COVID-19: Ask the Experts about Contacts Tracing: The Bahamian experience

Haemosporidian parasites of resident and wintering migratory birds in The Bahamas.

In temperate regions, some avian haemosporidian parasites have evolved seasonal transmission strategies, with chronic infections relapsing during spring and transmission peaking during the hosts' breeding season. Because lineages with seasonal transmission strategies are unlikely to produce gametocytes in winter, we predicted that (1) resident birds living within wintering areas of Neotropical migrants would unlikely be infected with North American parasite lineages; and (2) if infected, wintering migratory birds would be more likely to harbor Plasmodium spp. rather than Parahaemoproteus spp. or Haemoproteus spp. parasites in their bloodstreams, as only Plasmodium produces life stages, other than gametocytes, that infect red blood cells. To test these predictions, we used molecular detection and microscopy to compare the diversity and prevalence of haemosporidian parasites among year-round residents and wintering migratory birds during February 2016, on three islands of The Bahamas archipelago, i.e., Andros, Grand Bahama, and Great Abaco. Infection prevalence was low and comparable between migratory (15/111) and resident (15/129) individuals, and it did not differ significantly among islands. Out of the 12 lineages detected infecting migratory birds, five were transmitted in North America; four lineages could have been transmitted during breeding, wintering, or migration; and three lineages were likely transmitted in The Bahamas. Resident birds mostly carried lineages endemic to the Caribbean region. All North American-transmitted parasite lineages detected among migratory birds were Plasmodium spp. Our findings suggest that haemosporidian parasites of migrants shift resource allocation seasonally, minimizing the production of gametocytes during winter, with low risk of infection spillover to resident birds.

"Getting to Zero New HIV Infections in the Caribbean": Knowledge and Attitudes Toward Male Circumcision Among Adolescent Males in The Bahamas.

Male circumcision (MC) plays a significant role in reducing new HIV infections, particularly in high prevalence countries. This cross-sectional study assesses the prevalence of MC and attitudes toward MC among youth aged 15-18 years in The Bahamas, a medium HIV prevalence country. The survey included 797 young men who completed a questionnaire on MC. Data analyses included chi-squared tests. The self-reported prevalence of MC among youth was 16.7% (121/759). Most of the circumcised youth were circumcised as infants, 84% (107/121) were pleased with their circumcision, and 71% would recommend it to others. For uncircumcised youth, 35% (189/533) would consider voluntary male circumcision (VMC) and 26% would recommend MC to others. In all scenarios, circumcised youth were more likely to be positive about MC. Among uncircumcised young men, being older (17-18 years compared to 15-16 years) was the only variable statistically associated with considering MC or recommending MC. After being presented with information on the benefits of MC for HIV prevention, the number of men who were positive about MC increased. Most of the young men in this cohort would consider VMC for reducing HIV incidence. Also, many stated that, if they had a male child, they would have him circumcised. The attitudes of these youth emphasize the need to provide information on HIV in addition to general health benefits of MC if there were to be a sustainable MC program within this population.

Ten-year Survival Rates for Women of Grand Bahama Island, The Bahamas, Diagnosed with Breast Cancer in 1988-2002 / Tasas de diez años de supervivencia en las mujeres de Gran Bahama, Bahamas, diagnosticadas con cáncer de mama en 1988-2002

ABSTRACT A total of 150 women from Grand Bahama Island, The Bahamas, with cancer of the breast were followed up for 10 years post-diagnosis to assess survival rates, not only generally, but also by age and stage of disease at diagnosis, the presence or absence of axillary lymph node metastases, the treatment modalities received, and the diagnostic periods. The patients' medical records and the death registers of the Medical Records Department of Rand Memorial Hospital (RMH), Grand Bahama Island, supplemented with data from the ledgers of the Pathology Department of RMH and from The Bahamas ' national death register, were utilized. By Pearson Chi-square and Kaplan-Meier survival analysis, females who were 40 years old or younger lived significantly longer (71.2% of whom for at least 10 years; mean: 213.8 months) than those who were older than 40 years (42.9% of whom for at least 10 years; mean: 167.9 months). The absence or presence of axillary lymph node metastases also had a bearing on survival, with 71.9% surviving at least 10 years (mean: 243.9 months) versus 32.7% (mean: 108.1 months) respectively. Despite the accepted importance of the diagnostic stage of disease, the small sample size obtained allowed only a limited assessment of the influence of staging on the survival rates. Neither the treatment received nor the diagnostic periods had any significant influence on the survival rates. The establishment of a national cancer registry in The Bahamas would alleviate the problems due to retrieval of information and aid in the better management and follow-up of cancer. Because of a relatively young age at diagnosis, consideration must also be given to beginning mammography screening of Bahamian women at an age below 40 years.

