Regional reef fish assemblage maps provide baseline biogeography for tropicalization monitoring.

The Anthropocene rise in global temperatures is facilitating the expansion of tropical species into historically non-native subtropical locales, including coral reef fish. This redistribution of species, known as tropicalization, has serious consequences for economic development, livelihoods, food security, human health, and culture. Measuring the tropicalization of subtropical reef fish assemblages is difficult due to expansive species ranges, temporal distribution shifts with the movement of isotherms, and many dynamic density-dependent factors affecting occurrence and density. Therefore, in locales where tropical and subtropical species co-occur, detecting tropicalization changes relies on regional analyses of the relative densities and occurrence of species. This study provides a baseline for monitoring reef fish tropicalization by utilizing extensive monitoring data from a pivotal location in southeast Florida along a known transition between tropical and subtropical ecotones to define regional reef fish assemblages and use benthic habitat maps to spatially represent their zoogeography. Assemblages varied significantly by ecoregion, habitat depth, habitat type, and topographic relief. Generally, the southern assemblages had higher occurrences and densities of tropical species, whereas the northern assemblages had a higher occurrence and density of subtropical species. A total of 108 species were exclusive to regions south of the Bahamas Fracture Zone (BFZ) (South Palm Beach, Deerfield, Broward-Miami) and 35 were exclusive to the north (North Palm Beach, Martin), supporting the BFZ as a pivotal location that affects the coastal biogeographic extent of tropical marine species in eastern North America. Future tropicalization of reef fish assemblages are expected to be evident in temporal deviance of percent occurrence and/or relative species densities between baseline assemblages, where the poleward expansion of tropical species is expected to show the homogenization of assemblage regions as adjacent regions become more similar or the regional boundaries expand poleward. Ecoregions, habitat depth, habitat type, and relief should be incorporated into the stratification and analyses of reef fish surveys to statistically determine assemblage differences across the seascape, including those from tropicalization.

Identifying opportunities for harmonized microplastics and mesoplastics monitoring for Caribbean Small Island Developing States using a spatiotemporal assessment of beaches in South Eleuthera, The Bahamas.

Increasing quantities of microplastics and mesoplastics in the marine environment underscore the need for marine microplastics to be included in the global Plastics Treaty to end plastic pollution. Caribbean Small Island Developing States (SIDS) lack harmonized microplastics monitoring protocols, leaving them data deficient at the science-policy interface required for treaty negotiations. This baseline study assessed spatial and seasonal abundance and distribution of microplastic (1-5 mm) and mesoplastic (5-25 mm) on 16 beaches with three coastal exposures (Atlantic Ocean, Exuma Sound, Bahama Bank) in South Eleuthera, The Bahamas and its implications for Caribbean SIDS. Microplastics were the dominant debris type sampled (74 %) across all beaches, with significant spatial (p = 0.0005) and seasonal (p = 0.0363) differences in abundance and distribution across study sites. This baseline study identifies opportunities required for developing harmonized microplastics and mesoplastics monitoring by Caribbean SIDS to collect data to help support global plastics treaty negotiations.

Biophysical larval dispersal models of observed bonefish (Albula vulpes) spawning events in Abaco, The Bahamas: An assessment of population connectivity and ocean dynamics.

Biophysical models are a powerful tool for assessing population connectivity of marine organisms that broadcast spawn. Albula vulpes is a species of bonefish that is an economically and culturally important sportfish found throughout the Caribbean and that exhibits genetic connectivity among geographically distant populations. We created ontogenetically relevant biophysical models for bonefish larval dispersal based upon multiple observed spawning events in Abaco, The Bahamas in 2013, 2018, and 2019. Biological parameterizations were informed through active acoustic telemetry, CTD casts, captive larval rearing, and field collections of related albulids and anguillids. Ocean conditions were derived from the Regional Navy Coastal Ocean Model American Seas dataset. Each spawning event was simulated 100 times using the program Ichthyop. Ten-thousand particles were released at observed and putative spawning locations and were allowed to disperse for the full 71-day pelagic larval duration for A. vulpes. Settlement densities in defined settlement zones were assessed along with interactions with oceanographic features. The prevailing Northern dispersal paradigm exhibited strong connectivity with Grand Bahama, the Berry Islands, Andros, and self-recruitment to lower and upper Abaco. Ephemeral gyres and flow direction within Northwest and Northeast Providence Channels were shown to have important roles in larval retention to the Bahamian Archipelago. Larval development environments for larvae settling upon different islands showed few differences and dispersal was closely associated with the thermocline. Settlement patterns informed the suggestion for expansion of conservation parks in Grand Bahama, Abaco, and Andros, and the creation of a parks in Eleuthera and the Berry Islands to protect fisheries. Further observation of spawning events and the creation of biophysical models will help to maximize protection for bonefish spawning locations and nursery habitat, and may help to predict year-class strength for bonefish stocks throughout the Greater Caribbean.

