Does marriage explain murders in a society? In what way is divorce a public health concern?

INTRODUCTION: Like medicine, public health practitioners seek to understand causes of mortality, practices of humans and issues that can change population conditions, in order to preserve and care for life. The murder pandemic has been such in Jamaica that the World Bank sponsored a qualitative study on crime in urban areas in Jamaica in the late 1990s to provide a platform to guide policy intervention and programmes. As a result this study will fill the gap in the literature by providing the evidence to support that divorce and marriage are public health concerns from the perspective of murders. OBJECTIVE: To evaluate the role of divorce and marital relationships on murders. MATERIALS AND METHODS: The data for this study are taken from various Jamaica Government Publications. The period for this work is from 1950 through 2013. Data were recorded, stored and retrieved using the Statistical Packages for the Social Sciences (SPSS) for Windows, Version 21.0. The level of significance that is used to determine statistical significance is less than 5% (0.05). Ordinary least square (OLS) regression analyses and curve estimations were used to determine models and best fitted models. RESULTS: On average, annually, 523 Jamaicans are murdered (± 484), with there being 9,531 marriages (± 22,747) and 904 divorces (± 468). Logged marriage rate and divorce rate are factors of murder rate, with both independent factors accounting for 82.2% of the variability in the murder rate. Both factors are positively correlated with the murder rate, with the divorce rate accounting for most of the variance in the murder rate (R2 = 79.2%). CONCLUSION: Death can be extremely devasting to families, however, murder among married couples can severely disrupt the lives of both families along with any children from such relationship.

Re-testing theories on the correlations of health status, life satisfaction and happiness.

BACKGROUND: Empirical evidences have shown that happiness, life satisfaction and health status are strongly correlated with each other. In Jamaica, we continue to collect data on health status to guide policies and intervention programs, but are these wise? AIMS: The current study aims to fill the gap in the literature by examining life satisfaction, health status, and happiness in order to ascertain whether they are equivalent concepts in Jamaica as well as the coverage of the estimates. MATERIALS AND METHODS: The current study used a cross-sectional survey of 2000 men 55 years and older from the parish of St. Catherine in 2007 which is it also generalizable to the island. A132-item questionnaire was used to collect the data. The instrument was sub-divided into general demographic profile of the sample; past and Current Good Health Status; health-seeking behavior; retirement status; social and functional status. Ordinal logistic regression techniques were utilized to examine determinants of happiness, life satisfaction and health status. RESULTS: Happiness was correlated with life satisfaction - Pseudo r-squared = 0.311, -2LL = 810.36, χ(2) = 161.60, P < 0.0001. Life satisfaction was determined by happiness - Pseudo r-squared = 0.321, -2LL = 1069.30, χ(2) = 178.53, P < 0.0001. H ealth status was correlated with health status age, income, education and area of residence - Pseudo r-squared = 0.313, -2LL = 810.36, χ(2) = 161.60, P < 0.0001. CONCLUSION: The current study refuted the empirical finding that self-reported happiness depends on perceived health status for older men in Jamaica.

Paradoxes in self-evaluated health data in a developing country.

BACKGROUND: Statistics showed that males reported fewer illnesses and greater mortality rates than females, but are outlived by approximately 6 years by their female counterparts, yet their self-rated health status is the same as that of females. AIMS: THIS STUDY EXAMINES THE FOLLOWING QUESTIONS: (1) Are there paradoxes in health disparity between the sexes in Jamaica? and (2) is there an explanation for the disparity outside of education, marital status, and area of residence? METHODS AND MATERIALS: The current study utilised a data set collected jointly by the Planning Institute of Jamaica and the Statistical Institute of Jamaica. The data set is a survey on the living conditions of Jamaicans. It was conducted between May and August of 2007. The JSLC is a modification of the World Bank's Living Standards Measurement Study. The sample size was 6,783 respondents, with a non-response rate being 26.2%. RESULTS: Good health status was correlated with self-reported illness (OR =0.23, 95% CI = 0.09-0.59), medical care-seeking behaviour (OR = 0.51, 95% CI = 0.36-0.72), age (OR = 0.96, 95% CI = 0.96-0.97), and income (OR = 1.00, 95% CI = 1.00-1.00). Self-reported illness is statistically correlated with sex (OR = 0.25, 95% CI = 0.10-0.62), head of household (OR = 0.33, 95% CI = 0.12-0.96), age (OR = 1.04, 95% CI = 1.01-1.07) and current good self-rated health status (OR = 0.32, 95% CI = 0.12-0.84). CONCLUSION: This paper highlights that caution must be used by researchers in interpreting self-reported health data of males.

