Quality of Asthma Management in Children Attending Health Centres in Kingston & St. Andrew, Jamaica Compared with International Clinical Practice Guidelines.

OBJECTIVES: To assess the quality of asthma care within the paediatric population who attended health centres in Kingston & St. Andrew (KSA) and compare this quality to Global Initiative for Asthma (GINA) guidelines. METHODS AND MATERIALS: Data were collected from 257 dockets of children aged 2-17 years old with asthma attending seven health centres in KSA. RESULTS: Children aged 6-10 years accounted for 36.6% of the sample and males accounted for the majority (54.1%). There was generally poor documentation of performance indicators for asthma including written asthma action plans (1%), peak expiratory flow measurements (0%), inhaler demonstration (2.1%), and asthma control assessment (8.4%). The best documentation was for controller (60.9%) and reliever medication (63.4%) prescriptions/review. CONCLUSION: The study indicates that the documentation of paediatric asthma management in health centres in Jamaica is not congruous with international clinical practice guidelines and change is required.

Predictors of Health Service Utilization Among Older Men in Jamaica.

OBJECTIVES: To determine the relative influence of sociodemographic, socioeconomic, psychosocial, and health variables on health service utilization in the last 12 months. METHODS: Data were analyzed for 1,412 men ≥60 years old from a 2012 nationally representative community-based survey in Jamaica. Associations between six health service utilization variables and several explanatory variables were explored. Logistic regression models were used to identify independent predictors of each utilization measure and determine the strengths of associations. RESULTS: More than 75% reported having health visits and blood pressure checks. Blood sugar (69.6%) and cholesterol (63.1%) checks were less common, and having a prostate check (35.1%) was the least utilized service. Adjusted models confirmed that the presence of chronic diseases and health insurance most strongly predicted utilization. A daughter or son as the main source of financial support (vs self) doubled or tripled, respectively, the odds of routine doctors' visits. Compared with primary or lower education, tertiary education doubled [2.37 (1.12, 4.95)] the odds of a blood pressure check. Regular attendance at club/society/religious organizations' meetings increased the odds of having a prostate check by 45%. DISCUSSION: Although need and financial resources most strongly influenced health service utilization, psychosocial variables may be particularly influential for underutilized services.

Patterns of depressive symptoms among younger elderly (60-74 years old) and older elderly (≥75 years old) in Jamaica.

OBJECTIVES: We sought to explore factors associated with depressive symptom severity among older persons (≥60 years of age) and to compare the depressive symptoms commonly experienced by older elderly (≥75 years) with those commonly experienced by younger elderly (<75 years). DESIGN: Secondary analysis was conducted on data from a nationally representative survey. SETTING: Four parishes in Jamaica. PARTICIPANTS: A total of 2,943 older community dwellers participated. MEASUREMENTS: The survey included the Zung Self-rating Depression Scale (ZSDS), the Mini Mental State Examination (MMSE), and items on age, sex, and educational level. Linear regression analysis was used to determine the association between ZSDS score and: age, sex, MMSE score, and educational level. Logistic regression analysis was used to determine, for each ZSDS item, whether particular responses were more associated with older or younger elderly. RESULTS: Higher ZSDS scores were associated with increasing age (B = 0.13, p < 0.001), lower MMSE score (B = -0.42, p < 0.001), the female sex (B = 3.52, p < 0.001), and lower educational level (B = -1.27, p < 0.001). The ZSDS items that were endorsed significantly more (p < 0.05) by older elderly related to negative evaluations about their functionality and value. Hopelessness was also more prominent among the older elderly. The items that were endorsed significantly more (p < 0.05) by the younger elderly had less of a focus. CONCLUSION: Among older persons, increasing age was associated with marginally higher levels of depressive symptoms. Female gender, cognitive deficits, preoccupations about value and functionality, and feelings of hopelessness may serve as useful screening parameters.

Alcohol use, depression, and life satisfaction among older persons in Jamaica.

