Está en la página 1de 821

Females, Health

&

Sex in Jamaica

Paul A. Bourne † $$ ££

?
ψ χ

Ϡ

Females, Health

&

Sex in Jamaica

i

Females, Health

&

Sex in Jamaica

PAUL ANDREW BOURNE Director, Socio-Medical Research Institute

ii

©Paul A. Bourne, 2011 First Published in Jamaica, 2011 by Paul Andrew Bourne 66 Long Wall Drive Stony Hill, Kingston 9, St. Andrew National Library of Jamaica Cataloguing Data

Females, Health & Sex in Jamaica
Includes index ISBN Bourne, Paul Andrew All rights reserved. Published , 2011 Cover designed by Paul Andrew Bourne

iii

Contents
Preface Acknowledgement vi viii

Part 1
Health, Illness and chronic health conditions Chapter 1 Health of females in Jamaica: using two cross-sectional surveys Chapter 2 The uninsured ill in a developing nation Chapter 3 Self-rated health of the educated and uneducated classes in Jamaica Chapter 4 Health status of patients with self-reported chronic diseases Chapter Chapter Chapter Chapter Chapter Chapter Chapter Chapter 5 6 7 8 9 10 11 12 1
1 21 52

in Jamaica 77 The changing faces of diabetes, hypertension and arthritis in a Caribbean population 103 Self-assessed health of young adults in an English-speaking Caribbean nation 129 Disparities in self-rated health, health care utilization, illness, chronic illness and other socioeconomic characteristics of the Insured and Uninsured 160 Good Health Status of Rural Women in the Reproductive Ages 192 Determinants of Quality of Life of Jamaican Women 225 Examining Health Status of Women in Rural, Peri-urban and Urban Areas in Jamaica 246 Social determinants of self-reported health across the Life Course 288 Modeling social determinants of self-rated health status of hypertensive in a middle-income developing nation 310

Part 2
Sex and reproductive practices of females Chapter 13 Factor Differentials in contraceptive use and demographic profile Chapter Chapter Chapter 14 15 16
among females who had their first coital activity at most 16 years versus those at 16+ years old in a developing nation Reproductive health matters: Women whose first sexual intercourse occurred at 20+ years old On sexual and non-intimate unions among the general reproductive population of women in Jamaica: A cross-sectional survey Sociodemographic correlates of age at sexual debut among women iv 335 368 392

of the reproductive years in a middle-income developing nation

430

Chapter Chapter Chapter Chapter Chapter

17 18 19 20 21

Current use of contraceptive method among women in a middle-income developing country Females with multiple sexual partners and their reproductive health matters: A comprehensive analysis of women aged 15-49 years in a developing nation Sexually assaulted females on their sexual debut: Reproductive health matters Females of the reproductive ages who have never used a condom with a non-steady sexual partner Multiple sexual partnerships among young adults in a tropically developing nation: A public health challenge

458

484 513 538 559

Part 3
Sex Chapter Chapter Chapter and reproductive practices of males 22 Psychosocial correlates of condom usage in a developing country 23 Young males whose first coitus began at most 15 years old 24 Young males who delay first coitus for the statutory age and
beyond in Jamaica 592 621 646

Part 4
Validity and reliability testing of survey data Chapter 25 The image of health status and quality of life in a Caribbean society 671 Chapter 26 Paradoxes in self-evaluated health data in a developing country 691 Chapter 27 The validity of using self-reported illness to measure objective health 716 Chapter 28 Dichotomising poor self-reported health status:
Using secondary cross-sectional survey data for Jamaica 736 758

Chapter

29

The quality of sample surveys in a developing nation

Part 5
Additional chapter Chapter 30 Self-rated health status of young adolescent females in a
middle-income developing country v 791

Preface
Many developing countries as well as developed nations continue to experience sexual explosions, the lowering of the age at first sexual intercourse. It appears that inspite of the inroads of public health practitioners to effectively tackle sanitary issues, water quality, vaccination and countless other reproductive health matters; they have failed in their efforts to adequately address the continuous lowering of the age at first coitus. This is equally the same in the United States. Jamaica like many societies has tried to revert the lowering of the age at first sexual relations, but this is to no avail. With the lowering of the age of sexual consent from 18 to 16 years in Jamaica, this is equally responsible for the continued sexual experimentation at an even younger age among adolescents as well as children (under 16 years). The high diet of sexual relations is not limited to young children, adolescents and young adults, the prevalence and incidence of among Jamaicans are exorbitantly high. Statistics revealed that almost 23 out of every 25 Jamaicans aged 15-74 years old have had have sex, 33 out of every 50 Jamaicans aged 15-74 years old had sex at least once per week, 21 out of every 25 Jamaicans aged 15-24 years had sex and about 41 in every 50 Jamaicans of the early age had sexual intercourse at least once per week (Wilks et al., 2008). The percentage of reported sexual intercourse increased with age in Jamaica (Wilks et al., 2008), suggesting that sexual relations must have some cultural underpinnings. Clearly from the aforementioned findings, Jamaicans are in a highly sexed people. One of the notable irony (or paradox) is that they (Jamaicans) are not openly expressive about sex, dislike public dialogues on the phenomenon, the older adults are speechless to advice young children and young adults about sexual expression, expect to say ‘abstain’, ‘wait for adulthood’ and ‘in time you will know what to do’. The silent sexed culture is equally responsible for rape. Dialectic situations arise when females are raped (or sexually assaulted) as some people believe that the female is to be blamed for inviting the peer by her code of dress or ‘common’ behaviour. Then there is sympathy for the perpetrator (rapist). Some people become empathetic toward the position of the perpetrators, with social expressions for the behaviour. More so, females are victims and sexually assaulted by

vi

powerful males because of poverty, and the economic power disparity protect the economically powerful males. In response to the aforementioned issues, this volume collated some search papers on various issues on health, sex and sexual experiences of females. Even though the issues are primarily on females, any discussion on sexuality must relate to both sexes. Therefore, I added an entire section on males’ sexual expression as this will broaden the discourse and provide clarity to females’ sexual issues. This book would have been incomplete if it had not examined the quality of survey data. I believe that scientists cannot accept cosmology, without questioning, testing and verifying that knowledge. It is as a result of questioning, further testing of knowledge and truths that truths are established, modified or changed with more information. Knowledge is not stationary; therefore, I sought to question the validity and reliability of survey data used in this text. The purpose was to provide readers with better understanding of findings, their roles in being skeptics, and how knowledge is created through questioning. I believe strongly in readable and engaging writing style, and so many complex concepts were simplified in keeping with my purpose to engage and connect with the readers. In some instances technical statistical terms and calculations were unavoidable. In those cases, I tried to explain the issues surrounding the technical terms for the readers to be adequately informed on the subject without a thorough knowledge of introductory or advanced statistics. Knowledge of introductory or advanced statistics will be good but not necessarily for the readers. The majority of the chapters are 1) published in peer reviewed journals, and 2) solely written by yours truly. However, a few chapters are co-authored with Caribbean and International scholars. This book will broaden the discourse as it represents a useful contribution to the literature that is Jamaican in scope. Paul Andrew Bourne 2011

vii

Acknowledgements

Many people have contributed to the completion of this book. I would like to extend my sincere gratitude to them. I would like to single out, 1) Ms. Neva South-Bourne for her advice in penning my ideas, 2) Mrs. Evadney Bourne, my wife, for support, understanding and patience when things were difficult and surmountable at times, 3) all my co-authors, 4) God, for his wisdom, 5) the Data Bank in Sir Arthur Lewis Institute of Social and Economic Studies, the University of the West Indies, Mona, Jamaica for making the dataset available for use in this study, and 6) all my associates (including best friends) whose love, support and encouragement provided the impetus that I drew from to complete this project.

viii

1
Health of females in Jamaica: using two cross-sectional surveys
The 21st Century cannot have researchers examining self-rated health status of elderly, population, children and adolescents and not single out females as they continue to be poorer than males; and are exposed to different socioeconomic situation. The current paper 1) examines the health conditions; 2) provides an epidemiological profile of changing health conditions in the last one half decade; 3) evaluates whether self-reported illness is a good measure of self-rated health status; 4) computes the mean age of females having particular health conditions; 5) calculates the mean age of being ill compared with those who are not ill; and 6) assesses the correlation between self-rated health status and income quintile. 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). In 2007 over 2002, the mean age of females with unspecified health conditions fell by 33%. Although healthy life expectancy for females at birth in Jamaica was 66 years which is greater than that for males, improvements in their self-rated health status cannot be neglected as there are shifts in health conditions towards diabetes mellitus and a decline in the mean age at which females are diagnosed with particular chronic illnesses.

Introduction

Life expectancy is among the objective indexes for measuring health for a person, society, or population. In 1880-1882, life expectancy at birth for females in Jamaica was 39.8 years which was 2.79 years more than that for males. One hundred and twenty-two years later, health disparity increased to 5.81 years: in 2002-2004, life expectancy at birth for females was 77.07
1

years [1]. For the world, the difference in life expectancy for the sexes was 4.2 years more for females than males: for 2000-2005, life expectancy at birth for females was 68.1 years [2]. Within the expanded conceptual framework offered by the World Health Organization (WHO) in the late 1940s, health is more than the absence of morbidity as it includes social, psychological and physiological wellbeing [3]. Some scholars [4] opined that using the opposite of ill-health to measure health is a negative approach as health is more than this biomedical approach. Brannon and Feist [4] forwarded a positive approach which is in keeping with the ‗Biopsychosocial‘ framework developed by Engel. Engel coined the term Biopsychosocial when he forwarded the perspective that patient care must integrate the mind, body and social environment [5-8]. He believed that mentally patient care is not merely about the illness, as other factors equally influence the health of the patient. Although this was not new because the WHO had already stated this, it was the application which was different from the traditional biomedical approach to the study and treatment of ill patients. Embedded in Engel‘s works were wellbeing, wellness and quality of life and not merely the removal of the illness, which psychologists like Brannon and Feist called the positive approach to the study and treatment of health. Recognizing the limitation of life expectancy, WHO therefore developed DALE – Disability Adjusted Life Expectancy – which discounted life expectancy by number of years spent in illness. The emphasis in the 21st Century therefore was healthy life and not length of life (ie life expectancy) [9]. DALE is the years in ill health which is weighted according to severity, which is then subtracted from the expected overall life expectancy to give the equivalent healthy years of life. Using healthy years, statistics revealed that the health disparity between the sexes in
2

Jamaica was 5 years in 2007 [10], indicating that self-rated health status of females on average in Jamaica is better than that for males. This is not atypical to Jamaica as females in many nations had a greater healthy life expectancy than males. The discipline of public health is concerned with more than accepting the health disparity as indicated by life expectancy or healthy life expectancy, as it seeks to improve the quality of life of the populace and the various subgroups that are within a particular geographical border. In order for this mandate to be attained, we cannot exclude the study of females‘ health merely because they are living longer than males and accept this as a given; and that there is not need therefore to examine their self-rated health status. Many empirical studies that have examined health of Caribbean nationals were on the population [11-15]; elderly [16-25]; children [26, 27]; adolescents [28-30] and females have been omitted from the discourse. A comprehensive search of health literature in Caribbean in particular Jamaica revealed no studies. The values for the healthy life expectancy cannot be enough to indicate the self-rated health status of females neither can we use self-rated health status of population, children, elderly and adolescents to measure that of females. WHO [31] forwarded a position that there is a disparity between contracting many diseases and the gender constitution of an individual, suggesting that population health cannot be used to measure female health. Females have a high propensity than males to contract particular conditions such as depression, osteoporosis and osteoarthritis [31]. A study conducted by McDonough and Walters [32] revealed that women had a 23 percent higher distress score than men and were more likely to report chronic diseases compared to males (30%). It was found that men believed their health was better (2% higher) than that self-reported by females.
3

McDonough and Walters used data from a longitudinal study named Canadian National Population Health Survey (NPHS). Those aforementioned realities justify a study on female health in Jamaica. The current paper fills the gap in the health literature by investigating health of females in Jamaica. The objectives of the current paper 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 self-rated 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 self-rated health status and income quintile.

Materials and methods
Sample The current paper extracted subsample of females from two secondary cross-sectional data collected by the Planning Institute of Jamaica and the Statistical Institute of Jamaica [33, 34]. 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. The survey is called the Jamaica Survey of Living Conditions (JSLC) which began in 1989. The JSLC is modification of the World Bank‘s Living Standards Measurement Study (LSMS) household survey. A self-administered questionnaire is used to collect the data from Jamaicans. Trained data collectors are used to gather the data; and these individuals are trained by the Statistical Institute of Jamaica
4

The survey was drawn using stratified random sampling. This design was a two-stage stratified random sampling design where there was a Primary Sampling Unit (PSU) and a selection of dwellings from the primary units. The PSU is an Enumeration District (ED), which constitutes a minimum of 100 residences in rural areas and 150 in urban areas. An ED is an independent geographic unit that shares a common boundary. This means that the country was grouped into strata of equal size based on dwellings (EDs). Based on the PSUs, a listing of all the dwellings was made, and this became the sampling frame from which a Master Sample of dwelling was compiled, which in turn provided the sampling frame for the labour force. One third of the Labour Force Survey (i.e. LFS) was selected for the JSLC. The sample was weighted to reflect the population of the nation. The non-response rate for the survey for 2007 was 26.2% and 27.7%. Measures Self-reported illness (or Health conditions): The question was asked: ―Is this a diagnosed recurring illness?‖ The answering options are: Yes, Cold; Yes, Diarrhoea; Yes, Asthma; Yes, Diabetes; Yes, Hypertension; Yes, Arthritis; Yes, Other; and No. Self-rated health status (self-rated health status): ―How is your health in general?‖ And the options were very good; good; fair; poor and very poor. The first time this was collected for Jamaicans, using the JSLC, was in 2007. Social class: This variable was measured based on the income quintiles: The upper classes were those in the wealthy quintiles (quintiles 4 and 5); middle class was quintile 3 and poor those in lower quintiles (quintiles 1 and 2).
5

Health care-seeking behaviour. This is a dichotomous variable which came from the question ―Has a doctor, nurse, pharmacist, midwife, healer or any other health practitioner been visited?‖ with the option (yes or no). Statistical analysis The data were collected, stored and retrieved in SPSS for Windows 16.0 (SPSS Inc; Chicago, IL, USA). Descriptive statistics were used to provide information on the socio-demographic variables of the sample. Cross Tabulations were employed to examine correlations between nonmetric variables and Analysis of Variance (ANOVA) were utilized to examine statistical associations between a metric and non-metric variable. The level of significance used in this research was 5% (ie 95% confidence interval). Bryman and Cramer [35] correlation coefficient values were used to determine, the strength of a relation between (or among) variables: 0.19 and below, very low; 0.20 to 0.39, low; 0.40 to 0.69, moderate; 0.70 to 0.89, high (strong); and 0.90 to 1 is very high (very strong).

Results
Demographic characteristic of sample In 2002, 14.7% of sample reported an illness and this increased by 19.1% in 2007. Over the same period, health insurance coverage increased by 81.0% (to 21.0% in 2007); those seeking medical care increased to 67.6% (from 66.0%); the mean age in 2007 was 30.6±21.9 years which marginal increased from 29.4 ± 22.3 years; diabetic cases exponentially increased by 227.7% (in 2007, 15.4%); hypertension decline by 45.5% (to 24.8% in 2007) and arthritic cases fell by 66.1% (to 9.4% in 2007). Urbanization was evident between 2007 and 2002 as the number of
6

females who resided in urban areas increased by 114.7% (to 30.4% in 2007), with a corresponding decline of 19.4% in females zones. Table 1.1 revealed that the increase in self-reported illness was substantially accounted for by increased cases in the rural sample (from 12.9% in 2002 to 20.0% in 2007). The drastic increase in health insurance coverage in 2007 was due to public establishment of public health insurance coverage. The greatest increase was observed in semi-urban areas 17.8%) followed by urban (9.6%) and rural (7.8%) Table 1.1. The increases in self-reported illness can be accounted for by diabetes mellitus, asthma and other dysfunctions. Concurrently, most of the increased cases were diabetic in semi-urban zones (17.1%); other health conditions in semi-urban areas (12.4%) and asthma in urban zones (12.0%) (Table 1.1). Bivariate analyses There was a significant statistical correlation between self-rated health status and self-reported illness - χ2 (df = 4) = 700.633, P < 0.001; with there being a negative moderate relation between the variables – correlation coefficient = - 0.412(Table 1.2). Based on Table 1.2, 10.7% of those who reported an illness had had very good self-rated health status compared to 40.2% of those who did not indicate an illness. On the other hand, 2.5% of those who did not report a dysfunction had at least poor self-rated health status compared to 19.8% of those who indicated having an illness. Even after controlling self-rated health status and self-reported illness by age, marital status and per capita annual expenditure, a moderate negative correlation was found – correlation coefficient = - 0.362. On further examination of the self-reported illness by age, it was found that in 2002 the mean age of individual who reported an illness was 43.97 ± 26.81 years compared to 27.05 ±
7

001.95 years for those who did not report an ailment – t-test = 15. the mean age of females with unspecified health conditions fell by (33%.54 ± 17. Concurrently.20.42 ± 23. No significant statistical correlation was found between diagnosed self-reported illness and income quintile .41 years for who without an illness – t-test = 30. with the relationship being a very weak one – correlation coefficient = 0. P < 0. Based on Figure 1.85 ± 16.53 years compared to 28. hypertension (60. Discussion Self-rated health status of female Jamaicans can be measured using self-reported illness.161.14 years).7%).62 ± 21.41 years). The current paper found a moderate significant correlation between the two aforementioned variables. from 54.77 years in 2002 to 36. However. the wealthy reported the greatest self-rated health status (ie very good) compared to the wealthiest 20% (36.001. P < 0. there is reduction in the mean age of females reported being diagnosed with chronic illness such as diabetes mellitus (60. In 8 . In 2007.001 (Table 1. suggesting that self-reported illness is a relatively good measure of female‘s health.χ2 (df = 16) = 54.69 years in 2007).3.2 years) and asthma (21.41 years).001.73 ± 20. A cross tabulation between self-rated health status and income quintile revealed a significant statistical correlation .83 ± 26.818.00 ± 36. The greatest decline in mean age of chronically ill diagnosed females was in arthritic cases (by 7.93 years) and arthritis 59.4).3).16 ± 19. P > 0.51 years). P < 0. Based on Table 1.044.χ2 (df = 28) = 36.126 (Table 1. the mean age of reporting an illness was 42. with the poorest 20% recorded the least very good self-rated health status.1.263. there is an increase in the mean age of females being diagnosed with diarrhoea (32.72 ± 15.

this study found that income is able to buy some improvement in self-rated health status. Using a sample of elderly Barbadians. Self-rated health status is people‘s self-rated perspective on their general selfrated health status [35]. Concomitantly. It is evident from the findings that self-rated health status is wider than illness. the discourse must address the biases in subjective indexes which are found in studies like this one. The other components of this status include life satisfaction. Any study on subjective indexes in the 9 . which concurs with the literature [35. with 20 out every 100 indicated a least poor health. and psychosocial wellbeing. which includes a percentage of poor health (or ill-health). Before this discussion can proceed. In 2007 over 2002. Embedded in this finding is the role of income plays in improving self-rated health status [38]. the self-rated health status of females in different social standing (measured using income quintile) is different. happiness. the 15 out of every 100 females reported being diagnosed with diabetes mellitus compared to 5 in 100 in 2002 indicating the negative effects of life behaviour of female‘s self-rated health status. Like Marmot [38]. However. Hambleton et al [37] found 33.this study it was revealed that 60 out of every 100 who reported an illness had at most fair selfrated health status. There is a disparity between the current paper and that of Hambleton et al‘s work as more of self-rated health status of the elderly is explained by current illness with this being less for females in Jamaica. Another important finding of the current paper is that diagnosed illnesses are not significantly different based on income quintile in which a female is categorized. there is an epidemiological shift in the typology of illnesses affecting females as the change is towards diabetes mellitus. 36]. which is keeping with the propositions of the WHO that health must be more than the absence of illness.5% of explanatory power of selfrated health status is accounted for by illness. but this work goes further as it found that income does not reduce the typology in health conditions affecting females.

[41] for more information). mortality or diagnosed morbidity. and that self-reported illness accounted for 54% of the variance in life expectancy. A study by Finnas et al [41] opined that there are some methodological issues surrounding the use of self-reported (or self-rated) health and that these may result in incorrect inference.0. he found a strong correlation between males‘ health (correlation coefficient. In spite of this fact. life satisfaction. the next issue of concern is the reduced aged of reported illness and age of being diagnosed with 10 .796) than for females (correlation coefficient. but that this measure is useful in understanding health. selfreported illness) needs to address the challenges of biases that are found in self-reported data in particular self-reported health data. and must be prone to systematic and nonsystematic biases [40]. suggesting that there is validity to the use of this approach in the measurement of health (or wellbeing) like the objective indexes such as life expectancy. the current research recognized some of the problems in using self-reported health data (read Finnas et al. When Bourne [42] disaggregated the life expectancy and self-reported illness data by sexes.684). while providing empirical findings using people‘s perception on their health. R = 0.731). R = . R = 0. but that it is good measure for health in Jamaica and more so for males. The discourse of subjective wellbeing using survey data cannot deny that it is based on the person‘s judgement. Self-reported data therefore do have some biases. Diener [36] argued that the subjective measure seemed to contain substantial amounts of valid variance. morbidity and mortality. Using life expectancy and self-reported illness data for Jamaicans. Bourne [42] found a strong significant correlation between the two variables (correlation coefficient. self-rated health status. happiness. Now that the discourse on objective and subjective indexes is out of the way.measurement of health (for example.

poverty among rural females was 2.1% increase in urban and 2.3 times in 2007. indicating that on average females are becoming diagnosed with an illness on average 2 months earlier. improvements in their self-rated health status cannot be neglected as there are shifts in health conditions (to diabetes mellitus) as well as the decline in ages at which females are being diagnosed with particular chronic illnesses. In addition to the aforementioned issues. There is an issue 11 . in 2007.7% increase over 2002 compared to a 3. 4. and this increased to 3. In summing.particular chronic illness. Conclusion The current paper revealed that rural females recorded the highest percentage of self-reported illness. In 2002. Furthermore. 20 out of every 100 females in rural Jamaica reported an ailment which is a 3.13 years earlier with diabetes mellitus.2 times more than urban poverty. In 2002. Concurrently.2% increase in semi-urban females. it was revealed that on average females were being diagnosed 7. The greatest increase in cases of diabetes mellitus occurred in semi-urban females followed by urban and rural females.95 years earlier with hypertension and 1. the current paper has revealed that. When self-reported illness was disaggregated into acute and chronic health conditions. there were noticeable increases in diabetes mellitus over the same period. however. the mean age recorded for those who self-reported an illness was 44 years and this fell by 1 year in 2007. poverty was greatest for rural females.41 years earlier with arthritis in 2007 over 2002. Hypertension and arthritis have seen a decline in 2007 over 2002. there is a shift in chronic illnesses occurring in females in Jamaica. although healthy life expectancy for females at birth in Jamaica is 66 years.

3. Engel G. Kingston: STATIN. 2. signed on July 22.‖ In Basic Documents. 4. Engel G . 1946 by the representatives of 61 States (Official Records of the World Health Organization. 1948. 2009. no. Perspectives in Biology and Medicine 1960. Brannon L. The care of the patient: art or science? Johns Hopkins Medical Journal 1977. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference.which emerged from the current finding. Annals of the New York Academy of Sciences 1978. 1948. World health statistics. 2002. 1946. June 19-22. An introduction to behavior and health 6th ed. 1960. A unified concept of health and disease. 5. 2007. World population ageing 19590-2050. The need for a new medical model: A challenge for biomedicine. Statistical Institute of Jamaica. 6. WHO. 12 . Science 1977. New York.3:459-485. Department of Economic and Social Affairs Population Division. Switzerland: WHO. the increasing cases of unspecified illness among females and this must be examined as to classification in order that public health practitioners will be able to address it before it unfolds into a public health challenge in the future. ―Constitution of the World Health Organization. Engel G. Engel G. Demographic statistics. 2005. WHO Issues New Healthy Life Expectancy Rankings: Japan Number One in New ‗Healthy Life‘ System. 2009. Los Angeles: Thomson Wadsworth. The biopsychosocial model and the education of health professionals. 2006. 10. Feist J. 2000. (STATIN). United Nations. References 1. (WHO). 7. (UN).196:129-136. 8.140:222-232. Geneva.310: 169-181. Health psychology. 100) and entered into force on April 7. Washington & Switzerland: WHO. 15th ed. New York: United Nations. 2. p. 1948. World Health Organization. 9 WHO. Geneva: WHO.

12. 14. The elderly in Barbados: problem and policies.11. Decomposing Mortality Rates and Examining Health Status of the Elderly in Jamaica. Hennis AJ. Bourne PA. A theoretical framework of good health status of Jamaicans: using econometric analysis to model good health status over the life course. West Indian Med J. Brathwaite F. Older women: A situational analysis. Brathwaite FS. Ageing and Society 1989. 1 (4):101-130. Hutchinson G. Health Determinants: Using Secondary Data to Model Predictors of Wellbeing of Jamaicans. Demographic and health conditions of ageing in Latin America and the Caribbean. The elderly in the Commonwealth Caribbean: A review of research findings. Historical and current predictors of self-reported health status among elderly persons in Barbados. selfreported illness and Self-evaluated Health status in Jamaica. Int J of Soci Psychiatry. 15.Eldemire D. LeFranc E. Lipps G. Caribbean Affairs 1994. 2:34-44. 2008. Reid ME.Eldemire D. Williams-Green. 21.31:762-771. 13 . The Jamaican elderly: A socioeconomic perspective and policy implications. 1(2): 86-95. Bourne PA.9:297-304.46: 175-193. 16.50:43-53. Fraser HS. 20. 17. 13. 2004. Bourne. Bulletin of Eastern 23. The Open Geriatric Med J. Clarke K. 2004. Pelaez M.8:890. North American Journal of Medical Sciences. Int J of Epidemiology 2002. Simeon DT. Asnani MR. Brathwaite FS. Rev Pan Salud Public. 18. Palloni A. New York: United Nations Division for the Advancement of Women. (2009). Bain BC.23:314-29. McGrowder DA.19:31-46. Social and Economic Studies 1997. 17: 342-352. International Journal of Collaborative Research on Internal Medicine & Public Health. Ali SB. Jamaica 1996. P. Tucker MB. Bulletin of the Pan American Health Organization 1990. Eldemire D. J of Rural and Remote health 2008.A. 2009. 19. 2005. 1996. Quality of life in patients with sickle cell disease in Jamaica: rural-urban differences. 57:476-81. 22. 2009. Hambleton IR. Broome HL. Bourne PA. Social and Health determinants of well-being and life satisfaction in Jamaica. Pinto-Aguirre G. The elderly and the family: The Jamaican experience. Socio-demographic determinants of Health care-seeking behaviour. Crawford TV. Wyatt GE.

Social Science and Medicine 2001. Kingston: Ian Randle. Good Health Status of Older and Oldest Elderly in Jamaica: Are there differences between rural and urban areas? Open Geriatric Medicine Journal. editor. epidemiology. 29. Nutrition and child health development. 2005: p. 26. Bourne PA. In: Morgan W. Jamaica Survey of Living Conditions. Blum RW. Venema A. In: Morgan W. University of the West Indies [distributors]. American Journal of Public Health 2003. Kingston: Ian Randle. editor. Bourne PA. Halcon L. 2008. Quantitative data analysis with SPSS 12 and 13: a guide for social scientists. Jackson M. 2003. Jamaica: Using cross-sectional data for 2002 and 2007. 32. 214-219. Statistical Institute Of Jamaica. 2005: p. Demographic shifts in health conditions of adolescents 10-19 years. University of the West Indies [distributors]. 25. Medical Sociology: Modelling Well-being for elderly People in Jamaica. Bourne PA. Kingston. 2009. Kingston. Wynter S. 2007. In: Morgan W. Campbell-Forrester S. Samms-Vaughn M. Adolescent heath in the Caribbean: Risk and protective factors. Cramer D. editor. 31. Jackson J. Bryman A. Walters V. Ageing and health. 2002. McDonough P. Ashley D. 14 . London and New York: Routledge. West Indian Med J 57:596-04. Hamilton P. Jamaica Survey of Living Conditions. North American Journal of Medical Sciences 2009. 2005: p. 34. 41-50. 93: 456-460. Issues affecting reproductive health in the Caribbean. 52:547-559. 2005: p. Jamaica: Planning Institute of Jamaica and Derek Gordon Databank. Kingston: Ian Randle. WHO. 2:18-27. Beuhring T. 33. Walker S. Kingston. Jamaica: Planning Institute of Jamaica and Derek Gordon Databank. Wynter H. 28. Gender and health: reassessing patterns and explanations. 2005. Health issues in the Caribbean. Frederick C. 27. 2008. Pate E. 2007 [Computer file]. Frederick J. School achievement and behaviour in Jamaican children. Jamaica: Statistical Institute Of Jamaica [producer].24. 1:125-133. Kingston. 26-37. DaCosta V. 35. Health issues in the Caribbean. 30. 2002 [Computer file].Statistical Institute Of Jamaica. 15-25. Jamaica: Statistical Institute Of Jamaica [producer]. Regional Office in Africa: WHO. Health issues in the Caribbean.

In: Kahneman D. In print. Diener E. 1984. Broome HL. 40. Hennis. Hambleton IR. 36. 285-304.31-46.pp 61-84. Bourne P. Living. two perspectives. Schwarz N. Some methodological remarks on self-rated health. and thinking about it. Finnas F. Kaverne B. Well-being: The Foundations of Hedonic Psychology. Psychological Bulletin. Brathwaite F. 342-352. Schwarz N. editors. 15 . 42. p. Saarela J. Subjective well-being. Is self-reported health a good measure of objective health? North American J of Medical Sciences. 21. Historical and current predictors of self-reported health status among elderly persons in Barbados.1:32-39. 41. Marmot M . London: Oxford University Press.The influence of Income on Health: Views of an Epidemiologist. Kahneman D. Does money really matter? Or is it a marker for something else? Health Affairs 2002. A. Diener E. Clarke K. Fraser HS. Baylis N.35. 1999. psychology. The science of well-being: Integrating neurobiology. Revista Panamericana de salud Públic 2005. and social science. Riis J.J. Nyqvist F.95:542–75 37. Russell Sage Foundation: New York. The Open Public Health J 2008. Reports of subjective well-being: judgmental processes and their methodological implications. 38. 2005. 17. In: Huppert FA. pp. Strack F. editors.

1) 51 (6.0) 864 (84.6) 16 (3.0) 2811 (88.9) 11 (1.2) 627 (85.0) 30.0) 215 (65.2) 523 (68.3) 56 (17.4) Rural 262 (23.4) 45 (26.1) 0 (0.7) 27 (1.0) 125 (74.7) 97 (9.8) 33 (19.4) 1864 (24.7) 8 (6.2) 20 (12.4) 2007 1 (0.7) 331 (18.3) 341 (19.8) 9 (5.6) 735 (71.0) 16 .9) 1540 (87.2) 20 (12.9) 22 (13. Sociodemographic characteristics of sample by area of residence.0) 362 (68.0) 0 (0.8) 1867 (24.0) 23 (13.1) 8 (1.9) 6 (5.2) 1 (0.9) 117 (16.3) 21 (20.6 (22.0 (21.7) 1340 (17.2) 0 (0.4) 22 (1.3) 1430 (80.8) 31.9) 34 (6.1) 13 (7.8) 33 (19.1) 453 (9.5) 511 (15.9) 18 (1.2) 539 (16.5) 113 (34.8) 2 (1.7) 30.0) 1 (4.7) 18 (17.7) 3033 (63.0) 265 (25.1) 89 (8.6 (21.1) 384 (12.7) 71 (5.4) 9 (8. Private Yes.9) SemiUrban 568 (25.4) 77 (10.2) 154 (9.3) 6051 (83.5 (23.0) 2 (6.9) 22 (13.1) 498 (29.9) 16 (2.8) 547 (76.4) 161 (21.3) 652 (19.1) 29 (27.0) 1 (3.4) 183 (24.6) 8 (24.Table 1.7) 3 (2.5) 38 (28.1) 126 (7.0) 354 (33.2) 441 (24.3) 25 (0. 2002 and 2007 2002 Variable Rural Marital status Married Never married Divorced Separated Widowed Income quintile Poorest 20% Poor Middle Wealthy Wealthiest 20% Health conditions Diagnosed Acute: Cold Diarrhoea Asthma Diagnosed Chronic: Diabetes mellitus Hypertension Arthritis Other Non-diagnosed Self-reported illness Yes No Health care-seekers Yes No Health insurance Yes.9) 437 (26.2) 759 (22.6 (21.3) 605 (33.2) 324 (20.2) 2 (6.0) 228 (12.8) 894 (11.6) 191 (18.4) 212 (20.0) 57 (42.8) 9 (5.0) 261 (66.0) 12 (1.0) 29.5) 51 (1.8) 1559 (20.0) 540 (7.2) 10 (41.0) 407 (34.7) 16 (0.5) 114 (7.0) 20 (60.7) 98 (9.0) 0 (0.0) 1298 (80.6) 7 (6.7) 2690 (83.0) 0 (0.6) 29.2) 164 (16.8) 2 (1.4) 45 (26.7) 965 (28.6) 206 (11.4) 43 (25.7) 79 (35.1) 38 (36.8) 130 (33.7) 791 (66.5) 237 (14.8) 1361 (85.2) 342 (20.2) 147 (6.4) 231 (12.2) SemiUrban 111 (21.0) 13 (7.9) Urban 243 (19.0) 23 (13.4) 1181 (16.2) Urban 161 (21.2) 146 (19.3) 28.7) 1452 (65.3) 907 (71.0) 2 (1.4) 6723 (92. Public No Age Mean (SD) in yrs 1232 (25.1) 145 (64.2) 6 (25.7) 450 (13.2) 131 (12.8) 65 (63.7) 7 (29.1.6) 104 (14.9 (22.4) 26 (19.0) 5 (0.3) 185 (75.7) 13 (12.9) 723 (65.

5) 2768 17 .001.2) 55 (2.2) Total 590 χ2 (df = 4) = 700.2) 1305 (47. P < 0.6) Very poor 13 (2. 2007 Self-rated health status Yes Very good 63 (10.2.412 Self-reported Illness No 1114 (40.8) Fair 234 (39.Table 1.0.7) Poor 104 (17. correlation coefficient = .1) 281 (10.633. Self-rated health status by self-reported illness.7) Good 176 (29.0) 13 (0.

2002 and 2007 18 .Figure 1.1. Mean scores for self-reported diagnosed health conditions.

00 3.8) 107 (15.0) 695 4 (0.2) 237 (34.126 19 .6) 26 (3. correlation coefficient = 0.3) 663 χ2 (df = 16) = 54.4) 282 (42.3.1) 108 (16.2) 110 (15.0) 697 7 (1.00 4.7) Good 287 (44.6) 665 2 (0.8) Fair (moderate) 105 (16.2) 320 (45.3) 284 (42.Table 1.4) Wealthiest 20% 243 (36. Self-rated health status by income quintile.0) 225 (32.6) 23 (3.3) 24 (3.044. P < 0.9) 650 7 (1. 2007 Income Quintile Self-rated health status Poorest 20% 2.9) 268 (40.3) 30 (4.9) Very poor Total 6 (0.4) 87 (13.00 Very good 196 (30.3) Poor 56 (8.9) 326 (46.001.

7) 24 (20.5) 29 (26.6) 38 (28.4. Unspecified No Total χ2 (df = 28) = 36.2) 110 20 . Cold Yes.3) 25 (21.5) 11 (8.5) 5 (4. Arthritis Yes.3) 7 (5.8) 6 (4. Diarrhoea Yes.9) 25 (20.1) 114 21 (15. P < 0.161.5) 26 (19.00 Yes.7) 123 20 (17.3) 2 (1.5) 5 (4.1) 23 (19.8) 133 9 (8.3) 27 (23.00 4.9) 14 (12. Hypertension Yes.7) 7 (6.0) 26 (23.Table 1.00 3.8) 13 (11.6) 24 (21.1) 117 12 (9.4) 13 (11. Asthma Yes.8) 6 (4.8) 17 (13.4) 2 (1.7) 5 (4. Self-reported diagnosed health condition by per capita income Income Quintile Diagnosed health condition Poorest 20% 2.6) 12 (9.8) 35 (28.7) 13 (11.4) 9 (7.5) 11 (8.4) 13 (9.3) 1 (0.7) Wealthiest 20% 12 (10.9) 3 (2. Diabetes Yes.5) 5 (4.001 14 (11.4) 27 (23.

The current paper aims to narrow this divide by investigating health.21-0.45. uninsured people and the health status of those who are chronically ill.60.82).50-5.2 The uninsured ill in a developing nation Empirical studies have used a piecemeal approach to the examination of health.48.95). Despite the fact that there is health insurance coverage available for those who are chronically ill and elderly in Jamaica. and is the rationale for investments in health options such as exercise. 95% CI = 1. age (OR = 1.37-0. but no study emerged in an extensive literature search.54. that has investigated health and health care-seeking behaviour among uninsured ill people in a single research.25.00). Sixty-one of every 100 uninsured respondents with ill health sought medical care. there are still many such people who are without health insurance coverage. income (OR = 1. people desire good health and long life.27-0. Introduction In all cultures. 95% CI = 0.28-0. 95%CI = 1. 95% CI = 1. 95% CI = 1. and married people (OR = 0. The task of public health specialists and policy makers is to fashion public education and interventions that will address many of the realities which emerged in this research. 95% CI = 0. and to model factors which account for their moderate-to-very good health status as well as health care-seeking behaviour.33. Medical care-seeking behaviour was significantly related to chronic illness (OR = 2. Uninsured ill Jamaicans who resided in rural areas had the lowest moderate-tovery good health status. is a challenge to the aim of healthy life expectancy. and in particular Latin America and the Caribbean. 95^% CI = 1.01-1. male (OR = 0. health careseeking. 59 out of every 100 uninsured ill persons dwelled in rural areas.98).87.24). Urban – OR = 2. two-thirds had chronic health conditions.04).74).19-4.88). and 22 out of every 100 reported at least poor health. crowding (OR = 1. 43 out of every 100 were poor. middle class (OR = 0. 95%CI = 1. 1. area of residence (Other Town – OR = 2. Sixty out of every 100 uninsured ill Jamaicans were females. 95% CI = 0. and health care-seeking behaviour (OR = 0. science and technology. diet.45. but there was no difference in health care-seeking behaviour based on the geographical location of residence. and health care-seeking behaviour among uninsured ill Jamaicans. 1 of every 2 utilised public health care facilities.97). 95% CI = 0.49). nutrition. therefore. Moderate-to-very good health status was correlated with age (OR = 0.97. medical consultation and/or health care 21 .03.11-3. on the developing nations. logged income (OR = 2.12. 95% CI = 0. Ill-health.01-1.00.62).95-0.31-3.00-1.01. self-reported diagnosed health conditions.

curing illness means that the individual must forego consuming something in order to restore his/her good health. Demand for health care must be paid for by (1) a combination of health insurance coverage and out-of-pocket payment. the individual and the wider society. and because of that humans demand the best health care options. (2) the state. kidney problems. Ill-health (i. All living organisms will experience ill-health as well as good health over their life courses. HIV/AIDS. which require the attention of traditional medical experts to address their cure. hypertension. (3) out-of-pocket payments or (4) relatives. Because individuals desire to restore their health. The traditional medical practitioners require payment in the form of cash and/or health insurance coverage. address and possibly postpone illnesses. and when ill-health threatens the quality and length of life. heart disease. they are expected to provide payment for health care. community and the nation. productivity. Some illnesses such as the common cold may not require a trained medical practitioner to cure.e. but often the individual will be required to spend money on over-the-counter medications. All illnesses require some typology of treatment. sickness or ailment) threatens existence. family. it becomes the justification for humans‘ willingness to rectify. associates and/or family members. illness. development. There are other illnesses such as diabetes mellitus. 22 . and it is a probability against which people and the society seek to protect themselves.utilisation. which for particular health conditions can be exorbitantly high. Illhealth can be a burden to the individual. and other chronic and noncommunicable diseases. sexually transmitted infections. and while this does not necessarily have to be a traditional medical practitioner. use a home remedy or utilise non-traditional healers in the quest to restore his/her former healthy state.

Poverty makes it an insurmountable hurdle for poor people to effectively address illness unless health care services are free. People who are already poor are the most likely to suffer financially from chronic diseases. as they are crippled by their material deprivation and low health options. and the fact that health insurance provides some cushion against this. [5] which means that illness can make the vulnerable less likely to survive and the wealthy become poor. Such a 23 . [1] Among the challenges for people living in poverty is access to health insurance coverage. poverty and human suffering. The WHO captures this aptly ―. The World Health Organization (WHO) [1] opined that 80% of chronic illnesses were in low and middle income countries. The WHO continued that 60% of global mortality was caused by chronic illness. Other studies have equally found that there is a significant statistical relationship between poverty and illness [2-4] and poverty and chronic illness. those in the lower socioeconomic class will be expected to have poorer health. and poverty and future retardation of economic growth. which often deepen poverty and damage long term economic prospects‖. The high risk of mortality in developing countries is owing to food insecurity. low water quality and low sanitation coupled with inadequate access to material resources. suggesting that illness interfaces with poverty.. between poverty and premature mortality.. and this should be understood within the context that four-fifths of chronic dysfunctions are in low-to-middle income countries [1]. Hence.It is this reality which may result in premature mortality if the state does not provide health care coverage for those who are economically challenged and/or vulnerable. low and middle income countries are at the centre of both old and new public health challenges‖ [1]. for the individual and for society. the association between poverty and illness. It also postulated that ―In reality. Embedded in the realities outlined by the WHO are the incapacity of the poor.

Material deprivation is such that the poor will be far from concerned with health insurance coverage. [9] on the other hand. This indicates the extent of the health challenge of the poor.e. nutrition. This viewpoint is somewhat deceptive.possibility means that the burden of health care is an out-of-pocket payment that cannot be provided by the poor.3 years. dietary choices and health information which are not readily available to the poor. Smith and Kington. and they further exemplify the challenges if an individual does not have access to it. proper diet and nutrition. but money allows for access to better health choices and by extension can change health outcomes. Those issues could be the intent of Smith and Kington. [6] found that infant mortality in Peru for those in the poorest quintile (i. indicating that money makes a difference in health. the best health care options. wealthiest 20%). Grossman [8] found a positive correlation between income and health status. 24 . Cass et al. physical milieu and health care coverage. when they say that money buys health. Another research paper revealed that life expectancy between the poorest 20% and the wealthiest 20% was 6. and this figure rose to 14.3 years for disability-free life expectancy. Health is not a commodity for sale. went further than Grossman when they postulated that money buys health. health care-seeking behaviour. as money provides access to good physical milieu. and this will eliminate life in the process. poorest 20%) was almost 5 times more than for those in the wealthiest quintile (i. [7] suggesting that access and lack of access to resources explain health and healthy life expectancy in and among the social classes in a society. health care choices.e. but more with survivability. and the role that the lack of health insurance and income play in the demise of individuals and even their children. and so it cannot be purchased. but it does not buy health.

and use this to plan for them in a developing nation? An extensive review of the literature in developing nations. minimal education and health options. Can we assume that they are all poor people.. Within the context of material and widespread health deprivation for those in the lower socioeconomic strata. at the same time examining who are the unhealthy and uninsured. but a dearth of information existed in Latin America and the Caribbean. clothing. poverty and illness. Methods and material 25 . It is through this avenue that public health must act in order to fulfill the aim of the state in improving the quality of life of all residents in the nation. on the sick and uninsured. ―In Jamaica 59% of people with chronic diseases experience financial difficulties because of their illness. shelter. the state must play a role in aiding improvements in the healthy life expectancy of those therein. self-reported diagnosed health conditions and health care-seeking behaviour. in order to provide public health specialists with pertinent information that can be used to address some of the challenges within the society. and health care-seeking behaviour among uninsured ill people.This denotes that they will be living on the margins of survivability and the decision to purchase health insurance will be the opportunity cost of food. poverty and chronic illness. and this requires continuous research findings. According to the WHO. Public health uses information from within and outside the society to improve the health and quality of people‘s lives. and in particular Jamaica.. did not produce a single study that has examined health. and modelling factors which account for the moderate-to-very good health status of uninsured ill Jamaicans. and in particular Latin America and the Caribbean. The current paper aims to narrow this divide by investigating health.‖ Hence. and poverty and low access to material resources are well established in research literature.

This means that the country was grouped into strata of equal size based on dwellings (EDs). The cross-sectional survey was conducted between May and August 2002 in the 14 parishes across Jamaica. The JSLC used a stratified random probability sampling technique to draw the original sample of respondents. One third of the 2007 Labour Force Survey (i.783 respondents [12]. This work extracted a sample of 736 respondents who indicated that they were ill and not insured. The JSLC is a modification of the World Bank‘s Living Standard Household Survey [10. An ED is an independent geographical unit that shares a common boundary. The design was a two-stage stratified random sampling design where there was a Primary Sampling Unit (PSU) and a selection of dwellings from the primary units. and included 6. 11]. and this became the sampling frame from which a Master Sample of dwellings was compiled. and to model factors which account for the moderate-to-very good health status of unhealthy and uninsured Jamaicans. The Jamaica Survey of Living Conditions (JSLC) began collecting data from Jamaicans in 1988 and the latest dataset available is for 2007.Data The current paper utilised the latest cross-sectional survey data in Jamaica to examine health.783 respondents of all ages. Pursuant to the PSUs. self-reported diagnosed health conditions and health care-seeking behaviour. LFS) was selected for the survey. which in turn provided the sampling frame for the labour force. from a sample of 6. which constitutes of a minimum of 100 dwellings in rural areas and 150 in urban areas. Study instrument 26 .2%. The sample was weighted to reflect the population.e. The PSU is an Enumeration District (ED). with a non-response rate of 26. a listing of all the dwellings was made.

The questionnaire was modelled on the World Bank‘s Living Standards Measurement Study (LSMS) household survey. Statistical methods Descriptive statistics were used to provide socio-demographic characteristics of the sample. moderate – 0.The JSLC used an administered questionnaire where respondents were asked to recall detailed information on particular activities.6) was re-examined in order to address multicollinearity and/or autocorrelation between or among the independent variables [14-16].0. as well as 2) a correlation between medical care-seeking behaviour and some socio-demographic. and strong – 0. The method for retaining or excluding a variable from the model was based on its contribution to the predictive power of the 27 . Based on Cohen and Holliday [13] correlation can be low (weak) .from 0 to 0.7-1. economic and biological variables. education. Logistic regression analyses examined 1) the relationship between good health status and some socio-demographic. The statistical package SPSS 16. daily expenses. A p-value less than 5% (2-tailed) was used to indicate statistical significance. Chisquare analyses were used to examine the association between non-metric variables. The questionnaire covered demographic variables.69.4-0. non-food consumption expenditure.0 was used for the analysis. Analysis of variance was used to test the statistical significance of a metric and non-dichotomous variable. The correlation matrix was examined in order to ascertain if autocorrelation and/or multicollinearity existed between variables. Any variable that had at least moderate (r > 0.39. health. Interviewers were trained to collect the data from household members.6) was to independently enter variables in the model to determine which one should be retained during the final model construction. Another approach in addressing collinearity (r > 0. economic and biological variables. and other variables.

Age is a continuous variable which is the number of years alive since birth (using last birthday). Crowding is the total number of individuals in the household divided by the number of rooms (excluding kitchen. other-aged adults (ages 31 to 59 years). or pharmacist been visited in the last 4 weeks?‘ with there being two options: Yes or No. Medical care-seeking behaviour was taken from the question ‗Has a health care practitioner. not likely to be resolved spontaneously. middle class was quintile 3 and the poor were those in the lower quintiles (quintiles 1 and 2). 28 .model and its goodness of fit [17]. healer. young elderly (ages 60 to 74 years). Wald statistics were used to determine the magnitude (or contribution) of each statistically significant variable in comparison with the others. Age group is a non-binary measure: children (aged less than 15 years). old elderly (ages 75 to 84 years) and oldest elderly (ages 85 years and older). how do you feel about your health‖? Answers to this question were analyzed on a Likert scale ranging from excellent to poor. 0= otherwise which is determined from ―Generally. verandah and bathroom). Medical care-seeking behaviour therefore was coded as a binary measure where 1=Yes and 0= otherwise. and are infrequently cured. Measurement Health status is a binary measure where 1= moderate-to-very good health. young adults (ages 15 to 30 years). Social hierarchy: This variable was measured based on income quintile: The upper classes were those in the wealthy quintiles (quintiles 4 and 5). Chronic illnesses: These are ailments or diseases that are prolonged. and the Odds Ratio (OR) for the interpreting of each significant variable. Sex: This is a binary variable where 1= male and 0= otherwise.

[1] Health Care-seeking Behaviour Model Hit = f(Ait.05 to indicate statistical significance. ARit. Equity in health means (1) equal access to care for equal needs. but are also thought to be unfair and unjust. avoidable and important within a country. SSit. lnYit. Using a p-value of less than 0. CRit. εit) ………………………………. and (3) equal quality of care for all in the society. Model The multivariate model used in this study is in keeping with wanting to capture the multidimensional concept of health and the health care-seeking behaviour of uninsured ill people. εit) ………………………………. Health Model Hit = f(Ait. and these are adjudged based on the context of the customs operating in the society in general. each model reflects only those variables that are statistically significant. Inequalities in health mean patterns of socioeconomic disparities in health outcome which are systematic. MSit. [2] 29 . Utilising logistic regression on secondary cross-sectional data.Inequity denotes differences that are unnecessary and avoidable. CIit. HSBit. lnYit. the present study modelled moderate-to-very good health status and the health care-seeking behaviour of uninsured ill Jamaicans. (2) equal access to utilisation for equal needs. Xi. Hit.

The mean cost of public medical care was USD 4.689.at the time of the survey).44 ± USD 16. young adults.14 compared to USD 13.0 for public care facilities). young-old. US$ 1.22 for private medical expenditure. ARit is area of residence in time period time t. εit is residual error of person i . Concurringly.2. and of which 40. 30 . 10.56 – 32.4%.e. old-old. 10.Where Hti is current moderate-to-very good health status of uninsured ill person i in time period t.5%. CRi is crowding in the household of person i in time period t. other adults. The median total annual expenditure was USD 5. Ai is age (in years) of person i in time period t.4 ± 1.0 years (range = 0 – 99 years). and oldest-old. SSit is social class of person i in time period t. The sample was 736 respondents (i. of the sample 95.4% had at most primary level education and 0. 16. Results Table 2. 22.2 ± 5.780.00 = J$ 80. 10. CIit is chronic illness of person i in time period t.0%.8% had tertiary level education. The number of visits made to medical practitioner(s) was 1.78.in time period t.85% of the initial survey) who indicated that they were both sick and uninsured.5% were males. Children constituted 28. Of those who utilised public health care facilities.9% of them purchased the prescribed medication compared to 78. MSit is marital status of person i in time period t.0). HSBit is health care-seeking behaviour in time period t.64 ± USD 28.2%. 31.1 presents information on the demographic characteristics of the sample.8 compared to 5.89 (range = USD 261.3%.0 ± 2. Xi is gender of person i.7% of the sample. while the amount of time spent in private care facilities was 3. lnYit is logged income of person i in time period t. The median age was 42. 3.47 .8% who visited private health care facilities.

8%.χ2 = 62. Thirty-seven percent of 31 .2. There was a statistical relationship between having chronic illness and being the household head – χ2 = 63. P < 0. 63.e. and (3) private health care centre utilisation and social hierarchy. young-old. There was a significant statistical association between health status and typology of illnesses (i. (2) public health care centre utilisation and social hierarchy. P = 0. 73. As uninsured ill people become older. and oldest old. old-old. There was a statistical association between health care-seeking behaviour and age group of respondents – χ2 = 11.3%. there were no significant statistical relationships between the other variables and area of residence – P > 0.3. However. P < 0.4% who did not have chronic illness but were household heads. compared to 22.05. other-age adults.3%.031.05. there were significant statistical associations between (1) health care-seeking behaviour and social hierarchy. 66. Based on Table 2. P < 0. Table 2. 64.0001. health care utilisation.7.0001.1. medical expenditure and selfreported diagnosed illness by area of residence.Table 2. length of illness. they are more likely to seek medical care: Children. Almost 55% of those with chronic illnesses were household heads. acute and chronic conditions) . More females had chronic illness (69. 54.3 highlights information on monthly food expenditure. old-adults. Based on Table 2.7%. A significant statistical association existed between sex and having chronic illness .3.8%) than males (61. there were significant statistical associations between (1) monthly food expenditure and area of residence and (2) per capita consumption and area of residence – P < 0.χ2 = 4.7%).2 highlights information on health care-seeking behaviour.0.3. per capita consumption.048. 54. self-reported illness and area of residence by social hierarchy.8%. number of visits made to health practitioners.

middle class. USD 1. P < 0.5 shows variables which are correlated (or not) with the moderate-to-very good health status of uninsured ill respondents. P < 0. P = 0.9 – and they accounted for 23% of the variability in health status.07. second wealthy. USD 4.1.3% of those with chronic conditions. 35 out of every 100 were in the upper 32 .55 ± 254. A statistical difference was found between the mean income of those in the different social hierarchies – F statistic = 277. 43 out of every 100 were poor.69 ± 169.0001.131.39 ± 235. n = 736).Hosmer and Lemeshow goodness of fit χ2= 8. -2 Log likelihood = 482.11. USD 2.62. P < 0.489. USD 1. On the other hand.07 ± 175.090. 61. Discussion The current research used a sample of respondents who indicated both experiencing ill-health and having no health insurance coverage.49 and the wealthiest 20%.40 followed by the second poor. 60 out of every 100 were females.9. The model is a good fit for the data . Multivariate analysis Table 2. The mean income for those in the poorest 20% was USD 666.14.001.6 presents information on variables and self-reported health care seeking behaviour of uninsured respondents.2% of those with acute conditions. P = 0.those with chronic illnesses reported at least poor health status compared to 12.Hosmer and Lemeshow goodness of fit χ2= 3. The model is a good fit for the data . Seven variables emerged as significantly associated with moderate-to-very good health status – Model χ2 = 83.201.001. Six variables emerged as significant statistical correlates of self-reported health care-seeking behaviour . -2 Log likelihood = 486.Model χ2 = 47.88.e.50.68 ± 132.72. Table 2.1% of those with acute conditions reported at least good health status compared to 31.26.70. Of the sample of respondents (i.

sex. Given that 50% of those who claimed to be experiencing ill-health utilised the public health care system and the fact that twothirds of the illnesses were chronic conditions (3 females for every 2 males were uninsured and ill. Statistics from the Planning Institute of Jamaica and the Statistical Institute of Jamaica [10] showed that 15. 59 out of every 100 dwelled in rural areas. 78. area of residence and health care-seeking behaviour. it computes that 71% of those who were experiencing illness were without health insurance coverage.0 times more likely to claim moderate-tovery good health status. and 6 out of every 10 uninsured ill people were of the dependent age cohort . People who dwelled in Other Towns were 2. two-thirds reported being diagnosed with a chronic illness.less than 15 33 . Concurringly. 3 out of every 100 had been injured during the last 4 weeks. In addition. Fifty-four percent of those in the poorest 20% sought medical care in the last 4 weeks compared to 72% of those in the wealthiest 20%. Moderate-to-very good health status was explained by age. and 29 out of every 100 were children. and those in urban areas were 2.5% of Jamaicans reported ill-health in 2007. Those who indicated having a chronic illness were 37% less likely to report moderate-to-very good health. 50 out of every 100 utilised public health care. Those in the lower socioeconomic class were more likely to dwell in rural areas. income. Within the context of the current findings and that of PIOJ and STATIN. and the wealthiest 20% were more likely to utilise private health care centres. of the sample. 61 out of every 100 sought medical care.4% indicated at least fair health status. 31 out of every 100 were elderly. the present sample represents 70% of those who indicated having an illness in Jamaica for 2007. social class.3 times more likely to indicate moderate-to-very good health compared to those in rural areas. Rural residents had the least moderate-to-very good health status among uninsured ill Jamaicans. Those in the poorest 20% were more likely to use public health centres.social class.

9]. The challenge for those in the lower class is more than lower health status. as the chronically ill were more likely to be elderly (42. 15.2%) [10]. Using per capita consumption to measure income in this 34 . explaining how financial deprivation accounts for lower ownership of health insurance coverage.2% of poorest 20%) compared to 35. 4. 19]. This paper found that uninsured ill people with more income are 2. Income is well established in the health literature as being associated with health [4. were more likely to utilise public health facilities.0%. [5] found that the chronically ill were more likely to be poor. semi-urban poverty. Van Agt et al. those who are uninsured and ill must interface with chronic health conditions as well as income deprivation.2% of the upper class (15. This study highlights that those who are ill and uninsured are likely to dwell in rural zones.9 times more likely to report moderate-to-very good health status. a statement with which this study concurs. Clearly the poor are highly vulnerable to chronic illness [1.3%. Hence.8%) and more likely to be females (63%). it is also being deprived of the health care that they need. the public health care sector in Jamaica needs to recognize the impending challenges of uninsured unhealthy people. 8.‘s work. urban poverty 6.1%). more likely to live in rural areas (59. 5] and material deprivation [4]. and this explains the fact that those in the lower socioeconomic class have poorer health than those in the upper class [18. and they are also more likely to seek medical care.2% of the chronically ill were poor (25. 43. to seek more medical care. Statistics revealed that poverty in Jamaica is substantially a rural phenomenon (prevalence of poverty in rural areas.5% of the chronically ill were 60+ years). In this paper.3% of the wealthiest 20%). the worst health being found among those in rural areas compared to city dwellers. which accounts for more of them not having health insurance coverage while suffering from ill-health. This study went further than Van Agt et al. more likely to be household heads (54.years or 60+ years).

suggesting that the health disparities between the geographical dwellers is explained by this income inequity. unlike area of residence. concurring with the literature on a population [8. but material and other deprivations are greater in rural areas. 9.study. self-employed or have low-income employment. which further argues for greater health for urban and semi-urban dwellers. accounting for the greater health of those who are able to choose. compared to the rural dwellers. [20] found an interrelationship between income.3 times more income than rural dwellers. 20]. Such a finding provides clarification for a study done by Vila et al. Hence. which is also the case among uninsured ill people. health and employment status. than their place of residence. and it highlights a real need to correct income inequality among the socioeconomic groups in the nation. [21] which stated that great health disparities in the city of Milwaukee were associated with area of residence by different social hierarchy. therefore. as it offers a better explanation for peoples‘ choices. and that semi-urban residents had 1. It is therefore this access to more income that accommodates the greater health status of the urban and semi-urban respondents. 35 . explains health and material deprivation. Income has a greater influence on better health than area of residence. Money matters in the health of uninsured Jamaicans as well as the general populace. a factor which provides an understanding for the massive health disparity between them and city residents.7 times more income than rural residents. it was revealed that urban residents had 1. it is not the fact of being in a rural area that accounts for poor health. as rural residents are more likely to be seasonally employed. Lack of access to money. A study by Stronks et al. the great health disparity between the different social classes is more related to income than place of residence. in any geographical locality. and it even correlates with health care-seeking behaviour among the uninsured ill. While income is related to better health status.

This work showed that a large percentage of uninsured ill people dwelled in rural areas. 61.Poverty is associated with premature mortality. the inference is that many of them will seek health services based only on severity of illness. 68. as those with chronic health conditions in Jamaica are able to access public 36 . arguing for the role of the culture in preventing them from accessing assistance from the state. This research found that 70. but clearly poverty.5 times more than urban poverty and 3. the second wealthy. It is this culture underpinning that accounts for the premature mortality and not the poverty or illness.7% and the wealthiest 20%. clearly the culture prevents some people from accessing this facility. and the current research provides some explanation for this established fact. the second poor. 58% of the poor compared to 65% of the second wealthy and 72% of the wealthiest 20%. 72. accompanied by their low demand for health services compared to the wealthy.1% of those in the poorest 20% had at least one chronic health condition. and not merely the condition. The WHO had stated that 60% of global mortality is caused by chronic illness. non-treatment of chronic illnesses and cultural practices are all a part of the rationale for mortality.2%. the poor are not as privileged as the upper class. where poverty was 2. which means that non-utilisation of medical care is likely to lead to complications and possible premature mortality. While the affluent class has access to material and other resources to address health concerns. Although those who suffer from chronic conditions in Jamaica are able to access public health insurance which can reduce out-of-pocket payments for treatment and medication.8% more than semi-urban poverty. and the findings highlighted that 54% of those in the poorest 20% visited a health care practitioner. Chronic illnesses are such that nonmedical practitioners should not interpret when conditions are serious and warrant health care assistance. This paper is on uninsured ill Jamaicans.7%. With this preponderance of unwillingness on the part of poor and rural residents to access health insurance.

that great disparities in health status among the different geographical areas in Jamaica can be explained by the nutritional intake (or lack of intake) based on where people dwell in this nation. 3. and this means that they will be less concerned about the required nutrient intake than food consumption and mere survivability. With not having health insurance coverage. but what about the general health status of the uninsured ill.health care despite their reluctance to access public health insurance coverage. to that of the current one. There is a question which must be addressed in order to provide some explanation for the seemingly low nutritional intake of rural uninsured residents: Are rural residents less likely to intake the required nutrients compared to residents in other geographical areas in Jamaica? The answer is clearly yes as more of the uninsured ill Jamaicans are poor. It can be extrapolated from the aforementioned studies. Furthermore. but a study by Khetarpal and Kochar [22] found a statistical relationship between nutrition and health in rural women. illness. lower health status and health careseeking behaviour than the geographical area of residence. poverty and illness are likely to become a burden to individuals and family.3 times more 37 . which is greater than that for the uninsured ill people. it will then become the responsibility of the state. A study by Bourne [24] found that 82 in every 100 Jamaicans reported at least good health status. This paper did not examine nutrition and health. which offers some explanation for the great health disparities in geographical areas of residence. as the body requires particular nutrients. and when those social agents are unable to assist with the costing of medical treatment. Another study by Foster [23] on low-income rural areas concurs with Khetarpal and Kochar [22] that nutrition accounts for health or ill-health. Poverty is therefore more a factor in insurance. and is it lower than that of the population of Jamaica? Almost 78 out of every 100 uninsured ill Jamaicans claimed to have at least good health status.

39% did not seek medical care. The current paper concurs with (1) Reed and Tu‘s work [25] that uninsured chronically ill people in America reported lower health status (or worse health) and (2) Bourne and McGrowder [26] which stated that 25. as chronic illness can erode the economic livelihood of an individual and therefore delay needed health care [29]. Reed and Tu went on to state that the majority of uninsured people with chronic illnesses delay health care utilisation owing to cost. 4. disruptions in family life.3% of chronically ill Jamaicans reported at least poor health. poorest 20% and second poor income quintile). and 3 times more uninsured chronically ill Jamaicans reported at least poor health status compared to those with acute health conditions. high out-of-pocket medical bills. indicating that if a household was already in poverty this will become the burden of the state or may lead to premature mortality.4 times more uninsured ill Jamaicans claimed at least poor health as compared to the general population (i. high risk of health complications.9%). Faced with poverty. which explains an aspect of this study. When this burden becomes untenable for the individual. no health insurance coverage and chronic illness. but were also evident for poor health status. as the individual will be unable to access needed health care 38 .e. The health disparities were not only between the good and very good health status of Jamaicans and uninsured ill Jamaicans. This justifies the need to expand public health insurance to protect the poor. uninsured ill Jamaicans are highly likely to face all kinds of life challenges such as material deprivation. 4. dietary and nutritional deficiencies. family and wider community. the chronically ill and the vulnerable in a society [28].e. One study stated that uninsured households are one illness away from financial catastrophe [30]. Comparatively. it will then become the responsibility of the state [27]. future vulnerabilities and premature mortality. that although 43.2% of the uninsured ill people were living in poverty (i.Jamaicans indicated very good health compared to the uninsured ill Jamaicans.

rural poverty is less easily identifiable and may be overlooked by the naked eye. According to Harpham and Reichenheim [31]. improper sanitation. Clearly. The NHF is a statutory company which was established by the NHF Act (2003) with a Chairman and Board of Management appointed by the Minister of Health. While impoverishment in urban areas is highly visible in the form of squalor. which argues for an immediate health campaign to address the challenges among the socioeconomic strata and area of residence. semi-urban and rural uninsured ill Jamaicans.owing to his/her inability to afford medical care. The discipline of public health cannot only use external findings to carry out its mandate. lack of productive assets. This implies that poverty encapsulates powerlessness. ill and poor are highly vulnerable to ill-health and premature mortality. emotional distress. illness. physical weakness. and illness can result in poverty [32-34]. rural poverty in Jamaica is showing signs of depleting the human capital more than urban poverty. dilapidated edifices. poverty is destroying the human capabilities and resilience of the Jamaican people and more so in the case of rural uninsured ill people. zinc fencing. or divorce itself from the realities which emerge from the current paper. premature mortality. using health disparities between area of residence and the socioeconomic strata. Because poverty is strongly associated with illness. on the disaggregating of rural and urban health indicators. It was established in 2003 to provide direct assistance to patients with chronic conditions. as these were not alleviated with the introduction of the National Health Fund – NHF [35]. those who are presently uninsured. This study dispels the notion of ‗appearance‘ and goes to the reality of the health differential using self-reported health among urban. squatting and violence. the latter ‗appear‘ to have better health status. to purchase drugs and fund 39 . chronic illness. if they are not addressed by policy makers. constricted freedom and future impoverishment due to the aforementioned conditions.

ischemia and vascular diseases. owing to income inequalities. arthritis. psychosis. breast cancer.support to private and public companies for approved projects [35]. high cholesterol. With all the investment. that merely instituting an agency to carry out a particular task (which is to distribute benefits evenly across the socioeconomic strata. The NHF became operational in August 2003. Fourteen chronic illnesses are covered by the NHF. major depression. which is an urban area in Jamaica. with respect to pharmaceutical benefits in direct assistance to ill individuals. and female. The individuals are mostly rural residents. Conclusion 40 . diabetes mellitus. glaucoma. rheumatic heart disease. epilepsy. This study concurs with one in Finland [36] showing that the poor are more vulnerable to illnesses. area of residence and sex) will not provide solutions to the inequalities and inequities in health between the particular groups in Jamaica. non-poor and poor Jamaicans. the NHF has not failed to have a major coverage of chronically ill respondents using the Fund. poor. prostate cancer. and research conducted in the United Kingdom [37] found that those in the lower socioeconomic stratum were more likely to die prematurely than those in the upper income groups. The chronic health conditions that are covered by the NHF are hypertension. The verdict is in. The NHF is a social health insurance which is geared towards alleviating out-of-pocket payments for medication for those who suffer from chronic illnesses. and has undoubtedly aided many chronically ill. Such a reality speaks to the administrative and operational failure of the NHF to improve the lives of its intended population owing to the centralization of its operations in Kingston. under 60 years of age. Embedded in those findings is the fact that any equitable distribution of NHF benefits to those in the different socioeconomic strata will show further unfairness and injustices in the health outcomes which already exist. asthma.