Rural male health workers in Western Jamaica: Knowledge, attitudes and practices toward prostate cancer screening.

BACKGROUND: Statistics have shown that since 1988, a significant percentage of males are unwilling to seek medical care. The question is if they had the knowledge, worked in the health system and were educated, would this be any different? AIM: The current study aims to fill this void in the literature by examining the perception of rural male health workers (from the Western Region) about prostate examination, and why they are reluctant to inquire about the probability of having, or the likelihood of not having prostate cancer. MATERIALS AND METHODS: The study utilized primary cross-sectional data that was collected during February and March 2008 from 170 males (ages 29 years and older), health-care workers who were employed in particular rural health institutions in Jamaica (i.e. Western Regional Health Authority). SPSS was used to analyze the data. RESULTS: When the respondents were asked "Have you ever heard about the screening procedure for prostate?" 71.2% indicated yes, but only 27.1% had got their prostate checked by a health practitioner. When respondents were asked to state what influenced their choice of not doing a digital rectal examination, 20.6% indicated comfort level; 9.4% stated the gender of the health practitioner, 5.3% mentioned fear and others did not respond. Of those who had the examination 2 years ago, 96.5% did not state the choice of method. CONCLUSION: The current study is limited in terms of its generalizability to rural males or rural males in Western Jamaica, but it does provide an insight into the difficulty of men in breaking away from culture.

Self-rated health of the educated and uneducated classes in Jamaica.

BACKGROUND: Education provides choices, opportunities, access to resources and it is associated with an increased likelihood of higher income. Does this holds true in developing nations like Jamaica, and does the educated class experience greater self-rated health status than the uneducated classes? AIMS: The current study will identify the socio-demographic correlates of self-rated health status of Jamaicans, examine the effects of these variables, explore self-rated health status and self-reported diagnosed recurring illness among the educated and uneducated classes, compute mean income among the different educational types, and determine whether a significant statistical correlation exists between the different educational cohorts. MATERIALS AND METHODS: The current study utilised the data set of Jamaica Survey Living Conditions which is a cross-sectional survey. It is a national probability survey, and data were collected across the 14 parishes of the island. Stratified random sampling techniques were used to draw the sample. RESULTS: Self-rated health statuses of respondents are correlated with age, income, crowding, sex, marital status, area of residence, and self-reported illness (es) - χ(2) = 1,568.4, P < 0.001. Respondents with tertiary level educations were most likely to be classified in the wealthiest 20% (53.4%) and there was no significant statistical difference between their health status and the lower educated classes. CONCLUSION: There is a need for a public health care campaign that is specifically geared towards the educated classes as their educational achievement is not translating itself into better health care-seeking behaviour and health status than the uneducated classes.

Self-reported health and medical care-seeking behaviour of uninsured Jamaicans.

BACKGROUND: On examination of the literature in Latin America and the Caribbean, and in particular Jamaica, no study could be found that investigated the health and health care-seeking behaviour of uninsured people. This study bridges the gap in the literature by evaluating uninsured Jamaicans' medical care-seeking behaviour and good health status. MATERIAL #ENTITYSTARTX00026; METHOD: The study extracted a sample of 5,203 uninsured respondents 15 years and older from a national probability cross-sectional survey of 6,782 Jamaicans. Descriptive statistics were used to provide background information on the sample; cross-tabulations evaluated bivariate analyses, and logistic regression was used to model health and medical care-seeking behaviour. RESULTS: Good health of uninsured Jamaicans is correlated -reported biological condition (OR =0.114, 95% CI = 0.090 -0 .145) followed by age (OR =0.952, 95% CI = 0.946- 0.959); gender (OR = 1.501, 95% CI = 1.221-1.845); consumption (OR = 1.000, 95% CI = 1.000-1.000); social class (upper class OR = 0.563, 95% CI = 0.357-0.888); education (secondary and above OR = 0.622, 95%CI = 0.402-0.963), and area of residence (other towns OR = 1.351, 95% CI = 1.026-1.778). Medical care-seeking behaviour is associated with age (OR = 1.020, 95% CI = 1.006 - 1.033); poor health status (OR = 2.303, 95% CI = 1.533-3.461), and marital status (married OR = 0.518, 95% CI = 0.325-0.824). CONCLUSION: The findings are far reaching and provide an understanding of the uninsured, and the information can be used to aid public health intervention and education programmes.

Impact of poverty, not seeking medical care, unemployment, inflation, self-reported illness, and health insurance on mortality in Jamaica.