Validity of the Food Insecurity Experience Scale and prevalence of food insecurity in The Bahamas.

INTRODUCTION: Despite UN recommendations to monitor food insecurity using the Food Insecurity Experience Scale (FIES), to date there are no published reports of its validity for The Bahamas, nor have prevalence rates of moderate or severe food insecurity been reported for the remote island nation. At the same time, food security is a deep concern, with increasing incidence of natural disasters and health concerns related to diet-related disease and dietary quality plaguing the nation and its food system. This article aims to examine the validity of the FIES for use in The Bahamas, the prevalence of moderate and severe food insecurity, and the sociodemographic factors that contribute to increased food insecurity. METHODS: The FIES survey was administered by randomized and weighted landline telephone survey in Nassau in The Bahamas to 1000 participants in June and July 2017. The Rasch modelling procedure was applied to examine tool validity and prevalence of food insecurity. Equating procedures calibrated this study's results to the global FIES reference scale and computed internationally comparable prevalence rates of both moderate and severe food insecurity. A regression analysis assessed the relationship between household variables and food security. RESULTS: The FIES met benchmarks for fit statistics for all eight items and the overall Rasch reliability is 0.7. As of 2017, Bahamians' prevalence of moderate and severe food insecurity was 21%, and the prevalence of severe food insecurity was 10%. Statistically significant variables that contribute to food insecurity included education, age, gender, and presence of diabetes, high blood pressure, or heart disease. Results also indicated that Bahamians experience food insecurity differently than populations across the globe, likely due in large part to the workings of an isolated food system heavily dependent on foreign imports. Responses showed that by the time a Bahamian worries they will not have enough food to eat, they have already restricted their meals to a few kinds of foods and begun to limit their intake of vegetables and fruits. CONCLUSION: This study, which is among the first to comprehensively measure food security in The Bahamas, provides a baseline for further research and evaluation of practices aimed at mitigating food insecurity in small island developing states. Further, this study provides a benchmark for future research, which may seek to understand the impacts of Hurricane Dorian and COVID-19, disasters further isolating the remote island nation. Post-disaster food security data are needed to further understand the extent to which food security is impacted by natural disasters and identify which sectors and stakeholders are most vital in restructuring the agricultural sector and improving food availability following catastrophic events.

Annual Report 2020. Universal Health and the Pandemic. Resilient Health Systems. The Bahamas and Turks and Caicos Islands

Founded in 1902 as the independent specialized health agency of the inter-American system, the Pan American Health Organization (PAHO) has developed recognized competence and expertise, providing technical cooperation to its Member States to fight communicable and noncommunicable diseases and their causes, to strengthen health systems, and to respond to emergencies and disasters throughout the Region of the Americas. In addition, acting in its capacity as the World Health Organization’s Regional Office, PAHO participates actively in the United Nations Country Team, collaborating with other agencies, the funds and programs of the United Nations system to contribute to the achievement of the Sustainable Development Goals (SDGs) at country level. This 2020 annual report reflects PAHO’s technical cooperation in the countries for the period, implementing the Country Cooperation Strategy, responding to the needs and priorities of the country, and operating within the framework of the Organization’s regional and global mandates and the SDGs. Under the overarching theme of Universal Health and the Pandemic – Resilient Health Systems, it highlights PAHO’s response to the COVID-19 pandemic as well as its continuing efforts in priority areas such as communicable diseases, noncommunicable diseases, mental health, health throughout the life course, and health emergencies. It also provides a financial summary for the year under review.