BACKGROUND: We aimed to determine the prevalence of alcohol use among older Jamaicans as well as to explore among this population the relationships between alcohol use and: age, sex, depressive symptoms, and life satisfaction. Although the nature of these relationships among the proposed study population were uncertain, in other settings alcohol use has tended to decline with increasing age, occur more commonly among men than women, and show non-linear relationships with depressive symptoms and life satisfaction. METHODS: Data gathered by two-stage cluster sampling for a nationally representative health and lifestyle survey of 2,943 community-dwelling older Jamaicans, aged 60 to 103 years, were subjected to secondary analysis using the Student's t-test and χ 2 test as appropriate. RESULTS: Current alcohol use was reported by 21.4% of the participants. It steadily declined with age and was six times more prevalent among men (37.6%) than women (6.2%). These findings were statistically significant as were associations of current alcohol use with comparatively lower levels of depressive symptoms. Current alcohol use was also more prevalent among persons who were either highly satisfied or highly dissatisfied with their lives, compared to others who had levels of life satisfaction between these two extremes. CONCLUSIONS: Current alcohol use among older Jamaicans occurs primarily among men, declines with increasing age, and is associated with a relatively low likelihood of depression. It is also associated with very high and very low levels of life satisfaction.

Participation in Social Activities and the Association with Socio-Demographic and Health-Related Factors among Community-Dwelling Older Adults in Jamaica.

Social participation is critical for maintaining independence and facilitating active ageing. The aim of this paper is to describe participation in social activities among older adults in Jamaica and to identify independently associated socio-demographic and health characteristics. We analysed data from a nationally representative, community-based survey of 2943 persons 60 years and older. Sixty-three percent of older adults attended religious services and 60 % were visited by friends at least once per month in the 12 months preceding the survey. Age was not independently associated with social participation. Persons with post-secondary level education were twice as likely as those with primary education or less, to be visited by friends and to attend meetings of formal organisations. Men, persons not in union, and those with less functional independence had reduced odds of attending meetings of formal organisations. These variables were however not independently associated with having visits with friends. Persons with a positive depression screen were between 42 % and 44 % less likely to be visited by friends. Persons who received an income through livestock/farming were more likely to visit or be visited by friends. The variables independently associated with social participation vary depending on the type of social activity considered. Where possible, health and social interventions should focus on prevention, delay and reversal of risk factors associated with reduced social participation. Social participation programmes should be prioritized and be informed by input from older adults. Future research should include other forms of social interactions and clarify older adults' perceptions of their quality.

Characteristics related to sexual experience and condom use among Jamaican female adolescents.

Young women in Jamaica face significant risk for HIV and other STIs. A clearer understanding of the factors associated with sexual experience and unprotected intercourse is needed. Data were collected from 330 adolescent females aged 13 to 17 recruited through community based organizations in Kingston, Jamaica, from 2009-2011. Nearly one-third of sexually experienced participants reported not using a condom the last time they had sex. Characteristics associated with sexual experience included older age, marijuana use, and less comfort talking to mother about sexual topics. Characteristics associated with condom use included perceived importance of religion, positive attitudes toward condoms, and not-having multiple sexual partners. Sexually experienced Jamaican female adolescents were engaging in behaviors that made them vulnerable to HIV and other STIs. Interventions with young adolescent girls and their mothers are recommended to postpone sexual debut and promote safer sexual behaviors in those who do engage in sex.

Asthma and allergies in Jamaican children aged 2-17 years: a cross-sectional prevalence survey.