The great health disparity between the lower socioeconomic strata and those in the upper strata. The task of public health specialists and policy makers. emphasizing people‘s interpretation of illnesses that require medical attention. There is an inverse relationship between the health status of uninsured ill Jamaicans and those in socioeconomic strata. as well as those who reside in rural areas. cannot be left to resolve itself. they are female and are rural respondents who are generally poor people. 45 out of every 100 of those uninsured and ill did not seek medical care. With one half of the uninsured ill respondents utilising the public health care system. Despite the fact that health insurance coverage is freely accessible to those who are chronically ill in Jamaica. The Way Forward The variations in health status and health care-seeking behaviour within and between the socioeconomic strata who are uninsured ill people. there are serious future challenges for public health in Jamaica. clearly present information that reveals public health concerns. The current paper did not examine the emotional distress and mortality patterns of uninsured ill 41 . Another reality which emerged from this paper is that although health care utilisation is free in Jamaica for children 18 years and younger. is to fashion public education and intervention programmes that will address many of the realities which emerged in this research. there are still many such people who are without health insurance coverage. The uninsured ill are mostly within the dependent age cohort (children and elderly). and only 2 in every 10 of them purchasing medications. and how this retards health care demand. and some are not even seeking medical care. and highlights many challenges which are still unresolved in Jamaica. The findings of this study highlight the likely challenge of the state in assisting uninsured ill Jamaicans. as clearly it has not happened in the past and the situation cannot be allowed to continue indefinitely in the future.Two-thirds of uninsured ill Jamaicans are chronically ill. therefore.

despite having access to public health insurance. neither can it deal equitably with those who reside in different geographical areas. Survey data and health officials indicate that the poor suffer as much from chronic diseases as the rich. The health disparities will not be addressed by merely offering equal 42 . did not possess such insurance. studies need to examine the breadth and scope of cognitive dimensions in explaining health inequalities. which show that the NHF cannot treat different socioeconomic strata in the same way. and this should be the subject of some future study. In order to understand how to address policy intervention and health education programmes for people in Jamaica. there is still a need to study the heterogeneity in health outcome between the socioeconomic strata and area of residence. as it would provide needed information about these individuals. This will allow public health technocrats to understand why 70. and some of the chronically ill people. Another unresolved issue stemming from the present research is how much of the cognitive dimension explains the health differential between the socioeconomic strata and the area of residence. and did not seek medical care. or are only able to pay for part of their prescription drugs by reducing out-ofpocket payment …‖ This study is 4 years after the operational establishment of the NHF. A critical issue which needs to be addressed in the future is the structure of the National Health Fund (the NHF is accessible to.3% of those who were ill in Jamaica in 2007 did not have health insurance. and provides public health insurance coverage for. the health sector and poverty alleviation programmes in Latin America and the Caribbean. but are less likely to seek treatment. as health disparity between and within countries is still great and not in keeping with health inequality eradication in the region. and new findings are coming in.respondents. Despite the investments in health. those experiencing chronic illnesses). Barrett and Lalta [32] wrote that ―The National Health Fund dealt with these issues by treating the non-poor and the poor as part of the same target beneficiary.

a theoretical and empirical investigation. 9 2. Demography 1997. Solis JA. 21: 3146. Retrieved on 29th October from http://www. WHO. 22-49. Occasional Publication No. World Health Organization. 2005: p. 2001: pp. Van Agt HME. Washington DC. Occasional publication No. Chronic illness and poverty in the Netherlands. Does money really matter? Or is it a marker for something else? Health Affairs. 9. 2001: pp. Mackenbach JP. Marmot M. equity. 2002. Demographic and Economic Correlates of Health in Old Age. as these will only perpetuate health inequalities and inequities. 1972. 34:159-70. Washington DC. 7. Dying for change .Poor peoples experience of health and ill health. Equity and health: Views from the Pan American Sanitary Bureau. US.85-98. Pan American Health Organization. The demand for health . none of the errors that are within this paper should be ascribed to the Planning Institute of Jamaica or the Statistical Institute of Jamaica as they are not theirs.int/hdp/publications/en/index. 8. Conflict of interest The author has no conflict of interest to report. Pan American Health Organization. New York: National Bureau of Economic Research. In: Equity and health: Views from Pan American Sanitary Bureau. Stronks K. Geneva: WHO. and health: Some research findings. Occasional publication No. but are instead owing to the researcher.html. Smith JP. Washington DC. 43 . The influence of Income on Health: Views of an Epidemiologist. Preventing Chronic Diseases a vital investment. 3. Pate E. so as to effectively alleviate some of the challenges which emerged from this research. Eur J of Public Health 2000. 8. 8. 4. Dachs JN. WHO. Wagstaff A Poverty.56-60. 5. US. Collado C. 8.who. In: Equity and health: Views from Pan American Sanitary Bureau. The NHF therefore needs to be restructured in order to provide definitions based on socioeconomic class and area of residence. 10:197-200.benefits to all within the context of the current findings. Kington R. References 1. Casas JA. In: Pan American Health Organisation. Health equity and maternal mortality. Grossman M. Health disparity in Latin America and the Caribbean: The role of social and economic determinants. Disclaimer The researcher would like to note that while this study used secondary data from the Jamaica Survey of Living Conditions. 2001: pp. 6. Bambas A. 2007.

18. Remington PL. Reed MC. Mamingi N. Issue Brie Cent Stud Health Syst Change 2002. 23.( 49):1-4. Washington DC. 84:216-220. Svensson PG. Khetarpal A. Tatham RL.org/INTLSMS/Resources/. 22. Statistical Institute Of Jamaica. Anderson RE. Stronks K.. 26. Van De Mheen H. Cohen P. 2007. Vila PM. 106:366-372. Babin BJ. Applied regression/correlation analysis for the behavioral sciences. 2009. 44 . University of the West Indies [distributors]. New Jersey: Lawrence Erlbaum Associates. Applied regression/correlation analysis for the behavioral sciences. Tu HT. 11. from. Cohen P. Holliday M. Theoretical and empirical exercises in econometrics. Jamaica Survey of Living Conditions (LSLC) 1988-2000: Basic Information. The interrelationship between income. MacKenbach JP. Bourne PA. Hair JF. 2005. 14.S. New Jersey: Lawrence Erlbaum Associates. Black B. 19. Swain GR. 21. Med Anthropol. Int J of Epidemiol 26:592-600. Options for expanding health insurance for people with chronic conditions. Kingston. 24. The Internet Journal of Nutrition and Wellness 2007. London: Harper & Row. 2007. North American J of Med Sci. chronically ill and uninsured in America. Cohen J. 1983./binfo2000. 13. 2009. Baumgardner DJ. Kingston: PIOJ & STATIN. 27. 1(7): 356-364.worldbank. Health and well-being of rural women.. Bourne PA. Halsmer SE. 28. eds: Health inequities in Europe. Dichotomising poor self-reported health status: Using secondary crosssectional survey data for Jamaica. Triple jeopardy: low income. 2nd ed. http://www. Aldershot: Gower Publishing Company Limited. Jamaica Survey of Living Conditions.siteresources. 2009. 6th ed. The uninsured and the politics of containment in U. Kingston. Wisconsin Med J 2007. Planning Institute of Jamaica (PIOJ). 1982. Health status of patients with self-reported chronic diseases in Jamaica. Statistics for Social Sciences. Foster AD. 1989-2008. Kochar GK. Development Research Group. 2008. 25. ed: Health inequalities in European Countries. Van Den Bos J. Multivariate data analysis. Issue Brief Cent Stud Health Syst Change 2002 . Poverty and human resources. Jamaica: Statistical Institute of Jamaica [producer]. health care. Jamaica Survey of Living Conditions. North American J of Med Sci. Statistical Institute of Jamaica (STATIN). 3. Tu HT. Poverty and illness in Low-Income Rural Areas. 26(4):293-8. Illsley R. Becker G. 1988-2007. 2005. Reed MC. Soc Sci Med 1990. Cohen L. Health disparities in Milwaukee by socioeconomic status. McGrowder DA. 1(6): 295-302. 1989.pdf 12. health and employment status. 31(special issue):223-420.10. 15. 1983. 50:1-4. Cisler RA. Fox J. Cohen J. 2007 [Computer file]. World Bank. The Am Economic Review 1994. Kingston: University of the West Indies Press. 16. Jamaica: Planning Institute of Jamaica and Derek Gordon Databank. Retrieved on August 14. 17. New Jersey: Prentice Hall. 2nd ed. 2002. 20.

et al. Tu HT. Washington DC.D. [Epub]. Helsinki. Bourne PA. Need. 34. 31. 1974-76. 1(3):99-109. Does major illness cause financial catastrophe? Health Serv Res 2009. and health: Some research findings. Bergstrom S. 35. Phillmore P. Occasional publication No. Lalta S. inflation. 1983.3-11. Makela PH. health insurance on mortality in Jamaica. New York and Washington DC: Sustainable Development Department. University of Bristol. 36. Track Rep 2009.. 8. Urbanisation and health. Financial and health burdens of chronic conditions grow. Wagstaff A Poverty. Technical Paper Series. 30. Social Insurance Institution. Impact of poverty. Cook K. use and expenses of health services in Finland. not seeking medical care. Reichenmeim M. Harpam T. Pan American Health Organization. US. 32. unemployment. 12).29. Peltomaa M. 2004. 24:1-6. London and Oxford: MacMillan. US. In: Lankinen KS. Washington DC. Barrett R. Equity and health. Shortened lives: premature death in North Tyneside. Inter-American Development Bank. 85-94. Health and disease in developing countries. equity. In: Equity and health: Views from Pan American Sanitary Bureau. 2001: pp. 1994: pp. selfreported illness. 2001: pp. Kalimo E. Sfekas A. Alleyne GAO. Pan American Health Organization. Cohen GR. Dranove D.56-60. Health financing innovations in the Caribbean: EHPO and the National Health Fund of Jamaica. Occasional publication No. 37. 1989 (Briston Papers in Applied Social Studies No. North American Journal of Medical Sciences 2009. Bristol. 45 . 8. 33. In: Equity and health: Views from Pan American Sanitary Bureau.

6 3.6 58.Table 2.7 1.6 29.9 11.2.5 30.9 18.1.8 22.8 2.8 28.1 19.4 23.6 46 .3 22.9 10.9 17.0 6.4 19.9 10. n=736 Characteristic Sex Male Female Marital status Married Never married Divorced Separated Widowed Social hierarchy Poorest 20% Second poor Middle Second wealthy Wealthiest 20% Area of residence Urban Semi-urban Rural Injury in last 4-weeks Yes No Self-reported diagnosed illness Acute conditions Influenza Diarrhoea Asthma Chronic conditions Diabetes mellitus Hypertension Arthritis Other Health care-seeking behaviour Yes No Health care utilization Public hospital (yes) Private hospital (yes) Public health care centres (yes) Private health care centres (yes) Other (yes) Purchased medication Yes n 298 438 161 276 14 10 62 170 146 165 142 111 176 128 432 23 712 124 26 73 69 147 40 189 446 280 146 27 96 212 8 411 % 40.7 3.3 61.4 1.3 15. Demographic characteristic of sample.9 23.5 19.9 5.5 59.8 52.4 58.6 43.1 96.4 38.

7) 83(94.3) 29(33.337 32(37.e.3) 55(64.4) 37(41.0) 37(24.0) 52(58.3) 0.2) 36(25.1) 10.4) 77(78.451 8(9.2) 15(15.9±21.2) 21(18.0) 49(50.7) 58(40.3) <0.4) 35(21.046 Health care-seeking behaviour Yes No Health care utilization Public hospitals Yes No Private hospitals Yes No Public health care centres Yes No Private health care centres Yes No Self-reported diagnosed illness 90(54. health care utilization.3) 35(41.5) 61(68.9) 21(21.1) 9(6.7) 0.6) 64(45.1) 30(18.1) 15(15.4) 135(79.7) 63(64.2) 42(29.4) 44(27.2) 54(62.2) 50(58.1) 0.0) 73(83.6 12.5) 25(19.2) 21(14.1) 15(9.3) 59(67.2) 4(4.7) 59(66.1) 65(39.7) 32(28.5) 0.3) 6(4.9) 21(13.6) 16(9.7) 7(4.7) 83(93.7 11.2.4) 38(23.5) 30(35. Health care-seeking behaviour.9 31.3) 9(6.8) 35(35.6) 49(50.9) 80(94.1) 21(24.9) 17(13.Table 2.7) 15(11.0) 49(35.0) 28(31.3) 3(2.6) 33(29.0) 30(33.2) 4(4.7) 5(5.5) 23(17.9) 73(90.1) 6(4.3) 15(17.8 19(11.5) 100(60.3) 71(87.016 10(12.0) 3(1.0) 12(12.7) 64(75.6) 8(6.3) 33(40.7) 27(21.5±116.0) 81(71.0) 15(11.4) 100(68.001 48(59.3) 3(3.5) 62(76.7) 39(26.7) 0.6±11. in days) mean± SD 24(15.0) 27(27.0001 59(52. self-reported illness and area of residence by social hierarchy Characteristic Poorest 20% n (%) Second poor n (%) Social hierarchy Middle n (%) Second wealthy n (%) Wealthiest 20% n (%) P 0.2) 14.8) 86(59.3 0.8) 15(9.9) 91(65.8) 5(5.2) 76(45.0) 34(22.4) 25(17.1±15.2) 22(22.6) 19(23.9±22.7) 45(35.3) 98(60.200 Acute conditions Influenza Diarrhoea Asthma Chronic conditions Diabetes mellitus Hypertension Arthritis Other Area of residence Urban Semi-urban Rural Length of illness (i.7) 7(4.3) 6(6.7) 17(11.0) 26(20.1) 34(26.006 47 .1) 95(96.

256 mean ± standard deviation 1. Monthly food expenditure.47 at the time of the survey) 48 .162 illness Acute conditions Influenza 19(12.851 mean ± standard deviation Self-reported diagnosed 0.7 1.002 mean ± standard deviation 2425.59 †Monthly food expenditure 0.71±192. number of visits made to health practitioner.9) 4(3.0 17.65 0.60 13. medical expenditure and self-reported diagnosed illness by area of residence Area of residence Characteristic P Urban Semi-urban Rural n (%) n (%) n (%) 280.1 1923.47±7.8 < 0.72±16.1) Other 48(31.6) 9(7.1) Hypertension 37(24.30±1179.37 0.78±18.8) 17(17.0) 40(10.62±1241.4 Length of illness in day 0.5) 6(5.0001 Per capita consumption mean ± standard deviation 8 0 5 9.Table 2.3) 86(21.7) Arthritis 10(6.6 1441. length of illness.21 15.4±1.0) 24(20.1 13.3) 34(28.9) Chronic conditions Diabetes mellitus 16(10.58±13.4±0.5±19.51 4.14±35.3. per capita consumption.0 Number of visits made to 0.23±1992.38±15.07 4.7) 113(28.4±1.00 = Ja.2) 28(23.1) 24(6.927 health care practitioner in last 4-weeks mean ± standard deviation †Medical expenditure Public 3.97 237.7±65. $ 80.8) Asthma 21(13.6) 43(10.3 1.5±23.787 mean ± standard deviation Private 13.4) 19(4.07±145.45±162.00 277.5) †Quoted in USD (USD 1.9) Diarrhoea 3(1.4) 13(11.

0) 4(6.6) 9(12.6) 10(15.7) 18(15.1) 6(2.5) 2(3.2) 9(12.4) 25(21.0) 1(4.9) 2(1.6) 35(54.1) 2(3.7) Asthma 42(23.5) 5(22.4) Chronic conditions Diabetes mellitus 1(0.2) 13(6.5) 36(48.1) 2(2.7) 49 .4) Old-old n (%) Oldest-old n (%) P < 0.4) Other 43(23.0) 1(4.0) 12(5.9) Hypertension 0(0.1) 11(17.5) 1(4.0) Arthritis 0(0.3) 21(17. Self-reported diagnosed health conditions of uninsured ill respondents by age cohort Age cohort Characteristic Children Young adults Other-aged Young old adults n (%) n (%) n (%) n (%) Self-reported diagnosed illness Acute conditions Influenza 83(45.7) 10(13.3) 41(35.6) 11(50.7) 2(2.0001 6(8.2) 4(3.1) Diarrhoea 13(7.2) 0(0.7) 72(34.4.1) 6(5.Table 2.5) 3(13.1) 32(15.0) 0(0.6) 19(9.3) 55(26.

278 0.349 1.33* 1.63* 1.50 .967*** 1.36 1.033 0.332 0.32 .70.761 9.0.5: Logistic regression: Variables of moderate-to-very good health status of uninsured ill respondents Variable Age Average Medical Expenditure Male Middle Class Upper class †Lower class Married Divorced.30 1.553 0.Table 2.1% Correct classification of cases of self-rated moderate-to-very good health status = 93.029 0.54 0.255 0.342 0.27 .374 4.45* 0.387 0.244 0.000 0.511 -0.3.140 -0. *P < 0.1.49 1.008 18. Wald Error statistic 0.345 3.807 -1.33 .95 0.696 0.250 0.351 10.76 .0.063 5.465 0.218 -0.37 .06 0.74 0.00 0.5% †Reference group *** P < 0.I.66 1.62 1.001 -2 Log likelihood = 482.87** 2.4.23 Coefficien t -0. P < 0.03 0.4% Correct classification of cases of not self-rated not moderate-to-very good health status = 26.21 .67 .0.000 -0.96 Nagelkerke R2 = 0.0.092 0.0001.455 95.01* 2.00 1.803 -0.2.5.45** 0.668 4.0% C.19 .60* 0.365 6.72.300 0.421 Std.844 0.00 0. separated or widowed †Never married Logged Income Urban area Other town †Rural area Head household Dummy health care-seekers Chronic illness Model χ2 (12) = 83.456 0.253 1.12 .24 0.00 0.15 0. **P < 01.00 1.605 0.98 1.053 0.882 1.95 .88 Overall correct classification = 75.86 Hosmer and Lemeshow goodness of fit χ2= 3.00 .696 2.0.98 0.11 . P = 0.05 50 .1. Odds ratio 0.97 0.1.1.

06 0.358 0.001 -2 Log likelihood = 486.812 0.000 -0.13.72 1.85.336 0.024 -0.04 0. Error 0.41 .05 51 .6: Logistic regression: Variables of self-reported health care-seekers of uninsured ill respondents Variable Chronic illness Age Moderate-to-very good health Secondary education Tertiary education †Primary and below education Male Crowding Logged income Length of illness Married Divorced.13 1.094 1.74 0.31 .274 2.00 0.692 0.053 0.19 0.0.33 .48** 0.013 7.154 4.222 Wald statistic Odds ratio 8.88 1.4% Correct classification of cases of self-reported health care-nonseekers = 32.000 0.1.281 0.0001.00 95% CI 1.1 Nagelkerke R2 = 0.1.42 -0.694 4. separated.29 Hosmer and Lemeshow goodness of fit χ2= 8.06 3.00 .70 1.69 .28 .3.08 0.00 0. P < 0.59 1.1.24 .609 2.00* 1. **P < 01.733 -0. or widowed †Never married Urban area Other town †Rural area Model χ2 (13) = 47.286 0.117 1.01 .277 0.238 1.138 0.24 .0.274 0. *P < 0.2% †Reference group *** P < 0.00 .002 0.50 1.000 0.181 3.857 1.00 0.248 0.62 Overall correct classification = 69.171 -0.12* 1.244 0.359 1.278 Std.1.82 0.762 1.114 0.1.0% Correct classification of cases of self-reported health care-seekers = 89.03** 0.302 0.00 0.384 2.42** 3.68 .11.25** 9.00 1.008 0.24 1.39. P = 0.60 0.43 .15 Coefficient 0.01 -1.Table 2.148 1.1.593 9.2.

and diagnosed illness. Self-rated health statuses of respondents are correlated with age. mortality. the concept of health is measured using life expectancy.4. access to resources and it is associated with an increased likelihood of higher income. Traditionally. and determine whether a significant statistical correlation exists between the different educational cohorts. In the social sciences. income. area of residence. opportunities. 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 careseeking behaviour and health status than the uneducated classes. 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. researchers have used self-rated health status [1-9]. P < 0. and does the educated class experience greater self-rated health status than the uneducated classes? The current paper will identify the socio-demographic correlates of self-rated health status of Jamaicans.001. Apart from those terminologies. crowding. marital status. and selfreported illness [10-17] to measure health. examine the effects of these variables.4%) and there was no significant statistical difference between their health status and the lower educated classes. and self-reported illness (es) – χ2= 1. Does this holds true in developing nations like Jamaica. It is within this context that a study of health is critical as it relates to the wider society.568. other synonyms such 52 . sex. a society and a nation. Respondents with tertiary level educations were most likely to be classified in the wealthiest 20% (53.3 Self-rated health of the educated and uneducated classes in Jamaica Education provides choices. Introduction Health is imperative for socio-economic and political development of people.

bias can occur in subjective indexes. Within the context of the time recollection. Self-rated health status is among the subjective indexes used to measure health. 22-24] and life expectancy [25]. global health status. 21] as it included one‘s health and general life satisfaction. per capita income. Concurringly. Studies have shown that subjective indexes are a good measurement for mortality [2. their mental faculties decline [27-32]. or mortality [18-20].as self-assessed health. The subjective indexes in measuring health open themselves up to systematic and unsystematic biases [26]. a recently conducted study by Bourne [25] found that self-assessed illness was not a good measure of mortality. It is well established in research literature that as people age. 5. It follows from the aforementioned perspective that all those terms imply the same measurement of health or health status.e. self assessment of health. The subjective/objective indexes of measuring health emerged as scholars sought to ensure that the measurement of health was a reliable and valid one. People‘s perception can be biased as they may inflate or deflate their status in an interview or on a self-administered instrument (i. suggesting that some people will have difficulties recalling experiences which happened in the past. Kahneman [33] devised a procedure of integrating and reducing the subjective biases when he found that instantaneous subjective 53 . it was was very useful when it came to the subject of life expectancy in Jamaica. Another aspect of bias in subjective evaluation of health is the matter of recall. perceived health. and health status have all been used to speak about health. self-reported health. however. questionnaire).. and some scholars argue that they are not a good assessment of health when it comes to life expectancy. Some scholars opined that the self-assessment of one‘s health status was more comprehensive than objective assessment [3.

income.001]. and other variables. It is well established in health research that there is a correlation between or among different socio-demographic.. education. opportunities. noted that there was an association between educational level and physical functioning of people over 65 years. access to resources and is associated with increased likelihood of achieving a higher income. Another study by Koo.83. 6-17. the former still contains biases. using multivariate regression. The correlates include education. Contrary to Kahmeman‘s work. which Diener [34] opines still have valid variance. marital status. While education provides choices. area of residence. P<0. Bourne‘s [25] results show that self-assessed health for a 4-week period is a good measure of life expectancy (objective index). Rie & Park [36]. positive and negative psychological affective conditions). In spite of the fact that subjective indexes are a good measure of objective health.evaluations are more reliable than assessments of recollection of experiences. concluded that education was a predictor of increased subjective wellbeing (t [2523] = 7.e. psychological conditions (i. 20] and self-rated health status. psychological and economic variables [4. Concomitantly.e. the Quantity Theory) was a crucial predictor of health status of an individual [37] which indicates that tertiary level graduates are more likely to be healthier than non-tertiary level educated people. does it hold true in developing nations like Jamaica that the educated class has greater self-rated health status than the uneducated classes? A paucity of information (research literature) exists in Jamaica on the educated and 54 . which means that education was more than associated with health. another research found that the number of years of school (i.. Freedman & Martin [35]. using data from 1984 and 1993‘s panel survey of Income and Program Participation.

(2) examine the effects of these variables. (3) health insurance coverage and educational levels. (5) compute mean income among the different educational types. the areas in which the educated and uneducated classes reside. (5) social standing and educational levels. self-reported illness(es). Dichotomising self-rated health status in good and poor health means that some of the original information will be lost. The current paper is important.uneducated classes and their self-rated health status. (3) explore self-rated health status and self-reported diagnosed recurring illness among the educated and uneducated classes. Materials and methods Data 55 . Secondly. (2) educational levels and health care-seeking behaviour. (4) self-reported illness(es) and educational levels. the study is significant as it included more variables: (1) educational levels and area of residence. health care-seeking behaviour among the different educational classes and the self-rated health status of Jamaicans and its correlates. and this explains why some researchers argue for the maintenance of the Likert nature of the measuring tool over dichotomisation [38-40]. and (6) determine whether a significant statistical correlation exists between the different educational cohorts. The objectives of the current paper therefore are to (1) identify the sociodemographic and economic correlates of self-rated health status of Jamaicans. (4) calculate the mean age of respondents in the different educational categories. as it uses a statistical technique which accommodates all items in self-rated health status categories as opposed to dichotomising self-rated health.

which constitutes a minimum of 100 residences in rural areas and 150 in urban areas. One third of the Labour Force Survey (i. The survey is called the Jamaica Survey of Living Conditions (JSLC) which began in 1988 and is now conducted annually. The sample was weighted to reflect the population of the nation. The design for the JSLC was a two-stage stratified random sampling design where there was a Primary Sampling Unit (PSU) and a selection of dwellings from the primary units. and 56 . with a non-response rate of 26. This means that the country was grouped into strata of equal size based on dwellings (EDs).783 respondents. The PSU is an Enumeration District (ED).A joint survey on the living conditions of Jamaicans was conducted between May and August of 2007 by the Planning Institute of Jamaica (PIOJ) and the Statistical Institute of Jamaica (STATIN) [41]. provided the sampling frame for the labour force. a listing of all the dwellings was made.e. in turn..2%. It had a sample size of 6. The questionnaire covers socio-demographic variables such as education. age. questionnaire) was used to collect the data from respondents. The JSLC is a modification of the World Bank‘s Living Standards Measurement Study (LSMS) which is a household survey [42]. LFS) was selected for the JSLC. Based on the PSUs. and data was collected across the 14 parishes of the island. The JSLC is a cross-sectional survey which used stratified random sampling techniques to draw the sample. The current paper used the JSLC‘s data set for 2007 in order to carry out the analyses of the data [43]. Instrument A self-administered instrument (i. An ED is an independent geographic unit that shares a common boundary. It is a national probability survey. and this became the sampling frame from which a Master Sample of dwellings was compiled. This.e.

self-rated health status. medical care.0 to 0. as well as other variables like social security. mean. and 3) nonresponse rate. Statistical Analyses The Statistical Packages for the Social Sciences – SPSS-PC for Windows version 16. Any correlation that had at least a moderate value was excluded from the model in order to reduce multicollinearity and/or 57 . economic and biological correlates of health status of Jamaicans. low (weak) correlation ranges from 0.consumption. retrieve and analyze the data. Many survey teams were sent to each parish according to the sample size. living arrangements.0.0 (SPSS Inc. There was no selection criterion used for the current paper. The correlation matrix was examined in order to ascertain if autocorrelation and/or multicollinearity existed between variables. Analysis of variance was used to evaluate a metric and a nondichotomous variable. 2) low correlations. This was used to exclude (or allow) a variable in the model. moderate – 0. Descriptive statistics such as median. On the other hand. inventory of durable goods. immunisation of children 0–59 months. Chicago.69. A 95% confidence interval was used to examine whether a variable is statistically significant or not. Cross tabulations were used to examine non-metric dependent and independent variables. Based on Cohen and Holliday [44] and Cohen and Cohen [45]. IL. and identify whether the educated have a greater self-rated health status than uneducated respondents. and strong – 0.7-1. for the model. the selection criteria were based on 1) the literature. Ordinal logistic regression was used to determine socio-demographic.39.4-0. self-reported health conditions. The teams consisted of trained supervisors and field workers from the Statistical Institute of Jamaica. percentages. USA) – was used to store. and standard deviation were used to provide background information on the sample. and other issues.

In the current paper. Simply put. positive estimation of coefficients means poor health and negative estimation of coefficients denotes better self-reported health status. Measurement of variables Dependent variable 58 . and other levels of health are relative to ―very good‖.autocorrelation between or among the independent variables [46-51]. a positive estimation of coefficient denotes that those with this characteristic would be negatively associated with good health status and those without would positively associated with good health status (or self-rated health status). Based on Anderson‘s arguments. Another approach in addressing and/or reducing autocorrelation was to include in the model all variables that were identified from the literature review with the exception of those where the percentage of missing cases were in excess of 30%. and αs. αl stand for the intercepts in the regression models. and that other constraints are possible. Ordered regression model is written as: . Anderson [52] opined that ø1=1 and øk. (1) Where x is the vector of covariates with coefficient to be estimated. …k. Within this context. the monotone increase of ‗ø‘s are dealt with by varying the sign for β. k is the number of cut-points for the dependent variable. the researcher set ø1=1 and 0= ø1< ø2 < …< øk =1 to correspond to the levels from very good to very poor. s = 1. The current paper used the ordinal nature of the dependent variable (self-rated health status or self-rated health) which denotes that none of the original data will be lost as is the case in dichotomising self-rated health.

Self-rated health status (i. and veranda (i. total number of people in household divided by the total number of rooms excluding kitchen. hypertension. A further question about illness asked. Information on medical care-seeking behaviour was taken from the question.. diabetes mellitus or other illness. hypertension.e. arthritis. bathroom. ―Has a health care practitioner. cold. (7) yes. Medical care-seeking behaviour therefore was coded as a binary measure where 1 = yes and 0 = otherwise. (3) yes. (4) yes. 1 = yes and 0 = otherwise. how is your health?‖ with the options being very good. poor. arthritis. (8) no. The ordinal nature of this variable was used as was the case in the literature [38-40]. diarrhoea. fair (or moderate). or pharmacist been visited in the last 4 weeks?‖ The options were yes or no. or very poor. asthma. bathroom and veranda). self-rated health) was derived from the question. Independent variables Information on self-reported illness was derived from the question. Total annual expenditure was used to measure income. other. The term crowding refers to the average number of person(s) per room excluding the kitchen. good. (2) yes. asthma attack. (6) yes. ―Generally. diarrhoea.. 59 . ―Have you had any illnesses other than injury?‖ The examples given include cold. ―Is this a diagnosed recurring illness?‖ The options were: (1) yes.e. ―(Have you been ill) In the past four weeks?‖ The options were yes and no. healer. (5) yes. Information about self-reported diagnosed recurring illness was derived from the question. diabetes mellitus. This variable was re-coded as binary value.

9 years (range = 99 years). The income quintiles ranged from poorest 20% to wealthiest 20%. Similarly. cold (14.3.8% of rural respondents had tertiary level education and 5. P > 0.4 times more urban residents had tertiary level education compared to rural respondents. A cross-tabulation between educational level and area of residence revealed a significant statistical correlation – χ2(df = 40 = 78.Income quintile was used to measure social standing. 89% reported that the dysfunction was a diagnosed recurring one.783 respondents: 48.05 (Table 3.4%) followed by hypertension (20.2).20). P < 0.2. 0.6%).3% females. The median age of the sample was 29. and median crowding was 4.05. P > 0. The most frequently recurring illness was unspecified conditions (23.9%).3. Results Demographic characteristic of sample and bivariate analyses The sample was 6.001 (Table 3.7% males and 51. Based on Table 3.9.0 persons per room (range = 16 persons).050. Eighty-two percent of respondents rated their health status as at least good compared to 4. range = US $4.1). The median annual income was US $7.47.66 (rate in 2007: 1US$ = Ja$80. and others (Table 3.02.3. Of those who recorded an ailment.61. diabetes mellitus (12.9% who rated it as poor.406.3). No significant statistical correlation existed between educational level and sex of respondents – χ2 (df = 2) = 5.χ2 (df = 10) = 11. 60 . Fifteen percent of respondents reported some form of illness within the last 4 weeks.3%). no significant statistical association was found between purchased prescribed medication and educational levels of respondents .

5%) and primary level respondents (8.2%) and secondary level respondents (5. A cross-tabulation between self-reported illness and educational level revealed a significant statistical association . P < 0. P < 0.2%) followed in descending order by tertiary level (9.001.64.3%) compared to secondary level (22.7. Respondents with primary education level and below recorded the greatest percent of people with illness(es) (16. The mean age of respondents with primary level of education and below was 32.0 years (SD = 22.A significant statistical difference was found between mean age of respondents who are at different educational levels – F statistic [2. asthma was the greatest among tertiary level respondents (33.6.4%) compared to those with secondary education who were more likely to be 61 . Similarly.56. 95% CI = 24.4 years (SD = 10.4-32.χ2 (df = 2) = 61.001 (Table 3.6) compared to 14.6%. The statistical correlation was a weak one – correlation coefficient = 0.7%). Respondents with secondary level education (37.4).7%). Respondents with tertiary level education were most likely to be classified in the wealthiest 20% (53.10. diabetes mellitus (12. A significant statistical correlation existed between self-reported diagnosed recurring illness and educational level – χ2 (df = 14) = 42.5-14.0% of secondary level respondents. 95% CI = 14.4%).33.8%) was more prevalent among primary level respondents compared to 5. P < 0.3%) and primary level respondents (22. compared to 8.8) for those with secondary education level and 26.6.3% of tertiary level individuals.5%) had the highest percent of unspecified health conditions followed in descending order by tertiary (33. Hypertension was substantially a phenomenon occurring among those with primary education level and below: 21.001. On the other hand. 6589] = 214.6 years (SD = 1. 95% CI = 31.6-28.2) for those with tertiary education level.

the mean age of respondents with no formal education was 42. P < 0.0 years (SD = 2. there was no statistical difference between self-rated health status for rural and semi-urban residents.2% of respondents who had health insurance coverage. and primary to tertiary.4).0. (2) income.6.3%) or in the wealthiest 20% (20.001 (Table 3. 6589] = 214.6%) – χ2 (df = 4) = 76.3) (Table 3.6) compared to a mean age of 26. and that the data is a good fit for the model – LL = 9.7 years (SD = 18.5. P < 0. The 7 socio-demographic and economic correlates accounted for 33% of the variability in self-rated health status (Table 3. tertiary level people were more likely to have private coverage (35. basic. and 9.4) – F statistic [2.0 years (SD = 22.9%) followed by primary or below (12. Married people are more likely to report better self-rated health 62 .9) for basic school level respondents. 2.6587] = 2207. (6) area of residence. P < 0.in the middle class and those with primary level education were either in the poorest 20% (20.568.5).001.7 years (SD = 1.0). Of the 20. Based on the Table 3. (3) crowding.001.001 Multivariate analysis Self-rated health statuses of respondents are correlated with (1) age.4) – χ2 (df = 8) = 124.53. When educational level of respondents was disaggregated into no formal. However.95. (4) sex.001: mean age for those with at most primary level education was 32.4 years (SD = 10.218.9. Urban residents are more likely to report poor self-rated health status than rural residents. the older the respondents get.2) for those who have primary level education – F statistic [4. a significant statistical difference existed between the mean age among the different educational levels in which respondents were categorised (Table 3. P < 0.0%) and secondary level individuals (11. (5) marital status. Concurringly. P < 0.6) for those with tertiary level education. and (7) self-reported illness(es) – χ2= 1. the more likely they are to rate their health status as poor and this was the same for crowding and for those who report an illness (health condition).4.

Diener [34] noted in 1984 that there are still some valid variances. 25]. In another study on married people in Jamaica. In a study of elderly Barbadians (ages 60+ years). Subjective indexes such as self-rated health and self-reported illness can be used to measure health.7% of the variance in self-rated health status. but the latter is a better measure and this must be taken into consideration in the interpretation of findings using this measurement. and this increased to 63% for males. Hambleton et al. and this has been established by other studies [10-17. Bourne and Francis [53] found that 73% of self-reported illnesses explains the variability in self-reported health status. Embedded in the current finding is whether self-rated health is examined on elderly or married people. A recently conducted research found that self-reported illness accounted for 54% (r-square) of the variance in life expectancy of Jamaicans [25]. Within this context. Discussion The current paper concurs with the literature in that self-reported illness has the most influence on self-rated health status of people [8]. which was validated in a recent study by Bourne [25]. the validity of using the measure is high. However. no significant statistical difference was found between self-rated health status among the educated and uneducated cohorts. happiness. 63 . While bias is synonymous with subjective assessment or evaluation of any construct. The challenges noted by some researchers in using self-rated health are: (1) bias and (2) the dichotomisation of the measure. self-reported illness is a good measure of self-rated health. Health literature has long established that subjective indexes such as self-rated health.status than widowed people. and males are more likely than females to report better health status. Current self-reported illnesses accounted for a critical proportion of self-rated health and can be used to measure health. [8] found that current illness accounted for 87. people with more income are more likely to report better health status.

Jamaica. which suggests that health literature among regions has revealed different findings. area of residence.. psychological conditions.and life satisfaction are good measures of health as they are more comprehensive (including social activities and relationships. emotions. 34]. self-rated health status). What are the similarities and dissimilarities between the two statistical approaches in operationalising subjective health? Studies in the Caribbean found that age. and biological variables. economic. like other nations. 53]. indicating that dichotomising self-rated health status does not fundamentally change most of the sociodemographic. can use subjective indexes to assess health status of its people and by extension its entire population. Even some non-Caribbean studies have found the aforementioned variables to be statistically associated with subjective health [7. life satisfaction) while still incorporating the objective component [3. self-reported illness) and mortality are lowly correlated in Jamaica [25]. crowding. sex of respondents. is now resolved by this study as self-rated health was dichotomised and findings were similar to those who had dichotomised the dependent variable (i.. This is justified by studies that found strong statistical correlations between subjective health and objective indexes such as life expectancy [25] and mortality [2. This denotes that the wholesale use of what is obtained in one nation cannot be applied to another without understanding socio-demographic characteristics. It should be noted here that subjective indexes (e. The issue of the dichotomisation of self-rated health. 9]. However. because some of the original values will be lost. marital status. spirituality. income and illnesses were statistically correlated with subjective health [8.e. 1017. which is validated by the current paper. 64 . 21.g. 22-24].

Examining data on married people by way of dichotomising self-rated health status. income and sex to be the only factors of self-reported good health while in the non-dichotomised study more variables accounted for health status. indicating the closeness of the statistical approaches. he found in descending order selfreported illnesses. Embedded here is the fact that health insurance coverage in Jamaica is not an indicator of health care-seeking behaviour but a product that is purchased for the eventuality of the onset of illness. crowding. Education influences social standing and income. ranking of the correlates were similar in both studies as in the current. health insurance coverage is not significantly associated with better health status. in Bourne‘s work [25]. it becomes an even weaker variable. The literature showed that income is strongly correlated with self-rated health. sex and the others. However. age. the current work found that education is positively correlated with more health insurance coverage. Bourne [25] found that men had a greater self-reported health status than women. 65 . and in the current paper (non-dichotomisation of self-rated health status). as it will lower out-of-pocket medical care expenditure. Married people are a component of the general populace and they have socio-demographic and economic experiences which differ from some unmarried people. On the other hand. However. This finding is contrary to the literature that showed the association between higher education and health [7-9]. but it does not directly influence good health status in Jamaica. age. Although income affords one particular choices (or lack thereof). income. the educated class in Jamaica received more income than uneducated classes. The factors in descending order were self-reported illness. Nevertheless. in Jamaica this is clearly not the case. In Jamaica. males had a higher health status than females. yet the former class is not healthier than the latter. Concurringly. income plays a secondary role to illness and age and when self-rated health is non-dichotomised.

who still subscribe to the traditional notion that illness is correlated to weakness and that men should not display weakness. but the disparity ranged between -2 to 6%. except in cases of severe illness or if they are married [25]. therefore. in particular for men. is not fundamentally improving the health status of females or even males. females sought more medical care than males. which means that higher education.Education provides its recipients with knowledge. 68% of females sought medical care compared to 63% of males. It is this cultural perspective that bars many men from visiting health care facilities. Education is still unable to break the bondages of the perceptions of society which purport that health is weakness. The current findings found 66 . This reluctance to seek medical care is not limited to males. Jamaicans with the least level of education were most cognizant of their ailments and sought medical care just as much as did educated Jamaicans. mortality being greater for men is not surprising [54] as many men will die prematurely because of the fact that they are reluctant to visit health care institutions. and that to display weakness as a man removes his masculinity. but it does not mean that the educated classes are more concerned about their health. particularly men. access to knowledge. This continues to shackle Jamaicans. which is substantially a female phenomenon in Jamaica. when Jamaica began collecting data on the living conditions of its people. access to income and other empowerment. does not denote empowerment to seek medical care. In 2007. Educated Jamaicans are more likely to live in urban areas and those with primary education levels or below are more likely to live in semi-urban zones. and this can be measured using health care-seeking behaviour and knowledge about the illnesses that are affecting the individual. In 1988. which is embedded in the culture. The current paper found that 25 out of every 100 educated Jamaicans are aware of their health condition(s). Hence. and this is greater than that for uneducated classes. Education.

3% of Jamaicans in rural areas were below the poverty line compared to 4% of semi-urban and 6. This study cannot stipulate a baseline income that people should receive in order to prevent a decline in health status. although they are more likely to have at most primary level education. self-reported illness) and life expectancy – a correlation coefficient between 50 and 60% for a single variable is strong. In 2007.2% of urban Jamaicans [41].. However. indicating that poverty is more synonymous with rural areas. The health disparity between them and the educated showed no significant statistical difference and this emphasises that wealth does not automatically transfer itself into health. and violent communities. socio-demographic and biological variables accounted for 33% 67 . yet there is no significant statistical difference between the self-rated health status of rural and urban Jamaicans. inner-city neighbourhoods. Another issue which is evident in the data is the variability in the measurement of health among the social classes. as the poorest 20% reported less illness than the wealthiest 20% [41]. Conclusion While the dichotomisation of self-rated health status loses some of the original data. However. there is clearly a state of contentment among the poor and very poor who were equally as healthy as the wealthy. Income makes a difference in health. but clearly income beyond a certain amount is retarding the health status of Jamaicans.e.that semi-urban respondents were more likely to have better health status. this highlights that there are still some challenges embedded in the use of self-rated health status. as those with more means can access more and greater resources including health care. Despite Diener‘s findings [34] that the variance is minimal. statistics revealed that 15. Bourne‘s work showed a strong association between subjective health (i. yet the former group still dwells in slums. when selfrated health is non-dichotomised. and they have lower levels of education.

but that health insurance coverage cannot be used to measure health care-seeking behaviour or measure better health status of Jamaicans. Education is associated with more health insurance coverage. Acknowledgement Disclaimer The researcher would like to note that while this study used secondary data from the Jamaica Survey of Living Conditions. it is correlated with better social standing and higher income. Another critical finding that emerged from the current work is that education is not improving the health status of Jamaicans. 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 which suggests that societal pressures are barring Jamaicans from better health status choices. In summary. suggesting dichotomisation of health status still holds some validity. none of the errors that are within this paper should be ascribed to the Planning Institute of Jamaica or the Statistical Institute of Jamaica. but rather to the researcher. Conflict of interest The author has no conflict of interest to report. 68 . Income is significantly associated with better health status and it played a secondary role to self-reported illness and age of respondents.of the explanation of the variance and this was 44% using dichotomisation for married Jamaica. However. 2007.

North American Journal of Medical Sciences. 1998. Hudson SV. 2009. Bourne PA. Self-rated health and mortality: A review of twenty-seven community studies. North American Journal of Medical Sciences. 16. Social psychology of health. and health status of the old-old-to-oldest-old in Jamaica: a comparative analysis. Good Health Status of Rural Women in the Reproductive Ages. Bourne PA. Rev Pan Salud Public. 2009. Jay GM. North American Journal of Medical Sciences. pp. 1994. Clarke K. 17. 69 . In print. Bourne PA. 17: 342-352. Social Choice and Welfare.Bourne PA. 11. 1972. The demand for health – A theoretical and empirical investigation. Bourne PA. The meanings of self-ratings of health: a qualitative and quantitative approach. 12. Fraser HS. Rural health in Jamaica: Examining and refining the predictive factors of good health status of rural residents. 1997. Paul A. inflation. 55:847-861. J of Health and Social Behavior. Good Health Status of Older and Oldest Elderly in Jamaica: Are there differences between rural and urban areas? Open Geriatric Medicine Journal. 14. 38:21-37. Objective measures of wellbeing and the cooperation production problem. 8.George LK. 217-238. 18. Goerge LK. Research on Aging 1999. 7. Benyamini Y. Rhule J. Bourne PA. Handbook of aging and the social sciences. Brathwaite F. 5th ed. What global self-rated health items measure? Medical Care. 2005. New York: National Bureau of Economic Research. 2:18-27. 13. In: Binstock RH. Childhood Health in Jamaica: changing patterns in health conditions of children 0-14 years. 15:95-112. health insurance on mortality in Jamaica. 10. & Kington R. 6. Grossman M. 1997. 5. Broome HL. 2009. Historical and current predictors of self-reported health status among elderly persons in Barbados. 3. 2001. 4. Krause NM.References 1. Bourne PA. In print. Demographic and Economic Correlates of Health in Old Age. not seeking medical care. 9. 34:159-70. Asian Journal of Gerontology and Geriatrics. Bourne PA. Journal of Rural and Remote Health 9 (2). North American Journal of Medical Sciences 2009. Gaspart F. selfreported illness. Impact of poverty. Demography. International Journal of Collaborative Research on Internal Medicine & Public Health. Leventhal H. An epidemiological transition of health conditions.Smith JP. 1:99-109. 21:458-476. 2. editors. Idler EL. Social variation in self-rated health in Estonia: A cross-sectional study. Hambleton IR. 1:211-219. 1(5):132155. 15. 2009: 1116. McGrowder DA. 2009. Social Science and Med. 32:930-942. Leinsalu M. Idler EL. San Diego: Academic Press. 1: 86-95. Hennis AJ. unemployment. North American Journal of Medical Sciences. 2002. 1:160-168. A theoretical framework of good health status of Jamaicans: using econometric analysis to model good health status over the life course. (2009). Self-rated health and health conditions of females in Jamaica. Bourne. A Comparative Analysis of Health Status of men 60 + years and men 73 + years in Jamaica: A Multivariate Analysis.

34. 70 . Martin LG. Lahelma E. 27:208-13. 1990. 1993. Withey SB. and selectivity. 1994. and Iowa and Washington counties. The validity of using self-reported illness to measure objective health. Human longevity: Nature vs. 31. Gavrilova NS. 28. Examining the continuity of self-rated health. Gavrilova NS. Med. Biol. 33. 47:S304-S312. Benjamini Y. 1991. 36. 40. Int J Epidemiol. 1(5):232-238. Int J Epidemiol. Park K. 24. Persp. Russell Sage: Foundation. 2001. 29. Well-being: The Foundations of Hedonic Psychology. 95: 542–75. 1999. Am J of Epidemiol. 1982-1986. Psychological Bulletin. 1984. Self-evaluated health and mortality among the elderly in New Heaven. editors. 30. van den Bos J. Rie J. Old age and natural death. J of Gerentology: Social Sci. Kahneman D. Wellbeing: Foundations of hedonic psychology. 4:S268-S270. van de Mheen H. Ross CE. Self-assessment health: A longitudinal study of elderly subjects. The role of education in explaining and forecasting trends in functional limitations among older Americans. Evolution in Age-structured Populations. 1976.Wolinsk FD. Kasl SV. theor. Schwarz N. 39. 1973. Schwartz N. Subjective well-being. 2:30-49. Reports of subjective well-being: Judgmental processes and their methodological implications. Grahn D. Leventhal H. Connecticut. Diener E. Manderbacka K. New York. Demography. 29:149-57. Freedman VA. 1999. Caldwell JC. 2009. 1999. 1950-2000. Iowa. 25. Evolutionary perspectives on human senescence. Dichotomous or categorical response: Analyzing self-rated health and lifetime social class. The reliability theory of aging and longevity. Gavrilov L A. Olshansky SJ. 1992. 131:91-103. Lemke JH.19. J of Health and Soc Behaviour. 37. J. 1999. Andrews FM. New York: Harwood Academic Publisher. editors. 23. Olshansky JS. The Biology of Lifespan: A Quantitative Approach. 14:87-93. Maddox GL. 21. Mackenbach JP. 35. 1998. New York: Plenum Press. Power C. 23:127381. Carnes BA. 1946. 1999. Russell Sage Foundation: New York. Joung IM. In: Kahneman D. 36:445-460. Self-assessment of health: What do people know that predicts their mortality? Research on Aging. 32. 1999. Asia-Pacific Journal. 213:527-545. 42: 422-441. 1994. Idler EL. Diener E. Matthews S. Gavrilov LA. nurture – Fact or fiction. Int J Epidemiol 2000. 20. In: Kahneman D. Population Development Review. Biol. Social indicators of wellbeing: American perceptions of life quality. Charlesworth B. 38. 221:477-500. Refining the association between education and health: The effects of quantity. Strack F. 1999. 61-84. 2004. 14:21-38. Koo J. Martikainen P. 26. Gavrilova NS. Mirowsky J. Gavrilov LA. 2nd ed. Manor O. credential. The determinants of excellent health: Different from the determinants of ill-health. Leventhal EA. 19: 793-806. Medawar PB. Johnson RJ. 27. Cambridge: Cambridge University Press. Age and gender differences in affect and subjective wellbeing. Stronks K. Mod Q. Perceived health status and mortality among older men and women. Bourne PA. 22. Diener E. Carnes BA. Geriatrics and Gerontology International. Objective happiness. North American Journal of Medical Sciences. Schwarz N. Good health for many: The ESCAP region. 2004. Demography. Douglas EB. 36:461-473.

New Jersey: Princeton University Press. Hair JF. Jamaica Survey of Living Conditions. Planning Institute of Jamaica (PIOJ). 1982. 51. Jamaica Survey of Living Conditions. Cohen P. 1988-2007. Theory of econometrics. Kingston: University of the West Indies Press. Mamingi N. 2005. Hamilton JD. 52. Theoretical and empirical exercises in econometrics. Babin BJ. 1970-2007. 1999. STATIN. New Jersey: Lawrence Erlbaum Associates. 48. 44. 46. Series B (Methodological). 49. 2005. New Jersey: Prentice Hall. 54. 1994. Bourne PA. 46:1-30. Multivariate data analysis. Self-rated health status of married people in Jamaica: Why do they have better health status? Irish Medical Journal. Development Research Group. 47. Jamaica Survey of Living Conditions. Kingston. 1991-2008. Washington: The World Bank. 6th ed. Regression and ordered categorical variables. 1989-2008. 45. 50. 2nd ed. 2007. 2009 from http://siteresources. Statistical Institute of Jamaica. 1988. Black B. Applied regression/correlation analysis for the behavioral sciences. Applied regression analysis and other multivariable methods. 1977. Kingston. J of the Royal Statistical Society. 1984. 2002. 4th ed. Kupper LL. Holliday M.41. 1983. Koutsoyiannis A. Muller KE. University of the West Indies [distributors]. Kleinbaum DG. 2nd ed.pdf 43. New Jersey: Prentice Hall. Tatham RL. Boston: PWS-Kent Publishing. Statistics for Social Sciences. London: Harper & Row. Kingston. Jamaica: Statistical Institute Of Jamaica [producer]. Basic information. 71 . 2008. Francis C. Biostatistical analysis. Kingston: PIOJ. 2007 [Computer file]. Time series analysis. Demographic statistics. Anderson JA. Zar JH. 42. Cohen J.worldbank. Jamaica: Planning Institute of Jamaica and Derek Gordon Databank. Anderson RE. Poverty and Human Resources. STATIN. World Bank. Cohen L. In print. Statistical Institute Of Jamaica. Retrieved on September 2. 1988-2000. 53. New York: MacMillan Publishing.org/INTLSMS/Resources/3358986-1181743055198/38773191190214215722/binfo2000.

9 19.0 19.8 .9 4.5 37.4 29.783 Characteristic Sex Male Female Marital status Married Never married Divorced Separated Widowed Social standing Poorest 20% Poor Middle Wealthy Wealthiest 20% Area of residence Urban Semi-urban Rural Self-reported illness Yes No Self-reported diagnosed recurring illness Cold Diarrhoea Asthma Diabetes mellitus Hypertension Arthritis Unspecified Not reported as diagnosed Health care-seeking behaviour Yes No Self-rated health status Very good Good Moderate Poor Very poor 72 n 3303 3479 1056 3136 77 41 224 1343 1354 1351 1352 1382 2002 1458 3322 980 5609 149 27 95 123 206 56 234 109 658 347 2430 2967 848 270 50 % 48.3 69.Table 3.1.5 21.0 14. Demographic characteristic of sample.0 45.6 5.2 12.9 19.3 23. n=6.3.9 2.2 1.9 85.1 0.7 51.7 0.9 20.7 9.5 34.1 14.4 10.8 20.9 65.3 20.5 12.5 49.6 23.9 4.

8 Tertiary 4.592 Characteristic Area of residence Total Educational level Urban Semi-urban Rural % % % % Primary and below 84.2 10.6 11. cc = 0.5 0.001.9 9. n = 6.0 Total 1952 1421 3219 6592 Chi-square (df = 4) = 78.Table 3. P < 0.2.0 88.3 Secondary 10.8 2.11 73 .3 1.02.8 89.0 87. Educational level by area of residence.3.

6 3207 Sex Female % 86.05 87.61.3 10. P > 0. n = 6.5 1.9 10.4 3385 Total % 87. Education level by sex of respondents.Table 3.592 Characteristic Male % Educational level Primary and below Secondary Tertiary Total Chi-square (df = 2) = 5.3.8 2.0 6592 74 .6 11.0 2.

P < 0.28) (7.9 12.641.84 (6.6 Unspecified condition 22.1 4.0 0.0 33.580.7 60.0 66.5 No 34.11 4 F statistic [2.3 13.9 Poor 20.6 0.6) 30.5 Total 953 40 12 1005 Income6 Mean (SD) in US$7 8.381.4 (10.5 17.5 33.95. cc=0.05 6 F statistic [2.0 (22.6 20. cc=0.874.7 7.6) 14.7 53.5 Public 8.8 79.0 8.001.9 Diarrhoea 2.9 Wealthiest 20% 20.5 16.Table 3. P < 0.7) 26.0 5.6589] = 214.9 0.1 19.6589] = 52.4.3 9.3 40. P < 0.31.001 7 Rate in 2007:1US$= Ja$80.0 11.20 2 Chi-square (df = 8) = 124. P > 0.4 20.5 25.4 Not diagnosed 10.0 19.6 (1.3 19.623.3 20. P < 0.0 0.6 6.0 2.8 Private 12. P < 0.0 12.4.0 10.6 Arthritis 5.3 34.3 7.47 75 .81) (9.0 14.712.001 5 Chi-square (df = 2) = 0.6.7 Total 5682 689 128 6499 Age4 Mean (SD) in years 32.3 23.7 57.9 Total 947 40 12 999 2 Social standing (income quintile) Poorest 20% 20.7 3.2 Total 5752 709 131 6592 Health Insurance coverage3 No 79.9 0.5 33.7 Asthma 8.8 83.5 0.001.6 35.7 65.8) Health care-seeking behaviour5 Yes 65.20 14.4 24.0 0.0 17.53.3 Hypertension 21.56.8 5.3 19.0 (21.001. Self-reported diagnosed recurring illness and social standing by educational level Educational Level Total Characteristic Primary or Secondary Tertiary below % % % % Self-reported diagnosed recurring illness1 Cold 15.7 37.67 8.10) (6.071.0 21.9 20.54) 1 Chi-square (df = 14) = 42.14 3 Chi-square (df = 4) = 76.5 Diabetes mellitus 12.9 Wealthy 19.7 22. cc=0.6.8 19.88 9.0 Middle 19.

591 3.782 5.554 0.238 0.025 8.126 0.025 0.008 -0.055 10.342 2.152 0.542 0.022 1.704 3.274 0.265 -0.372 -0.016 0.568.433 0.040 -0.681 -0.071 -0.369 0.874 0.927 0.481 -0.077 0.001 0.477 0.001 LL = 9.141 0.116 -0.279 4.040 0.636 11.307 0.149 0.001 0.615 0. P < 0.000 0.457 0.060 -1.327 36.935 8.768 0.064 -0.540 3.262 -0.401 35.026 0.163 0.865 0.200 0.553 0.219 -0.090 0.187 0.288 0.008 0.5.163 0.132 0.318 0.032 3.865 11.117 0.009 0.433 76 .203 0.030 -6.06E-007 0.068 0.0 0.554 -0.465 36.267 0.085 0.083 -0.51E-007 0.045 -3.175 0.109 0.33 Chi-square = 1.048 3. 95% CI Characteristic Estimate Error Wald Upper Lower P Excellent self-rated health Good self-rated health (ø1) Fair self-rated health (ø2) Poor self-rated (ø3) Very poor (ø4) Age Income Crowding Primary or below Secondary Tertiary (=0) Sex (female=0) Married Never married Divorced Separated Widowed (=0) Poorest 20% Poor Middle Wealthy Wealthiest 20% (=0) Urban Semi-urban Rural (=0) Private insurance Public insurance Public insurance – other No insurance coverage (=0) Illness 0.728 7.163 Nagelkerke r-square = 0.252 0.387 0.469 -0.034 -0.216 4.945 -0.042 -0.290 7.000 0.0 0.504 5.Table 3.005 5.135 2.832 -0.025 0.004 0.789 0.826 0.456 31.140 0.122 0.389 -0.171 0.395 0.0 n=4.925 0.377 0.729 -1.221 -0. Ordinal logistic regression: Socio-demographic and biological differentials of selfrated health status of Jamaicans Std.659 0.345 0.218.006 0.909 34.155 0.985 1.028 -0.217 0.052 0.192 0.209 2.452 0.566 -0.523 0.000 0.130 0.159 -0.110 0.000 0.111 0.859 0.000 0.796 2.008 2.213 0.4.094 -0.013 0.000 1.087 1.174 0.002 0.79E-007 0.319 0.625 0.352 -0.425 0.

Donovan A. Introduction The rapidly increasing burden of chronic diseases is a key determinant of global public health.2% diabetes mellitus and 13. Bourne. Approximately one-quarter (25. chronic diseases contributed to approximately 60% of the 56. 17. To examine the physical health status and use a model to determine the significant predictors of poor health status of Jamaicans who reported being diagnosed with a chronic non-communicable disease. Asthma affected 47. access to more effective medication and development of support groups among chronic disease patients. while asthma was the most prevalent among children.9% hypertension. In 2001. McGrowder Developing countries such as Jamaica suffer increasingly from high levels of public health problems related to chronic diseases.2% of young adults. Improvement in chronic disease control and health status can be achieved with improved patient education on the importance of compliance.3% asthma. Thirty-three percent of the sample indicated unspecified chronic diseases: 7. area of residence and inability to work.5 million total reported 77 . 28.2% of children and 23.3%) of the sample reported that they had poor health status. and adults with poor health status were more likely to report having hypertension followed by diabetes mellitus and arthritis. Majority of the respondents in the sample had good health. Significant predictors of poor health status of Jamaicans who reported being diagnosed with chronic diseases were: age of respondents.8% arthritis.4 Health status of patients with self-reported chronic diseases in Jamaica Paul A.

The proportion of the burden of non-communicable diseases is expected to increase to 57% by 2020 [1]. Leading up to the mid-1990s. In five out of the six regions of the World Health Organization (WHO). More recently. Jamaica has undergone a significant demographic transition in the last 5 decades [6. along with an increasing prominence of non-communicable diseases. There is an increased prevalence of diet-related chronic non78 . deaths caused by chronic diseases dominate the mortality statistics [2] and there is evidence that 79% of deaths attributable to chronic diseases are occurring in developing countries.deaths in the world and approximately 46% of the global burden of disease. predominantly in middle-aged men [2]. and the increase in life expectancy at birth from less than 50 years in 1950 to greater than 70 years in 2000 [8]. with 15-20% and 20-25% of the adult population in English and Dutch-speaking Caribbean countries having diabetes and hypertension respectively. such as those in the Caribbean. with decreases in fertility and mortality rates and changing disease patterns. the main causes of illness and death in Jamaica and many other Caribbean islands and regions at a similar state of development are the chronic noncommunicable diseases [9]. the mortality pattern changed from deaths being mainly due to communicable diseases to them being mainly due to non-communicable diseases [3. these non-communicable diseases account for the single largest expenditure in national drug budgets [5]. 4]. 7]. the doubling of the proportion of persons older than 60 years old to over 10%. Most Caribbean countries have experienced a health transition. As a result. these countries have additionally observed the re-emergence of ‗old‘ communicable diseases and the emergence of new communicable diseases. Some features of this transition include the increase in the median age of the population from 17 years to 25 years between 1970 and 2000. Furthermore.

9% and 15.5% obese). which constitutes a minimum of 100 79 . diabetes and obesity. et al.2% were obese) and 64. This design was a two-stage stratified random sampling design where there was a Primary Sampling Unit (PSU) and a selection of dwellings from the primary units.7% of the women were overweight (31. It is against this background that this study was undertaken. such as cardio-vascular diseases. Chronic diseases such as heart disease. reporting on a survey of body mass index in an urban population. and there is an absence in the literature of studies looking at the health status of persons in the Caribbean with chronic non-communicable diseases. In this same study. found that 30.2% among the females.783 Jamaicans (Jamaica Survey of Living Conditions. while the prevalence of diabetes was 8. A model is used to predict the social determinants of poor health status of Jamaicans who reported at least one chronic non-communicable disease. The survey was drawn using stratified random sampling. Wilks.3% among the males and females respectively [10]. peri-urban and urban areas of residence.1% among the males and 28.7% of the men were overweight (7. The PSU is an Enumeration District (ED). This study was designed to explore any association between chronic non-communicable disease and health status. [10].communicable diseases. cancer and diabetes negatively affect the general health status and quality of life of individuals [11]. The aim of the study was to examine the self-reported health status of Jamaicans in rural. it was found that hypertension had a prevalence of 19. Method The current paper extracted a subsample of 714 people who answered the question of having sought medical care in the last 4-weeks from a larger nationally representative cross-sectional survey of 6. 2007) [12].

The results were presented using unstandardized B-coefficients. The predictive power of the model was tested using the Omnibus Test of Model and Hosmer & Lemeshow [13]. This study made use of the Jamaica Survey of Living Conditions (JSLC) 2007 [12]. which was conducted by the Statistical Institute of Jamaica (STATIN) and the Planning Institute of Jamaica (PIOJ) between May and August 2007. because the dependent variable was a binary one (selfreported health status is 1 if the respondent reported poor health status and 0 if otherwise). which was used to examine goodness of fit of the model. An ED is an independent geographic unit that shares a common boundary. The researchers chose this survey based on the fact that it is the latest survey on the national population and that that it has data on self-reported health status of Jamaicans. Logistic regression examined the relationship between the dependent variable and some predisposed independent (explanatory) variables.residents in rural areas and 150 in urban areas. IL. Wald statistics. and these were then stored and analyzed using SPSS for Windows 16. The non-response rate for the survey was 26. economic and health variables. frequency and percentage were used to analyze the socio-demographic characteristics of the sample. standard deviation (SD). Chicago.0 (SPSS Inc. Descriptive statistics such as mean. odds ratio and confidence interval (95% CI). USA). The correlation matrix was examined in order to ascertain whether autocorrelation (or 80 .2%. The questionnaire covered areas such as socio-demographic. Chi-square was used to examine the association between non-metric variables. and an Analysis of Variance (ANOVA) was used to test the relationships between metric and non-dichotomous categorical variables. Self-administered questionnaires were used to collect the data. The questionnaire was modelled pn the World Bank‘s Living Standards Measurement Study (LSMS) household survey.

17].4-0.multicollinearity) existed between variables.7-1. The use of this approach is better than bivariate analyses as many variables can be tested simultaneously for their impact (if any) on a dependent variable. physical environment and psychological characteristics in determining the reported health status of Jamaicans. Model The use of multivariate analysis in the study of health and subjective wellbeing (i.. 81 . Based on Cohen & Holliday [14]. socio-economic characteristics. this has also been employed outside of Jamaica [16. moderate – 0.e. Wald statistics were used to determine the magnitude (or contribution) of each statistically significant variable in comparison with the others. peri-urban and urban areas of residence) and sex of respondents using only those predictors that independently predict the outcome. This was used to exclude (or allow) a variable in the model. final models were built for Jamaicans as well as for each of the geographical sub-regions (rural. 20].69. using logistic regression techniques. selfreported health or happiness) is well established [18] and this is equally the case in Jamaica and Barbados [19.05 was used to for all tests of significance. Having identified the determinants of health status from previous studies. Equation 1 was again tested and decomposed by (i) sex of respondents and (ii) area of residence in order to ascertain those social predictors of each sub-group. The current paper examined the social determinants of self-reported health status of Jamaicans (Equation 1). correlation can be low (weak) – from 0 to 0.0. and the Odds Ratio (OR) was used to interpret each significant variable.39. and strong – 0. Multivariate regression framework [15] was utilized to assess the relative importance of various demographic. A pvalue of 0.

