Determinants of adequate follow-up of an abnormal Papanicolaou result among Jamaican women in Portland, Jamaica.

BACKGROUND: Among Jamaican women, cervical cancer is the second leading cause of cancer mortality but factors that facilitate follow-up of women receiving abnormal Pap smear results are not known. We examined whether socio-demographic factors, factors reported by the women, and assistance received for follow-up facilitate adequate follow-up of abnormal Pap smears. METHODS: One hundred and twenty-one women who had abnormal Pap results during June 1998-September 2005 in Portland, Jamaica were interviewed to identify determinants of adequate follow-up. Chi-square, t-test and multivariable logistic regression analysis were used to identify determinants. RESULTS: Only half of the women in this sample sought adequate follow-up. These women had a lower number of surviving children, higher monthly income, and perceived the cost of services to be inexpensive. Advice about the timing of the follow-up activity and the next step to take by the healthcare workers were significant determinants of adequate follow-up. Women who received advice on the timing of follow-up were almost six times (adjusted OR: 5.99, 95% CI: 1.17, 30.66, p<0.05) more likely to seek adequate follow-up after adjusting for other factors. CONCLUSIONS: Perceived low cost of services as well as assistance provided by healthcare workers regarding follow-up action helps to facilitate adequate follow-up of abnormal Pap smear results.

The determinants of sexual intercourse before age 16 years among rural Jamaican adolescents.

Individual and family factors have been hypothesized to influence adolescent sexual behavior, but the extent to which this is true for adolescents in Jamaica as a whole and for those in rural areas in particular, has not been well studied. The objective of this study was to identify individual and family factors associated with initiation of sexual activity before the age of 16 among rural adolescents in Jamaica. We analyzed data for 469 sexually experienced adolescents attending public high schools in the rural parish of Hanover. Multivariate logistic regression was used to predict independent influences of these factors. The mean age at sexual debut was 11 years for boys and 15 years for girls. Early adolescent sexual activity was associated with liberal attitudes about negative sexual outcomes (OR = 1.96, 95%CI = 1.34-2.87) and first sexual partner not being a steady boyfriend or girlfriend (OR = 4.19, 95%CI = 1.62-10.84). Female gender (OR = 0.16, 95%CI = 0.07-0.36) and older age at time of survey were protective (OR = 0.40, 95%CI = 0.32-0.52). Girls who were early starters were more likely to have been initiated by partners who were not steady boyfriends. They also reported liberal attitude towards negative sexual outcomes. Boys were mainly influenced by liberal attitude towards negative sexual outcomes. Being older was protective for both genders. Considering the high rates of HIV and adolescent pregnancy in this population, reproductive health programs that attempt to delay age at first sex should begin early in primary school before adolescents become sexually active.

Influence of knowledge and attitudes on exclusive breastfeeding practice among rural Jamaican mothers.

BACKGROUND: A large number of mothers may not be practicing exclusive breastfeeding in rural Jamaica, although no recent systematic study has been conducted. The impact of knowledge about and attitude toward breastfeeding on the duration of exclusive breastfeeding is also poorly understood. The objective of this study was to gather information about factors that influence exclusive breastfeeding and its duration. METHOD: A cross-sectional study was conducted in 11 health centers within the parish of Saint Ann, Jamaica. A pretested questionnaire collected information on breastfeeding knowledge and attitudes toward intention to breastfeed and other relevant sociodemographic characteristics. RESULTS: Information was documented for 599 mother-child pairs. The prevalence of breastfeeding initiation was 98.2 percent; of mothers who initiated breastfeeding, 22.2 percent practiced it exclusively (at least 6 months). No difference occurred between exclusive and nonexclusive breastfeeding mothers in terms of knowledge about and attitudes toward breastfeeding. Of potential predictors assessed, the male partner's role as the main source of income for the family was the only significant predictor for exclusive breastfeeding. Women whose male partner was the main source of income for the family were twice as likely to exclusively breastfeed their infants compared with the referent group (mothers as main source of income)(OR=2.0; 95% CI=1.4-3.0). In addition, the dominant reason for partial breastfeeding was maternal anxiety that breastmilk alone might not provide sufficient nourishment. CONCLUSION: The level of exclusive breastfeeding was extremely low at the study site. Formulation of strategies to aggressively promote exclusive breastfeeding practices is urgently needed there. Such interventions should consider involvement of the male partner, especially, with respect to the financial support, as well as alleviating maternal anxiety regarding nutritional adequacy of breastmilk.

Predictors of sexual involvement among adolescents in rural Jamaica.

Early sexual activity of adolescents is associated with increased risk of teenage pregnancy, sexually transmitted infections including HIV, and higher maternal/perinatal morbidity and mortality. HIV and adolescent pregnancy are among the most serious public health problems in Jamaica. The objective of this study was to identify the potential predictors of adolescent sexual activity in Jamaica. A cross-sectional survey was conducted among 788 students 13-19 years of age in Jamaica. A questionnaire containing items on socio-demographic characteristics such as age and gender, and scales on adolescent values about sexual activity, self-efficacy for abstinence, parental love, and depression were administered to adolescents at secondary schools in the parish of Hanover. Reliability analysis of the scales, descriptive statistics, and logistic regression to determine predictors of sexual activity were conducted. Approximately 62% of adolescents who responded reported previous sexual intercourse and 38% reported never having had sex. The mean age for sexual debut was 13.6 years. Logistic regression revealed delay values (values towards delaying sexual activity) as protective (OR=0.16, CI=0.09-0.26) against involvement in sexual activity. Risk factors for sexual activity included being older (OR=1.9, CI=1.50-2.50), being male (OR=2.26, CI=1.39-3.68) and having grown-up values (OR=1.49, CI=1.05-2.12). Contrary to expectations, having higher self-efficacy skills was predictive (OR=1.47, CI=1.05-2.05) of adolescent sexual involvement. Analyses by gender revealed that delay and grownup values predicted male sexual activity, while self-efficacy, paternal love and delay values predicted female behavior. These findings show the importance of age, gender, self-efficacy, delay and grown-up values in predicting sexual activity in adolescents and indicate the need for gender-specific interventions for Jamaican adolescents.

Sociocultural contexts of adolescent sexual behavior in rural Hanover, Jamaica.

PURPOSE: To investigate sexual behavior of adolescents in rural Hanover, Jamaica, and to elucidate the cultural contexts of this behavior. METHODS: Focus group discussion (FGD) sessions with 73 out-of-school young adolescents aged 15 to 18 years, recruited from health centers, as well as community-based organizations through the Social Development Commission (SDC) in Hanover, a local youth and community development organization, within the Ministry of Local Government, Youth and Community Development. The discussions focused on the adolescents' knowledge of sex and sexual risks, perceived vulnerability to sexual risks, use of protection, self-efficacy, and societal expectations. Data were analyzed, using the content analysis technique. RESULTS: Analyses of transcripts revealed the existence of different sexual scripts for males and females. Whereas females are culturally restrained, abstinence is less desirable for males. Both male and female adolescents expressed the view that the family was an important part of an adolescent's life, and has a strong influence on adolescent sexual behavior. Perception of vulnerability to HIV/AIDS and other sexually transmitted infections, and knowledge of sexual risks among the adolescents was low, and often erroneous. CONCLUSIONS: The results show that sexual attitudes and behavior of adolescents in the study setting are shaped by cultural and gender norms that impose different standards on males and females.