Feminist perspectives on environmental justice and health in Jamaica.

Jamaica is an island nation with a history that is informed by Taino settlement, European colonisation, chattel slavery, disinvestment, and continued extractivism. This perspective paper leverages a historical analysis to explore environmental injustices affecting the health and quality of life of Jamaicans living in Jamaica. This article hopes to contribute to a growing but limited body of scholarly research that contends with environmental and climate justice in the context of the Caribbean. In discussing a lack of critical environmental infrastructure, such as reliable solid waste management, and the impacts of extractive industries, such as bauxite mining, the paper intends to highlight the environmental, public health, and social harms that are produced. Employing an intersectional approach grounded in Black feminist epistemology put forward by Patricia Hill Collins, the authors use their lived experiences as a source of knowledge. The paper analyses how these environmental injustices harm Jamaican communities at large but underscores the compounded challenges faced by Jamaican women who experience marginalisation on the basis of gender, urban/rural residency, and class. The paper concludes by urging researchers, policymakers, regulatory bodies, and other stakeholders to conduct further research and create sustainable and equitable environmental standards that have considerations for environmental injustice in Jamaica.

JA KIDS - Jamaica's second national birth cohort study: aims and methods.

Birth cohort studies across the world have yielded information that has been used to inform policy and programme decisions that have improved the health and well-being of populations. A few such studies have been conducted in low- and middle-income countries due to funding, methodological and other challenges. This paper briefly reviews the methods of comprehensive birth cohort studies with extensive follow-up of participants through the life course conducted in low- and middle-income countries. It then reviews the first Jamaican birth cohort study of 1986 and discusses the methodological advances in implementing JA KIDS, the second Jamaican birth cohort study conducted in 2011. The aims and methods of JA KIDS are described in detail.

Does household size matter? Crowding and its effects on child development.

There is very little compelling evidence that household size negatively affects child development. In this study, the effects of household size on child development were analysed using data collected for a sample of 1311 four-year-old Jamaican children. Children's development was assessed using the Griffiths Mental Development Scales across six developmental domains: locomotor, personal-social, language, coordination, performance and practical reasoning. The findings suggest that children's locomotor and personal-social development are negatively affected by household crowding, with no significant effects observed for other domains. Additional results show that these adverse effects are strongest if the child lives in a single room compared to a separately detached house. This evidence speaks to the need to tailor policies towards access to good housing infrastructure and the provision of recreational spaces to encourage play and social interaction among children.

Epidemiology of violence against young children in Jamaica.

Violence against young children is known to have detrimental short and long-term effects. Yet, few studies investigate the prevalence of violence against young children, particularly very young children under the age of 2 years. This paper reports on the prevalence of violence against young children in Jamaica using data obtained from the JA KIDS birth cohort study that undertook pre-enrolment of pregnant mothers in the antenatal period and followed full or sub-samples of parents and children at 9-12 months, 18-22 months and 4-5 years. Violence in pregnancy was experienced by 6.1% of pre-enrolled mothers. As many as 43.1% of Jamaican children ages 9-12 months were shouted at, and almost 30% were slapped. Physical and emotional violence increased with age, and by 4-5 years, approximately 90% of children experienced physical and emotional violence. Non-violent methods, primarily explaining and reasoning with children, were also reported by more than 95% of parents at 4-5 years. Corporal punishment was the most common form of violence experienced, but young children also witnessed hurtful physical and emotional violence between mothers and their partners and lived in communities in which there were violent events. Strategies to reduce young children's experiences as victims and witnesses of violence are discussed.

Prevalence and predictors of cigarette smoking among people with HIV in Western Jamaica.