BACKGROUND: An extensive review of the literature revealed that no study exists that has examined poverty, not seeking medical care, inflation, self-reported illness, and mortality in Jamaica. The current study will bridge the gap by providing an investigation of poverty; not seeking medical care; illness; health insurance coverage; inflation and mortality in Jamaica. MATERIALS AND METHOD: Using two decades (1988-2007), the current study used three sets of secondary data published by the (1) Planning Institute of Jamaica and the Statistical Institute of Jamaica (Jamaica Survey of Living Conditions) (2) the Statistical Institute of Jamaica (Demographic Statistics) and (3) the Bank of Jamaica (Economic Report). Scatter diagrams were used to examine correlations between the particular dependent and independent variables. For the current study, a number of hypotheses were tested to provide explanation morality in Jamaica. RESULTS: The average percent of Jamaicans not seeking medical care over the last 2 decades was 41.9%; and the figure has been steadily declining over the last 5 years. In 1990, the most Jamaicans who did not seek medical care were 61.4% and this fell to 52.3% in 1991; 49.1% in 1992 and 48.2% the proceeding year. Based on the percentages, in the early 1990s (1990-1994), the percent of Jamaicans not seeking medical care was close to 50% and in the latter part of the decade, the figure was in the region of 30% and the low as 31.6% in 1999. In 2006, the percent of Jamaicans not seeking medical care despite being ill was 30% and this increased by 4% the following year. Concomitantly, poverty fell by 3.1 times over the 2 decades to 9.9% in 2007, while inflation increased by 1.9 times, self-reported illness was 15.5% in 2007 with mortality averaging 15,776 year of the 2 decades. There is a significant statistical correlation between not seeking medical-care and prevalence of poverty (r = 0.759, p< 0.05). There is a statistical correlation between not seeking medical care and unemployment; but the association is a non-linear one. The relationship between mortality and unemployment was an unsure one, with there being no clear linear or non-linear correlation. The findings revealed that there is a strong direct association between not seeking medical care and inflation rate (r = 0.752). A strong negative statistical correlation was found between mortality and prevalence of poverty (r=0.717). There is a non-linear statistical association between not seeking medical care and illness/injury. CONCLUSIONS: Not seeking medical care is not a good indicator of premature mortality; but that this percentage must be excess of 55%. While this study cannot confirm a clear rate of premature mortality, there are some indications that this occurs beyond a certain level of not seeking care for illness.

Childhood health in Jamaica: changing patterns in health conditions of children 0-14 years.

BACKGROUND: The new thrust by WHO is healthy life expectancy. Therefore, health must be more than morbidity. It is within this framework that a study on childhood health in Jamaica is of vital importance. AIMS: This study 1) expands the health literature in Jamaica and by extension the Caribbean, 2) will aid public health practitioners with research findings upon which they are able to further improve the quality of life of children, 3) investigates the age at with children in Jamaica become influenced by particular chronic diseases and 4) assesses the subjective wellbeing of children. METHODS: The current study extracted a sample of 8,373 and 2,104 children 0-14 years from two surveys collected jointly by the Planning Institute of Jamaica and the Statistics Institute of Jamaica for 2002 and 2007 respectively. A self-administered questionnaire was used to collect the data. RESULTS: Ninety-one percent of children in Jamaica, for 2007, reported good health. The number of children who had diarrhea fell by 84.2% in 2007 over 2002, and a similar reduction was observed for those with asthma (42.1% in 2002 and 19.7% in 2007). Another critical finding was that 1.2% of children, in 2007, had diabetes mellitus compared to none in 2002. CONCLUSION: Public health now has an epidemiological profile of health conditions of children and the demographic shifts which are occurring and this can be used for effective management and planning of the new health reality of the Jamaican child.

Activities of daily living, instrumental activities for daily living and predictors of functional capacity of older men in Jamaica.

BACKGROUND: An extensive search of the literature found no studies that have examined functional capacity [Activities of Daily Living (ADL) and Instrumental Activities for Daily Living (I) ADL)] of Jamaican older men as well as factors that determine their functional capacity. AIMS: The current study examines 1) ADL, 2) (I) ADL), 3) self-reported health status, 4) functional capacity, and 5) factors that determine functional capacity of older men. METHODS AND METHOD: Stratified multistage probability sampling technique was used to draw a sample of 2,000 55+ year men. A132-item questionnaire was used to collect the data. Descriptive statistics provide background information on the sample, cross tabulations were used to examine non-metric variables and logistic regression provides a model of predictors of functional capacity. RESULT: Fifty-five percent of sample indicated good current health status. Four percent was mostly satisfied with life; 21.7% had moderate dependence; 77.1% had high dependence (i.e. independence); 1.2% had low dependence; 21.9% were ages 75 years and older; 35.6% were ages 65 to 74 years and 42.6% reported ages 55 to 64 years. Functional capacity can be determined by church attendance (ß=0.245; 95% CI: 0.264, 1.291); social support (ß=0.129; 95% CI: 0.129, 0.258), area of residence (ß=-0.060; 95% CI: -0.427, -0.061) and lastly by age of respondents. CONCLUSION: Ageing in explains deterioration in their (I) ADL, suggesting the challenges of ageing men's independence. More rural men were rarely satisfied with life; but more of them had a greater functional capacity than urban men. Depression was found to negatively relate to functional capacity, and church attendees had a greater functional status than non-attendees.