OBJECTIVE: To determine the prevalence and severity of asthma and allergies as well as risk factors for asthma among Jamaican children aged 2-17 years. DESIGN: A cross-sectional, community-based prevalence survey using the International Study of Asthma and Allergies in Childhood questionnaire. The authors selected a representative sample of 2017 children using stratified, multistage cluster sampling design using enumeration districts as primary sampling units. SETTING: Jamaica, a Caribbean island with a total population of approximately 2.6 million, geographically divided into 14 parishes. PARTICIPANTS: Children aged 2-17 years, who were resident in private households. Institutionalised children such as those in boarding schools and hospitals were excluded from the survey. PRIMARY AND SECONDARY OUTCOME MEASURES: The prevalence and severity of asthma and allergy symptoms, doctor-diagnosed asthma and risk factors for asthma. RESULTS: Almost a fifth (19.6%) of Jamaican children aged 2-17 years had current wheeze, while 16.7% had self-reported doctor-diagnosed asthma. Both were more common among males than among females. The prevalence of rhinitis, hay fever and eczema among children was 24.5%, 25% and 17.3%, respectively. Current wheeze was more common among children with rhinitis in the last 12 months (44.3% vs 12.6%, p<0.001), hay fever (36.8% vs 13.8%, p<0.001) and eczema (34.1% vs 16.4%, p<0.001). Independent risk factors for current wheeze (ORs, 95% CI) were chest infections in the first year of life 4.83 (3.00 to 7.77), parental asthma 4.19 (2.8 to 6.08), rhinitis in the last 12 months 6.92 (5.16 to 9.29), hay fever 4.82 (3.62 to 6.41), moulds in the home 2.25 (1.16 to 4.45), cat in the home 2.44 (1.66 to 3.58) and dog in the home 1.81 (1.18 to 2.78). CONCLUSIONS: The prevalence of asthma and allergies in Jamaican children is high. Significant risk factors for asthma include chest infections in the first year of life, a history of asthma in the family, allergies, moulds and pets in the home.

Jamaican mothers' influences of adolescent girls' sexual beliefs and behaviors.

PURPOSE: The purpose of this study was to identify the ways in which urban Jamaican mothers influence their adolescent daughters' sexual beliefs and behaviors in order to incorporate them into the design of a family-based human immunodeficiency virus (HIV) risk reduction intervention program. DESIGN: Focus groups were conducted with 46 14- to 18-year-old adolescent girls and 30 mothers or female guardians of adolescent girls recruited from community-based organizations in and around Kingston and St. Andrew, Jamaica. Separate focus groups were held with mothers and daughters; each included 6 to 10 participants. Focus group sessions were scripted, led by teams that included trained Jamaican and American facilitators and note-takers, and audio-taped to ensure data accuracy. Data were analyzed using qualitative content analysis. FINDINGS: Four major maternal influences were identified: mother-daughter relationship quality, mother-daughter sexual communication, monitoring or supervision, and maternal sexual role modeling. Mothers' and daughters' reports were consistent; both groups identified positive and negative influences within each category. CONCLUSIONS: Some maternal influences were positive and health promoting; others were negative and promoted unsafe sexual activity and risk for HIV and other sexually transmitted infections. These influences were incorporated into the design of a culture-specific family-based HIV risk reduction intervention tailored to the needs of urban Jamaican adolescent girls and their mothers. CLINICAL RELEVANCE: In order to be effective, family-based HIV risk reduction interventions should be theory based and tailored to the target audience. The four maternal influences identified in this formative study were incorporated into the subsequent intervention design.

Jamaican adolescent girls with older male sexual partners.

PURPOSE: The purpose of this study was to describe the relationships between adolescent girls and older male sexual partners in urban Kingston, Jamaica, and identify the human immunodeficiency virus (HIV)-related sexual risks that occur within these relationships. DESIGN: The study employed a descriptive qualitative design. METHODS: Data were collected through focus groups and individual interviews conducted with 43 late adolescent girls (18-21 years old). An age-discordant relationship was defined as a sexual relationship between a Jamaican adolescent female and a man who was 2 or more years older. Data were analyzed using qualitative content analysis. FINDINGS: Age-discordant relationships were common and often began when girls were early adolescents. Both adolescent girls and older men tended to have multiple partners, and transactions of gifts, money, or resources from an older partner were expected and common. Older partners were highly influential in HIV-related risk behaviors. CONCLUSIONS: Age-discordant relationships need to be explicitly addressed in HIV prevention programs for adolescent girls in Jamaica. Further, the implications of gift-giving, informal sexual transactions, and intradyadic power must be incorporated into strategies for reducing HIV-related sexual risk with older partners. Future studies should examine the perspectives of Jamaican men. CLINICAL RELEVANCE: This study found that many Jamaican adolescent girls engage in sexual relationships with older men and that the unique characteristics of these relationships may increase girls' risks for HIV and other sexually transmitted diseases. HIV risk reduction interventions for adolescent girls should address sexual risks associated with older male partners.

