A grounded theory exploration of the enablers and barriers of public healthcare access for people with comorbid serious mental and chronic physical illnesses in Jamaica.

Chronic physical illnesses (CPI) are highly prevalent among people with serious mental illnesses (PWSMI) yet people in this population experience significant challenges accessing healthcare. This study utilised a constructivist grounded theory approach to collect and analyse data related to the enablers and barriers to public healthcare access for PWSMI & CPI. Data were collected through semi-structured interviews conducted with fifty-seven participants comprising PWSMI &CPI and their caregivers, health policymakers, primary care physicians, psychiatrists, and mental health nurses. Enablers and barriers to healthcare access were represented using a socio-ecological model consisting of five levels: wider society, health system, clinician, family and community, and individual. Jamaica's free public healthcare system was the most pronounced enabler of healthcare access, while poverty, stigma, and discrimination were the most pronounced barriers. Factors such as social support, time, clinician beliefs, attitudes and training, and individual characteristics were identified as consisting of dimensions that were both enablers and barriers to healthcare access. These findings indicated that factors that influenced healthcare access for PWSMI & CPI were aligned with the social determinants of health. Improved healthcare access for PWSMI & CPI necessitates strategies that incorporate a multi-sectoral approach to address social and environmental factors influencing healthcare access across all levels of the socio-ecological model.

Drug driving: a secondary analysis of factors associated with driving under the influence of cannabis in Jamaica.

OBJECTIVES: To determine cannabis use patterns, the predictive sociodemographic correlates of driving under the influence of cannabis (DUIC) and the association between risk perception and cannabis dependence among vehicle drivers in Jamaica. DESIGN: Secondary data analysis. SETTING: Used the Jamaica National Drug Prevalence Survey 2016 dataset. PARTICIPANTS: 1060 vehicle drivers extracted from the population sample of 4623. PRIMARY AND SECONDARY OUTCOME MEASURES: Analysis used Pearson's χ2 test and logistic regression. ORs and 95% CIs were recorded. A p<0.05 was considered statistically significant. RESULTS: More than 10% of Jamaican drivers admitted to DUIC in the past year. Approximately 43.3% of drivers who currently use cannabis reported DUIC only. Evidently, 86.8% of drivers who DUIC were heavy cannabis users. Approximately 30% of drivers with moderate to high-risk perception of smoking cannabis sometimes or often were dependent on cannabis. Notwithstanding, drivers with no to low-risk perception of smoking cannabis sometimes or often were significantly likelier to be dependent (p<0.001 and p<0.001, respectively). Logistic regression highlighted male drivers (OR 4.14, 95% CI 1.59 to 14.20, p=0.009) that were 34 years and under (OR 2.97, 95% CI 1.71 to 5.29, p<0.001) and were the head of the household (OR 2.22, 95% CI 1.10 to 4.75, p=0.031) and operated a machine as part of their job (OR 1.87, 95% CI 1.09 to 3.24, p=0.023) were more likely to DUIC, while those who were married (OR 0.42, 95% CI 0.22 to 0.74, p=0.004) and had achieved a tertiary-level education (OR 0.26, 95% CI 0.06 to 0.76, p=0.031) were less likely. CONCLUSIONS: Two in five Jamaican drivers, who currently smoke cannabis, drive under its influence, with over 85% engaging in heavy use. Public health implications necessitate policy-makers consider mobile roadside drug testing and amending drug-driving laws to meet international standards.

Potency trends of cannabis in Jamaica during the period of 2014 to 2020.