An epidemiological transition of health conditions, and health status of the old-old-to-oldest-old in Jamaica: A comparative analysis.

BACKGROUND: There is a paucity of information on the old-old-to-oldest-old in Jamaica. In spite of studies on this cohort, there has never been an examination of the epidemiological transition in health condition affect this age cohort. OBJECTIVES: The aims of the current study are 1) provide an epidemiological profile of health conditions affecting Jamaicans 75+ years, 2) examine whether there is an epidemiological transition in health conditions affecting old-old-to-oldest-old Jamaicans, 3) evaluate particular demographic characteristics and health conditions of this cohort, 4) assess whether current self-reported illness is strongly correlated with current health status, 5) mean age of those with particular health conditions, 6) model health status and 7) provide valuable information upon which health practitioners and public health specialists can make more informed decisions. METHOD: The current study utilized a sub-sample of approximately 4% from each national cross-sectional survey that was conducted in 2002 and 2007. The sub-sample was 282 people ages 75+ years from the 6,783 respondents surveyed for 2007 and 1,069 people ages 75+ years from the 25,018 respondents surveyed for 2002. RESULTS: In 2007, 44% of old-to-oldest-old Jamaicans were diagnosed with hypertension, which represents a 5% decline over 2002. The number of cases of diabetes mellitus increased over 570% in the studied period. The poor indicated having more health conditions than the poorest 20% of the sample. CONCLUSION: The implications of the shift in health conditions will create a health disparity between 75+ year adults and the rest of the population.

The validity of using self-reported illness to measure objective health.

BACKGROUND: There is a longstanding discourse on whether self-reported health is a good measure of objective health. This has never been empirical examined in Jamaica. AIMS: Study seeks to 1) examine the relationship between particular subjective and objective indexes; 2) investigate the validity of a 4-week subjective index in measuring objective indexes; 3) evaluate the differences that exist between the measurement of subjective and objective indexes by the sexes; and 4) provide policy makers, other researchers, public health practitioners as well as social workers with research information with which can be used to inform their directions. MATERIALS AND METHODS: Data published by the Statistical Institute of Jamaica, and the Planning Institute of Jamaica and the Statistical Institute of Jamaica were used for this study. Descriptive statistics were used to provide background information on data. Scatter diagrams were employed to establish 1) statistical associations, and 2) linearity and non-linearity between variables under examination. Multiple regression, using the enter method, was employed to a predictive model of linear associations. RESULTS: A strong significant association was found between life expectancy at birth for the Jamaican population and self-reported illness (r = -0.731); and this was weaker females (r = - 0.683) than males (r = - 0.796). However, the relationship between mortality and self-reported illness was a weak non-linear one. CONCLUSIONS: Self-reported illness in a 4-week reference period is a good measure of objective health and that self-reported illness for males was a better measure for objective health than for females.

Health of females in Jamaica: using two cross-sectional surveys.

BACKGROUND: The 21(st) Century cannot see the examination of health status of elderly, population, children and adolescents; but not for females. AIMS: current study are 1) to examine the health conditions; 2) provide an epidemiological profile of changing health conditions in the last one half decade (2002-2007); 3) evaluate whether self-reported illness is a good measure of health status; 4) compute the mean age of females having particular health conditions; 5) calculate the mean age of being ill compared with those who are not ill; and 6) assess the correlation between health status and income quintile. METHODS AND RESULTS: In 2002, a subsample of 12,675 females was extracted from the sample of 25,018 respondents and for 2007; a subsample of 3,479 females was extracted from 6,783 respondents. RESULTS: There is reduction in the mean age of females reported being diagnosed with chronic illness such as diabetes mellitus (60.54 ± 17.14 years); hypertension (60.85 ± 16.93 years) and arthritis 59.72 ± 15.41 years). The greatest decline in mean age of chronically ill diagnosed females was in arthritic cases (by 7.41 years). Concurrently, the mean age of females with unspecified health conditions fell by (33%, from 54.62 ± 21.77 years in 2002 to 36.42 ± 23.69 years in 2007). CONCLUSION: Although healthy life expectancy for females at birth in Jamaica was 66 years, improvements in their health status cannot be neglected as there are shits in health conditions (to diabetes mellitus) as well as the decline in ages at which females are being diagnosed with particular chronic illnesses.