With highly active antiretroviral therapy, HIV infection has become a treatable chronic disease. However, modifiable risk factors such as cigarette smoking continue to impact the morbidity and mortality of people with HIV (PWH). We assessed the prevalence and factors associated with cigarette smoking and motivation to quit among PWH in Western Jamaica. A cross-sectional study was conducted in which 392 adults seeking HIV care at health facilities in Western Jamaica completed an interviewer-administered questionnaire. Current smoking prevalence among participants was 17.4%. Current smoking was significantly associated with being male (OR = 2.99), non-Christian/non-Rastafarian (OR = 2.34), living or working with another smoker (aOR =1.86), being moderate to severely depressed (OR = 3.24), having an alcohol drinking problem (OR = 1.84), and never being asked by a healthcare provider if they smoked (OR = 3.24). Among the PWH who currently smoke, 36.7% are moderately to highly dependent on nicotine. One-third of people who smoke (33.8%) started smoking for the first time after HIV diagnosis, while 66.2% initiated smoking before; 88% were willing to quit smoking. These findings provide baseline information for designing and implementing a comprehensive smoking cessation program that considers the needs of PWH in Jamaica, with the potential of becoming a replicable model for other HIV-specialized healthcare settings in the Caribbean.

Poor Sleep Quality in Jamaican Adults With Sickle Cell Disease: Prevalence, Risk Factors, and Association With Quality of Life.

Poor sleep and chronic illnesses have a bidirectional relationship where presence of one can worsen the other. Sickle cell disease (SCD) is associated with significant morbidity and early mortality. In this study, we examine sleep quality, its predictors, and its association with quality of life in Jamaican adults with SCD. This cross-sectional study evaluated 177 well adult SCD patients for sleep quality using The Pittsburgh Sleep Quality Index (PSQI) and quality of life using the Adult Sickle Cell Quality of Life Measurement Information System (ASCQ-Me). Multiple linear regression models examined the predictors of poor sleep quality. The mean global PSQI score was 6.9 (SD 4.2) with 56.5% having poor sleep quality. Women had significantly worse scores for sleep efficiency (p 0.005), sleep latency (p 0.03) and higher use of sleeping medications (p 0.02). Those overweight/obese had significantly worse subjective sleep quality (p 0.001) and sleep efficiency (p 0.05). In multivariate regression analysis, overweight individuals had poorer sleep quality (OR: 2.9; 95% C.I.: 1.07, 7.88) than those with normal weight whereas those unemployed and looking for a job had lower prevalence of poor sleep quality (OR 0.2; 95% C.I.: 0.05, 0.77) compared to employed individuals. Participants with good sleep quality had significantly better functioning in all 5 domains of the ASCQ-Me. In conclusion, persons with SCD who are overweight or obese are at increased risk of poor sleep which can negatively affect quality of life. Patient populations and healthcare providers will need to manage the emerging burden of overweight/obesity.

Fathers' Experiences during Delivery of Their Newborns: A Content Analysis.

Background: Paternal involvement during pregnancy has been shown to have a positive impact on the mother-baby dyad during and after birth. The presence of the father during birth also positively influences father-child attachment, reduces, apprehension, and stress, increases maternal satisfaction, and increases love and respect for the partners. This study explored the experiences of fathers who were present in the delivery room during the delivery process. Methods: This qualitative content analysis study was conducted at a maternity hospital in Kingston, Jamaica from June to July 2022. A total of ten (10) fathers of babies delivered within six weeks were purposefully selected to be interviewed via telephone over four weeks. Data were analysed using a thematic approach. Results: Four sub-themes and one theme were extracted from data analysis. Fathers perceived satisfaction and empowerment in the shadow of positive and negative feelings as the theme. Sub-themes emerged from the data including "clinician's acceptance and support", "close bonding and attachment with mother and baby", "preparedness of fathers to give support", and "inspiring and amazing feeling by fatherhood experiences". Conclusion: Fathers experienced the feeling of empowerment and wished to take up their role during the delivery of their newborns. Their experiences were influenced by the midwives and the resources available to support their accommodation. More policies are needed to strengthen the fathers' involvement during antenatal clinic visits, delivery, and postnatal care.