3% of the sample reported that they had 82 . ARi. ARi. EDi. It. logged consumption per person per household member. crowding of individual i. MRi. young elderly (60 to 74 years).Ht=f(Ai. Ht = f(Ai. Ji. logged duration of time that individual i was unable to carry out normal activities. Ji. EDi. area of residence. 13. logged income. Si. medical expenditure of individual i in time period t. lnY.1% divorced and 37.e. 3. length of time living in current household by individual i. Ti.HHi. hypertension) and social class. lnDi. household head of individual i..7% separated. and an error term (i. residual error). SAi.e. lnC. lnDUt. injuries received in the last 4 weeks by individual i. 1. HIi. SAi. CRi. sex of individual i. CRi. εi) [1] where Ht (i. Gi. Results Demographic characteristics of sample The sample constituted 714 respondents (36. young adults (15 to 30 years). other-aged adults (31 to 59 years). Some 25.. ARi. The final model that was derived from the general Equation [1] can be used to predict health status of Jamaicans (Equation [2]). social assistance of individual i. HHi. old elderly (75 to 84 years) and oldest elderly (85 years and older). Gi. εi) [2] Variables that were investigated include age.4% were widowed. current selfreported illness of individual i. HIi. The majority of the sample was never married (44. lnY. education level of individual i. Ai .3% women) with a mean age of 49. Age group is a non-binary measure: children (under 15 years).1% married. lnC. lnDi. MCt.7% men and 63. MRi.15 years. self-reported illness (diabetes mellitus. marital status of person i. Ti . MCt.7%). It. social class of person i. Si. self-rated current health status in time t) is a function of age of respondents. health insurance coverage of person i.

4% of the other town residents were in the lower class and 18% of the urban dwellers were in the lower class.001. Most of the rural respondents were in the lower class (52. Table 4.D. p = 0.9 persons in other town areas (S. With regards to self-evaluated health and area of residence..7% young adults and 15.42) – F statistic [2.3% asthma.41) and 3.41 for urban residents.poor health status. The mean annual income of rural residents was US$5.D..07 (S.9% hypertension. Table 4.4% of other town residents and 18.4.7% in the middle class and 38. most of the residents reported fair health status: urban residents (46. poor) compared to 26.8%) and rural residents (38. annual income and area of residence (p < 0.6% other-aged adults.05 for other town residents and US$10. 2.1 revealed that there is a statistical correlation between social class. other town residents (50.e. 9. Marginally more of the sample was in the upper class (41.2% diabetes mellitus and 13.9%). the mean number of persons per room was 4.4.218.2 revealed that there is a statistical correlation between diagnosed chronic diseases and age group [χ2 (df = 20) = 297. 31. 28.8% indicated fair.7% of other town residents and 38.D.4%). Asthma was primarily an illness for the 83 . poor). Interestingly.D.001.75 persons) compared to 3.6% of rural residents indicated that they had good self-evaluated health status compared to 31. self-evaluated health status.312.08 compared to US$8.7% in the lower class (i.63 persons) and in rural areas it was 4.6 persons in urban areas (S.9% indicated at least good and 42.6%). 2. Thirty-three percent of the sample indicated unspecified chronic illness: 7. n = 714]. 2. 711] = 6. Just over 50% of the rural residents were in the lower class (i. while 26.8% arthritis. 17. 19.e. 2.6%) compared to 33. 28.1% children.0% of urban dwellers.642.5%). The majority of the respondents were elderly (ages 60 years and older – 41.5% of urban dwellers. On the other hand. p < 0.001).701.873.38 (S.

7% of young old.7% of other-aged adults.085. 14.3% of oldest-elderly. it was the fourth most reported dysfunction associated with income and consumption expenditure. Arthritis was more likely to affect older ages than young ages: 0% of children.4% of young adults.2% of children and 23.5.1% of other-aged adults..2). Diabetes mellitus was found to be the third leading reported chronic disease influencing people with more income and consumption. only 3 emerged as statistically significant predictors of poor health status of Jamaicans who reported 84 . the findings also revealed that as an individual aged.e. 1.4). 7. there is a similarity across the aforementioned variable as asthma was found to be associated with the most income. 50. 2. 35.3% of otheraged adults. 19.4. 12. he/she was more likely to report being diagnosed with hypertension: 0% of children.7% of young adults.8% of children had diabetes compared to 4.9% of young-old. he/she was more likely to be aware of the typology of chronic illness that he/she has than they were at young ages (i. a statistical relationship was found between income. and unspecified chronic disease was the second leading reported dysfunction.4% of old-elderly and 6.younger ages and primarily affects children: 47. p = 0. consumption and persons per room.3.5% of old-elderly and 48. Furthermore.882.3% of young adults. Multivariate analyses Using logistic regression analyses.9% of oldest-elderly. 18. n = 714]. On the other hand. consumption.2% of oldest-elderly. Interestingly. The findings revealed that as an individual aged. no statistical correlation was found between diagnosed chronic disease and social class [χ2 (df = 8) = 13. Table 4. 31. 28. of the 17 variables that were tested for this study.6% of old-elderly and 17. under 31 years). On the other hand.7% of young old. crowding and chronic disease (p < 0. Based on Table 4.2% of young adults (Table 4. 8.4. While hypertension was the third most reported chronic disease associated with crowding.

while approximately one-quarter indicated poor health.956.041(urban residents) -1.018 – 1. area of residence (urban areas – OR = 0. These results concur with those by other researchers from Dominica [26] and Trinidad [27].191 – 0. Self-reported health status has been widely used in censuses. The logistic regression model can be written as: Log (probability of poor health status/probability of not reporting poor health status) = -0.041 (other towns) + 0. The results of this study showed that the majority of those sampled reported to be experiencing at least good or fair health.711. p < 0. the predictors accounted for 24% of the variability in poor health status (Table 4. 95% CI = 1. 95% CI = 1. surveys. Furthermore.001. 040).744) and log duration unable to work (OR = 1.being diagnosed with chronic diseases (Table 4. 85 .271).280 – 2.537 (log duration unable to work).5): age of respondents (OR = 1.4% of the sample (correctly classified 92. p = 0.352.029.5).652.352.704 + 0. The model (Equation 2) had statistically significant predictive power [χ2 (4) =59. and observational studies and there is evidence suggesting that self-reported health is an indicator of general health with good construct validity [22] and is a respectably powerful predictor of mortality risks [23]. disability [24] and morbidity [25].149.6% of those who were not in poor health).268] and correctly classified 74. Discussion There is an association between chronic disease and health status and the former has a significant negative impact on the physical aspects of health [21].6% of those who were in poor health and 31.028 (age) -1. 95% CI = 0.173 – 0. Hosmer and Lemeshow goodness of fit χ2 = 9. 95% CI = 0. other towns – OR = 0.76.

Among persons known to be hypertensive. 33]. especially in women. 37]. prevalence increased with age in both rural and urban populations and in both sexes. hypertension is more common among women and the elderly in Jamaica.7% had been able to lower and maintain their blood pressure at 140/90 or less. 37.and sex-adjusted prevalence in Jamaica is 24% [30] with somewhat higher levels in women than in men. with the old-elderly recording the most among the elderly cohorts. the higher prevalence of hypertension was associated with an increased prevalence of obesity.The current paper revealed that hypertension was the most common chronic disease among the respondents. The Jamaican Healthy Lifestyle Survey Report 2000 [31] noted a prevalence of hypertension of 19. The prevalence of diabetes mellitus is high in Jamaica and the Caribbean and many patients have poor metabolic control [34]. In Jamaica the prevalence of diabetes among persons 25-74 years old is estimated to be 12% to 16% [35-37]. In a study by Sargeant et al. Studies from developed countries have reported prevalence of raised blood pressure among the elderly to vary from 60% to 80% [29]. There is also evidence that the diabetes prevalence has increased 86 . and of this group. but of which a third is unrecognized [36. followed by diabetes mellitus and arthritis. Hypertension is one of the most important treatable causes of morbidity and mortality and accounts for a large proportion of cardiovascular diseases in the elderly in Jamaica [28]. The age. [28]. Hypertension was highest among the elderly. Diabetes was the second leading cause of chronic disease in this study and was most prevalent among the young-old with just under one-third reporting that they have diabetes mellitus. In the Caribbean and the USA.7% among females. Diabetes mellitus is an important cause of morbidity and mortality in Jamaica and represents a significant burden on health services.9% among males and 21. 42% were on treatment. and with greater intake of dietary sodium [32.

In 2001. In the Jamaican Healthy Lifestyle Survey Report 2000 [31]. diabetes mellitus was found in 6. hospital morbidity patterns and primary care data indicated that respiratory illnesses dominated the list of childhood infirmities among children 0-14 years.3%. Asthma is an important public health issue in Jamaica. asthma was the predominant chronic disease affecting approximately one-half of the children and almost one-quarter of young adults. compared to 6.3% of males and 8. asthma was the major condition for which patients were seen in health facilities. Almost one-third of those classified as diabetic were not being treated. For children aged 0-4 years. a condition mainly attributable to the high incidence of tobacco smoke to which these children are exposed [42].2% of females and there was a sharp increase with age. Diabetes mellitus accounts for about 10% of mortality in Jamaica [39] and is ranked fourth as the principal cause of death among Jamaicans during the period 1990 to 1994 [40]. Awareness of diabetes mellitus among those classified as diabetic by the survey was 76.3 days for diabetes mellitus in 2002.3 days for all conditions [31]. treatment and control among patients with diabetes mellitus [34]. five percent of clinic visits are asthma related and 25 percent of respiratory admissions to hospital are due to asthma [44]. and 60% of those who reported being on medication did not have their condition under control. Furthermore. Exercise-induced asthma has been reported to occur in 20 percent of school age children [43]. In this study. In the Caribbean. there is evidence that the high prevalence of diabetes in Jamaica is due to the low rates of awareness. there has been growing concern at the apparent increase in asthma in children and young adults. The average length of stay in hospitals was 8. In government hospitals in Jamaica.[38]. But the impact of diabetes mellitus on mortality is under-reported since the disease may contribute to mortality from such other conditions as cerebrovascular accidents and myocardial infarctions [41]. Barnes and colleagues [45] studied asthmatic children in Barbados where treatment was 87 .

In Jamaica.6 and 19.75%) is similar to that in the West [50]. The unspecified chronic diseases could be other chronic non-communicable diseases such as a malignant neoplasm or a chronic communicable disease. 49]. the prevalence of rheumatoid arthritis (0. just over one-third of the respondents indicated an unspecified chronic illness. resulting in a death rate of approximately 5 per 100. with rates in 1991 of 22.2 per 1. Rheumatoid arthritis is the third chronic illness among the respondents in the study. The rarity of rheumatoid arthritis in rural Africa contrasts with the high prevalence of the disease in Jamaica. Quality of life is significantly low in patients with rheumatoid arthritis.000 88 .associated with use of inhalers. Due to its physical. often progressing to destruction of the articular cartilage and ankylosis of the joints [48. patients experience many difficulties in various aspects of their lives can contribute to their self-reported poor health. Studies conducted over the last three decades in Third World countries have confirmed that rheumatoid arthritis occurs throughout the world. these patients should be managed using a multidisciplinary approach including psychiatric support. but no distinction between bronchodilators and corticosteroids was made [46]. Asthma is a significant cause of mortality in Jamaica. where over 2% of the adult population is affected [51]. Cancers of the breast and cervix are the most common neoplasms in women. social and psychological burden. cancers accounted for 15% of non-communicable diseases and 9% of total disease burden in 1990. rheumatoid arthritis was the reason for seeking medical advice in 22% of rheumatology clinic patients [52]. In India. knee osteoarthritis and fibromyalgia syndrome. In a study in Latin America. Rheumatoid arthritis is a chronic systemic inflammatory disorder that may affect many tissues and organs but particularly the joints. whose depression and/or anxiety scores are high [53]. Therefore. In this study.000 [47].

Diabetes mellitus was found to be the third leading reported chronic disease influencing persons with greater income and consumption.7% [58]. Prostate cancer was the number one form of cancer found in men [54]. representing 56% of all cancers. In 2002. In addition. [57] concluded that the presence of diabetes mellitus increases the risk of depression and studies have shown that in persons diagnosed with diabetes mellitus the prevalence of depression ranges from 6. which has become a serious public health concern in Jamaica.000. The unspecified chronic illness may include HIV/AIDS. The 2000 Lifestyle Survey found approximately 25 % depressive symptoms in the general population [31]. there were 3. leukemia. The study found that there was an income differential between respondents in rural compared with urban areas of residence. The national incidence of AIDS in 2000 was 352 per 1. The majority of the respondents resided in rural areas and just over one-half of these were in the lower class. bronchus. trachea.60. a communicable disease. and non-Hodgkin‘s lymphoma. bronchus. The types of neoplasms involved for males.000 population members [56]. and lungs. respectively. in order of decreasing frequency. the unspecified chronic disease may include depression and there is evidence to suggest that depressive disorders frequently accompany other chronic medical diseases. For females. While hypertension was the third most reported chronic disease associated with crowding. other malignant neoplasms of female genital organs. with those in the rural areas having mean annual income of approximately two-thirds of their urban counterparts.population members. it was 89 . cervix uteri. were: trachea. leukemia. the order was as follows: breast.769 public hospital discharge diagnoses (4% of total discharge diagnoses) for malignant neoplasms with an equal gender distribution.1% . and lungs. prostate. Anderson et al. and non-Hodgkin‘s lymphoma. together representing 56% of all cancers [55].

Given the high prevalence and poor levels of control. and who are males are less likely to seek health care [64]. Male-headed households are smaller and have a per capita expenditure 10 times higher than female-headed households [62. female-headed households are poorer than those headed by males and twice as likely to be unemployed. According to Sobal and Stunkard [59]. We suggest that 90 . These men are at increased risk of developing type 2 diabetes mellitus [60] which is increasing in the adult population. Poverty. Conclusion The general epidemiological shift from infectious to chronic non-communicable diseases in Jamaica puts the residents at risk. while asthma was the most prevalent among children. hypertension and diabetes mellitus remain formidable issues for public health care in Jamaica and the Caribbean. Predictors of poor health status of Jamaicans who reported being diagnosed with a chronic disease were: age. Adults with poor health status were more likely to report having hypertension followed by diabetes mellitus and arthritis. 63]. in developing societies there is a higher likelihood of obesity among men in higher socio-economic strata. who are in the poorest quintile.the fourth most reported dysfunction associated with income and consumption expenditure. The majority of the respondents in the sample had good health. Most of the respondents in this study were female and single women constitute 45% of Jamaican heads of household [61]. and inability to work (therefore being unemployed). Poor health status was more prevalent among those of lower economic status in rural areas who reported the least annual income. area of residence. The 1999 data from STATIN show that individuals who live in rural areas. In Jamaica. low education and poor access to health care in rural communities intensify the inertia to the lifestyle modifications that are necessary to bring about greater levels of control.

Caribbean Commission on Health and Development Report. 8. Forrester T. Research into policy. Hypertension and diabetes mellitus in the Caribbean. West Indies 1953-1992. Demographic Statistics 2001. 4. References 1. World Health Organization (WHO). Bennett F. Int J Epidemiol 1996. The world health report 2002: reducing risks. Statistical Institute of Jamaica (STATIN). West Indian Med J 1998. Kingston: STATIN. McFarlane-Anderson N. 2002. 2002. West Indian Med J 2003. 6.further improvement in chronic disease control can be achieved with improved patient education on the importance of compliance. Epidemiological transition in Trinidad and Tobago. Diet. Geneva. Geneva: World Health Organization. 2002. 91 . 2004. Forrester TE. 3. 50 (Suppl 4): 15-22. access to more effective medication and development of support groups among patients with chronic disease(s). Guilliford MC. 52: 164-169. promoting healthy life. 2. physical activity and health. West Indian Med J 2001. World Health Organization. Figueroa JP. 25: 357-365. World Health Organization. 7. 5. 47(Suppl 4): 40-44. Significant progress and a vision for the 21st century. Wilks R. Health trends in Jamaica. Chronic diseases: The new epidemic.

Lipps G. McFarlane-Anderson N. London. Rev Pan Salud Public 2005. Cooper RS. Lemeshow S. Hennis AJ. West Indian Medical Journal 1998. 92 . Asnani MR. Cruickshank JK. Reid ME. Demography 1997. 12. Smith JP. Kingston: PIOJ. Bennett F. 2000. Jamaica Survey of Living Conditions 2007.9. Rural and Remote Health 2008. Brathwaite F. Measuring Healthy Days: Population assessment of health-related quality of life. 11. Historical and current predictors of self-reported health status among elderly persons in Barbados. Statistics for social sciences. Applied logistic regression. 18. 16. Kington R. New York: National Bureau of Economic Research. 8(890): 1-9. Rotimi C. Ga: Centers for Disease Control and Prevention. New York. John Wiley & Sons Inc. Wilks RJ. Chronic diseases-facing a public health challenge. 47(suppl 4): 40. Fraser HS. Cohen L. Homer D. 17(5-6): 342-352.. Sargeant LA. 2nd edn. England: Harper and Row. Forrester T. 10. 2000. Demographic and economic correlates of health in old age. Atlanta. 2008. Grossman M. Holliday M. Quality of life in patients with sickle cell disease in Jamaica: Rural-urban differences. Wilks R. 34: 159-170. 1982. 15. STATIN. West Indian Med J 2001. 1972. Planning Institute of Jamaica and Statistical Institute of Jamaica (PIOJ & STATIN). 17. Forrester TE. 13. Clarke K. Anderson SG. 50(Suppl 4): 27-31. Chronic disease: the new epidemic. 14. Broome HL. The demand for health – A theoretical and empirical investigation. Ali SB. Kaufman JS. Hambleton IR. Williams-Green P.

Health status of the elderly in the Marigot Health District. International Journal of Social Psychiatry 2004. Wyatt GE. D. 50: 43-53. Aging. Journal of Health and Social Behavior 1997. West Indian Medical Journal 1996. 25. 23. in N. Ann Arbor. Simeon DT. 50B(6): S344-S353. Smith J. Knauper and S. 27. 21.19. Heymans HS. Tucker MB. Sudman [ed. Idler EL. 24. 56(suppl 3): 39-40. and Self-Reports. Groothoff JW. Simeon DT. Schechter S. 22. Luteijn B. 34: 491-496. West Indian Medical J 2007. Hutchinson G. Bourne P. Chadee DD. Schwarz. Self-ratings of health: Do they also predict change in functional ability? Journal of Gerontology 1995. Park. Benjamin Y. Nephrol Dial Transplant 2003. Quality of life in adults with end-stage renal disease since childhood is only partially impaired. 45(Suppl. Willis GB. B. 20. Idler EL. Dominica. Grootenhuis MA. West Indian Medical Journal 2008. Gruppen MP. Offringa M. Kasl S. 1998. 38: 21-37. The elderly in Trinidad: Health. LeFranc E. Self-rated health and mortality: A Review of twenty-seven community studies. Social and health determinants of wellbeing and life satisfaction in Jamaica. 57: 589595.]: Cognition. social and economic status and issues of loneliness. 18: 310-317. Korevaar JC. Rawlins JM. Gerontologist 1994. Using the biopsychosocial model to evaluate the wellbeing of the Jamaican elderly.2): 31. Measuring health and economic status of older adults in developing countries. 26. 93 . Bain BC. Beatty P. Asking survey respondents about health status: Judgment and response issues. Ramdath DD. Michigan: Taylor and Francis.

13: 9-15. Am J Public Health 1997. Ravallion M. Wilks R. The prevalence of hypertension in seven populations of West African origin. Diabetes in the Caribbean: Results of a population survey from Spanish Town. Jamaica. Bennett F. Geneva: World Health Organization. Comparative analyses of more than 50 household surveys on health status. Cooper R. Prevalence. Wilks R. 16: 875-883. Kingue H. Natl Med J India 2000. Management of diabetes mellitus in three settings in Jamaica. Bennett F. Gulliford M. Sadana R. 1994. Ashley DE. Wilks R.28. Forrester T. Figueroa JP. Kadir S. Diabetic Medicine 1999. 31. Reid M. 32. Ataman S. 35. Forrester T. 16: 35-42. 7: 160-168. 2000. The Jamaican Diabetes Survey. Bennett F. Impaired glucose regulation in adults in Jamaica: Who should have the oral glucose tolerance test? Pan American Journal of Public Health 2004. Sharma PS. Sargeant L. Lopez AD. Iburg K. Cooper RS. awareness. 33. Diabetes Care 1995. Sargeant L. India. McFarlane-Anderson N. Switzerland: Harwood Academic Publishers. 2000. Rotimi C. Forrester T. Kaufman JS. 9: 65-71. British Diabetic Association. Mathers CD. 94 . Cooper R. Muna W. 18(9): 1277-1279. Ward E. Rotimi C. Pan Am J Public Health 2001. McGee D. 34. Murray CJL. 30. 36. Wilks R. 29. Vasan RS. Jamaica Healthy Lifestyle Survey Report. Fraser H. Poverty comparisons. Kalavathy MC. Morrison EY. Forrester T. Thankappan KR. Walters C. Osotimehin B. Anderson SG. Boyne M. Lewis-Fuller E. Ragoobirsingh D. Chur. Cruickshank JK. treatment and control of hypertension in an elderly community-based sample in Kerala. Wilks RJ.

Demographic statistics 1995. Fraser H. 38. West Indian Med J 1992. Mortality from diabetes mellitus in Jamaica. Plenty children got wheeze these days: Lay knowledge. Caribbean Regional Health Study. DC: Pan American Health Organization. 39. Forrester T.2001Paho01. 46. 45. 2002. Alleyne SI. 20(3): 343-348. 1996: 21-22. Riste LK. Bull Pan Am Health Organ 1989. 41. Prendergast K. Cruickshank JK. Ashley D. 44. Rotimi CN.37. Kingston. FG. Kaufman JS. http:/w/wwww. Helm R M. Washington. The prevalence of diabetes in a rural population of Jamaican adults. A Ten Year Review. Naidu R P. Epidemiological Profile of Selected Health Conditions and Selected Services in Jamaica. Ward E. Golding AL. Int J Epidemiol 1972. 40.gov/tobacco/global/gyts/reports/paho/2001/ Jamaica. 42(suppl 1): 37. Statistical Institute of Jamaica. Naidu R P. West Indian Med J 1995. Roach T. The role of the house dust mite and other household pests in the incidence of allergy among Barbadian asthmatics.cdc. Cooper RS. Longsworth. 42. Grant A. 1996. Report on the Results of the Global Youth Tobacco Survey in Jamaica – 2001. West Indian Med J 1993.htm 43. Diabetes Care 1997. McDonald J. Owoaje EE. Brenner R J. 41 (suppl 1): 38. Jamaica. Miall WE. Cruickshank JK. Florey Cdu V. Prevalence of NIDDM among populations of the African diaspora. 1(2): 157-166. Barnes K C. 44: 16-19. beliefs and stated behaviours related to asthma in Barbados. Morrison EY. Barnes K C. St Andrew and St Catherine. Jamaica: Statistical Institute. Pan American Health Organization. 2001. McDonald H. Prevalence of exercise-induced asthma in schoolchildren in Kingston. 23(3): 306-314. Nichols DJ. 95 . Wilks R. Howitt M E.

Mullings RL. Malaviya AW.org/English/DD/AIS/cp_388. Rheumatology International 1993. Kocer E. Woo P. Health in the Americas. Ministry of Health Annual Report. www. 49. West Indian Medical Journal 2007.. Icmeli C. Pan American Health Organization. Diagnosis and Management of Rheumatic Diseases. 1998. Prevalence of Rheumatoid arthritis in the adult Indian population. 54. Ataoglul A. 2002. Effects of depression and anxiety on quality of life in patients with rheumatoid arthritis. Katz WA. In: Maddison PJ. Pande I. Glass DN. Singh RR. Ministry of Health. Mijiyawa M. Rev Rhum Engl Ed 1995. Kingston: Ministry of Health. Second Edition. Kerr G. In: Katz WA.paho. ed. Richards J. Isenberg DA. 51. 1998. 89(4): 829-868. Ozcetin A. Medical Clinics of North America 2005. Ravinder N. 47: 129-132. Philadelphia: Lippincott. 380-396. 1004-1027. 1998. Epidemiology and Semiology of rheumatoid arthritis in third world countries. Pan American Health Organization. New York: Second Edition.C. Harris E. Bronchial asthma deaths in Jamaica. knee osteoarthritis and fibromyalgia syndrome. ed.47. 53. 62(2): 121-126.htm 96 . 50. 52. 2003 56. Jamaica – Health situation analysis and trends summary. West Indian Med J 1998. Yildiz O. Washington D. Rheumatic disease in minority population. Rheumatoid arthritis. 56(2): 122129. Rheumatoid arthritis. Feldmann MM. Ataoglus S. Jamaica. Kapoor SK. 48. Kumar A. Yazici S. New York: Oxford University Press. Volume II – Jamaica. 1998 Edition. Oxford textbook of Rheumatology. 13(4): 131-134. Scott PW. 55.

60. Diabetes Care 2001. 2002. Soc Sci Med 1986. 62. International Labor Organization: International Program on the Elimination of Child Labor. Anderson R. 63. 2001. The Statistical Institute of Jamaica. 24: 1069-1078. Sobal J. 59.57. The prevalence of co-morbid depression in adults with diabetes. Switzerland. Situation analysis on excluded children in Jamaica. Stunkard AJ. Kingston. Jamaica Survey of Living Conditions: report. Astrup A. 1(2): 57-59. The Statistical Institute of Jamaica. 58. Finer N. Socioeconomic status and obesity: A review of the literature. Diabetes. depression and employment status. DC: The World Bank. Obesity Reviews 2001. Freedland KE. 2006. Redefining Type 2 diabetes: Diabetes or obesity dependent diabetes. 2006. Kingston: UNICEF. 105: 260-275. 1999: 45-47. 61. 21866-LAC. 23: 471-475. Jamaica. World Bank. 2002. Haiti and Jamaica. Psychol Bull 1989. Friis R. Dunn LL. 97 . 64. Report No. United Nation‘s Nation Children Fund (UNICEF). Clouse RE. Jamaica: Situation of children in prostitution: A rapid assessment. Lustman PJ. Nanjundappa G. A review of gender issues in the Dominican Republic. Geneva. Washington.

8) Age Mean (SD) 47.70) (USD7.5) 204 (51.00 = Ja.082 0.001 < 0.3) 64 (16.3) 249 (63.4) 130 (33.3) 34 (31.05 USD5. (23.166 0.114 < 0.0) Household head Yes 105 (52.9) Middle 30 (15.4 (1.842 98 .5 (1.3) 84 (21.1) 25 (6.7) 2 (0.0) 6 (5.473.5) 1.873.5) 61 (50.8) Never married 78 (45.5) 72 (59.059.84) (US 4.8) 3 (0.1) 6 (5.0) 27 (22.61) 48.0) 21 (17.9) 48 (44.5) 189 (48.0) 27 (22.1) No 95 (47.0) 62 (51.Table 4.6) Fair 93 (46.3) 30 (7.3) 101 (25.6) Unspecified 72 (36.0) 13 (3.5 yrs (25.7) 112 (28.4 (1.7) Self-evaluated health status Good 77 (38.8) 150 (38.4) Poor 30 (15.001 0.6) Female 130 (65.5) 1 (0.6) Widowed 21 (12.5) 49 (40.9) 118 (30.7 (25.5) 11 (9.79 yr) †Annual Income Mean (SD) USD10.4) Secondary/High 9 (4.4.4) Upper 134 (67.08 (USD9.41 USD8.702 0.8) 130 (39. $ 80.0) 32 (26.5) 41 (33.001 0.0) 106 (87.51) 1.5) 129 (33.214 < 0.1) 51 (13.5) 38 (31.218.2) Basic 14 (7.3) 13 (3.7) Self-reported chronic illness Asthma 33 (16.1: Socio-demographic characteristics of sample Area of residence Variable Urban Other towns Rural n (%) n (%) n (%) Sex Male 70 (35.07 yrs) 53.466 0.7) 144 (36.1) 1.8) Educational level No formal 160 (80.47 at the time of the survey) P 0.1) 33 (8.0) 380 (96.6) 6 (1.4) Primary/Preparatory 12 (6.0) Diabetes 32 (16.3) No 195 (98.4) 208 (52.8) Marital status Married 60 (35.8) Separated 4 (2.1) Social class Poor 36 (18.3) Tertiary 5 (2.0) 5 (4.3) Hypertension 47 (23.4) Injury Yes 4 (2.653.0) 45 (13.4) 4 (3.0) 115 (95.9) 144 (44.347 0.5) 4 (3.0) 48 (39.0) 32 (26.0) Arthritis 16 (8.0) 73 (60.0) 5 (4.36 yrs.0) Divorced 7 (4.4) 15 (14.1) Number of visits to health care practitioner Mean (SD) †Annual Income is quoted in USD (US$ 1.0) 10 (8.312.6) 319 (81.

P < 0.7) 61 (35.0) 3 (4.0) 43 (62.6) 49 (50.3) 51 (47.2) 14 (48.9) 56 (7.2) 206 (28.1) Diagnosed chronic illness Asthma Children n (%) Young adults n (%) Old elderly n (%) 2 (2.1) 29 54 (50.701.4) Total n (%) 95 (13.3) 123 (17.4.7) 22 (12.4) 13 (13.7) 17 (7.1) Oldest elderly n (%) 1 (3.2) Diabetes mellitus Hypertension Arthritis Other (unspecified) Total χ2 (df = 20) = 297.8) 234 (32.4) 44 (18.5) 14 (14.9) 7 (24.9) 32 (18.5) 7(4.3) 76 (31.3) 108 69 99 .4) 240 49 (28.3) 6 (8.0) 0 (0.Table 4.2: Diagnosed chronic recurring illness by age group Age group Other-aged adults Young old n (%) n (%) 18 (7.4) 97 5 (17.1) 85 (35.7) 1 (1.7) 171 19 (19.2) 16 (23.8) 714 2 (6.8) 0 (0.001 3 (2.

Table 4.2) 76 (25.9) 82 (29.6) 19 (6.7) 25 (9.2) 206 (28.1) 86 (31.6) 141 Upper class n (%) 34 (11.5) 16 (11.2) 276 Social class Middle class n (%) 19 (13. P = 0.5) 46 (32.882.8) 714 100 .4) 66 (22.0) 12 (8.8) 234 (32.9) 56 (7.2) 41 (14.085 Poor n (%) 42 (15.3) 297 Total n (%) 95 (13.3: Diagnosed chronic illness by social class Diagnosed chronic illness Asthma Diabetes mellitus Hypertension Arthritis Other (unspecified) Total χ2 (df = 8) = 13.4) 102 (34.3) 48 (34.4.3) 123 (17.

01 536998.18 0.66 3.65 4.73 †Crowding – F statistic [4.55 3.778.26 865493.71 590084.97 4.04 438796.69 2.37 573083.10 65321.62 450169.07 735796. 709] = 7.59 1.15 498529. P = 0. Error 0.88 2.58 604650.51 2.25 574802.14 31364.87 642193.21 Hypertension 206 500635.98 647657.250.78 47093.41 554090.28 460341. P = 0. P < 0.62 28261.59 Std.33 2. 709] = 4.012.66 Total 714 543277. Deviation 2.30 4.37 561310.81 Upper 5.33 38681. income and annual consumption expenditure by diagnosed chronic disease 95% CI Std.40 725505.21 0.33 574096.61 749288.14 Other (unspecified) 234 586512.94 489952.89 649294.09 363216.18 0.85 330599.22 3.14 Lower 4.55 3.10 47337.4: Crowding.26 0.96 568805.72 3.97 554806.88 606099.49 655299.66 429059.41 530832.18 4.14 3.95 3. $80.52 645414.01 32750.50 441764.32 39832.11 461384.47 = USD1.63 563886.07 511752.85 444432.52 37414. †††Annual consumption Expenditure – F statistic [4.472.42 16057.Table 4.24 591718.65 N †Crowding Asthma Diabetes mellitus Hypertension Arthritis Other (unspecified) Total Asthma Diabetes mellitus Hypertension Arthritis Other (unspecified) Total Asthma 95 123 206 56 234 714 95 123 206 56 234 714 95 Mean 5.63 636673.96 480323.69 4.43 64740.86 3.30 0.33 352416.00 at the time of the survey) 101 .001 ††Income – F statistic [4.40 432316.14 3.93 2.15 †† Annual income* †††Annual consumption expenditure* Diabetes mellitus 123 509264.001 *Income and Annual Consumption Expenditure were quoted in Jamaican dollars (Ja.38 562474.88 20763.32 309774.86 627856.15 484472.23 Arthritis 56 404152. 709] = 3.

268 †Reference group – rural areas *P < 0.006 0.76.01.0. **P < 0. P < 0.05.018 .313 0.001.803*** 1.271 Log duration unable to 0.353 0. 1.0.372 Odds ratio 1. n = 714) -2 Log likelihood = 332.145 13.652 0.711 work χ2 (df = 4) =59.029 0.325 Nagelkerke R2 =0.173 .Table 4.149.289 .040 0.359 95.240 Hosmer and Lemeshow goodness of fit χ2 = 9. ***P < 0. error 0.I.001 102 .0% C.191 .061** 7.582** Predictors Age Urban areas Other towns Std.131*** 11.1.956. P = 0.5: Logistic regression: Predictor of poor health status of patients who reported chronic disease Wald statistic 26.744 1.2.

confectionary manufacturers and government. in order to address the tsunami of chronic diseases facing the nation.000 in 2002 to 56 per 1. hypertension and arthritis. Statistics indicate that 79% of all mortalities are attributable to chronic diseases. and that they are occurring in developing 103 . Beckford Globally. The average annual increase in particular chronic diseases was 17. chronic illnesses are the leading cause of mortality. Bourne. & Orville W.7%) and arthritis (.4% less than 15 years).8%). Maxwell S. Maureen D. Cynthia Francis. particularly in the Caribbean. Samuel McDaniel. Almost 5 percent of diabetics were less than 30 years of age (2. 2]. This research highlights the urgent need for a diabetes campaign that extends beyond parents to include vendors. and this is no different in developing countries. This study examines the transitions in the demographic characteristics of those with diabetes. Little information emerged in the literature on the changing faces of particular self-reported chronic diseases. Introduction Globally. chronic illnesses are the leading cause of mortality (60%) [1. Williams. Diabetes mellitus showed an exponential average annual increase of 185% compared to hypertension (+ 12. The prevalence of particular chronic diseases increased from 8 per 1.000 in 2007.3. and this is no different in developing countries.5 The changing faces of diabetes. Kerr-Campbell. hypertension and arthritis in a Caribbean population Paul A. and 41% less than 59 years. as we hypothesized that there are changing faces of those with these illnesses. Three percent of hypertensive respondents were 30 years and under as well as 2% of arthritics. The demographic transition in particular chronic conditions now demands that data collection on those illnesses be lowered to < 15 years.2%. particularly in the Caribbean [2-6].

Holder & Lewis [7] showed that hypertension and diabetes mellitus were among the 5 leading causes of mortality in the English-speaking Caribbean and Suriname.000). chronic non-communicable illnesses have arisen and are still lingering in spite of all the advances in science.e.countries such as those in the Caribbean [3]. The findings from Holder and Lewis indicated that mortality resulting from hypertension was highest in Dominica (over 90 per 100. Using data for 1989 and 1990. Morrison [8] titled an article ‗Diabetes and Hypertension: Twin Trouble‘ in which he established that diabetes mellitus and hypertension have now become two problems for Jamaicans and people in the wider Caribbean. 10].6% of hypertension were associated with senior citizens (i.8% of new cases of diabetes and 39. Bubonic Plague). The 20th century has brought with it massive changes in the typology of diseases. where deaths have shifted from infectious diseases such as tuberculosis. Black Death (i.000 of the population were the greatest in Trinidad and Tobago (over 85 per 100. Although diseases have moved from infectious to degenerate. In an article published by Caribbean Food and Nutrition Institute. pneumonia. ages 60 and over). Eldemire [11] found that 34. They found that there is a positive association between diabetic and hypertensive patients .e.000 of the population) and diabetes crude death rates per 100. smallpox and ‗diphtheria‘ to diseases such as cancer. 104 .50% of individuals with diabetes had a history of hypertension [9. the prevalence rate of diabetes mellitus affecting Jamaicans is noted to be higher than in North American and ―many European countries‖ [9]. yellow fever. Prior to those scholars‘ work. which was held in Jamaica in March 2000. This situation was corroborated by Callender [9] and Steingo at the 6th International Diabetes and Hypertension Conference. heart complaints and diabetes. medicine and technology.

African-Caribbeans. Of this figure 298 million of these persons will be in developing countries. Within the context of a strong association between poverty and chronic illness. hypertension and other chronic conditions in developing countries should not be surprising [16. 22%.5%) in 2030. Chronic diseases can be likened to a tsunami [19] in developing nations [20-22]. emphasizing the association between not only diabetes and poverty. A study in Barbados found that between 1988 and 1992 the prevalence rate of diabetes mellitus for the population was 17.8%) in 2000 to 366 million (6.5%. 33% [14]. The relationship between poverty and chronic conditions extends to premature mortality [17]. Van Agt et al.0% in white/other and 0. but chronic conditions and poverty. and particularly Jamaica. The 105 . Another research. The WHO [16] stated that 80% of chronic illnesses were in low and middle income countries. found that the prevalence among newly diagnosed diabetics in Europeans was 20%. and it seems to be spiralling because of the unhealthy lifestyle of people. 6.Chronic illnesses have been on the rise in the Caribbean. In a 1996 study conducted by Morrison and colleagues in Trinidad and Tobago [12]. Yach et al. [15] went further when they found that poverty was greater among the chronically ill. which offers an explanation of the face for those with these particular conditions. [18] further opined that the global figure for diabetes is projected to move from 171 million (2. with which a later study by the World Health Organization [16] concurred. Findings from the WHO [4] showed that 60% of global mortality is caused by chronic illness. 18].5% in mixed population (black/white). the high prevalence of diabetes mellitus. 21]. The tsunami of chronic illnesses in the developing countries is equally reflected in the Americas [20. in Europe.3% in the younger population [13]. and in Pakistanis. 12. they noted that there is an alarming rise in the prevalence rate of diabetes mellitus (15-18%). They also postulated that there is an association between poverty and diabetes. which reinforces the poverty-illness relationship.

The study will utilize three chronic diseases (i. hypertension. health insurance status. The present gap in the literature will be lowered by this study examining the faces of chronic illness from half a decade of data. health care utilization. chronic illness and other sociodemographic characteristics in order to ascertain the transition occurring in the population. as these go to the health status and mortality of a population [23. (2) rural residents. diabetes mellitus. A great deal of research exists on the management of chronic illnesses. the current paper will investigate the changing faces of chronic diseases in Jamaica. Hence information is available on one or a few of the aforementioned faces of chronic illness. and analyze health status. and arthritis). hypertension. The present subsample represents 0. 24]. and rightfully so.face of chronic illness in developing nations is therefore for (1) lower socioeconomic strata. and studies outside of this region have used a piecemeal approach to the investigation of chronic conditions. and some research has examined diabetes mellitus and hypertension but not arthritis. Only respondents who indicated that they were diagnosed with particular chronic conditions were used for this analysis (i. (3) adults. and (6) married people. hypertension and arthritis over the last half a decade (2000-2007). Materials and methods Data The current paper extracted a sample of 592 respondents from the 2002 and 2007 Jamaica Survey of Living Conditions (JSLC). We hypothesized that there are changing faces of those with diabetes. (5) lower educational level.8% of the 2002 national sample 106 . diabetes mellitus. (4) gender differences. and arthritis).e. Using data for 2002 and 2007.e. The profiles of those with chronic diseases have never been examined in Latin America and the Caribbean.

standard deviation.3% for 2002. Chi-square was used to examine the association between non-metric variables.783 non-institutionalized civilians living in Jamaica at the time of the survey. health status.(25. Chicago. demographic characteristics and other issues [25]. The information is from the civilian and noninstitutionalized population of Jamaica. The JSLC is an annual and nationally representative cross-sectional survey that collects information on consumption. independent sample t-test.8% and 72.0 (SPSS Inc. Statistical analysis Statistical analyses were performed using the Statistical Packages for the Social Sciences for Windows 16. 107 A self-administered . IL. The residents of a total of 620 households were interviewed from urban areas. health conditions. education. It is a modification of the World Bank‘s Living Standards Measurement Study (LSMS) household survey [26]. Over 1. The JSLC used complex sampling design. health care utilization.7% of the 2007 sample (6. health insurance coverage. Overall. the response rate for the 2007 JSLC was 73. housing conditions. and it is also weighted to reflect the population of Jamaica. and an Analysis of Variance was used to test the equality of means among non-dichotomous categorical variables.783). and analysis of variance f test. questionnaire was used to collect the data. Descriptive statistics such as mean. inventory of durable goods. non-food consumption expenditure. USA). frequency and percentage were used to analyze the socio-demographic characteristics of the sample. This sample represents 6. social assistance.05 using chi-square.994 households of individuals nationwide are included in the entire database of all ages [27].018) and 5. 439 from other towns and 935 from rural areas. Means and frequency distribution were considered significant at P < 0.

Furthermore.3 presents information on self-reported diagnosed particular chronic illness by sex of respondents for 2002 and 2007.7% in males. diabetes mellitus.7% and diabetes mellitus.2. Results Health care utilization. + 8. the annual increase in particular chronic illness in males was 19. + 10.2% between 2002 and 2007.7%. private health care centre.0% compared to 16.9% (public hospital. + 17. the average annual increase in health care utilization (visits to health care institutions) was 11. This shift could be attributed to cultural factors affecting how and what individuals eat in rural versus urban areas. + 185. private hospital.5% in females. On average the annual increase in health insurance coverage was + 148%. + 8. The findings in Table 5.2%.0%). Arthritis showed an average annual reduction of 3. while the health care utilization (health seekers) increased by 11. The particular chronic illnesses have shifted mostly from urban (67. This could be 108 . and sociodemographic characteristics are presented in Table 5.9%) compared to an increase in males (average annual 10.1%).0%) compared to 9. hypertension.1%).4%).e. The sedentary lifestyles of urban areas also added to the overall dramatic increase in chronic illnesses. Diabetes mellitus showed the highest annual percentage increase (males 186. On average. Hypertension increased more in females (average annual 14.0%.Measures Table 5.4%.8%. health insurance status. Table 5. public health care centre.7%.6%) to rural residents (55.1 presents the operational definitions of some of the variables used in this study. + 12.7% and females 184.2 showed that the average annual increase in the particular chronic illness was 17. while arthritis fell in females (average annual 7. particular chronic illness (i. hypertension and arthritis).

9% for those in the lower strata compared to 11.4 examines information on health coverage.0% for those in the middle class and 16. law. the highest average annual increase in hypertension occurred in the lower socioeconomic group (26. A more detailed analysis of their diet and lifestyle is needed to ascertain the real causes for the drastic increase relative to other socioeconomic groups.4%) and upper socioeconomic strata (7. uninsured. health status. The massive increase in cases of diabetes within the upper class is clearly not due to the lack of resources for seeking health care. and the police force. However. Table 5.attributed to the increasing absorption of females into the upper echelons of management in stressful occupations such as banking and finance.7%). although particular chronic illnesses have decreased in rural respondents. the greatest increase occurred in diabetics belonging to the upper class (average annual + 200%) compared to those lower class (116. there is a change in the face of particular chronic ailments in Jamaica. health care utilization and some sociodemographic characteristics by self-reported diagnosed particular chronic illnesses for 2002 and 2007.5 presents information on the age of respondents and particular self-reported chronic conditions for 2002 and 2007. Table 5. 109 . On the other hand. rural dwellers continue to be the face of chronic conditions as well as married. Based on this information. private health centres and those in the lower class. The face is changing to reflect the inclusion of those less than 30 years of age (including children) as distinct from the elderly population.9%) as compared to those in the middle class (7. The average annual increase in particular chronic illnesses increased by 22. Based on Table 5.4. primary.0% for those in the wealthy socioeconomic strata.1%).

8%). the prevalence of health insurance coverage on average saw an exponential annual increase of 148%. This reality supports the large reservoir of literature on elderly diabetic. while health care seeking behaviour over the same period showed a marginal increase of 12%. and (4) lower socioeconomic strata to upper class. hypertension was greatest among those in the lower class and those in the upper class had the greatest reduction in arthritic cases. However when the particular chronic ailments were disaggregated.2%.e. The transitions of particular chronic conditions are accounted for by (1) urban-to-rural shift. the findings indicated that those in the wealthy socioeconomic group had the largest prevalence increase in diabetes mellitus. Traditionally chronic conditions such as diabetes mellitus were mostly prevalent among the elderly. diabetes mellitus. hypertensive 110 . The average annual increase in particular chronic diseases was greatest among those in the lower socioeconomic groups.000 in 2002 to 56 per 1. Similarly.000 in 2007. There is an emerging body of literature to support the changing face of people with particular chronic diseases from old ages (30+ years) to younger people including children [2832].7%) and arthritis (.Discussion The present study revealed that the prevalence of particular chronic diseases (i. diabetes mellitus showed the greatest annual increase.3. While hypertension remained the most prevalent of the particular chronic diseases in this study. hypertension and arthritis) increased from 8 per 1. Diabetes mellitus showed an exponential average annual increase of 185% compared to hypertension (+ 12. (3) aged-to-young people. (2) female-to-male. Particularly of note is the switching from public health care utilization by particular chronically ill respondents to private health care utilization. The average annual increase of particular chronic illnesses was 17.

but no children had hypertension or arthritis. (2) diet [35] and the environment [30]. Two percent of diabetic respondents were less than 15 years of age. With the emergence of epidemiological and population transition. This hooked-on-egame syndrome 111 . hypertension and arthritis) are found mostly among the elderly (60+ years). Because lifestyle practices were mostly responsible for chronic illness. The present paper supports the literature that particular self-reported chronic diseases (such as diabetes. This is somewhat deceptive as 41% of those with diabetes were less than 60 years of age. The findings revealed that the mean ages of those with the specific self-reported chronic ailments have fallen marginally in Jamaica over the period (2002-2007). 23. many researchers limited their investigation to people 30+ years old [8-11. compared to 40% of those with hypertension and 31% of arthritic respondents. as almost 2% of cases were among people ages 15-30 years of age.and arthritic patients. Another emerging face of particular self-reported chronic illness is that of those with arthritis. This is evidence that self-reported particular chronic diseases are changing face as almost 5% of diabetics were less than 31 years old in 2007 compared to 0% in 2002. Similarly. increases were observed in diabetes and arthritis for the young adult (diabetics aged 15 – 30 years) for the period. The young face of those with diabetes and other chronic diseases can be accounted for by (1) maternal nutrition during pregnancy [31]. much attention was placed on diseases in middle and later ages as well as those conditions that accounted for most of the mortality and morbidity in a population. The sedentary lifestyles of the youth in the population are further entrenched by the modern electronic games which have removed the young person from the playing field and see him spending longer periods on the couch in front of the television. 33 and 34].

[37]. and medical practitioners understanding that testing for diabetes. hypertension and arthritis must be a rudimentary part of medical examinations. health care practitioners. policy makers and the general society need to be cognizant of these facts.has also resulted in the increased consumption of sweet snacks and other so-called junk food. and in particular the statistical agency. the emergence of those conditions requires researchers. demographers. The emerging young face of diabetics. they used teens of 15+ years to present information on those with particular diseases. place of reference. and children about the current reality of children and young adults being diagnosed with particular chronic illnesses. even of children. In a recently conducted study by Wilks et al. epidemiologists and policy makers to embark on the inclusion of data on those conditions in publications in order that they can be examined. parents. The new face of those with particular chronic diseases is changing. and hypertensive and arthritis patients requires a new thrust in the study of mortality and morbidity data for health planning. There is an urgent rationale for an intervention campaign that will sensitize educators. publishing findings on the new reality in order to commence the discourse and 112 . chronic disease management. even if their parents are not experiencing those conditions. nutrition. The intervention programme that should be formulated must include signs of ailments. Although diabetes. but neglected to mention the new reality of children of younger ages with particular chronic illnesses. hypertension and arthritis may not be among the 10 leading causes of mortality in Jamaica [36] or the developing society. This means that policy makers. educators and the wider community need to recognize that chronic conditions such as diabetes. and further. hypertension and arthritis have begun manifesting in young people as well as children. and this reality is therefore a cause for public health concern. This will be accommodated by researchers. medical practitioners. The new reality means that researchers.

On disaggregating the particular chronic diseases. while more hypertensive and arthritic respondents were in the lower socioeconomic group. and particularly poverty and chronic illness [15]. Fifty-four out of every 100 persons with particular chronic diseases (i. With the absence of information on the matter. However. this can be construed as a miniscule problem. but this study found that more people in the wealthy class had diabetes.‘s research. 16 and 22]. Despite the majority of those with particular chronic illnesses having hypertension.8% of infected children or 2.intervention campaign. Although the prevalence rate of particular chronic illnesses was greater among the wealthy strata for 2002 and 2007. diabetes. and the opposite was noted for hypertension and arthritis. the new findings are reflecting the early onset of diabetes (< 15 years) and the provision of data beginning at 15 years omits 0.4% of diabetics. the present paper showed that the prevalence of diabetes was greater among the upper than the lower class. those in the lower socioeconomic group recorded the greatest average annual percentage change. Many studies have established a relationship between poverty and illness [1. 2.‘s research. Van et al.‘s work [15] revealed that chronic diseases were greater among those in the lower socioeconomic strata than the other social classes. The current findings are providing some clarification for Van et al. the prevalence rate for those with diabetes increased exponentially more than the other conditions. This finding does not only clarify Van et al. but provides pertinent information on the unhealthy lifestyle practices among 113 . The present paper unearths more information on the new faces of those with particular chronic conditions at younger ages. hypertension and arthritis) had hypertension. 32 out of every 100 had diabetes and 15 out of every 100 had arthritis.e.

The very reason that health is non-transferable is the rationale behind the mortality of the wealthy elderly. safe drinking water. medical facilities. resources and privileges that are not available to the poor. heart disease. While those matters provide a virtual door leading to better health. money enhances the scope of better health. and reinforces the role of material deprivation on health. A study by Wilks et al. leisure and good physical milieu. Two scholars opined that money can buy health [38]. The wealthy will continue to live by their desires. Socioeconomic status was found to be the strongest determinant of variations in health [39. opportunities. Clearly Smith and Kington‘s claim [38] can be refuted as 42 out of every 100 chronically ill respondents were in the upper class. proper sanitation. health conditions and mortality. as wealth allows for particular choices. and morbidity among the upper class. [37] found that most (71%) of 114 . nutrition. but the reality is that whenever unhealthy lifestyle practices become the choice of an individual. and at the onset of chronic ailments.the wealthy. but it cannot buy good health as this is not transferable from one person to the next. money or wealth does not reduce the risk of ill-health arising from poor choices. one of the key axioms that needs to be looked at is the health conditions being lower among the wealthy than those in the lower class. and more than half of those with diabetes were part of the wealthy income group. For any postulation to hold true about money purchasing health. hypertension. his/her money will not be able to eradicate the onset of diabetes. and that unhealthy lifestyle practices by the wealthy can be reversed with money. implying that health is a transferable commodity. It is well established that income is positively correlated with health. Therefore. as money affords a particular diet. access. 40]. may be able to reverse this by medical expenditure. or other chronic diseases.

6% of the population. 8. The carbonated soft drink industry is experiencing a boom in the USA and the Caribbean [41.7% of males) behind hypertension (20. [37] found that 73% of Jamaicans aged 15 to 74 years practice a sedentary lifestyle. Wilks et al.those in the upper socioeconomic strata currently use alcohol which is more than those in the lower class (59%) and the middle class (64%). unhealthy lifestyle choices cannot be reversed with money. requires urgent policy and public health intervention. over 50% of men and 33. and although the association between income and health is well established. 42]. According to Bostrom and Eliasson [44]. The carbonated soft drink industry has infiltrated the consumption intake of young adults and children. Twice as many people in the upper class (14%) had heart attacks compared to those in the middle class (7%) and 6% in the lower class [37].2%) and diabetes mellitus (7. Another study showed that among children aged 6 to 19 years there was a positive significant statistical association with soft drink consumption and a negative one with milk intake [43]. This explosion in carbonated soft drinks means that added sugar is infesting the dietary intake of young people and children more than in previous decades. They accounted for 39. and obesity was the third most popular disease (5.3% of women between the ages of 16 and 74 years in Sweden are overweight and obese. Recently. The growing global tsunami of chronic diseases in developing countries.1% of total beverage consumption. salted food and fast food are accounting for the overweight and obesity in the world. and in particular Jamaica. [41] found that carbonated soft drinks and milk were the two most popular non-alcoholic beverages in the USA. Sugar in the form of 115 .6%). A sedentary lifestyle along with the consumption of sugar. The evidence is in that concretizes and refutes the proposition that ‗money can buy health‘.5% of females and 2. research conducted by Ha et al.

hypertension and arthritis) in Jamaica. et cetera) is sold in every shop and supermarket. protein. With the exponential increase in diabetes over the last 5 years in Jamaica. legumes. With 2 out of every 100 diabetics being children 116 . 47].e. fruits and fibre. nuts. candies. with the increase in carbonated soft drinks. This is not just affecting countries in the Americas. and may no longer be an epidemic but a pandemic disease. Embedded in the increase in diabetes in children and young adults in Jamaica are parents‘ and children‘s nutritional intake (or lack thereof). diabetes. and at school gates in Jamaica. as was the case a generation ago. as it is now being diagnosed in children in Jamaica and other countries [48.sweets (lollipops. The WHO contextualized the global public health Type 2 Diabetes epidemic when it stated that during 1999-2025 the prevalence of this ailment will be 40% in the developed nations and 170% in the developing countries. beans. coupled with the sales explosion of the carbonated soft drink industry and the increase in fast food outlets. Type 2 diabetes is no longer an ―adult‖ or ―later life‖ disease. the diabetes epidemic of Jamaica may become a reality across the Americas. This extends beyond Jamaica to Barbados [44] and the USA [41]. as studies have shown that Type 2 diabetes has become a global public health problem [46. 49]. As is clearfrom the literature. Children and young adults are fed a diet of more sugar than vegetables. Jamaica is experiencing a diabetes epidemic which cannot be resolved without government and policy interventions. reduction in milk intake and influx of fast food entities in the Americas. This study highlights the changing image of those with particular chronic diseases (i. diary products. and the increase in unhealthy lifestyle practices of the people. as the dietary habits of Jamaicans have changed to include more fast foods and less nutrient dense diets. Clearly this paper is showing that diabetes has now reached an epidemic state in Jamaica.

The demographic transition. children and other young adults. the present research highlights significant public health problems. which requires public health intervention as well as lifestyle management of diabetes.(< 15 years) and the new image of hypertensive and arthritic patients being 15 – 30 years. This is an obvious problem. in particular chronic conditions. now demands that data collection on those illnesses be lowered to < 15 years. The cost of public health care in the next 5-10 years will increase phenomenally. Forty-seven out of every 100 chronically ill people in Jamaica utilize public health care facilities. but the average annual increase in diabetes mellitus was 200% for those in the wealthy class. The image of particular chronic illness in Jamaica continues to be lower class female and rural residents. This has serious implications for the sustainable development of developing countries as well as their future achievements regarding the United Nations Millennium developments goals. To act now will not only save lives but will also save the various developing countries billions of dollars that can be spent on other development programmes. plus the exponential increase in diabetes in the wealthy class. public health specialists need to address the massive changes in new diabetic cases. In the last half a decade (2002-2007). This sensitization and lifestyle management campaign must 117 . which denotes that the matter is a public one and not solely individual. compared to 117% of those in the lower socioeconomic class. Apart from the lowering of the ages in the data collection process. the average annual increase in diabetes mellitus has risen by 185% indicating the unhealthy lifestyle practices of pregnant women. as greater proportions of the population who rely on the public health care system will be afflicted with these chronic diseases.

extend to include educators. Conclusion In summary. Currently. and institution guidelines about the sugar and salt components of manufactured commodities. this research highlights the urgent need for a diabetes campaign that extends beyond parents to include vendors. soft drink manufacturers and government. (3) lower production cost. confectionary and fast food) as this is contributing to a public health problem which will cost the government and people in the medium to long-term. the theoretical position that underlines testing for diabetes among other chronic diseases should be abandoned. as the findings show the need to begin rudimentary health examinations of all ages. (5) the imputed cost of ignorance. (2) increasing cost of diabetic care and management. The wider confectionary and food industry cannot be left unregulated as the chronic diseases tsunami is upon us. there is a lifestyle campaign dealing with sexual behaviour. in order to sensitize the public about this new public health problem. (4) increased unemployment benefits. Governments need to regulate the sugar content of products in Jamaica (carbonated soft drinks. and (6) an increased mortality rate. The new thrust of governments. vendors (especially those at schools). The gravity of the situation is that such a programme cannot be delayed for some time in the future as the opportunity costs of delay are (1) higher public expenditure. and the government. Diabetes can be likened to a tsunami in Jamaica and one that demands government intervention. and cancer in Jamaica. and it will require a concerted effort from everyone to combat this public health 118 . children. condom usage. public health specialists and researchers is to commence a mandate that addresses confectionary products‘ ingredients. confectionaries. parents.

Conflict of interest The authors have no conflict of interest to report. none of the errors in this paper should be ascribed to the Planning Institute of Jamaica or the Statistical Institute of Jamaica.problem as the nation addresses the diabetes epidemic. 119 . Diabetes has risen to such epidemic proportions that it now requires a policy initiative aimed at reducing the level of increases in a managed way. Disclaimer The researchers would like to note that while this study used secondary data from the Jamaica Survey of Living Conditions. but to the researchers.

Callender J. North Am J Med Sci. promoting healthy life. 2002. Lewis. Hennis A. Geneva: World Health Organization. including Europeans. 33: 67-70. Nemesure B. 2009. Kingston: Planning Institute of Jamaica. Wu Suh-Yuh. 50 (Suppl 4):15-22. World Health Organization. Riste L. Int J Epidemiol. J 2001. Steingo B. 120 . Smith-Richardson S. 33: 61-63. Bourne PA. Holder Y. World Health Organization. Eldemire S. McGlashen ND. Fletcher C. 16: 212-22. 1. editor. MJ. Causes of death in ten English-speaking Caribbean countries and territories. Health conditions in the Caribbean. Significant progress and a vision for the 21st century. 7. 25:357-65. Health status of patients with self-reported chronic diseases in Jamaica. Cruickshank K. Cajanus 2000. 5. 6. 80: 1996-2001. 1: 356-364. 1995. Thompson H. physical activity and health. The World Health report 2002: reducing risks. 1982. A situational analysis of the Jamaican elderly. Diet. Khan F. 12. 2002. Diabetes and hypertension: twin trouble. 1996. 13. 1992. 31: 234239. High prevalence of Type 2 diabetes in all ethnic groups. Bull Pan Am Health Organ. Guilliford MC. Phasic insulin dependent diabetes mellitus: manifestations and cellular mechanisms. Morrison EY. in a British Inner City. J Clin Endo & Metabl. 24: 1377-1383. Morrison E. Cajanus 2000. 3. Lifestyle management in the hypertensive diabetic. Epidemiological overview of morbidity and mortality. Int J of Epidemiol. 9. Cajanus 2000. 33: 70-76 10. In: PanAmerican Health Organization. Epidemiological transition in Trinidad and Tobago. Ragoobirsingh D. 8. 1995. McFarlane S. Diabetes Care 2001. 2002.References 65. p. 2. 4. 1997. Health trends in Jamaica. Figueroa JP. Leske MC. Geneva: World Health Organization. West Indian Med. 11. Li Xiaowei. et al. West Indies 19531992. Neurological consequences of diabetes and hypertension. 22-45. Washington: PAHO. McGrowder DA. Diabetes in a Caribbean population: epidemiological profile and implications.

Douglas KA. 23. Major public health problems – diabetes. 17: 130-141. 1988-2000: basic information [Internet]. Zevallos JC. 2005. West Indian Med J. Gould CL. Bostrom G. Gonzales F. Stronks K. Van Agt HME. World Bank. Kingston: PIOJ. Jamaica survey of living conditions. Foster AD. Washington: The World Bank. 26. Statistical Institute Of Jamaica. the Am Economic Review 1994. [Unpublished manuscript]. Bonita R. Hawkes C. Preventing chronic diseases a vital investment. Sue-Ho R. 19. Huicho L.worldbank. Jamaica survey of living conditions. Statistical Institute of Jamaica. [cited 2009 Sept 2]. 291: 2616-2622.org/INTLSMS/Resources/33589861181743055198/3877319-1190214215722/binfo2000. Enhancing regional capacity in chronic disease surveillance in the Americas. 25. 216-220. The global burden of chronic diseases: overcoming impediments to prevention and control. 49: 262-265. Jamaica Survey of living conditions. 20. Kingston. 2001. 24. 84 (2): pp. Eur J of Public Health 2000. 9: 47. 2002. 10: 197-200. Choi BC. Poverty and illness in low-income rural areas. 2008. 44: 171175. Mendoza W. 16. Hofman. Catford J. PNG Med J. Rev Panam Salud Publica.14. World Health Organization. Diabetes and hypertension in the Americas. McQueen DV. Corber SJ. Geneva: WHO. Planning Institute of Jamaica.pdf). Yach D. Chronic illness and poverty in the Netherlands. Swaby S. KJ. Wilson E. 1989-2007. 121 . 21. Mackenbach JP. 2007. Mortality profile in a country facing epidemiological transition: an analysis of registered data. STATIN. JAMA 2004. Eliasson M. Available from: http://siteresources. Trelles M. Chronic disease: preventing the world‘s next tidal wave – the challenge for Canada 2007? Health Promotion International 2007: 22:1-3. 2005. 34(Suppl 67): 59-68. 18. Pierre R. Chronic diseases management in Jamaican setting: HOPE worldwide Jamaica‘s experience. 15. Miranda J. 2000. 22. Barcelo A. Swaby P. Scandinavian J of Public Health 2006. BMC Public Health 2009. 17. Jamaica: Statistical Institute of Jamaica.

2009. Socioeconomic inequalities in health: no easy solution. Demographic statistics. Hagley KE. 1999. Nutrition Journal 2007. Struben HWA. University of the West Indies. 2009. Girls at five are intrinsically more insulin resistant than boys: the programming hypotheses revisited – the early bird study (Early Bird 6). 36. 269: 3140-3145. 30. Voss LD. Kington R. JAMA 1993. physical activity. Barreto SM. Fogel RW. Caine-Bish N.27. Lowry-Gordon K. Adler NE. Chronic diseases. Kingston: Tropical Medicine Research Institute. Diet. Ha E-J. Boyce T. 32. 33. 28. 1995. Changes in the disparities in chronic diseases during the course of the 20th century. 34. Francis D: Jamaica health and lifestyle survey 2007-8. In: Morgan O. Rev Saude Publica. 39. 2007. 34: 779-782. Evaluation of effectiveness of class-based nutrition intervention on changes in soft drink and milk consumption among young adults. 6: 1. 34: 477-483. Chesney MA. Kingston: Ian Randle. School-age children with diabetes: role of maternal self-efficacy. Mona. Kirby J. Health issues in the Caribbean. The Diabetes Educator 2008. Ozanne SE. p. self-perceived health status and health risk behaviors: gender differences. Biochemical Society Transactions 2006. Kesarlal-Sadhoeram SM. Kingston: STATIN. Pediatrics 2004. Anand SS. 113: 82-86. Folkman S. US socioeconomic and racial differences in health. environment. Smith JP. and adiposity in children in poor and rich neighbourhoods: a cross-sectional comparison. Demography 1997. Syme SL. 35. Demographic and economic correlates of health in old age. McFarlane S. 28: 1119-1123. editor. Diabetes mellitus among South Asian inhabitants of The Hague: high prevalence and age-specific socioeconomic gradient. Collins C. 8: 50. Jeffery AN. Maternal nutrition during pregnancy and health of the offspring. 21: 349-386. 115-121. Wilks R. 2005. Middelkoop B JC. Williams DR. 40. 43: 1-9. Merchant AT. 2008. Statistical Institute of Jamaica. Marvicsin D. Nutrition J. Younger N. 122 . 37. Murphy MJ. Int J of Epidemiol. and management behaviors. Martin-Gronert MS. Figueirredo RC. 34: 159-170. Behnke-Cook D. Metcalf BS. Annu Rev Sociol. 38. Holloman C. 48: S150-S165. Mallam KM et al. Perspectives in Biology and Medicine 2005. 31. Dehghan M. 29. Tulloch-Reid M. Ramsaransing GN. Diabetes mellitus – the deluge. 2008.

Type 2 diabetes among North American children and adolescents: an epidemiological review and a public health perspective. Harris R. PAHO Journal 2004. 136: 11-16. 48. Eliasson M. J Intern Med. 2000. World Health Organization. Scandinavian J of Public Health 2006. 21: 150-158. Fagot-Campagna A. Jacoby E. Zimmet P. 2000. Diabetes Care 2000. 45. coca-colonization and the chronic disease epidemic: can the doomsday scenario be averted. Globalization. 123 . Forshee RA. 34 (Suppl 67): 69-77. Bostrom G. 23: 381-389. 54: 297-307. Hennis AJM. Leske MC. J Pediatr. Int J Food Sci Nutr. Total beverage consumption and beverage choices among children and adolescents. American Diabetes Association. J Hum Nutr Diet 2008. Pettitt DJ. 43. 46. Obesity: preventing and managing the global epidemic.41. Geneva: WHO. Assessing dietary patterns in Barbados highlights the need for nutritional intervention to reduce risk of chronic disease. 47. 44. et al. Type 2 diabetes in children and adolescents. 2003. Major public health problems – overweight and obesity. 247: 301-310. Sharma S. 42. MM. 1998. Cao X. Wu S. Storey ML. The obesity epidemic in the Americas: making healthy choices the easiest choices. Engelgau. 15: 278-84.