RESUMEN Un total de 150 mujeres con cáncer de mama en Gran Bahama, Bahamas, recibieron un seguimiento de 10 años después del diagnóstico, a fin de evaluar las tasas de supervivencia. La evaluación de las tasas de supervivencia se realizó no sólo de manera general, sino también sobre la base de la edad y etapa de la enfermedad en el momento del diagnóstico, la presencia o ausencia de metástasis en los ganglios axilares, las modalidades de tratamiento recibidas, y los períodos de diagnóstico. A tal fin, se utilizaron las historias clínicas de los pacientes y los registros de defunción existentes en el Departamento de Historias Clínicas del Hospital Rand Memorial (HRM) de Gran Bahama, complementados con datos provenientes de los libros de archivo del Departamento de Patología de HRM y el Registro Nacional de Defunciones de Bahamas. Según el análisis de la supervivencia mediante Pearson Chi-Square y Kaplan-Meier, las mujeres de 40 años o más jóvenes vivieron significativamente más tiempo (71.2% de ellas por lo menos diez años; promedio: 213.8 meses) que las mayores de 40 años (42.9% de ellas por lo menos diez años; promedio: 167.9 meses). La ausencia o presencia de metástasis en los ganglios axilares también tuvo una incidencia en la supervivencia, sobreviviendo el 71.9% por lo menos 10 años (promedio: 243.9 meses) frente a un 32.7% (promedio: 108.1 meses) respectivamente. A pesar de la reconocida importancia de la etapa diagnóstica de la enfermedad, el pequeño tamaño de la muestra obtenida permitió sólo una evaluación limitada de la influencia de la estadificación en las tasas de supervivencia. Ni el tratamiento recibido ni los periodos de diagnóstico tuvieron influencia significativa en las tasas de supervivencia. El establecimiento de un registro nacional del cáncer en las Bahamas aliviaría los problemas relacionados con la recuperación de información y ayudaría a un mejor tratamiento y seguimiento del cáncer. Debido a la edad relativamente joven en que realiza el diagnóstico, debe considerarse también comenzar la investigación de la mamografia de las mujeres de las Bahamas antes de los 40 años.

Short report: Follow-up of Bahamian women with a BRCA1 or BRCA2 mutation.

PURPOSE: We sought to determine to what extent the knowledge of carrying a BRCA1 or BRCA2 mutation influences the uptake of preventive surgeries in Bahamian women, including bilateral salpingo-oophorectomy and bilateral mastectomy. PATIENTS AND METHODS: The study population consisted of 78 female residents of the Bahamas for whom a BRCA1 or BRCA2 mutation had been detected between 2004 and 2014. The mean age of the 78 participants at the time of genetic testing was 46 years (age range 22-73 years). The mean time of follow-up was 4.4 years. RESULTS: Of the 78 study participants, 19 women had a bilateral salpingo-oophorectomy (24%). Seven out of 37 patients who had unilateral breast cancer chose to remove the unaffected contralateral breast (19%). Three of 13 patients with no history of breast cancer chose to have a prophylactic bilateral mastectomy (23%). CONCLUSION: Preventive surgery is an acceptable option for a significant proportion of Bahamian women with a BRCA1 or BRCA2 mutation. It will be important to identify and reduce barriers to preventive surgery in the Bahamas in order that the benefit of getting testing can be fully realized.