Factors associated with blood mercury concentrations and their interactions with three glutathione S-transferase genes (GSTT1, GSTM1, and GSTP1): an exposure assessment study of typically developing Jamaican children.

BACKGROUND: Jamaican soil is abundant in heavy metals including mercury (Hg). Due to availability and ease of access, fish is a traditional dietary component in Jamaica and a significant source of Hg exposure. Mercury is a xenobiotic and known neuro-toxicant that affects children's neurodevelopment. Human glutathione S-transferase (GST) genes, including GSTT1, GSTM1, and GSTP1, affect Hg conjugation and elimination mechanisms. METHODS: In this exposure assessment study we used data from 375 typically developing (TD) 2-8-year-old Jamaican children to explore the association between environmental Hg exposure, GST genes, and their interaction effects on blood Hg concentrations (BHgCs). We used multivariable general linear models (GLMs). RESULTS: We identified the child's age, consumption of saltwater fish, canned fish (sardine, mackerel), string beans, grain, and starches (pasta, macaroni, noodles) as the environmental factors significantly associated with BHgCs (all P < 0.05). A significant interaction between consumption of canned fish (sardine, mackerel) and GSTP1 in relation to BHgC using either a co-dominant or recessive genetic model (overall interaction P = 0.01 and P < 0.01, respectively) indicated that consumption of canned fish (sardine, mackerel) was significantly associated with higher mean BHgC only among children with the GSTP1 Ile105Val, Ile/Ile [Ratio of mean Hg (95% CI) = 1.59 (1.09, 2.32), P = 0.02] and Ile/Val [Ratio of mean Hg (95% CI) = 1.46 (1.12, 1.91), P = 0.01] genotypes. CONCLUSIONS: Since this is the first study from Jamaica to report these findings, replication in other populations is recommended.

Unravelling Delay in Care for Sexually Transmitted Infections-Related Symptoms in a Developing Country Setting (Jamaica).

BACKGROUND: Sexually transmitted infections (STIs) and STI treatment remain a challenge in public health. There is little understanding of related factors influencing health seeking behaviour and delay of care among clinic attendees in Jamaica. AIM: To determine socio-demographic profile of clinic attendees with STI and identify factors associated with delay in seeking care for STI-related symptoms. METHODS: A cross-sectional study was done. 201 adult patients presenting with STI symptoms from four health centres in Kingston and St Andrew were selected. A 24-item interviewer-assisted questionnaire was used to obtain data on socio-demographic characteristics, patients' symptoms and duration, previous STIs, knowledge of complications and seriousness of STIs, and factors influencing decision to seek medical care. RESULTS: Almost 75% delayed seeking care for STIs. Recurrent STIs was identified in 41% of patients. 'Could not find time' was the most commonly reported reason for delay in seeking care (36%). Females were 3.4 times more likely to delay seeking care for STI symptoms than males (OR 3.42, 95% CI: 1.73-6.73). Those with primary level education and below were 5 times more likely to delay seeking care for STI symptoms than those with at least secondary level education (OR 5.05, 95% CI: 1.09-23.46). Participants viewed staff as confidential (68%) and 65% thought health-care workers spent adequate time during consultations. CONCLUSION: Lower education level and the female gender are associated with delay in seeking care for STI-related symptoms. These factors should be considered when developing interventions to reduce delay in care for STI-related symptoms.

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.

Factors associated with discussing HIV pre-exposure prophylaxis (PrEP) among Jamaican medical providers.