This is taken from the question ‗What are the illnesses that you have been diagnosed with – Cold. diabetes mellitus. arthritis. diarrhoea. poor or very poor?‖ Being male or female Age group is classified into 4 categories.ages < 15 years old Young adults . medical practitioners. asthma.15 to 30 years old Other age adults – 31.1: Operational definitions of particular variables Variable Self-evaluated health status (or health status) Sex Age group Operational definition Coding This is taken from the question ―In general. asthma. middle = middle quintile and upper = wealthy to wealthiest 20% 1 = visits to health care professionals. would you say your health is excellent. hypertension. moderate. have you had a cold. diabetes. do not resolved spontaneously. other chronic conditions (unspecified)? The chronic conditions were diabetes mellitus. nurses in the last 4-weeks Have you had any illness or injury during the past four weeks? For example.Table 5. hypertension and arthritis. 0=otherwise Social hierarchy Health careseeking behaviour (health seeking behaviour) Self-reported illness Chronic illness Income quintiles were used to measure social class. and these range from quintile 1 (poorest 20%) to 5 (wealthiest 20%) Visits to pharmacies. arthritis or other? These can be broadly defined as conditions which prolonged. good. hypertension. and are infrequently curable.59 years old Young old – 60 – 74 years old Old old – 75 – 84 years old Oldest old – 85+ years old Low = poorest 20% to poor. Children . diarrhoea. 124 .

9 Arthritis 69 33.0 Female 149 72.6 42.0 Young adults 2 1.8 Age cohort Children 0 0.Table 5.2 Health care utilization Public hospital 51 28.4 32.6 44.3 55.6 35.9 19.9 Health insurance status Insured 15 7.6 16.0 Poor 40 19.7 20.6 Semi-urban 43 20.8 Hypertension 126 60.7 20.1 3.2 0.9 53.5 29.7 Young-old 90 43.7 Wealthy 39 18.7 Income quintile Poorest 20% 29 14.8 Wealthiest 20% 50 24.0 Other age adults 49 23.5 14.5 Old-old 58 28.6 32.1 Never married 50 24.7 67.2 Uninsured 192 92.5 Separated 3 1.8 2.0 Marital status Married 95 46. Demographic characteristic of sample.9 Area of residence Urban 24 11.0 Oldest-old 8 3.3 25.6 16.2 21.3 Private health centre 68 38.7 2.8 67.6 125 2007 n 123 206 56 113 272 163 130 14 10 64 83 65 76 79 82 72 23 61 126 258 125 126 258 3 10 137 132 82 21 95 78 212 % 31. 2002 and 2007 2002 Characteristic n % Chronic illness Diabetes mellitus 12 5.3 21.4 Health care utilization Sought medical care 163 79.3 Sex Male 58 28.3 Divorced 1 0.5 Public health centre 43 24.8 34.2.5 8.5 21.5 24.8 Rural 140 67.1 Did not seek care 43 20.5 Widowed 57 27.1 .3 Middle 49 23.4 70.3 5.6 34.8 21.8 Private hospital 15 8.

2002 and 2007 20021 20072 Characteristic Sex of respondents Sex of respondents Male Female Male Female n (%) n (%) n (%) n (%) Chronic illness Diabetes mellitus 3 (5.3) 148(54. P = 0.8) 58 149 113 272 1 2 χ = 1.048 126 .2) 32 (11.2) 9 (6.4) Arthritis 16 (27.7) 92 (33.6) 53 (35.39.0) 31 (24.499 2 2 χ = 6. P = 0.3.8) Hypertension 39 (67.6) 24 (21.09. Self-reported diagnosed chronic illness by sex of respondents.2) 87 (58.4) 58 (51.Table 5.

0) 35 (27.5)† Insured 1 (8.4) Fair NI NI NI 67 (54.3) 47 (38.0) 31 (29.6) 32 (26.6) 5 (6.1) 52 (25.9) 0 (0.9)† 58 (28.9) Never married 4 (33. 2002 and 2007 2002 2007 Chronic illness Chronic illness Characteristic Diabetes Hypertension Arthritis Diabetes Hypertension Arthritis mellitus mellitus n (%) n (%) n (%) n (%) n (%) n (%) Area of residence Urban 1 (8.0) 91 (44.8) 37 (18.1) 48 (40.8) 14 (20.0) 20 (27.05) 127 .6) 61 (44.6) Semi-urban 1 (8.4) 24 (42.6) 1 (1.3)† 82 (39.5) 24 (35.8) 43 (63.2) 25 (44.8) Widowed 4 (33.0) 13 (18.3) 29 (23.5) 0 (0.1) 48 (69.0) 118 (57.0) 56 (44.1) 45 (21.6) 16 (23.8) 27 (22.6) 64 (52.9) Rural 10 (83.0) NI – No information † Significant (P < 0.0) 44 (41.9) 32 (43.8)† 41 (74.0) Tertiary 0 (0.4: Particular demographic and health variable by diagnosed chronic illness.2) 34 (27.9) 8 (11.0) 9 (8.0) 1 (0.0) 8 (14.8) 16 (28.3)† 12 (21.7) 114 (90.8) 89 (72.5) 4 (3.3) 15 (11.5) 12 (38.9) 54 (43.3) 12 (9.3) 61 (48.4) 205 (99.1)† 148 (71.Table 5.8) 12 (21.1) 10 (4.2) 121 (98.0) 21 (20.0) Health coverage Uninsured 11 (91.2) 5 (16.0) 2 (1.6) 0 (0.8) 11 (13.0) 0 (0.4) 30 (44.0) 41 (19.4) 1 (1.9) Private centre 4 (40.3) 8 (3.3) 82 (65.7)† 76 (36.3) 3 (1.3) 5 (2.0) 35 (27.3) Divorced 0 (0.2) 21 (25.4) 27 (39.4)† 140 (68.6) 1 (1.8) 16 (23.9) 10(17.5) 56 (100.0)† 27 (48.7) Health seekers Did not 1 (9.3) 30 (23.0) Secondary 4 (33.5) 17 (23.2) 20 (29.3) Health utilization Public hospital 3 (30.6) 41 (33.8)† Education Primary 8 (66.0) 47 (22.0) 23 (28.1) Very poor NI NI NI 4 (3.4)† Upper 6 (50.6) Marital status Married 4 (33.0) 2 (1.1) Public centre 2 (20.0)† 48 (23.4) 7 (5.9)† 19 (33.8)† 25 (44.8) Good NI NI NI 21 (17.4) 19 (15.1) 34 (24.2)† 14 (25.5) 10 (8.2) 18 (32.9) 100 (79.9)† Health status Very good NI NI NI 5 (4.3) 16 (13.8) Separated 0 (0.0) 1 (1.3) Private hospital 1 (10.9) 1 (1.3) 30 (53.6) Poor NI NI NI 26 (21.0) 0 (0.4) 33 (26.6)† Middle 0 (0.3) 2 (1.6)† 66 (32.8) 4 (12.7) 22 (39.5) 10 (32.5)† Social class Lower 6 (50.5) 39 (32.0)† 29 (51.0) 27 (32.1) 26 (20.5) 69 (33.4) 53 (76.5) 1 (1.8) 28 (40.1) 66 (53.2)† Sought 10 (90.1) 69 (56.9) 35 (25.5) 91 (44.5) 2 (2.5) 67 (97.5) 0 (0.7) 73 (59.

8) 64.3 (12.4) 24 (34.1 67.4) 5 (4.05) 128 .0) 0 (0.9) 49 (39.6) (11. 2002 and 2007 2002 2007 Chronic illness Chronic illness Characteristic Diabetes Hypertension Arthritis Diabetes Hypertension Arthritis mellitus mellitus n (%) n (%) n (%) n (%) n (%) n (%) Age cohort Children 0 (0.6) 22 (39.9 62.8) 76 (36.4 60.8) 68.3) Old-old 2 (16.8) 61 (29.9) 17 (30.8) 44 (35.8) 2 (3.2 (12.8) 19 (15.5 (16.6) 1 (1.9) 31 (44.Table 5.0) Oldest-old 0 (0.8) Other age adult 5 (41.5.4) 0 (0.6) 13 (18.7) 54 (42. Age of respondent by particular chronic illness.1) 14 (6.0) (14.6) 0 (0.0) Young adult 0 (0.4) 6 (2.9) 1 (1.8) 14 (25.5) (16.7) 32 (25.0) 3 (2.0) 2 (1.0) 7 (5.0) 0 (0.4) Young-old 5 (41.7) 31 (24.0) 3 (2.0) 0 (0.4) 49 (23.5) † Significant (P < 0.6) Age Mean (SD) 62.

diabetes mellitus (7.e. injuries and impact of injuries on health [1-7]. teenage pregnancy. Nine social determinants and biological condition explained 19. The biological condition accounted for 78. Introduction Gender differences in self-assessed health in young adults (i. (3) identify social determinants that explain good health status for young adults. HIV/AIDS. The aims of the current research are to (1) provide demographic characteristics of young adults. Injury accounts for a miniscule percentage of illness and so using it to formulate intervention policies would lack depth to effectively address health of this cohort. One percent of sample claimed injury and 8% illness.1%).e.2% of the variability of self-assessed health.8%). arthritis (2. substance use and abuse. The mean length of illness was 26.9. ages 15 – 44 years) are understudied in the English-speaking Caribbean.0 days (SD = 98.6 Self-assessed health of young adults in an English-speaking Caribbean nation Paul Andrew Bourne & Christopher A. and (5) gender differences in self-assessed health. Previous studies that have examined young adults have focused on reproductive health. (4) determine the magnitude of each social determinant.1% of the explanatory model. hypertension (7.2%). Self-reported diagnosed illnesses were influenza (12. While studies on injuries have shown 129 . Charles Gender differences in self-assessed health in young adults (i. diarrhoea (2.8%). survivability. (2) examine self-assessed health of young adults. ages 15 – 44 years) are understudied in the English-speaking Caribbean.9%). respiratory disease (14.7%).9%) and unspecified conditions (41.D.

130 . statistics [8] revealed that many of the deaths occurred in this age group can be accounted for by injuries. reproductive health. In 2004. A study by Hambleton et al. survivability and mortalities. Injuries accounted for most morbidities and/or mortalities in the world [7]. using general health status and health conditions would provide invaluable insights from the individual‘s perspective on those issues. statistics from the Jamaica Ministry of Health [9] indicated that injuries was not among the 5 leading cases of hospital utilisation in Jamaica. injuries or crime. mortality. which would add value to addressing health concerns that waiting for particular outcomes such as pregnancies. 7]. but more so from data on injuries. making studies on injuries germane but lacks extensive coverage on health. Policy intervention on those issues are pertinent and cannot be neglected from the general pursuit of health. Policies therefore in Jamaica would not have been formulated using general health status research. the research identified other factors (i. violence and victimization by young adults. Injuries are among reasons for ill-health and by extension do not constitute a significant percentage of illness.that young males 15 to 44 years are mostly affected by violent-injuries [6. Statistics on Jamaica showed that of the 10 leading causes of mortality. [12] identified that illness constituted significant percentage of the explanatory power of self-assessed health of older Barbadians (ages 60+ years) and while this provides some understanding of the role of illness on general health status of which may be caused by injuries. homicides and injuries were the 5th and 10th causes of deaths respectively [10]. but this is not typical to Jamaica. in 2002 [8-10].e. in Jamaica. statistics from the World Health Organization (WHO) showed that injuries were the 4th leading cause of morality in Jamaica [11] and in 2006. social determinants) that played roles in health status determination.

and victim prolife of individuals in Jamaica for 2005. Age 15 – 45 years does not only represent most of the victims of crime. (3) identify social determinants that 131 . which indicates that health care utilisation and victims of crimes are substantially between 14 and 45 years. Empirical literature showed that any study of health must coalesce biological and social determinants [13. Recently a study by Bourne [26] provided invaluable insights into the typology of health conditions and the demographic shifts in these between 2002 and 2007. mortality and hospital utilization in Jamaica. Tables 1-3 highlight hospital utilisation for gunshot wounds and suicides. In addition what about their general health as well as those members of this age group who are not likely victims owing to other social conditions such as social hierarchy. indicating that a study of their typologies is imperative but this cannot abate or replace a study on general health of young adults. The data highlights the crime and hospital utilisation profile. area of residence or those who do not reside in inner-cities communities. An extensive reveal of health literature in the English-speaking Caribbean nations found a lack of studies on the general health status of young adults. It is within this context that the current paper chose to examine selfreported health of this group in order to provide insights into the health of young adults and the social determinants that explain their health status. but what about those persons of this group who are alive and fear being a victim of violence as well as those who reside in those communities in which such incidences are perpetuated each day. The aims of the current research are to (1) provide demographic characteristics of young adults. it also denotes the group which constitutes arrest for major crimes. (2) examine self-assessed health of young adults. which is also lacking for young adults.25]. Some of the issues are social and do affect mortality.Injuries therefore do account for a percentage of ill-health.

132 .e. housing conditions. data collection and policy guidelines for Jamaica. education. The current paper extracted a sub-sample of 3. daily expenses.explain good health status for young adults. where 1 (good health) = not reporting an ailment or dysfunction or illness in the last 4 weeks.024 respondents (i. This study used the dataset of the JSLC for 2007 [29]. non-food consumption expenditure. health. The survey is conducted between April and July annually. Self-reported is a dummy variable. ages15 44 years) from a larger nationally cross-sectional survey of 6. The JSLC is an administered questionnaire where respondents are asked to recall detailed information on particular activities. These two organizations are responsible for planning.782 Jamaicans. and have been conducting the JSLC annually since 1989 [28]. Measures An explanation of some of the variables in the model is provided here. as JSLC is more focused on policy impacts. Materials and Methods The Jamaica Survey of Living Conditions (JSLC) was commissioned by the Planning Institute of Jamaica (PIOJ) and the Statistical Institute of Jamaica (STATIN) in 1988 [27]. inventory of durable goods and social assistance. Interviewers are trained to collect the data from household members. (4) determine the magnitude of each social determinant. The questionnaire covers demographic variables. The questionnaire was modelled from the World Bank‘s Living Standards Measurement Study (LSMS) household survey [28]. 0 (poor health) if there were no self-reported ailments. There are some modifications to the LSMS. which was the survey period. immunization of children 0–59 months. and (5) gender differences in self-assessed health.

injuries or illnesses. Positive affective psychological condition is the number of responses with regard to being hopeful. having lost property. Social supports (or networks) denote different social networks with which the individual is involved (1 = membership of and/or visits to civic organizations or having friends who visit one‘s home or with whom one is able to network. standard deviation (SD). Crowding is the total number of individuals in the household divided by the number of rooms (excluding kitchen. it is still an accurate proxy of ill-health and mortality. Descriptive statistics such as mean. 0 = otherwise). how do you feel about your health‖? Answers for this question are in a Likert scale matter ranging from excellent to poor. and this is subdivided into positive and negative affective psychological conditions. 0= otherwise) which is determined from ―Generally. Psychological conditions are the psychological state of an individual. with an option of yes or no. Negative affective psychological condition is number of responses from a person on having lost a breadwinner and/or family member. 0=otherwise. Health status is a binary measure (1=good to excellent health. While self-reported ill-health is not an ideal indicator of actual health conditions because people may underreport. verandah and bathroom). optimistic about the future and life generally. Statistical analysis Statistical analyses were performed using the Statistical Packages for the Social Sciences v 16. Chicago. Age is a continuous variable in years. Health care-seeking behaviour is derived from the question: Have you visited a health care practitioner. USA) for Widows. IL. For the purpose of the regression the responses were coded as 1=yes.0 (SPSS Inc. frequency and percentage were used to analyze the socio-demographic 133 . being made redundant or failing to meet household and other obligations. pharmacist or healer in the past four 4 weeks.

and the odds ratio (OR) for interpreting each of the significant variables. or strong (0. and all other variables were removed from the final model (p >0.7–1). biological conditions and welfare.characteristics of the sample.05). Model To study the relationship between self-assessed health status and social determinants. Chi-square was used to examine the association between nonmetric variables. moderate (0.39). Categorical variables were coded using the ‗dummy coding‘ scheme or a reference category. and an Analysis of Variance (ANOVA) was used to test the relationships between metric and non-dichotomous categorical variables. because the dependent variable was a binary one (self-reported health status: 1 if reported good health status and 0 if reported poor health status).69). Finally. and logistic regression was used to estimate the following regression 134 . Logistic regression examined the relationship between the dependent variable and some predisposed independent (explanatory) variables. This was used in the present study to exclude (or allow) a variable. The predictive power of the model was tested using the ‗omnibus test of model‘ and Hosmer & Lemeshow‘s [30] 3 technique was used to examine the model‘s goodness of fit.05).4–0. The correlation matrix was examined in order to ascertain whether autocorrelation (or multicollinearity) existed between variables. The final model was based on those variables that were statistically significant (p <0. Cohen & Holliday [31] stated that correlation can be low/weak (0–0. forward stepwise technique in logistic regression was used to determine the magnitude (or contribution) of each statistically significant variable in comparison with the others.

6 presents the results from the econometric exercise.6% males and 52.024 respondents: 47.1% in urban areas. and biological condition. Wij. 1% claimed injury and 8% mentioned illness.4% common-law. Of the sample population. 3 welfare variables.model. Bi. 100% stated that the health 135 . and 27.1% and 97% responded respectively. Of those respondents.1% in visiting unions.8 years).5 years (SD = 8.4% males. Equation [1] denotes the 20 social. When respondents were asked whether the illness was diagnosed and the typologies of conditions. which is captured in Equation [2].1% in the poorest 20% compared to 44.1% in the wealthy social hierarchies. SDHij. 22% in peri-urban and 32. Forty-five and nine tenth percent of the sample dwelled in rural area. 13% married. 20. Thirty percent of the sample was single. The mean age of the sample was 28. [1] Table 6. SDHij denotes the 9 statistically significant social determinants of person i. of which 23. with respect to the questions on injury and illness 97.2% was in the wealthiest 20%. Results The sample was 3. of self-assessed health status (Hi) and some standard error: . [2] where: Hi is the level of self-assessed health status of person i. Thirty-six and three-tenth percent of the sample was poor with 17. Equation [2] therefore presents only those variables which are significantly correlated with selfassessed health status of young adults: .

0 days (SD = 98.8%). age 25 – 29.0%. 64.608): age 15 – 19 years.condition was diagnosed by a medical practitioner. age 30 – 34 years.0001. arthritis (2. 60. The health care institutions were public hospitals (34. A cross-tabulation of health care-seeking behaviour and illness shows no significant statistical association. 136 . Ninety-seven percent of those who seek medical care were ill compared to 94% of those who sought medical care in the last 4-weeks.0%). hypertension (7.4.6%).9%) and unspecified conditions (41. pharmacist. age 20 – 24 years. with 1 visit made to a health care practitioner in the last 4weeks.2% said yes.7%). 69. and wife) in the last 4-weeks. When respondents were asked if they had visited a health care practitioner (including healer.3% very poor health).1%.0% and age 40 – 44 years. public health care centres (14%). 68.9). The self-reported diagnosed health conditions were influenza (12. Figure 6. age 35 – 39 years.2% very good selfassessed health) compared to 1. 60%.1%). 67. and private health care centre (51. diarrhoea (2. 53.6% claimed at least good health (including 42.9% who stated at least poor health (including 0.8%).7%. 89.1 provides the information on the age group and percentage of young adults who indicated that they had an illness in the last 4-weeks.%. The mean length of illness was 26.9%). P < 0. Twenty percent of the sample had health insurance coverage. nurse. No significant statistical association was found between health care-seeking and age group (P = 0.2%). private hospitals (7. respiratory disease (14.8%). A cross-tabulation between illness and age group revealed a significant statistical association – χ2 = 39. diabetes mellitus (7.

3 years (SD = 9. Figure 6.2 showed that over 50% of those with illness and injury dwelled in rural areas. diabetes mellitus. Biological variable (i.3 shows sex composition of those who utilised health care facilities in Jamaica.001.1% of the explanatory power of the model (i. The mean ages of particular health conditions were influenza.9 years (SD = 9. 51.2 highlights young adult who reported injury (%) and illness (%) that dwelled in particular area of residence controlled for sex of respondents.8 years (SD = 7. respiratory.93. 137 .7%. P < 0.2 years (SD = 8. Multivariate analysis Tables 6 represent the results from the econometric exercise: Of the 24 variables that were tested in an initial model. 67.e. 36. 37.5. Figure 6. P < 0.2%.9). P < 0.1%. and wealthiest 20%.6). 69.7). hypertension. 9 were social determinants and 1 a biological variable. 29.323. Figure 6.3 years (SD = 5.1) and other. Most young adult males utilised private hospitals (36. P < 0.No significant statistical relationship was found between health care-seeking behaviour and social hierarchy (P = 0.4%.3%).6%) compared to public health care centres for males (27. there was no significant statistical relationship when illness and injury by area of residence was controlled for by sex of respondents (illness – male χ2 = 2. middle class. 67.7%).5.6. 32. injury – male χ2 = 2. P < 0.3). 29. There is a statistical difference between age of respondents who reported having particular health conditions – F-test = 4.e.628).292 and female χ2 = 0.271 and female χ2 = 2. poor. However. 30.2). diarrhea.4%) compare to females who visited public health care (72. self-reported illness) accounted for 78. 65. wealthy.3.5%.3 years (SD = 9. The least percentage of females visited private hospitals (63.339): poorest 20%.

Outside of the gender differences in self-assessed health status. economic.5 times more than that of females.15. The association was a very weak one. males were 2.half percent of those with an injury had an illness.3%). On the other hand. A cross-tabulation between self-reported injury and self-reported illness showed a significant statistical relationship.12 (or 12%). Concurrently. culture. Discussion In the present study. the odds ratio of recording good health married young adults was 1. the present study used secondary survey data and variables such as psychological.6 times more than their single counterparts and this was similar for peri-urban respondents with 138 . Forty-one of every 100 young adults who reported having an injury stated that they had an illness in the last four-weeks. Based on the multi-dimensional nature of health determinants.3 times likely to record injury while females were 2 times more likely to have an illness in the last 4-weeks. Limitations of study Health is a function of social. Those omissions reduced the explanatory power of the current paper. indicating that less than one. psychological. 2 times more young adult-females sought medical care more than males. and injuries. ecological and some social issues. but provide a platform with which future studies can be launched. medical care-seeking behaviour. correlation coefficient = 0. belief and value system were omitted from the model. Furthermore. the prevalence of injury in Jamaica for young adults was 1% compared to 8% in illness. indicating that the social determinants accounted for 21. biological and ecological factors. the odds ratio of recording better good self-assessed health status for males was 1.9% of the self-assessed health status of young adults. such as childhood health history.

reference to rural young adults.7% of the explanatory power of good health status of elderly Barbadians could be accounted for by current illness. a young adult who sought medical care was 65% less likely to record good health. along with injuries. They found that 87. It is clear that despite the cultural and biological differences rooted in both figures. biological. 32-37].. The small percent of injuries experienced by young adults denote that using injuries as a guide in health policy intervention would be addressing an even smaller percent of health status than illnesses. [12] went further when he disaggregated the contribution of biological and non-medical conditions of self-assessed health status. psychological. One of the challenges in effectively comparing the aforementioned issues (which is embedded in the data) is that the perception of people across different nations are not the same. economic and biological variables [12-25. young adults with tertiary level education were 47% more likely to record good health and those who spent more on medical care (i. psychological 139 . On the other hand. which suggests that illness accounted for less of young adults‘ health status than for elderly people. research has established that any investigation of health must coalesce social. medical careexpenditure) were 1% less likely to have good self-assessed health status. The present study has not only highlighted the role that social determinants play in health status but also that they play a greater role in the health of younger adults than old people.1%. Empirically.e. Hambleton et al. From the aforementioned results which show that illness contributes more to health status than social determinants. and this as well as the age component could account for some aspects of the disparity. Statistics seemingly show a large percent of young adults being victims of injuries but the current findings indicate that these represent a small part of ill-health of young adults. current illness is a strong determinant of selfassessed health status in each region and if health must combine social. The present study found that current illness accounted for 78.

the study can effective compare selfassessed health status as both studies collected this from its population. meaningful comparison using disaggregated social determinants would be close to impossible as the components are not necessarily the same. Therefore within the limitations of the current paper. public health interventions that are using any one determinant in particular injuries would not be addressing the health concerns of young adults. Therefore the usage of injuries and/or illness to measure and guide public intervention denotes that1 in 5 of the health status of young adults would have been unaddressed in this effort and as much as 9 out of 10 of injury statistics are used in public policy interventions.‘s finding in this study found that education was the only factor of those identified in the Barbadian health status. Disaggregating social determinants to ascertain a value for historical determinants to compare with Hambleton et al. Inspite of the limitations of the current work.and ecological determinants.3% of the explanatory model in this study.1% of health and historical determinants. Historical determinants which included education. occupation. economic situation. suggesting the increased role of biological determinant in the health process with ageing. children. 140 . This empirical evidence concretizes the rationale for social determinants in the discussion and research on health status as well as ill-health.9 times more than that for elderly Barbadians. Current social determinants of health for elderly Barbadians accounted for 4. childhood nutrition. The current paper which uses data for 2007 and Hambleton et al‘s work used data for December 1999 to June 2000 showed that young adults‘ health was between 1. Although there are time differences which cannot be discounted for in this study. The finding in the present paper showed that social determinants of young adults constituted more explanation than for elderly. childhood health and diseases theoretically is apart of social determinants.5 to 1. and that education accounted for only 0.

The current paper revealed that as young people age. taking this car home and locking it away in the car porch under cover for 20 years. the odds ratio (OR = 0. McGrowder and Crawford [38] showed that illness affecting elderly Jamaicans was more chronic than acute compared to the converse in this study. Injuries from accident affect 1 in every 100 young adults. health care utilisation and lowered health status The issue of the car symbolizes the natural ageing and progressive depleted state of things and this is similarly the case for humans. Ageing is a nature event. it would have aged. With the changes in the typology of illnesses from acute to chronic conditions. the health status of the former is still greater and this is due largely to lower risk of biological conditions. making its effect on health smaller than illnesses which accounts for 8 in every 100 young adults. and therefore account for illness. this supports lower health status than young adults and greater health care participation for the former as they seek to address the ageing of the organism and the increased depreciation owing to old age. Imagine purchasing a new car.97) of indicating good health falls by 3% and using the aforementioned statistics would mean that odds ratio of good health for elderly people should fall.there is emerging information in the reduction of health status with ageing. Gompertz‘s law in Gavriolov and Gavrilova [39] shows that there is a fundamental quantitative theory of ageing and mortality of certain species (the examples here are as follows – 141 .With biological conditions accounting for more of self-assessed health of older people. the elderly‘s health status must be lower than that for young adults. On using the car however increases the deterioration or depreciation on the human structure. Again the biology of an individual accounts for greater percentage of self-assessed health than external factors such as injuries from accidents. and on removing the covers although the item was not used. A study by Bourne. Hence although homicides accounted for more deaths of young adults that elderly people.

fruit flies. statistics 142 . But studies have shown that using evolutionary theory for ―late-life mortality plateaus‖. The present study revealed that the odds ratio of good health of young adults in Jamaica decline by 65% for those who seek medical care. but that this becomes less progress in advance ageing. which is explored in evolutionary biology [40-43]. Illness in the current work is substantially a female phenomenon. Young adult females were 2 times more likely to report an illness.e. This phenomenon means that human mortality increases with age of the human adult. Ageing therefore denotes gradual deterioration in living organisms as well other nonliving items. and this justifies their greater probability to utilize medical care seeking in order to address ill-health. fail because of the arguable unrealistic set of assumptions that the theory uses to establish itself [44-46]. human lice. Gompertz‘s law went further to establish that human mortality increases twofold with every 8 years of an adult life. These findings have a high degree of validity as statistics from the Ministry of Health (Jamaica) showed that females attended health care institutions twice as much as men for curative care since 2000-2007 [9]. Since 1988. which accounts for demand in medical care. Medical care for young adults therefore is a good measure of curative than preventative care. which means that ageing increases in geometric progression. reinforcing the cultural perception of illness and the reason why young adults seek health-care is curative than preventative for this group. The current work revealed that 94 out of every 100 young adults who sought medical care were ill. Thus. that health is illness and so care is sought for ill-health as against preventative care. This also speaks of the cultural impact on health through people‘s conceptual perceptions of health. mice. and flour beetles.humans. the cells die with increasing in age). Medical seeking-behaviour could indicate either preventative or curative care. biological ageing is a process where the human cells degenerate with years (i.

Caribbean males including Jamaicans are socialised to be strong. Although the current findings showed that the odds of recording good health is 1. 143 . Health care facilities are primarily governed by females for females and this adds to cultural handicap of males afford attending public health care institution on experiencing ill-health. The feminization of health care facilities and the large percent of people in particular females who utilise public health care institution is another rationale for males use of private health care facilities. therefore accounting for the reasons why they are skeptical to visit medical institutions and often times wait for severity. do not show weakness. A Caribbean anthropologist [49] stated that the macho socialisation of the Caribbean male accounts for his unwillingness to seek medical care. Another study conducted in Anyigba. apart of this is owing to the reality that often times males do not see themselves as ill. . This reinforced the cultural biasness of illness and health care facilities.obtained from Jamaicans in national cross-sectional surveys revealed that females were approximately more likely to report an illness and utilize medical care than males. and be involved in particular tasks to exhibit their masculinity as a result illness is a signal of weakness. Nigeria found that [48] found that 85 out of every 100 respondents waited for less than a week after the onset of illness to seek medical. This is not atypical to Jamaica as a qualitative study in Pakistan on street children found that boys would attend formal health care if it affects their economic livelihood and health conditions were severe [47]. it is sometimes so difficult for traditional medical practioner to offer cure.5 times greater for young adult males. This then offers an explanation for females living longing than males. On visiting medical practitioners. and that 57 out of every 100 indicated that they would recover without treatment. North-Central. Males on the other hand will attend medical care facilities when ill-health interfaces with their economic livelihood and the severity is such that this is the only avenue.

Like this paper. specifically in Jamaicans since 1960 (i. education) was associated with healthier patterns of behaviour. Unlike this study. challenges to implement health interventions to improve health of young adults in particular males are great as definition of illness and severity of symptoms reduce the quality of life of people and this finding concurs with a previous study by Williams et al. Williams et al. The current paper concurs with the literature as the odds ratio of good health status of young adults with tertiary level education are 1. Dunlop et al [51] found that African American men had few physician contacts than minority and non-Hispanic white women.e. The indirect way that education affects health can be measured using social hierarchy.visit medical practitioner less and justifies the higher mortality among them than females. Education affects health directly and indirectly. educational levels). A study on twins in USA found that more years in schooling (i.e. The present findings revealed that the middle class who are the educated ones were 1. With the advancement in literacy and numeracy in the world since the 19th century. In the Fujiwara & Kawachi [52] work on increased schooling was associated with reducing smoking habit and other such healthier practices.5 times more likely to report good health status and that wealth or income was not correlated with good health status or for that matter the self-assessed health status of wealthy social hierarchies did not differ from 144 . empirical findings showed education is among the social determinants that influence health status [12-26]. which is an example of the direct impact of education on health. [50].5 times more than those with primary or below education. The irresponsiveness of young adult males in seeking health care comparable to their female counterparts in Jamaican extends to even older African American men. [50] found that medical care-seeking behaviour did not differ significant between the sexes. The social determinants are therefore offering explanation for the biological issues as well. with this study finding the opposite. [52].

In an effort to contextualize the psychosocial and biomedical health status of particular marital status. To provide a holistic base to the argument. They pointed to a paradox within this discourse as ―…this is not observed among men‖. 53-58]. one demography cited that the death of a spouse meant a closure to daily communicate and shared activities. Rie and Park [54] findings revealed that being married was a ‗good‘ cause for an increase in psychological and subjective wellbeing in old age. Smith and Waitzman [55] offered the explanation that wives found dissuade their husband from particular risky behaviours such as the use of alcohol and drugs. 145 . which is not an unexpected result [57]. Koo. which sometimes translate into depression that affect the wellbeing more of the elderly who would have had investment must in a partner [57]. the researcher will quote a sentence from the findings of Delbés and Gaymu [57] study that reads ―The widowed have a less positive attitude towards life than married people. Those findings highlight the value of marriage to females which commences at an early age.6 times more for married males than their female counterparts. but that this was only explained by females.those in the poor social hierarchies. The present study concurs with the literature that the health status of married young adults is greater than those who are single. This is clearly not the case as study by Bourne [58]. Empirical evidence existed that among the social determinants of health is marital status. 56]. and seemingly that the benefits of marriage are not for males. Some research showed that married people are healthier than non-married people [12-25. and would ensure that they maintain a strict medical regimen coupled with proper eating habit [53. using data on Jamaicans. found that the odds ratio of reported good health was 1.

economic. and should justify a call for a research and policy direction that include avoidabilities such as technical. The use of injuries to measure and guide policies and programmes because seemingly there are many young adults who are affected is a misnomer and does not capture the gamut of illness or even health of this group of people.Conclusion and policy recommendations In sum. psychological. While the biological determinant of selfassessed health of young adult predominates health determinants. ecological and biological determinants. With the demographic reality of young adults in the country. inequity and/or inequalities in health outcomes among young adults. narrow and fails to understand the matter of health. statistics for 2007 revealed one in every two Jamaicans was 15-44 years old. financial and moral as these would provide additional explanations for health disparities. The present study highlights some of the health disparities between the sexes and affords research findings that can be used to refashion health policies and research focus in the future. using injury to examine health is grossly inadequate. injury accounts for a miniscule percentage of illness and so using injury to formulate intervention policies would be lacking in depth to effectively address health of this cohort. choices. Although the health of young adult Jamaicans is very good. Health is more that illness as it incorporates social. Health policies must utilize the wide spectrum of health determinants in order to address the multi-dimensional nature of health. there are many health disparities between the sexes which are justifying inequities in health outcomes between males and females. The identified health disparities are among reasons for health inequities in health outcome. 146 . This speaks to the importance of a research on this age group.

57:476-81. Abel W. Kingston: Ian Randle. Egan M. Historical and current predictors of self-reported health status among elderly persons in Barbados. 82 (1). (WHO). 5. Coping with teenage pregnancy. 12. 19912009. Medical Sociology: Modelling Well-being for elderly People in Jamaica. In: Morgan O. Kingston: Ian Randle. 2005: pp. Washington DC: PAHO. 9. 2005: pp. 41-50. HIV/AIDS – the rude awakening/stemming the tide. 2005: pp. West Indian Med J 2008. 57:596-04. Rural health in Jamaica: examining and refining the predictive factors of good health status of rural residents. Annual report. Hennis AJ. (PAHO). New York: National Bureau of Economic Research. Williams-Green P. 11. Quality of life in patients with sickle cell disease in Jamaica: rural-urban differences. Clarke K. Douglas K-G. McGrowder DA. McCartney TB. 10. Kingston: MoH. Patterns of substance use among adolescents students in Jamaica. Health Determinants: Using Secondary Data to Model Predictors of Wellbeing of Jamaicans. In: Morgan O. Geneva: WHO. Journal of Epidemiology and Community Health 2004. Bourne PA. 1971-2009. West Indian Med J 2008. Health statistics. Graham H. 17(5-6): 342-352. Fraser HS. Health issues in the Caribbean. volume II – countries. Hamilton P. Jackson J. Pan American Health Organization. 7. Evidence for Public Health Policy on Inequalities: 1: The Reality According To Policymakers. Issues affecting reproductive health in the Caribbean. Wynter H. 87-92. (STATIN). In: Morgan O. Kingston: Ian Randle. 5. 15. 2005: pp. Kingston: Ian Randle. ed. 4.References 1. ed. McIntyre SJ. McDonald A. The demand for health . Frederick C. Graham H. In: Morgan O. McNeil P. ed. 62-76. Health issues in the Caribbean. 77-78. ed. 1972. 13. 2005: pp. Kingston: Ian Randle. 50. Lipps G. Social Determinants and their Unequal Distribution Clarifying Policy Understanding The MilBank Quarterly 2004. Grossman M. 19. Kingston: STATIN. Ali SB. 79-86. 8: 890-899. 2009. Health issues in the Caribbean. Frederick J. Kingston: Ian Randle. Health in the Americas 2007. In: Morgan O. Ministry of Health (MoH). 101-124. 93-95. Hambleton IR. Whitehead M. ed. Asnani MR. Reid ME. Revista Panamericana de Salud Pứblica 2005. 9 (2). 17. 2007. 811 – 816. 2005: pp. Demographic statistics. In: Morgan O. Journal of Rural and Remote Health 2008. Health issues in the Caribbean. 2009: p. Bain B. 6. ed. The health impact of injuries (Abridged). Wynter S. Bourne PA. 14. 2005: pp. Pettigrew M. 147 . Broome HL. Jamaica. In: Morgan O. 1990-2007. Substance use – health consequences. Dacosta V. Injuries – the broad picture. Kingston: Ian Randle. Health issues in the Caribbean. 1116. ed. World Health Organization. Health issues in the Caribbean. Statistical Institute of Jamaica. 18. 16. Health issues in the Caribbean. 51-57.a theoretical and empirical investigation. 8. 1970-2008. Rural and Remote Health 2009. Brathwaite F. 2. 3. Bourne PA.

28. Kingston. Demographic and Economic Correlates of Health in Old Age. 2002. 33. 34. Basic information. World Bank. 2009).worldbank. Jamaica: Planning Institute of Jamaica and Derek Gordon Databank. (PIOJ). 1(3):125-133. International Journal of Collaborative Research on Internal Medicine & Public Health. Statistical Institute Of Jamaica. Statistics for Social Sciences. Poverty and Human Resources. Wilkinson RG. London. Demographic shifts in health conditions of adolescents 10-19 years. Engel G. Applied Logistic Regression. Rhule J. North American Journal of Medical Sciences. The care of the patient: art or science? Johns Hopkins Med J 1977. 1989-2007. Health disparity in Latin America and the Caribbean: The role of social and economic determinants. Kington R.who.int/social_determinants/resources/csdh_framework_action_05_07. Jamaica: Statistical Institute Of Jamaica [producer]. University of the West Indies [distributors]. England: Harper and Row. Bourne PA. Occasional Publication No. 2007 [Computer file]. 1989-2008. 2009. North American Journal of Medical Sciences 2009. In: Pan American Health Organisation. 30. Discussion paper for the Commission on Social Determinants of Health DRAFT April 2007. Homer D.pdf (Accessed April 29. (September 2. A Conceptual Framework for Analysis and Action on the Social Determinants of Health. 2003. Bourne PA. Jamaica: Using cross-sectional data for 2002 and 2007. Irwin A. 2000. 31. Cohen L. 21. 2007. 26. New York. 1(2): 86-95. 148 . at http://siteresources. 22-49. Casas JA. A unified concept of health and disease. 2nd edn. Holliday M.pdf). 3:459-485. 2009. Jamaica Survey of Living Conditions. 2009. 140:222-232. 25. 29. Solar O.20. Bourne PA. Jamaica Survey of Living Conditions. The Solid Facts. (Online). Dachs JN. Engel G. Marmot M. Washington: The World Bank. Perspectives in Biology and Med 1960. Washington DC. Lemeshow S. Copenhagen: World Health Organization.org/INTLSMS/Resources/33589861181743055198/3877319-1190214215722/binfo2000. 1982. 2nd ed. Available from http://www. International Journal of Collaborative Research on Internal Medicine & Public Health. 1988-2000. 1(5):132-155. Kingston. Socio-demographic determinants of Health care-seeking behaviour. Bourne PA. Kingston: PIOJ. 34:159-70. 23. Bambas A.. 2008. Statistical Institute of Jamaica. A theoretical framework of good health status of Jamaicans: using econometric analysis to model good health status over the life course. John Wiley & Sons Inc. 1 (4):101-130. Development Research Group. Planning Institute of Jamaica. selfreported illness and Self-evaluated Health status in Jamaica. Good Health Status of Rural Women in the Reproductive Ages. 32. 8. Equity and health: Views from the Pan American Sanitary Bureau. Jamaica Survey of Living Conditions. 24. Social Determinants of Health. STATIN. Smith JP. Demography 1997. 27. 2009. (STATIN). 22. 2001: pp.

Evolutionary demographic models for mortality plateaus. 2:34-44. Grahn D. The Open Geriatric Medicine Journal 2009. Jamaica: University of the West Indies Press. de Muynck A. Proc. Partridge L. Rie. Pletcher SD. marital status.1-13 53. Int J Epidemiol 2009. 1999. The clinical application of the biopsychosocial model. 42. Curr. Persp. The reliability theory of aging and longevity. Biol 2001. 49. Sci 1977. 43. Gavrilova NS. Gavrilova NS. K. Gavrilov LA. Gore WR. Kingston.. Geriatrics and Gerontology International. Olshansky SJ.35. Fujiwara T. Kawachi I. Medawar PB. Charlesworth B. ed. 52: 454-464. 23(11):1667-1675. American Journal of Sociology 1973. Evolutionary perspectives on human senescence. 40. Annals of the New York Academy of Sciences 1978. 48. theor. Q. Child: Care. Engel. Andrews EB. 2004. and K. Manheim LM. Chang RW. Koo. Learning to be a man: Culture. B. New York: Basic Books. Sci. J of Gerontology: Soci Sci 2002. Mueller L. Kim H-Y. McGrowder DA. 1997. P. 36. Carnes B A. Ageing: Leveling of the grim reaper. Mod.. 1999. The need for a new medical model: A challenge for biomedicine. 137:535-544. Cambridge: Cambridge University Press. Song J. 30:189-208. 149 . 1958). 57B (3): S221-S233. Natl Acad. 1994. Illness incidence and health seeking behaviour among street children in Rawalpindi and Islamabad. 38. 47. 93 (15): 249-253. [Reprinted in the Uniqueness of the Individual (Medawar. Am J of Psychiatry 1980. Engel G. 213:527-545.fact or fiction. 96 (10): 544-10 547. GL. 45. Williams RE. 196:129-136. Is education causally related to better health? A twin fixed-effect study in the USA. Pakistan – a qualitative study. Human longevity: Nature vs. Determinants of health-care-seeking behaviour among subjects with irritable bowel syndrome. Charlesworth B. Olshansky SJ. Age and gender differences in affect and subjective wellbeing. 51. Biol. Evolutionary theory predicts late-life mortality plateaus.A. 52. 44. Med. 42: 422-441. 54. J. Bourne PA. Chevannes B. 1946. 7: R440-R442. Evolution in Age-structured Populations. 19: 793-806. Gender and ethnic/racial disparities in health care utilization among older adults. J. Mortality plateaus and the evolution of senescence: why are old-age mortality rates so low? Evolution 1998. Population.A. Wachter. 46. Natl Acad. Black CL. Gavrilov LA. 4:S268-S270. 310: 169-181 37. Development Review 1993. Engel G. Dunlop DD. Cook SF. & Crawford TV. 41. Sci. Buda JJ. S. Rose MR. Sex. 39. 2001. 17-43. 50. 31(5):525-532. 1996. Decomposing Mortality Rates and Examining Health Status of the Elderly in Jamaica. Mangel AW. Proc. pp. The biopsychosocial model and the education of health professionals. Biol. and mortality. 1999. Park. nurture . Alimentary Pharmacology & Therapeutics 2006. Curtsinger JW.W. 2:30-49. Ali M. Carnes B. J. Health & Development 2005. S. Old age and natural death. socialization and gender identity in five Caribbean communities. 2nd ed.

. The shock of widowed on the eve of old age: Male and female experience. 2002. and K. Goldsteen. Ross. 57. J. Double jeopardy: interaction effects of marital and poverty status on risk of mortality. Waitzman NJ. Mirowsky. E. Gaymu. C. and J.55. 1990. 56. Bourne PA. C. 31:487-507. Delbés. 58.. Journal of Marriage and the Family 52:1059-1078. Demography 1994. Self-evaluation of health of married people in Jamaica. Demography 3: 885-914. (in review) 150 . The impact of the family on health. Smith KR.

Figure 6.1: Illness (%) by age group 151 .

Figure 6.2: Area of residence of those with Injury (%) and Illness (%) controlled for by sex 152 .

Figure 6.3. Sex composition of those who attend health care facilities 153 .

5 1.0 30.4 26.3 0.9 8. Of Public Hospitals by Gender and Age cohort (in %): 1999-2002 Age cohort 1999 Male Female < 5 years 5-9 years 10-19 years 20-29 years 30-44 years 45-64 years 65+ years 0.1: Treatment for Gunshot wounds at the Accident and Emergency Depts.2 11.2 3.2 0.0 0.7 16.2 35.8 32.6 29.0 35. 2002 published by the Policy.2 Year 2001 Male Female 0.8 2.6 Not unknown 1.5 23.3 3.2 32.5 31.0 0.4 11.6.7 0.7 2002 Male Female 0.1 6.6 3.6 17.3 8.3 13.3 3.3 2.1 11.5 32.1 28.3 17.8 0.5 30.7 6. Jamaica 154 .0 0.3 10.9 36.6 0.9 22.1 17.9 39.2 40.7 2.0 24.0 2000 Male Female 0.2 0. Ministry of Health.0 19.0 1.7 3. Bourne from Annual Report.1 1.1 1.3 12.Table 6.9 18. Planning and Development Division.8 0.3 10.2 3.4 Total % 100 100 100 100 100 100 100 100 Calculated by Paul A.6 12.6 6.

0 4.8 6.0 0.1 6.0 4. Jamaica 155 .2 3.5 17.4 2. Ministry of Health.4 2002 Male Female 1.7 3.0 3. Planning and Development Division.0 19.0 49.9 0.0 13.5 12.5 38.9 3.0 13.2: Visitation to the Accident and Emergency Depts.7 0.4 34.0 20.1 34.4 0.0 2.0 4.0 2.0 2.3 36.2 3.0 0.0 13. 2002 published by the Policy. Of Public Hospitals for attempted suicide by Gender and Age cohort (in %): 2000-2002 Age cohort 2000 Male Female < 5 years 5-9 years 10-19 years 20-29 years 30-44 years 45-64 years 65+ years Not unknown 0.4 39.0 0. Bourne from Annual Report.0 20.0 24.0 1.6.4 0.3 36.Table 6.0 13.0 0.5 2.0 13.2 Year 2001 Male Female 1.6 Total % 100 100 100 100 100 100 Calculated by Paul A.0 4.9 3.4 2.

Jamaica Constabulary Force 156 .Table 6. 2005 Age Group Carnal Abuse Female 3 15 223 103 0 0 0 0 0 0 0 0 2 346 346 Age Group Male 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55 & Over Unknown Total Total Reported 2 3 10 122 268 252 223 177 139 72 46 81 91 1486 Murder Female 4 5 8 18 23 33 22 17 12 16 9 16 5 188 Total 6 8 18 140 291 285 245 194 151 88 55 97 96 1674 1674 Male 3 0 4 107 212 192 161 138 107 68 46 50 408 1496 Shooting Female 1 5 11 13 30 22 16 15 15 5 8 6 3 150 Total 4 5 15 120 242 214 177 153 122 73 54 56 411 1646 1646 Male 0 1 16 59 162 233 198 199 171 146 98 152 28 1463 Robbery Female 0 0 11 49 115 130 112 102 77 44 32 66 9 747 Total 0 1 27 108 277 363 310 301 248 190 130 218 37 2210 2210 Male 0 0 0 8 52 81 114 140 116 98 75 171 32 887 Breaking Female 0 0 6 17 75 106 115 104 107 75 47 100 14 766 Total 0 0 6 25 127 187 229 244 223 173 122 271 46 1653 1653 Rape Female 3 27 212 223 122 48 28 23 17 12 7 16 8 746 746 Source: Statistics department.3: Victims of Major Crimes by Age Cohorts.6.

Table 6.4: Age Group of Persons Arrested for Major Crimes for 2005 Age Group Murder Age Group 12-15 16-20 21-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61& Over Unknown Total Male 6 157 235 160 85 54 15 7 5 1 0 40 765 Female 1 6 8 2 1 3 0 1 1 0 0 0 23 Total 7 163 243 162 86 57 15 8 6 1 0 40 788 Shooting Male 4 167 239 137 74 40 12 2 0 1 2 86 764 Female 0 1 1 0 0 1 0 0 0 0 0 0 3 Total 4 168 240 137 74 41 12 2 0 1 2 86 767 Robbery Male 10 183 214 120 71 36 13 1 2 6 2 23 681 Female 0 0 1 1 1 1 0 0 0 0 0 0 4 Total 10 183 215 121 72 37 13 1 2 6 2 23 685 Breaking Male 54 122 129 105 93 69 44 18 2 1 3 11 651 Female 0 3 3 3 2 0 1 0 0 1 1 0 14 Total 54 125 132 108 95 69 45 18 2 2 4 11 665 Rape Male 12 66 68 73 48 23 18 12 3 1 2 10 336 C/Abuse Male 11 43 52 27 26 19 12 5 2 1 0 0 198 Total 98 748 950 628 401 246 115 46 15 12 10 170 3439 Source: Statistics department.6. Jamaica Constabulary Force 157 .

0 0.2 < 0.82) 0.6 5.1 65. of visits to health care facilities Mean (SD) Age Mean (SD) Medical expenditure Mean (SD) in US $ †US$ 1.4 3.6 10.3 1.42 (26.9 21.4 13.9) 16.585 0.5 89.756 32.2 P 0.2 < 0.5 16.1 19. $ 80.5 96.4 22.8 93.9 12.144 0.746 0.6 45.4 0.3) 28.5 39.1 30.5 6.00 = Ja.439 Sex Female (%) n = 1.9 8.5 11.3 12.1 6.5 21.3 1.0001 6.0001 < 0.0001 < 0.7 1.47 Male (%) n = 1.4 yrs (8.037 1.5.0001 73.1 21.2 28.2 0.8 47.0 26.103 15.4 8.7 44.9 6.289 12.2 (0.4 45.971 158 .1 3.01) 16.8 47.8) 28.7 28.4 98.6 1.1 0.4 2.2 31. Particular variables by sex of respondents Variable Injury Yes No Illness Yes No Self-assessed health status Very good Good Moderate Poor Very poor Health care-seeking behaviour Yes No Household head Yes No Union status Married Common-law Visiting Single Not stated Self-reported diagnosed health condition Acute: Influenza Diarrhoea Respiratory Chronic: Diabetes Hypertension Arthritis Other (unspecified) Area of residence Urban Peri-urban Rural No.7 0.0 27.8 9.5 46.5 yrs (8.5) 1.5 (1.3 94.6.Table 6.67 (42.4 10.6 99.5 34.5 39.

00 0.006 0.009 0.004 0.11-1.27-1.28 0.003 0.041 0.043 0.6.seeking Biological condition: Self-reported illness Std.62 0.11-0.00 0. 0.91 1.47 1.0001 0.005 0. P = 0.I.43 1.0001 R2 0.009 0.007 0.14 0.03 0.63 1.07 1.017 < 0.45 1.0% C.20-0.12-2.21 0.153 Hosmer and Lemeshow goodness of fit χ2 = 4.30 0.24 Odds ratio 0.01 0. 832 Explanatory variable Social determinants: Age Crowding Tertiary †Primary Male MiddleClass †Poor classes Married †Single Other town †Rural Medical expenditure Health care.18 0.97 0.003 0. Logistic regression: Explanatory variables of good health status.4 (8).81 1.35 0.00 1. Error 0.17 95.90-1.007 0. n = 2.61 1.99 0.82 -2LL = 1615.003 0.18 0.018 0.00 0.006 0.Table 6.99-1.95 1.196 †Reference group 159 .09-2.0001 < 0.28 P < 0.45 1.00 1.99 0.004 0.29 0.00 1.00 1.96-0.02-2.7 Nagelkerke R2 =0.

NI Gold. 60.5%). and they were 1. children and the poor) will seek less care. and how these differ between the insured and uninsured. by those in the lower socioeconomic strata. their health care utilization being 1. health care utilization.62. Public health insurance was mostly had by those with chronic illnesses (76%) compared to 44% private health coverage and 38% had no coverage (χ2 = 42. The majority (61. 59. (65%).3 years (SD = 16. 5.9 times (95% CI = 1.3%.15) more likely to rate their health as moderate-to-very good compared to the uninsured.64) to seek more medical care. arthritis.8 years (SD = 15. P < 0. chronic illness and other socioeconomic characteristics of the Insured and Uninsured This study examines self-rated health status.5 times more than the uninsured.1%) of those who reported being diagnosed with a chronic condition were 60+ years old (diabetes mellitus. The mean age of those with chronic illness was 62.9 times more than the uninsured and illness being a strong predictor of health care seeking.022. Most of the chronically ill were uninsured (67%). However. income distribution.42) more likely to report having chronic illness. and more likely to have greater income (β = 0.7 Disparities in self-rated health. 160 .6 times (95% CI = 1. health care utilization. and this will further increase the mortality among those cohorts.2%.9%) and 2.0001).5 times (Odds ratio.5) for the uninsured and 63.2% of respondents had health insurance coverage (private. hypertension. other public. Only 20.094) than the uninsured.4% were children.31-2.4%). Insured respondents were 1. any reduction in the health care budget in developing nations denotes that vulnerable groups (such as elderly.9%).4%. compared to uninsured chronically ill elderly (58.3%.2% of 71. OR.9%).2).8) for those with insurance coverage. and health insurance status of Jamaicans. 95% CI = 1. With the health status of the insured being 1. 1. health care utilization. and this was 61. Majority of health insurance was owned by those in the upper class. illness. (65. income distribution. 2. health care utilization is a strong predictor of self-reported illness. 12. 67.1% of 66. Illness is a strong predictor of why Jamaicans seek medical care (R2 = 71. but it was weaker than illness explaining health care utilization (61. and the disparity by the insured and uninsured. More people with chronic illnesses who had health insurance coverage were elderly. and health insurance coverage accounted for less than one-half percent of the variance in health care utilization. and 19%. It also models self-rated health status.06 – 2.5 years (SD = 16. public.4%).

health insurance coverage.140. Within the context of the realities in those nations. government assistance and families‘ aid. standard of living.e. suggesting that a large percent of the population are having to use out of pocket payment or government‘s assistance to pay their medical bills. Individuals‘ health is therefore the crux of human‘s development. and demand for health care as well as health choices are based on affordability. the health of the populace is primarily based on the choices. health care is substantially an out of pocket expenditure aided by health insurance policy and government‘s health care policy. people demand and utilize health care services. It also models self-rated health status.Introduction This study examines self-rated health status. The health of individuals within a society goes beyond the individual to the socioeconomic development. income distribution. as the 161 . and the disparity between the insured and uninsured. These approaches can be any combination of out of pocket payment. and how these differ between the insured and uninsured. The current findings revealed that 20. using end of year population for 2007). and health insurance status of Jamaicans. Survival in developing nations are distinct from Developed Western Nations as Latin America and Caribbean peoples‘ willingness. Affordability of health care is assisted by health insurance coverage. Western societies are structured that people meet health care utilization with a combination of approaches. 2.2% of Jamaicans had health insurance coverage (i. health care utilization. decisions. frequency.316 Jamaicans are uninsured. In seeking to preserve life. production and productivity of the nation. In Latin America and the Caribbean. responsibility and burden on the individual. income distribution. survivability and explains the rationale as to why people seek medical care on the onset of ill-health. health care utilization.

unemployed. people purchase health insurance policies as a means of reducing futuristic health care cost as well as an avoidance of the utilization of public health care. and in particular Jamaica. unemployable. long waiting times. Because of the nature of health insurance and insurance. and 60% of global mortality is caused by chronic illnesses [7]. The public health care system in many societies often time involve long queues.provisions of care offered by the governmental policies mean that the public health care system will be required to meet the needs of many people. elderly. elderly and other vulnerable groups. is private system between the individual and a private insurance company. The insured on the other hand are able to circumvent many of the experiences of the poor. people buy into a pool which is usually accommodated through employment. It can be extrapolated from the WHO‘s findings that 162 . According to the World Health Organization (WHO). Uninsurance in any society means a dependency on the public health care system. particularly in Jamaica [1-6]. Those people will be mostly children. and children of those cohorts. There is high proportion of uninsured in the United States and this is equally the reality in many developing nations. premature mortality and oftentimes public humiliation. frustrated patients and poor people who are dependent on the service. 80% of chronic illnesses were in low and middle income countries. In order to circumvent the public health care system. insurance coverage (or lack of) becomes crucial in any health discourse. In seeking to understand health care non-utilization and high mortality in developing nations. children and other vulnerable cohorts who rely on public health care system. Insurance in developing nations. Such a reality excludes retired elderly.

Previous studies showed that health insurance coverage is associated with health care utilization [1-6]. the people who are poor will suffer even more so from chronic diseases. The realities of the health inequalities between the poor and the wealthy and the sexes in a society and those in the lower income strata having more illnesses and in particular chronic conditions [7-12] is embedded in financial deprivation. The high risk of death in low income countries is owing to food insecurity. The WHO captures this aptly ―. According to the WHO [7]...uninsurance is critical in answering some of the health disparities within and among groups and the sexes in the society. low water quality. The WHO stated that ―In reality. ―In Jamaica 59% of people with chronic diseases experienced financial difficulties because of their illnesses. low and middle income countries are at the centre of both old and new public health challenges‖ [7]. Poverty makes it insurmountable for poor people to respond to illness unless health care services are free. 13]. Studies have been conducted on the general health of the insured and/or uninsured.‖ and emphasize the importance of health insurance coverage and the public health care system for vulnerable groups.People who are already poor are the most likely to suffer financially from chronic diseases. Hence. and this provides some understanding of health care demand (or the lack of) in developing countries.. low sanitation coupled with in access to financial resources [11.. poverty and non-access to financial resources. which means that there is a gap in the literature that could provides more insight into the insured and uninsured. While the current body of health literature provide pertinent 163 . health care utilization and other health related issues [1-6] have used a piecemeal approach. This goes back to the inverse correlation between poverty and higher level education. which often deepens poverty and damage long term economic prospects‖ [7]. and now poverty and illness.

the response rate for the 2007 JSLC was 73. A total of 620 households were interviewed from urban areas. inventory of durable goods. 439 from other towns and 935 from rural areas. health insurance coverage. non-food consumption expenditure. Over 1994 households of individuals nationwide are included in the entire database of all ages [16]. It is a modification of the World Bank‘s Living Standards Measurement Study (LSMS) household survey [15]. social assistance. Materials and methods Data methods This study is based on data from the 2007 Jamaica Survey of Living Conditions (JSLC). The JSLC used complex sampling design. conducted by the Planning Institute of Jamaica (PIOJ) and the Statistical Institute of Jamaica (STATIN). 164 . demographic characteristics and other issues [14]. The information is from the civilian and non-institutionalized population of Jamaica. Overall. and it is also weighted to reflect the population of Jamaica. education.783 non-institutionalized civilians living in Jamaica at the time of the survey. health conditions. This sample represents 6. health care utilization.information on health and health care utilization and how these differ based on the insured and uninsured. health choices are complex and requires more than piecemeal inquiry. housing conditions. The JSLC is an annual and nationally representative cross-sectional survey that collects information on consumption.8%. health status.

Chicago. and income. Overall model fit was determined using log likelihood ratio statistic.05 using chi-square. and analysis of variance f test. Chi-square was used to examine the association between nonmetric variables. (2) health care utilization. USA) for Windows. independent sample t-test. Analytic Models Cross-sectional analyses of the 2007 JSLC were performed to compare within and between subpopulations and frequencies. using multiple logistic and linear regressions. were used to ascertain factors which are associated with (1) self-rated health status. Logistic regression examined the relationship between the dichotomous binary dependent variable and some predisposed independent (explanatory) variables. (3) selfreported illness. odds ration and rsquared. Descriptive statistics such as mean. All confidence interval (CIs) for odds rations (ORs) were calculated at 95%. A pvalue < 0. Analytic models.05 was selected to established statistical significance. frequency and percentage were used to analyze the socio-demographic characteristics of the sample. IL.0 (SPSS Inc. (4) self-reported diagnosed chronic illness. multiple logistic and linear regressions. 165 . Stepwise regressions were used to determine the contribution of each significant variable.Statistical analysis Statistical analyses were performed using the Statistical Packages for the Social Sciences v 16. Means and frequency distribution were considered significant at P < 0. standard deviation (SD). design or dummy variables were for all categorical variables (using the reference group listed last). and an Analysis of Variance (ANOVA) was used to test the equality of means among non-dichotomous categorical variables. For the regressions.

9% were widowed respondents. 10. other aged adults.3%. Two-thirds of the sample sought health in the last 4-weeks. Marginal more people were in the upper class (40.9%. young adults.3% married.3%.2% were never married. 2.3%) compared to the lower socioeconomic strata (39.0001).3%. 6. 1.8%).(χ2 = 26. Only 39% of those with chronic conditions were non-elderly compared to 83. Almost 15% reported an illness in the last 4-weeks (43.7%. other public.weeks. primary. Children constituted 31. secondary.6% of those with other conditions (including acute ailments). 2. and elderly.3%. 12. 30.9%.1%.3% did not specify the condition). Only 20.2% old-old and 1. 11. and specified conditions.7% young-old.4% of those with other conditions – (χ2 = 187.3% females). 3.783 respondents (48.0% oldest-old. P < 0.32.3% had chronic conditions.8%. 69.5%. diarrhea. 3.8% and tertiary. 0. asthma.4%. 16. 23. Majority of the sample had no formal education (61. 26. 5.4%). public.4% had acute conditions and 26. Thirty-three percent of those with chronic illnesses had health insurance coverage compared to 17. 23.Results Demographic characteristic of sample The sample was 6. diabetes mellitus. Majority of health insurance was owned by those in the upper class (65%) and 19% by those in the lower socioeconomic strata.3%.7%. NI Gold.2% of respondents had health insurance coverage (private. arthritis. 87.7% males and 51.8% of those with acute and other conditions .0001). 31.8%). 25. The elderly comprised 7.7% divorced. hypertension.0%. Bivariate analyses Sixty-one percent of those with chronic conditions were elderly compared to 16.9% provided information on the typology of conditions: cold.9% separated and 4. 25. P < 0. Of those who reported an illness in the last 4. 13. 166 .65.0%. 10.

2%). 43. 23. Thirty-three percent of upper class respondents had health insurance coverage compared to 16.(χ2 = 23. P < 0.5%).Furthermore examination of self-reported health conditions by health insurance status revealed that diabetics recorded the greatest percent of health insurance coverage (43. Fourteen percent of those with health 167 .5% of rural residents.8%).0001). Sixty-seven percent of respondents who reported being diagnosed with chronic conditions sought medical care in the last 4-weeks compared to 60. Forty-two percent of those with at most primary level education had health insurance coverage compared to 16.0001).80.adults.0%) compared to secondary level (6.1% of semi-urban respondents and 14.4% of young adults. P < 0. 44.06. and (3) age cohort (χ2 = 83.0001).12. A significant statistical association was found between health insurance status and area of residence (χ2 = 138.(χ2 = 0.0001).4% of those with acute and other conditions (χ2 = 4. There was no statistical association between typology of illness and social class .6%. 28.6% of young-old and 24.1% and lower class.63. P < 0. P = 0.3% of secondary level and 42.0%) and other health conditions respondents (18. middle class. arthritic (25. P < 0.2% of tertiary level respondents. 41.0%.13. P < 0. similarly a significant relationship existed between health care seeking behaviour and health insurance status (χ2 = 33. (2) social class (χ2 = 441. Those with primary or below education were more likely to have chronic illnesses (45.0001).1% of children.7% of those in the middle class and 9. This study found significant statistical association between health insurance status and (1) educational level (χ2 = 45.9% of old-old.1%) .1%) and tertiary level graduants (11.50.0001).9%) compared to hypertensive. P < 0.042). 18.4% of those in the lower socioeconomic strata.61. Twenty-eight percent of urban dwellers had health insurance coverage compared to 22. acute conditions‘ patients (17.50.730): upper class. P < 0. Almost 33% of the oldest-old had health insurance coverage compared to 15. (28.6% of other aged. Furthermore.

