRH) in Jamaica to describe the patterns of non-fatal VRIs. We also carried out simulation analysis to estimate rates of hospital admission under various injury-reduction scenarios, and the potential savings that could be realized by reducing violent crimes and the hospital care associated with them. METHOD: Data used were for the one-year period, August 1, 1998 to July 31, 1999. In this period there were 6107 registered violence-related visits to the Accident and Emergency Department (AED) of the KRH, representing 11.5 percent of all recorded visits. Questions on the form included age, gender, circumstance and method of injury, victim-perpatrator relationship, and admission status. cases are non-fatal violence-related injuries resulting from threatened or actual use of physical force with the intent to cause harm, and do not include accidental or self-inflicted injuries. Simulation results are based on predicted values of admission status following maximum likelihood multiple regression models and the appropriate manipulation of relevant independent variables. RESULTS: 16.6 percent (1001) of subjects were admitted. The most common method of inflicting injury was by stabbing, accounting for 52.1 percent of injuries. Bodily force or blunt objects accounted for another 37.9 percent, while gunshot wounds accounted 7.3 percent of injuries. Multivariate analyses indicated gumshot injuries, stab injuries, being male, between the ages of 15 and 44 years, receiving the injury in November or December, and being injured by a stranger or unknown assailant, to be significant correlates of probability of admission ranging from 12 percent to 44 percent, with estimated savings of up to 20 percent of the annual budget of KRH. CONCLUSIONS: Non-fatal VRIs compromise a significant proportion of admissions to KRH. There are predicatble correlates of the likelihood of admission, and educational drives aimed at reducing specific risk factors can lead to large savings of limited resources. (AU)

The exposure to violence and the development of symptoms of psychological distress in boys ages 10-15 years in two schools in Jamaica

Violence is a growing public health problem throughout the world. Violence impacts negatively on the quality of life and living conditions of many worldwide. The objectives of the study were to identify the exposure to violence, of males between the ages 10-15 years in two Jamaican schools, identifying the environments in which this took place, the weapons used and the development of symptoms of psychological distress in the boys exposed to violence. The study used a survey design with an anonymous self-report questionnaire and two focus group interviews were conducted. The results showed that there were high levels of exposure to violence in respondents from both schools. More that 50 percent of the boys had been involved in physical fights, 39 percent of students carried weapons to school, 97.8 percent witnessed fights and 55.9 percent of boys had had a family member or friend murdered. Exposure to violence occurred in their communities, at school and at home. Respondents experienced symptoms of psychological distress such as, difficulty in sleeping, crying in their sleep, an increased heart rate and anger. Two boys stated that they would like to kill themselves. In order to reduce the exposure of juveniles to violence and the development of psychological problems due to this, strategies involving non-violent methods of conflict resolution need to be taught to juveniles, their parents and caregivers. A multifaceted approach also needs to be used involving the juveniles, various government associations as well as non-governmental institutions and the private sector, to provide support systems for victims and their families (AU)

Domestic and School Violence Among High School Students in Jamaica

This study determined the prevalence of domestic and school violence among high school students in Jamaica. A self-report questionnaire was administered to 3,124 students (1,468 boys and 1,657 girls) from 34 randomly selected high schools in 13 of the 14 parishes in Jamaica. There were 1,590 tenth graders (mean age 16 years) and 1,534 eleventh graders (mean age 17 years). One thousand six hundred and seventeen students were from rural and 1,507 from urban communities and 1,642 and 1,482 were children of professionals and nonprofessionals, respectively. The results revealed that 78.5 percent of the students had witnessed violence in their communities, 60.8 percent in their schools, and 44.7 percent in their homes. Twenty-nine percent of the students had caused injury to persons. Several weapons and techniques were used by the students during violent acts and these included the use of hands or feet 59.8 percent, nasty words 59.1 percent, kicks and punches 54.5 percent, blunt objects 26.5 percent, knives 18.4 percent, ice picks 9.3 percent, machetes 8.9 percent, scissors 8.5 percent, forks 7.5 percent, guns 6.9 percent, other weapons (e.g. bottles, dividers) 6.7 percent, acids 5.5 percent, and alkalis 4.9 percent. Significantly higher numbers of boys, 10th graders, and urban students indicated that they used more of the 14 weapons than girls, 11th graders and rural students, respectively. Effective programmes are urgently need to address the high rate of violence recorded in this study among high school youths in Jamaica.(Au)

The exposure of violence and the development of symptoms of psychological distress in boys ages 10-15 years in two schools in Jamaica

Violence is a growing public health problem throughout the world. Violence impacts negatively on the quality of life and living conditions of many worldwide. The objectives of the study were to identify the exposure to violence, of males between the ages of 10-15 years in two Jamaican schools, identifying the environments in which this took place, the weapons used and the development of symptoms of psychological distress in the boys exposed to violence. The study used a survey design with an anonymous self-report questionnaire and two focus group interviews were conducted. The results showed that there were high levels of exposure to violence in respondents from both schools. More than 50 percent of the boys had been involved in physical fights, 39 percents of students carried weapons to school, 97.8 percent witness fights and 55.9 percent of boys had a family member or friend murdered. Exposure to violence occurred in their communities, at school and at home. Respondents experienced symptoms of psychological distress such as, difficutly in sleeping, crying in their sleep, and increased heart rate and anger. Two boys stated that they would like to kill themselves. In order to reduce the exposure of juveniles to violence and the development of psychological problems due to this, strategies involving non-violent methods of conflict resolution need to be taught to juveniles, their parents and caregivers. A mulifaceted approach also needs to be used involving the juveniles, various government associations as well as non-governmental institutions and the private sector, to provide support systems for victims and their families.(AU)