BACKGROUND: The Ministry of Health and Wellness of Jamaica has endorsed the use of pre-exposure prophylaxis (PrEP) as an HIV prevention strategy; however, PrEP was not included in the national HIV prevention program in 2021. METHODS: A cross-sectional online study involving physicians in Jamaica was conducted in 2021 to describe PrEP awareness, beliefs, attitudes, and practices. The study also assessed individual and social factors associated with discussing PrEP with patients and willingness to prescribe PrEP. FINDINGS: The mean age and standard deviation (SD) of the 69 physicians who completed the survey were 45.5 ± 13.6 years. Most of the participants (80%) reported that they were somewhat familiar with PrEP. PrEP attitude and perceived comfort in prescribing PrEP were moderate among participating physicians, with a mean and SD of 3.9 ± 0.8 and 3.6 ± 0.9 respectively. Six percent of physicians reported that they had prescribed PrEP and 17% had discussed PrEP with their patients in the past year. However, most (90%) reported that they were willing to prescribe PrEP after being informed about it. In the unadjusted model, identifying as Christian (compared to non-Christian) and reporting stronger homophobic beliefs were associated with reduced odds of discussing PrEP with patients. In the multivariable model, only homophobia remained statistically significant (OR, 0.24; 95% CI: 0.07-0.63). CONCLUSION: The findings suggest that physicians in Jamacia may be willing to prescribe PrEP; however, homophobia is a barrier to discussions, underscoring the need for the Ministry of Health and Wellness to recognize the role that homophobia plays in the national HIV program to further reduce HIV incidence in Jamaica.

Sociodemographic characteristics, attitudes, and knowledge associated with previous screening for cervical cancer among women in western Jamaica.

BACKGROUND: About 90% of new cervical cancer cases and deaths worldwide in 2020 occurred in low- and middle-income countries. This can be attributed to the low rates of cervical cancer screening in these countries. This study was conducted to identify factors associated with lack of cervical cancer screening among women in western Jamaica with the aim to increase screening and decrease cervical cancer risk. METHODS: This cross-sectional study assessed associations between previous Pap testing or lack of testing in five years or more, sociodemographic characteristics, attitudes, and knowledge of cervical cancer among women recruited from clinics and community events in the four parishes of western Jamaica. Analyses included chi-square tests, Fisher's exact tests, and logistic regression. RESULTS: Of the 223 women included in the study, 109 (48.9%) reported Pap testing five years or more previous to the study. In the multivariate analysis, women from St. James (Odds Ratio [OR]: 3.35, 95% Confidence Interval [CI]: 1.12-9.99), Trelawny (OR: 5.34, 95% CI: 1.23-23.25), and Westmoreland (OR: 3.70, 95% CI: 1.10-12.50) had increased odds of having had Pap test screening compared to women from Hanover. Women ≥ 50 years of age compared to women 18-29 years of age (OR: 6.17, 95% CI: 1.76-21.54), and employed compared to unemployed women (OR: 2.44, 95% CI: 1.15-5.20) had increased odds of Pap test screening. Similarly, women with one (OR: 4.15, 95% CI: 1.06-16.22) or two or more children (OR: 8.43, 95% CI: 2.24-31.63) compared to women with no children had higher odds of screening. Women who were aware, compared to women who were unaware, of the purpose of Pap tests had increased odds of screening (OR: 3.90, 95% CI: 1.55-9.82). Lastly, women who believed Pap tests were painful compared to women who did not, had decreased odds of having had a Pap test (OR: 0.33, 95% CI: 0.16-0.71). CONCLUSIONS: Uptake of Pap tests among the women was suboptimal and varied among parishes. Young women and women without children were less likely to have ever been screened. Increased education of the purpose of Pap tests to treat pre-cancer to prevent cancer and minimization of the notion that Pap tests are painful could promote screening among women in this population.

Situating commercial determinants of health in their historical context: a qualitative study of sugar-sweetened beverages in Jamaica.