Fifty-eight percent of those with insurance coverage had chronic illnesses compared to 38. P < 0.62. Further examination revealed that other public health insurance was mostly had by those with chronic illnesses (76%) compared to NI Gold (public. Furthermore.2) compared to 29. There is a statistical difference between the mean age of respondents with non-chronic and chronic illnesses (t = . 42% of those with insurance coverage had acute or other conditions compared to 62% of those who did not have health insurance coverage.65.insurance sought medical care in the last 4-weeks compared to 9.07) .93 (SD = 18.001.1) for those with non-chronic illnesses. 49.3 years (SD = 26. P < 0. There was no significant statistical relationship between health care utilization (publicprivate health care visits) and health conditions (acute or chronic illnesses) – χ2 = 0.0% of those who did not have health insurance coverage.365.1.8 years (SD = 168 .975.47 = US $1.3% of those without health insurance.2% of those who had chronic illnesses used public health care facilities compared to 49. Private health coverage was most had by those with non-chronic illnesses (56%) compared to 35% with NI Gold (public) and 25% other public coverage.(Ja.0001).3% of those with acute conditions.23.3 years (SD = 16. P = 0.715) – mean average medical expenditure of those without health insurance was USD 10. P = 0. 65%) and 44% private health coverage (χ2 = 42. P < 0.00 at the time of the survey).68 (SD = 33. Concurringly.0001). the mean age of insured respondents with chronic illnesses was 63.0001). No significant statistical difference was found between the average medical expenditure of those who had insurance coverage and non-insured (t = 0. The mean age of some with chronic illnesses was 62. $80.94) and insured respondents‘ mean average medical expenditure was USD 9. Likewise a statistical association was found between health insurance status and typology of illness (χ2 = 26.

uninsured chronically ill respondents‘ mean age was 61.8. 62.3 years (SD = 25. P < 0. social class. annual non-food expenditure. age.0).5 years (SD = 16.4 examines illness by age of respondents controlled for by health insurance status. 38.5) compared to 28.3 presents information on age cohort of respondents by diagnosed health conditions. time in household.5 years (SD = 16. Self-rated health status. Table 7.4). length of illness and number of visits made to medical practitioner by health insurance status. There is a statistical difference between the mean age of respondents and the typology of self-reported illnesses (F = 99. Concurringly. hypertension.3 years (SD = 31.9 years (SD = 16.9 years (SD = 22. Table1 examines information on crowding index.6 years (SD = 25. and diagnosed health conditions controlled by health status. 19. total annual food expenditure. P < 0.15.8). 22. and health conditions.8) compared to 32. diabetes mellitus. 60. A significant statistical association was found between the two variables χ2 = 436. Table 7. Those with cold. but none between the uninsured and insured. length of marriage. There existed a significant statistical relationship between illness and age of respondents.5).3 years (SD = 14. P = 0.5 presents information on the age cohort by diagnosed health conditions. area of residence.9.3). and other conditions. 64. health care seeking behaviour. 169 .2 years (SD = 23.9). diarrhoea.410. arthritis. income.2. health care utilization by health insurance status are presented in Table 7. 30.0001).9) for those with non-chronic illnesses.5 years for those with non-chronic conditions. Table 7. illness.0001. asthma.1). educational level.

health care utilization. health insurance status. crowding index.9% of the variance in health care utilization.11 presents information on the explanatory variables which account for health insurance coverage.7% of the variance in self-reported diagnosed chronic illness (Table 7. income. Self-reported diagnosed chronic illnesses can be explained by 5 variables (gender. Table 7. area of residence and marital status). 32.Analytic Models Nine variables account for (Table 7.6).2%. health insurance status. marital status and upper 170 . They accounted for 71. Ninety-two percent of the variability in self-reported illnesses was accounted for by health care utilization (health care seeking behaviour). health insurance status.8% of the variance in moderate-to-very good selfrated health status of Jamaicans The variables are medical expenditure.7 shows information on the explanatory factors of self-reported illnesses. Self-reported illnesses accounted for 62. and they accounted for 27. Sixty-two percent of the variability in income can be explained by crowding index. Seven factors accounted for 66. Table 7.9). Table 7. Three variables emerged as statistically significant correlates of health care utilization. health care utilization.8). age. Most of the variability can be explained by self-reported illnesses (71. age and length of illness). health care utilization and illness. Six variables emerged as significant determinants of health insurance coverage (age. marital status. chronic illness. household head.10).2% of the explained variability of moderate-to-very good health status.5% of the variability in self-reported illnesses. household head. Most of the variability in income can be explained by social class (Table 7. area of residence. total food expenditure. self-rated health status. social class.

The explanatory variables accounted for 19.9%). 67% of the chronically ill sought medical care when compared to 66% of the population. Discussion The current paper revealed that 15 out of every 100 Jamaicans reported having an illness in the last 4-weeks.5%).6 times more likely to report having chronic illnesses. The chronically ill had mostly primary level education. Insured respondents were 1. but it was weaker than illness explaining health care utilization (61. and they were 1.4% of the variability in health insurance coverage.socioeconomic class). Illness is a strong predictor of why Jamaicans seek medical care (R2 = 71. Those in the upper 171 . and 57% of those with an illness had chronic conditions. However. and more likely to have greater income than the uninsured. and health insurance coverage accounted for less than onehalf percent of the variance in health care utilization. Public health insurance was most common among those with chronic illnesses (76%) compared to 44% private health coverage and 38% had no coverage. 1. Nine percent more of the chronically ill who the other aged adult cohort did not have health insurance coverage. Almost 2 in every 100 chronically ill Jamaicans were children (less than 19 years). 19.2% of 71.4%).5 times more likely to rate their health as moderate-to-very good compared to the uninsured.9 times more likely to seek more medical care.1% of 66. and most of them were uninsured. Sixty-one out of every 100 of those with chronic illnesses were 60+ years. Income was the most significant determinant of health insurance coverage (explained 43% of the explained variance. health care utilization is a strong predictor of self-reported illness. Most of the chronically ill respondents were uninsured (67%). and there was no statistical association between typology of illness and social class.

married. Like Hafner-Eaton‘s research [2]. the individual or the family. Forty-nine to every 100 chronically ill persons use the public health care facilities. of working age or children. and this economic burden of health care is either going to be the responsibility of the state. Health disparities in a nation are explained by socioeconomic determinants as well as health insurance status.income strata‘s income was significant more than those in the middle and lower socioeconomic group. chronically ill. This mean that health insurance coverage appeases the health care burden of its holder. but the insured in Jamaica are mostly wealthy. Health insurance coverage provides valuable economic relief for chronically ill respondents as this allows them to access needed health care. 38 out of every 100 chronically ill are in the lower class. Previous research showed that health care utilization and health disparities are enveloped in unequal access to insurance coverage and social differences [2. Although this study found that those in the lower class does not have more chronic illness than those in the wealthy class. with less than 20 in every 100 insured being in the lower socioeconomic class. 17-19]. older. these provide a comprehensive understanding of the insured and uninsured that will allow for explanations in health disparities between the socioeconomic strata and sexes. With 43 out of every 100 people in the lower socioeconomic strata self-reported 172 . experienced more acute illness. but chronic illnesses were statistically the same among the social classes. this paper found that health insurance status was the third most powerful predictor of health care utilization. 86 out of every 100 uninsured respondents indicated that their health status was poor. The difficulty here is that the uninsured are more likely to be in the lower-tomiddle class. 4. The uninsured ill are therefore less likely to demand health care. and seek more medical care than the uninsured. The present paper revealed that health insurance coverage is mostly had by those in the upper class.

their choices (or lack). Although the poor may be dissatisfied with the public health care system (waiting time. this is a futuristic product in enhancing a decision to utilize health care. And Gertler and Sturm [3] identified that health insurance cause a switching from public health to the private health system. The public health care system will relieve the burden of the poor. Those in the wealthy socioeconomic group in Jamaica were 3. and health care utilization. public health system and other policy intervention aid in their health. This research showed that only 19% of those with health insurance were in the lower class. the cost of public health care. and while those with health insurance are more likely to utilize health care.being diagnosed with chronic illness.5 times more likely to be holder of health insurance coverage than those in the lower socioeconomic strata. want to avoid the public health care system owing to dissatisfaction or inafffordability. health insurance coverage. Therefore issue of uninsurance creates futuristic challenges for the poor in regard to their health and health care utilization. discriminatory practices by medical practitioners). Among the material deprivation of the poor is uninsurance. better health for them without health coverage is through this very system. It can be extrapolated therefore from the present data that there are unmet health needs among some people in the lower socioeconomic strata. and will only seek health care when their symptoms are severe and sometimes 173 . national insurance scheme and general price index in the society further lowers their quality of life. crowding. those in the lower income strata without health insurance must first think about their illness and weight this against the cost of losing current income in order to provide for their families as well as parents of ill children must also do the same. As on the onset of illness. But outside of those issues. which indicates that a reduction in public health expenditure and health insurance will significantly influence the health of the poor. As those who do not have health insurance.

‘s work [20] that they receive worse access to care. this is an indication of further resistant of the poor from willingly demanding health care as this rehashes their dissatisfaction and humiliation. Apart of the rationales why those in the lower socioeconomic strata have fewer health coverage than those in the wealthy income group are (1) inafffordability. proper nutrition. low paid and uninsured position) which makes it too difficult for them to be holders of health insurance and this retards the switch from public-to-private health care utilization. and this means their conditions would not have been rectified by the health care visitation. It is this lower health care utilization which accounts for their increase risk of mortality as the other deprivations such as proper sanitation and nutrition exposes them to disease causing pathogens which means that their inability to afford health insurance increased their reliance on the public health care system. Recently a study conducted by Bourne and Eldemire-Shearer [21] found that 74% of those in the poorest income quintile utilized public 174 . cripple their future health status. Despite the dissatisfaction and humiliation. Even if they attend the public health care system and are treated. The challenge of the poor is to forego purchasing medication for food. By their very nature. the system does not have all the medications which is an indication that they are expected to buy some. their choices are substantially the public health care system. this accounts for high premature mortality and hinders health care utilization. The present findings showed that the uninsured are mostly poor and within the context of Lasser et al. (2) type of employment (mostly part time. the socioeconomic realities of the poor such as lower access to education. are less satisfied with the care they receive and medical services than the insured in the US. and the burden of private health care. risk of death. poor sanitation and lower health coverage. Among unmet health needs of the poor will be medication. good physical milieu. seasonal.the complications from the delay make it difficult to be addressed on their visits. abstinence from care.

life expectancy. Illness and particularly chronic condition can easily result in poverty. health status. Therefore the opportunity cost of reduced public health care budget is the economic cost of the aforementioned issues.hospitals compared to 58% of those in the second poor quintile and 31% of those in the wealthiest 20%. socioeconomic development. the chronically ill in the United States were 1. orphanage and elderly who become the responsibility of the state from the death of the poor. lowered life expectancy and cost of care for children. leveling insurance coverage can reduce burden of care for those in the lower socioeconomic strata. but the increased health care utilization that result from health coverage. children and other vulnerable groups) will become increasingly exposed to more agents that are likely to result in their deaths. Then.5 times more likely to seek medical care and while this is about the same for Jamaicans. they benefit from health insurance coverage not because of the reduced cost of health care. increased utilization of home remedy as well as the widening of the health outcome inequalities among the socioeconomic strata. poverty reduction strategy and health intervention must include increase health insurance coverage of citizenry within a nation. 175 . With the World Health Organization (WHO) opined that 80% of chronic illnesses were in low and middle income countries and that 60% of global mortality is caused by chronic illness [7]. the socioeconomically disadvantaged population (poor. mortality. Particularly the chronically ill. before mortality sets in. payment of sick time. health insurance is responsible to their health care utilization and not the condition or illness. production. and goes to the explanation of premature mortality in a society. elderly. The economic cost of uninsured people in a society can be measured by the lost of production. if public health becomes privatized or become increasingly more expensive for recipients. The importance of health insurance to health care utilization. From the findings of Hafner-Eaton‘s work [2]. productivity.

and more illness in the future. increased uninsurance. eliminate the barriers to equal opportunity. undernourished. more likely to be unemployed. lower health care utilization. poor health care service delivery. 8. Lifestyle practices are voluntary lifestyle choices and practices [24]. deprived from financial resources. safe drinking water. neither does it increase health and wellness for the poor and remove lower health disparities among the socioeconomic groups. and their voluntary actions will be about survival and not diet. Increases in diseases (acute and chronic) are owing to lifestyle practices of people. which oftentimes occurs because of poverty. Lifestyle choices such as diet. The poor are less educated. However. some people can afford to make these choices. productivity. exercise and other healthy lifestyle choice. premature mortality and lower life expectancy of the population and particular subpopulations. production. lower-income. ―Any truly successful. higher mortality among particular social class. The relationship between poverty and illness is well established in the literature [7. and 176 .According to Andrulis [22]. and those issues contribute to lower health. increase poverty. removal of government subsidy from public health care. safe drinking water are costly. It follows therefore that those in the lower socioeconomic strata‘s voluntary action will be unhealthy choices which are cheaper. and sanitation. especially for low-income populations who have suffered from chronic underservice if not outright neglect‖ Embedded in Andrulis‘s work is the linkage between poverty. deep-seated barriers in health care delivery and the perpetuation of those and how they can increase health differences among the socioeconomic strata. 23] as poverty means deprivation from proper nutrition. increase price indices. differences in health outcomes among the socioeconomic groups. nutrition. Free public health care or lower public health care cost does not mean equal opportunity to access. Poverty therefore handicaps its people. proper nutrition. long-term solution to the health problems of the nation will require attention at many points.

which further accounts for greater mortality. Conclusion Poverty is among the social determinants of health. Any increase in health care utilization will be able to improve health outcome. and goes to the crux of health disparities among the socioeconomic groups and sexes. and this will even increase premature mortality among those in the lower socioeconomic strata.predetermines unhealthy lifestyle choices. health care utilization. and health insurance coverage in a society. building clinics and hospitals and there is definite a need to include health insurance coverage to their public health measure as this will increase access to health care utilization. health insurance coverage and private health care utilization. and this embodies the challenges of those in the vulnerable groups. reduce health disparities between the socioeconomic groups and the sexes that will see improvements in the quality of life of the poor. 177 . While the current paper does not support the literature that chronic illnesses were greater among those in the lower socioeconomic strata. Governments in developing nations continue to invest in improving public health measures such as safe drinking water. Health care utilization is associated with health insurance coverage as well as government‘s assistance. lower life expectancy. they were less likely to have health insurance coverage compared to the upper class. Poverty denotes socioeconomic deprivation of resources which appears in a society. Within the current global realities. many governments are seeking to reduce their public financing of health care which would further shift the burden of health care to the individual. mass immunization) and the training of medical personnel. sanitation.

and this will further increase the mortality among those cohorts. none of the errors in this paper should be ascribed to the Planning Institute of Jamaica or the Statistical Institute of Jamaica.9 times more than the uninsured and illness being a strong predictor of health care seeking. their health care utilization being 1.In summary. any reduction in the health care budget in developing nations denotes that vulnerable groups (such as elderly. Disclaimer The researchers would like to note that while this study used secondary data from the Jamaica Survey of Living Conditions. but to the researchers.5 times more than the uninsured. with the health status of the insured being 1. 178 . Conflict of interest The authors have no conflict of interest to report. children and poor) will seek less care.

Health insurance coverage in Jamaica: Multivariate analyses using two crosssection survey data for 2002 and 2007. Stronks K. Poverty: An ordinal approach to measurement. (PIOJ). 1988-2000. and health insurance. Jamaica: Planning Institute of Jamaica and Derek Gordon Databank. at http://siteresources. 10:197-200. Bourne PA. 7. In: Pan American Health Organisation. Bambas A. Issue Brief (Common Fund) 729:1-6. 2002.org/INTLSMS/Resources/33589861181743055198/3877319-1190214215722/binfo2000. Washington: The World Bank. Hafner-Eaton C. 2007 [Computer file]. Fox J ed. 2009. 22-49. Men. 4. 15. Gertler P. Jamaica Survey of Living Conditions. University of the West Indies [distributors]. Doty MM. Statistical Institute Of Jamaica. Marmot M . Sen A. Geneva: WHO. Jamaica Survey of Living Conditions. 179 . Kingston: PIOJ. Miles S. 16. 3. 10. Health inequalities in Europe. Illsley R. Parker K. 2008. and well nonelderly populations. Statistical Institute of Jamaica. Poverty and Human Resources.The influence of Income on Health: Views of an Epidemiologist.pdf). Soc Sci Med 1990. 11. 21:3146. 2005. World Health Organization. 1989-2008. Jamaica: Statistical Institute Of Jamaica [producer]. 77:237-257. Private health insurance and public expenditures in Jamaica. Casas JA. Journal of Econometrics 1997. Self-reported health and medical care-seeking behaviour of uninsured Jamaicans. Unequal access: insurance instability among low-income workers and minority. 2007. 13. WHO. Physical utilization disparities between the uninsured and insured: Comparisons of the chronically ill.worldbank. Eur J of Public Health 2000. 2001: pp. Svenson PG. Jamaica Survey of Living Conditions. 269:787-792. Chronic illness and poverty in the Netherlands. (September 2. 219231. 336:218-221. 6. Kingston. Preventing Chronic Diseases a vital investment. Basic information. Aldershot: Gower Publishing Company Limited. The New England Journal of Medicine 1997. Mackenbach JP. 2: 71-80. World Bank. (STATIN). 9. STATIN. 1989. 44. 12. ed. acutely ill. Does money really matter? Or is it a marker for something else? Health Affairs 2002. Health disparity in Latin America and the Caribbean: The role of social and economic determinants. Van Agt HME. women. Planning Institute of Jamaica. Occasional Publication No. 14. Econometricia 1979. 5. Holmgren AL. Kingston. Bourne P. Equity and health: Views from the Pan American Sanitary Bureau. 8. 31(special issue):223-420. Int J of Collaborative Research on Internal Medicine and Public Health 1:195-213. Health inequalities in European Countries. North Am J Med Sci 2010. JAMA 1993. Dachs JN. Development Research Group. Washington DC. 8. 2.References 1. 1989-2007. Sturm R.

Australian J of Basic and Applied Scie 2009.79:1139-47. health status. Am J Public Health 200696:1300-1307. The American Economic Review 1994. N Engl J Med 1988. Poverty and illness in low-income rural areas. Acad Med 2004.318:1507-12. 23. and health disparities in the United States and Canada: Results of a Cross-National PopulationBased Survey. Williams DR. 129:412-416. Hayward RA. et al. Access to care is the centerpiece in the elimination of socioeconomic disparities in health. Jansson E. Hedberg GE. J Natl Med Assoc 2002. European J of Public Health 1998. Do working-age adults have less access to medical care than the elderly. Andrulis DP. 22. 3:3067-3080. Lasser KE. 180 . Inequalities in health services among insured Americans. LaVeist TA. 18. Health status and health behaviour in men and women at the age of 34 years. 20. Fiscella K. Janlert U. Barnekow-Bergkvist M. 24. Shapiro MF. 19. 94:937-43. Carroll T. 84:216-220. Ann Intern Med 1998. Race of physician and satisfaction with care among AfricanAmerican patients.17. Access to care. Bourne PA. Foster AD. Health disparities based on socioeconomic inequities: implications for urban health care. Himmelstein DU. Public hospital health care utilization in Jamaica. 21. Eldemire-Shearer D. 8:179-182. Woolhandler S.

7±51.5±1.0 1.32.21.89±9713.6.2 t = .75.00 at the time of the survey) 181 .0.81.0001 1 Income 7703.8 t = .1±2.60 t = . 0. expenditure.97 3948.6 4.97 t = .62.Table 7.104 Length of marriage 16.122 Length of illness 14.4 35.7±21. 0.0001 Time in household (in years) 11. and other characteristics by health insurance status Health insurance status P Characteristics Non-insured Insured mean ± SD mean ± SD Crowding index 4.62±5620.12±2257.1 14.1.33. < 0. of visits to medical practitioner 1. < 0.828 No.4±1.00 t = . income. < 0.8±1. 0.9.09±2129. age.7 t = .0001 Age (in year) 28.6 11.1 t = 10.1.3 18.40±5597.511 1 Expenditures and income are quoted in USD (Ja.1±36.50 6339.47 = US $1.9±14. 0.2 t = . Crowding.3 t = .40.217.659.94 12374.22.0001 Total annual food expenditure1 3476.9 ± 2.1.0 ±22. < 0.7±1.55.91±3332.3±13.0001 Annual non-food expenditure1 3772. $80. < 0.0.

P < 0. health care seeking behaviour.7) 63 (18.8) Semi-urban 212 (26.0001 Health conditions Acute and other 53 (56.09.2) 4735 (91.8) Yes 112 (13.Table 7.7) Chronic 41 (43.4) Secondary 80 (9.8) Public 17 (20.7) 736 (14.6) 101 (64.0001 Education level Primary and below 684 (84.0001 Illness No 699 (86.7) 736 (14.0001 Self-rated health status Poor 699 (86. Health.0001 Health care utilization Private 65 (79.8) 74 (21.2) 272 (78.3) 283 (81.1) 1397 (26.1) 1773 (34.1) χ2 = 190.2) 272 (78.1) 32 (20.2) 4 (2.7) 4536 (87.0001 Social class Lower 78 (9. P < 0.5) 18 (46.6) 63 (40.9) 174 (50.1) Middle 111 (13.0) 106 (30.7) 2345 (45.0) χ2 = 67. P < 0.6) 45 (65.1) 27 (17.3) 62 (39.2) 1085 (20.7) 131 (37.7) 9 (5.7) 577 (11.0) 31 (19.7) 32 (52.5) 2715 (52.8) Moderate-to-excellent 112 (13.8) 468 (9.2) χ2 = 30.8) 244 (53. P < 0.3) 4453 (85.2) 39 (24.7) 80 (23.1) 66 (19.5) 415 (61.4) 56 (35.4) 1091 (21.2) 40 (75.4) 56 (35.08. illness and particular demographic characteristics by health insurance status Health insurance status P Characteristic Coverage No coverage Private n (%) Public.4) χ2 = 596.0001 Health care seeking behaviour No 724 (89.2) 182 . P < 0.14.4) 24 (34.4) 318 (92.7) 4 (1.2.29.0001 Area of residence Urban 373 (46.5) 21 (53.06.0) Yes 87 (10. P < 0.10.0) Rural 226 (27.6) 101 (64.1) Tertiary 46 (5.9) Upper 622 (76.3) 4453 (85.6) 135 (39.3) 118 (75. P < 0.9) 99 (63. NI Gold n (%) Other Public n (%) n (%) χ2 = 42.2) 144 (91.9) 23 (6.2) χ2 = 78.62.5) 258 (38.8) 13 (24.2) χ2 = 67.3) 29 (47.14.3) χ2 = 70. P < 0.8) 74 (21.2) 215 (46.5) 74 (1.

4) 85 (36.1) 51 (53.8) 76 (36.4) 16 (16.4) 0 (0.Table 7.4) 2 (7.0) 0 (0.6) 22 (39.3) 32 (13.4) 49 (39.3.6) 108 (12.9) 17 (30.8) 14 (25.7) 27 1 (1.1) 218 (24.8) 206 2 (3.2) 18 (18.4) 7 (7.5) Young adults 14 (94) 2 (7.8) 43 (18.3) 268 (30.8) 3 (2.7) 181 (20.0) 54 (23.0) 13 (5.6) 56 7 (3.1) 13 (48. Age cohort by diagnosed illness Diagnosed illness Acute condition Cold Age cohort n (%) Children n (%) n (%) n (%) n (%) n (%) n (%) n (%) Diarrhoea Asthma Diabetes mellitus Chronic condition Hypertension Arthritis Other Total 97 (65.1) 19 (15.7) 3 (2.8) 61 (29.4) 890 183 .4) 3 (11.8) 6 (22.0) 149 1 (3.4) 49 (23.4) 6 (2.4) 85 (9.9) 1 (1.1) Young old 8 (5.1) 123 14 (6.9) 44 (35.3) Old Elderly 8 (5.1) 2 (2.0) 234 30 (3.6) Other-aged adults 22 (14.1) Oldest Elderly Total 0 (0.1) 95 5 (4.

Table 7.4. Illness by age of respondents controlled for health insurance status Age of respondents Characteristic Uninsured Insured Mean ± SD Mean ± SD Illness Acute condition Cold 18.8 ± 23.5 21.0 ± 26.3 Diarrhoea 28.4 ± 30.3 31.8 ± 13.5 Asthma 21.0 ± 21.7 29.4 ± 22.9 Chronic condition Diabetes mellitus 58.7 ± 16.1 63.8 ± 15.4 Hypertension 62.1 ± 17.3 63.6 ± 15.7 Arthritis 64.0 ± 13.3 65.0 ± 18.7 Other condition 38.1 ± 25.0 39.2 ± 26.8 F statistic 73.1, P < 0.0001 23.3, P < 0.0001

184

Table 7.5. Age cohort by diagnosed health condition, and health insurance status Diagnosed health condition Acute Chronic n (%) Age cohort Children Young adults Other aged-adults Young-old Old-old Oldest-old Total n (%) Diagnosed health condition Acute Chronic Uninsured n (%) n (%) Acute Chronic Insured n (%) n (%)

Characteristic

215 (42.6) 3 (0.8) 75 (14.9) 10 (2.6) 131 (25.9) 137 (2.6) 49 (9.7) 132 (34.3) 26 (5.1) 82 (21.3) 9 (1.8) 21 (5.5) 505 385 2 χ = 317.5, P < 0.0001

183 (44.1) 1 (0.4) 32 (35.6) 2 (1.6) 58 (14.0) 6 (2.3) 17 (18.9) 4 (3.2) 110 (26.5) 100 (38.6) 21 (23.3) 37 (29.4) 37 (8.9) 82 (31.7) 12 (13.3) 50 (39.7) 20 (4.8) 55 (21.2) 6 (6.7) 27 (21.4) 7 (1.7) 15 (5.8) 2(2.2) 6 (4.8) 415 259 90 126 2 2 χ = 234.5, P < 0.0001 χ = 73.6, P < 0.0001

185

Table 7.6. Logistic regression: Explanatory variables of self-rated moderate-to-very good health
Explanatory variable Average medical expenditure Health insurance coverage (1= insured) Urban Other †Rural Household head Age Crowding index Total food expenditure Health care seeking (1=yes) Illness Model fit χ2 = 574.37, P < 0.0001 -2LL = 1477.76 Nagelkerke R2 = 0.328 †Reference group ***P < 0.0001, **P < 0.01, *P < 0.05 Coefficient Std. error Odds ratio 95.0% C.I. R2 0.003 0.005 0.007 0.006

0.000 0.410 0.496 0.462

0.000 0.181 0.180 0.197

1.00* 1.51* 1.64** 1.59* 1.00 1.46* 0.96*** 0.86*** 1.00*** 0.51** 0.24***

1.00 -1.00 1.06 - 2.15 1.15 - 2.34 1.08 - 2.34

0.376 -0.046 -0.156 0.000 -0.671 -1.418

0.154 0.004 0.035 0.000 0.211 0.212

1.08 - 1.97 0.95 - 0.96 0.80 - 0.92 1.00 - 1.00 0.34 - 0.77 0.16 - 0.37

0.004 0.081 0.010 0.003 0.005 0.204

186

Table 7.7. Logistic regression: Explanatory variables of self-reported illness
Explanatory variable Average medical expenditure Male Married Age Coefficient Std Error Odds ratio 95.0% C.I.

R2
0.001 0.003 0.002 0.037 0.002 0.009 0.611

0.000 -0.467 0.527 0.031 0.000 -1.429

0.000 0.137 0.146 0.004 0.000 0.213 0.262

1.00* 0.63** 1.69*** 1.03*** 1.00** 0.24*** 342.11***

1.00 - 1.00 0.48 - 0.82 1.27 - 2.25 1.02 - 1.04 1.00 -1.00 0.16 -0.36 204.71 -571.72

Total food expenditure
Self-rated moderate-to-excellent health

5.835 Health care seeking (1=yes) Model fit χ2 = 2197.09, P < 0.0001 -2LL = 1730.41 Hosmer and Lemeshow goodness of fit χ2 = 4.53, P = 0.81 Nagelkerke R2 = 0.665 †Reference group ***P < 0.0001, **P < 0.01, *P < 0.05

187

Table 7.8. Logistic regression: Explanatory variables of health care seeking behaviour
Explanatory variable Coefficient Std error Odds ratio 95.0% C.I. R2

Health insurance coverage (1= insured)
Self-reported illness Self-rated moderate-to-excellent health

0.620 5.913 -0.680

0.179 0.252 0.198

1.86** 369.92*** 0.51**

1.31 - 2.64 225.74 - 606.17 0.34 - 0.75

0.003 0.712 0.004

Model fit χ2 = 1997.86, P < 0.0001 -2LL = 1115.93 Hosmer and Lemeshow goodness of fit χ2 = 1.49, P = 0.48 Nagelkerke R2 = 0.719 †Reference group ***P < 0.0001, **P < 0.01, *P < 0.05

188

Table 7.9. Logistic regression: Explanatory variables of self-reported diagnosed chronic illness
Explanatory variable Male Married †Never married Coefficient -1.037 0.425 Std error 0.205 0.199 Odds ratio 0.36*** 1.53* 1.00 1.58* 1.05*** 1.13* 95.0% C.I. 0.24 - 0.53 1.04 - 2.26

R2 0.048 0.012

Health insurance coverage (1= insured)
Age Logged Length of illness

0.454 0.047 0.125

0.220 0.005 0.059

1.02 - 2.42 1.04 - 1.06 1.01 - 1.27

0.008 0.201 0.008

Model fit χ2 = 136.32, P < 0.0001 -2LL = 673.09 Hosmer and Lemeshow goodness of fit χ2 = 15.96, P = 0.04 Nagelkerke R2 = 0.277 †Reference group ***P < 0.0001, **P < 0.01, *P < 0.05

189

Table 7.10. Multiple regression: Explanatory variables of income
Unstandardized Coefficients B 11.630 0.206 1.265 0.692 Std. Error 0.061 0.008 0.052 0.047 Standardized Coefficients Beta 95% CI 11.511 - 11.750 0.190 - 0.221 1.162 - 1.368 0.599 - 0.784

Explanatory variable Constant Crowding index Upper class Middle Class †Lower class Household head

R2

0.625*** 0.649*** 0.347***

0.195 0.320 0.133

-0.181 0.137 0.165 0.109 0.145 0.130 0.075

0.038 0.042 0.040 0.039 0.046 0.049 0.038

-0.108*** 0.075** 0.094*** 0.063** 0.079** 0.063** 0.044*

-0.256 - -0.106 0.054 - 0.220 0.088 - 0.243 0.033 - 0.185 0.055 - 0.235 0.033 - 0.226 0.000 - 0.150

0.012 0.007 0.006 0.003 0.002 0.003 0.001

Health insurance coverage (1= insured)
Self-rated good health status

Health care seeking (1=yes)
Urban Other town †Rural area Married †Never married

F = 144.15, P < 0.0001 R2 = 0.682 †Reference group ***P < 0.0001, **P < 0.01, *P < 0.05

190

Table 7.11. Logistic regression: Explanatory variables of health insurance status (1= insured)
Explanatory variable Age Income Chronic condition Health care seeking (1=yes) Married †Never married Upper class †Lower class Coefficient 0.014 0.000 0.563 0.463 0.647 Std. error 0.006 0.000 0.210 0.211 0.192 Odds ratio 1.01* 1.00*** 1.7** 1.59* 1.91** 95.0% C.I. 1.00 - 1.03 1.00 - 1.00 1.16 - 2.65 1.05 - 2.40 1.31 - 2.79 R2 0.040 0.082 0.013 0.010 0.024

0.841

0.227

3.46***

1.49 - 3.62

0.025

Model fit χ2 = 95.7, P < 0.0001 -2LL = 686.09 Hosmer and Lemeshow goodness of fit χ2 = 5.08, P =0.75 Nagelkerke R2 = 0.194 †Reference group ***P < 0.0001, **P < 0.01, *P < 0.05

191

8
Good Health Status of Rural Women in the Reproductive Ages
Paul A. Bourne & Joan Rhule

Women are traditionally overrepresented among the poor and therefore in the long run, have less access to remuneration and health resources, including health insurance and social security services. Women are disadvantaged on some fundamental economic indicators such as unemployment and access to economic resources. In 2007 in Jamaica, for instance among the 124 500 unemployed persons in the labour force, 65.4 % were women (Planning Institute of Jamaica, 2008). Thus, women's health and the control that they can exercise over resources are key factors in achieving effectiveness, efficiency, and sustainability in health interventions. This study examined the good health status of rural women in the reproductive ages of 15 to 49 years. Having extensively reviewed the literature, this paper is the first study of its kind in Jamaica and will provide pertinent information on this cohort for the purpose of public health planning. Using logistic regression analyses, 6 variables emerged as statistically significant predictors of current good health status of rural women (i.e. ages 15 to 49 years) in Jamaica. These are social standing (two wealthiest quintile – OR=0.524, 95%CI: 0.350,0.785); marital status (separated, divorced or widowed – OR=0.382, 95%CI: 0.147, 0.991); health insurance (OR=0.041, 95%CI: 0.024, 0.069); negative affective psychological conditions (OR=0.951, 95%CI:0.704, 1.284); asset ownership (OR=1.089, 95%CI:1.015, 1.168) and age of respondents (OR+0.965, 95%CI:0.949, 0.982). Poverty is synonymous with rural area and women, and inspite of this reality majority of rural women in Jamaica ages 15 to 49 years reported current good health status. Wealth creates more access to financial and other resources, and makes a difference in nutritional intake, water and food quality as well as an explanation for better environmental conditions. In this study, wealth did not mean better health but that poor women had greater health status than their wealthy counterparts. Another interesting finding was that good health is inversely correlated with the ownership of health insurance coverage.

192

Introduction

Many studies have shown that there is a statistical relationship between health status and poverty (Murray, 2006; Marmot, 2002; Muller & Krawinkel, 2005; Bloom & Canning, 2003; Smith & Waitzman, 1994), standard of living (Pacione, 2003; Bourne, 2007a, 2007b), and other socioeconomic determinants (Grossman, 1972; Smith & Kington 1997; Bourne, 2009; Bourne & McGrowder, 2009 Benzeval et al, 2001) . According to Abel-Smith (1994), the influence of income on health decreases as the society shifts from lowers to higher levels of income. And this is in keeping with the findings that show an inverse relationship between income of a country and levels of mortality, and the reverse is equally true (Abel-Smith, 1994; Matsaganis, 1992). Other scholars have refined this association when they opined that it is inequalities of income within a country that explains higher mortality and not mere income (Cochrane et al, 1978). The use of mortality to assess health is primary because this is easily measurable unlike the use of morbidity which is a minimalist‘s approach to the study of health (Grossman, 1972); but the latter still does not capture quality life expectancy and so is the former measure. The emphasis on income to provide explanation for health status without incooperating sanitation, education and lifestyle practices (Bourne, 2007a, 2007b; Hambleton et al, 2005), water and (Abel-Smith, 1994), health care do not provide the core rationale for the health status of a population as the determinants of health covering, social, economic, psychological, environmental, and biological conditions. In many societies across the world, poverty is rural and gender specific. Poverty is more than just the lack of income (ie. low income) as it includes the lack of access to services,
193

resources and skills, vulnerability, insecurity and powerlessness. There is another result of poverty which has a multiple effect on the economy, and that is poor health conditions owing to malnutrition, low water quality, non-access to primary health care and food insecurity. According to the WHO (2005), 80% of chronic illnesses were in low and middle income countries, suggesting that illness interfaces with poverty and vice versa. A study by Bourne, Beckford and McGrowder (2009), using 2-decade of data on unemployment, self-reported and health-care-seeking behaviour of Jamaicans (from 1988-2007), found that there was a positive correlation between poverty and unemployment; poverty and illness; and crime and unemployment. In Jamaica, poverty is substantially a rural and gender phenomena. Statistics from the Planning Institute of Jamaica and the Statistical Institute of Jamaica (PIOJ & STATIN, 2008) revealed that in 1997, 19.9% of Jamaicans were poor. Of this figure, 73.3% were in rural areas; 13.1% in semi-urban zones and 13.6% in urban areas. One decade later (ie 2007), the prevalence of poverty fell to 9.9% of which 71.3% was in rural areas, 8.9% in semi-urban and 19.9% in urban zones. In the same year (ie 2007), 11.1% of persons living in female-headed households were classified as poor compared to 8.6% of those residing in male-headed household. Poverty is not only rural as there has been a rising in its levels in urban areas. The survey determined the poverty line was US$ 1,070.32 per year (US $2.92 per day) for an individual and US$ 4045.29 per year for a family of five (US $2.22 per person per day). The Jamaica Survey of Living Conditions (2002) indicated that the wealthiest 20% of the population accounted for 45.9% of national consumption while the poorest 20% accounted for only 6.1% of national consumption. On average, the wealthiest 10% of the population consumed approximately 12.5 times more than the poorest 10%. This is a mean per capita annual consumption expenditure of US$ 3963.53
194

compared to US$314.48. The Jamaica is not atypical in having poor people or having to address the predominance of this rural phenomenon. The World Bank (1996) estimated that in 1996,

38% of the total population (or 25% including Haiti) in the Caribbean or more than seven million people to be poor. According to Bourne (2008), in 1880 to 1882, life expectancy at birth for men was 37.02 years and 39.80 years for women with the gap between sexes widening to 5.81 years (71.26 for men and 77.07 for women). Despite the high life expectancy of women in Jamaica which is comparable to that of many developed nations (United Nations, 2002), people with lower socioeconomic status have worse health in all adult age groups, including older ages (House et al, 2005). Reduced capacity to generate income and the growing risk of illness increase the vulnerability of the elderly to poverty, regardless of their original economic status, in developing and industrialized countries (Lloyd-Sherlock, 2000). Poverty, therefore, is age, area and gender specific. Women are traditionally overrepresented among the poor and therefore in the long run, have less access to remuneration and health resources, including health insurance and social security services. Women are disadvantaged on some fundamental economic indicators such as unemployment and access to economic resources. In 2007 in Jamaica, for instance among the 124 500 unemployed persons in the labour force, 65.4 % were women (Planning Institute of Jamaica, 2008). Thus, women's health and the control that they can exercise over resources are key factors in achieving effectiveness, efficiency, and sustainability in health interventions. According to Marmot (2002), poverty accounts for poor nutrition and physical milieu, deprivation from material resources and further explains the higher levels of health conditions of
195

those that are therein. The WHO (2005) concurs with Marmot as it opined that poverty explains chronic illness and premature death. Women are more likely to be poor, unemployed and have lower material wealth compared to men. Like the WHO (2005), Marmot (2002) and Abel-Smith (1997) that showed the health challenges of being poor and by extension female, any study of health status and women must include not only poverty but other socio-demographic variables. Poverty is substantially more than income poverty; it is the denial of choices and opportunities for living a tolerable life (UNDP, 1997). Over the past two to three decades, our understanding of poverty has broadened from a narrow focus on income and consumption to a multi-dimensional notion of education, health, social and political participation, personal security and freedom, and environmental quality. Hence, those socio-economic factors not only explain poverty they influence health status for the individual, household, society, country and world. Health which is more than the absence of diseases (WHO, 1948) suggests that people are multi-dimensional and any study of their health status must incorporate the environment (Pacione, 2), income (Grossman, 1972; Smith & Kingston, 1997; Bourne, 2009). The WHO has endorsed the evaluation of social determinants in any examination of health status (WHO, 2008; Kelly et al. 2007). It is the social determinants (ie non-biological factors) which produce the inequality in income, health and regards health development. Hence, addressing those determinants account for a percentage of health status (Hambleton et al. 2005). In a study of elderly Barbadians, Hambleton et al. (2005) found that biological conditions accounted for 67.5% of health status of sample. This indicates that the social determinants are equally

important in the examination of health status (they account for 32.5% of the explanatory power of health status).
196

Concomitantly, Hambleton et al.‘s work reveals that there was a statistical causal relationship between socioeconomic conditions and the health status of Barbadians. The

findings reveal that 5.2% of the variation in reported health status was explained by the traditional determinants of health. Furthermore, when this was controlled for current

experiences, this percent fell to 3.2% (falling by 2%). When the current set of socioeconomic conditions were used they account for some 4.1% of the variation in health status, while 7.1% were due to lifestyle practices compared to 33.5% that was as a result of current diseases (see Hambleton et al. 2005). It holds that importance place by medical practitioners on the current illnesses – as an indicator of health status – is not unfounded as people place more value on biomedical conditions as responsible for their current health status. Diener (1984, 2000) and others (Idler & Benyamini 1997; Idler & Kasl, 199) have showed that wellbeing, happiness or health status is equally good to measure health or subjective wellbeing. Economists like Grossman (1972) and Smith & Kington (1997) have used selfreported health status in evaluating health of people. Hence, self-reported health status (health status) is widely accepted in health literature as a measure of health status. In this study, data were not collected on health status but on health conditions. The sample was asked to state whether they have an illness or not, and if they do what were the typology of health conditions. For this paper the researcher used good health status to indicate not reported a health condition and poor health to indicate at least one reported health condition. Self-reported ill-health is not an ideal indicator of actual health conditions because people may underreport; however, it is still an accurate proxy of ill-health and mortality (Idler & Kasl, 1991; Idler & Benyamini, 1997).

197

The reason for the importance of health conditions (illness) is simply that a healthy population holds the key to development. It is within this framework that a study of health is required to examine the factors that determine health status of women in the reproductive years of 15 to 49 years. It is clear from the review of the literature that health is influenced by income and other social factors. A literature search revealed that no study existing in the Caribbean, in particular Jamaica has sought to examine factors that determine the health status of rural women in the reproductive ages of 15 to 49 years. This is the first research of its type in the Caribbean and in particular Jamaica. It provides an insight into the factors that determine self-reported health status of women in ages 15 to 49 years, and this can now be used to guide public health policy. Hence, the purposes of this study are to (i) examine the good health status of women in the reproductive ages, (ii) model socio-economic determinants of good health status of women in the reproductive ages, and (iii) provide public health policy makers with research information on this cohort for better policies design in the future. Methods Participants and questionnaire The current research extracted a sample of 3 450 respondents who indicated that they were rural women ages 15 to 49 years. This sample was taken from a national cross-sectional survey from the 14 parishes in Jamaica. The survey used a stratified random probability sampling technique to drawn the original 25 018 respondents. The non-response rate for the survey was 29.7%. The study used secondary cross-sectional data from the Statistical Institute of Jamaica (2003) (ie Jamaica Survey of Living Conditions or JSLC). The JSLC was commissioned by the Planning

198

Institute of Jamaica and the Statistical Institute of Jamaica. These two organizations are responsible for planning, data collection and policy guidelines for Jamaica.

The JSLC is a self-administered questionnaire where respondents are asked to recall detailed information on particular activities to trained interviewers from the Statistical Institute of Jamaica. The questionnaire covers demographic variables, health, immunization of children 0– 59 months, education, daily expenses, non-food consumption expenditure, housing conditions, inventory of durable goods and social assistance. Interviewers are trained to collect the data from household members. The survey is conducted between April and July annually. Model The multivariate model used in this study (a modification of Bourne and McGrowder‘s health status model) captures a multi-dimensional concept of health and health status. It is fundamentally different from that of Bourne and McGrowder‘s model (2009) as it is gender (women) and age specific (15 to 49 years), and a number of new variables were included such as social standing; crime and pregnancy. Hence, the proposed model that this research seeks to evaluate is displayed (Eqn (2)):
Ht = f(lnPmc, EDi, Rt, HIi, HTi, Xi, CRi,(ΣNPi, PPi), Mi, Fi, Ni, Ai, εi) [1]

Where the current good health status of a rural resident, Ht, is a function of 12 explanatory variables, where Ht is current good health status of person i, if good or above (ie no reported health conditions in the 4 weeks leading up to the survey period to trained interviewers from the
199

PPi) NPi is the sum of all negative affective psychological conditions. Only those explanatory variables that are statistically significant (p <0. Here. 0 if poor (ie at least one health condition reported to trained interviewers from the Statistical Institute of Jamaica).05) were used in the final model to predict current health status of Jamaican women in the reproductive ages of 15 to 49 years. the final model that accounted for self-reported good health of Jamaican women in the reproductive years of 15 to 49 years is expressed in Eqn. Rt is the retirement income of person i. Ai is the age of the person i and Ni is the number of children in the household of person i. [2]. HTi is the house tenure of person i. 1 if female.Statistical Institute of Jamaica). Di. 0 if otherwise. (∑2i=1 NPi. where 1 = living with family members or relatives.. and 0 = otherwise. Ai. Di is 200 . Ht = f(Wi. 0 if male. HIi. HIi. Variables were identified from the literature. CRi is crowding in the household of person i. marital status of individual i. NPi. 1 if they have a health insurance policy. and PPi is the sum of all positive affective psychological conditions. εi) [2] The current good health status of Jamaican women in the reproductive ages of 15 to 49 years. is a function of social standing of individual i. Xi is the gender of person i. LLi is the living arrangements. 0 if squatted. Mi is the number of males in the household of person i and Fi is the number of females in the household of person i. EDi is the educational level of person i. lnPmc is the logged cost of medical care of person i. using the principle of parsimony. health insurance of person i. Wi. NPi is negative affective psychological conditions of person i. 1 if rent. 1 if receiving private and/or government pension. Ht. HIi is the health insurance coverage of person i. 1 if tertiary and the reference group is primary and below. 1 if secondary. MRi. MRi. 0 if otherwise.

where 1 (good health) = not reporting an ailment or dysfunction or illness in the last 4 weeks. it is still an accurate proxy of ill-health and mortality (Idler & Kasl. Social supports (or networks) denote different social networks with which the individual is involved (1 = membership of and/or visits to civic organizations or having friends who visit ones home or with whom one is able to network. injuries or illnesses. middle class were those classified as in quintiles 3 and wealth (upper classes) were those classified in quintiles 4 and 5 ( quintile 5 being the wealthiest income quintile). Harris & Lightsey. 0 (poor health) if there were no self-reported ailments. Negative affective psychological condition is the number of responses from a person on having lost a breadwinner and/or family member. Measures An explanation of some of the variables in the model is provided here. 0 = otherwise). Health status is a dummy variable. While self-reported ill-health is not an ideal indicator of actual health conditions because people may underreport. which was the survey period. optimistic about the future and life in general. Psychological conditions determine the psychological state of an individual. Per capita income quintile was used to measure social standing. Idler & Benyamini. Poor (ie lower class) were all individuals classified as in poorest and poor quintiles (ie quintiles 1 and 2). being made redundant or failing to meet household and other obligations. 2005) Positive affective psychological condition is the number of responses with regard to being hopeful. Statistical analysis 201 . 2000. 1997).total number of durable good owned by individual i (excluding property and land) and Ai is the age of the person i. having lost property. 1991. and this is subdivided into positive and negative affective psychological conditions (Diener.

39). IL.5% had 202 . 20. 84.Statistical analyses were performed using the Statistical Packages for the Social Sciences v 16.4–0. The correlation matrix was examined in order to ascertain whether autocorrelation (or multi-collinearity) existed between variables.3% were pregnant. The logistic regression used as dependent variable was binary. The enter method in logistic regression was used to test the hypothesis in order to determine those factors that influence the health status of rural residents. social.7–1). Wald statistics were used to determine the magnitude (or contribution) of each statistically significant variable in comparison with the others. Results: Demographic Characteristics of sample Of the sampled respondents (n=3. 78.0 (SPSS Inc. moderate (0. Chicago.6% had secondary level education. 89.7% reported good health. The predictive power of the model was tested using the ‗omnibus test of model‘ and Hosmer and Lemeshow‘s (2000) technique to examine the model‘s goodness of fit. and all other variables were removed from the final model (p >0. A single hypothesis was tested.69). The final model was based on those variables that were statistically significant (p <0. USA) for Widows. Finally. Cohen and Holliday (1982) stated that correlation can be low/weak (0–0. and the odds ratio (OR) for interpreting each of the significant variables. which was: the health status of rural residents is a function of demographic. 3. This was used in the present study to exclude (or allow) a variable. Descriptive statistics included frequency.450). psychological and economic variables. or strong (0.05).05). Categorical variables were coded using the ‗dummy coding‘ scheme. mean and standard deviation were used to provide background information on the sample. 5.6% were never married.1% were married.

mean age was 29.3% reported being diagnosed with (chronic) recurring illness.1% who were classified in the two wealthiest quintiles and 49.7% belonged to the two poorest quintiles compared to 34. 31. the median number of days was 7 days.4%).3% of the sample that indicated poor current health status.7 years (SD=9.3% were owners of lands. When those who mentioned having a recurring dysfunction were asked about the length of the last attack. 45.7% indicated arthritis and 9.private health insurance coverage.1). 203 .6% visited a public hospital or public health care establishment in the 4-week period of the survey (Table 8.40. 22. 69.37 (SD= US$40.9 years). Marginally. On an average. 58. They also indicated that 3 days were the median number of days that prevented them from carrying out their normal activities. more of those who reported being diagnosed with a recurring ailment had hypertension (36.1% had some form of social support. there were 2 persons per household (SD=1 person). Of the 15.8% did not specify the condition.81).1% claimed diabetes mellitus. with average medical expenditure being US $26.

97 = 1 US$ 204 .6 Tertiary 149 5.22 ± Ja.4 3 698 20.6 Private hospital or establishment 124 50.6 Divorced/Separated/Widowed 45 1.3 Secondary or post-secondary 2574 89.3 Health Insurance: No 3138 94.3 Social Support: No 2065 59.1 ± 1.$2.546 to maximum: Ja.2 4 707 20.7 Yes 106 3.5 5=Wealthiest 469 13.$1.7 Yes 1432 58.5 Yes 183 5.$1.3 Good 2832 84.35.7 ± 9.876.3 2 808 23.$39.1 Never married 2605 78.9 Yes 1385 40.1: Demographic characteristic of sample Number Percent Current Health Status: Poor 511 15.6 Marital status: Married 665 20.64± Ja. $30.Table 8.344.4 Social Standing (ie per capita Income quintile): 1=Poorest 768 22.5 Land Ownership: No 1025 41.87 †Ja $50.079.7 Pregnant: No 3143 96.3 Age (Mean ± SD) 29.$1.095.821) Medical Expenditure (Mean ± SD) †Ja.2 Visits to: Public hospital or establishment 122 49. (Minimum: Ja.3 Average Annual Consumption per household (Mean ± SD): †Ja.9 Crowding (Mean ± SD) 2.1 Educational Level: Primary or below 151 5.216.

356 205 . p=0.2: Current Health Status by Pregnancy Status Pregnancy Status Health status Not pregnant n (%) Pregnant n (%) Total n (%) Poor 480 (15.231.0) 498 (15.0) 2751 (84. Approximately 85% of the sample reported good current health status compared to 83% of the women who were pregnant and 85% for those who were not pregnant (Table 8. Table 8.7) Total 3143 106 3249 χ2 (1) = 0.Disaggregating current good health status of the sample by pregnancy or no pregnancy revealed that there is no statistical difference between the two groups (p=0.7) 88 (83.3) 18 (17.356).2).3) Good 2663 (84.

7) 116 (31.A cross tabulation between reported recurring illness and per capita population quintile revealed a statistical correlation (p=0.6) 50 115 Total χ2 (12) =22.6) 50(100.0) 0 (0. 50% of those in quintile 3 and 75% of the wealthiest quintile. Substantially.0) 50 (76.3: Recurring Illness by Per capita Population Quintile Per Capita Population Quintile 1=poorest n (%) 0 (0.030 206 . Table 8.755.0) 67 Total n (%) 33 (9.3 showed that 42% of those in quintile 2 who reported a recurring illness had hypertension.0) 49 (42. Self-reported diabetes mellitus was reported as illness of wealthy rural women in the reproductive ages of 15 to 49 years (24% for quintile 4 and 25% for quintile 5).0) 33 (28.0) 50 (75.0) 0 (0.0) 66 5=wealthiest n (%) 17 (25.4) 83 (22.8) 22 Recurring Illness Diabetes mellitus Hypertension Arthritis Unspecified 0 (0. more rural women in the reproductive ages of 15 to 49 years reported an unspecified illness (100%) compared to 28.0) 3 n (%) 0 (0.0) 2 n (%) 0 (0. p=0.0) 33 (50.0) 0 (0.3).6% for those in quintile 2.0) 66 4 n (%) 16 (24.0) 33 (50.6% of those in the poor quintile and 50% of those in the middle income quintile.0) 33 (28. Table 8. Self-reported arthritis was greater in the wealthy quintile (76%) compared to 28.0) 0 (0.1) 132 (36.030) (Table 8.0) 0 (0.0) 0 (0.

069). health insurance (OR=0. 207 . 95%CI: 0.9) 33 (54.There is a statistical correlation between visits to the type of health care facilities and social standing of rural women in the reproductive ages of 15 to 49 years (χ2 (4) =22. 0.4: Visits to Private or Public Health Care Establishment by Social Standing Per Capita Population Quintile Visits to health care establishment Private Public 5.1) 61 3.4 showed that as ones social standing increases from poorest to wealthiest.00 n (%) 37 (61. ages 15 to 49 years) in Jamaica (Table 8. Here Table 8.00 n (%) 19 (50.00= Wealthiest n (%) 27 (73.0) 37 (74.00 n (%) n (%) 13 (26.0) 37 1=Poorest 2.991).3) 60 Total n (%) 124 (50.4) 122 (49. negative affective psychological conditions (OR=0.785).6) 246 Count χ2 (4) = 22.382.993.350.4).951. p < 0.0.0) 50 28 (45.524.5).0) 19 (50.024. marital status (separated. Table 8.147. p<0. they switch from the usage of public to private health care facilities. 0. divorced or widowed – OR=0.7) 23 (38. Three times more of the poorest respondents visited public health care establishment than private health care facilities in comparison to 3 times more of the wealthiest who attended private than public health care establishment for health care visits (Table 8.0) 10 (27.001).041. 95%CI: 0.001 Results: Multivariate Regression Using logistic regression analyses. 6 variables emerged as statistically significant predictors of current good health status of rural women (ie.0) 38 4.993. These are social standing (two wealthiest quintile – OR=0. 95%CI: 0.

949. 0.964 (Separated. Equation (2)) revealed that this had a significant predictive power (model χ2 = 259. the average likelihood of reporting good health increased by nearly 5 times. 95%CI:1. Further examination of the model (i. Controlling for the effect of other variables.195 (Ownership of Health Insurance Coverage) – 0.015. p <0.71.057 (Negative Affective psychological conditions score) + 0. The logistic regression model can be written as: Log (probability of good health/probability of not good health) = 3.131 – 0. p = 0.5% of those who reported good health and 26. Divorced or widowed) – 3.704.95%CI:0. Hosmer and Lemeshow‘s goodness of fit χ2 = 9.982). 95%CI:0.284).035 (Age).085 (Asset ownership score) – 0. Nagelkerke R2 =0.645 (two health quintiles) -0.965.649.089.168) and age of respondents (OR+0. 208 .0%) and correctly classified 87.001.945.230 or 23. asset ownership (OR=1.e.1% of the sample (correctly classified 98. 1.2% of those who indicated poor health status). 1.

1. 1.645 0.956 0.991* 0.000 0.206 0.069 -0.364 0. 1.741 0.036 3.230 Overall correct classification = 87.195 0.008 0.085 -0.184 0.949.430 0.314 0.153 0.033 0.487 0.168* 0.05.801 1. 0.704.057 0.112 -0.5% Correct classification of cases of no dysfunctions =26.207 0.074 1.147.114.095 -0.024 0.807. 0.355. 3. 0. p < 0.681.267 0.558.902.017 0. 8.069*** 0.041 1.461 0.820.258 0.051 -0.594.001 -0.945. 2. 1. ***p < 0.198 - χ2 (23) =259.177 -0. 0.046 -0. Upper 0.000.062 0.123 0.405.000.965 0. 1.001 0.015.118 0.564 0.046 0.931 1.000 0.508. 1.024.549 0. 0.966 0. 1.000 0.001.976 1.Table 8.945.990* 0.964 0.964 -0.902 95.000 -0. Lower.985.036 0. 1. -2 Log likelihood = 1316.537 1.524 1.945 1.007 0.166 0.141 0.940 1.037 -3.072 0.077 0.131 Std Error 0.951 0.004.982*** 0.009 0.425 0.284 0.000 1. **p < 0. 2.092 1.2% †Reference group *p < 0.148 0. 1.5: Logistic Regression of Good Health Status of Women in the Reproductive Ages Variable Middle Quintile Two Wealthiest Quintiles †Poorest quintile Log HealthCare Cost Separated.563 Hosmer and Lemeshow goodness of fit χ2=9.000 0. 1.649.715.838 0.071 0.197 0.201 1. 4. 1.177 0.0% C.089 0.000 -2.I.000 0. 3.350.01.234 0.485 0.007 1.1% Correct classification of cases of good or beyond health status =98. 1.965 22.304 Odds Ratio 0.785** 1.277 0. Divorced or Widowed Married †Single Health Insurance Physical environment Social support Secondary schooling Tertiary schooling †Primary and below Living arrangement Crowding Crime Index Landownership Negative Affective Positive Affective Asset ownership (exclude land) Age Dummy pregnant Household Head Average Income per head House tenure (rented) House tenure (owned) †House tenure (squatted) Constant Coefficient -0.062 0.487.382 0.001 209 .71 Nagelkerke R2 =0.035 -0. p = 0.926 1.

Gaspart (1998) opined about the difficulty of objective quality of life (GDP per capita) and the need to use self-reported wellbeing in the assessment of the wellbeing of people. These socioeconomic determinants are social standing (two wealthiest quintiles). psychological condition (negative affective psychological condition). 2003) and Diener went further when he found a strong correlation between the two variables (Diener.Discussion The current paper found that of the thirteen socio-economic variables that were examined. widowed). He wrote. Lynch. marital status (separated. Using people‘s assessment of their life satisfaction and health is old. Another study (Hambleton et al. 2005) found social. asset ownership and age of respondents. economic and biological determinants of health status of Barbadian elderlyContinuing. 1998) This speaks to the necessity of using a measure that captures more to this multidimensional construct that continues with the traditional 210 . and has already been resolved. 1984). Nevertheless. This concurs with the findings of the WHO (2005) that social determinants should be taken into consideration in the study of health status. six of them are predictors of good health status of women in the reproductive ages. 2000. Scholars have established that there is a statistical association between subjective wellbeing (self-reported wellbeing) and objective wellbeing (Diener. health insurance coverage. divorced. opening the door to a mixed approach. in which preferences matter as well as objective wellbeing‖ (Gaspart. social determinants are The use of self-reported health status (ie subjective wellbeing) is well established in research literature as a good measurement for health or wellbeing. it will be succinct issues here for those who are not cognizant of this discourse. ―So its objectivism is already contaminated by post-welfarism.

e. when they said that ―Although GDP per capita is usually used as a proxy for the quality of life in different countries. gender.income per capita approach. The current research used self-reported health status to examine those factors that determine good health status of rural women in the reproductive ages 15 to 49 years. a group of economists noted that ―happiness or reported subjective well-being is a satisfactory empirical approximation to individual utility‖ (Frey & Stutzer. typology of household members and age of respondents and retirement income. negative affective psychological conditions. 2000). house tenure. Unlike a recent study conducted by Bourne and McGrowder (2009) – using a randomly selected sample of 5. 2004) and that wellbeing depends on both the quality and the quantity of life lived by the individual. material gain is obviously only one of many aspects of life that enhance economic wellbeing‖ (Becker et al. This will not be addressed in this paper as this is not the nature or its scope.683 rural Jamaicans. Despite this limitation. 2005). positive and negative affective psychological conditions). and added some new factors such as social standing. The discourse of subjective wellbeing using survey data cannot deny that it is based on the person‘s judgement. and must be prone to systematic and non-systematic biases (Frey & Stutzer. psychological conditions (i. Another group of scholars emphasized the importance of measuring wellbeing outside a welfarism and/or purely objectification. 2005) and this justifies its usage in wellbeing research. This research has revealed that there was no statistical 211 . Diener. health insurance. They found that good health status was predicted by medical expenditure. and asset ownership. education. marital status. health insurance. This study concurred with age. an early survey wrote that ―[the] measures seem to contain substantial amounts of valid variance‖ (Diener.

While wealth opens access to financial and/or other materials resources. This study has not only highlighted the current good health status inequality between rural Jamaicans and rural women in the reproductive ages 15 to 49 years in Jamaica. 2006. Muller & Krawinkel. it means access to liquor. Wealth does not mean that people become more health conscious. but it showed the health disparity between the typology of variables. 1994). while it is in the former one. 2003. Instead. The finding in this paper revealed that the odds of self-reported good current health status of those rural women in two wealthiest quintiles were 48% lower than that of the odds of rural women in the two poorest quintiles. and the non-access to material resources further validate poor health status. Bloom & Canning. This contradicts works that have established the correlation between poverty and health status (Murray. hard drugs. it is an explanation of poor lifestyle choices. 2005.difference between the self-rated good health status of rural women who were pregnant or not pregnant. Marmot. In the latter work this variable was not significant. low water and environmental quality. cigars. One of the disparities between the current paper and that of Bourne and McGrowder was social standing. and many excess that are of 212 . Marmot (2002) opined that poverty influences health through malnutrition. This assumes that wealth accounts for better environmental quality and good health status. Smith & Waitzman. Bourne and McGrowder‘s work showed that 83 out of every 100 rural residents had good health status compared to this study that revealed that 85 out of every 100 rural women (ages 15 to 49 years) reported good health. 2002.

This research showed that hypertension and diabetes mellitus which are lifestyle causes of non-communicable diseases were higher in the wealthiest quintile 213 . which is a psychiatric disorder. Diabetes Mellitus was not the only challenge faced by patients. p. Hence. the prevalence rate of diabetes mellitus affecting Jamaicans was higher than in North American and ―many European countries‖ (Callender. 2000. The issue of poor environment is not a disparity for rural areas in Jamaica as the quality of milieu in those places is about the same. McCarthy (McCarthy. it can be inferred from the data that although poverty is a health hazard. 2002. Jamaica Social Policy Evaluation. and neoplasm cancer). arthritis. The issue of the lifestyle practices accounted for the health disparity between rural women in the reproductive years of 15 to 49 years and those in the two wealthiest quintiles compared to those in the two poorest quintiles is reinforced in the fact that there is no statistical difference between the health status of rural women who were in the two poorest quintiles and those in the middle quintile. it is advantageous for rural women in the reproductive years 15 to 49 years. This is supported by the morbidity data that showed the five leading causes of health conditions in women in Jamaica (heart disease. In an article published by CAJANUS. the health status difference between rural women in the reproductive years of the two wealthiest and two poorest quintiles would be owing to lifestyle practices and access to more financial resources. diabetes mellitus. the wealth disparity between the two aforementioned groups is narrowed and can aid in the explanation of the health disparity between wealthy and poor rural women in Jamaica. In light of the above. 67. 2000) argued that between 30 to 60% of diabetics also suffered from depression. hypertension. In this study. 2003).themselves health hazards. most of those diseases are causes of lifestyle practices (Davidson et al.

According to Delbés & Gaymu (2002). Manning and Gupta (1999) concurred with Prause et al that there is a direct relationship between married women and economic well-being.6) or singles (7. (2004) found that married individuals had greater subjective health-related quality of life index (8. 1987).3 ) than divorced persons (7. a sample size of 2665 females from 60 years and older was used. 1994. pp. unlike those in the middle to upper classes. Prause et al. Smock. Some studies have shown that married people have a lower mortality risk in the healthy category than the ‗nonmarried‘ (Goldman. 885-914). Of the sample. It was found that females who were remarried experienced an 214 . Studies have shown that a statistical correlation existed between marital status and health status. 2 out of every 100 had arthritis. ―The widowed have a less positive attitude towards life than married people. Using a sample of 1049 Austrians from ages 14 years and over.than the poorest quintile. The research revealed that married women had a higher economic well-being than divorced females. An interesting finding was unwillingness of those in the poor to poorest quintile to declare their dysfunction. Another factor is marital status. Umberson. 4 out of every 100 rural women in the reproductive ages 15 to 49 years reported having hypertension. 1 out of every 100 had diabetes mellitus and 3 out of every 100 did not specify their recurring illness. Drawing on longitudinal data from the National Survey of Families and Households for 19871988 (NSHH1) and a follow-up survey (NSFH2) of some 13. 2002. 1993). and this justifies why they take less life-threatening risks (Smith & Waitzman.7). which is not an unexpected result‖ (Delbés & Gaymu. 008. Social standing is among the variables that explain health status of rural women in the reproductive years of 15 to 49 years. Each study had a response rate of approximately 74 % for NSFH1 and 82% for NSFH2.

For this study. separated or widowed. This leads to the next variable. The current paper refutes the aforementioned finding as there was no statistical difference between current health status of married rural women in the reproductive ages of 15 to 49 years and non-married ones.equally high well-being as their married counterparts. which is health insurance coverage. Hambleton et al. Grossman. 215 . In the pursuit of healthy lifestyle. Health insurance is a curative measure of illness as people hold health plan policies more if they are more likely to be ill than less likely. Age is the next variable which is a predictor of current good health status of rural women in this sample. it can be used to evaluate poor health of rural women in the reproductive ages of 15 to 49 years. 1994. one of the measures of wellness is health seeking behaviour. This indicates that health insurance coverage is not an indicator of health seeking behaviour. the odds of reporting good health status for divorced. It is well established in health literature that there is a negative correlation between age and health status (Abel-Smith. However. they will hold health insurance and not the vice versa. suggesting that people analyze their health risk and if it is highly likely to become ill. non-married rural women in the reproductive years 15 to 49 years had a greater current health status than those divorced. the odds of good health for rural women in the reproductive ages 15 to 49 years who had health insurance coverage was 96% less than the odds of good health for rural women who do not have health insurance coverage. 1972. in this study. which was higher than that experienced by single females. Instead. health insurance coverage was negatively correlated with good health status which concurs with Bourne and McGrowder‘s work (2009). In the current research. Furthermore. 2005. separated or widowed rural women in this study was 62% less likely than the odds of reporting good health status of non-married rural women in the current work.