Dichotomising poor self-reported health status: Using secondary cross-sectional survey data for Jamaica.

BACKGROUND: Caribbean scholars continue to dichotomise self-reported health status without empirical justification for inclusion or exclusion of moderate health status in the dichotomisation of poor health. AIMS: This study will 1) evaluate which cut-off point should be used for self-reported health status; 2) assess whether dichotomisation of self-reported data should be practiced; 3) ascertain any disparity in dichotomisation by some covariates (i.e., marital status, age cohort, social class); and 4) examine the odds of reporting poor or moderate-to-very poor self-reported health status if one has an illness. MATERIALS AND METHODS: The current study used cross-sectional survey data for 2007. The survey used stratified probability sampling techniques to collect the data from Jamaicans. The sample consisted of 6,783 respondents, with a focus on participants aged 46+ years (n=1,583 respondents). Self-reported health status was a 5-item Likert scale question. The dichotomisation was poor health status or otherwise and poor (including moderate) self-reported health. Odds ratios were calculated in order to estimate the effect of the covariates. RESULT: When moderate self-reported health status was used in poor health status, the cut-off revealed moderate effect on specified covariates across the age cohorts for women. However, for men, exponential effects were used on social class, but not on area of residence or marital status across the different age cohorts. CONCLUSIONS: The cut-off point in the dichotomisation of self-reported health status does not make a difference for women and must be taken into consideration in the use of self-reported health data for Jamaica.

Self-rated health and health conditions of married and unmarried men in Jamaica.

BACKGROUND: Since 1988, when Jamaica began collecting data on the living conditions of its people, men have reported seeking less health care than women. Despite this fact, the group has never been studied by researchers. The same is true about the health status of married and non-married men. OBJECTIVES: The current study will 1) evaluate the changing epidemiological patterns of diseases affecting men in Jamaica; 2) determine factors that correlate with good health status of men; 3) compare and contrast the differences in health status of men, in particular marital status; and 4) determine which marital status has the greater health status. MATERIALS AND METHODS: The data for this research were taken from two secondary cross-sectional surveys. A sample of 8,078 respondents 15 years and older was extracted from the 2002 survey (n=25,018 respondents) and 2,224 respondents from the 2007 sample (n=6,783 respondents). SPSS for Windows 16.0 was used to store, retrieve and analyse the data. Chi-square, analysis of variance, t-test and logistic regression were used in this paper. RESULTS: Married men are more likely to report an illness than never married (OR = 1.68, 95% CI = 1.45-1.95), separated, divorced or widowed men (OR = 2.62, 95% CI = 2.06-3.33). No significant statistical difference existed between the self-rated health status of married and unmarried men. CONCLUSION: This study provides a platform upon which future studies can commence as we begin to examine men's health in Jamaica.

Determinants of quality of life of youths in an English-speaking Caribbean nation.

BACKGROUND: Studies on quality of life (QoL) on youths are limited and have not examined determinants of QoL for this cohort. AIMS: The current study seeks to examine the QoL of Jamaican youths and to build a model that identifies factors that explain QoL. MATERIALS AND METHOD: During the period June to August 2006, the Centre of Leadership and Governance, Department of Government, at the University of the West Indies, Mona Campus, conducted a stratified random probability survey of 1,338 respondents. Data were collected using a 166-item questionnaire. Of the sampled population (N=1,338), the proportion of those respondents age 18 to 25 years was 27% (N=364) and this constitutes the sample for the current study. The data were stored and retrieved in the Statistical Package for the Social Sciences (SPSS 12). Descriptive statistics were used to analyse the data, and logistic regression was used to establish the model. RESULTS: The quality of life of Jamaican youths was determined by 4 factors which explain 20% of the variability in quality of life. The parents' economic wellbeing has the most influence on the quality of life of Jamaican youths (OR=1.348; 95% CI: 1.35, 3.04), followed by moderate religiosity (OR=3.594; 95% CI: 1.47, 8.82), the extent of the welfarism of the state (OR=5.273; 95% CI: 1.04, 1.69) and gender (OR = 1.329, 95% CI = 1.04, 1.69). CONCLUSION: The current work has offered us an understanding of the determinants of QoL of youths and how interventions can be planned for in the future.