Reports suggest that cannabis potency has dramatically increased over the last decade in the USA and Europe. Cannabinoids are the terpeno-phenolic compounds found in the cannabis plant and are responsible for its pharmacological activity. The two most prominent cannabinoids are delta-9-tetrahydrocannabinol (Δ9 THC) and cannabidiol (CBD). Cannabis potency is measured not only by the Δ9 THC levels but also by the ratio of Δ9 THC to other non-psychoactive cannabinoids, namely, CBD. Cannabis use was decriminalized in Jamaica in 2015, which opened the gates for the creation of a regulated medical cannabis industry in the country. To date, there is no information available on the potency of cannabis in Jamaica. In this study, the cannabinoid content of Jamaican-grown cannabis was examined over the period 2014-2020. Two hundred ninety-nine herbal cannabis samples were received from 12 parishes across the island, and the levels of the major cannabinoids were determined using gas chromatography-mass spectrometry. There was a significant increase (p < 0.05) in the median total THC levels of cannabis samples tested between 2014 (1.1%) and 2020 (10.2%). The highest median THC was detected in the central parish of Manchester (21.1%). During the period, THC/CBD ratios increased from 2.1 (2014) to 194.1 (2020), and there was a corresponding increase in the percent freshness of samples (CBN/THC ratios <0.013). The data show that a significant increase in the potency of locally grown cannabis has occurred in Jamaica during the last decade.

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.

Drunk driving: a secondary analysis of factors associated with driving under the influence of alcohol in Jamaica.

OBJECTIVES: To determine the prevalence of alcohol use patterns, sociodemographic factors and risk of alcohol dependence among vehicle drivers in Jamaica. DESIGN: A secondary data analysis. SETTING: This study was conducted using the Jamaica National Drug Prevalence Survey 2016 dataset. PARTICIPANTS: This included 1060 vehicle drivers derived from the population sample of 4623. The participants from each household were randomly selected as the respondent for the survey. PRIMARY AND SECONDARY OUTCOME MEASURES: Alcohol use and dependence were measured using the Alcohol Use Disorders Identification Test questionnaire. Driving under the influence of alcohol (DUIA) was assessed by questions regarding its use in the past 12 months. The analysis involved the use of Pearson's χ2 test and logistic regression. RESULTS: 75% of Jamaicans reported lifetime alcohol use. Approximately 65% of drivers indicated that they currently drink alcohol. 18% of drivers who currently drink alcohol admitted to DUIA. Reportedly, 54.5% of these drivers were alcohol binge drinkers, with 41.5% also driving under the influence of cannabis. The bivariate analysis demonstrated that DUIA was higher among Christian participants and those who worked in non-machine operator jobs (p=0.002 and p=0.008, respectively). Vehicle drivers altogether and drivers who drive under the influence of alcohol had significant associations with hazardous drinking (p=0.011 and p<0.001, respectively). Logistic regressions highlighted drivers 34 years and under (p=0.012), male drivers (p=0.002) and the head of the household (p=0.050) were 1.82, 3.30 and 1.86 times more likely, respectively, to report driving under the influence of alcohol in the past year. CONCLUSIONS: The prevalence of alcohol use among Jamaica's population and vehicle drivers is high. That one in five drivers, who currently consume alcohol, also admits to driving under the influence suggests the urgent need for mitigation strategies and legislative action as part of a preventative effort to reduce drunk driving.

Neighborhoods and adolescent polysubstance use in Jamaica.

Background: The purpose of this study was to identify latent classes of polysubstance use among adolescents in Jamaica and the role of neighborhood factors in the association with polysubstance use class membership. Methods: This secondary analysis utilized a national cross-sectional household drug use survey conducted across 357 households in Jamaica (April 2016-July 2016) among a total of 4,625 individuals. A total of 750 adolescents (11-17 years) were included in this analysis. Latent class analysis (LCA) was conducted to identify polysubstance use patterns as well as latent neighborhood constructs. Neighborhood factors included social disorganization, concentrated disadvantage, community resources, community violence, and police station concentration. Multinomial regression analysis was implemented to evaluate the association between polysubstance use class membership and latent classes of neighborhood factors. Result: The prevalence of lifetime polysubstance use was 27.56%. Four classes of polysubstance use were identified by comparing a series of five class models. The Bootstrap Likelihood Ratio Test (BLRT) indicated a good fit for the four-class model (<0.001). The prevalence of alcohol latent classes was: (1) heavy alcohol users and experimental smokers (Class I) (15.20%), (2) most hazardous polysubstance users (Class II) (5.33%), (3) heavy smokers and moderate alcohol users (Class III) (7.07%), and (4) experimental alcohol users (Class IV) (72.44%). Three classes of neighborhoods were identified by comparing a series of four-class models. The prevalence of the neighborhood classes was: (1) low social disorganization and disadvantage (Class I) (58.93%), (2) high social disorganization and moderate disadvantage (Class II) (10.93%), and (3) high social disorganization related to perceived drug use and disadvantage (Class III) (30.13%). The BLRT indicated a good fit for the three-class model (p =  < 0.004). Multinomial regression analysis indicated that adolescents living in neighborhoods with high disorder and moderate disadvantage (Class II) were 2.43 times (odds ratio (OR)) = 2.43, confidence interval (CI)) = 1.30-4.56) more likely to be heavy alcohol users and experimental smokers (Class I) compared to experimental alcohol users, adjusting for sex, age, ethnicity, religion, and income. Class II of neighborhood classes presented with the highest levels of community violence (100%), perceived disorder crime (64.6%), police station concentration (6.7%), and community resources (low resources is 87.6%), while the concentrated disadvantage was moderate (14.8%). Conclusions: Alcohol polysubstance use latent classes were identified among youth in this context. Neighborhoods with high disorder and moderate disadvantage (Class II) were associated with a higher likelihood of polysubstance use. The role of neighborhood conditions in shaping adolescent polysubstance use should be considered in policy, prevention, and treatment 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.