5% less than the odds of a rural woman who is one year younger. it has a high correlation with relapse to many psychiatric disorders‖ (Acton & Zodda. 2006).8% less than the odds of lowered negative affective psychological conditions for rural women in ages 15 to 49 years. family members. Bourne & McGrowder. 373-399). 1985) it is further stated that hopelessness was a major predictor of suicidal behaviour which was equally concurred by Smyth & MacLachlan (2005). From a 10-year longitudinal study conducted in the United States by Beck et al (Beck et al. Unlike the other predictors of good health status. pp. The findings revealed that the odds of reporting good health status for those who owned more assets 216 . Another variable that is inversely correlated with good health status was negative affective psychological conditions. 2008. Acton & Zodda (2005) aptly summarized these negative affective psychological conditions and they found that ―expressed emotion is detrimental to the patient's recovery. In this study negative affective psychological conditions were operationalized using loss of breadwinners. jobs and general hopelessness of an individual which further explains the negative association between this variable and good health status. asset ownership was the only one that was positively correlated with current good health status for the sampled respondents. The negative association between age and good health status is once again concurred with as the current work revealed that the odd of reporting good health status for each additional year of the rural women in the reproductive ages of 15 to 49 years is 3. 2009) and this also extends to biological studies. 2005. Studies have revealed that up to 80% of people who committed suicide had several depressive symptoms (Rhodes et al. the odds of reporting good health status based on increased negative affective psychological conditions is 9.Bourne. Continuing.

cultural and psychological variables which are all interrelated (World Bank. An interesting finding that is embedded in this research is the quality of the health care institutions in Jamaica. cultural. nutrition. and if quality of life extends beyond monetary objectification then it includes biological.e. ―The index most commonly used until now to compare countries' material well-being is their GDP POP' [production of goods and services]‖ ―However. Generally. The World Bank went further when it said that women‘s health status is influenced by a complex set of biological. social.was 8. they are both able to visit private health care institutions and spend substantially more on health care than those in the poor social standing. then a part of the explanation for the good health status of this group will be owing to the quality of primary health care and public medical health care institution in the society. GDPPOP is an inadequate measure of countries' immediate material well-being.9% more than for those who owned less assets. Summers & Heston. social. and that those in the poorest quintiles enjoyed the same good health status as those in the middle class (i. Given that 46% of the sample was in the poorest social standing and that 74% of those who were in this social standing visited public health care establishment for medical care. This concurs with other studies that showed the direct correlation between asset ownership and health status (Grossman. 1995). highly economic and excludes the psychosocial factors. from that perspective. 1994). 1995) and according to Summers & Heston (1995). 1972. This spending does not translate into better health status. the measurement of quality of life is. even apart from the general practical and conceptual problems of measuring countries' national outputs‖ (Summers & Heston. therefore. The research showed that those in the poorest quintile had a greater health status than those in the wealthiest quintile. Within the context that those in the wealthy and wealthiest social standings have a greater access to financial resources. economic and psychological factors. quintile 3). suggesting that 217 .

In this study. In keeping with some issues raised in this paper. 218 . the researchers recommend that a lifestyle survey be conducted on this age cohort in order to provide pertinent information and direction for public health policy programmes. marital status. understanding women‘s health is to comprehend its multiple effects on different areas of the family. the household and the nation. negative affective psychological conditions. Conclusion Poverty is synonymous with rural area and women. health insurance. Hence. good health in this study can be predicted by 6 factors (social standing. wealth did not mean better health but that poor women had greater health status than their wealthy counterparts. Women‘s health is not merely important because of academic literature. suggesting that Jamaican rural women (ages 15 to 49 years) do not buy health plans because they are healthy but owing to unhealthy risk factors. health of the children and the general household. but that it is pivotal to their earning capacity. assets ownership and age of respondents) this adds more information than voluminous amount of literature on maternal mortality and/or fertility of this age cohort. To summarize. Another interesting finding was that good health is inversely correlated with the ownership of health insurance coverage. water and food quality as well as an explanation for better environmental conditions. Wealth creates more access to financial and other resources and makes a difference in nutritional intake. and inspite of this reality majority of rural women in Jamaica ages 15 to 49 years have reported good current health status.income cannot buy better health.

219 inequality. The health and poverty of nations: From theory to practice. Kovacs M. http://www. Hopelessness and eventual suicide: A 10year prospective study of patients hospitalized with suicidal ideation. Bourne PA (2007a). Social Science and Medicine. 2006). Becker GS.pdf#search=%22preston%2C%20quality%2 . RA. 142. (Suppl 3). Acton GS. West Indian Medical J. 559-563. Income and health: the time dimension. planning and financing. [Abstract]. An introduction to health: Policy. Zodda JJ (2005). Classification of psychopathology: Goals and methods in an empirical approach. Canning D (2003). Using the biopsychological Model to evaluate the wellbeing of the Jamaican elderly. 4. Determinants of Wellbeing of the Jamaican Elderly.html (accessed July 24. Soares RR (2004). Journal of Human Development. Theory of Psychology. pp.org/acton/goals.uchicago. Bourne PA (2009). 2:18-27. 56. 373-399.personalityresearch. pp. Unpublished MSc Thesis. Judge K. Mona. Benzeval M. Bloom DE.References Abel-Smith B (1994). Philipson TJ. 39-40. Quoted in Benzeval M.spc.15. pp. Bourne PA (2007b). 2006).edu/prc/pdfs/becker05. 1371-1390. Beck AT. Steer. the University of the West Indies. Understanding the relationship between income and health: How much can be gleamed from cross-sectional data? Social policy and Administration. Good Health Status of Older and Oldest Elderly in Jamaica: Are there differences between rural and urban areas? Open Geriatric Medicine Journal. Judge K. The quantity and quality of life and the evolution of world 0of%20life%22 (accessed August 22. Garrison B (1985). 47-72. 52. http://www. Longman Group. pp. pp. American Journal of Psychiatry. Shouls S (2001).

Statistics for Social Sciences. Subjective well-being: The science of happiness and a proposal for a national index. 6770. Diener E (1984). Lowe H (2002). 9. McGrowder DA (2009). Diener E (2000). Cohen L. 55. pp. 1116. The Wellness Handbook: Your Guide to Healthy Living.Bourne PA. Lifestyle management in the hypertensive diabetic. (2008). Caribbean Studies Association Conference 2009 June 1-5.Hilton Kingston. Unemployment. Rural and Remote Health. Delbés C. Holliday M (1982). input and mortality output in developed countries. Diener E (2000). West Indian Medical Journal. Psychological Bulletin. England: Harper and Row. pp. 596-604. Bourne. 3. pp. Gaymu J (2002). pp. Subjective well-being: the science of happiness and a proposal for a national index. Journal of Epidemiology and Community Health 32. CAJANUS. PA. 542–75. Illness and Health Seeking Behaviour in Jamaica. 33. 55. (2009). 57. & Beckford OW. 2009. Davidson W. pp. London. 34-43. Medical Sociology: Modelling well-being for elderly people in Jamaica. pp. 95.org. p. Subjective well-being. Demography.au Callender J (2000). 34–43 220 . Kingston: Pelican Publishers. American Psychologist. Cochrane AL. Rural health in Jamaica: examining and refining the predictive factors of good health status of rural residents. et al (1978). 885-914. Jamaica. Health service. Paper presented at the 34th annual conference. Wright V. Available from: http://www. Bourne PA. American Psychological Association.rrh. The shock of widowed on the eve of old age: Male and female experience.

Bergman V. Constructive thinking as a mediator of the relationship between extraversion. Brathwaite F. Butt J. 2009). 15-26. 2nd edn. Journals of Gerontology: Social Sciences. Hambleton IR. Harris PR. Benyamini Y (1997). Gaspart F (1998). John Wiley & Sons Inc.Frey BS.pdf. Kingston: JASPEV. 95-112. pp. Hennis A (2005). Idler EL. House JA. Self-reported health and mortality: a review of twenty-seven community studies. Demography 1993. and subjective wellbeing.bsfrey. 17. Fraser HS. Idler EL. Lantz PM. Jamaica Social Policy Evaluation (JASPEV). Kelly MP. 19. Lightsey OR Jr (2005). (Special Issue II). Kasl S (1991). Review of Social Economy (LXII). Objective measures of well-being and the cooperation production problem.. 46. 21-37. Lemeshow S (2000). Rev Panam Salud Publica. 15. (2007). accessed April 6. Clarke K. Social Choice and Welfare. 342-353. The demand for health. 60B.The social determinants of health: Developing an evidence base for political action. neuroticism. pp. 409-426. Herd P (2005). 207-228. pp. Marriage selection and mortality patterns: Inferences and fallacies. pp. New York.30:189-208. S55-S65. Happiness Research: State and Prospects.a theoretical and empirical investigation. Grossman M (1972). Cabinet Office Jamaica. Journal of Gerontology. J Health Soc Behav. pp. pp. Stutzer A (2005). Final Report to World Health Organization 221 European Journal of . Annual Progress Report on National Social Policy Goals 2003. Homer D. (2003). Morgan A. Health perceptions and survival: Do global evaluations of health status really predict mortality. Bonnefoy J.ch/articles/420_05. Applied Logistic Regression. Goldman N. (Available: http://www. Continuity and change in the social stratification of aging and health over the life course: Evidence from a nationally representative longitudinal study from 1986 to 2001/2002 (Americans‘ Changing Lives Study). New York: National Bureau of Economic Research. Personality. 38. pp. Broome Hl. Historical and current predictors of self-reported health status among elderly persons in Barbados.

2003. pp. 174. 21. Kunze M. CAJANUS. 2001. Canadian Medical Association Journal. Demography. An economic approach to international and inter-regional mortality variations with special reference to Greece. Does money really matter? Or is it a marker for something else? Health Affairs. Holzinger. pp. 2004 Planning Institute of Jamaica. 923-923. University of Bristol). (Unpublished PhD thesis. Statistical Institute of Jamaica (2008). Krawinkel M (2005). 2004. Murray S. Kingston: PIOJ.int/social_determinants/resources/mekn_final_report_102007. pp. Popovic R. pp. Kingston Planning Institute of Jamaica. Lynch SM (2003). Zeitlhofer J. Graetzhofer E. Diagnosing and Treating Psychological problems in Patients with Diabetes and hypertension. World Development. Available from http://www. Kaplhammer G. Economic and Social Survey Jamaica. Survey of Living Conditions. Survey of Living Conditions. Kingston. Kingston. 33. 65.pdf (accessed . Old age and poverty in developing countries: new policy challenges. pp. Muller O. 77-83. Prause W. Tribl GG. The influence of Income on Health: Views of an Epidemiologist. Human Psychopharmacology Clin Exp. 28. Landscape and Urban Planning. 222 Network. Statistical Institute of Jamaica (2002). Poverty and health (2006). pp. Saletu B.31-46. Bolitschek J. Cohort and Life-course patterns in the relationship between education and health: A hierarchical approach. Canadian Medical Association Journal. B. 2157-2168. 279-286. Planning Institute of Jamaica (2008). Urban environmental quality of human wellbeing–a social geographical perspective. Planning Institute of Jamaica and the Statistical Institute of Jamaica. 19-30. Malnutrition and health in developing countries. 309-331..Commission on the Social Determinants of Health from Measurement and Evidence Knowledge April 29. Marmot M (2002).who. pp. Rosengerger A. 2009) Lloyd-Sherlock P (2000). Katschning H. Survey of Living Conditions. McCarthy FM (2000).20:359-365. Matsaganis M (1992). 173. 2007. 2007. Rieder A. Pacione M (2003). 40.

487-507. Smyth C. Department of Economic and Social Affairs. MacLachlan M (2005). Kingston. World Bank (1994). Suicidality. Bethel J. Confirmatory factor analysis of the Trinity Inventory of Precursors to Suicide (TIPS) and its relationship to hopeless and depression. Standard of Living: SLPOP An Alternative Measure of Nations' Current Material Well-Being. 2002 [Computer file]. Journal of Health and Social Behavior. A New Agenda for Women‘s Health and Nutrition. Human development report 1997. Gupta S (1999). Kingston. American Sociological Review. Washington D. 2002. Canadian Journal of Psychiatry. Heston A (1995). Summers R. 35-41. and mental health service use in Canada. 31. 2002. Population ageing.pdf (accessed January 24. Demographic and Economic Correlates of Health in Old Age. pp. pp. 2006). depression. Jamaica: Statistical Institute Of Jamaica [producer]. (1997). WHO. United Nations (2002). The effects of marriage and divorce on women‘s economic well-being.econ. World Bank (1996). Bondy S (2006). Death Studies. 2008. Smock P. The Social Determinants 223 of Health. Development in Practice. Jamaica: Planning Institute of Jamaica and Derek Gordon Databank. Demography 34:159-70. Poverty Reduction and Human Resource Development in the Caribbean. pp. 51. Smith JP. 1997. 28. 794-812. Manning WD. University of the West Indies [distributors]. Jamaica Survey of Living Conditions. Population Division. New York: OUP. 306-19. Statistical Institute Of Jamaica (2003). http://pwt. United Nations Development Programme.C. 64. Smith KR. Waitzman NJ (1994). 29. pp. (2008).Rhodes AE. Double jeopardy: Interaction effects of martial and poverty status on the risk of mortality. pp. Available at . New York: UN. & Kington R. 333-350. Demography.upenn. Family status and health behaviors: Social control as a dimension of social integration.edu/papers/standard_of_living. Umberson D (1987). Washington DC: World Bank.

224 . Geneva: WHO. 2. World Health Organization. 1946 by the representatives of 61 States (Official Records of the World Health Organization. p.‖ In Basic Documents. and June 1922. Preventing Chronic Diseases a vital investment. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference. 100) and entered into force on April 7. no. Switzerland: WHO. 2009). (1948). 1946.http://www. ―Constitution of the World Health Organization.who. New York.int/social_determinants/en/ (accessed April 28. 1948. 1948. World Health Organization. signed on July 22. 15th ed. (2005). Geneva.

0.198. the factors of quality of life of a Jamaican Woman are social class. -0.304.070) is the most influential factor followed by employment status (Beta = 0.167. The study reveals that the model explains 18. 95%CI:0.020.077).974). The current work does not provide all the answers. Employment does not merely about the income. 95%CI:0.893. income and religiosity. religiosity(Beta = 0. 95%CI:0.214. 0.101).1. but it is catalysts upon which we are able to build.152. the administration of the governance of the nation (Beta = -0. 95%CI:0. subjective or self-reported wellbeing) of Jamaican women by building a model that will capture socio-demographic and economic determinants of quality of life of this cohort.5% (Adjusted R-squared) of the variability of quality of life of women. the choices. but it is about the independence. 1.676). the sense of freedom. 95%CI:-0. 0.203) and lastly by interpersonal trust (Beta = 0. modify and refute research as this provide a platform upon which this is probable in the future.094. with social class being the most influential of all the variables. with 6 variables accounting for this variance. employment.155. In summary. 95%CI:0. The rationale that underpins the current work is principally driven by the lack of academic literature on the subjective wellbeing or quality of life 225 . income (Beta = 0. the positive psychological attributes that this freedom gives as well as the selfadvancement that it is likely to provide why this variable is of that importance in determining the quality of life of Women.380.9 Determinants of Quality of Life of Jamaican Women The current paper seeks to examine the quality of life (or subjective wellbeing) of Jamaican women by building a model that will capture socio-demographic and economic determinants of their quality of life. Further examination of the sociodemographic determinants revealed that subjective social class (Beta = 0.e.015. 0. Introduction The current paper seeks to examine the quality of life (i.139.

The more drastic reduction in the unemployment rate for women cannot constitute any form of betterment of females over their male counterparts as in 2007 the unemployment rate for female was twice more than that of males. Diener 2000. In the Economic and Social Survey of 226 . 2004. 2005. as the physiological composition of the sexes is different. Another good measure that can be used to evaluate betterment of the sexes is economic resources (i. 1985. A primary rationale for this awareness is owing to the opportunity differential because of one sex in society.on the particular gender.e.5 per cent for females (Table 9. In 1991. researchers. Easterlin 2001a. gender culturalization is dissimilar as well as the disparity between gender opportunities. 2001. Grossman 1972). 2001b. One study examining a particular quality of life of an elderly man shows how medical practitioners over many years sought to address a particular issue that was eroding the wellbeing of a patient who had a certain physiological dysfunctions (Ali and colleagues 2007).2 per cent for females compared to 9. Lyubomirsky 2001. Hutchinson et al. Cummins 2000. Murphy and Murphy 2006. Can medical practitioners and social researchers assume that the quality of life of sexes is the same. given that they are of the same species? Such a situation is simple. Within this context. Most studies on quality of life have incorporated gender as a predictive factor or a determinant of subjective wellbeing studies (or quality of life) (Bourne. and this indicates the opportunity of greater economic resources (Table 9. Smith and Kington 1997. medical practitioners and policy makers need to understand the factors that influence quality of life of each gender as they are sex specify in enhancing the specificity that is needed to planning for the sex differential. 2007. purchase power party differs. the unemployment rate was 22.4). 1995. The statistics reveal that men enjoy a 17 per cent higher employed labour force than females.4 per cent for males and in 2007. Stutzer and Frey 2003. the figure fell to 6.4). Hambleton et al.2 per cent for males and 14. wages or salaries).

1996. using survey data from 1988 to 1999.7 million). 1987b. Caribbean societies have patriarchal roots and so economic resources are primarily in the hands of males. 2001). a survey done by Rudkin found that women have lower levels of wellbeing (i. If males are still receiving greater salaries compared females and they experience high degrees of employment. Hambleton et al. 2005. and that 76 per cent of senior positions were held by males although 54 per cent of executive and managerial positions were held by females. Brathwaite. 1995a. Eldermire 1997. but of the quality of life of female? How are they living in Jamaica? Is there is disparity between the quality of life of the sexes? However. p. we cannot concur with Miller nor Chevannes or Gayle that they are marginalized despite the fact that they are living fewer years than females (Table 9. 1994. their works on the quality of life have been substantially on elderly people ( ages 60 years or older or 65 years and older) with no particular interest on a certain sex. On the other hand.4 million) was 2 times more than that of females ($ 1. 2005). 1987a.2). 2007. Brazil and Costa Rica. 21. what about our women? The importance of women in fertility as well as the fact that they have a greater life expectancy compared to their male counterparts (Table 9. conducted in Argentina. Other studies on the same region have looked on the total population (Hutchinson et al. which is evident from the some of economic indicators in Jamaica.Jamaica (2004.9). the publication showed that on an average the earnings of males (mean wage = $2. the researchers found that there is no general trend of economic marginalization of males in those societies (Omar Arias.e.1). economic) than men (Rudkin 1993 227 . it is timely that a research be done on this cohort to unearth ‗what constitute their quality of life?‘ Scholars who have done studies on different Caribbean nations like Bourne. From a study. 1995b.

Thus with men receiving more than women. This finding is further sanctioned by Haveman et al (2003) whose study reveal that retired men‘s wellbeing was higher than that of their female counterparts. and more retired benefits compared to women ages 65 years and older. McDonough and Walters used data from a longitudinal study named Canadian National Population Health Survey (NPHS). The information was taken form 228 . and it is a practice that they continue throughout their life time which makes the gap in age differential what it is – which is approximately a 4-year difference in Jamaica. life expectancy for male is lower than of females. and having a more durable possession than women. Moore et al. Unlike women. Generally. because men usually received had more material resources. 1997). their material wellbeing is higher is later life. worldwide men have a reluctance to ‗seek health-care‘ compared to their female counterpart. Moore et al. (1997) added. Among the justification for the differential between life expectancy the sexes is linked with the health consciousness of women and their approach to preventative care. This is particular true for females in the old aged cohorts (United Nations 2004. ―Females‘ life expectancies are likely to remain above that for males [Elo 2001] for the foreseeable future. A study conducted by McDonough and Walters (2001) revealed that women had a 23 percent higher distress score than men and were more likely to report chronic diseases compared to males (30%). 1997. from the United Nations statistical databases. The study was initiated in 1994.222). and data were collected every second year for a duration of six years. among both the population as a whole and the elderly‖ (Moore et al. It follows in truth that women have bought themselves additional years in their younger years. 12). It was found that men believed their health was better (2% higher) than that self-reported by females.

Po.Eqn. MCt. Grossman‘s model further expanded upon by Smith and Kington to include socioeconomic variables (Eqn. A research carried out by a group of economists (Headey and Wooden) revealed that ―…women are slightly more likely to report higher levels of life satisfaction than men (mean=78. Bt.. MCt. Et. Thus. Theoretical Framework The overarching theoretical framework that will be adopted in this study is an econometric model that was developed by Grossman (1972). Ht = H* (Ht-1..use of medical care. [2] 229 . Rt. ED. Based on the nature of the study. and further modified by Smith and Kington 1997. and all sources of household income (including current income).e. Bt – smoking and excessive drinking.. [1]) by Michael Grossman reads: Ht = ƒ (Ht-1.2). compared with 77.000 household members who were 12 years and older. At. education of each family member (ED). ED) ……………………………………………………… [1] where Ht – current health in time period t.………. stock of health (Ht-1) in previous period. The initial model (i. 159-160). Eqn.(Smith and Kington 1997. the reported wellbeing (measure by life satisfaction) of women is higher than that for men but that males have a higher financial wellbeing than females (Headey and Wooden 2003. Go.3.20. and good personal health behaviours (including exercise – Go). 16). Go) ……………………………. 14). the discourse is inconclusive and we will not add to the literature in this regard but will examine quality of life of women as this is the first of its kind in Jamaica and in the wider Caribbean literature.1 for men…‖ (Wooden and Headey 2003. ‗…subjective wellbeing and ill being‘. Pmc.

Descriptive statistics were done to provide background information on the sample. where Li i=1…5 denotes each Need Item of Abraham Maslow‘s 5-Need Hierarchy i=1 (Each is a 10-point Likert Scale: Health status.748 (or 75%). Basic Necessities. The survey uses a questionnaire of some 166 items. education of each family member (ED).). 230 . Reliability analysis of the 5-Need Likert Scale Item is 0. wellbeing and political participation. Then. tests were done for Cronbach alpha to examine the validity of the construct – i. family background or genetic endowments (Go). This is a binary measure. where from 1 to 3. Ci . Department of Government. the current paper will test this general hypothesis in seeking to establish a quality of life model for Jamaican Women (Eqn. ARj . the price of other inputs Po. using the descriptive research design.9 are moderate and with high being from 7 to 10. WSj εi)…….[3] Method The current paper uses a sample of 723 women. SSj . which probes issues relating to the orientation of democracy. leadership and governance in Jamaica. Thus. Ej . [3]): QoLj = ƒ(Gj.e. Sex. (2) expresses current health status Ht as a function of stock of health (Ht-1).9 are low. This study is taken from a general study conducted by the Centre of Leadership and Governance. ESj . Sex is the biological makeup of males and females. lnAj . The University of the West Indies between July and August 2006 of some 1. with a mean age of 34.4 yrs. multiple regressions were used to build a model for quality of life of Jamaican Women. RAj . Oj . all sources of household income (Et). where 1=male and 0=female. Rj . PPIj.Eq. Quality of Life Index ranges from: 1≤Quality of Life Index≥10.33yrs ±13. price of medical care Pmc. The survey was a stratified random sample of the fourteen parishes of Jamaica. Self-Esteem. retirement related income (Rt ).…Eqn. Measures: 5 QoLj = 1/10∑Lij . Social Needs. Tj .338 Jamaicans. Xj . 4 to 6. asset income (At. Self-Actualization). Yj. Data were collected and stored using the Statistical Packages for the Social Sciences (SPSS).

Manchester.e. The survey instrument asked the question ‗Generally speaking would you say that most people are essentially good and can be trusted. unskilled worker. doctors. 1=St. church attendances more than once per week) Religiosity2 1=Moderate religiosity (i. and Clarendon. the more people have confidence in sociopolitical institutions within the society. or that most people are not essentially good and cannot be trusted. Interpersonal Trust. with a Cronbach α for the 22-item scale being 0. Trust is on a continuum. Confidence in sociopolitical institutions. with each question on a scale of (4) a lot of confidence. 0 if otherwise. ranging from (1) under $5. vendor. haggler. Age is a continuous variable. Occupation is a dummy variable. The frequency with which people attend religious services. and 0≤confidence index≤88. managers and/or supervisors whereas in the low category the following were includes – farmers. Catherine. Kingston and St. 231 . Trelawny. 1 Others constitute St.896. 1 if in high occupation. office workers and so on. which is recorded in years. Ann. it will be treated as a continuous variable. The higher the scores. This means the geographic location of one‘s place of abode It is a dummy variable. Thus. Religiosity. For each. Mary.e. tradesmen. 62 to 78 is moderate confidence and 79 to 88 is most confidence. Based on the nature of this variable. and so low trust is a proxy for distrust. (3) christenings. none to several times per year) Income. Hanover. Confidence index = summation of 22 items.000 to (20) $250.e. St. (2) weddings. Westmoreland. shopkeeper.000 and above. based on social stratification. This is people‘s perception of their social and economic position in life. church attendance once per week or fortnightly) Referent group is low religiosity (i. St. Portland. St. (3) some confidence. James. Those categories which are classified within this are – teachers. The variable was then dummied. This variable was recorded as: Religiosity1 1=High religiosity (i. 0 if otherwise.Area of residence. the confidence index is interpreted as from 0 to 34 represents very little confidence. businessmen. (2) a little confidence. with each question being weighted equally. lawyers. Age. St. Elizabeth. 35 to 61 is low confidence. Andrew. tell me how much CONFIDENCE you have in that group or institution. Thomas. (4) funerals. which does not include attending functions such as (1) graduations. This is the summation of 22 likert scale questions. Income is an ordinary variable with twenty-categories. The heading that precedes the question reads: I am going to read to you a list of major groups and institutions in our society. 1 if most people essential good and can be trusted. to (1) no confidence. socialcl1 1=Middle class socialcl2 1=Upper class Referent group is lower class. 0=Other1 Subjective Social Class.

e. The Cronbach alpha for the 22-item scale. Munroe. Caucasians (6%).8 ±1. such as the right to protest. [3]) explains 18. part-time. 2002:4.2) indicate that political participation for Jamaican Women is low (i. the right to vote.6 ±3. 6. The demographic characteristics of the sample also reveal that approximately 7 out of every 10 women indicate that they are employed (i.e. seasonally and self-employed).828. the population has moderate confidence in the various socio-political institutions in Jamaica (56. and bi represents each response to a question on political behaviour. w use that construct to formulate a PPI = Σbi. temporarily.. is 0. with 0≤PPI≤19. which is used to constitute this Index.the extent to which citizens use their rights.3 years ± 13. to influence or to get involved in political activity‖ (Munroe.7: Range 10: 10– 0). ‗political participation‘ ―. Most of the respondents report that they are Blacks (78%) with some indicates Browns – i. full-time. is defined as people‘s perception of administration of the society by the elected officials.5% (Adjusted R232 . 3. Based on Trevor Munroe‘s work.Political Participation Index.(14%). where 1 denotes in favour of a few powerful interest groups or the affluent.3±10. Approximately 6 out of 10 women indicate that they are in the lower class.e. Insert Table 9. On an average the quality of life of the sample was high (i. involvement in protest.4 years. with a sample report a high ‗welfare system of governance‘ of the Jamaican state. Governance of the country. bi ≥ 0. Furthermore.5: Range 17: 17– 0).8: Range 79:86 – 7).e. the findings (Table 9. This is a dummy variable. 1999:33)..2 here Findings: Multivariate Analysis Using econometric analysis (i. multiple regressions) – of the surveyed research data of some 723 Jamaican women – we found that the final model (Eqn. Mixed . the right of free speech. such as voting.e. G. On the contrary. 0 is otherwise Extent of the Welfare System of governance: Results: Sociodemographic Characteristics of Sampled Population The findings of the current research has a sampled population of 723 women ages 16 to 85 years with a mean age of 34.

203) and lastly by interpersonal trust (Beta = 0..(Beta = 0. parish of residence) of person j gender of respondent of person j educational level of person j employment status of person j ethnicity of person j extent of welfare state of a nation as reported by person j QoLij = ƒ(Yj.3). The model is a good fit (F statistic [15.3 here 233 . Xj .e. 0. the administration of the governance of the nation (Beta = -0.101). -0. income (Beta = 0. PPIj Yj. RAj .214.3). 95%CI:0. self-reported administration of the governance of the nation of political participation index of person j income of person j religiosity of person j logged age of person j occupation of person j interpersonal trust of person j subjective social class of person j area of residence (i. Ej .413.077). SSj .[3] where QoLj Gj person j.198.(Beta = 0. QoLj = ƒ(Gj.001]. [4] revealed that subjective social class – middle class with referent to lower class . p value = 0.139. 0.094. Oj .155.152.167.070) is the most influential factor followed by employment status (Beta = 0. lnAj . WSj .893. Rj . 95%CI:-0.1. 95%CI:0. Xj . Gj. 410] = 7. RAj . religiosity. Rj .…………….…Eqn. εj)…………………………………….squared) of some 6 variables. 1. 95%CI:0. Insert Table 9.304.high religiosity . SSj .015.Tj . ARj . 95%CI:0. Tj . ESj . Oj .676) (Table 9. 0. ESj . ARj .020. Yj.…Eqn. lnAj . Rj . WSj .εj)…………. Tj . SSj .974). ESj . PPIj. (Table 9. Ej . 0. 95%CI:0. the quality of life of person j.[4] Examination of the sociodemographic determinants in Eqn.380.

e. it has an adjusted R-square of less than 20%. Some statisticians argue that a cross-sectional study that is less than 30% and over is not a good predictor of the phenomenon. those who cited being in moderate religiosity had a greater quality of life compared to those with had a low religiosity. A woman who trusts other people has a greater quality of life compared to another who reported that she does not trust other people. political administration) benefits mostly equally with referent to those who indicated that it favours the rich have a lower quality of life. and the greater the income of a person the higher is the quality of life of that individual. Discussion 234 .e. [4]). Those who reported that the governance of the nation (i. A similar result was observed for employment status as an employed woman has greater quality of life compared to those who are unemployed.e. church attendance at least twice per week) with referent to low religiosity (i. In addition to what has been reported so far. The religiosity with which we speak is high church attendance (i. The current research is the first of its kind. Eqn. An individual who is in the self-reported middle class with referent to lower class contributes the most to quality of life of Jamaican Women.Further examination of the findings will now be forwarded to provide a more in-depth understanding of determinants in model (i. those in the upper class with referent to lower class contribution are marginally more than interpersonal trust that influence is the least. However. Limitation of the Model Although the current model used data from a cross-sectional study by way of stratified probability sampling technique. Thus. from no church attendance to once per year). and is more so a platform for future studies than a conclusion on the matter of quality of life of women in Jamaica.e. a woman‘s quality increases with greater church attendance. Religiosity is the fourth most significant factor of quality of life of sampled population.

and more retired benefits compared to women ages 65 years and older. their material wellbeing is higher is later life. stress. Rodin and Ickovics (1990) this can be explained by epidemiological trends. to which Courtenay (2003) explained are due to behavioural practices of the sexes and goes to explain the fact that men are dying 6 years earlier 235 . a survey done by Rudkin found that women have lower levels of wellbeing (i. Rice believed that this health difference between the sexes is due to social support. However. This finding is further sanctioned by Haveman et al (2003) whose study reveal that retired men‘s wellbeing was higher than that of their female counterparts. Thus with men receiving more than women.e. The issue extends beyond those two types of chronic illnesses as Courtenay (2003) noted from research conducted by the Department of Health and Human Services (2000) and Centers for Disease Control (1997) that from the 15 leading causes of death except Alzheimer‘s disease. Phillip Rice. in concurring with WHO. life styles and ‗preventative health practices‘ (Rice 1998). Embedded within this theorizing are the differences in fatal diseases that are explained by gender constitution (Seltzer and Hendricks 1989. argued that differences in death and illnesses are the result of differential risks acquired from functions.The physiological composition of the sexes explains the rationale of some typologies of diseases affecting a particular sex (WHO 2005). According to Rice (1998). and having a more durable possession than women. Lifestyle practices may justify the advantages that women enjoy compared in men concerning health status. 7). Biomedical studies showed that there are gender specific diseases. because men usually received had more material resources. economic) than men (Rudkin 1993 222). the death rates are higher for men and boys in all age cohorts compared to women and girls. One health psychologist. The examples here are prostate cancer (affect only men) and cervical cancer (plague only women).

2001b) showed that income is important to happiness. Ardelt 2003. potable water. She noted that financial inadequacy prevents an individual from accessing – food and good nutrition. According to Kart (1990). It is well accepted that religiosity is positively associated with wellbeing. modifying what exists and so in keeping with these epistemological traditions. 1978). and even diet.S. but provides new information on factors that explain variability in quality of life of females (or women) in Jamaica.than females (U.e. drinking of alcohol. and many theologians continue to argue that there are reality benefits to have from this practice. In a paper titled Poverty and Health. The current paper has concurred with the literature that religiosity is positively associated with quality of life. 1996). In contemporary Jamaica. but that income does not buy unlimited happiness. Murray (2006) argued that there is a clear interrelation between poverty and health. Religion is gender bias. Among the fundamental characteristics of research are that adding something new to the discourse. and this dates back to nation‘s slavery past. Graham et al. Preventive Services Task Force. We go further to say that the quality of life Jamaican Woman is the highest when she has the greatest degree of church attendance followed by moderate religiosity and lastly by the lowest religiosity. Traditionally income was used to proxy wellbeing (i. and that is goes beyond the theologians‘ views (Krause 2006. proper 236 . economic wellbeing). and that Richard Easterlin (2001a. religious guidelines aid wellbeing in that through restrictive behavioural habits which are health risk such as smoking. and this is the fourth most influential predictor of quality of life of a Jamaican Woman. Moody 2006: Jurkovic and Walker 2006. church attendance is substantially a woman issue. we will maintain these traditions in the current work. The current research does not expand on past literature.

327). self-reported quality of life using Abraham Maslow‘s 5 Need Item scale). Arendt.sanitation. using ordered logistic models. Murray 2006. Although the current work counter the findings of Edward Diener‘s work (1984). other environmental factors. ―…. preventative care. knowledge of health practices and attendance at particular educational institutions among other things. medicinal care. what contributes the most to quality of life of a Jamaican woman? The answer is social class followed by employment status. This contradicts the work of Edward Diener. such as lack of access to clean water. 11). The issue of resource insufficiency affects the ability and capacity of the poor from accessing the quality of goods and services comparable to the rich that are better able to add value to wellbeing. The quality of life of a 237 . Sen 1999). and that income‘s contribution to the quality of life of a Jamaican Woman is highly important as the current paper reveals that it (income) is the third most influential factor in determining quality of life of the sampled population. there is a mixed pattern of evidence regarding the effects of income on SWB [subjective wellbeing]‖. This is succinctly forwarded by Murray in her monograph that: Poverty also leads to increased dangers to health: working environments of poorer people often hold more environmental risks for illness and disability. disproportionately affect poor families (Murray 2006. and it shows that income is the third most valued predictor of quality of life of a Jamaican woman. 923) Michael Grossman‘s work had established the direct link between income and health (Smith and Kington 1997. According to Diener (1984. adequate housing.e. states that the correlation between income and subjective wellbeing was small in most countries. The current research was subjective wellbeing (i. Diener (1984). found that ―it cannot be rejected that the income effects are causal‖ and this proceeded the finding that ―[a] robust relations exist between income and some measures of wellbeing of [the] elderly‖ (Ardent 2005.

Bourne. The current work does not provide all the answers. on the other hand. the sense of freedom. 1972. Employment does not merely about the income. In this study education was not related to quality of life. 2005. but it is a catalyst upon which we are able to build. 2007). Employment‘s contribution to the quality of life of woman is highly important because of significant of employment in socio-economic independent. modified and refute as these are pillows upon which research is based. choices and freedom and power of independency in this regard. which contravenes the finding of many studies (Diener 1984. with social class being the most influential of all the variables. opportunities. with middle class women having the greatest quality of life and working class female experiencing the least quality of life. 238 .‘s work. employment. the positive psychological attributes that this freedom gives as well as the self-advancement that it is likely to provide why this variable is of that importance in determining the quality of life of Women.Jamaican Women is primarily determined by her social class. the factors of quality of life of a Jamaican Woman are social class. Conclusion In summary. Grossman. found that the statistical relation was a weak one. the choices. but it is about the independence. income and religiosity. Hambleton et al. Hambleton et al.

Funny Turns in an Elderly Man. The clinical‘s approach to the elderly patient. Effects of religion and purpose in life on elders‘ subjective wellbeing and attitudes toward death. Subjective Well-Being: The Science of Happiness and a Proposal for a National Index. Jamaica: The Univer. 2001. Hyattsville.27:35-47. Available at SSRN: http://ssrn. B.com/abstract=634452 Bourne. Kingston. 1987. The University of the West Indies. D. Department of Health and Human Services. Objective and subjective quality of life: an interactive model. 2001. 1987. Bulletin of Eastern Caribbean Affairs 1994. Life cycle welfare: Evidence and conjecture.14:55-77. 1992-1994. Social Indicators Research 2000. Income and happiness: Towards a unified theory. Determinants of well-being of the Jamaican Elderly. Journal of Religious Gerontology 2003. 239 . Unpublished thesis. Brazil.641. Eldemire D.48.2:1-30. Key determinants of the health and well-being of men and boy. International Journal of Men‘s Health 2003. Learning to be a man: Culture. C. Jamaica: University Printery. O. Jamaica: University Printery.61. West Indian Medical Journal. Grell. The elderly in the Caribbean: Proceedings of continuing medical education symposium. Journal of Economic Behavior and Organization. 1992. 56:376-379. Kingston. of the West Indies Press. Deaths: Final data for 1998 (DHHS Publication No.. The elderly in the Caribbean: Proceedings of continuing medical education symposium. 2000. Psychological Bulletin 1984. Kingston. Gerald A. Economic Journal 2001a.95:542-575. 2001). World Bank Policy Research Working Paper No. Journal of Socio-Economics 2001b. Grell. Key determinants of the health and wellbeing of men and boys.52:55–72.19:31-46. Eldemire D. Diener E. 1987b. [PHS] 2000-1120) National Vital Statistics Reports. Will raising the incomes of all increase the Happiness of all. Cummins RA. Kingston: Planning Institute of Jamaica. 2740. Demographic differences in notifiable infectious disease morbidity United States. E. American Psychological Association 2000. Morbidity and Mortality Weekly Report 1997. Easterlin RA. Arias. Chevannes. 1995.111: 465-484 Easterlin RA. Are Men Benefiting from the New Economy? Male Economic Marginalization in Argentina. Christian.The elderly – A Jamaican perspective. The elderly and the family: The Jamaican experience. Quoted in Courtenay. Ardelt M. Eldemire D . ed. Mona Campus. MD: National Center for Health Statistics. 1995a. WH. P. (ed). Subjective wellbeing. Diener E.Reference Ali. A situational analysis of the Jamaican elderly. 46:637. 1987a. 2007.2:1-30. A.55:34-43. Easterlin RA. (2007). socialization and gender identity in five Caribbean communities. Eldemire D. & Chung. and Costa Rica (December 18.. Courtenay WH. 30:31. G. Centers for Disease Control. International Journal of Men‘s Health 2003.

Eldemire D. Grossman M. Poverty and health. 23-26 January 1995 and in Bridgetown. 2005. Jamaica 1996. Kart CS. 50. Rosenberg MW.56:239-249. Bain BC.Eldemire D.1:43-53. The Jamaica Adolescent Reproductive Health Project (Youth. 2006. Examining masculine gender-role conflict and stress in relation to religious orientation and spiritual wellbeing in Australian men. Hambleton IR.52:547-559. Social and health determinants of wellbeing and life satisfaction in Jamaica. Miller.paho. Herbert. Barbados. Kingston: Jamaica Publishing House. New York: National Bureau of Economic Research. Eldemire D. Haveman R. International Journal of Social Psychiatry 2004. Ontario: Nelson. Gayle. New York: United Nations Division for the Advancement of Women.40:369-394. McDonough P. Social security. Comparing quality of life using the World Health Organization Quality of Life measure (WHOQOL-100) in a clinical and non-clinical sample: Exploring the role of selfesteem. Journal of Men‘s Studies 2006. Murray S. 1986. Demography 2003.org/index. Clarke K. United States: Allyn and Bacon. Walters V. 3rd. 240 . The elderly in Jamaica: A gender and development perspective. Marginalization of the Black Male. Jurkovic D. Social Science and Medicine 2001. 6-9 December 1994. Kingston: Kingston Publishers. eds.. American Psychologist 2001. 1991. Brathwaite F.1:37-43. Perspective from Asia and the Caribbean. and economic wellbeing: Inter-temporal and demographic patterns among retired-worker beneficiaries. Murphy H. Review of Religious Research 2006. Older women: A situational analysis. The Jamaican elderly: A socioeconomic perspective and policy implications. Growing old in Canada: Demographic and geographic perspectives. Walker GA. Hutchinson G. Simeon DT. Religious doubt and psychological wellbeing: A longitudinal investigation. self-efficacy and social functioning. Heyden S. http://journal. and sustainable development. Kaplan BH. Murphy EK. The demand for health a theoretical and empirical investigation. 1972. Kitts J. Holden K. Men at Risk. Wyatt GE. Why are some people happier than others? The role of cognitive and motivational process in well-being. health. Tucker MB. Boston. now). Errol. Arsenault LJ. Lyubomirsky S. Wolfe B. Becker C. Ottawa: International Development Research Centre. Hames CG.174:923-923. Wilson K.14:27-46. LeFranc E. Proceedings of workshops held in Singapore. Graham TW. Canadian Medical Association Journal 2006. 2002. McGuinness D.47:287-302.46: 175-193. James SA.15:289– 300.php?a_ID=290 (accessed March 22. Miller. Fraser H S. Kingston. 1995b. Errol. Krause N. age of retirement. Broome H L. 1997. 2006). Kingston. Social and Economic Studies 1997. Adolescent Male Survivability in Jamaica. The Realities of Aging: An introduction to gerontology. 1990. Frequency of church attendance and blood pressure elevation. Historical and current predictors of self-reported health status among elderly persons in Barbados. Journal of Behavioral Medicine 1978. Moore EG. In: Robert JH. Cornoni-Huntley JC. Gender. Gender and health: reassessing patterns and explanations. Journal of Mental Health 2006. 1996. Hennis A J.

Kington R. Hendricks JA. Frey BS. 1990-2007. Ickovic JR. Preventive Services Task Force. 2004.pdf (accessed August 31. Happiness and Economics. Women‘s health: Review and research agenda as we approach the 21st century. Development as freedom. (PIOJ).2:1-30 United Nations.crema-research. ed. Los Ángeles: Brooks/Cole. Oxford: Oxford University Press. Sen A. Puerto Rico: UN. Australia: Melbourne Institute of Applied Economic and Social Research 2004. Kingston: PIOJ. 2006). American Psychologist 1990.Planning Institute of Jamaica. Stutzer A.pdf (accessed June 29. World Bank. Demography 1993. Key determinants of the health and wellbeing of men and boys. Headey B.ch/papers/2003-07. Demographic and economic correlates of health in old age. 1999.pdf (accessed October 14. Frey BS. Baltimore: Williams & Wilkins. 2003. World development indicators. The University of the West Indies.org/agingwatch/events/regionals/eclac/popagingdevsanjuan2004. 2006).com/wp/wp2004n03. International Journal of Men‘s Health 2003.S. Jamaica for allowing them to utilize the dataset which facilitates this study. 1998. Demography 1997. 1990-2007. Population. Rudkin L.: IRDB. U.34:159-170.globalaging. Seltzer MM. Health and economic status of older women ed.C. San Juan. Gender differences in economic wellbeing among the elderly of Java.30:209-226. 241 . Economic and Social Survey. In: Courtenay WH. http://www. Rodin J. Reported subjective well-being: A challenge for economic theory and economic policy. Guide to clinical preventive services 2nd ed. 2006). Mona. 1996. Wooden M. 2005. ageing and development. Smith JP. On your marks: Research issues on older women. D. http://www. Department of Government. New York: Baywood Publishing. Princeton University Press. Health psychology. The effects of wealth and income on subjective well-being and ill-being. 1989. Acknowledgement The authors would like to single out the Centre for Leadership and Governance. In: Hendricks JA. 2001. http://melbourneinstitute.45:1018-1034. ECLAC. Stutzer A. Rice PL. Washington.

1: Expectation of Life at Birth by Sex. 2007. 1999 and * Economic and Social Survey.58* 2002-2004 71.64 1999-2001 70.89 1959-1961 62. 150) Note e0 is life expectancy at birth 242 . 1880-1991.70 70. Jamaicans Period Average Expected Years of Life at Birth Male Female e0 e0 1880-1882 37.97 72.63 1969-1970 66.94* 75.80 1890-1892 36. Statistical Yearbook of Jamaica.20 1945-1947 51.02 39.30 1910-1912 39.58 1950-1952 55.65 66.20 1979-1981 69.37 1989-1991 69.89 38.03 72.73 58.26 77.41 1920-1922 35.25 54.04 41.07 Sources: Demographic Statistics (1972-2006). p. Jamaica 2005 (Quoted in Bourne.Table 9.74 38.

3.2 6.3±10.9 14.4 28.4 1. 56. 243 .: Range 69: 85 – 16 yrs.2 1.1 31 69 34.Table 9.7:10 – 1.8: Range 79:86 – 7.4 77. N=723 Number Subjective Social Class Working (lower) class Middle class Upper class Ethnicity Caucasian Blacks Browns Other Educational Level No formal Education Primary/Preparatory and All Age school Secondary Post-secondary Tertiary Employment Status Unemployed Employed Age Quality of Life Political Participation Index Extent of Welfare System of governance Confidence in sociopolitical institution index 409 259 29 46 562 104 9 8 116 246 127 195 222 494 Percent 58.7: Range 10: 10– 0.2 4.8 ± 1.6 ±3. 6.7 37.8 35.5: Range 17: 17– 0.5 18.2: Demographic Characteristics of Sampled Population.4 yrs.2.2 16.33yrs ±13.5: Range 8. 6.8 ±1.

167 0.676 -0.071 -0.001< 0.028 0.461 1.101 1.167 0.810 0.022 0.038 Dummy Governance(1=Benefit s most equally.214 0.050 0.721 R = 0.235 -0.088 0.085 -0.015 0.096 0.691 0.042 0.185 N=425 F-test [15.401 0.058 0.116 0.017 Area of Residence -0.197 0.348 0.204 -0.462 R2 = 0.233 -0.193 0.155 0.387 0.3: Quality of Life of Jamaican Women by Some Explanatory Variables Unstandardized Coefficients Variable Beta P Coefficient Std.175 0.263 Religiosity (1=High) 0.Table 9.693 0.020 -0.974 0.432 -0.070 1.139 0.094 0.370 0.152 0.036 -0.060 0. -0.362 0.413.277 6.317 1.893 0.000 0.086 -0.064 0.002 Religiosity (1=Middle) 0.000 socialcl2 0.594 0.002 0=Favours Rich) Income Employment status Race2 (1=black and brown) Index of Political Participation lnAge 0.254 0.060 0.725 0.034 0.341 -0.194 0.820 0.189 0.198 0.424 0.077 0.007 0.598 244 .044 0.002 0.008 0.581 0.847 0.139 0.252 0.466 0.203 0. Error (Constant) 4.05 Standard error of the estimate 1.879 Extent of Welfare 0.209 0. P = 0.293 0.022 0.813 (1=Lower level ) socialcl1 0.176 -0.548 0.053 0.063 0.000 Tertiary Education 0.031 0.035 Trust 0. 410] = 7.522 System of Governance Dummy Occupation 0.304 -0.213 Adjusted R2 = 0.380 0.225 0.222 0.013 0.383 CI (95%) 2.

5 23.4 22. 3 531. 1 656. 9 611. 8 15.3 10. 7 397. 6 557. 9 611. 8 618.6 16. 6 646. 3 613.3 9. 7 402. 1 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 245 . 9 551. 8 518.9 7. 5 520.5 494.6 10. 8 549. 4 618.0 10.2 22. 9 617. 3 529. 0 397. 4 528.5 10. 1 552.6 9.4 9. 5 476. 6 504.8 22. 1990-2007 Year 1990 Male: Labour Force (000’s) Employed Labour Force (000’s) Unemploymen t Rate (in %) Female: Labour Force (000’s) Employed Labour Force (000’s) Unemploymen t Rate (in %) Compiled by Paul A. 8 519. 2 480.1 22.9 9. 0 614. 3 615.8 14.5 22.0 6. 9 661.2 10.6 7. Bourne from Planning Institute of Jamaica (in Economic and Social Survey 1990 – 2007) 9.0 10.2 564. 7 507. 7 550. 4 552. 8 389.6 10. 6 553. 6 896. 1 500. 4 393.1 22. 3 663.4: Particularized Labour Force Indicators By Sex. 3 509. 1 516. 5 610. 0 614. 2 406. 1 401. 2 574.Table 9. 2 532.8 10. 3 444. 0 571.0 10. 1 515. 7 506. 2 400. 3 552. 2 412. 8 611. 7 384. 0 513. 4 695. 1 570. 7 511.7 17. 0 552.3 21.7 7. 6 490. 9 514. 9 562.5 14. 3 571. 7 389.0 20.8 22. 6 487. 8 403.1 23. 1 554.4 15. 3 486.4 21. 8 699. 1 445.

Health insurance was the critical predictor of good health status of women in Jamaica. Donovan McGrowder and Tazhmoye Crawford 3 A comprehensive review of the literature revealed that less information is available in literature on health status of women. Denise Eldemire-Shearer. urban OR = 1.320. 95% CI = 0. and this was equally the same across the 3 geographic areas. and differences based on area of residence. Bourne. 95% CI = 0.679-0. and that married women were 1. Peri-urban and Urban Areas in Jamaica Paul A. and 20 of the region‘s largest cities are home to nearly 20% of its population.00) and that they were the least likely to have health insurance coverage.819.054. Jamaica is a predominantly 246 . This study provides an understanding of women‘s health status in Jamaica as well as the disparity which correlates based on the different geographical regions.8421.036-1.3. For every 13 persons there are in the region.3% in 2007) [1]. 10 of them live in cities (78.10 Examining Health Status of Women in Rural. This study examined data on the health status of women in Jamaica in order to provide some scientific explanation of those factors that account for their health status. and health status of women in 3 geographical zones in Jamaica. 95 CI = 1. Background Latin America and the Caribbean have the second highest urbanization level in the world.989) among all women (peri-urban OR = 1. Rural women had the lowest health status (OR = 0.3 times more likely (OR 1.501) to report good health compared to those who were never married.

Afro-Caribbean society, 75% black and 13% mixed, with a class structure based on land and wealth rather than race. Although a developing country, it possesses features of a developed country. While there is much industrialization and modernization, customs, cultural and social habits of several centuries are common-place. Jamaica is the third largest English speaking Caribbean island (total area of 10,991 km2) with an estimated population of 2.7 million (2007). The country is classified into three geographical planes (Cornwall, Middlesex and Surrey) and has 14 parishes. Cornwall covers the Western belt which includes parishes such as Westmoreland, Hanover, St. James, St. Elizabeth. Middlesex constitutes the middle proportions of the island with parishes such as Clarendon and St. Catherine. Surrey comprises the Eastern region with parishes such as Kingston, St. Thomas and Portland. Another classification is cities (urban areas) which constitute 27.3% of the population, peri-urban 30.2% and rural areas, 42.5% in 2007. In 2007, Jamaica‘s poverty rate was 9.9%, and this was 15.3% in rural areas, 4.0% in periurban areas and 6.2% in urban areas. Furthermore, the mean annual per capita consumption for country was US $2,059.91 while it was US $2,736.60 for urban dwellers, US $2,231.04 and US $1,513.17 for rural Jamaicans. Statistics for the same period showed that the sex ratio of the population was 97 per 100 and 84 per 100 for older ages (60 years and over). This indicates that there are marginally less men than women in the population, and an even greater feminization at older ages. It was estimated that 10.9% of the population was 60 years and over which indicates an ageing population that began in the 1960s [2-4], 28.3% under 15 years, and 53.5% in the reproductive years of 15 to 49 years. Women comprised 50.7% of the population and elderly women accounted for 13.0% compared with 11.4% for elderly men. It was also found that 46.6%
247

of household heads were women; life expectancy at birth for women was 77.1 years (2002 to 2004). The unemployment rate in 2007 was 65.4% for women [3-5] with women participation rate being 55.4% compared to 72.9% for men. Fifty-three percent of women in the poorest quintile were heads of households compared to 46.9% of men. An important difference between the sexes was the mean annual per capita consumption. Statistics revealed that the mean annual consumption for male headed-household was US $2,188.03 compared to US $1,892.92 for female headed-household. It is well established that health status is determined by socio-physiological factors (age, income, education, culturalization, crime and negative psychology) and that lifestyle practices also account for good (or poor) health status [6-8]. Women‘s health therefore is intricately a mix of socio-physiological response or outlay and is expressed through behaviour relating to culture, religion, and legal norms [6]. Although recent attention has been directed towards exploring the ramifications of women‘s health in the Western Hemisphere including the Caribbean, an extensive review of the literature revealed that only a few studies have examined health determinants of women in the Caribbean, including Jamaica [7, 8]. Using secondary data from a stratified probability survey on political culture of 1,338 respondents, Bourne [7] extracted a sample of 722 women in investigating the determinants of quality of life of women in Jamaica. The study showed that the mean quality of life of Jamaican women was moderately high (6.8 out of 10; SD =1.7). Six variables (social class, employment, income, religiosity, governance of the nation and interpersonal trust) accounted for 18.5% of the variability of quality of life. Eldermire [8] investigated the general life situation of elderly Jamaican women and found that their life situations were on an average good.
248

Many economic indicators showed that women are disadvantaged in Jamaica and the wider Caribbean when compared to men [9-11]. In 2007, Statistics for Jamaica showed that the mean consumption per capita on food was US $2,378.39 for male head-household compared to US $1,898.56 for women. Studies have showed that women seek more health care then men [12-14], and that this commences in earlier childhood. Therefore, the similarities and dissimilarities based on area of residence of women was examined (via econometric models) in order to determine the composition of women‘s health status. Econometric models such as Bourne‘s health determinant model [15] denotes that an individual‘s health is a function of cost of medical care and other factors such as: educational level, age, the environment, gender, marital status, area of residence, psychological status which include positive and negative affective status, occupancy per room, home tenure, property, and crime and victimization. Bourne‘s work modelled health determinants of Jamaicans, and with the aforementioned issues surrounding women as were outlined above, a study on Jamaicans is not necessarily providing an understanding of women‘s health and significant of particular factors determining their health status or the disparity in health status of women based on the 3 geographic sub-regions in the island. This study sought to examine 1) the consumption expenditure of women in the different income quintiles (or social classes); 2) health insurance coverage, and visits to health care facilities by area of residence; 3) health status by age cohorts (ie young, other adults and elderly women); 4) diagnosed illness by age cohorts; diagnosed illness by area of residence; 5) the health status of women in Jamaica using a modification of Bourne‘s health determinant model; 6) the health status of women in and sub-regions namely urban, periurban and rural residence; and 7) the strength of those factors which affect health status of women in the nation and the sub-regions.
249

Materials and methods
Materials and Methods The sub-sample for the current paper was all 8,541 women (ages of 15 to 100 years) extracted from a nationally representative cross-sectional survey of 25,018 Jamaicans, the Jamaica Survey of Living Status (JSLC, 2002) [16]. This survey was drawn using stratified random sampling. The design was two-stage stratified random sampling, where there was a Primary Sampling Unit (PSU) and a selection of dwelling from the primary units. The PSU is an Enumeration District (ED), which constitutes a minimum of 100 dwellings in rural areas and 150 in urban areas. An ED is an independent geographic unit that shares a common boundary. This means that the country was grouped into strata of equal size based on dwellings (EDs). Based on the PSUs, a listing of all the dwellings was made and this became the sampling frame from which a master sample of dwelling was compiled which provided the sampling frame for the labour force. Ten percent was selected for the JSLC. The survey was weighted to represent the population of Jamaica. This study used JSLC 2002 which was conducted by the Statistical Institute of Jamaica (STATIN) and Planning Institute of Jamaica (PIOJ) between June and October 2002. The researchers selected this survey because it was the second largest sample size for the survey in its history (since 1988 to 1998), and in that year, the survey had questions on crime and victimization, and the physical environment unlike previous years. A self-administered questionnaire was used to collect the data, which was stored and analyzed using SPSS for Windows 16.0. The questionnaire was modeled from the World Bank‘s Living Standards
250

Measurement Study (LSMS) household survey. There were some modifications to the LSMS as JSLC was more focused on policy impacts. The questionnaire covered questions such as: sociodemographic, economic and wealth, crime and victimization, social welfare, health status and services, nutrition, housing, immunization of infants and physical environment. The survey was weighted in order for it to represent the population. The non-response rate for the survey was 27.7%. Descriptive statistics such as mean, standard deviation (SD), frequency and percentage were used to analyze the socio-demographic characteristics of the sample. Chi-square was used to examine association between non-metric variables; an Analysis of Variance (ANOVA) was used to evaluate the relationships between metric and non-dichotomous categorical variables. Logistic regression examined the relationship between the dependent variable and some predisposed independent (explanatory) variables because the dependent variable was a binary one (selfreported health status, with 1 if good health status was reported and 0 if poor health). Results were presented using unstandardized B-coefficients, Wald statistics, odds ratio and confidence interval (95% CI). The predictive power of the model was tested using Omnibus Test of Model and Hosmer and Lemeshow [17] was used to examine goodness of fit of the model. The correlation matrix was examined in order to ascertain whether autocorrelation (or multicollinearity) existed between variables. Based on Cohen and Holliday [18], correlation can be low (weak), from 0 to 0.39; moderate, 0.4 to 0.69, and strong, 0.7 to 1.0. This was used to exclude (or allow) a variable in the model as any variable that had at least moderate correlation was excluded from the final model. Wald statistics was used to determine the magnitude (or contribution) of

251

each statistically significant variables in comparison with the others, and the odds ratio (OR) for interpreting each significant variables. Multivariate regression framework [19, 20] was used to assess the relative importance of various demographic, socio-economic characteristics, physical environment and psychological characteristics in determining the health status of women in Jamaica. This approach allowed for the analysis of a number of variables simultaneously. Secondly, the dependent variable is a binary dichotomous one which has enabled the use of this statistic technique to be utilized in the past to do similar studies. Having identified determinants of health status from previous studies, using logistic regression techniques, final models were build for women in general as well as for each geographical sub-regions (rural, peri-urban and urban areas) using only those predictors that independently predict the outcome. The level of significance for this study is 95% (ie P < 0.05). Equation 1 is a modification of Bourne [21, 22] health determinant model which was previously used to determine the health status of the elderly in Jamaica.
Hi = ƒ(Wi, HHi, Pmci, Ci, MRi, ARi, EDi, SSi, CRi, (∑NAi, PAi), Mi, Fi, CHi, At, Ai, HIi, LLi, Eni, Yi, Vi,εi)

(1)

The health status of person i, Hi, is a function of Wi, the two wealthiest quintiles of person i with 1 if yes or 0 for the two poorest quintiles; HHi, household head of person i, with 1 if yes or 0 if otherwise; Pmci, cost of medical care of person i, in United States (US) dollars; Ci, average consumption per person in household, in US dollars; MRi,is marital status of person i; ARi,, area of residence of person i; EDi, educational level of person i; SSi, having social support of person i with 1 if yes or 0 if no; CRi, crowding of person i, in numbers; (∑NAi, PAi), psychological status which is the summation of negative affective status of person i, NAi where values are in
252

continuous number; PAi, positive affective psychological status of person i, where values are in continuous numbers; Mi, number of men in household of person i; Fi, number of women in household of person i; CHi, number of children below the age of 14 years of person i; At, asset owned of person i, in continuous numbers; Ai, age of person i, in continuous numbers; HIi, of private health insurance (proxy ); LLi, living arrangement where 1 is living with family members or relative, 0 if otherwise; Eni, physical environment of person i, with 1 if affected by flood, landslides, soil erosion or 0 if not affected; Yi, average income per person in household (this variable is proxied by total expenditure); Vi, crime of person i, where values are continuous numbers, and εi is the residual error. Measures Self-reported health status is self-assessed illness (cold, diarrhoea, asthma attack, hypertension, diabetes mellitus or any other illnesses) reported by respondents in the last 4-weeks of the survey period. Good health status is a dummy variable; where 1 is good health (not reporting an ailment, injury or dysfunction) and 0 is poor health (self-reported illness, injury or ailment). Household crowding is the average number of persons living in a room excluding kitchen, bathroom and verandah. Physical environment is the summation of responses reported by respondents on suffering landsides; property damage due to rains, flooding; or soil erosion in the last 4-weeks. Psychological conditions are the psychological state of an individual, and this is sub-divided into positive and negative affective psychological status. Positive affective psychological status refers to the number of responses that are hopeful and optimistic about the future and life
253

generally. Negative affective psychological status refers to the number of adverse events occurred to the respondents over the last 4-week period. Each event was equally weighted. Age is the number of years lived, which is also referred to age at last birthday. This is a continuous variable, ranging from 15 to 100 years. Age group is classified into three sub-groups. Young are ages 15 to 30 years, other adults 31 to 59 years, and elderly 60 years and over. Age is used as a continuous variable for the logistic regressions. Crime and victimization index (crime index) measures the number of cases and severity of crimes committed against a person or his/her family members but not against property. Social support (or network) denote different social networks with which the individual has or is involved (1= membership of and/or visits to civic organizations or having friends that visit ones home or with whom one is able to network, 0 = otherwise). Living arrangement denotes whether the individual is living alone or with family, friends or associates; where 1 = living with family members or relatives, and 0 = otherwise.

Results
Demographic characteristics of sampled population The sub-sample consisted of 8,541 respondents (ages 15 to 100 years), with a mean age of 40.1 years (SD 19.29 years). Of the sub-sample of respondents, 65.2% were never married, 24.7% married and 10.1% divorced, separated or widowed. The mean annual consumption per person per household was US$762.35 (SD US$917.81) (rate in 2002: 1US$ = Ja$50.97) with the
254

maximum consumption being US$136,822.08. Moreover, 36.6% of the sample was in poverty with 17.5% being below the poverty line (i.e. poorest poor) compared to 44% who were in the two wealthiest quintiles, of which 23% were in the wealthiest quintile (Table 10.1). On examination of area of residence by age group, it was found that 21% of rural women were 60+ years compared to 15.2% of peri-urban women and15.1% of urban women (Table 10.1) – P < 0.001. Of the population, 17.2% reported poor health status (suffering from an illness, ailment, or injuries) in a 4-week period of the survey, with 82.8% indicated good health status. Of the 17.2% of women who reported poor health status, 6.5% visited public-private health care facilities for treatment. Of this 6.5%, 6.3% visited public health care institutions compared to 0.2% who visited private health care facilities, 66.1% of those who had reported an illness in the 4-week survey period bought the prescribed medication, with 40.9% of them took the medication in full. Some 5.6% of the sample reported that they resided alone (living arrangement), and 57.8% indicated no social support. Based on Table 10.1, there was a significant statistical correlation between good health status and area of residences – P < 0.001. Rural women recorded the lowest health status among all women of the three geographic areas (Table 10.1): Rural women recorded the least good health status (75.5%) compared to 77.0% of urban women and 81.8% of semi-urban women. More crowding was in the rural sample (1.9 ± 1.3 persons per room) compared to 1.8±1.3 persons per room in peri-urban and urban areas – P = 0.020. A statistical difference was found between area of residences and mean number of visits made to health care facilities – P = 0.023:
255

1.6 ± 1.1 days for rural women; 1.7 ± 1.3 days for peri-urban women and 2.0 ± 2.7 days for urban women. A statistical correlation was found between social standing and area of residences – P < 0.001: 22.3% of rural women were in the poorest 20% compared to 11.5% of peri-urban women and 9.5% of urban women. Rural women had the most of primary or below level education respondents (23.5%) compared to 18.4% of peri-urban and 14.6% urban – P < 0.001. Concomitantly, mean income of rural women was US$ 2,871.86 ± US$2,646.39 which was 76.1% of the income of peri-urban women and 64.5% of that of urban women – P < 0.001.

The general positive affective psychological condition of Jamaican women was moderate (3.5 out of 6 ± 2.4) and negative affective psychological condition of the same sample was low (4.6 out of 15 ± 3.4). On disaggregating both affective conditions by area of residences revealed a significant statistical difference: positive – F statistic =36.205; P < 0.001 and negative – F statistic = 30.774, P < 0.001. Based on Table 10.1, rural women had the highest negative affective psychological conditions – 4.8 out of 15 ± 3.2 compared to peri-urban (4.2 out of 15 ± 3.5) and urban women (4.3 out of 15 ± 3.8). However, there was no statistical difference between the negative affective psychological conditions of peri-urban and urban women (P = 0.655). Rural women had a lower mean score in positive psychological conditions (3.3 out of 6 ± 2.4) than periurban women (3.9 out of 6 ± 2.3) – P < 0.001; however there was no significant statistical difference between rural and urban women‘s positive affective psychological conditions ( 3.4 out of 6 ± 2.4) – P = 0.990.

