A qualitative exploration of the health system responses to the screening and management of comorbid mental illness and chronic physical illness in Jamaica.

BACKGROUND: People with comorbid mental illness (MI) and chronic physical illness (CPI) face a range of health and quality of life challenges. The appropriate screening and management of comorbid MI and CPI are crucial to improving outcomes for this population. Despite this, there is a dearth of research exploring the health system response to the screening and management of patients with these comorbidities in public primary care settings, in several jurisdictions including Jamaica. This study explored and described the attitudes, perspectives, experiences, and practices of policymakers, primary care physicians, psychiatrists, and mental health nurses regarding screening and management of comorbid MI and CPI. METHOD: Twenty-nine participants representing policymakers, primary care physicians, psychiatrists, and mental health nurses took part in semi-structured interviews. Data was collected over the period April to November 2020 and subject to thematic analysis. RESULTS: Three overarching themes emerged from the data related to: 1) Policies and Protocols; 2) Clinical Practice; and 3) Personnel. The interplay of these themes illustrated fragmentation and gaps between national policies and guidelines and clinical practice. The findings also identified factors related to personnel, including barriers that limit clinicians' abilities to adequately screen and manage this patient population. CONCLUSION: There is a need for the continued development and revision of policies and protocols that support integrated care for patients with comorbid MI and CPI in primary care settings in Jamaica. Additionally, programs and strategies to improve clinicans knowledge, skills and access to resources are necessary to help them offer improved quality of care around screening and management for this patient population.

Investigating the associations of age of initiation and other psychosocial factors of singular alcohol, tobacco and marijuana usage on polysubstance use: analysis of a population-based survey in Jamaica.

OBJECTIVES: This study aimed to examine concurrent polysubstance use of alcohol, tobacco and marijuana and determine correlations with access to marijuana, friend and familial drug use habits, risk perception and the age of initiation associated with the singular use of these substances. DESIGN: A secondary data analysis. SETTING: Used the Jamaica National Drug Prevalence Survey 2016 dataset. PARTICIPANTS: Involved the entire dataset comprising 4623 randomly selected respondents between 12 and 65 years old. OUTCOME MEASURES: Primary outcome: concurrent polysubstance use recorded as using two or more of alcohol, tobacco and marijuana. Predictor variables include risk perception and age of initiation of singular alcohol, tobacco and marijuana use, ease of marijuana access and family and friend alcohol and illegal drug use. RESULTS: Approximately 58%-66% of respondents commenced singular alcohol, tobacco or marijuana use under 17. Participants commencing marijuana use at 11 years and under and between 12 and 17 were 3.346 and 4.560 times more likely to report past month concurrent polysubstance use (p=0.030 and p<0.001). Respondents who did not believe that smoking tobacco sometimes (p=0.049), and smoking marijuana sometimes and often was harmful, had increased odds of concurrent polysubstance use (p=0.047 and p<0.001, respectively). Respondents who indicated access to marijuana as easy were significantly more likely to report past month concurrent polysubstance use compared with those who reported access as difficult (p=0.002). Participants who indicated that friends or family members get drunk and take illegal drugs were associated with 1.722 and 1.864 increased odds of reporting past month concurrent polysubstance use (p=0.004 and p=0.017, respectively). CONCLUSIONS: Decreased perceived risk, childhood and adolescent age of initiation and easy access to marijuana were significantly associated with polysubstance use among Jamaicans. The influence of friends and family members' drug and alcohol use behaviours on individuals developing polysubstance use habits further endorses the need for interventions.

Prevalence and sociodemographic factors associated with polysubstance use: analysis of a population-based survey in Jamaica.

BACKGROUND: In Latin America and the Caribbean, there is a dearth of research exploring polysubstance use. This study aims to determine the prevalence, varying combinations and associated sociodemographic characteristics of polysubstance use in Jamaica. METHODS: This study involved a secondary data analysis of the Jamaica National Drug Prevalence Survey 2016 dataset where 4,623 participants between the age of 12 and 65 years from each household were randomly selected as respondents. Statistical analysis was performed to determine the prevalence and the sociodemographic correlates of polysubstance use among Jamaicans. RESULTS: 19.6% of respondents used two or more drugs in their lifetime. Of this amount 68.7% reported past year use and 61.9% reported past month use. Bivariate analyses reported polysubstance use was statistically significantly higher amongst males (U = 54,579, p = 0.000), those living in rural areas (U = 91,892, p = 0.003), non-Christian (U = 89,514, p = 0.014), and married persons (U = 74,672, p = 0.000). Past month polysubstance use was statistically significantly higher among employed persons than unemployed persons were (U = 81,342, p = 0.001). Surprisingly, there was a lack of significant differences between education level, household income and past month concurrent polysubstance use (p = 0.609; p = 0.115 respectively). Logistic regression model indicated males were 3.076 times more likely than females to report past month polysubstance use than females. Also, when compared to those 55-65 years old, participants 35-54 years were 2.922 times more likely and those 18-34 years were 4.914 times more likely to report past month polysubstance use. Additionally, those living in rural areas were 1.508 times more likely than participants living in urban areas to report past month polysubstance use. As it relates to occupational status, when compared to armed forces, skilled workers were 4.328 times more likely and unskilled workers were 7.146 times more likely to report past month polysubstance use. CONCLUSIONS: One in five Jamaicans identified as polysubstance users, predominated by marijuana as the most common factor amongst the polysubstance combinations examined, signalling the need for early marijuana interventions.