Prevalence, perceived risk and associated factors of tobacco use amongst young, middle-aged and older adults: analysis of a national survey in Jamaica.

Introduction: tobacco smoking remains a significant threat to public health. This paper sought to examine the prevalence, perceived risk and the associated factors of current tobacco use amongst Jamaican adults. Methods: this study is a secondary data analysis of the Jamaican National Household Survey 2016. The data for this study was extracted from a pre-coded questionnaire using a standardized extraction sheet. Adults were categorized into young adults (18-35), Middle-aged adults (36-55) and Older adults (56 and older) groups. Statistical analysis was performed to determine the prevalence, perceived risk and associated factors of tobacco use among Jamaican adults. Results: young adults had the lowest lifetime prevalence of tobacco smoking at 23% yet the highest percentage of current users at 48.3% (p=0.000), with gender being the only significant associated factor. Males were 2.565 times more likely to be current tobacco users than females (p < 0.01). In middle-aged adults, and older adults the highest predictive factor was risk perception. Current tobacco use was 3.375 times higher in middle-aged adults (p=0.044) and 2.815 times higher in older adults with low risk perception (p=0.025). Conclusion: four out of 10 Jamaican adult tobacco users are current users. Young adults had significantly fewer mitigating factors to tobacco usage despite being the most prevalent group for current use. Significantly, perception of risk impacted current usage in middle-aged and older adults but not in younger adults. Innovative and targeted approaches are needed in young adults such as incorporating the health and wellness promotion model with tobacco emphasis.

Form and content of Jamaican cannabis edibles.

BACKGROUND: In 2017, the Jamaican government banned the sale of cannabis-infused edibles after reports of over-intoxication in adults and children. There is a general lack of public awareness regarding the risk involved with edible dosage. Vandrey et al. in 2015 reported that random cannabis edibles sampled from dispensaries in California and Washington in the USA failed to meet the basic labeling standards for pharmaceuticals (Vandrey et al.; JAMA 2015). This study aims to measure the levels of THC and CBD in a variety of edibles available locally in order to establish current cannabinoid content and to report on safety and packaging. This study is deemed necessary as no such study has been done to measure the potency levels of edibles and to raise awareness of the potential risk to children. METHODS: Forty-five cannabis-infused edible items were collected as convenience samples over a 4-year period (2014-2018) and analyzed. The QuEChERS technique (modified) was used to extract cannabinoids from each item. The extracts were then derivatized with MSTFA prior to analysis by gas chromatography-mass spectrometry (GC-MS). The descriptive statistics were calculated using the Statistical Package for Social Sciences-SPSS Software. Descriptive statistics presented include the mean, median, standard deviation, and range for each product category. The distribution of data with a box and whisker plot and frequency of THC to CBD ratios with a histogram was also presented. RESULTS: Edibles on the Jamaican market comprise baked goods, candies, frozen foods, and beverages. Eighty-six percent of samples were poorly labeled and failed to meet basic labeling requirements. None of the packages were observed to be child-proof. THC levels ranged from 0.01 to 99.9 mg per product while CBD levels ranged from 0.001 to 69.2 mg per product. The highest THC and CBD levels were detected in cookies and brownies. Thirty percent of the samples had THC levels greater than the recommended 10 mg THC per serving. CONCLUSION: The lack of proper labeling and the wide range of THC levels in cannabis edibles raises public health concerns for all consumers including inexperienced persons who may be at a greater risk of overdosing. Concern must also be raised over the possibility that the attractive and tasty ways in which the drug is being presented might tempt young children and teens to take cannabis. Impact statement It is hoped that this information will raise public awareness of the current potential danger these edibles pose to children and inexperienced users and that policymakers will see the need for the imposition of suitable regulations.