256

Table 10.1. Demographic characteristics of sample.
Variable Marital status Married Never married Divorced Separated Widowed Social Standing Poorest 20% Poor Middle Wealthy Wealthiest 20% Good Health status No Yes Educational level Primary and below Secondary University Social support No Yes Living arrangement With family or relative Without family (alone) Age group Young (15 – 30 years) Older adults (31 – 59 years) Elderly (60+ years) Age Mean (SD) Crowding Mean (SD) Mean Income per person (SD) Mean consumption per person (SD) Mean number of visits for health care (SD) Negative affective Mean (SD) Positive affective Mean (SD) Rural areas n (%) n = 4,962 1232 (25.7) 3032 (63.3) 25 (0.5) 51 (1.1) 453 (9.5) 1106 (22.3) 1162 (23.4) 1014 (20.4) 973 (19.6) 707 (14.2) 1184 (24.5) 3641 (75.5) 1010 (23.5) 3099 (72.0) 194 (4.5) 2724 (54.9) 2238 (45.1) 4714 (95.0) 248 (5.0) 1865 (37.6) 2055 (41.4) 1042 (21.0) 41.02 yrs (20.06) 1.9 (1.3 persons) US 2871.86 (US $2646.39) US $614.04 (US $871.47) 1.6days (1.1) 4.8 ± 3.2 3.3 ± 2.4 Peri-urban n (%) n = 2,283 568 (25.7) 1451 (65.7) 16 (0.7) 27 (1.2) 147 (6.7) 263 (11.5) 320 (14.0) 433 (19.0) 522 (22.9) 745 (32.6) 405 (18.2) 1820 (81.8) 355 (18.4) 1360 (70.4) 216 (11.2) 1418 (62.1) 865 (37.9) 2148 (94.1) 135 (5.9) 910 (39.9) 1025 (44.9) 348 (15.2) 38.65 yrs (18.19) 1.8 (1.3 persons) US$3773.41 (US $2752.03) US$888.24 (US $727.32) 1.7days (1.3) 4.2 ± 3.5 3.9 ± 2.3 Urban n (%) n = 1,296 243 (19.3) 907 (71.9) 18 (1.4) 22 (1.7) 71 (5.6) <0.001 123 (9.5) 149 (11.5) 222 (17.1) 321 (24.8) 481 (37.1) <0.001 292 (23.0) 979 (77.0) 159 (14.6) 807 (74.0) 125 (11.5) 741 (57.2) 555 (42.8) 0.005 1202 (92.7) 94 (7.3) < 0.001 501 (38.7) 599 (46.2) 196 (15.1) 39.12 yrs < 0.001 (17.91) 1.8 (1.2 0.020 persons) US$4451.23 < 0.001 (US 5181.68) US$1108.34 (US 1217.18) 2.0 (2.7) 4.3 ± 3.8 3.4 ± 2.4 < 0.001 0.023 < 0.001 < 0.001 < 0.001 < 0.001 P < 0.001

* Rate in 2002 was US$ 1= Ja.$50.97 The recorded p-value is for each variable by area of residence (ie rural, peri-urban and urban)
257

Upon examination of consumption and per capita income quintile (social standing), a significant statistical difference was found between consumption of women in different social standing F = US$22.32, P< 0.001 (Table 10.2). Those in the poorest quintile had a mean consumption per person per household of Jamaican US$225.38 (rate in 2002:1US$ = Ja$50.97) which was 67% less than those in quintile 2; 133% less than those in quintile 3; 237% less than quintile 4 and 659% less than those in the wealthiest quintile (quintile 5). Those in the wealthiest quintile had an average consumption per person per household of 125% more than those respondents in the wealthy quintile (quintile 4). Owing to the wide disparity in values, the best measure for average consumption per person per household is the median consumption – US$554.39 (rate in 2002: 1US$ = JA$50.97).

258

Table 10.2. Average consumption per person per household by per capita income quintile. N Mean US$ Poorest 20% Poor Middle class Wealthy Wealthiest 20% 1492 1631 1669 1816 1933 225.38 376.37 525.07 759.91 1709.65 Std. Deviation Std. Error US$ 64.03 45.66 70.19 123.34 1550.86 917.81 US$ 1.66 1.13 1.72 2.89 35.27 9.93 95% CI Lower US$ 222.13 374.15 521.7 754.24 1640.47 742.88 Upper US$ 228.63 378.59 528.44 765.59 1778.83 781.82

Total 8541 762.35 F statistic = US$22.32, P < 0.001 Rate in 2002 was US$1 = Ja$50.97

259

There was no statistical difference between visits to either public or private health care facilities and area of residence of the sample (Table 10.3) – P > 0.05. However, a statistical difference existed between health insurance coverage and area of residents in Jamaica (χ2 = 24.4, P< 0.001), with there being a weak correlation (contingency coefficient = 0.167). Of those who responded (n = 8,268), 12.5% of had private health insurance coverage. The least number of rural women had health insurance coverage (7%) compared to 16.5% of peri-urban women and 18.7% of urban women.

Table 10.3. Health insurance, self-reported good health status by area of residence (in %). Area of Residence Details Rural n = 4796 Health insurance Yes No Self-reported visits to public facilities for health care Yes No Self-reported visits to private facilities for health care Yes No 7.0 93.0 Peri-urban n = 2216 16.5 83.5 Urban n = 1263 18.7 81.3

7.1 92.9

4.4 95.6

6.1 93.9

0.3 99.7

0.0 100.0

0.0 100.0

Health insurance - P< 0.001 Self-reported visits to public health care facilities – P < 0.386 Self-reported visits to private health care facilities – P < 0.617

260

Table 10.4 revealed that there was a negative statistical correlation between self-reported good health status and age group (χ2 = 820.397, P< 0.001), with the association being a moderate one (cc = 0.301). The findings indicated that 7.5% of young respondents reported a poor health status compared to 15.6% other adults and 40.9% of elderly respondents indicating the substantial erosion of good health status of women as they age.

Table 10.4. Self-reported good health status by age group. Age group Young (n = 3,114) Good status No Yes health 234 (7.5) 2,880 (92.5) 558 (15.6) 3,021 (84.4) 631 (40.9) 913 (59.1) Other Adults (n = 3,579) Elderly (n = 1,544)

χ2 = 413.247, P< 0.001 Of the 1,417 respondents who reported an illness, 7.0% indicated that it was diagnosed as chronic recurring illness. A statistical correlation was found between illness being recurring and age group of respondents (χ2 = 413.247, P< 0.001), with relationship between the two aforementioned variables being a moderate one (cc = 0.473). Based on Table 10.5, Diabetes mellitus, hypertension and arthritis were found to be more an elderly chronic illness than the other age sub-samples. Simply put, as women age, chronic illness such as diabetes mellitus,

261

hypertension and arthritis increased, with arthritis having the greatest increase in elderly compared to middle age. Table 10.5. Diagnosed with recurring illness by age group. Diagnosed/recurring illness Cold Diarrhoea Asthma Diabetes Hypertension Arthritis Other No Age Group Young Age (n = 236) 64 (27.1) 9 (3.8) 37 (15.7) 5 (2.1) 17 (7.2) 3 (1.3) 65 (27.5) 36 (15.3) Total Middle Age (n = 562) 62 (11.1) 10 (1.8) 33 (5.9) 82 (14.6) 206 (36.7) 20 (3.6) 99 (17.6) 49 (8.7) Elderly (n = 636) 21 (3.3) 7 (1.1) 12 (1.9) 150 (23.6) 275 (43.2) 91 (14.3) 65 (10.2) 15 (2.4) (n = 1,434) 149 (10.4) 26 (1.8) 82 (5.7) 237 (16.5) 498 (34.7) 113 (7.9) 229 (16.0) 100 (7.0)

χ2 = 413.247, P < 0.001, cc = 0.473

When a correlation was performed between the duration of illness (How long did the last episode of illness last?) and area of residence, a relationship was found between the two variables (F = 7.513, P < 0.001). On an average, the mean duration for the illness was 11.09 days (SD 10.742 days), 95% CI: 10.51-11.67 days. Rural residents reported suffering from illness for a mean of 11.74 days (SD 10.691 days), 95% CI: 11.04-12.44 days which was not statistically different from mean number of days reported by peri-urban residents, 10.50 days (SD 10.573
262

5) 157(16.3) 25(13.6) 29(16.9) 159(16. Of the 1. 95% CI: 9.0) 100(7.6) 148(10.44-9.21-11.2) 10(3. There was no statistical difference between the mean duration of illness for peri-urban and urban residents.8) 12(6.0) 61(33. 95% CI: 6.days).9) 229(16. The findings revealed that health status by area of residence had no statistical correlation.3) 54(5.7) 4(2. 16% from diabetes mellitus. The mean number of reported days in which rural and urban resident were ill [8. 93. P = 0.5) 498(34.7) 15(8.091. P = 0.4) 13(4.05) 263 .6).8) 95(32. Table 10.79 days.0% said that these were diagnosed as recurring and acute.6.7) 114(7.96 days.434 respondents who indicated poor health status.0% in each area of residence suffered from hypertension.3) 26(1.6) 27(9.434) Diagnosed illness Cold Diarrhoea Asthma Diabetes Hypertension Arthritis Other No 98 (10.5) 17(5.2) 12(1. in excess of 30.5) 342(35. P < 0.2) 12(6.6) 23(12.001.0) No significant association (P > 0.7) 237(16.051 (Table 10. 13% other and 5% arthritis.233].8) 47(16.1) 34(11. Diagnosed/recurring illness by area of residence.20 days (SD 10. P= 0. Despite the no statistical difference.6) 82(8.8) 82(5. Area of Residence Total Periurban Urban Rural Areas (n = (n = (n = 961) 292) 181) (n = 1.879 days).5) 49(16.2) 57(5.

251) of the data were correctly classified: 97.001. Rural women were less 264 .0% of the variability in health status of women in Jamaica.8)followed by assets owned (OR = 1.91. The current work has found that women who have health insurance were 27.9). Income positively influences good health status of women (OR = 1.5 times likely to report good health than those who do not have health insurance coverage.1). one was excluded because the correlation coefficient between it (consumption) and income was 0. age of the respondents (OR = 0.0.8-1. 95% CI = 0.0).19 P < 0.9. 95% CI = 0. On examination of data (Table 10.0). P = 0.7% of those who indicated good health status and 37.7). income (OR = 1.2.1. marital status – married – (OR = 1.0) (Table 10.7). number of men in the household (OR = 0. it was revealed that overall 84.000. area of residence and negative affective psychological status (OR = 1.0001. 95% CI = 1.9. Nine variables were found to be determinants of good health status of women in Jamaica (Table 10.68.0). 95%CI = 1. positive affective psychological status (OR = 1. 95% CI = 1. 95% CI = = 1.7).0).0.0-1.135.Multivariate Analyses Of the 20 predisposed variables that were used in the used in Eq.5. 95%CI = 0.1. In addition.9-0. 95% CI = 0. [2].0-1.9% (n = 7. it was revealed that private health insurance was the most significant factor predicting good health status of women in Jamaica (OR = 27.1-1.691).0-1.6).606. All the factors explain 36.9. 95%CI 1. crowding (OR = 0.249.000).8-1.8% of those who indicated poor health status. 95% CI = 21. Hosmer and Lemeshow goodness of fit χ2 = 5. The model had a statistical significant predictive power (χ2 = 1.

Married women were 1.7). Women who were experiencing greater positive affective psychological conditions were 1. 265 . and women who experienced greater negative affective psychological conditions were 0.2 times more likely to report good health status with reference to those who were never married. The older women get.03 times less likely to report good health status. and that peri-urban women were 1.likely to report good health status compared to urban women.1 times more likely to report good health status compared to urban women.19 times less likely to report good health status (Table 10. they are 0.1 times more likely to report good health status.

943*** 1.671 0.0.000 1. Widowed Married †Never married Rural Peri-Urban † Urban Secondary level Tertiary level †Primary and below level Social support Crowding Psychological conditions Positive Affective Negative Affective No.003 1.017 - 266 .1.952 .115 0.248 0.112 0.179 0.1.055 0.759 .591 1.168 1. of females in household No.1.054 1.036 .059 0.910 1.8% Correct classification of cases of good health status = 97.606.330 0.055 0.004 0.507 .842 .231 1.679 .134 0.306 0. ***P < 0.999 .003 0.01.chi-square=1.0.1.1.907 95% CI 0.935 . P < 0.1.989* 0.831 .765*** 0.320* 0.691 Model: Omnibus Test .19.000 0.889 .288 0.000 1.Table 10.966** 0.048 0.104 0.0.1% †Reference group *P< 0.891 1.966 0.883 .1.1.998* 0.044 0.417 1.018 0.017 0.1.965 . of children in household Age Asset owned Health Insurance Living Arrangement Physical Environment Average Income Crime Index Constant Nagelkerke R-square = 36.136 0.1.027 0.817 .000 .637 Hosmer and Lemeshow chi-square=5. of males in household No.931 .819 1.0.080*** 0. Error 0.035 27.041*** 21.7.030 . n = 8.945 1. Divorced .084 1.1.177 1.111 35.9% Correct classification of cases of poor health status = 37.965 0.887 0.814 .131 0.042 0.566 0. Logistic regression of the general good health status of Jamaican women by some explanatory variables.1.077 0.001 Std.045 Odds Ratio 1.033 0.123 0.183 0. **P < 0.951 .619 .991* 0.478 0.1.05.247 1.000 0.001 Overall correct classification = 84.0% -2 Log likelihood= 4656.000** 0.096 0.1.541 Explanatory variables Two wealthiest quintiles Household Head Log medical Expenditure Separated.012 0.879 0.029 .989 0. P=0.102 0.878 .1.063 1.928 .1.0.501* 0.095 0.008 0.249.1.387 0.

8-0. P = 0. 95% CI = 1.9).498.8 revealed that health insurance was the most influential factor determining the good health status of rural women in Jamaica (OR = 25. 95% CI = 0.9. married rural women are 1. women with health insurance are 25. The model had a statistical significant predictive power (χ2 = 884.0-34. one was omitted (consumption. Overall.05). 95% CI = 1.4.940) of the data were correctly classified: 96. they are 0. Hosmer and Lemeshow goodness of fit χ2 = 8.0-1. nine of them explained 38.8). 95% CI =18.8-2. Of the 19 predisposed variables that were examined in the initial model. and as rural women become older.102 times 267 .3.7-0. 95% CI = 1.1-1.8).1-1. 20 initial predisposed explanatory variables were tested to ascertain factors and degree of significance of each factor (P < 0.1).0. positive affective psychological status (OR = 1.0-1. those rural women with social support were 1.001. 95% CI = 1.3).0-1.6).476 P < 0.8% (n = 2.593) of those who had indicated good health status and 42. 95% CI = 1.1.3% (n = 347) of those with poor health status. Table 10.9). number of men in household (OR = 0. 95% CI = 0. age (OR = 0. marital status – married (OR = 1.68). Continuing.Using a sub-sample of 4.962 rural residents.9) followed by assets owned (OR = 1. 84% (n = 2.6% of the variability in health status of rural women in Jamaica (Table 10.4 times more likely to report good health status with reference with those who were never married.0 times more likely to have good health status than those without health insurance coverage.0.1).3 times more likely to report good health status compared to those who did not have social support. and lastly income (OR = 1.0.0).386). 95% CI = 0. because the correlation coefficient between it and income was 0. The current findings revealed that income plays the least role in determining good health status of rural women.4. Social support (OR = 1.8. educational attainment – secondary and post-secondary level education (OR = 1.

1.1.063 .8% .75-0.8.090 .971 .498.000 1.043 0. Model: Omnibus Test . Error 0.003 0.298 1.056 0.93): indicating that more males in a household will decrease rural women‘s good health status by 0.005 0.121 0.033 0.167 0.571* 0.031 1.000** 0.933** 0.1.100 0.001 268 .183 1.790 . †Reference group.074 . Table 10.1.6% 2 Log likelihood=2. 95% CI = 0.075 0.378 0.038 24.360 1.858 .0.955 0.498 Explanatory variables Two wealthiest quintiles Household Head Log medical Expenditure Separated.292 0.069 Nagelkerke R-squared = 38.017 0.2. n = 3.83.898 1.1.805 .087 0.001 Overall correct classification = 84% .1.248 0.005 1.822 1.01.541 0.040 1. divorced Married †Never married Secondary or post-secondary Tertiary level †Primary and below Social support Crowding Psychological conditions Positive Affective Negative Affective Number of males in house Number of females in house Number of children in house Age Assets owned Health Insurance Living Arrangement Physical Environment Average Income Crime Index Constant Std. Correct classification of cases of poor health status =42.043 0. P=0. More males in the household will reduced the good health status of rural women (OR = 0.241 .1.007 1.924 . ***P < 0.964 0.05.127 0.512 1.899 0.1.1.386.950 0.17 times compared to less males in the household.834 0.046*** 18.chi-square=884.000 1.087** 0.942*** 1.004 0.774.413 1.058 0.006 34.873 .586*** 0.019 .770 0. Logistic regression of the good health status of rural-Jamaican women by some explanatory variables.132 0.000 .940 .922 1.169 0.1.991 .000 0.724* 1.252 0.82 Hosmer and Lemeshow chi-square = 8.476.142 0.1. P < 0.1.271 0.745 .474 .309 1.114 0.1.352 1.795 .018 0.832** 0.021 0.025 0.385 0.1.3% Correct classification of cases of good health status = 96.961 95% CI 0.less likely to report good health status.1.855 0.035 0.1. **P < 0.058 Odds Ratio 1.053 0.718 .000 1. *P < 0.

0). 269 .8. the more asset they own this increased their good health by 1.0-1.1 times less likely to record good health.7). six factors accounted for 36. Hosmer and Lemeshow goodness of fit χ2 = 7. 95%CI: 1. The factors that predict good health status of peri-urban Jamaican women in descending order were health insurance (OR=57.226.0).001.0). asset ownership (OR=1. 95%CI: 29. age of respondents (OR=0.0.7 times more likely to report good health status compared another who do not have this coverage. The older peri-urban women get. 95%CI: 0. 95%CI: 1.5% of those who had indicated poor health status (Table 10. P= 0. a sub-sample of 2. The findings revealed that income contributed the least to good health status of peri-urban residents.9-1.1.7. this direct increase their good health status and the converse is the case for those with greater scores in negative affective psychological conditions. 88.8-111.283 respondents were used to establish the good health status model.8% of those classified as having had good health status and 35.9-1.0 times more another with less assets and that the more they are positive.0).0-1. they are 0.1) and consumption (OR=1. more men contributes 0. negative affective psychological status (OR=0.512). This model had a statistical significant predictive power (χ2 = 285. Upon reviewing the classification table. Of the 19 predisposed variables that were tested in the initial model.2 times less to their good health.6% of the variability in good health status of women in peri-urban area in Jamaica (Table 10.0).6-1. positive affective psychological status (OR=1. 95%CI: 1.9).9).With regard to peri-urban areas in Jamaica. number of men in household (OR=0. 95%CI: 0.2% of the data were correctly classified: 98. overall.807 P < 0.0.9.9.01. Another interesting finding of the current paper is peri-urban women who had health insurance coverage is 57. 95%CI: 0.

367 0.874 95% CI 0.451 .006 0.867 .807.068 1.609 .992* 0.704 0.870 0.01.220 0.988 .001 Overall correct classification = 88.1.683 0.1. ***P < 0.074 0.961 1.051 0.554 0.286 0.510 0.616 .659 0.303 .2% Correct classification of cases of poor health status =35.461 0.000 0.111.482 .767 .620 .008*** 1.1.949 2.512 Model: Omnibus Test .999 1.023 - Nagelkerke R-square=36.283 Explanatory variables Two wealthiest quintiles Household Head Log medical Expenditure Average Income Separated.10.008 .000 0.953 1.105 0.chi-square=285.634 .1.1.115 0.1.027 0. Logistic regression of the good health status of peri-urban-Jamaican women by some explanatory variables.000 0.959* 0.044*** 29.291 0.43 Hosmer and Lemeshow chi-square=7.05. n=2.235 0. widow Married †Never married Secondary or post-secondary Tertiary level †Primary and below Social support Crowding Psychological conditions Positive Affective Negative Affective Number of males in house Number of females in house Number of children in house Age Assets owned Health Insurance Living Arrangement Physical Environment Crime Index Constant Std.363 0.062 0.0.103 0.1.1.1.Table 10.277 0.444 .923 0.037 0.107 0.001 270 .622 1.175 0.549 .226.961 0.000 0.143 1.851 .1.058 0.000 .786 .095 Odds Ratio 0.829 .785 . Error 0.071. P < 0.005 0.780 0.337 0. P=0.1.1.0.853 1.182 0.1.726 .1.1.5% Correct classification of cases of good health status = 98.722 0.203 0.009 0.065 1.031 57.9.000 0.619*** 0. **P < 0.1.849 0.120* 0.704 0.1.169 0.8% †Reference group *P < 0. divorced.935 1.958 0.038 0.859 .919 0.018 .523 0.6% -2 Log likelihood = 1.

overall.0).0-1.4% of the data were correctly classified: 97. two wealthiest quintiles (OR = 1. 95%CI: 1.7) followed by in descending order are age of respondents (OR = 0.10). Upon observation of classification.A sub-sample of 1. six of them accounted for 30.1-2.8.8% of those who reported poor health status.0-1. 95%CI: 1.0-1.2. 95% CI= 0.388).1) and number of men in the household (OR = 1.2 times more likely to good health status. Health insurance had the most impact on good health status of urban women (OR = 22.296 women of urban Jamaica was used to build the good health status model. P = 0.8 times more likely to report good health status with reference to women in the poor-to-poorest 20%.9).3-43. urban women in the two wealthiest quintiles were 1. 271 .2.2 times more likely to record good health status compared to those who do not have health insurance coverage. Embedded in the current findings are that urban women with health insurance coverage were 22.7% of the variability in good health status of urban women in Jamaica (Table 10. 83. Of the 19 predisposed variables that were examine in the initial model. 95%CI: 1. the older urban women get. Hosmer and Lemeshow goodness of fit χ2 = 8. The model had a statistical significant predictive power (model chi-square = 263.08 P < 0.0).94.001.5). they are 0.0.1. 95%CI: 1. positive affective psychological status (OR = 1.481.1 times less likely to record good health status and that more men in urban household contributed 1. asset ownership (OR=1.9-1. 95%CI: 11. Concomitantly.1% of those who had indicated good health status and 31.

Table 10.616 .237 1.147 1.096 0.110 1.602 0.0% Correct classification of cases of good health status = 97.4.349 0.000 0.812 .1.3% †Reference group *P < 0.3. P=0.509 0.1.1.106 0.936 1.1.714 1.000 1.687 .722 1.808 1.010 1.010 .405 0.661 .413 . Error 0.481.028 22.027 0.000 0.2.312 .116 Odds Ratio 1.005 .043 0.163 1.655*** 0.431 0. n = 1.911 0.1.200 0.830 .040 0.960 1.001 Discussion The findings of the current paper showed that poverty for rural women was 2.482 0.829 Explanatory variables Two wealthiest quintiles Household Head Log Medical Expenditure Average Consumption Separated.001 Overall correct classification = 82. **P < 0.019 1.9% Correct classification of cases of poor health status =37.321 .296 Std.234 0.043 1.10.247 0.937 .669 .013 .066 1.964 .399 0. divorced.027 - Nagelkerke R-square=41.124* 0.154 1.222 1.2.894 Hosmer and Lemeshow chi-square=8. widowed Married †Never married Secondary or post-secondary Tertiary level †Primary and below Social Support Crowding Psychological conditions Positive Affective Negative Affective Number of males in house Number of females in house Number of children in house Age Assets owned Health Insurance Living arrangement Environment Crime Index Constant 95 % CI 1.044 0.9 times more than that for peri-urban women.1.346 0.251 0.1.2.167 0.3.541 1.1.092 0.4 times more than that for urban women and 1.400 0.000 0. Logistic regression of the good health status of urban-Jamaican women by some explanatory variables.044 0.941 .1.279 0.988 .000 0.475 1.113 .01.327 0.1.05.127 0.chi-square=263.008 0.043*** 11. An interesting finding 272 .1.43.886 0.858 .000 .935* 0.923 0.021*** 1.1.08.029 1.1.524 .108 1.345 0.1. P <0.5% -2 Log likelihood = 738.007 0.074 0.388 Model: Omnibus Test . ***P < 0.706 .390 0.522* 0.

but that it had the most impact on good health for periurban women and the least for urban women. Rural women‘s consumption expenditure was 45% less than that for urban women and 31% less than for peri-urban women. accounted for rural women having the lowest good health status. Jamaican women report good health status (over 80%). The study revealed that the most significant factor 273 .5% elderly had private health insurance coverage and the mean consumption expenditure for the poorest was 13% of that for those in the wealthiest income group.6%) was more prevalent in the elderly than in the other adult and young respondents.2 times that of peri-urban women. age of respondents and other psychosocial factors. Interestingly.2%) and diabetes mellitus (23. Another important finding was that income played a secondary role to factors such as health insurance. and the rates of these two chronic diseases were similar in the three geographical locations. Education did not explain good health status for peri-urban or urban women. Hypertension (43. When health status of Jamaican women was deconstructed into area of residence. Overall. Those with poor health status were more likely to report having hypertension followed by diabetes mellitus. Those socioeconomic disparities between sub-regions in Jamaica. supporting the that poverty was a rural phenomenon and that this significantly retards consumption pattern of rural women in Jamaica.is that on average urban women received income which was 1. A critical finding of this study was that health insurance coverage accounted for the most influence on good health status of women in the 3 sub-regions. only 7. and that more males contributed positively to the health status of urban women and negatively for women in the two other sub-regions.6 times more than rural women and 1. Another fundamental disparity was in education as 161 rural women for every 100 urban women had at most primary education and the ratio was 127 to 100 rural women for every peri-urban woman respectively. some major similarities were observed among them.

Mead et al [26] noted that low-income women were less likely to have health insurance. which are concurred by this study. which explains why rural women in this study had the least health insurance coverage. those with health insurance coverage were approximately 60 times more likely to report good health status than those without this coverage.predicting health status of women in Jamaica across the three sub-regions was health insurance coverage. Shi [24] reported that income was the most significant predictor of lack of health insurance coverage. Financial resource availability plays an important role in health care decisions. but that it is more so for peri-urban women. The resources regarding health care decision-making could be health insurance or monetary resources. Low-income adult women tended to have lower health status and uninsured women tended to have problems accessing health care services [25]. chronic illness and lower overall health status than their richer counterparts. while they were more likely to have health care access problems. Life of Jamaica and Blue Cross Jamaica Limited are the only total health insurance companies catering to the widest cross. Embedded in this study is the fact that health insurance aids in the health care-seeking behaviour of women. suggesting that lifestyle practices of these women account for their health status. For peri-urban women.section of Jamaica‘s population. Health insurance is important for access to health care and being uninsured significantly reduces access to health services and substantially increases health problems. These companies offer a 274 . the lowest income and consumption and the lowest good health status. In Jamaica. Uninsured persons with poor health status are much more likely than their insured counterparts to report that they or a family member did not receive doctor‘s care or prescription medicines [23]. This finding can be supported by the fact that women in peri-urban zones visited health care practitioners more than that of rural but less than urban women.

which is similar to 7. and therefore account for the health insurance disparity between the 3 sub-regions.1% versus 13.wide range of health insurance products to best suit the needs of clients from individuals. the probability of a worker being covered by an employer-sponsored insurance plan is lower than for urban workers [29. and that rural respondents were more likely than urban counterparts to report having deferred health care because of cost (15. In studies done in rural areas. In terms of geographical areas. The authors found that small firm size and low wages in rural areas are the main reasons for this difference. In this study 7. who found that almost threequarters of the urban population (73%) have coverage compared to 38% of those in rural areas. low275 . 30]. 17 out of every 100 peri-urban women and 19 out of every 100 urban women possessed health insurance coverage.3%). 7 out of every 100 rural women. Hence this justifies why rural women recorded the least number of visits to health care practitioners. These results are not in agreement with findings from a study by Wong and Diaz [27].8% versus 15. Bennett et al. because health care cost will be substantially an out of pocket expense that they would be unable to afford. [28] postulated that rural residents were more likely to be uninsured than urban residents (17. women showed a slightly higher and similar coverage (56%) than men (52%). However. This study revealed that an overall 11 out of every 100 of sample had health insurance coverage.5% of women residents in all three regions reported having health insurance coverage. students.6% reported in a previous study [31]. This causes low-income women to frequently face health care decisions. associations and companies.1%). Unemployed women were reported to have poorer mental and physical health status than employed women [32. 33]. which reinforced the aforementioned findings that income plays a critical role in health insurance coverage and health status. executives. Good health is a determinant of the individual and societal economic status.

Another fact that this study highlights is the increased indirect role that income plays. but the increase gets smaller as income increases and justifies why income plays a secondary role to health insurance coverage. and this was not the case for rural or peri-urban women. which is also the case in Jamaica. poor health. Rural Americans are more likely to be poorer [43] and less healthy than their urban counterparts. but wage rates are depressed in the formal sector.8 times more likely to report good health. while in urban areas this problem is usually observed in single mother-headed households. An individual or household‘s position can decline or improve over short periods according to changing circumstances such as illness. unemployment. vulnerability to market shocks. According to Hinrichson [40]. Average incomes in rural areas are often lower than in urban areas [41.income women often experience conflicts between their poor health status and lack of resources. The causes of urban poverty are interlinked. poverty leads to health-related problems not only for single mothers but also for mothers with partners. sub-standard housing. most urban poverty does not result from a lack of jobs. Although social class (ie wealthy class) is a predictor of good health status of urban women. This study goes farther as it found that urban women in the two wealthy quintiles were 1. In rural areas. and many are self-employed in the informal sector. steady jobs. stemming from such factors as employment insecurity. but from a lack of well-paying. and limited education [36-39]. Wagstaff and Doorslaer [34] reported that an individual‘s absolute income affected his/her mortality. eviction or other events. and urban poverty is a dynamic status. 42]. These authors supported Rodgers‘ [35] argument that the relationship between an individual‘s health and income is concave. low levels of income generation. Unemployment rates are generally below 15% in most developing country cities. Poverty is related to poor health. once again peri-urban 276 . which is weaker than it direct role. This means that each additional dollar of income raises an individual‘s health status.

reports of cancer. when seeking medical services. Hence this would account for an aspect of premature mortality of these women. In this study. 277 . Non-communicable diseases such as cardiovascular diseases. Hypertension was higher in rural than urban and peri-urban areas. This indicates that after certain sum of wealth. health care facilities in rural areas are unfavorable compared to non-rural areas due to limited medical resources and shortage of physicians [46]. Furthermore. arthritis. The self-report of disability and chronic status is higher for older than younger residents. The prevalence of hypertension and diabetes mellitus among respondents in the three regions were similar. However. cancer. Income therefore will add substantially more to the good health status of poor women than it is likely to increase good health for middle and wealthy women‘s health status. and visual impairments than their urban counterparts. they are more likely to be ill. Rural women tend to have higher rates of chronic status of hypertension. chronic respiratory diseases and diabetes mellitus are rapidly increasing problems for the socially disadvantaged [44]. spinal disorders.women had the greatest good health status. We can deduce from current paper that with rural women having less economic resources and lowered visits to health care facilities. They also make fewer doctor visits than urban women. asthma and arthritis are low compared with hypertension and diabetes mellitus. hospitalized than women in urban areas [45]. the duration of sickness in women residents in rural areas was longer than their counterparts in urban and peri-urban areas. influenza. bursitis. findings of diagnosed chronic health conditions show patterns of worse health status among elderly women living in rural areas. income adds increasing less to good health status. In addition. they would be using more home remedy or non-traditional healers to treat their ill-health. hearing. In this study.

In Jamaica. Rural adults were more likely to report having diabetes mellitus than were urban adults (9. available hospital records show that between 1990 to 98 showed that twice as many women than men were admitted for hypertension and diabetes mellitus [48]. The gender gap is widest for hypertension with twice as many women as men (12% vs.5% versus 15.8 times more in elderly women compared to young women and 4. [28] found that residents in rural area were more likely to report fair to poor health status than were residents of urban counties (19.4%). or in the case of those who do receive treatment.2 times more than that for young women and 1. women are more likely to report an illness. The predominance of women with chronic disease visiting health care facilities (82%) is in keeping with the experience of other public health areas for chronic diseases.0 times more than that in young women and 1. hypertension in elderly women was 6. In addition. but there seemed to be no differential use of doctor visits or hospitalizations [28]. In the current paper.6% versus 8.6%).In this study a higher percentages of the elderly in the rural areas reported poor health status. with 15% women compared to 12% men reported suffering from an illness or injury in the previous four weeks in 1991.2 times more than in middle aged adults. the clinical management of the status is poor. [47] chronic diseases such as diabetes mellitus and hypertension are either undetected or medically untreated.0 times more in elderly than in middle aged adult women. Bennett et al. acute dysfunctions such as cold. 278 . Arthritis was 10. the researchers found that diabetes mellitus for elderly women was 11. Continuing. According to Brenzel et al.6 times more than for middle aged adult women. diarrhoea and asthma decreases as women become older and the same was recorded for unspecified illness. On the other hand. 6%) reporting having the disease [47]. The authors also found that urban residents are more likely to use preventative care than their rural counterparts.

[57] compared the health practices of rural women with those of a large 279 . treatment of illness and child-care practices. Presumably. and sanitary practices [51]. and hypothesized that the effect of education on child health becomes less important as access to public health care services improves. the type of provider. studies have found that it is not just general education. and thus the advantage conferred by schooling on health outcomes is narrowed. Mansfield et al. Majority of the women residents in this study attained secondary level education. The more highly educated are likely to better understand the importance of proper health care.54] argued that educated mothers are more likely than the uneducated ones to take advantage of modern medicine and comply with recommended treatments because education changes the mother‘s knowledge and perception of the importance of modern medicine in the care of her children. Rosenzweig and Schultz [55] viewed women schooling and health care services as partial substitutes for information regarding knowledge of diseases. The latter was believed to be the most dominant determinant of health care behavior [50]. In contrast. although they may play some role [56]. Ross and Miroswky [49] reported that education significantly improved self-reported health and physical functioning. In addition. It is unlikely that the observed effects of maternal education on child-health outcomes simply reflects health knowledge and habits acquired in school.Women‘s education also affects attitudes toward health. However. the choice of private versus public provider. in areas where such services are readily accessible. Education is strongly associated with the level of health service utilization. they are used by both educated and uneducated women. Education could thus influence a woman‘s beliefs about disease causation and cure and the value she places on modern medicine. dietary and child-feeding. knowledge of and experiences with health care were found to affect an individual‘s health care behaviour more so than age. Barrera [52] and Caldwell [53. but also healthspecific knowledge that is important.

61] and that the positive factors influence self-reported wellbeing in a direct way. but there was none between tertiary and at most primary education for rural women. this was not the case for rural women. Human emotions are a mix of not only positive status but also negative factors [58]. friends etc) affect subjective wellbeing in a negative manner (guilt. Hence. They found that rural women adopted more health practices overall than their urban counterparts. In addition. disgust [60. negative affective psychological status was inversely affect good health status of Jamaican women. However. anger. Rural residents are more likely than their urban counterparts to experience negative circumstances such as 280 . neuroticism and pessimism are seen as measures of the negative psychological status that affect subjective wellbeing [59. and younger women in both groups exhibited more awareness of health promotion.metropolitan area. higher education or income seems to have no association with differential use of hospitalizations [57]. Negative psychological status (loss of family members. and the opposite was true for positive affective psychological conditions. In this study. depression. anxiety. only positive affective conditions influence good health status of urban women while positive and negative affective psychological conditions determined good health status for rural and peri-urban women. The current paper both concurs and disagrees with the aforementioned works. 63]. fear. 60]. This was concurred in a study conducted by Fromson et al [62] and other researchers [59. Education was not found to be significantly correlated with good health status of Jamaican women. On disaggregating the good health status by the 3 sub-regions. An irony that lies in this study is the fact that there is a health disparity between women who have had a most primary education compared to those with secondary education. However. they found that there is higher utilization of doctors‘ visits and preventative care among persons with the highest level of education and in the highest income groups.

[64] found the prevalence of depression were slightly higher in residents in rural than in urban areas. persons do not always answer factually in interview surveys. 281 . and interviewer instructions included directions for probing participants on these issues. Concurrently. Embedded in these findings are the higher over affective conditions of peri-urban women. Therefore. poor health status. which this study concurs with. and this fact accounts for peri-urban women having the greatest health status. Some limitations must be considered in interpreting these results as this study was completely based on data reported by interviewed residents. Depression is subsumed in negative affective psychological condition. Probost et al. chronic diseases and poverty. Hambleton et al.unemployment. and of course. while peri-urban women recorded the greatest self-reported good health. People in rural areas are more likely to have characteristics that are strongly associated with depression. Interviewers and supervisory staff were aware of this problem. poorer. survey participants could be subject to recall bias in their health status. lower rate of health insurance coverage. and so this work agrees with the literature. and lowered consumption and earnings and this retards their health care seeking behaviours and further becomes challenges for their health. the strength of the study's sample design and data collection procedures compensated for these limitations. However. [20] found that an individual‘s psychological state influences his/her health status. rural women were older. poor health status. Conclusions The findings revealed that rural women had the least good health. The current paper however found that there is no significant statistical difference between the negative psychological state of peri-urban and urban women in Jamaica as well as between positive affective psychological conditions and urban and urban women.

were the least likely to have health insurance coverage and they recorded the lowest consumption expenditure.received the lowest income per person. Concomitantly. poverty continues to reduce the self-rated health status of women and while they are living 6 years longer than men. this does not mean that we neglect the reality that poverty is eroding their health status. recorded the highest negative affective psychological conditions. had the greatest percentage of primary level eduction. This study therefore provides a comprehensive understanding of health of women in Jamaica and the 3 subregions as well as the disparity in socio-demographic correlates of health based on the different geographical regions. 282 .

57: 476-481. 1996. 14. 11. editors. Cohen M. The Lancet 2004. the University of the West Indies. Quality of life of Jamaican women. Gender equality in the Caribbean: Reality or Illusion. Jamaica Survey of Living of Jamaica. 1995. Long. 2007. Planning Institute of Jamaica. Kingston: Planning Institute of Jamaica. STATIN. 52: 83-120. Planning Institute of Jamaica. Kingston: Department of Community Health and Psychiatry. 4. Bourne. Thorson. N. Jamaica. Older women: A situational analysis. The demand for health . PIOJ. D. [STATIN]. 33: 187-196. 57 :( suppl 4): 49. In: Nain GT.. A situational analysis of the Jamaica elderly. Bourne. 2007. Jamaica. P. Planning Institute of Jamaica and Statistical Institute of Jamaica (PIOJ & STATIN).. 2003: p. 7. 2003. Bailey B. 1972. PIOJ. N. STATIN. 16. Jamaica Survey of Living Conditions. Jamaica 1996. New York: National Bureau of Economic Research. 1992. West Indian Medical Journal 2008. 1990-2006. 1991-2007. 10. Statistical Institute of Jamaica. PIOJ. 5. Rickets H. 2007 2. 108-144. Kingston: PIOJ. STATIN. United Nations Department of Economic and Social Affairs. The search for gender equity and empowerment of Caribbean women: The role of education. Eldemire D. Towards a framework for women‘s health. [PIOJ]. Bourne PA. Kingston. B. Why are women in the Caribbean so much more likely than men to be unemployed? Social and Economic Studies 2003. Determinants of well-being of the Jamaican elderly. Seguino S.a theoretical and empirical investigation.References 1. Mona Campus. Bourne PA. 2009. Bailey. 356: 1823-1824. 3. Hoa. 15. Kingston: Ian Randle Publishers. Health-seeking behaviour of individuals with a cough of more than 3 weeks. Growing old in Jamaica: Population ageing and senior citizens‘ wellbeing. Mona. Social and Economic Studies 2003. Faculty of Medical Sciences. 13. 2008. P. STATIN. The University of the West Indies. A. West Indian Medical Journal 2008. 8. World Urbanization Prospects: The 2007 Revision. 12. Bailey B. Washington DC: UN. 6. 52: 49-81. Health determinants: Using secondary data to model predictors of well-being of Jamaicans. New York: United Nations Division for the Advancement of Women. Grossman M. Gender vulnerabilities in Caribbean labour market. Patient Education and Counseling 1998. Statistical Institute of Jamaica. Population Division 5. 9. 283 . Jamaica Survey of Living Conditions 2002. Eldemire.

Brathwaite F. Hambleton IR. Health disparities: A rural-urban chart book. West Indian Medical Journal 2008. Hennis AJ. Fraser HS. Salud Publica de Mexico 2007. Shi L.. New York. Jamaica Survey of Living Conditions 2002. Solis B. and work status on women‘s well being. West Indian Medical Journal 2007. Wong R. Maine Rural Health Research Center. 1994. Probost J. Employer-based health insurance coverage of workers: Are rural firms and workers different? Research & Policy Brief. Hartmann H. 23. John Wiley & Sons Inc. Mead H. Rural Health Research and Policy Centre. education. Historical and current predictors of self-reported health status among elderly persons in Barbados. 2nd edn.17. 31. Healthcare utilization among older Mexicans: health and socioeconomic inequalities. Bourne P. Applied logistic regression. 57: 596-604. 2000. The uninsured with chronic health conditions: Access to care in the western region.familiesusa. Lemeshow S. Small and rural: The double jeopardy in expanding employer-based health insurance coverage. Using the bio-psychosocial model to evaluate the wellbeing of the Jamaican elderly. Retrieved on April 7. 28. The influence of income. Clarke K. Wyn R. Olatosi B. USA. Research & Policy Brief. Rev Pan Salud Public 2005. The convergence of vulnerable characteristics and health insurance in the US. 57: 476-481. 20. Health Determinants: Using Secondary Data to Model Predictors of Wellbeing of Jamaicans. 19.pdf 24. England: Harper and Row. 2003. Bennett K. Diaz J. Women‘s Health Issues 2001. Planning Institute of Jamaica. Kingston. 17: 342-352. Women‘s Health Issues 2001. Broome HL. Homer D. 49: S505-S514. 1998. Bourne PA. 284 . 29. Families. Maine Rural Health Research Center. 1982. Medical sociology: Modeling well-being for elderly people in Jamaica. 2002 from http://www. 26. 53:519-529. 25.org/media/pdf/factsheet. West Indian Medical Journal 2008. 21. 2000. Women‘s health issues across the lifespan. 27. 18. Cohen L. 2008. 56(suppl 3): 39-40. Social Science and Medicine 2001. 11: 160-172. Witkowski K. Bourne PA. Gault B. Statistics for Social Sciences. London. 11: 148-159. Holliday M. Statistical Institute of Jamaica. 30. 22.

35. Cohen B. Conceptualizing urban poverty. Becker C. Food insufficiency and the physical and mental health of low-income women. 2003. Meeting the urban challenge. Methods. 33: 343-351. 53:5356. Reed H. The National Academy Press (North America)/Earthscan (Europe). Geneva. WHO. Ezeh A. Environment and Development 1995. Environment and Urbanization 1995. Goldsteen K. Making sense of urban poverty. 46. The World Health Report 2000. NH: Heinemann. Hamer A. 33. Beyond urban bias in Africa. Health issues of women in rural environments: An overview. Urban social policy and poverty reduction. Urban health in developing countries: Insights from demographic theory and practice. 2005. Moser C. Baltimore: The Johns Hopkins Bloomberg School of Public Health. Demographic change and its implications in the Developing World. Handbook of Urban Health: Populations. JAMA 1998. 1999. 285 . Ross C. and Practice. Amis P. 44. 21: 543-567. 45. Blackburn R. WHO. Rodgers G. No. 42. 43. Cities transformed. US Census Bureau. Ricketts T. 7: 145-157. Annual Review of Public Health 2000. Population Studies 1979. Doorslaer E. Hinrichsen D. Galea S. Portsmouth. Springer. Stren R. Series M. Bushy A. Journal of Marriage and the Family 1990. 32: 159-177. Corcoran M. Salem R. 52:1059-1078. Current Population Reports. 41. 40. Siefert K. Population Information Program. The changing nature of rural health care. 37. Population Reports. 2000. Vlahov D. Wagstaff A.E. health systems: improving performance. New York. 1994. Poverty in the US. Heflin C. Washington DC. 7: 159-171. 7: 11-36. Women and Health 2001. 38. 21: 639-657. 2002. Wratten E. Morrison A. eds. Income inequality and health: What does the literature tell us? Annual Review of Public Health 2000. 34. 16. Montgomery M.32. The impact of the family on health: The decade in review. 39. Income and inequality as determinants of mortality: An international cross-section analysis. 2000. Montgomery M. In: S. Mirowsky J. 36. Environment and Urbanization 1995.

. Ministry of Health. neuroticism. Anell A. The American Economic Review 1982. 52. The Australian National University. WHO. World Health Organization. 53. 49. 33:395-413. 54. Constructive thinking as a mediator of the relationship between extraversion. Canberra: Health Transition Centre. 57. Watson D. Submitted to The Pan American Health Organization. 510: 44-59. 12th October. Journal of Personality and Social Psychology 1988. Chakraborty M. 78: 291-321. 72: 803-815. Ross C. Crawford. Lightsey O. Tellegen A. Harris P. D. 51. Mirowsky J. Hjortsberg C. Rosenzweig M. Ministry of Health and the Jamaica Cancer Registry. Barrera A. Brenzel L. Population Studies 1979.. Patient views on choice and participation in primary health care. Development and validation of brief measures of positive and negative affect: The PANAS Scale. 50. Preston. genetic endowments. 48. 58. 56. The influence of maternal education on infant and child mortality in Bangladesh. Gender and equity in access to health care in Jamaica and Barbados. University of the West Indies. Schultz P. 19: 409-426. Santow G. Selected Readings in the Cultural. C. Caldwell JC. 2006. 2000. and intra-family resource distribution: Child survival in rural India. Health Finances: A basic guide. (6). Social and Behavioural Determinants of Health. 55. editors. Le Franc E. Does medical insurance contribute to socioeconomic differentials in health? The Milbank Quarterly 2000. The Annals of the American Academy of Political and Social Science 1990. 32: 69-91. 55: 121-128. and subjective well-being. Health Values 1989.1989: p. Henry-Lee A. Mansfield. The health behaviors of rural women: Comparisons with an urban sample. Western Pacific Region. Caldwell JC. 54: 10631070. Education as a factor in mortality decline: an examination of Nigerian data. 12-19. Sir Arthur Lewis Institute of Social and Economic Studies. In: Caldwell JC. European Journal of Personality 2005. Clark L.47. Market opportunities. Lindenbaum S. Journal of Development Economics 1990. Elias M. 2001. Health Policy 2001.112–131. Annual Report. The role of maternal schooling and its interaction with public health programs in child health production. 286 . Rosen P. Cultural and social factors influencing mortality in developing countries. P. 59.

Personality and Social Psychology Bulletin 2001. Moore C. 34: 333-350. and the big five. rumination. Johnson JL. Kashdan T. depression. 61. Personality and Individual Differences 2004. 20: 88-500. 62. Bellah C. 27: 601-610. Laditka S. Nakase-Thompson R. Journal of Head Trauma Rehabilitation 2005. Sherer M. 36: 1225-1232. The assessment of subjective well-being (issues raised by the Oxford Happiness Questionnaire). Baxley E. Evans C. Powell M. well-Being. Vengefulness: Relationships with forgiveness.60. 63. Self-discrepancies and negative affect: The moderating roles of private and public self-consciousness. Harun N. Public Health 2004. Fromson P. Yablon S. 287 . and subjective well-being following traumatic brain injury. Nick T. Rural-urban differences in depression prevalence: implications for family medicine. 64. Social Behavior and Personality 2006. 95: 1695-1703. McCullough M. Kilpatrick S. Early impaired self-awareness. Probost J.

area of residence (other towns:. which emerged from the current findings. this study is timely and will add value to understanding the elderly. With the value of research to public health.11).46. marital status (Separated or widowed or divorced: 95%CI=0. 95%CI=1. married: 95%CI=0. Although World Health Organization (WHO) began this broaden conceptual framework in the late 1940s [1].75-0. number of males in household (95%CI:1. Never married). elderly.046).12-1. ailment or injuries) [1-14].17-1. health insurance (95%CI=0.24).051.67.98. The findings are far reaching and can be used to aid policy formulation and how social determinants of health are viewed in the future. There are disparities in the social determinants of health across the life course.706). psychological affective conditions (negative affective: 95%CI=0.939-0. gender (95%CI=1. education (secondary: 95%CI=1. INTRODUCTION Health is a multidimensional construct which goes beyond dysfunctions (illnesses. rural area:). middle age and young adults in Jamaica.46.58. tertiary: 95%CI=1.05). logged medical expenditure (95% CI =0. In spite of this.07-1.96).82. Engel [3] was the first to develop the biopsychosocial model that 288 . social support (95%CI=0.91-0.05-1.96).47-2. primary or below: OR=1. extensive review of health Caribbean revealed that no study has examined health status over the life course of Jamaicans. The factors are retirement income (95%CI=0.11 Social determinants of self-reported health across the Life Course The socio-psychological and economic factors produced inequalities in health and need to be considered in health development. The aim of this study is to develop models that can be used to examine (or evaluate) social determinants of health of Jamaicans across the life course.00).029-0.281-1.27) and previous health status.49-0. middle age and young adults.50-0. Eleven variables emerged as statistically significant predictors of current good health Status of Jamaicans (p<0.99). positive affective: 95%CI:1.31-0. number of children in household (95%CI=1.

as some economists have used happiness as a proxy of health and wellbeing [18-20]. Psychologists have argued that the use of diseases to proxy health is unidirectional (or negative) [2]. Unlike classical economists who developed Gross Domestic Product per capita (GDP) to examine standard of living (or objective wellbeing) of people as well this being an indicator of health status along with other indicators such as life expectancy. and embedded therein is wider scope for health than diseases. Diener took the discussion into subjective wellbeing. Grossman [9] used econometric to capture factors that simultaneously determine health stock of a population. although this perspective has some merit. self-reported health status. Theoretical Framework Whether the proxy of health (or wellbeing) is happiness. Both WHO and Engel‘s works were considered by some scholar as too broad and as such difficult to measure [15]. economic and psychological conditions in health is broader and more in keeping with the WHO‘s definition of health than diseases. it was not until in the 1970s that econometric analyses were employed to the study of health. Diener was the first psychologist to forward the use of happiness to proxy health (or wellbeing) of an individual [16. life satisfaction or ill-being. He opined that happiness is a good proxy for subjective wellbeing of a person. and they argued that it is a good measurement tool of the concept. Diener and others believe that people are the best judges of their state. 17]. Instead of debating along the traditional cosmology health. and that the inclusion of social.can be used to examine and treat health of mentally ill patient. This is no longer a debate. Grossman‘s work transformed the 289 . Engel‘s biopsychosocial model was both in keeping with WHO‘s perspective of health and again a conceptual model of health. selfrated health conditions. scholars have ventured into using different proxy to evaluate the ideal conceptual definition forwarded by WHO for some time now.

however.. one of the drawbacks to this model was the fact that some crucible factors were omitted by the aforementioned model. ED) ………………………………………………. stock of health (Ht-1) in previous period. the price of other inputs Po. Go. They refined Grossman‘s work to include socioeconomic variables as well as some other factors [Model (2)]. education of each family member (ED). It is Grossman‘s work that accounts for economists like Veenhoven‘s [20] and Easterlin‘s [19] works that used econometric analysis to model factors that determine subjective wellbeing. family background or genetic endowments (Go). ED. Pmc. and good personal health behaviours (including exercise – Go). Rt. education of each family member (ED). Bt – smoking and excessive drinking. expanded and modified Grossman‘s work as it omitted important variables such as price of other inputs and family background or genetic endowment which are crucible to health status.. At. Go) ………………………. Bt. Grossman established an econometric model that captures determinants of health.. Smith and Kington [10] refined.use of medical care. asset income (At). MCt. and all sources of household income (including current income). Et. price of medical care Pmc.…………… Model (2) Model (2) expresses current health status Ht as a function of stock of health (Ht-1). retirement related income (Rt ). Ht = H* (Ht-1. MCt. all sources of household income (Et). Using data for the world. Based on that limitation. Po. Grossman‘s model was good at the time.conceptual framework outlined by WHO and Engel to a theoretical framework for the study of health. using literature. Model (1) where Ht – current health in time period t. 290 . The model read (Model 1): Ht = ƒ (Ht-1.

Hambleton et al. and social factors 18. Hutchinson et al. there is a gap in the literature on a theoretical framework explains good health status of the life course of Jamaicans. he found that current disease conditions accounted for 67. Despite the contribution of Hutchinson et al‘s and Bourne‘s works to the understanding of wellbeing. middle age adults and elderly in order to provide a better understanding of the factors that influence each cohort. number of children living outside of household.‘s study was actual proportion of each factor on health status and life style risk factors. [21] employed the principles in econometric analysis to examine social and health factors of Jamaicans.2%. quality of life or wellbeing [5. 23].‘s work refined the work of Grossman and added some different factors such as geriatric depression index. 8. past and current nutrition. [6] used the same theoretical framework developed by Grossman to examine determinants of health of elderly (ages 65+ years) in Barbados. Easterlin [19] and Smith and Kington [10].6%. with life style risks factors accounting for 14. crowding. One of the additions to Grossman‘s work based on Hambleton et al.Like Veenhoven [20]. 291 . Hambleton et al.2% of the explained variation in health status of elderly Barbadians. A study published in 2004. 22.580 Jamaicans. Other studies conducted by Bourne on different groups and sub-groups of the Jamaican population have equally used the principles of econometric analysis to determine factors that explain health. Unlike Grossman‘s study. using life satisfaction and psychological wellbeing to proxy wellbeing of 2. The current paper will model predictors of good health status of Jamaicans as well as good health status of young adults. and living alone.

data collection and policy guideline for Jamaica.5% who did not respond to particular questions. non-food consumption expenditure.018 respondents from the 14 parishes in Jamaica. The survey used stratified random probability sampling technique to draw the 25. 9. number of people per household and a deconstruction of the numbers by particular characteristics i. The present study further refine the two aforementioned works and in the process adds some new factors such as psychological conditions.018 respondents.e. Model The multivariate model used in this study is a modification of those of Grossman and Smith & Kington which captures the multi-dimensional concept of health.0% did not participated in the survey and another 0. crowding. health. house tenure. The JSLC was commissioned by the Planning Institute of Jamaica (PIOJ) and the Statistical Institute of Jamaica (STATIN).METHODS Participants and questionnaire The current research used a nationally cross-sectional survey of 25. daily expenses. males. education. These two organizations are responsible for planning.2% was rejected due to data cleaning.7% with 20. The questionnaire covers demographic variables. The JSLC is a self-administered questionnaire where respondents are asked to recall detailed information on particular activities. inventory of durable goods. immunization of children 0 to 59 months. The study used secondary cross-sectional data from the Jamaica Survey of Living Conditions (JSLC). The survey is conducted between April and July annually. housing conditions. Interviewers are trained to collect the data from household members. females and children (ages 292 . and health status. The non-response rate for the survey was 29. and social assistance.

Ai. At. Model (3) The current health status of a Jamaica. Xi is gender of person i. MSi. LLi is living arrangement where 1= living with family members or relative. Chicago. HTi is house tenure of person i. is a function of 23 explanation variables. Mi is number of male in household of person i and Fi is number of female in household of person i.e.≤ 14 years).. HIi is health insurance coverage of person i. 0 if poor (i. Rt is retirement income of person i. Eni. and 0=otherwise and social standing (or social class). EDi. if good or above (i. HTi. Wi. LLi. USA).PPi). Wi. no reported health conditions four week leading up to the survey period). 1 if rent. Rt. 0 if male. HIi. IL. Ht. Ht-1 is stock of health for previous period. The proposed model that this research seeks to evaluate is displayed below [Model (3)]: Ht = f(Ht-1. Di. EDi is educational level of person i. A single hypothesis was tested. reported at least one health condition). 1 if tertiary and the reference group is primary and below.Ni. 1 if receiving private and/or government pension.Xi. 1 if female. 1 if secondary. lnPmc is logged cost of medical care of person i. Σ(NPi. where Ht is current health status of person i. Version 16.e. Ci.PPi) NPi is the summation of all negative affective psychological conditions and PPi is the summation of all positive affective psychological conditions. HHt. and Smith and Kington is that it is area specific as it is focused on Jamaican residents. Statistical analysis Statistical analyses were performed using Statistical Packages for the Social Sciences (SPSS) for Windows. 0 if squatted. Σ(NPi. 0 if otherwise. Oi. SSi. CRi is crowding in the household of person i. Mi.Pmc. 1 if have a health insurance policy. FSi. CRi. Ai is the age of the person i and Ni is number of children in household of person i. 0 if otherwise.0 (SPSS Inc. which 293 . εi)…. Another fundamental difference of the current research and those of Grossman. Qt.

variables were entered independently into the model to determine those that should be retained during the final construction of the model.0). and all other variables were removed from the final model (p>0. 294 . Finally.39). Continuing.05) – ie 95% confidence interval (CI). The final model was established based on those variables that are statistically significant (ie.was ‗health status of rural resident is a function of demographic. moderate (0.69). Cohen and Holliday [25] stated that correlation can be low/weak (0 to 0. and linear multiple regression in the event the dependent variable was a normally distributed metric variable .4-0.05). The correlation matrix was examined in order to ascertain whether autocorrelation (or multi-collinearity) existed between variables. p < 0.‘ The enter method in logistic regression was used to test the hypothesis in order to determine those factors that influence health status of rural residents if the dependent variable is a binary one. psychological and economic variables. NC). and this was adjusted for the survey‘s complex sampling design. This was used in this study to exclude (or allow) a variable in the model. categorical variables were coded using the ‗dummy coding‘ scheme. Research Triangle Park. or strong (0.7-1. we used SUDDAN statistical software (Research Triangle Institute. Wald statistics was used to determine the magnitude (or contribution) of each statistically significant variables in comparison with the others. Where collinearity existed (r > 0. To derive accurate tests of statistical significance. and the odds ratio (OR) for the interpreting each significant variables. The predictive power of the model was tested using Omnibus Test of Model and Hosmer and Lemeshow [24] was used to examine goodness of fit of the model.7). social.

3% of cases of good health status and correctly classified 33. HIi. health insurance. Σ(NPi. logged medical expenditure. marital status.. Rt.703. number of children in household and previous health status (Table 11. and so these were omitted from the initial model (ie model 3).7% of the sample (correct classified 98. Pmc. The factors are retirement income. EDi.ARi.Results: Modelling Current Good Health Status of Jamaicans. retirement income. see Model 4). εi). separated or widowed. Hosmer and Lemeshow goodness of fit χ2=4. property ownership. p = 0. Elderly. Using logistic regression analyses.1).. area of residence. There were some modifications of the initial model in keeping with the age group. MSi.. education. three age groups were classified (young adults – ages 15 to 29 years.. divorced. psychological affective conditions. Model (4) The model [ie Model (4)] had statistically significant predictive power (χ2 (27) =1860.PPi).. marital status. The exclusion was based on the fact that more than 15% of cases missing in some categories and a high correlation between variables. There was a moderately strong statistical correlation between age. per capita income quintiles. Ht = f(Ht-1. property ownership. SSi. For young adults the initial model was amended by excluding retirement income. Xi.05.001. and house tenure. 295 . number of children in household. middle age adults – ages 30 to 59 years. social support. and elderly – ages 60+ years) and the initial model was once again tested. education. Mi.789) and overall correctly classified 85. Based on that fact. number of males in household. gender.Ni.9% of cases of dysfunctions).639. p < 0. Middle Age and Young adults Predictors of current Good Health Status of Jamaicans. eleven variables emerged as statistically significant predictors of current good health status of Jamaicans (p<0.. ….

. six variables emerged as statistical significant predictors of current good health status of middle age Jamaican (p < 0. Predictors of current Good Health Status of middle age Jamaicans. Xi... εi).Ni. gender of respondents.2)..………… …….543. Using logistic regression.. psychological condition..Ni. physical environment. p = 0.3. Mi. p = 0. EDi. Model (6) Based on Table 11.001. p < 0. psychological conditions..2% of the sample (correctly classified 98. P < 0. εi). Σ(NPi). From the logistic regression analyses that were used on the data.. Xi. Pmc.05) (Model 6).. marital status.026. These factors are logged medical expenditure.3) Ht = f(Ht-1.ARi... HIi. health insurance.. Model (5) The model had statistically significant predictive power (model χ2 (27) =595. Eni..677) and overall correctly classified 75.2% of cases of dysfunctions).. eight variables were found to be statistically significant in predicting good health Status of elderly Jamaicans (P < 0. MSi. number of males in household..... area of residence.827) and overall correctly classified 87. HIi. Σ(PPi). These factors were education.... gender.736. Ht = f(Ht-1..Predictors of current Good Health Status of elderly Jamaicans. the model had statistically significant predictive power (model χ2 (27) =547. number of children in household and previous health status (see Table 11. . number of children in household and previous health status (see Table 11.7% of cases of dysfunctions).. ……….001. health insurance. 296 .318..5% of the sample (correctly classified 94.5) (see Model 5)..3% of cases of good or beyond health status and correct classified 28.. Hosmer and Lemeshow goodness of fit χ2=4. Hosmer and Lemeshow goodness of fit χ2=5.6% of cases of good or beyond health status and correct classified 44..

Mi. Good Health Status[ie Model (4) – Model (7)] cannot be distinguished and tested over different time periods.....733.. and young adults [ie Model (7) are derivatives of Model (3).Predictors of current Good Health Status of young adult in Jamaica.. Model (6) Ht = f(Ht-1...... SSi.... Model (4) Ht = f(Ht-1... Σ(PPi). εi). Hosmer and Lemeshow goodness of fit χ2=5.. Rt..... p = 0. Wi. Xi. Σ(NPi)..6% of the sample (correctly classified 99... EDi. εi).. LLi. Σ(NPi.. Limitations to the Models Good Health Status of Jamaicans [ie Model (4)]. middle age adults [ie Model (6)].. Ai..... EDi.. and these are important components of good health.ARi. HIi.. εi).001..... Qt..... …. HIi... HIi. CRi. SSi........ Wi...Ni. Pmc..……………………………………….Ni....2% of cases of dysfunctions). HIi...……. Mi.. Σ(NPi. MSi. Σ(NPi)........ Model (3) 297 ....Ni...... Model (5) Ht = f(Ht-1.. Using logistic regression.. social class and previous health status (Table 11.. p < 0.. Σ(NPi)..0% of cases of good or beyond health status and correct classified 28...……………………………. HIi....Xi.... . At..Pmc. elderly [ie Model (5)].... EDi......εi)………………………………………………………………………... Pmc.. MSi..Model (7) Ht = f(Ht-1. person differential.. Di.. HHt.. psychological condition... Eni. HIi. the model had statistically significant predictive power (model χ2 (19) =453. Ht = f(Ht-1. Xi. εi).05) (Model 7)..... Eni. Rt.4).Ni.. These are health insurance coverage.. HTi... εi)..738) and overall correctly classified 92.....Model (7) From Table 11. MSi..PPi). Ci..185....……………………….... two variables emerged as statistically significant predictors of current good health status of young adults in Jamaica (p<0.. Xi..………………………..... FSi.ARi.....PPi)..3... Oi. Wi. Ht = f(Ht-1. Mi....

and differently from that of the general populace. socialization and genetic composition.The current work is a major departure from Grossman‘s theoretical model as he assumed that factors affecting good health Status over the life course are the same. as this is one of the assumptions. the researcher is proposing the inclusion of a time dependent parameter in the model. Secondly. An unresolved assumption of this work which continues from Grossman‘s model is that people choose health stock so that desired health is equal to actual health. This study revealed that predictors of good health status are not necessarily the same across the life course. Each individual‘s is different even if that person‘s valuation for good health Status is the same as someone else who share similar characteristics. a variable P representing the individual should be introduced to this model in a parameter α (p). healthy time gained can increase good health status directly and indirectly but this cannot be examined by using a single cross-sectional study. Health does not remain constant over any specified period. the individual‘s good (or bad) health is different throughout the course of the year and so time is an important factor. the general proposition for further studies is that the function should incorporate α (p. and to assume that this is captured in age is to assume that good or bad health change over year (s). Hence. The current data cannot 298 . Despite those critical findings. Neither Grossman‘s study nor the current research recognized the importance of differences in individuals owing to culture. Therefore. This was not accounted for in the Grossman‘s or the current work. Thus. and so must be incorporated within any health model. nationality. t) a parameter depending on the individual and time. next of kin and socialization. this study disagreed with this fundamental assumption. Health stock changes over short time intervals. People are different even across the same ethnicity.

2123. Defining health into two categories (ie good – not reported an acute or illness. in Model (4) approximately 98% of those who had reported good health status were correctly classified. and that approximately 86% of the data was correctly classified in this study. Discussions This study has modelled current good status of Jamaicans. but that none of those works have established a general and sub-models of good health over the life course. suggesting that using logistic regression to examine good health status of the Jamaican population with the eleven factors that emerged is both a good predictive model and a good evaluate or current good health status of the Jamaican population. number of children or males or females in household and social support) and had a greater explanatory power (adjusted r square = 0.13] were similar to that of Hambleton et al‘s study. they did not examine the goodness of fit of the model or the correctness of fit of the data.459) but again the goodness 299 . the scholars identified the factors (ie historical.test this difference in the aforementioned health status and so the researcher recommends that future study to account for this disparity so we can identify factors of actual health and difference between the two models. However. This is not the first study to examine current good health status or quality of life in the Caribbean or even Jamaica [6. diseases) and how much of health they explain (R2=38. this study has found that using logistic regression health status can be modeled for Jamaicans. Continuing. The findings revealed that the probability of predicting good health status of Jamaicans was 0. In Hambleton et al‘s work. or poor – reported illness or ailment).2%). as his study identified more factors (psychological conditions. physical environment. using eleven factors. Bourne‘s works [12. life style.789. current. 26].

The current paper has concluded that the factors identified to determine good health status for elderly. Like previous studies in the Caribbean that have examined health status [6. we have assumed that the social determinants are the same across the life.6%) and middle age adults (R2=23%). 21-23. Such a finding highlights that we know more about the social determinants for the elderly than across other age cohorts (middle-aged and young adults). with latter having a greater goodness of fit for the data as this is owing to having more variables to determine good health. Again this was the case in Hutchinson et al. 26]. those conducted by the WHO and other scholars [27-32] did not explore whether social determinants of health vary across the life course.of fit and correctness of fit of the data were omitted. Because this was not done. And that using survey data for a population to ascertain the social determinants of health is more about those for the elderly than across the life course of a population. the current paper shows that there are also differences in social and psychological determinants of health across the life course. Such a work brought into focus that there are disparities in the social determinants of health across particular social characteristic and so researchers should not arbitrarily assume that they are the same across the life course. 300 . However. a study by Bourne and Eldemire-Shearer [33] introduced into the health literature that social determinants differ across social strata for men. The findings also revealed low explanatory powers for young adults (R2=22. While Bourne and EldemireShearer‘s work [33] was only among men across different social strata in Jamaica (poor and wealthy). had the lowest goodness of fit (approximately 68%) while having the greatest explanatory power (R2= 35%).‘s research.

