Table S1 Summary Table of papers on Adolescent Health in the Caribbean



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Table S1 - Summary Table of papers on Adolescent Health in the Caribbean




No.

Reference No.

Citation

Sample Description

Methodology

Results

Associated Risk / Preventive factors identified

1

6

Singh H, Mustapha N: Some factors associated with substance abuse among secondary school students in Trinidad and Tobago. J Drug Educ 1994, 24(1):83-93.

1603 secondary school students aged 14-18 in Trinidad and Tobago

Multi staged sampling with stratification of island into health administrative areas and selection of secondary schools with probability proportionate to the size of population and selection of seniors. Self-administered questionnaire completed in classroom and supervised by trained supervisor.

80% response rate.



Students at all levels of academic performance were involved in substance use.

Students at lower levels of academic performance were more likely to be involved with substance use.

Adolescents who perceived religious youth programs as important, believed in the importance of prayer, or had a strong perception of the importance of religious counsel or teaching, tended to be less involved in substance use when compared with those who perceived these factors as unimportant.

Students who received higher levels of spending money were more likely to be involved in substance use.

Students whose fathers or mothers used alcohol were more likely to admit to using alcohol when compared with children of parents who did not use alcohol.

Students who were likely to perceive themselves as ‘bright’ or ‘likely to come at the top of the class’ were less likely to be involved in substance use.




2

7

Boyd-Patrick HA, Forsythe-Duke V, Edwards R, Holder Y: Behavioural risk factors in the adolescent and adult populations of Trinidad and Tobago, 1989 [abstract]. West Indian Med J 1992, 41(Suppl. 1):16.

306 adolescents (16-19 yrs old)


2-stage sample of 1,700 households.

1,448 (36% of target sample) persons to study non communicable diseases. Participants were interviewed with a KAPB questionnaire.



4.8% of adolescent males and 14.9% of adult males were former or current smokers (100 cigarettes per lifetime).

Smoking started before 25 yrs old.

One in 2 of all smokers had attempted to stop but was susceptible to advertisement.


Not stated.

3

8

Harvey SC: Patterns of drug abuse in persons referred to the drug rehabilitation unit in Barbados [abstract]. West Indian Med J 1997 Apr, 46(Suppl. 2):39.

197 cases analysed- 182 males and 15 females

Mean age =31

Range 14 – 69 yrs old




A review of case notes

53.6% were referrals from the Psychiatric Hospital; 16.2% self referrals.
Polydrug abuse most common – 34%;

Then rank order: cannabis, alcohol and cocaine.


Most common polydrug was combination of alcohol, cannabis and cocaine – 67%
Most common for adolescents – cannabis at 71.1%, declining to 3.8% in the over 44 yr old group.
Most common for over 44 yrs – alcohol 69.2%, declining to 2.6% in the 16-21 yr old group
27-32 yr olds had the greatest use of cocaine


Use of cannabis as a risk factor for adolescents to use cocaine during productive, adult years.
Concern about polydrug use.



4

9

Blum RW, Ireland M: Reducing risk, increasing protective factors: findings from the Caribbean Youth Health Survey. J Adolesc Health 2004 Dec, 35(6):493-500.

Caribbean Youth Health Survey (n= 15 695). African 78.5%, East Indian 6.5%, Amerindian 5.5% descent.

Data from an anonymous survey of 9 countries in Anglophone Caribbean using a pre-tested 87-item pencil and paper instrument derived from the Minnesota Adolescent Health Survey and the Youth Risk Behavior Survey.

They also analysed the results of the Caribbean Youth Health Survey studying the prevalence of health-compromising behaviours. The four health-compromising behaviours studied were tobacco use and alcohol use, sexual intercourse and involvement in violence. They also attempted to determine the risk and protective behaviours associated with these for the same population.


Rage, defined by the authors as “thinking of hurting or killing someone” was the strongest risk factor for every health-compromising behaviour for both genders and across all age groups. 6% males and 4% of females reported rage. When “reported rage, skipping school and abuse” were reported violence occurred in 91% of males and 77% of females versus 22% and 8% for each gender, respectively, when none of the risk factors were present. Protective factors were considered to be parental and school connectedness. Parental connectedness was determined by the responses to items such as: feel parents care, can tell parents about their problems, feels other family members care, feels people in the family understand and family pays attention to you. It was found to be associated with a lower likelihood of reporting poor or fair health, and protective of suicide attempts in all age groups. Among those aged 16 and below parental connectedness was protective against violence and promoted a delay of sexual activity.
School connectedness based on the questions “do you get along with teachers and do you like school” was observed to be the strongest protective factor. Family connectedness and religious attendance had roughly equivalent protective association. Risk factors as well as protective factors were shown to be cumulative for the four health-compromising behaviours studied by Blum and Ireland. They concluded that for many of the outcomes increased protective factors were associated with as much or more reduction of involvement in health-compromising behaviours than a decrease in risk factors.

Rage was defined by the question ‘Do you ever think about hurting or killing someone?’ Rage was the strongest risk factor for violence involvement, sexual intercourse, tobacco use and alcohol use, across all age groups and both genders.

School connectedness was the strongest protective factor.


5

10

Blum RW, Halcón L, Beuhring T, Pate E, Campell-Forrester S, Venema A: Adolescent health in the Caribbean: risk and protective factors. Am J Public Health 2003 Mar, 93(3):456-460.

Caribbean Youth Health Survey (n= 15 695). African 78.5%, East Indian 6.5%, Amerindian 5.5% descent.

Data from an anonymous survey of 9 countries in Anglophone Caribbean using a pre-tested 87-item pencil and paper instrument derived from the Minnesota Adolescent Health Survey and the Youth Risk Behavior Survey.



Across all age groups, both parental substance use and parental mental health problems were associated with substance use. In most age groups studied, rage, abuse, parental violence and a friend or family member who attempted suicide were found to correlate highly with substance use.

Across all age groups, the strongest association with attempted suicide was a history of a friend or family member’ suicide.

Parental connectedness was strongly protective against suicide in all age groups.

23% of those who experienced sexual abuse reported attempting suicide vs. 9.1% of persons not experiencing abuse reporting attempted suicide.

Connectedness to parents was strongly protective with delayed sexual initiation among those less than 16 yr.

Both rage and physical or sexual abuse were associated 6with early sexual intercourse among all age groups.


6


11

Ohene S, Ireland M, Blum R. The clustering of risk behaviors among Caribbean youth. Matern Child Health J. 2005;9(1):91-100

Caribbean Youth Health Survey (n= 15 695). African 78.5%, East Indian 6.5%, Amerindian 5.5% descent.

Studied the associations between cigarette smoking, alcohol and marijuana use, early initiation of sexual intercourse, involvement in violence and delinquency using odds ratios and also used survival analysis to determine the association between the initiation of sexual activity and risk behaviours. Data from an anonymous survey of 9 countries in Anglophone Caribbean using a pre-tested 87-item pencil and paper instrument derived from the Minnesota Adolescent Health Survey and the Youth Risk Behavior Survey.

Percentages of school-going adolescents reporting risk behaviours in the presence of 3 protective factors: school connectedness, family connectedness and religious attendance

Percentages of school-going adolescents reporting risk-behaviours in the presence of 3 risk factors: abuse, skipping school and rage.

Risk Behaviours

Males (%)


Females (%)

Violence

27

6

Sexual activity

34

7

Alcohol use

3

1

Tobacco use

5

2




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