Presence of Salmonella and Escherichia coli O157 on the hide, and presence of Salmonella, Escherichia coli O157 and Campylobacter in feces from small-ruminant (goat and lamb) samples collected in the United States, Bahamas and Mexico.

The objective of this study was to evaluate the frequency of Salmonella and E. coli O157 found on the hides, as well as presence of Salmonella, Campylobacter and E. coli O157 found in small-ruminant fecal samples from abattoirs and farms in California, New Mexico, Texas, Mexico and the Bahamas. In small-ruminant fecal samples, overall organism presence was identified as 13.9% Salmonella (n=532), 15.3% E. coli O157 (n=477) and 80.7% Campylobacter (n=176). Overall, on small-ruminant hide surfaces, Salmonella frequency was 17.1% (N=339) and E. coli O157 was detected at 1.5% (n=266). The overall lower detection (P<0.0001) of E. coli O157 from hide samples (1.5%) when compared to presence in fecal samples (15.3%), is not consistent with trends expected. Results from this study can be used to better understand and potentially control pathogens in small-ruminants utilized for meat and milk.

Adolescent HIV Risk Reduction in the Bahamas: Results from Two Randomized Controlled Intervention Trials Spanning Elementary School Through High School.

To address global questions regarding the timing of HIV-prevention efforts targeting youth and the possible additional benefits of parental participation, researchers from the USA and The Bahamas conducted two sequential longitudinal, randomized trials of an evidence-based intervention spanning the adolescent years. The first trial involved 1360 grade-6 students and their parents with three years of follow-up and the second 2564 grade-10 students and their parents with two years of follow-up. Through grade-12, involvement in the combined child and parent-child HIV-risk reduction interventions resulted in increased consistent condom-use, abstinence/protected sex, condom-use skills and parent-child communication about sex. Receipt of the grade-6 HIV-prevention intervention conferred lasting benefits regarding condom-use skills and self-efficacy. Youth who had not received the grade-six intervention experienced significantly greater improvement over baseline as a result of the grade-10 intervention. The HIV-risk reduction intervention delivered in either or both grade-6 and grade-10 conferred sustained benefits; receipt of both interventions appears to confer additional benefits.

Cross-sectional data on alcohol and marijuana use and sexual behavior among male and female secondary school students in New Providence, The Bahamas.

BACKGROUND: While The Bahamas have significantly reduced poor reproductive health outcomes among adolescents and emerging adults, data indicate that youth are engaged in sexual risk behaviors. Substance use has been linked to increased risk for HIV and sexually transmitted infections in other contexts. There are limited data on Bahamian youth in relation to consumption of alcohol and marijuana use and engagement in sexual behaviors. OBJECTIVE: This study aimed to assess potential relationships between alcohol and marijuana use and engagement in sexual behavior among government secondary school students in New Providence, The Bahamas. MATERIALS AND METHODS: Total sample size was 2572, and about 56% of respondents were female. Mean age was 14.2 (SD 2.7 years). Cross-sectional data came from a baseline survey conducted as part of a longitudinal randomized controlled evaluation of a school-based HIV prevention and reproductive health program in New Providence. RESULTS: Overall, 46.5% (519) males and 44.8% (652) females reported alcohol consumption; 7.3% (82) males and 1.7% (25) females reported use of marijuana in the last 6 months. About 43% (477) male respondents and 16% (231) female respondents reported ever having vaginal sex. Logistic regression analysis indicates that increased likelihood of engaging in sex during the past 6 months is associated with being older, male, and consuming alcohol and marijuana. CONCLUSION: These data provide a 'global correlation' between substance use and engagement in sexual behaviors among Bahamian adolescents. Longitudinal research is needed to assess event specific risks and identify mediating and moderating factors. These findings indicate the importance of integrating reproductive health and substance use education.

Factors influencing implementation dose and fidelity thereof and related student outcomes of an evidence-based national HIV prevention program.