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).

Jamaican adolescents' receptiveness to digital mental health services: A cross-sectional survey from rural and urban communities.

BACKGROUND: Improving access to mental health resources for young people is an urgent healthcare challenge. As the majority of youth live in low and middle-income countries (LMICs) mental ill health can exert substantial adverse impacts on societies that can least afford it. Digital mental health technologies might help close the treatment gap but we need to understand barriers to implementing these strategies, especially in resource constrained contexts such as LMICs. METHODS: We surveyed adolescents (N = 107; aged 10-19 years) from Jamaican communities using questionnaires adopted from previous studies conducted in LMICs. The questions addressed mental health help-seeking preferences, expectations of help-seeking effectiveness, and practical and attitudinal barriers to using mobile-phone-based mental health resources. We present descriptive data alongside exploratory analyses of differences in attitudes and preferences expressed by subgroups of respondents. RESULTS: Adolescents reported very few practical or infrastructure barriers to accessing digital mental health resources. >90% of the sample had access to a smartphone, 78% expected that digital solutions could benefit adolescents with symptoms of mental distress, and 56% were interested in using mental health apps to monitor their own mental health. Stigma, shame, and embarrassment were major barriers to help-seeking and formal professional help was only preferred for more severe conditions such as psychosis and substance abuse. CONCLUSIONS: Practical barriers are unlikely to impede the uptake of digital mental health resources by Jamaican adolescents. Our data suggest that mental health literacy, stigma, and embarrassment pose more serious blocks to help-seeking.

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.

Neighborhood crime, disorder and substance use in the Caribbean context: Jamaica National Drug Use Prevalence Survey 2016.

The purpose of the study was to examine the role of objective and subjective measures of neighborhood crime and disorder on substance use among a nationally representative sample of 4525 Jamaicans aged 12-65 years. Log-Poisson models with generalized estimating equations were used to estimate relative risks (RR) and 95% confidence intervals (CI). A test of interaction was used to determine presence of effect modification by sex. Approximately 39% of the study population reported past-month alcohol use; 10% past-month tobacco use; and 15% past-month marijuana use. In fully adjusted models, past-month alcohol and tobacco use were associated with perceived neighborhood disorder (p<0.05). The likelihood of alcohol use was 1.12 (95%CI:1.04, 1.20) times greater among participants who perceived higher neighborhood disorder. The likelihood of tobacco use was 1.22 (95%CI: 1.01, 1.46) times greater among participants who perceived higher neighborhood disorder. A significant test for interaction in adjusted models (P<0.2) suggested that the associations between substance use and perceived neighborhood disorder varied by sex. Examination of stratified models indicated that the role of perceived neighborhood disorder on alcohol and tobacco consumption varied among females, but not males. Females who perceived higher levels of neighborhood disorder had an increased likelihood of past-month alcohol and tobacco use (RRa:1.25 95%CI:1,07, 1.45; RRa:1.73 95%CI: 1.10, 2.67). Objective neighborhood crime measures were not associated with alcohol, tobacco, or marijuana use. The study findings provide evidence for the importance of considering subjective and objective neighborhood measures when examining relations with health outcome and demonstrate that perceptions of context and contextual exposures are not uniform across populations within neighborhoods. Interventions focused on building community trust and social cohesion (e.g. neighborhood community watch groups) and greening of blighted or abandoned spaces may help increase the sense of safety and order, reducing stress and maladaptive coping such as substance use.