Infertility and assisted reproductive technology outcomes in Afro-Caribbean women.

OBJECTIVE: To assess the causes of infertility and artificial reproductive technology (ART) outcomes in women of African descent living in the Caribbean and Bermuda. DESIGN: Cross-sectional study composed of a questionnaire administered to providers who care for women undergoing ART in the Caribbean and Bermuda. MATERIAL AND METHODS: A questionnaire from the Deerfield Institute was adapted to meet the aims of our study with their permission. Eight infertility clinics in the Caribbean and Bermuda were identified. The primary physician at each site was contacted via email and invited to participate in the study. Questionnaires were completed via interview or electronically. Responses were collected in a REDCap database for statistical analysis. RESULTS: There were five respondents from Barbados, Bermuda (× 2), Puerto Rico, and the Bahamas. The most commonly reported etiologies of infertility among Afro-Caribbean patients were female-male factor and uterine factor. In vitro fertilization (IVF) combined with intracytoplasmic sperm injection (ICSI) is performed more often than conventional IVF. The cumulative live birth rates (LBR) after ART for those ages ≤ 34, 35-37, 38-42, and > 42 were 52%, 40%, 22%, and 12%, respectively. The cumulative live birth rate was 31.5% for total patients. The factors reported to be most important in hindering patients from cycling were coping emotionally with poor ovarian response and cost. The biggest restraints to infertility care were costs and a lack of local IVF centers on all islands. CONCLUSION: Afro-Caribbean women receiving infertility care in the Caribbean may have better ART outcomes compared to African-American women in the United States (US).

A Fly on the Cave Wall: Parasite Genetics Reveal Fine-scale Dispersal Patterns of Bats.

Dispersal influences the evolution and adaptation of organisms, but it can be difficult to detect. Host-specific parasites provide information about the dispersal of their hosts and may be valuable for examining host dispersal that does not result in gene flow or that has low signals of gene flow. We examined the population connectivity of the buffy flower bat, Erophylla sezekorni (Chiroptera: Phyllostomidae), and its associated obligate ectoparasite, Trichobius frequens (Diptera: Streblidae), across a narrow oceanic channel in The Bahamas that has previously been implicated as a barrier to dispersal in bats. Due to the horizontal transmission of T. frequens, we were able to test the hypothesis that bats are dispersing across this channel, but this dispersal does not result in gene flow, occurs rarely, or started occurring recently. We developed novel microsatellite markers for the family Streblidae in combination with previously developed markers for bats to genotype individuals from 4 islands in The Bahamas. We provide evidence for a single population of the host, E. sezekorni, but 2 populations of its bat flies, potentially indicating a recent reduction of gene flow in E. sezekorni, rare dispersal, or infrequent transportation of bat flies with their hosts. Despite high population differentiation in bat flies indicated by microsatellites, mitochondrial DNA shows no polymorphism, suggesting that bacterial reproductive parasites may be contributing to mitochondrial DNA sweeps. Parasites, including bat flies, provide independent information about their hosts and can be used to test hypotheses of host dispersal that may be difficult to assess using host genetics alone.

Spatial trends and drivers of marine debris accumulation on shorelines in South Eleuthera, The Bahamas using citizen science.

This study measured spatial distribution of marine debris stranded on beaches in South Eleuthera, The Bahamas. Citizen science, fetch modeling, relative exposure index and predictive mapping were used to determine marine debris source and abundance. Citizen scientists quantified debris type and abundance on 16 beaches within three coastal exposures (The Atlantic Ocean, Great Bahama Bank and The Exuma Sound) in South Eleuthera. Marine debris, (~2.5 cm or larger) on each beach was monitored twice between March-May and September-November 2013 at the same locations using GPS. Approximately, 93% of all debris items were plastic with plastic fragments (≤2.5 cm) being the most common. There were spatial differences (p ≤ 0.0001) in plastic debris abundance between coastal exposures. Atlantic Ocean beaches had larger quantities of plastic debris by weight and by meter (m) of shoreline. Stranded plastic may be associated with Atlantic Ocean currents associated with leakage from the North Atlantic sub-tropical gyre.