BACKGROUND: Teachers' implementation of evidence-based prevention programs in schools is inconsistent. Using data gathered from the national implementation among grade six students in The Bahamas of an evidence-based HIV intervention [Focus on Youth in the Caribbean (FOYC)], this study examines differences in the degree of implementation ("dose") and adherence to the core activities ("fidelity of implementation") by teachers according to theoretically and historically relevant teachers' characteristics, attitudes, and experiences pre-intervention and post-intervention. The relationship of implementation dose and implementation fidelity is assessed according to student outcomes. METHODS: Beginning in 2008, the Bahamian Ministry of Education (MOE) included FOYC in the grade six curriculum nationwide. Consistent with standard practice, teachers were offered MOE training workshops in FOYC prior to delivery. The MOE conducted an anonymous curricular assessment among the grade six students at the beginning and end of the school year. Teachers agreeing to participate in the research component were asked to complete a pre-implementation and post-implementation assessment of attitudes and prior experiences. RESULTS: Teachers taught 15.6 out of 30 core activities, 24 out of the 46 total activities, and 4.6 out of 8 sessions on average. Three teachers' implementation groups were identified: 1) High Implementation Group (31.7% of the teachers), characterized by high levels of implementation dose and fidelity of implementation; 2) Moderate Implementation Group (52.8%), showing moderate levels of implementation dose but high levels of fidelity of implementation; and 3) Low Implementation Group (15.6%), with low levels of implementation dose and fidelity of implementation. Low Implementation Group teachers compared to teachers in the two higher performing groups had less training in interactive teaching, limited prior exposure to the FOYC curriculum, incomplete attendance at FOYC training workshops, and low levels of comfort in teaching FOYC lessons. Students taught by teachers in the Low Implementation Group demonstrated poorer outcomes relevant to the four student outcomes (HIV/AIDS knowledge, preventive reproductive health skills, self-efficacy, and intention to use protection if they were to have sex). CONCLUSIONS: Both implementation dose and implementation fidelity are related to student outcomes. Teachers at risk for limited implementation can be identified pre-intervention, thus opening the possibility for focused pre-intervention training.

Reptile-associated ticks from Dominica and the Bahamas with notes on hyperparasitic erythraeid mites.

Ticks were collected or recorded from 522 individual reptiles on Dominica and from 658 reptiles from the Bahamas. Two species of ticks were collected on Dominica: Amblyomma antillorum and Amblyomma rotundatum. Similarly, 2 species were collected in the Bahamas: Amblyomma albopictum and Amblyomma torrei. On Dominica, A. antillorum was recorded from 517 Lesser Antillean iguanas (Iguana delicatissima), 2 boa constrictors (Boa nebulosa), 1 Antilles snake (Alsophis sibonius), and 1 Dominican ground lizard (Ameiva fuscata), whereas A. rotundatum was recorded from 1 Lesser Antillean skink (Mabuya mabouya). In the Bahamas, A. albopictum was recorded from 131 Andros iguanas (Cyclura cychlura cychlura), 271 Exuma Island iguanas (Cyclura cychlura figginsi), and 1 Andros curlytail lizard (Leiocephalus carinatus coryi), whereas A. torrei was recorded from 255 Exuma Island iguanas. In the Bahamas, A. albopictum parasitized iguanas on Andros Island and the central Exuma Islands, and A. torrei parasitized iguanas in the southern Exumas. An exception to this trend was that A. torrei was collected from iguanas on Pasture Cay in the central Exumas, an anomaly that is explained by the fact that iguanas (with attached ticks) on Pasture Cay were introduced by humans in the past from islands further south. External hyperparasitic larval erythraeid mites ( Leptus sp.) were recorded from A. torrei in the Bahamas.

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.

Parasitism in Pterois volitans (Scorpaenidae) from coastal waters of Puerto Rico, the Cayman Islands, and the Bahamas.