Blood Pressure Screening Campaign in Jamaica: May Measurement Month 2017.

BACKGROUND: Hypertension (HTN) is responsible for a significant disease burden in Jamaica. We are reporting the results of the 2017 blood pressure (BP) screening campaign May Measurement Month in Jamaica that aimed to increase the awareness of HTN. METHODS: Adults, 18 years old and older, from different parishes of Jamaica were invited to participate during May to June 2017. Demographic data were collected. BP, weight, and height were measured and recorded. RESULTS: Five hundred sixty-six participants (n = 566) were enrolled, 91.6% (519) from urban areas, and 72.6% (410) were females. The average age was 53.7 (18-95) years old and body mass index was 28.2 ± 6.6 kg/m2. The prevalence of HTN was 47.3% (267/566), without gender or living areas differences (both P > 0.1). Prevalence of HTN was lower in those who self-identified as Interracial ethnicity, in comparison with Afro-Caribbean (33% vs. 48.3%; P = 0.04). About third of the hypertensive patients were not aware of the high BP (89/267; 35.6%). Between hypertensive patients, 64.4% (172/267) were receiving antihypertensive drugs. The rate of BP control was 32% of the hypertensive patients and 50% of those receiving antihypertensive medication. Significant lower BP control was observed between diabetic vs. nondiabetic patients (34.3% vs. 60%; P < 0.001). CONCLUSION: We found a high prevalence of HTN in this population, especially in patients with diabetes or previous cardiovascular diseases. We report an increase in HTN awareness in Jamaica but more advances need to be performed to increase HTN treatment and control.

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.

Risperidone Provides Better Improvement of Sleep Disturbances Than Haloperidol Therapy in Schizophrenia Patients With Cannabis-Positive Urinalysis.

A high percentage of persons with Schizophrenia also uses Cannabis and this may potentially alter the therapeutic benefits of the antipsychotic medications prescribed. The aim of this study was to assess the impact of Cannabis usage on antipsychotic therapy of sleep disturbances in schizophrenia subjects. Male subjects, ≥18 years, admitted to the University Hospital of the West Indies psychiatric ward between October 2015 and October 2016, and diagnosed with schizophrenia were recruited for the study. Following written informed consent to the study, subjects were prescribed either risperidone monotherapy or haloperidol monotherapy orally for 14 days and classified as Cannabis users (CU) or non-users (non-CU), with presence/absence of Cannabis metabolite in urine samples. After 1 week of admission, subjects wore the Actiwatch-2 device, to record sleep data for 7 consecutive nights. Inferential statistical analysis involved non-parametric tests, expressed as median and inter-quartile ranges (IQR), with p<0.05 considered statistically significant. Fifty subjects were assessed, with a median (IQR) age of 28 (14) years. Majority (30; 60%) were CU, displaying longer sleep latency (SL) than non-CU when receiving haloperidol; but equivalent SL when receiving risperidone. In comparison to non-CU, the CU also displayed longer time in bed, but shorter durations asleep, awoke more frequently during the nights and for longer durations, whether receiving haloperidol or risperidone. This resulted in lower sleep efficiency for the CU (<85%) compared to the non-CU (≥85%). Over the study period, sleep efficiency was significantly improved for non-CU receiving either risperidone (p = 0.032) or haloperidol (p = 0.010); but was only significantly improved with risperidone for the CU (p = 0.045). It is apparent that the presence of Cannabis may be impacting the therapeutic benefits of antipsychotic drugs on sleep. In schizophrenia subjects with concomitant Cannabis use, risperidone is more beneficial than haloperidol in improving sleep efficiency.