Cross-sectional mixed-methods study protocol exploring the enablers and barriers for people with severe and enduring mental illness in Jamaica when accessing healthcare for chronic physical illness.

INTRODUCTION: Extant international research suggests that people with severe and enduring mental illness (PWSEMI) experience increased rates of chronic physical illness (CPI), reduced life expectancy and higher mortality than those in the general population. The high prevalence of CPI among PWSEMI is associated with a number of barriers that this population experiences when accessing physical healthcare. Although substantial research has been conducted in North America, Europe and Australia, there appears to be a paucity of research exploring CPI among PWSEMI in the Caribbean region, although this region has reported very high rates of non-communicable diseases within its populations. The current study will be situated in Jamaica and will explore the enablers and barriers to PWSEMI accessing healthcare for CPI. METHODS AND ANALYSIS: A convergent mixed-method design will explore the enablers and barriers to accessing healthcare for CPI among PWSEMI. This cross-sectional study will collect data from PWSEMI, caregivers and family members, community health aides, primary care physicians, psychiatrists and health policymakers. ETHICS AND DISSEMINATION: The study findings will provide baseline data describing the prevalence of CPI among PWSEMI in Jamaica and will identify enablers for, and barriers to, PWSEMI accessing CPI care. Findings will be disseminated widely in Jamaica and internationally to key stakeholders through publications and conferences. Institutional ethical approval was granted from Jamaica's Ministry of Health and Wellness Medico-legal Ethics Review Panel (# 2019/49), the Curtin University Human Research and Ethics Committee (HRE 2020-0022) and the University of the West Indies FMS Ethics Committee (ECP 101, 19/20).

Is sense of belonging at school associated with cannabis use among secondary school students in Barbados?

The objective of this study was to assess whether students' sense of belonging at school was associated with cannabis use among secondary school students in Barbados. This was a cross-sectional study involving a nationally representative weighted sample of 8,538 students drawn from 2nd to 6th forms across public and private secondary schools in Barbados in 2013. Descriptive and inferential statistics was performed using SPSS. Students who had a sense of belonging at school, were attending public schools and were in the 2nd form, had higher odds of reporting past-year and past-month cannabis use. We conclude that there was a significant positive association between students' sense of belonging at school and cannabis use.

Policonsumo simultáneo de drogas en estudiantes de facultades de ciencias de la salud/ciencias médicas en siete universidades de cinco países de América Latina y un país del Caribe: implicaciones de género, legales y sociales / Simultaneous polydrug consuption among undergraduate students of health sciences of seven universities in five Latin American countries and one Caribean country: gender, legal and social implicacions / Policonsumo simultâneo de drogas entre estudantes de graduação de ciências da saúde de sete universidades em cinco países da América Latina e um país do Caribe: implicações de gênero, legal e sociais

El objetivo de este estudio fue comprender los patrones de policonsumo simultáneo de sustancias psicoactivas y sus implicaciones de género, legales y sociales, en estudiantes de primer y segundo año de las facultades de ciencias de la salud/ciencias médicas, en siete universidades de cinco países latinoamericanos, Colombia, Nicaragua, Chile, Brasil y El Salvador, y un país caribeño, Jamaica. El diseño fue un corte transversal. Las combinaciones de alcohol + tabaco y de alcohol + marihuana fueron las mas reportadas en todas las universidades, a excepción de alcohol + tabaco en Jamaica. Los factores asociados al policonsumo más referidos fueron "tener relaciones sexuales inesperada" en la universidad de Brasil, "tener relaciones sexuales sin protección" en las universidades de Chile, Colombia y Nicaragua, "tener problemas con su pareja sentimental" en la universidad de Jamaica, y "ausentarse de clases" en la universidad de El Salvador. Tres entornos se relacionaron, de manera positiva o negativa, con el policonsumo simultáneo de sustancias psicoactivas: estudiantil, familiar y de comportamiento sexual.