BACKGROUND: Non-communicable diseases (NCDs) are the leading cause of mortality across the Caribbean and similar regions. Structural determinants include a marked increase in the dependency on food imports, and the proliferation of processed foods, including sugar-sweetened beverages (SSBs). We focused on Jamaica as a case study and the health challenge of SSBs, and situated contemporary actions, experiences and policies within their historical context to investigate underlying drivers of commercial determinants of health and attempts to counter them. We asked: how can a historical perspective of the drivers of high level SSB consumption in Jamaica contribute to an enhanced understanding of the context of public health policies aimed at reducing their intake? METHODS: An ethnographic approach with remote data collection included online semi-structured interviews and workshops with 22 local experts and practitioners of health, agriculture and nutrition in Jamaica and attending relevant regional public webinars on SSBs and NCD action in the Caribbean. Our analysis was situated within a review of historical studies of Caribbean food economies with focus on the twentieth century. Jamaican and UK-based researchers collected and ethnographically analysed the data, and discussed findings with the wider transdisciplinary team. RESULTS: We emphasise three key areas in which historical events have shaped contextual factors of SSB consumption. Trade privileged sugar as a cash crop over food production during Jamaica's long colonial history, and trade deregulation since the 1980s through structural adjustment opened markets to transnational companies. These changes increased Jamaican receptiveness to the mass advertisement and marketing of these companies, whilst long-standing power imbalances hampered taxation and regulation in contemporary public health actions. Civil society efforts were important for promoting structural changes to curb overconsumption of SSBs and decentring such entrenched power relations. CONCLUSION: The contemporary challenge of SSBs in Jamaica is a poignant case study of commercial determinants of health and the important context of global market-driven economies and the involvement of private sector interests in public health policies and governance. Historically contextualising these determinants is paramount to making sense of the sugar ecology in Jamaica today and can help elucidate entrenched power dynamics and their key actors.

Pachydermoperiostosis with bilateral ptosis and its associated systemic comorbidities: a rare case report.

Pachydermoperiostosis is a rare genetic disease known as primary or idiopathic hypertrophic osteoarthropathy (HOA)/Touraine-Solente-Gole syndrome. It is an autosomal dominant or recessive disorder comprising digital clubbing, periostosis, hyperhidrosis, and pachydermia (thickening of facial skin). Ocular manifestations are uncommon; however, blepharoptosis may occur. This case presented with severe bilateral ptosis due to the disease progression. A large 20 mm upper lid resection with levator advancement was performed to improve his ability to see. This is the first reported case of pachydermoperiostosis (PDP) in Jamaica. We present a rare case of pachydermoperiostosis with severe blepharoptosis, who attained a good result with surgical intervention.

Maternal feeding styles in infancy predict child body mass index z-scores at 72 months: findings from a cohort of Jamaican children.

Objective: To explore whether maternal feeding styles at 12 months predict child Body Mass Index (BMI) z-scores at 72 months and evaluate whether BMI z-scores at 18 months mediates the association. Methods: Data from 239 mother-child pairs participating in a parenting intervention were analyzed. Feeding information was ascertained at 12 months by questionnaire with feeding styles identified using factor analysis. Children's weight and length/height were measured at 18 and 72 months and BMI z-scores computed. Maternal sociodemographic data, depressive symptoms and language skills were obtained by questionnaire. Multilevel linear regression analysis was used to examine whether feeding styles predicted 72 month BMI z-scores. Complete case analysis was conducted and multiple imputation used to treat missing values of explanatory and outcome variables at 18 and 72 months. Mediational analysis was performed to assess the indirect effects of feeding styles on 72 month BMI z-scores via 18 month BMI z-scores. Results: Restrictive feeding at age 12 months predicted higher 72 month BMI z-scores in both complete case analysis [ß (95%CI): 0.19 (0.02, 0.37)] and multiple imputation [ß (95%CI): 0.20 (0.02, 0.39)]. Uninvolved, forceful, indulgent and responsive feeding styles were not significant predictors of 72 month BMI z-scores. A significant indirect effect was observed between restrictive feeding and child BMI z-scores at 72 months via 18 month BMI z-scores [ß (95% CI) 0.12 (0.03, 0.22)]. Conclusion: Restrictive feeding at 12 months was associated with higher BMI z-scores at 72 months and appeared to be mediated by BMI z-scores at 18 months.