Recently, Pterois volitans, a Pacific species of lionfish, invaded the Atlantic Ocean, likely via the aquarium trade. We examined for internal and external parasites 188 individuals from 8 municipalities of Puerto Rico collected during 2009-2012, 91 individuals from Little Cayman, Cayman Islands, collected during the summers of 2010 and 2011, and 47 individuals from Lee Stocking Island, Bahamas, collected during the summer of 2009. In total, 27 parasite taxa were found, including 3 previously reported species from lionfish, the digenean Lecithochirium floridense, the leech Trachelobdella lubrica, and an Excorallana sp. isopod. We also report another 24 previously unreported parasite taxa from lionfish, including digeneans, monogeneans, cestodes, nematodes, isopods, a copepod, and an acanthocephalan. Among these parasites, several were previously unreported at their respective geographic origins: We report 5 new locality records from Puerto Rico, 9 from Cayman Islands, 5 from the Bahamas, 5 from the Caribbean, and 3 from the subtropical western Atlantic region. Three parasites are reported to associate with a fish host for the first time. The parasite faunas of P. volitans among our 3 study sites were quite different; most of the species infecting lionfish were generalists and/or species that infect carnivorous fishes. Although our study did not assess the impact of parasites on the fitness of invasive lionfish, it provides an important early step. Our results provide valuable comparative data for future studies at these and other sites throughout the lionfish's invaded range.

Neighbourhood factors and depression among adolescents in four Caribbean countries.

BACKGROUND: Past research suggests that perceived neighbourhood conditions may influence adolescents' emotional health. Relatively little research has been conducted examining the association of perceived neighbourhood conditions with depressive symptoms among Caribbean adolescents. This project examines the association of perceived neighbourhood conditions with levels of depressive symptoms among adolescents in Jamaica, the Bahamas, St. Kitts and Nevis, and St. Vincent. METHODS: Adolescents attending grade ten of the academic year 2006/2007 in Jamaica, the Bahamas, St. Vincent, and St. Kitts and Nevis were administered the Neighbourhood Characteristics Questionnaire along with the BDI-II. Social cohesion, attachment to the neighbourhood, neighbourhood quality, neighbourhood crime, and neighbourhood disorder scales were created by summing the relevant subscales of the Neighbourhood Characteristics Questionnaire. Multiple regression analyses were used to examine the relationships of perceived neighbourhood conditions to depressive symptoms. RESULTS: A wide cross-section of tenth grade students in each nation was sampled (n = 1955; 278 from Jamaica, 217 from the Bahamas, 737 St. Kitts and Nevis, 716 from St. Vincent; 52.1% females, 45.6% males and 2.3% no gender reported; 12 to 19 years, mean = 15.3 yrs, sd = .95 yr). Nearly half (52.1%) of all adolescents reported mild to severe symptoms of depression with 29.1% reporting moderate to severe symptoms of depression. Overall, Jamaican adolescents perceived their neighbourhoods in a more positive manner than those in the Bahamas, St. Vincent and St. Kitts and Nevis. Results of a series of hierarchical multiple regression analyses suggested that a different pattern of neighbourhood factors for each island were associated with depressive symptoms. However, neighbourhood factors were more highly associated with depressive symptoms for Jamaican students than for students in the other three islands. CONCLUSIONS: Neighbourhood factors appear to be partially associated with adolescents' self-reports of depressive symptoms. However, other factors may mitigate this relationship.

High-risk cervical human papillomavirus infections among human immunodeficiency virus-positive women in the Bahamas.

BACKGROUND: High-risk (HR) HPV genotypes other than 16 and 18 have been detected in a significant proportion of immunocompromised females. We aim to evaluate the frequency of HR HPV genotypes in a population of HIV-positive Caribbean women. METHODS: One hundred sixty-seven consecutive, non-pregnant, HIV-positive females ≥18 years were recruited in this study. Each participant received a vaginal examination, PAP smear, and completed a questionnaire. DNA was extracted for HPV testing in 86 patients. RESULTS: Mean age was 39.1 years for women positive for HR HPV and 43.1 years for women negative for HR HPV (P value  = 0.040). 78% (130/167) of the women had HR HPV infections; the prevalence of abnormal cervical cytology was 38% among women who were HR HPV-positive compared to women who were HR HPV-negative (22%). Fifty-one percent of the 86 women with available genotype carried infections with HPV 16 and/or HPV 18; genotypes of unknown risk were also frequently observed. Women who had a CD4+ count of ≤200 had 7 times increased odds of carrying HR HPV infection in comparison to women with CD4+>200. CONCLUSIONS: HR HPV infections in HIV infected females may consist of more than just HPV 16 and 18, but also HPV 52 and 58. Further studies are needed to determine whether HPV 52 and 58 play a significant role in the development of cervical cytological abnormalities in HIV+ women.