The prostate cancer screening clinic in the Bahamas: a model for low- and middle-income countries.

PURPOSE: Grand Bahama (pop. 51,000) is an island within the Bahamas archipelago. A local chapter of International Us TOO Prostate Cancer Support Group (UTGB) has led an annual community-based prostate cancer screening clinic in Grand Bahama each September since 2009. Features of this initiative, characteristics of attendees, and a description of found cancers were summarized to determine the clinic's value and to guide improvements. METHOD: We analyzed the established clinic from 2012 to 2015, wherein UTGB attracted corporate funding, volunteers managed clinics, and health professionals provided healthcare services. An explicit algorithm was used to sort clients by age, comorbidities, and findings from digital rectal examinations, and prostate-specific antigen (PSA) values, to determine which clients would undergo secondary assessment and prostate biopsy. RESULTS: Overall, 1,844 males were registered (mean age 57.6 years), and only 149 men attended on more than one occasion for a total of 1,993 clinic visit. The urologist reviewed 315 men in secondary follow-up, for elevated PSA and/or an abnormal digital rectal examination. Of these, 45 men fulfilled criteria for trans-rectal ultrasound biopsy, and there were 40 found cases of prostate cancer, for a positive-predictive value of 89%. By D'Amico risk-stratification, these 40 cases were low (10%), intermediate (40%), and high risk (50%). The urologist counseled all 40 cases and facilitated access to standard care. CONCLUSION: This study suggests that low-resource countries can advance cost-effective screening clinics, apply policy guidelines, and provide services within acceptable standards of care. It is the expectation, with a sustained effort and community participation over the ensuing years, that earlier disease presentation will occur and, consequently, a concomitant decrease in the disease-specific mortality.

Do physical habitat complexity and predator cues influence the baseline and stress-induced glucocorticoid levels of a mangrove-associated fish?

As human populations continue to expand, increases in coastal development have led to the alteration of much of the world's mangrove habitat, creating problems for the multitude of species that inhabit these unique ecosystems. Habitat alteration often leads to changes in habitat complexity and predation risk, which may serve as additional stressors for those species that rely on mangroves for protection from predators. However, few studies have been conducted to date to assess the effects of these specific stressors on glucocorticoid (GC) stress hormone levels in wild fish populations. Using the checkered puffer as a model, our study sought to examine the effects of physical habitat complexity and predator environment on baseline and acute stress-induced GC levels. This was accomplished by examining changes in glucose and cortisol concentrations of fish placed in artificial environments for short periods (several hours) where substrate type and the presence of mangrove roots and predator cues were manipulated. Our results suggest that baseline and stress-induced GC levels are not significantly influenced by changes in physical habitat complexity or the predator environment using the experimental protocol that we applied. Although more research is required, the current study suggests that checkered puffers may be capable of withstanding changes in habitat complexity and increases in predation risk without experiencing adverse GC-mediated physiological effects, possibly as a result of the puffers' unique morphological and chemical defenses that help them to avoid predation in the wild.

Emergency care and referral among isolated island populations in the Bahamas.

BACKGROUND: Isolated island populations face unique health challenges. In the Bahamas, the islands of Mayaguana, Inagua, Crooked Island, Acklins, and Long Cay-referred to as the MICAL Constituency-are among the most isolated. OBJECTIVES: Our objective was to better understand regional emergency care needs and capabilities, and determine how emergency care can be optimized among island populations. METHODS: During the summer of 2013, the project team conducted semi-structured key-informant interviews and small-group discussions among all health care teams in the MICAL region, as well as a community-based household survey on the island of Mayaguana. The interviews and small-group discussions consisted of open-response questions related to health care services, equipment, supplies, medications, and human resources. The community-based survey examined the prevalence of chronic noncommunicable diseases (CNCDs) and associated risk factors affecting the inhabitants of the region. RESULTS: The average number of annual emergency referrals from each of the MICAL islands was approximately 25-30, and reasons for referrals off-island included chest pain, abdominal pain, trauma, and dysfunctional uterine bleeding. Traditional prehospital care is not established in the MICAL Constituency. Providers reported feelings of isolation from the distant health system in Nassau. Whereas most clinics have a well-stocked pharmacy of oral medications, diagnostic capabilities are limited. The household survey showed a high prevalence of CNCDs and associated risk factors. CONCLUSION: Ongoing in-service emergency care training among MICAL providers is needed. Additional equipment could significantly improve emergency care capabilities, specifically, equipment to manage chest pain, fractures, and other trauma. Community-based preventive services and education could improve the overall health of the island populations.