The Jamaica asthma and allergies national prevalence survey: rationale and methods.

BACKGROUND: Asthma is a significant public health problem in the Caribbean. Prevalence surveys using standardized measures of asthma provide valid prevalence estimates to facilitate regional and international comparisons and monitoring of trends. This paper describes methods used in the Jamaica Asthma and Allergies National Prevalence Survey, challenges associated with this survey and strategies used to overcome these challenges. METHODS/DESIGN: An island wide, cross-sectional, community-based survey of asthma, asthma symptoms and allergies was done among adults and children using the European Community Respiratory Health Survey Questionnaire for adults and the International Study of Asthma and Allergies in Children. Stratified multi-stage cluster sampling was used to select 2, 163 adults aged 18 years and older and 2, 017 children aged 2-17 years for the survey. The Kish selection table was used to select one adult and one child per household. Data analysis accounted for sampling design and prevalence estimates were weighted to produce national estimates. DISCUSSION: The Jamaica Asthma and Allergies National Prevalence Survey is the first population- based survey in the Caribbean to determine the prevalence of asthma and allergies both in adults and children using standardized methods. With response rates exceeding 80% in both groups, this approach facilitated cost-effective gathering of high quality asthma prevalence data that will facilitate international and regional comparison and monitoring of asthma prevalence trends. Another unique feature of this study was the partnership with the Ministry of Health in Jamaica, which ensured the collection of data relevant for decision-making to facilitate the uptake of research evidence. The findings of this study will provide important data on the burden of asthma and allergies in Jamaica and contribute to evidence-informed planning of comprehensive asthma management and education programs.

Culture-specific factors contributing to HIV risk among Jamaican adolescents.

The purpose of this article is to describe the results from an elicitation research study addressing the multisystem-level factors that contribute to HIV risk among Jamaican adolescents. Focus group and survey data were determined from parents, adolescents, and teachers in Kingston, Jamaica, from 2004 and 2005. Guided by an ecological extension of the Theory of Planned Behavior, focus groups and survey questionnaires identified cultural factors at the individual, family, and societal levels that significantly influence Jamaican adolescents' behavioral, normative, and control beliefs related to sexual behaviors that contribute to risk for HIV and other sexually transmitted infections. Although some factors were similar to those reported among adolescents living in the United States, others were culture-specific influences and beliefs that were unique to Jamaica. Results from the current study could contribute to the development of theory-based, culture-specific HIV risk-reduction interventions for use with Jamaican adolescents.

The Jamaica asthma and allergies national prevalence survey: rationale and methods

BACKGROUND: Asthma is a significant public health problem in the Caribbean. Prevalence surveys using standardized measures of asthma provide valid prevalence estimates to facilitate regional and international comparisons and monitoring of trends. This paper describes methods used in the Jamaica Asthma and Allergies National Prevalence Survey, challenges associated with this survey and strategies used to overcome these challenges. METHODS/DESIGN: An island wide, cross-sectional, community-based survey of asthma, asthma symptoms and allergies was done among adults and children using the European Community Respiratory Health Survey Questionnaire for adults and the International Study of Asthma and Allergies in Children. Stratified multi-stage cluster sampling was used to select 2, 163 adults aged 18 years and older and 2, 017 children aged 2-17 years for the survey. The Kish selection table was used to select one adult and one child per household. Data analysis accounted for sampling design and prevalence estimates were weighted to produce national estimates.DISCUSSION: The Jamaica Asthma and Allergies National Prevalence Survey is the first population- based survey in the Caribbean to determine the prevalence of asthma and allergies both in adults and children using standardized methods. With response rates exceeding 80% in both groups, this approach facilitated cost-effective gathering of high quality asthma prevalence data that will facilitate international and regional comparison and monitoring of asthma prevalence trends. Another unique feature of this study was the partnership with the Ministry of Health in Jamaica, which ensured the collection of data relevant for decision-making to facilitate the uptake of research evidence. The findings of this study will provide important data on the burden of asthma and allergies in Jamaica and contribute to evidence-informed planning of comprehensive asthma management and education programs.