The spectrum of BRCA1 and BRCA2 mutations in breast cancer patients in the Bahamas.

We sought to identify the full range of founder mutations in BRCA1 and BRCA2 in the Bahamas and to estimate the proportion of all BRCA1 and BRCA2 mutations that are accounted for by founder mutations. We studied 214 Bahamian women with invasive breast cancer, unselected for age or family history. A founder mutation had previously been identified in 49 patients. We conducted full sequencing of the BRCA1 and BRCA2 genes and multiplex ligation-dependent probe amplification (MLPA) for 156 patients. A novel founder mutation in BRCA2 (exon 17 818delA) was seen in four different patients and five other unique mutations in BRCA1 and BRCA2, including a large deletion (exons 8-9) in BRCA1. In total, a mutation was seen in 58 of the 214 patients (27%); 92% of carriers carried one of the seven founder mutations. Approximately 27% of unselected cases of breast cancer in the Bahamian population are attributable to a mutation in BRCA1 or BRCA2, a prevalence which far exceeds that of any other country. The majority of women who carry a mutation in the Bahamas, carry one of the seven founder mutations, making it possible to offer genetic testing to all women at risk for breast cancer in the Bahamas.

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.

Intention to use condom, cusp modeling, and evaluation of an HIV prevention intervention trial.

Adolescents are at particularly high risk to acquire HIV infection; increasing the likelihood of condom use is an effective measure to reduce the risk of such infections. Challenges in assessing actual condom use behavior among early adolescents render the precursor measure, intention to use condoms, an appealing alternative. While analyzing data from a randomized controlled trial to evaluate a theory-based intervention program to promote condom use among early adolescents, we observed a modest effect with regard to condom use intention when the linear analytical approach was used. If intention, as a measure of the readiness to perform a behavior, also contains a nonlinear discrete component, it would be more appropriately modeled using a nonlinear approach. In this study, data from a randomized controlled trial (N=1360) were analyzed using the cusp catastrophe method with HIV knowledge and condom skills as the asymmetry variables and condom use self-efficacy as the bifurcation variables. Findings from concurrent and longitudinal modeling analyses indicated a much better fit of the cusp model (R2 = 0.85); AIC and BIC were one-fourth that of than the linear (R2 lt; 0.10) or the logistic model (R2 lt; 0.15). Receipt of the intervention as an asymmetry variable was significantly predicted condom use intention but did not as a bifurcation variable. In conclusion, adolescent intentions to use a condom contain both a continuous process and a discrete process and can better be modeled with cusp catastrophe methods. A much greater program effect is likely from the same prevention intervention if additional measures are taken to foster sudden changes in condom intention.

Predictors of responsiveness among early adolescents to a school-based risk reduction intervention over 3 years.

This study assesses potential predictive factors for unresponsiveness to the "Focus on Youth in the Caribbean (FOYC)" intervention using longitudinal data from 1,360 Bahamian sixth-grade youth. Results from hierarchical logistic regression analyses indicate that the intervention had a greater impact on knowledge, skills, self-efficacy, and condom use intention among low and medium initial scorers. High initial scores in knowledge, skills, self-efficacy, and intention were predictive of relative unresponsiveness to the intervention. Advanced age and male sex were predictive of unresponsiveness to the intervention for HIV/AIDS knowledge. Female gender was predictive of unresponsiveness to the intervention for self-efficacy. High academic self-evaluation was predictive of unresponsiveness to the intervention for condom use intention. The greatest intervention impact was observed at the 6-month post-intervention follow-up; these intervention-related gains were sustained over the subsequent follow-up periods. Youth with higher risk attributes (lower knowledge, skills and self-efficacy) were more likely to respond to a risk reduction intervention.