Modeling the population dynamics of lemon sharks.

BACKGROUND: Long-lived marine megavertebrates (e.g. sharks, turtles, mammals, and seabirds) are inherently vulnerable to anthropogenic mortality. Although some mathematical models have been applied successfully to manage these animals, more detailed treatments are often needed to assess potential drivers of population dynamics. In particular, factors such as age-structure, density-dependent feedbacks on reproduction, and demographic stochasticity are important for understanding population trends, but are often difficult to assess. Lemon sharks (Negaprion brevirostris) have a pelagic adult phase that makes them logistically difficult to study. However, juveniles use coastal nursery areas where their densities can be high. RESULTS: We use a stage-structured, Markov-chain stochastic model to describe lemon shark population dynamics from a 17-year longitudinal dataset at a coastal nursery area at Bimini, Bahamas. We found that the interaction between delayed breeding, density-dependence, and demographic stochasticity accounts for 33 to 49% of the variance in population size. CONCLUSIONS: Demographic stochasticity contributed all random effects in this model, suggesting that the existence of unmodeled environmental factors may be driving the majority of interannual population fluctuations. In addition, we are able to use our model to estimate the natural mortality rate of older age classes of lemon sharks that are difficult to study. Further, we use our model to examine what effect the length of a time series plays on deciphering ecological patterns. We find that-even with a relatively long time series-our sampling still misses important rare events. Our approach can be used more broadly to infer population dynamics of other large vertebrates in which age structure and demographic stochasticity are important. REVIEWERS: This article was reviewed by Yang Kuang, Christine Jacob, and Ollivier Hyrien.

Layered stigma among health-care and social service providers toward key affected populations in Jamaica and The Bahamas.

While considerable research has documented stigma toward key populations affected by HIV and AIDS - men who have sex with men (MSM), sex workers (SWs) - it provided limited empirical evidence on the presence of layered stigma among health-care professionals providing services for these populations. C-Change conducted a survey among 332 staff of health-care and social service agencies in Jamaica and The Bahamas to understand the levels of stigma toward people living with HIV (PLHIV), including MSM and SWs and factors associated with stigma. While most health-care professionals responding to the survey said that PLHIV, MSM, and SWs deserved quality care, they expressed high levels of blame and negative judgments, especially toward MSM and SWs. Across a stigma assessment involving eight vignette characters, the highest levels of stigma were expressed toward PLHIV who were also MSM or SWs, followed by PLHIV, MSM, and SWs. Differences were assessed by gender, country, type of staff, type of agency, and exposure to relevant training. Findings indicate higher reported stigma among nonclinical vs. clinical staff, staff who worked in general vs. MSM/SW-friendly health facilities, and among untrained vs. training staff. This implies the need for targeted staff capacity strengthening as well as improved facility environments that are MSM/SW-friendly.

The socio-economic determinants of obesity in adults in the Bahamas.