The beta thalassaemia trait in Jamaica.

The objective of this study was to review the prevalence and features of the beta thalassaemia trait in Jamaican populations. Screening of 221,306 newborns over the last 46 years has given an indication of the distribution and prevalence of beta thalassaemia genes, and screening of 16,612 senior school students in Manchester parish, central Jamaica, has provided their haematological features. The prevalence of the beta thalassaemia trait predicted from double heterozygotes was 0.8% of 100,000 babies in Kingston, 0.9% of 121,306 newborns in southwest Jamaica, and 0.9% of school students in Manchester. Mild beta+ thalassaemia variants (-88 C>T, -29 A>G, -90 C>T, polyA T>C) accounted for 75% of Kingston newborns, 76% of newborns in southwest Jamaica, and 89% of Manchester students. Severe beta+ thalassaemia variants were uncommon. Betao thalassaemia variants occurred in 43 patients and resulted from 11 different variants of which the IVSII-849 A>G accounted for 25 (58%) subjects. Red cell indices in IVSII-781 C>G did not differ significantly from HbAA, and this is probably a harmless polymorphism rather than a form of beta+ thalassaemia; the removal of 6 cases in school screening had a minimal effect on the frequency of the beta thalassaemia trait. Red cell indices in the beta+ and betao thalassaemia traits followed established patterns, although both were associated with increased HbF levels. The benign nature of beta+ thalassaemia genes in Jamaica means that cases of sickle cell-beta+ thalassaemia are likely to be overlooked, and important clinical questions such as the role of pneumococcal prophylaxis remain to be answered.

Multimorbidity patterns and health-related quality of life in Jamaican adults: a cross sectional study exploring potential pathways.

Introduction: Multimorbidity and health-related quality of life (HRQoL) are intimately linked. Multiple chronic conditions may adversely affect physical and mental functioning, while poorer HRQoL may contribute to the worsening course of diseases. Understanding mechanisms through which specific combinations of diseases affect HRQoL outcomes can facilitate identification of factors which are amenable to intervention. Jamaica, a middle-income country with high multimorbidity prevalence, has a health service delivery system dominated by public sector provision via a broad healthcare network. This study aims to examine whether multimorbidity classes differentially impact physical and mental dimensions of HRQoL in Jamaicans and quantify indirect effects on the multimorbidity-HRQoL relationship that are mediated by health system factors pertaining to financial healthcare access and service use. Materials and methods: Latent class analysis (LCA) was used to estimate associations between multimorbidity classes and HRQoL outcomes, using latest available data from the nationally representative Jamaica Health and Lifestyle Survey 2007/2008 (N = 2,551). Multimorbidity measurement was based on self-reported presence/absence of 11 non-communicable diseases (NCDs). HRQoL was measured using the 12-item short-form (SF-12) Health Survey. Mediation analyses guided by the counterfactual approach explored indirect effects of insurance coverage and service use on the multimorbidity-HRQoL relationship. Results: LCA revealed four profiles, including a Relatively Healthy class (52.7%) characterized by little to no morbidity and three multimorbidity classes characterized by specific patterns of NCDs and labelled Metabolic (30.9%), Vascular-Inflammatory (12.2%), and Respiratory (4.2%). Compared to the Relatively Healthy class, Vascular-Inflammatory class membership was associated with lower physical functioning (ß = -5.5; p < 0.001); membership in Vascular-Inflammatory (ß = -1.7; p < 0.05), and Respiratory (ß = -2.5; p < 0.05) classes was associated with lower mental functioning. Significant mediated effects of health service use, on mental functioning, were observed for Vascular-Inflammatory (p < 0.05) and Respiratory (p < 0.05) classes. Conclusion: Specific combinations of diseases differentially impacted HRQoL outcomes in Jamaicans, demonstrating the clinical and epidemiological value of multimorbidity classes for this population, and providing insights that may also be relevant to other settings. To better tailor interventions to support multimorbidity management, additional research is needed to elaborate personal experiences with healthcare and examine how health system factors reinforce or mitigate positive health-seeking behaviours, including timely use of services.

