Attitudes of Jamaicans in Kingston and St.Andrew towards homosexuality [abstract]

OBJECTIVE: Jamaica has long been considered to be a homophobic society. The aim of this survey was to examine the attitudes of the Jamaican populance towards homosexuality, thus shedding light on the important issue of homosexuality, disclosure of one's sexual preference and the relationship to the HIV/AIDS epidemic. METHODS: There have been several subjective reports on the issue of homosexuality in Jamaica. Many of these reports have suggested that Jamaica is not truly a homophobic society. No objective study on attitudes towards homosexuality in Jamaica has been done to date; this is an attempt in that regard. A survey was conducted in the Kingston and St.Andrew region. A questionnaire consisting of 17 knowledge and attitude items with six items to determine demographic data was prepared. This was administered to every third person in 6 designated areas, ensuring that equal numbers of males and females aged 16 years and over were polled. RESULTS: The analysis indicates that the majority of those surveyed thought that the homosexuality lifestyle was unaccepatable. Of significance, views varied depending on the level of educational attainment: 100 percent of persons with primary level education found homosexuality unacceptable in contrast with 76 percent of those with teritiary level education with a similar opinion (p=0.028). There was a generally negative attitude towards befriending an acknowledged homosexual or having such persons in positions of authority. Many participants agreed that homosexual partners should have access to social services, including insurance plans, with 37 percent in outright agreement and 21 percent remaining neutral. There was a dramatic decrease in the number of persons who believed that HIV was solely a homosexual disease (13 percent) in contrast with the results of a 1989 survey conducted by the Ministry of Health (81 percent). CONCLUSION: Despite changing global opinions of the homosexual lifestyles, several biases still remain within the Jamaican society. These conditions force homosexuals to remain ensconced within the cloak of the more acceptable heterosexual lifestyle, which may have significant social and health implications. (AU)

Eliminating disparities in perinatal outcomes--lessons learned.

The disparity between blacks and whites in perinatal health ranges from a 2.3-fold excess risk among black women for preterm delivery and infant mortality to a 4-fold excess risk among black women for maternal mortality. To stimulate concerted public health action to address such racial and ethnic disparities in health, the national Healthy People objectives call for elimination of all health disparities by the year 2010. Eliminating health disparities requires a greater understanding of the factors that contribute to their development. This commentary summarizes the state of the science of reducing such disparities and proposes a framework for using the results of qualitative studies on the social context of pregnancy to understand, study, and address disparities in infant mortality and preterm delivery. Understanding the social context of African American women's lives can lead to an improved understanding of the etiology of preterm birth, and can help identify promising new interventions to reduce racial and ethnic disparities in preterm delivery.

Medical conditions and nearly lethal suicide attempts.

Physical illness has been studied as a risk factor for suicidal behavior, but little is known about this relationship among younger persons. We conducted a population-based, case-control study in Houston, Texas, from November 1992 through September 1995. The final sample consisted of 153 case- and 513 control-subjects aged 13 to 34 years. Case patients were identified at hospital emergency departments and met criteria for a nearly lethal suicide attempt. Control subjects were recruited via a random-digit-dial telephone survey. Case patients were more likely than controls to report having any serious medical conditions (crude OR = 3.23; 95% CI = 2.12-4.91). After controlling for age, race/ethnicity, alcoholism, depression, and hopelessness, the adjusted odds ratio for men was 4.76 (95% CI = 1.87-12.17), whereas the adjusted odds ratio for women was 1.60 (95% CI-0.62-4.17), suggesting that young men with medical conditions are at increased risk for nearly lethal suicide attempts. Increased efforts to identify and appropriately refer these patients are needed.

A public health framework for addressing black and white disparities in preterm delivery.

The Healthy People 2010 objectives call for the elimination of racial disparities in health, along with reductions in several multifactorial perinatal outcomes. Evidence-based interventions have been the focus of discussion to date. We propose a 6-component framework based on knowledge from the social, medical, psychological, and epidemiological literatures to guide development of interventions to reduce preterm delivery and eliminate disparities. Pilot testing and rigorous evaluation of the interventions developed from this framework are encouraged.

Opportunities for intervention: discussing physical abuse during prenatal care visits.

BACKGROUND: The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists recommend that screening for physical abuse during prenatal care visits becomes routine. Although prenatal care visits offer a unique intervention opportunity, screening is not yet standard practice. DATA AND METHODS: We used data from the 1996 and 1997 Pregnancy Risk Assessment Monitoring System (PRAMS) to assess the prevalence of and the factors associated with health care providers' discussion of physical abuse with pregnant women in 14 states. PRAMS is a state-specific, population-based surveillance system that collects information from women on maternal behaviors before and during pregnancy, and at 2 to 6 months postpartum. RESULTS: Between 22% and 39% of the women surveyed reported that health care providers talked with them about physical abuse during prenatal care visits. Health care providers were more likely to discuss physical abuse with women who were black, Hispanic, young (aged <20 and 20 to 29), had a high school education or less, or paid for prenatal care with Medicaid. CONCLUSIONS: Our results indicate that most pregnant women do not report that their prenatal care providers discussed physical abuse with them. Logistic regression analyses identified consistent associations across the 14 states between discussion of abuse and demographic and pregnancy-related factors. A better understanding of the factors associated with whether a health care provider discusses physical abuse with a pregnant woman could increase intervention opportunities.