Alcohol Consumption and Sexual Risk Behaviour among Jamaican Adolescents

Alcohol consumption has significant health, social and economic implications. Alcohol is the most prevalent psychoactive substance used by Jamaican adolescents. The aim of this study was to determine whether alcohol is associated with sexual risk behaviour among Jamaican adolescents. Methods: The data from National Secondary School Survey (NSS) conducted in 2013 was analysed. Descriptive statistics consisting of frequencies, percentages and Pearson's Chi square was done. Multivariate analysis was done using binary logistic regression. Result: The mean age of alcohol initiation among the participants was 12.3years [SD: 2.74]. There were significant associations between gender (X2= 14.56; p= 0.000), relationship with father/guardian (X2: 10.71; P= 0.03), relationship with mother (X2= 15.16; P= 0.004) and conversation with parents/ guardians about dangers of drug abuse (X2= 8.16; P=0.004). Adolescents who were males (AOR= 0.62, 95% CI= 0.43 - 0.88), in the 8th grade (AOR= 0.51, 95% CI= 0.26 - 0.98) or in the 10th grade (AOR: 0.52, 95% CI: 0.32 - 0.85) were less likely to engage in sexual risk behaviour. Lifetime alcohol consumption, past year alcohol consumption and past month alcohol consumption were not significantly associated with sexual risk behaviour (AOR= 0.35, 95% CI= 0.04 - 3.46; AOR= 1.75, 95% CI= 0.59 - 5.09, AOR= 0.78 95% CI= 0.56 - 1.11 respectively). Conclusion: Lifetime, past one year and past one month alcohol consumption among the students were not risk factors for sexual risk behavior (non-condom use) among Jamaican adolescents.

A School-Based Study of the Influence of Students' Relationship with Teachers on Their Cigarette Smoking Behaviour in Jamaican

Background: Cigarette is one of the most widely used addictive substances and a leading cause of death. Prevalence of cigarette smoking has been reported to be high in the Caribbean, including Jamaica. The aim of this study was to determine whether students' relationship with teachers influences their cigarette smoking behaviour in Jamaica. Methods: This was a statistical analysis of data based on a nationally representative sample of 3,365 secondary school students drawn from 8th to 12th grade across 38 secondary schools in Jamaica in 2013. Descriptive and inferential statistics were performed using SPSS. Results: There were significant differences in the past year and past month cigarette smoking respectively among students who had very good, good, average, bad and very bad relationship with their teachers (X2 = 11.67, p = 0.02; X2 = 9.61, p = 0.04) respectively. Students with very good relationship with teachers, were significantly less likely to report smoking cigarette in the past month (AOR= 0.09, 95% CI= 0.01- 0.88). Students who were 2 - 10 years, had very good relationship with teacher and father, and whose parents knew friends very well, were 0.96, 0.69, 0.70 and 0.94 times as likely to report smoking cigarette in the past year. However, these associations were not significant after controlling for other factors. Conclusion: Students' relationship with their teachers has a strong influence on cigarette smoking. Students with very good relationship with teachers were significantly less likely to report smoking cigarette in the past month.

Does Risk Perception Affect Alcohol Consumption among Secondary School Students in Jamaica?

Background: Alcohol consumption among young people is a major public health problem world-wide and in Jamaica. A number of factors have been reported to affect alcohol use among high school students. The aim of this study was to investigate the influence of perception of the harmfulness of alcohol on alcohol use among secondary school students in Jamaica. Methods: Data collected from a nationally representative sample of 3,365 students were analyzed. Descriptive and inferential statistics were performed using SPSS. Results: Students' perception of risk of drinking alcohol frequently and getting drunk respectively had positive and significant associations with past month alcohol use (AOR= 1.44, 95% CI= 1.09- 1.88 and AOR= 1.38, 95% CI= 1.02- 1.86, respectively) compared to students who felt that drinking alcohol frequently and getting drunk were very harmful. Males, 12 years or younger were significantly less likely to use alcohol in the past month (AOR= 0.77, 95% CI=0.60- 0.97; AOR= 0.68, 95% CI= 0.53-0.97 respectively). Students with good relationship with their mothers were less likely to use alcohol in the past year and past month (AOR= 0.55, 95% CI= 0.35-0.87; AOR= 0.50, 95% CI= 0.32- 0.78). Conclusion: Risk perception of the harmfulness of alcohol significantly affects alcohol use among secondary school students in Jamaica. Males, 12 years or younger, who had good relationship with mothers, were significantly less likely to use alcohol in past month