Community stressors (violence, victimization, and neighborhood disorder) with cardiometabolic outcomes in urban Jamaica.

Background: Despite limited data on neighborhood factors and health risk in Caribbean populations, previous analyses from Jamaica have shown that neighborhood and home disorder were associated with lower physical activity and higher cumulative biological risk among women, while poorer neighborhood infrastructure was associated with higher overweight/obesity among men. Design: Cross-sectional survey design. Objectives: In this study, we explored whether community stressors, as measured by community violence, victimization and neighborhood disorder scores, were associated with cardiometabolic outcomes (obesity, diabetes, hypertension and high cholesterol) in urban Jamaican communities. Sex-specific Poisson regression models were used to estimate prevalence ratios (PR) for these associations, adjusting for age, education, diet, physical activity and smoking. Participants: Of the 849 participants (M = 282; F = 567), mean age was 48 ± 18.5 years and most had at least a high school education. Men were more likely to be current smokers (29.4 vs. 10.6%) and adequately physically active (53.2 vs. 42.0%); more women were obese (46.0 vs. 19.0%), more likely to have hypertension (52.9 vs. 45.4%) and had high cholesterol (34.2 vs. 21.6%) (all p < 0.05). Results: We observed significant associations only for those in the middle tertile of neighborhood disorder with prevalence of higher cholesterol [PR:1.72 (1.20 to 2.47)] in women and lower prevalence of obesity [PR:0.24 (0.10 to 0.53)] in men. Conclusion: Results suggest that higher, but not the highest level of neighborhood disorder was associated with higher cholesterol levels in women and lower obesity in men. Future work will explore additional approaches to measuring neighborhood characteristics in Jamaica and the mechanisms that may underlie any relationships that are identified.

Factors Associated With Coronavirus Disease 2019 Vaccine Uptake Among Pregnant Women and Nonpregnant Women of Reproductive Age in Jamaica.

Background: Despite high rates of coronavirus disease 2019 (COVID-19)-related maternal mortality, Jamaica currently has little data on COVID-19 vaccine uptake among pregnant women. Methods: We conducted a cross-sectional, web-based survey of 192 reproductive-aged women in Jamaica from February 1 to 8, 2022. Participants were recruited from a convenience sample of patients, providers, and staff at a teaching hospital. We assessed self-reported COVID-19 vaccination status and COVID-19-related medical mistrust (operationalized as vaccine confidence, government mistrust, and race-based mistrust). We used multivariable modified Poisson regression to test the association between vaccine uptake and pregnancy. Results: Of 192 respondents, 72 (38%) were pregnant. Most (93%) were Black. Vaccine uptake was 35% in pregnant women versus 75% in nonpregnant women. Pregnant women were more likely to cite healthcare providers versus the government as trustworthy sources of COVID-19 vaccine information (65% vs 28%). Pregnancy, low vaccine confidence, and government mistrust were associated with a lower likelihood of COVID-19 vaccination (adjusted prevalence ratio [aPR] = 0.68 [95% confidence interval {CI}, .49-.95], aPR = 0.61 [95% CI, .40-.95], and aPR = 0.68 [95% CI, .52-.89], respectively). Race-based mistrust was not associated with COVID-19 vaccination in the final model. Conclusions: Pregnancy, low vaccine confidence, and government mistrust were associated with a lower likelihood of COVID-19 vaccination among reproductive-aged women in Jamaica. Future studies should evaluate the efficacy of strategies proven to improve maternal vaccination coverage, including standing "opt-out" vaccination orders and collaborative provider and patient-led educational videos tailored for pregnant individuals. Strategies that decouple vaccine messaging from government agencies also warrant evaluation.