OBJECTIVE: To determine the socio-economic determinants of obesity in adults in The Bahamas. DESIGN AND METHODS: A subpopulation of adults 21 to 60 years was analysed for socio-economic differences in obesity levels. Data from the 2001 Bahamas Living Conditions Survey, a nationwide comprehensive household survey which included anthropometric measurements, were used. Bivariate and binary logistic regression methods for complex samples were employed. FINDINGS: Overall obesity prevalence was 32% (38% female, 25% male, p = < 0.0001). An inverse relationship by education appeared to be the strongest predictor for all persons (OR = 0.78, CI 0.67, 0.90; p < 0.0001). This relationship was also evident for females (OR = 0.71, CI 0.59, 0.85; p < 0.0001) while a positive relationship existed by economic level for males (OR = 1.23, CI 1.07, 1.41; p = 0.005). There was a difference in food group expenditure for starchy vegetables only (p = 0.049). Other food group household expenditure, urban residence and female headed households showed no significant differences by obesity. CONCLUSIONS: In line with international trends, obesity rates are high in The Bahamas, and especially affect females of lower socio-economic status. Public policy that targets this group is necessary to address this health concern.

The socio-economic determinants of obesity in adults in the Bahamas / Las determinantes socioeconómicas de la obesidad en los adultos de Bahamas

OBJECTIVE: To determine the socio-economic determinants of obesity in adults in The Bahamas. DESIGN AND METHODS: A subpopulation of adults 21 to 60 years was analysed for socio-economic differences in obesity levels. Data from the 2001 Bahamas Living Conditions Survey, a nationwide comprehensive household survey which included anthropometric measurements, were used. Bivariate and binary logistic regression methods for complex samples were employed. FINDINGS: Overall obesity prevalence was 32% (38% female, 25% male, p = < 0.0001). An inverse relationship by education appeared to be the strongest predictor for all persons (OR = 0.78, CI 0.67, 0.90; p < 0.0001). This relationship was also evident for females (OR = 0.71, CI 0.59, 0.85; p< 0.0001) while a positive relationship existed by economic level for males (OR = 1.23, CI 1.07, 1.41; p = 0 .005). There was a difference in food group expenditure for starchy vegetables only (p = 0.049). Other food group household expenditure, urban residence and female headed households showed no significant differences by obesity. CONCLUSIONS: In line with international trends, obesity rates are high in The Bahamas, and especially affect females of lower socio-economic status. Public policy that targets this group is necessary to address this health concern.

OBJETIVO: Establecer cuáles son las determinantes socio-económicas de la obesidad en los adultos en Bahamas. DISEÑO Y MÉTODOS: Se analizó una subpoblación de adultos de 21 a 60 años en busca de las diferencias socio-económicas según los niveles de obesidad. Se usaron los datos de la Encuesta 2001 sobre las condiciones de vida en Bahamas - una encuesta general doméstica nacional que incluyó mediciones antropométricas. Se emplearon métodos de regresión logística bivariados y binarios para las muestras complejas. RESULTADOS: La prevalencia de obesidad global fue de 32% (38% hembras, 25% varones, p =< 0.0001). Una relación inversa para la educación pareció ser el predictor más fuerte para todas las personas (OR = 0.78, CI 0.67[N1], 0.90; p < 0.0001). Esta relación también se hizo evidente en las hembras (OR = 0.71, CI 0.59, 0.85; p < 0.0001) mientras que una relación positiva existió en el nivel económico para los varones (OR = 1.23, CI 1.07, 1.41; p = 0 .005). Hubo una diferencia en el gasto del grupo de alimentos en cuanto a verduras ricas en fécula solamente (p = 0.049). Otro gasto doméstico de grupo de alimentos, residencia urbana, y casas encabezadas por mujeres, no mostraron diferencias significativas en obesidad. CONCLUSIONES: En concordancia con las tendencias internacionales, las tasas de obesidad son altas en Bahamas, y afectan sobre todo a las mujeres de más bajo estatus socio-económico. Se necesitan políticas públicas dirigidas a este grupo, a fin de abordar este problema de salud.

A cluster randomized controlled trial of an adolescent HIV prevention program among Bahamian youth: effect at 12 months post-intervention.