The objective of this study was to understand patterns of simultaneous polydrug use of psychoactive substances and its gender, legal and social implications, among first and second year undergraduate students in health sciences/medical sciences faculties from six universities in five Latin American countries, Colombia, Nicaragua, Chile, Brazil, and El Salvador, and one Caribbean country, Jamaica. The study design was cross-sectional. The combinations of alcohol + tobacco and alchol + cannabis were the most frequently reported in all universities, with the exception of alcohol + tabaco in Jamaica. The factors associated to polidrug use most frequently mentioned were "to have unexpected sexual relationships" in the Brazilian university, "to have unprotected sex" in the universities of Chile, Colombia and Nicaragua, "to have problems with his o her sentimental partner" in the Jamaican university, and "to skip classes" in the university of El Salvador. Three environments were related, positively or negatively, with simultaneous polydrug use of psychoactive substances: academic, familiar and sexual behavioral.

Estudo de corte transversal que teve por objetivo compreender os padrões de policonsumo simultâneo de substâncias psicoativas e suas implicações de gênero, direitos legais e sociais entre estudantes do primeiro e segundo ano de faculdades de ciencias da saúde/médicas, de sete universidades, em cinco países latinoamericanos e um do Caribe. Os resultados indicam que o uso de múltiplas drogas simultâneas como álcool + tabaco foi maior para as universidades na Colômbia, Nicarágua, Chile, Brasil e El Salvador, com exceção da Jamaica, seguido por policonsumo simultâneo de álcool + maconha. A consequencia mais comum entre os estudantes que usam mais de uma substância psicoativa é o "sexo eventual" na Universidade do Brasil; "ter relações sexuais sem proteção" nas Universidades do Chile, Colômbia e Nicarágua; "ter problemas com seu parceiro sentimental" na Universidade da Jamaica, e ausentar-se das aulas" para a Universidade de El Salvador. Conclui-se que os modelos representam a existência de três ambientes relacionados entre si, positiva ou negativamente, com o uso simultâneo de substâncias psicoativas: ou seja, estudante, família do aluno e comportamento sexual.

Gender differences in simultaneous polydrug use among undergraduate students of one university, Kingston - Jamaica / Diferencias de género en el policonsumo simultáneo de drogas entre estudiantes de pregrado en una universidad, Kingston - Jamaica / Diferenças de gênero no policonsumo simultâneo de drogas entre estudantes de graduação em uma universidade, Kingston - Jamaica

This study sought to explore the simultaneous polydrug use pattern across genders of 1st and 2nd year undergraduate students in one university in Kingston, Jamaica. There were 295 study participants (58 males and 237 females) from the faculty of Medical Sciences at a local university. The study used a self administered questionnaire which addressed various aspects of drug use and simultaneous polydrug use. Unadjusted results revealed a significantly higher simultaneous polydrug use among males than females 40.9% and 14.3% respectively in the last 12 months (χ², p=0.009) and in the last 30 days 8.9% vs. 1.7% (χ², p=0.014). These results suggest a prominence of simultaneous polydrug use behaviour among male undergraduate students in this population compared with females, although further research is required.

Este estudio tuvo como objetivo explorar el patrón comparativo de policonsumo simultáneo de drogas entre géneros, en estudiantes de 1º y 2º año de pregrado en una universidad en Kingston, Jamaica. Hubo 295 participantes en el estudio (58 hombres y 237 mujeres) de la Facultad de Ciencias Médicas de esta universidad local. El estudio utilizó un cuestionario auto-administrado en el que se abordaron diversos aspectos del consumo y poli-consumo simultáneo de drogas. Los resultados no-ajustados revelaron un significativo mayor nivel de policonsumo simultaneo en hombres que en mujeres 40,9% y 14,3% respectivamente en los últimos 12 meses (χ², p=0,009) y en los últimos 30 días 8,9% vs. 1,7% (χ², p=0,014). Estos resultados sugieren un predominio en el comportamiento de policonsumo simultáneo de drogas entre hombres estudiantes de pregrado en esta población comparado con mujeres, aunque se refiere investigación adicional.

Este estudo procurou explorar o padrão de policonsumo simultâneo de drogas entre diferentes sexos de alunos do 1º e 2º ano de graduação em uma universidade em Kingston, Jamaica. Participaram do estudo 295 estudantes (58 homens e 237 mulheres) da Faculdade de Ciências Médicas em uma universidade local. O estudo utilizou um questionário auto-administrável que abordou diversos aspectos do uso de drogas e policonsumo simultâneo de drogas. Os resultados não ajustados revelaram que o uso entre os homens são significativamente maiores do que as mulheres 40,9% e 14,3% respectivamente foram encontrados uso simultâneos de drogas nos últimos 12 meses (χ², p=0,009) e nos últimos 30 dias 8,9% vs. 1,7% (χ², p=0,014). Estes resultados sugerem uma predominância no comportamento dos policonsumo de drogas entre os homens de graduação nesta população em relação às mulheres, embora a necessidade de mais pesquisas nessa área.