Surveillance for injuries and violence among older adults.

PROBLEM/CONDITION: Injuries and violence are major causes of disability and death among adults aged > or =65 years in the United States. Injuries impair older adults' quality of life and result in billions of dollars in health-care expenditures each year. REPORTING PERIOD: This report reviews 1987-1996 data regarding fall-related deaths, 1988-1996 data on hospitalizations for hip fracture, 1990-1997 data regarding motor vehicle-related injuries, 1990-1996 data on suicides, and 1987-1996 data on homicides. DESCRIPTION OF SYSTEMS: Data on fall-related deaths, suicides, and homicides are from the National Center for Health Statistics annual mortality data tapes for 1987-1996. Homicide data are supplemented with information from the Federal Bureau of Investigation's Supplemental Homicide Reports for 1987-1996. Data on hospitalizations for hip fracture are from the 1988-1996 National Hospital Discharge Surveys. Information regarding motor vehicle-related injuries for 1990-1997 is from the National Highway Traffic Safety Administration's Fatality Analysis Reporting System and General Estimates System. RESULTS: Rates of fall-related deaths for older adults increased sharply with advancing age and were consistently higher among men in all age categories. Men were 22% more likely than women to sustain fatal falls. A trend of increasing rates of fall-related deaths was observed from 1987 through 1996 in the United States, although rates were consistently lower for women throughout this period. Rates of hospitalizations for hip fracture differed by age and were higher for white women than for other groups. Rates increased with advancing age for both sexes but were consistently higher for women in all age categories. U.S. hospitalization rates for hip fracture increased for women from 1988 through 1996 while the rates for men remained stable. Rates of motor vehicle-related injuries increased slightly from 1990 through 1997, and marked variations in state-specific death rates were observed; in most states, older men had death rates approximately twice those for older women. Although suicide rates remain higher among older adults than among any other age group, rates of suicide among adults aged > or =65 years decreased 16% during the study period. Suicide rates among older adults varied by sex and age group. Homicide rates declined 36% among older adults. Homicide rates were highest for black men, followed by black women and white men; the homicide risk for blacks relative to whites decreased from 4.8 to 3.9 per 100,000 persons, indicating that the gap between rates for blacks and whites is closing. Half of the older homicide victims were killed by someone they knew. INTERPRETATION: The increase in rates of fall-related deaths and hip fracture hospitalizations from 1988 through 1996 might reflect a change in the proportion of adults aged > or =85 years compared with those aged 65-84 years - a change that results, in part, from reduced mortality from cardiovascular and other chronic diseases. Fall-related death rates might be higher among older men because they often have a higher prevalence of comorbid conditions than women of similar age. Racial differences in hospitalization rates might have some underlying biologic basis; the prevalence of osteoporosis, a condition that contributes to reduced bone mass and increased bone fragility, is greatest among older white women. Compared with whites aged > or =65 years, blacks of comparable ages have greater bone mass and are less likely to sustain fall-related hip fractures. Additional studies are needed to determine why rates of motor vehicle-related injury have increased slightly among older adults and why these rates vary by state. Declining rates of suicide among older adults might be related to changes in the effect or type of risk factors traditionally observed in this age group. Research is needed to identify reasons for variations in suicide rates among older persons. Homicides among olde

Socio-economic predictors of alienation among the elderly.

A study of 200 older clients of senior service centers in a metropolitan area was conducted to determine their level of alienation and the extent to which selected socio-economic variables (race, education, income, health, living arrangement, church work, and volunteer work) were associated with four subtypes of alienation. Group isolation and powerlessness were found to be much more prevalent than personal isolation or normlessness. Health, race, education, and income were found to be the strongest predictors of alienation. Higher levels of alienation were found among older blacks, and those with lower health rating, lower education, and lower income, compared to their opposites. The implications of the findings are discussed.

Outpatient views on direct access to physical therapy in Indiana.

The purpose of this study was to determine the opinions of outpatients receiving physical therapy in Indiana about physical therapy evaluation and treatment without referral (direct access). Subjects were 361 individuals being treated at one of 25 privately owned clinics. Each subject completed a 15-item questionnaire. Results showed that 82.8% of the respondents supported direct access to physical therapy. A majority indicated they would seek physical therapy services without referral if they were available. Physical therapists were cited as frequently as all other health care professionals combined as the practitioners providing the most thorough evaluation. Physical therapists were cited far more often than other health care professionals combined as the practitioners providing the best information about the control of symptoms. Subjects who had received more treatments than others were significantly more likely to support direct access (p less than .05). Conclusions were that individuals who have received physical therapy at private outpatient physical therapy clinics in Indiana are supportive of direct access to physical therapy services.