Behavioral interventions based on the Protection Motivation Theory (PMT) have been demonstrated to reduce HIV risk behavior among mid- and older adolescents in different settings across the globe but have not been evaluated among Caribbean nations and have received limited evaluation among pre-adolescents. To determine (1) the effectiveness among pre-adolescents in The Bahamas of a PMT-based HIV prevention program "Focus on Youth in the Caribbean" (FOYC) and (2) the role of the targeted PMT constructs in intervention effect. 1,360 sixth grade youth (10-11 years of age) from 15 urban schools in New Providence, The Bahamas were randomized by school to receive either FOYC or a control condition. Data collected at baseline, 6 and 12 months post intervention were analyzed. A five-step scheme was used to assess sexual behavior progression, ranging from "1" = "a virgin without intention to have sex" to "5" = "having sex without a condom". Group-based trajectory analysis was utilized in assessing the program effect. Two sexual behavior progression patterns were detected: slow progressors and quick progressors. Receiving FOYC reduced the likelihood for adolescents to become quick progressors (adjusted OR = 0.77, 95% CI: 0.64-1.00). The observed effectiveness was especially impacted by a subset of the targeted PMT constructs. FOYC effectively delays sexual risk among Bahamian pre-adolescents. The group-based trajectory analysis provides an analytical approach for assessing interventions among adolescents with low rates and diverse progression patterns of sexual activity.

Longitudinal predictability of sexual perceptions on subsequent behavioural intentions among Bahamian preadolescents.

OBJECTIVES: To assess the relationship of baseline behavioural intentions and sexual perceptions with subsequent intentions regarding sexual initiation and condom use in Bahamian preadolescents. METHOD: Longitudinal data were obtained at baseline and 8 months later from 424 sexually inexperienced Bahamian youth aged 9-12 years, who served as 'controls' in a HIV risk-reduction intervention study. Sexual perceptions were measured based on a social cognitive model, protection motivation theory. RESULTS: Baseline intention to have sex was a strong predictor of follow-up intention to engage in sex for boys, but was not a predictor for girls. Baseline condom use intention was not related to subsequent intention to use condoms for either male or female youth. Perceptions of girls, compared with boys, were less endorsing of sexual initiation. Some protection motivation theory constructs regarding sexual perceptions were predictive of subsequent behavioural intentions. Among boys, low perceived self-efficacy to avoid sexual intercourse and positive feelings about having sex predicted their intention to have sex. Among girls, perceived peer sexual behaviour and a limited understanding of the adverse consequences of sexual intercourse were predictors of their subsequent intention to initiate sex. Perceived self-efficacy to use condoms and response efficacy of condom use were significant predictors of condom use intention for both boys and girls. CONCLUSIONS: These results suggest that prevention intervention efforts should target predictive perceptions and consider sex differences in sexual perceptions.

Reduction in human immunodeficiency virus risk among youth in developing countries.

OBJECTIVE: To address the 6-month efficacy of a human immunodeficiency virus (HIV) prevention intervention targeted to youth and delivered with and without a parental monitoring intervention in a developing country (the Bahamas). DESIGN: Randomized, controlled, 3-cell intervention trial with a 6-month postintervention follow-up. SETTING: Elementary schools in the Bahamas. PARTICIPANTS: A total of 1282 Bahamian sixth-grade students (and 1175 parents) in 15 schools. INTERVENTIONS: Youth and parents were randomized at the level of the school to receive the following interventions: (1) Focus on Youth in the Caribbean (FOYC) plus Caribbean Informed Parents and Children Together (CImPACT), (2) FOYC plus an attention control for parents (Goal for It [GFI]), or (3) an attention control for the youth (Wonderous Wetlands [WW]) plus the GFI. The 10-session FOYC or WW curriculum was delivered as part of the elementary school curriculum. The GFI or CImPACT was delivered to parents in the evenings or on weekends. MAIN OUTCOME MEASURES: Risk and protective knowledge, condom use skills, perceptions, interventions, and self-reported behaviors. RESULTS: Compared with the WW, the FOYC significantly increased knowledge, condom use skills, protective perceptions, and intentions to engage in safer behaviors. Among youth, no differences were found in knowledge or condom use skills based on parent intervention; among parents, those receiving the CImPACT demonstrated superior condom use skills after the intervention. CONCLUSIONS: Protective knowledge, skills, perceptions, and intentions of youth from 1 developing country can be significantly improved by youth intervention delivered through the schools. Longer follow-up is needed to determine if risk behaviors will be reduced and how long protective results will be sustained.