301 . and health conditions). The findings are far reaching and can be used to aid policy formulation and how we examine social determinants of health. social class and negative affective psychological conditions). which emerged from the current findings. Hence. Smith and Kington [10] and purported by Abel-Smith [11] as well as the WHO [27] and affiliated researchers [28-32] are more for the elderly population than the population across the life course. Disclosures The author reports no conflict of interest with this work. the social determinants of health of the population are more in keeping with those of the elderly than at younger ages. this work revealed that as people age.Another important finding is of the eleven factors that emerge to explain good health status of Jamaicans. Conclusions There are disparities in the social determinants of health across the life course. the social determinants identified by Grossman [9]. Even though the good health status model that emerged from this study is good. the low explanatory power indicates that young adults are unique and further study is needed on this group in order to better understand those factors that account for their good health. Another issue which must be researched is whether there are disparities in social determinants of health based on the conceptualization and measurement of health status (using self-reported health. It should be noted that young adult is the only age cohort with which social standing is a determinant of good health. This suggests that young adult‘s social background and health insurance are important factors that determine their good health status and less of other determinants that affect the elderly and middle age adults. when age cohorts were examine it was found that young adults had the least number of predictors (ie health insurance. Furthermore.

none of the errors in this paper should be ascribed to the Planning Institute of Jamaica (PIOJ) and/or the Statistical Institute of Jamaica (STATIN). 302 . but to the researcher.Disclaimer The researcher would like to note that while this study used secondary data from the Jamaica Survey of Living Conditions (JSLC). Mona. and the National Family Planning Board for commissioning the survey. Acknowledgement The author thanks the Data Bank in Sir Arthur Lewis Institute of Social and Economic Studies. Jamaica for making the dataset (2002 JSLC) available for use in this study. the University of the West Indies.

World Health Organization. Planning and Financing. The clinical application of the biopsychosocial model. 137:535-544. signed on July 22. WHO. 14.2(5):465-476. Chicago. 56: (suppl 3). West Indian Med J. 1980. Health psychology. Fraser HS. 1948. An introduction to behavior and health 6th ed. 1948. p. 1997. 2005. 12. 8. Quality of Life of Jamaican women. New York. Feist J. 1960. 11. 39-40. West Indian Med J. 1972. 2008.‖ In Basic Documents. Kington R. Longest BB. 13. no. Am J of Psychiatry. 7. Smith JP. 1946 by the representatives of 61 States (Official Records of the World Health Organization. 34:159-170. 9. Hennis AJ. 2008. 10. Health measurement. 1946. The demand for health. Abel-Smith B. 3:459-485. 2002. West Indian Med J. Bourne PA. 303 . Health Policymaking in the United States. Geneva. Demography. 6. Medical Sociology: Modelling Well-being for elderly People in Jamaica. Bourne PA. ―Constitution of the World Health Organization.a theoretical and empirical investigation.REFERENCES 1. Engel GL. Los Angeles: Thomson Wadsworth. Engel G. Perspectives in Biology and Medicine. Broome HL. 3rd. 2. 100) and entered into force on April 7. New York: National Bureau of Economic Research. 2005. 57:476-481. Demographic and economic correlates of health in old age. Health 2010.Brannon L. Health Determinants: Using Secondary Data to Model Predictors of Well-being of Jamaicans. Bourne P. 1994. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference. 2008. Jr. Brathwaite F. 2. Bourne PA. Grossman M. 49. 4. 2007b. Harlow: Pearson Education. Switzerland: WHO. 15th ed. Clarke K. 57: (suppl 4). West Indian Med J. Historical and current predictors of self-reported health status among elderly persons in Barbados. 57:596-604. Bourne PA. An introduction to health: Policy. 3. IL: Health Administration Press. 1948. 5. Hambleton IR. Using the biopsychosocial model to evaluate the wellbeing of the Jamaican elderly. A unified concept of health and disease. Rev Pan Salud Public. 2007. 17:342-352. and June 19-22.

2009). Am Psychol Ass.4(2):284-296. Social and health determinants of wellbeing and life satisfaction in Jamaica.pdf (accessed May 26. Statistics for Social Sciences. Rethinking the WHO definition of health. Retrieved from http://www-rcf.edu/archives/win2005/entries/wellbeing (accessed August 22.15. 27. 2004. Rotterdam. 17.. Asnani MR.edu/ easterl/papers/BetterTheory. WHO. 2000. Retrieved from http://www. Diener E. 18. Reid ME. England: Harper and Row.golbalhealth. Tucker MB. 19. March 21-23. Subjective wellbeing. 2006). Ali SB. International J of Social Psychiatry. 2003.int/social_determinants/en/ (accessed April 28. Working Paper Series. 22. 2000. Easterlin RA. 2005. Bain BC. The science of happiness and proposal for a national index. Diener E. 1982.who. 1984.stanford. 25.3: 700-710. John Wiley & Sons Inc. HealthMed journal 2010. Simeon DT. 2nd edn. London. Building a better theory of well-being. 95:542-575. 50:43-53. http://www. 14. Bourne PA. Psychological Bulletin. LeFranc E. 304 Available at . Williams-Green P. Rural and Remote Health. J Biomedical Sci and Engineering. 55:34-43. 2008. Hutchinson G. Homer D. Prepared for presentation at the conference Paradoxes of Happiness in Economics. 23. Applied Logistic Regression.use. Wyatt GE. The Social Determinants of Health. Crisp R. Retrieved from http://plato. The Stanford Encyclopedia of Philosophy (winter edition) E N Zalta ed. Lemeshow S. 26. Bourne PA.pdf (accessed August 26. University of Milano-Biococca. 21.harvard. Social and environmental correlates of self-evaluated health of poor aged Jamaicans. Quality of life in patients with sickle cell disease in Jamaica: rural-urban differences. Cohen L. 20.edu/hcpds/wpweb/Bokwp14073. 24. 2007). 2010. Veenhoven R. 8: 1-9. 2004. 16. Wellbeing. Happiness in nations. Modelling social determinants of self-evaluated health of poor old people in a middle-income developing nation. Lipps G. 2008. Bok S. subjective appreciation of in 56 nations 1946-1992. Netherlands: Erasmus University. 2006). Subjective wellbeing. Holliday M. 1993. New York.

82 (1). North Am J of Med Sci 2010. Social Determinants of Health. Egan M. Available from http://www. Whitehead M. The Solid Facts.who. Discussion paper for the Commission on Social Determinants of Health DRAFT April 2007.pdf (Accessed April 29. 2009). 811 – 816. Graham H. Pettigrew M. Bergmer V. Morgan A.2(6):267-275. Evidence for Public Health Policy on Inequalities: 1: The Reality According To Policymakers. 2nd ed. 33. Wilkinson RG. Graham H. Social Determinants and their Unequal Distribution Clarifying Policy Understanding The MilBank Quarterly 2004. Kelly M.5.int/social_determinants/resources/csdh_framework_action_05_07. 2007. Bonnefog J. The Social Determinants of Health: developing Evidence Base for Political Action. McIntyre SJ. 305 . Bourne PA. Differences in social determinants of health between men in the poor and the wealthy social strata in a Caribbean nation. A Conceptual Framework for Analysis and Action on the Social Determinants of Health. 30. 32.28. Copenhagen: World Health Organization. WHO Final Report to the Commission. Eldemire-Shearer D. Irwin A. 101-124. Solar O. 2003. 31. Marmot M. 29. Beth J. Journal of Epidemiology and Community Health 2004.

31 0.000 0.71 0.320 Overall correct classification = 85.764 0.28 0.703.952 0.09 0.31 0.68 1.05 0.00 0.9% (N=550).93 1.06 0.1: Good Health Status of Jamaicans by Some Explanatory Variables Wald statistic Variable Middle Quintile Two Wealthiest Quintiles Poorest-to-poor Quintiles* Retirement Income Household Head Logged Medical Expenditure Average Income Average Consumption Environment Separated or Divorced or Widowed Married Never married* Health Insurance Other Towns Urban Area Rural Area* House Tenure .14 1.010 0.10 0.07 0.08 0.000 0.90 0.93 1.85 0.16 8.00 1.000 CI (95%) Odds Ratio 0.96 26.17 1.33 0.58 2.447 0.17 -0.01 -0.789.10 0.00 1.10 1.08 1.36 2.96 2. n = 8.7% (N=7.95 0.00 0.08 0.24 0.Squatted* Secondary Education Tertiary Education Primary and below* Social Support Living Arrangement Crowding Land ownership Gender Negative Affective Positive Affective Number of males in household Number of females in household Number of children in household Constant -0.95 1.124 0.05 0.085 Hosmer and Lemeshow goodness of fit χ2=4.212 0.02 0.13 0.23 1.00 0.46 0.07 0.56 0.21 -0.274 -2 Log likelihood = 6331.81 0.08 -0.07 0.08 1.24 1.48 0.96 1.04 0. p < 0.12 0.004 0.66 0.04 0.03 0.03 -0.82 -1.67 χ2 (27) =1860.00 1.17 0. *Reference group 306 .01 0.07 0.19 6.000 0.29 0.31 0.38 0.01 0.001.08 0.71 0.Owned House Tenure.17 1.891 0.31 0.93 -3.97 0.12 0.342 0.000 0.05 1.15 1.000 0.64 0.09 1.Table 11.74 0.05 P 0.48 0.26 4.26 13.75 0.11 -0.91 0.01 0.543 0.99 0.17 1.772 0.14 0.50 Upper 1. 0.99 0.59 0.012 0.01 -0.98 1.55 1.20 0.19 0.07 0.99 1.04 0.91 1.45 1.Rent House Tenure .42 0.539) Correct classification of cases of dysfunctions =33.73 0.08 0.659 0.00 0.36 53.00 0.65 6. Nagelkerke R2 =0.96 1.55 Std Error.98 1.13 776.88 0.00 1.64 6.06 0.46 1.89 0.09 0.261 0.58 Lower 0.01 0.04 1.39 -0.22 1.88 0.00 0. p = 0.07 0.78 0.11 1.03 1.224 0.639.34 0.02 87.94 1.17 -0.16 0.67 14.089) Correct classification of cases of good or beyond health status =98.689 0.90 28.58 0.000 0.07 1.3% (N=6.27 Coefficient -0.97 -0.88 0.16 0.17 15.04 0.68 0.37 5.38 0.06 1.000 1.00 1.36 2.07 0.05 1.36 29.81 18.06 -0.49 0.03 1.024 0.000 0.027 0.000 0.81 1.08 0.27 0.10 0.

72 CI (95%) Lower 0.18 0.68 0.00 1.00 0.04 1.33 0.09 0.07 0.026.000 0.96 1.26 0. p < 0. *Reference group 307 .000 0.15 0.97 38.18 0.16 0.495 0.11 0.19 1.44 0.19 1.15 0.736.Table 11.21 1.062 0.001 0.22 40192.93 1.82 P 0.44 0.95 1.10 0.05 1.06 5.86 2. Nagelkerke R2 =0.93 1.485 0.40 -0.26 -0.24 0.86 0.07 0.04 0.16 -0.49 12.67 0.00 0.47 1.56 1.05 0.91 1.335 0.80 0.08 0.92 1.00 0.76 1.11 0.32 0.75 0.39 1.88 5.000 0.02 0.7% (N=361).24 0.49 0.14 1.36 1.97 1.54 2.97 9.45 0.14 0.81 2.47 -0.05 0.32 3.30 0.47 0.146 0.07 1.82 0.00 0.26 0.61 0.49 -0.27 0.04 0.22 0.07 0.347 Overall correct classification = 75.02 0.492) Correct classification of cases of good or beyond health status =94.12 0.190 0.66 Hosmer and Lemeshow goodness of fit χ2=5.63 2.94 1.29 1.001 0.17 0.15 1.5% (N=1.53 0.83 2.03 0.51 1. n = 2.9 1.09 0.677.95 1.46 0.020 0.84 1.172 0.021 0.27 -0.000 0.11 0.14 0.91 0.12 1.00 4.495 0.001.10 1.owned House tenure – squatted* Secondary Education Tertiary Education Primary or below* Social support Living arrangement Crowding Landownership Gender Negative Affective Positive Affective Number of male Number of females Number of children Constant -0.67 1.00 3.37 1.15 Wald statistic 0.05 0.21 241.06 0.491 0.17 0.98 0.00 1.65 0.12 0.81 0.47 -20.22 1.40 0.362 0.593 0.12 -0.22 0.04 1.327 0.90 1.02 1.83 0.35 16.26 6.00 0.46 0.00 -0.48 0.35 0.23 8.02 1.028 Odds Ratio 0.12 0.81 0.54 Upper 1.002 0.6% (N=1.03 1.2: Good Health Status of Elderly Jamaicans by Some Explanatory Variables Coefficient Middle Quintile Two Wealthiest Quintiles Poorest-to-poor quintiles Retirement Income Household Head Logged Medical Expenditure Average Income Environment Separated or Divorced or Widowed Married Never married* Health Insurance Other Towns Urban Rural areas* House tenure .89 -0.142 0.60 0.60 χ2 (27) =595.13 0.72 14.002 -2 Log likelihood = 2.180 0.47 2.68 0.22 0.22 -1.80 11.rented House tenure .33 Std Error 0.88 1.06 1.317 0.08 0.75 0.38 0.160 0.104.009 0.79 4.131) Correct classification of cases of dysfunctions =44.05 1.01 1. p = 0.30 -3.

90 0. n = 3.135 0.827.3% (N=3.94 -1.04 0.05 0.11 0.43 2. *Reference group 308 .313) Correct classification of cases of good or beyond health status =98.450 0.146 0.45 0.75 0.799 -2 Log likelihood = 2.265 0.53 7.03 0.65 1.67 2.230 Overall correct classification = 87.00 0.149 0.57 0.00 1.17 0.66 4.387 0.04 3.09 0.12 0.380 0.23 0.04 0.44 0.226 0.94 0.28 0.06 0.03 0.10 3.03 0.232 0.rented House tenure .02 0.12 Wald statistic 0.000 0.318.57 1.93 0.42 1.21 χ2 (27) =547.999 0.776.630 0.01 0.95 0.19 0.13 1.019 0.006 Odds Ratio 1.78 1.87 0.82 0.009 0.10 0.51 0.85 0.13 0.14 1.06 0.543.00 1.92 1.00 0.07 1.04 1.44 1.34 -0.41 P 0.465 0.77 2.00 0.02 1.66 0.55 2.351 0.09 Upper 1.68 0.00 0.77 2.76 0.07 1.834 0.08 0.08 -0.51 -0.03 1.91 1.19 -0.21 1.20 -0.20 1.419 0.00 1.01 17. p = 0.98 1.Table 11.06 0.40 1.90 1.25 0.84 0.21 0.24 6.33 0.29 0.31 Std Error 0.68 320.21 1.06 0.11 0.18 -3.41 0.23 0.16 4.03 0.83 0.34 0.01 1.119 0.102 0.23 0.00 0.055 0.75 0.15 0.44 0.92 0.23 2.3: Good Health Status of Middle Age Jamaicans by Some Explanatory Variables Coefficient Middle Quintile Two Wealthiest Quintiles Poorest-to-poor Quintiles* Retirement Income Household Head Logged Medical Expenditure Average Income Environment Separated or Divorced or Widowed Married Never married* Health Insurance Other Towns Urban Rural areas* House tenure .76 0.09 5.57 0.87 0.19 20029.66 0.03 -0.02 0.11 0.11 -0.00 1.89 0.13 0.24 1.55 0.11 0.963 0.28 1.000 0.2% (N=170).05 -0.41 24.47 21.08 2.36 0.35 1.001.26 1.29 -0.12 0.011 0.68 0.15 0.owned House tenure – squatted* Secondary education Tertiary education Primary or below* Social support Living Arrangement Crowding Landownership Gender Negative Affective Positive Affective Number of males in house Number of female in house Number of children in house Constant 0.08 1. Nagelkerke R2 =0.11 26.71 -0.50 -0.71 1.76 0.99 0.05 1.972 Hosmer and Lemeshow goodness of fit χ2=4.68 0.08 0.47 6.11 2.88 1.85 1.53 0.97 1.10 1.95 1.2% (N=3.000 0.05 1.56 0.143) Correct classification of cases of dysfunctions =28.034 0. p < 0.37 CI (95%) Lower 0.04 0.

055 0.18 Wald statistic 0.226 Overall correct classification = 92.07 0.18 0.040 0.22 6.07 1.22 0. n = 4.00 1.15 0.93 1.68 Upper 1.19 -0.02 0.94 0.67 0.10 11.75 0.00 -0.97 0.02 0.39 0.2% (N=107).747 0.04 1.00 0.00 0.47 0.4: Good Health Status of Young Adults Jamaicans by Some Explanatory Variables Coefficient Middle Quintile Two Wealthiest Quintiles Poorest-to-poor quintiles* Household Head Logged Medical Expenditure Average Income Environment Health Insurance Other Towns Urban Rural area* Secondary education Tertiary education Primary and below* Social support Crowding Gender Negative Affective Positive Affective Number of males in house Number of females in house Married Never married* Constant -0.269 0.174 -2 Log likelihood = 2.206 0.70 2.67 0.717 0.27 0.39 0.73 0.68 0.19 0.Table 11.78 1.06 1.69 1.93 1.001 0. p < 0. Nagelkerke R2 =0.04 321.04 0.70 1.65 0.001.39 -0.43 0.00 0.10 0.05 Std Error 0.26 0.21 0.733.03 -3.420 0.10 1.59 -0.12 1.00 1.13 1.95 CI (95%) Lower 0.000 0.864) Correct classification of cases of good or beyond health status =99.00 0. *Reference group 309 .351 0.760 0.757) Correct classification of cases of dysfunctions =28.405 0.75 0.68 1.6% (N=3.26 0.78 1.29 1.94 0.091.02 0.08 2.41 0.09 1.14 0.04 0.13 1.06 -0.51 2.06 0.06 -0.04 0.29 0.62 0.65 1.96 1.68 0.13 0.34 χ2 (19) =453.88 Hosmer and Lemeshow goodness of fit χ2=5.009 0.87 1.13 16.01 1.05 1.788 Odds Ratio 0.09 15.20 1.37 0.69 1.738.070 0.09 3.16 1.06 0.57 0.36 0.94 0.886 0.22 0.94 0.02 1.81 3.13 0.23 -0.07 P 0.42 0.55 0.185.15 0.13 0. p = 0.68 -0.0% (N=3.87 0.20 0.06 0.120 0.25 0.03 0.02 1.60 1.90 0.07 0.60 4.520 0.01 0.94 0.840 0.41 0.000 0.

utilise private health care facilities. statistics revealed that there were 2.682. be elderly. A study conducted in 2007/2008 on Jamaicans between 15 310 . and be rural dwellers. record moderate health status. (2) healthcare seeking behaviour.12 Modeling social determinants of self-rated health status of hypertensive in a middleincome developing nation Paul A.4% had hypertension [2]. Bourne & Christopher A. The current paper found that 2.5 times more females than males were affected by hypertension. Charles A piecemeal approach has been taken in studies on hypertension. Twentyseven in every 100 hypertensive persons had at least good self-rated health status. and the hypertensives were more likely to: be married. (3) healthcare utilization.120 Jamaicans (end of year population) [1]. Introduction In 2007. be in the lower socioeconomic strata. The findings provide policy makers with evidence that can be used to enhance policy formulation and intervention programmes. Rural hypertensives recorded the greatest very poor health status.D. of whom 22. The aim of this paper is to elucidate information on hypertension and the socio-demographic profile of those with the disease in a Latin American and Caribbean nation as well as to model self-rated health status of the hypertensive. and two variables emerged as statistically significant factors of the self-rated health status of hypertensives in Jamaica. but there is a void in the literature on (1) the socio-demographic profile of those with the disease in a Latin American and Caribbean nation. and (4) modelling social determinants of self-rated health status. Most had sought medical care during the last 4-week period.

than obesity.and 74 years of age found that 25% of population had hypertension as well as obesity [3]. Diabetes. and come 2030 with 80% of the globe‘s population residing in cities compared to over 50% in 2008. Hypertension is not only a silent killer. and in the 1980s. cardiovascular disease. more people will be 311 . as they are the leading cause of mortality [5]. Peru and Venezuela [3. hypertension stood as the third leading cause of mortality in females and the 6th cause for males. Jamaica like the rest of the developing world is experiencing an epidemic in cardiovascular diseases. cardiovascular disease. but despite this reality. tuberculosis. heart diseases. a shift occurred which saw cardiovascular disease. Jamaica. 5]. and not the face behind hypertension [6]. While 11 to 21% of Latinos in the Americas are obese. it is an epidemic and needs to be examined as such in the developing world. pneumonia and influenza were the leading causes of mortality in the Caribbean. In the 1950s. other heart diseases and hypertension were among the 10 ten leading causes of death. In 2007. malignant neoplasm. chronic diseases account for 60% of deaths. obesity is the studied epidemic in the Americas. and this is as high as 80% in lowto-middle income nations [4]. The sedentary lifestyle of urban dwellers explains much of the chronic illness in the world. nephritis. Hypertension. heart disease. Globally. syphilis. Another shift was observed in the 1990s when malignant neoplasm. on the other hand. and hypertension are among the main causes of death in the world except in South Asia and sub-Saharan Africa. increases exponentially in middle to late ages and accounts for more deaths in the world as well as in developing countries. ischaemic heart disease. obesity accounts for between 20 to 33 1/3% of the populations in Chile. 3]. Mexico. This denotes that between 1 in 5 and 1 in 4 Jamaicans are living with at least one chronic illness [2. diabetes mellitus. hypertension and diabetes being the leading causes of death. cancers.

14]. as in Nigeria. Clearly. In 1998. [10]. 20]. the better financial pull factors that appear to people do not mean that they will have less chronic illness. found that early blood pressure problems were virtually nonexistent in rural Africans. as well as modelling their self-rated 312 . that in recent times hypertension in Nigeria. income [20] and advanced aging [21-23]. In fact. They noted. hypertension is an important cardiovascular risk factor which affects between 20-25% of the population [11]. Studies on hypertension have shown differences between areas of residence [13. being poor. measurement and treatment [18]. however. those in the former are still to admit this reality. using hypertension as an indicator of the emergence of chronic cardiovascular diseases. Western lifestyle [10]. sex [17].9]. which suggests that those in the lower socioeconomic strata in the developing world will in the future be vulnerable to more illnesses. diet [16]. despite urban-rural migration. saturated fat and environmental factors) like the wealthy. 3]. Forrester et al. and were modest in Caribbean people. diet. While urban settings appeal to too many people. Since blood pressure was measured for the first time in 1733 by Stephen Hales.expected to die from chronic diseases. hypertension in Jamaica as well as some nations in Africa is a silent epidemic [12]. and educational level [19. and in particular chronic diseases. Jamaica and the US has seen remarkably steep gradients. Urban zones continue to attract many people and some of them. many piecemeal studies have been conducted on the matter. An extensive research of the literature unearthed no study on selfreported hypertension that evaluates who hypertensives are. will not be able to change their lifestyles (cigarette consumption. it is well established that there is a direct relationship between poverty and chronic illness [7. stressors [15]. sugar. and while researchers have recognized this as the case in the latter state. In Jamaica [2.

hypertension requires an immediate assessment of the sociodemographic characteristics and health status of its patients. This is no longer a silent epidemic. 313 .health status. 26]. The face of hypertension is no longer middle-to-late ages in Jamaica. Chronic diseases are the next tsunami facing developing countries. and in particular the high prevalence of hypertension which is a predisposing factor for cardiovascular diseases [25. highlight the importance of a comprehensive study of the face of the hypertensive person. The 2007 JSLC was conducted in May and August of that year. The swelling increases in those conditions. as the current paper found that 2. as mortality figures indicate that a ‗red alert‘ needs to be sounded for hypertension among the other chronic ailments in developing countries. Thus. The current paper extracted a sub-sample of 206 respondents who indicated being diagnosed with hypertension from a larger nationally cross-sectional survey of 6.9% are young adults (15-30 years). The JSLC was conducted by the Planning Institute of Jamaica (PIOJ) and the Statistical Institute of Jamaica (STATIN). [24] stated that 3 in every 10 Jamaicans (ages 30+ years) had hypertension. In 2001. and in 2007 1 out of every 4 Jamaicans had the disease.782 Jamaicans. Methods and materials Sample The current paper used the 2007 Jamaica Survey of Living Condition (JSLC) dataset to carry out the analyses. Swab et al. If the ‗Rule of Halves‘ (half of those detected are treated or controlled) holds true [27-29]. the aim of this paper is to elucidate information on hypertension and the socio-demographic profile of those with the disease in a Latin American and Caribbean nation as well as to model self-rated health status of hypertensive.

The JSLC is a modification of the World Bank‘s Living Standards Measurement Study (LSMS) household survey [30]. Age group is a non-binary measure: children (ages less than 15 years). and published in a document entitled the Jamaica Survey of Living Conditions (JSLC). the organizations deliver evidence-based information. Since 1989. Funded by the central government. a listing of all the dwellings was made. This design was a two-stage stratified random sampling design where there was a Primary Sampling Unit (PSU) and a selection of dwellings from the primary units. An ED is an independent geographical unit that shares a common boundary. old elderly (ages 75 to 84 years) and oldest elderly (ages 85 years and older). The sample was weighted to reflect the population of the nation. The data is collected by way of an administered questionnaire. 314 . the organizations have been collecting data on Jamaicans in order to evaluate social programmes instituted by the government.The PIOJ and STATIN are non-profit organizations focusing on data collection and policy assessment. Measurement Age is a continuous variable which is the number of years alive since birth (using last birthday). other-aged adults (ages 31 to 59 years). The survey was drawn using stratified random sampling. and they aid in the evaluation of government‘s social programmes including census taking. and this became the sampling frame from which a Master Sample of dwellings was compiled. which constitutes a minimum of 100 residences in rural areas and 150 in urban areas. Based on the PSUs. which in turn provided the sampling frame for the labour force [30. This means that the country was grouped into strata of equal size based on dwellings (EDs). young elderly (ages 60 to 74 years). The PSU is an Enumeration District (ED). 31]. among other issues. young adults (ages 15 to 30 years).

poor and very poor. Other. Yes. Hypertension. Analytic model Using econometric analyses (multiple logistic regressions). Yes. Bourne and McGrowder [27] modeled social determinants of health of rural Jamaicans. Diabetes. Furthermore. Income is measured using total expenditure. the middle class was quintile 3. good. Social class: This variable was measured based on income quintile: The upper classes were those in the wealthy quintiles (quintiles 4 and 5). Yes. the selected variables which used in this model building were based 315 . The literature has shown that health status can be dichotomized into good-tovery good health status and poor-to-moderate health status [32-34]. and (iii) poor. Diarrhoea. and those in lower classes quintiles 1 and 2. The chosen method allows for the testing of many possible variables which account for health status. Yes.Self-reported illness (or self-reported dysfunction): The question was asked: ―Is this a diagnosed recurring illness?‖ The answering options were: Yes. Arthritis. A binary variable was later created from this variable (1 = good and fair. Cold. and No. Thus. Yes. 0 = otherwise) [32-34]. care should be taken in where moderate health status is placed as Bourne [34] opined that moderate health status is best fitted into good-to-very good health status. Self-reported health status: ―How is your health in general?‖ And the options were very good. for this study the dichotomization of health status was moderate-to-very good and very poor-to-poor. (ii) fair. Clearly. fair. Yes. which was measured as a binary variable. based on the findings in the literature. For this study the construct was categorized into 3 groups – (i) good. Asthma.

Cross tabulations were performed in order to examine demographics. and Hosmer & Lemeshow [36] was used to examine goodness of fit of the model. medical expenditure. Wald statistics. In order to develop accurate tests of statistical significance. health insurance coverage. income.05 was selected to indicate statistical significance. Multiple logistic regressions were used to analyze possible explanatory variables (health care-seeking behaviour in the last 4weeks. household head and age) of self-rated health status.05). adjusted for the survey‘s complex sampling design [37]. A p-value < 0. USA). with a confidence interval of 95% (CI 95%). 316 . The final model was based on those variables that were statistically significant (p < 0. area of residence. NC. Chicago. 1989). and Odds ratio.3% of the cells are less than 5 data vales. The results were presented using β coefficients. and where 33. Statistical analysis We used the SPSS computer statistical package. IL. Version 16. Research Park. Some modifications were made to Bourne and McGrowder‘s model as not all the variables which emerged in that model were applicable to the current work. The predictive power of the model was tested using the Omnibus Test of Model. In this model building. health. Fisher exact test was used instead of Chi-square. sex. Categorical variables were coded using the ‗dummy coding‘ scheme. marital status. and particular variables.on the established evidence on social determinants of health. the variables were entered in block from which the significant ones emerged as factors which account for moderate-to-very good health status of hypertensive in Jamaica.0 (SPSS Inc. the researchers used SUDAAN statistical software (Research Triangle Institute. and STATA.

95) was 3. the face of hypertension in Jamaica was elderly (60+ years. 60.002. The majority of the respondents indicated fair self-rated health status (44. illness.2%). 317 . health care utilisation. Twenty-eight percent of respondents had health insurance coverage (private. P = 0. The sample was 206 respondents (mean age = 62.2%) compared to 26.33).9%) and 29. A significant statistical association emerged between area of residence and self-rated health status (χ2 = 24.5 years ± 16. Predominantly. The final decision on whether to retain was based on the variables‘ contribution to the predictive power of the model and its goodness of fit [38]. 4. in 2007).Where collinearity existed (r > 0.2%). Results Table 12. Table 12.3%).2 examines sociodemographic characteristics and health care utilisation by selfrated health status. The average number of visits to medical practitioners(s) in the last 4 weeks were 1.2%).7). Most of the sample purchased the prescribed medication (70.1 presents information on the sociodemographic characteristics of the sample. $80. The mean cost of private medical expenditure (USD 15.3 (SD = 0. 8. contingency coefficient = 0. 3.00 = Ja.9%).8 days (SD = 85.9% had been involved in an accident in the last 4weeks.69.54± 36.1% who mentioned at least poor (very poor. The preferred health care utilisation of the sample was private health facilities (including hospitals. and the mean length of illness of the sample was 24. variables were entered independently into the model to determine those that should be retained during the final model construction.3 days).7 times more than that for public medical expenses – (US $1. and 3. and health care-seeking behaviour.8 years).47.7). 55.7% who said at least good (very good.

No significant statistical association existed between self-reported illness and self-rated health status (χ2 = 2.6% of those who self-rated their health as poor-to-very poor).78).8).241) as well as between health care-seeking behaviour and sex (χ2 = 0. Married men were 2.3): area of residence (urban: OR = 4.23 – 9.003.4% of those who self-rated their health as moderate-to-very good and 31. P = 0.788).49.072. P = 0.44 – 11.6.1 presents information on the health care-seeking behaviour of people in different marital statuses and sex of respondents.97. low 318 .1%) in the last 4weeks. Table 12.2 times more likely to have visited a health care practitioner in the last 4 weeks compared to never-married men.6 (8). Married people had sought the most medical care (42. 95% CI = 1. and it correctly classified 75. P = 0. P = 0.1% of the sample (correctly classified 93. P = 0. The model had statistically significant associative power (Model χ2 = 32. While infectious diseases. 95% CI =1. other towns: OR = 3.47. and more so in developing countries.Table 12. Discussion Diabetes mellitus. Multivariate analyses Using logistic regression analyses. cardiovascular diseases and neoplasm are among the leading causes of mortality in the world. one variable emerged as a statistically significant factor of the self-rated health status of hypertensive Jamaicans (Table 12.3 presents information on sociodemographic characteristics and health care utilisation by population income quintile of sample. health care-seeking behaviour and population income quintile (χ2 = 5.98.4%) and other social partnerships. Hosmer and Lemeshow goodness of fit χ2 = 9. compared to never married people (36.15.562).

as 97 out of every 100 hypertensive persons were ages 31+ years and 60 out of every 100. yet more extensive and comprehensive studies have been conducted on diabetes. While outside information affords a pertinent source of data in understanding a phenomenon. this may not provide the correct knowledge about a 319 . Public health planners use information from within and outside of their geopolitical boundaries to enhance decision-making. which is an important cardiovascular risk factor. the findings concur with the literature that hypertension is a middle-to-later life ailment [20-23]. but there is a growing decrease in the age of contracting those conditions. More Jamaicans have hypertension than any other type of chronic condition. chronic diseases were viewed as middle-to-late life ailments. neoplasms and arthritis. 60+ years old. and how we research this fact. Traditionally. will be under-planning for a critical cohort in the population. relying on research. to record moderate health status and to be in the lower socioeconomic strata or rural dwellers. and two variables emerged as statistically significant factors of the self-rated health status of hypertensives in Jamaica. does not have a clear face. and accidents continue to claim lives. to utilise private health care facilities. What is evident is that 3 out of every 100 hypertensives are 15-30 years old. chronic conditions are rising faster and will account for more deaths in the future. Studies have used 30+ years old to examine chronic illness [24]. Despite this reality hypertension. Most had sought medical care in the last 4 weeks. which supports the changing image of hypertension. elderly. and the hypertensives are more likely to be married. or factors which explain the self-rated health status of this group. rural hypertensives recorded the greatest very poor health status. The current paper found that 2.nutrient intake. heart disease. which means that public health planning. In this paper.5 times more females than males are affected by hypertension.

nutritional deficiency and environmental degradation.‘s work. Clearly. from which it can be extrapolated that poverty is associated with low health. A study by Van et al. This research concurs with Van et al. where they work. Poverty means the incapacitation of financial resources. and went further to find that poverty is associated with area of residence. low nutritional intake and poverty account for more hypertensive people than the ‗bad‘ elements of urbanization. with almost 50% of Jamaicans residing in cities. Urbanization is well established in the literature as having a key role to play in human health conditions such as hypertension. lifestyle. choice of health care services. area of residence is related to illness. suggesting that material deprivation is directly associated with particular health conditions. and their sedentary lifestyle. material deprivation. increased morbidity and mortality. biological and environmental conditions. In Jamaica.localized group with different socioeconomic. as health is not exchangeable (cannot be bought). [7] found that chronically ill people in the Netherlands were more likely to be poor. money provides access to better nutrition. 6 out of every 10 hypertensive person in this nation dwells in urban zones. Those realities form the core of the rationale for developing nations having more deaths owing to chronic illness than the developed world. and by extension hypertension is higher among rural respondents. diabetes mellitus and other chronic ailments. statistics reveal that 71% of poverty is in rural areas [2]. which are associated with low health and higher morbidity and mortality. the surrounding environmental conditions and concern as to what they are exposed to. Smith and Kington [39] postulated that money is able to buy health. While their argument is not entirely true. While urbanisation affects people‘s lifestyle in relation to the food they eat. good sanitation and 320 .

In this study no significant statistical relationship existed between health care-seeking behaviour and population income quintile (social standing). which means that money will influence the choice of care and not health care demand. but since 2005. In this paper 40 out of every 100 hypertensive persons were poor compared to 37 out of every 100 in the wealthy social strata. The push-pull factors associated with migration in developing countries are accounted for by poverty. Material deprivation in rural areas in Jamaica is accounting for more morbidity and low health status. and material deprivation. and rightfully so. life expectancy. This may appear paradoxical. This therefore accounts for the greater percentage of hypertensives having sought medical care in the last 4 weeks (68%) compared to the population 321 . and those who live in semi-urban areas were 3. economic progress. which are the very reasons that pull rural residents to urban areas. which otherwise is difficult for the poor to obtain without governmental or other interventions. are more evident among those in the lower socioeconomic group in those societies. So when it is said that chronic illness is becoming the next tsunami in developing countries.1 times more likely to record moderate-to-very good self-rated health status than their rural counterparts. among other psychosocial conditions. and in particular hypertension. which somewhat supports Smith and Kington‘s postulation. and clearly this will be a push factor for urban-rural migration. quality of life.5 times more likely to have greater moderate-to-excellent self-rated health status. the swelling increases in chronic illness. despite the negatives of urban living. as financial deprivation should affect people‘s ability to afford health care. In this research. the Jamaican government has instituted free health care in all public hospitals except the University Hospital of the West Indies. and brings nutritional deficiencies. urban dwellers were 4. Poverty hinders opportunity.physical milieu.

as their choices.5 females to 1 male (using hypertension). the non-children public health care system needs to cater to this cohort. and with the influx of females into the labour force. The preference for private health care utilisation among hypertensives is embedded in long queues. Furthermore.(66%) [2]. and the sixth leading cause for the latter group. but this study found that the disparity was as much as 2.6 322 . While the onset of hypertension commences at 15 years in Jamaica. A public health concern must be the ratio of males to females with hypertension in Jamaica. Hypertension is brought on by various stressors in lifestyle practices. Swaby et al. which refutes Swaby et al.2%) and female hypertensives (69. There was no statistical association between the health care-seeking behaviour of male (67.that push people into private health care demand. suggesting that public health will be required to plan for this group. as compared to males. findings. low privacy.2%) in Jamaica. Despite the removal of access fees from public health care institutions.‘s [24] earlier. higher education and single parents. there is a preference for private health care utilisation. top managerial positions. Statistics reveal that the unemployment rate for females (14. lifestyle. the preponderance of females to males with hypertension accounts for why this health condition is the third leading cause of mortality in the former. demands and tolerance for disrespectful behaviour are not the same as elderly or middle-aged adults. social treatment of patients. The reality still exists that public health care is the choice of 44 out of every 100 hypertensive Jamaicans. and milieu – the environment of public health care facilities .3%) is 2. they are now exposing themselves to the risk factors associated with those social roles that were once dominated by males. [24] opined that there is a preponderance of females with chronic illness and treatment for chronic illness.

times more than that for males [40]. the material deprivation. and these influence the higher blood pressure count seen in them. A study by Atallah et al. and during this period there are the social challenges of child rearing for mothers. The unemployed females are vulnerable to the dictates of males. in this study there is a greater prevalence of hypertension among married than non-married Jamaicans. dietary deficiency. lifestyle and role changes. gender-specific population and age-specific mortality. which explains 323 . the psychological stressors of unemployment. [41] found that hypertension was greater among unemployed Caribbean people than those who were employed. According to Smith and Waitzman [43] ―many observers have theorized that married individuals have access to more informal social support than do non-married individuals‖. but no difference in the self-rated health status between the groups. and while money reduces material deprivation. the psychological situation of a dictatorial male. and while economic development is associated with economic growth. The current work opens a comprehensive discussion and analysis of the hypertensives in Jamaica. as well as other types of social deprivation. Interestingly. as well as the economic burden of chronic illnesses such as diabetes mellitus and hypertension. For some time now Caribbean governments have instituted data collection units to examine epidemiological data [42] on prevalence. indicating that unemployment. increased employment of females in the labour force means lower male dependency. are associated with greater hypertension among females. which also emerged in the current research. The 21st Century has brought with it urbanization. compared to males. but for the purpose of effective public health policy planning more information is needed on the face behind hypertension. the side effect is increased hypertension among this group. and risk factors related to chronic diseases for many Caribbean peoples.

This speaks to a public health problem. as the treatment and prevalence of hypertension is undoubtedly greater than the percentage currently planned for in the nation. With more married people utilising health care services. Furthermore. the benefits of marriage as put forward by other scholars do not provide protection from hypertension among this cohort. Clearly. this means that more nonmarried Jamaicans would be ill but have not yet been diagnosed. Smith and Waitzman [43] opined that wives were found to dissuade their husbands from particular risky behaviours such as the use of alcohol and drugs. the greater prevalence of hypertension among married people is as a result of the greater half seeking more medical care than non-married people. and would ensure that they maintain a strict medical regimen coupled with proper eating habits. but this must be done in a holistic way. The hypertension epidemic is clearly highlighted as an important public health problem. but in order to effectively combat this 324 .the social reality of a higher quality of life for married couples than ‗non-married‘ individuals [44]. and this accounts for the greater prevalence of hypertension among them. compared to those who were never married. studies have shown that married people have a lower mortality risk in the healthy category than the ‗non-married‘ [45]. those who are married seek more care on the request of their wives which accounted substantially for more of them visiting a medical practitioner in the last 4-week period. There is a need to have more people seeking medical care. Although males do not like to seek medical care. If the ‗Rule of Halves‘ (half of those detected are treated or controlled) holds true [27-29]. and this justifies why they take less life-threatening risks [46]. Married people are more likely to seek medical care than non-married people. as outlined earlier from the findings of this paper. In fact they recorded a greater prevalence of hypertension than other marital states.

growth. gender. used the standard age-specific. social class and health care utilisation. A study as early as in the 1980s had stated that hypertension was the most prevalent chronic illness in the West Indies [47] and in 2000 Barcelo [48] called it a silent killer. as well as self-rated health status. and educational level) are examined by scholars. This study is more comprehensive than other works and provides research experts with social justification for the face behind hypertension in Jamaica. unemployment. removal of health care user fees.reality. early testing and lifestyle practices must be coalesced by health planners. gender and education-specific conditions. policy makers and governments to understand the complexity of effectively implementing programmes to address the management of hypertension. area of residence. social exclusion. Conclusion In summary. and social programmes. but researchers have continued to examine its aetiology. 325 . despite the gains of economic development. the current evidence shows that hypertension has changed compared to the traditional late life disease to middle-to-late years. It should be used to help public health practitioners. as well as other chronic illnesses. poverty. rural residents. like its predecessors. and when done the traditional variables (age. The social explanations are rarely examined. opportunity. or other sub-populations. instead of the more demographic variables such as marital status. and that it mostly affect females. disease management. And that the social determinants of self-rated health status are fundamentally different from those identified in the literature on the population. management. malnutrition. Poverty is the underlying challenge to greater health in the population. programmes and even a study conducted in 2007/08 [3]. married respondents and marginally inflect the poor more than those in the wealthy social strata.

Disclaimer The researcher would like to note that while this study used secondary data from the Jamaica Survey of Living Conditions. 326 . but to the researchers. none of the errors in this paper should be ascribed to the Planning Institute of Jamaica or the Statistical Institute of Jamaica.Conflict of interest The authors have no conflict of interest to report.

STATIN. McFarlane S. Stronks K. Kingston: PIOJ. 13. Aldershot: Gower Publishing Company Limited. 2005. Tesfay A. Am J Epidemiol 1996. Soc Sci Med 1990. 2008. Hawkes C. Health inequalities in Europe. University of the West Indies. Statistical Institute of Jamaica (STATIN). 28:465-477. Chronic illness and poverty in the Netherlands. S Afr Med J 1998. Mona. 143: 1203−1218. Mebrahtu G. Jamaica Survey of Living Conditions. Emergence of Western diseases in the tropical world: the experience with chronic cardiovascular diseases. Mufunda J. Illsley R. Mackenbach JP. 15:278-84. Obgamariam A. Weatherall D. The effects of sex and method of blood pressure measurement on genetic associations with blood pressure in the PAMELA study. Kifle A. Wai K. 88: 361−364. 1989. Tulloch-Reid M. 17. The obesity epidemic in the Americas: making healthy choices the easiest choices. Chifamba J. 17:574-575. Hofman KJ. Statistical Institute of Jamaica. World Health Organization. 10:197-200. Mancia G. 14. Kingston: Tropical Medicine Research Institute (TMRI). 9. Jacoby E. Ghebrat J. 19:255-256. Yach D. Nyarango P. Demographic statistics 2007. Fox J ed. Kosia A. stress and blood pressure in black adults. Delles C. 4. JAMA 2004. British Med Bulletin 1998. 3. (PIOJ). The global burden of chronic diseases: Overcoming impediments to prevention and control. High Blood Pressure 1995. Dominiczak AF. J of Hypertension 2010. 10. Preventing Chronic Diseases a vital investment. Goitom S. Laing S. Hypertension and cardiovascular disease in migrating population. Strogatz DS et al. Brambilla P. 54:463-473. Younger N. Cesana G. Usman A. Grassi G. Migration within Africa. Commentary: Cardiovascular disease in Sub-Saharan Africa: An emerging problem.References 1. Bebremichael A. 8: 482−497. Ethn Dis 2007. Gebresillosie S. Mufunda J. Rev Panam Salud Public 2004. Somova L & Sparks HV. Padmanabhan S. 31(special issue):223-420. Salt sensitivity is not associated with hyperinsulinemia in a sample of rural black Zimbabweans. (STATIN). Francis D: Jamaica health and lifestyle survey 2007-8. Social support. Kaufman JS et al. Cooper RS. Planning Institute of Jamaica. 1989-2007. Sega R. Forrester T. Chitate N & Vengesa PM. J of Human Hypertension 2005. 8. 6. Gould CL. 29:2616-2622. Eur J of Public Health 2000. 327 . 15. Wilks R. Sani MU. Mufunda J. 11. Noncommunicable diseases in Africa: a silent hypertension epidemic Eritrea. 5. 12. Menni C. 7. Perego R. Determinants of hypertension in West Africa: contribution of anthropometric and dietary factors to urban-rural and socioeconomic gradients. Kingston: STATIN. 2008. Health inequalities in European Countries. ed. 2. Chifamba J. Lee. 1989-2008. 4: 46−49. Van Agt HME. Epidemiology 1997. 16. Svenson PG. Geneva: WHO.

a middle-income developing country. Finnas F. Bull NY Acad Med 1973. Kessels AGH. and blood pressure in adults in Jamaica. Forrester T. Wilks R. Lewis-Fuller E. Pierre R. Washington: The World Bank. Jamaica Survey of Living Conditions. Lee AJ. Mennen L. Poverty and Human Resources. Luke A. Hypertension in four African-origin populations: current ‗Rule of Halves‘. Some methodological remarks on self-rated health. van der Kuy. 55:617-618. Johnson P. Jamaica: Planning Institute of Jamaica and Derek Gordon Databank. Statistical Institute Of Jamaica. Chronic diseases management in the Jamaican setting: HOPE worldwide Jamaica‘s experience. Ragoobirsingh D. Jamaica Survey of Living Conditions. Giampaoli S. The problem of undetected and untreated hypertension in the community. 3:2. 300: 981-983. Neef C. World Bank. Hypertension: Burden and risk factors. North Am J Med Sci 2009. ed. Kingston: Planning Institute of Jamaica. An international comparative study of blood pressure in populations of European vs.18. 1992. 28. 20. Boume PA. Benjamin Y. In: Morgan O. BMC Medicine 2005. Mendez MA. Cooper R. (September 2. Wilber JA. Smith WCS. Forrester T. 94 (7): 561-565. University of the West Indies [distributors]. 25. J of Hypertension 2010. 98-114. Forhan A. Journal of Health and Social Behavior 1997. Stegmayr B. van Onzenoort HAW. PNG Med J 2001. Luke A. 38: 21-37. 32. Williams RB. Thamm M. 19:41-46. Journal of National Medical Association 2002. Kingston: Ian Randle Publishers. Int J of Epidemiol 2003. Wilson E. Control of blood pressure in Scotland: the Rule of Halves. 24. 2007. Sue-Ho R. A situational analysis of the Jamaican elderly. 32:400-408. BAlkau B. J of Hypertension 2001. 33. 2002. P-HM. The Open Public Health Journal 2008. Kingston. 23. 27. McGrowder D. 1988-2000. Kastarinen M. BMJ 1990. Banegas JR. 31. 22.org/INTLSMS/Resources/33589861181743055198/3877319-1190214215722/binfo2000. 2005: pp. 2009. Nelemans PJ. Basic information. Cruickshank JK. Primatesta P. Anderson SG. Kingston. Health issues in the Caribbean. Morrison E. Riste L. Nyqvist F. Adeyemo A.pdf). Wilks R. McFarlane-Anderson N. Wilks R. Saarela J. Health status of patients with self-reported chronic diseases in Jamaica. Tunstall-Pedoe H. Verberk WJ. 21. African descent. How does lower education get inside the body to raise blood pressure? What can we do to prevent this? Hypertension 2010. Walf-Maier K. 1: 32-39. education.worldbank. 29. Jamaica: Statistical Institute Of Jamaica [producer]. de Leeuw PW. Crombie IK. 28:622-627. Income. 2008. Cooper RS. Mbanya JC. Idler EL. quality of blood pressure control and attributable risk of cardiovascular disease. 328 . Self-rated health and mortality: A Review of Twenty-seven Community Studies. 26. Forrester T. 1995. Joffres M. 44:171-175. Effect of self-measurement of blood pressure on adherence to treatment in patients with mild-to-moderate hypertension. The Jamaican Hypertension Prevalence Study. Eldemire D. 19. Kroon AA. McGrowder DA. 1: 356-364. Development Research Group. 49: 510-520. at http://siteresources. [Computer file]. Swaby S. Swaby P. 30. Fray J.

Applied logistic regression. 38. 57:383-392. 37. Polit DF. 45. Kingston: PIOJ. 2nd edn. Stat Methods Med Res 1996. Bourne PA. Lemeshow S. 44. Smith JP. New York. Lillard LA. 5:311-329. 2009:1116. 49:262265. Hypertension in the West Indies. 34: 159-170. Koch GG. Innovative strategies using SUDAAN for analysis of health surveys with complex samples. Reducing the burden of arterial hypertension: what can be expected from an improved access to health care? Results from a study in 2420 unemployed subjects in the Caribbean.. 47. Waitzman NJ. 59:616-621. 2008. A comparative study of the quality and availability of health information used to facilitate cost burden analysis of diabetes and hypertension in the Caribbean. Barcelo A. Marriage selection and mortality patterns: Inferences and fallacies. 41. 1996. Panis CWA. Lang T. West Indian Med J 2000. Rozet J-E. 21:316-322. McGrowder DA. West India Med J 2008. Demographic and economic correlates of health in old age. Dichotomising poor self-reported health status: Using secondary crosssectional survey data for Jamaica. Larabi L. Reid M. North Am J Med Sci 2009. 40. Cunninghma-Myrie C. 28:306-19. 2000. Postgraduate Med J 1983. 31:487-507. 39. Data analysis and statistics for nursing research. 1: 295-302. J of Human Hypertension 2007. Journal of Rural and Remote Health 9 (2). de Gaudernaris R. Atallah A. 42. Shah BV. Forrester TE. Demography 1997. Rural health in Jamaica: Examining and refining the predictive factors of good health status of rural residents. Demography 1996. 33:313-327. John Wiley & Sons Inc. 46. Demography 1994. Lafata JE. Family status and health behaviors: Social control as a dimension of social integration. 36. 35. Inamo J. 48. Umberson D. Homer D. Smith KR. Planning Institute of Jamaica (PIOJ). Economic and Social Survey Jamaica 2007. Double jeopardy: Interaction effects of martial and poverty status on the risk of mortality. 329 . Marital status and mortality: The role of health. Journal of Health and Social Behavior 1987. Kington R. 43. Diabetes and hypertension in the Americas. Grell GAC. Chatellier G. Stamford: Appleton & Lange Publisher. 30:189-208.34. Machuron C. Bourne PA. Goldman N. Demography 1993. Stearn SC. LaVange LM.

Table 12. Health seeking behaviour (in %) by marital status and sex 330 .1.

7 331 .7 1.1 5.6 31.5 22.8 6. n = 206 Characteristic Sex Male Female Marital status Married Never married Divorced Separated Widowed Partner in household Yes No Did not respond Social assistance (PATH) Yes No Area of residence Urban Semi-urban Rural Population income quintile Poorest 20% Poor Middle Second wealthy Wealthiest 20% Age cohort Young adults Other aged adults Young-old Old-old Oldest-old Illness (self-reported) Yes No Health care seeking behaviour Yes No Health care utilization Public hospital Private hospital Public health centre Private health centre n 58 148 91 69 3 5 37 93 12 105 41 165 47 41 118 47 35 48 38 38 6 76 61 49 14 205 1 140 64 35 7 34 78 % 28.9 36.8 99.4 18.4 22.0 19.9 80.0 23.4 18.7 4.8 44.8 17.Table 12.9 29.1.5 0.8 19.1 50.9 57.0 45.4 2.4 33.8 51. Sociodemographic characteristics of study population.1 22.2 71.5 2.3 22.6 23.5 68.3 18.

0) 4 (50.8) 36 (69.0) 2 (25.4) 16 (30.5) 2 (25.4) 34 (37.7) 28 (30.0) 1 (12.0) 8 (15.8) 16 (17.0) 2 (25.7) Second wealthy 2 (20.6) Old-old 0 (0.1) 26 (28.5) 1 (12.2) Very poor n (%) 0 (0.1) Separated 0 (0.0) 6 (75.8) 26 (28.4) Marital status Married 3 (33.6) 40 (76.0) 8 (17.1) Widowed 0 (0.8) 17 (32.3) 18 (19.7) 22 (24.5) 1 (12.3) 6 (11.2) 17 (18.0) 1 (12.4) Rural 4 (40.0) 5 (62.1) 14 (26.0) 2 (25.0) 10 (22.0) 4 (50.0) 0 (0.0) 2 (4.3) 24 (26.0) 14 (31.0) 0 (0.7) Sex Male 3 (30.8) 10 (19.0) 7 (15.2) Oldest-old 1 (10.7) Yes 7 (70.2) Second poor 1 (10.8) 3 (5.7) 21 (46.0) 6 (13.8) 9 (17.0) 1 (2.2) Other aged adults 6 (60.0) 0 (0.3) 22 (24.4) Young-old 2 (20.7) 16 (30.7) 2 (2.0) 8 (17.3) Never married 6 (66.4) 7 (7.0) 11 (24.0) 24 (53.0) 22 (24.2) 1 (1.0) 13 (28.9) Wealthiest 20% 4 (40.5) 16 (30.0) 21 (46.0) 3 (6.0) 26 (57.0) 1 (12.5) 332 .9) 1 (1. Sociodemographic characteristics and health care utilization by self-rated health status Self-reported health status Very good Good Fair Characteristic n (%) n (%) n (%) Area of residence* Urban 1 (10.2) 1 (1.6) 43 (47.8) 41 (45.5) 4 (50.05 Poor n (%) 7 (13.0) 9 (20.0) 6 (13.Table 12.5) 5 (9.7) Health care seeking behaviour No 3 (30.9) 13 (25.5) 7 (87.3) 16 (35.4) 17 (18.6) Semi-urban 5 (50.3) 25 (48.0) 1 (2.8) *P < 0.7) 35 (67.3) 67 (75.2) 0 (0.8) Divorced 0 (0.0) 20 (44.5) 2 (25.2.3) Age cohort Young adults 1 (10.0) 6 (13.1) Population income quintile Poorest 20% 1 (10.0) 16 (30.0) 0 (0.6) Middle 2 (20.6) 19 (20.9) 26 (28.8) 17 (32.9) 2 (3.5) 1 (12.2) 65 (71.6) Female 7 (70.0) 37 (82.

7) 24 (68.6) 16 (22.6) 0 (0.2) 27 (71.7) 19 (50.1) 9 (23.7) Age cohort Young adults 1 (2.1) 0 (0.0) 1 (2.3) 0 (0.2) 3 (7.6) 0 (0.0) 6 (15.3) 17 (44.2) 16 (42.8) 12 (34.2) Marital status Married 19 (40.0) 7 (20.0) Never married 18 (38.7) 29 (76.0) 9 (23.0) Sex Male 12 (25.7) 16 (42.5) Self-reported illness Yes 47 (100.0) 0 (0.8) 14 (36.Table 12.3) 11 (29.5) 5 (14.0) 10 (28.3) 10 (29.4) 13 (34.7) 26 (70.7) 38 (79.7) 10 (20.1) 0(0.8) 24 (63.0) Health Insurance* – no coverage 38 (80.9) Oldest-old 4 (8.6) 13 (27.4) 8 (22.0) 1 (2. Sociodemographic characteristics and health care utilization by Population Income Quintile Population Income Quintile Poorest 20% Second poor Middle Second wealthy Characteristic n (%) n (%) n (%) n (%) Area of residence Urban 3 (6.0) 1 (2.9) 16 (33.9) 10 (20.05 333 Wealthiest 20% n (%) 21 (55.9) 12 (31.1) 12 (31.8) 5 (13.9) 1 (2.3.6) Separated 1 (2.0) 0 (0.3) 17 (50.6) 14 (36.1) 2 (5.8) public 8 (17.9) 3 (8.5) 8 (22.0) 9 (25.0) 22 (57.3) 4 (8.3) 15 (31.7) Old-old 12 (25.9) 38 (100.6) 32 (66.1) 32 (66.7) Young-old 16 (34.6) 13 (27.5) 8 (22.3) 8 (21.4) 13 (27.1) 38 (79.1) 0 (0.2) 38 (100.7) .7) 3 (7.0) 20 (41.5) 27 (77.7) Other aged adults 14 (29.8) 15 (31.8) Female 35 (74.1) 1 (2.0) 5 (13.3) 9 (23.0) 0 (0.6) Divorced 1 (2.4) 10 (26.2) 11 (28.5) 27 (77.1) 3 (8.2) 0 (0.0) No 0 (0.0) private 1 (2.0) 2 (4.2) *P < 0.6) Rural 37 (78.3) Yes 20 (43.8) 5 (10.3) Widowed 8 (17.9) 7 (18.2) 24 (63.9) 18 (47.5) 8 (22.3) Semi-urban 7 (14.4) 9 (23.1) 4 (10.1) 16 (42.0) 35 (100.1) 1 (2.0) 47 (97.9) 23 (65.1) Health care seeking behaviour No 26 (56.

47* 1.01.42 0.26 .44 0.26 -0.21 0.97 3.51 0.4% Correct classification of cases of self-rated poor-to-very poor health status = 31.41 0.62 0.47 .35 .1.001 334 .2.61 0.41 0.70 1.1.92 5.6.6 (8).38 1. separated or widowed Lower class (reference) Middle class Upper class Logged income Rural area (reference) Urban area Other town Sex (1= male) Household head Age β Coefficient Std.1.01 3.54 0.6% *P < 0.02 0.41 0.03 1.41 0.99 0.00 4.35 .48 -0.48 1.48 . P = 0.76 0.31 .75 -0.22 Overall correct classification = 75.01 1.07 1.06 1.00 0.1% Correct classification of cases of self-rated moderate-to-very good health status = 93.25 0. P = 0.47 0.96 .01 6.1.44 .04 -0.04 0.05.68 0.09 0.53 0.Table 12.39 0.74 0.53 0.1.23 .31 0.87 0.003 Hosmer and Lemeshow goodness of fit χ2 = 9.41 1. error Wald statistic Odds ratio CI (95%) -0.49 0.1. Logistic regression: Variables of self-rated health status Variable Health seeking behaviour Health insurance (1=Yes) Logged medical expenses Never married (reference) Married Divorced.55 0.57 1.92 1.37 .99 0.02 0.24 -0.74 0.19 0.8 -2Log Likelihood = 201. **P < 0.32 .00 0.31 -0.15** 1.00 0.07 0.42 1.3.03 0.1.4.36 -0.7 Nagelkerke R2 = 0.16 .03 0.9.01 Model chi-square = 32. ***P < 0.54 0.11.19 1.38 0.3.78 0.2.26 .57 0.

95% CI = 1.13 Factor Differentials in contraceptive use and demographic profile among females who had their first coital activity at most 16 years versus those at 16+ years old in a developing nation Previous studies have examined age at first sexual intercourse and factors which determine contraceptive use. This research aims to bridge the gap in the literature by elucidating information on the differentials in factors of contraceptive use between females whose first coital activity was < 16 years and 16+ years old as well as sociodemographic and reproductive health characteristics of these respondents.94) for those who begin < 16 years old but not for those 16+ and area of residence (Rural area: OR = 1. Factor differentials on contraceptive use emerged between the two cohorts. The current results are far reaching and can be used to guide new public health intervention programmes.72.07 – 1. the developing countries like the developed nations have been experiencing lowered age at first coital activity. which commences during the adolescence years. 9%% CI = 0.47) for the latter but not the former.26. More females whose first coitus was < 16 were currently in a sexual union (83%) compared with 79% of those who began at 16+ years old.55 – 0. Introduction For decades. These were social class (upper class: OR = 0. Young people (ie. adolescents) continue to be engaged in sexual activities outside of marriage and even 335 . but none have explored factors which determined method of contraception use between females whose first coital activity began at 16+ years and those who started < 16 years old.

A previous study conducted by Wilks et al [13]. which found that sex among adolescents‘ starts as early as 14 years. Kenya. human papillomavirus (HPV). Dickson et al. 12]. some African nations (such as Uganda. using a national probability same survey of 2. and a group of researchers found that almost 12 out of every 25 individuals aged 15-19 years in the United States reported having had sexual intercourse at least once [10]. Tanzania. New Zealand and Jamaica. found that there were young people who were engaged in sexual activities before 13 years old. using a longitudinal study of a cohort born in Dunedin in 1972-3. the median age at first sexual debut was 17 years. and particularly in New Zealand [7]. the developed world is more so experiencing lowered age at first sexual debut than the prevalence and incidence of HIV/AIDS epidemic faced by the developing societies. It is well documented that early sexual initiation is associated with increased HIV. Like United States. cervical cancers. A previous study established that the lowering of the age of first coital activity has been so for the past 3 decades in developed nations. suggesting that premarital sexual behaviour is similar in many developing and particular developed societies. The aforementioned early sexual debut in the Caribbean and New Zealand is also obtained in the United States [9]. unwanted pregnancies. Furthermore. The continuity of early sexual debut means that there are some health and social matters that will face the society because of early sexual relationships. This concurs with a five community ethnographic study carried out by Chevannes in the Caribbean [8].the statutes. and lowered levels of education and financial opportunities [1-6]. Ghana. While the developing nations have been plagued by the HIV/AIDS epidemic and lowered age at sexual debut.‘s work [7].0 years) [11. which is higher than that in Jamaica (15. abortion (safe and unsafe). Zambia and Zimbabwe) had a median age which is statistical the same.848 Jamaicans aged 15-74 years. In United States. teenage pregnancy. found that 336 .

13]. range = 13 – 16 years) [14].3 years in 1997 [12]. However. particularly among adolescents and young adults. there were similarities between Jamaica and the United States as the age at sexual debut for males and females was relatively close [9. Statistics also showed that 2. suggesting congruency in sexual expressions. (3) sexual promiscuity. Comparatively between the United States and Jamaica. less Americans aged 14-22 years were sexually active compared to Jamaicans aged 15-24 years [9. the society has seen the continuous erosion of values because the aforementioned matters continue unabated and there seems to be no end in sight. (5) unwanted pregnancies and (6) better sexual practices in the world. median age at first intercourse = 15. particularly in Jamaica.0 years in 2001.11 out of every 25 males and 10 out of every 25 females [13]. this fell from 17. Inspite of public health campaigns to address (1) the lowering of age of sexual intercourse. and the median age of first coitus among females aged 16-49 years was 16. 13]. Using dataset for the 2002 Reproductive Health Survey in Jamaica [12].6% of Jamaicans aged 15-24 years had a STI in the last 12 months compared with 2.0. and (2) the median age of first coitus among females aged 15-49 years was 16 years. (4) inconsistent condom usage. the mean age at first coitus was 14. Many developed nations such as New Zealand and the United States is 337 . The rationales for using < 16 years and 16+ are (1) the age of individual sexual consent is 16 years.7 years (SD = 3.22 out of every 25 people aged 15-24 years have had sexual intercourse .1.21 out of every 25 males aged 15-24 years and 19 out of every 25 females of the same age [13]. (2) HIV/AIDS among the population.4% of Jamaicans aged 15-74 years old. The sexual expression and practices of young Jamaicans (aged 15-24 years) is embedded in the fact that 11 out of every 25 have sex at least once per week .

95). If research provides an understanding of issues in our physical and social milieu. The literature on age at first sexual intercourse is extensive but recent and factors that determine contraceptive use of female [2-7. which is the case in Jamaica.32). This is within context of increased public health education campaigns on sexual responsibility and the rise of HIV/AIDS in the nation.02 – 1.16.01. social class (upper class. Apart of the justification of this public health challenge is that lifestyle practices. 16]. number of sexual partners (OR = 1. beliefs and sexual practices of females. currently pregnant (OR = 0. norms.00 – 0. 95%CI = 1. statistics revealed that the incidence of STIs among female for 2007/2008 in Jamaica were greater for them than their male counterparts [13]. 95%CI = 1. [16] eight factors were statistical associated with contraceptive use among females aged 15-49 years.17).21 – 1. Embedded in the incidence of STIs are the cultural values. 95%CI = 0. but no research existed that examined differentials in factors of contraceptive use between females whose first coital activity was < 16 years and 16+ years old. 95%CI = 1.98 – 1.95. age began using method of contraception (OR = 0.4.00). which will not easily change because external agents such as health educators and professionals say that they are to do this.99. Bourne et al. OR = 0.98 – 0. thereby allowing health practitioners and educator to 338 . 95%CI = 0.57 – 2.85.60). a study on the aforementioned is critical and timely as it would provide insights into their behaviour.70). cultural values and expectation as well as orientations which are changing in the 21st century. lifestyle. Although females in world have been living longer than males (life expectancy or healthy life expectancy). OR = 1. 95%CI = 0. then. The factors were age (OR = 0. area of residence (rural.experiencing the early age of sexual debut epidemic like Jamaica. 95%CI = 1. and crowding (OR = 1.95 – 2.02).83.73 – 0. 15.29. 95%CI = 0. had sex in last 30 days (OR = 2.99).

understanding early sexual activity (before the statutory age 16 years in Jamaica) and post the statutory age will provide invaluable insights into practices and measure that can be formulated to address the lifestyle of these individuals. and (5) the issue of survivability. This current paper. cervical cancers and other health problems [1-6. unwanted pregnancy. can add value to public health by studying factor differentials in contraceptive use between females whose first coital activity was < 16 years and those 16+ years old as well as their demographic profile. With previous studies having demonstrated that early sexual activities are associated with increased HIV/AIDS infections. Such a research is timely and will guide policy formulation and intervention programmes. Methods Sample (participants) and procedures 339 . (4) income inequalities between the genders.better understand how to address the increasing HIV/AIDS virus and other public health problems such as unwanted pregnancies and unsafe abortions. 15]. abortions and high fertility [17-19] coupled with the continuous lowering of age of sexual debut over the decades. recognizing limitations of previous research on the aforementioned issue within the context of the increased HIV/AIDS virus. (2) females being less economic independent than their male counterparts. (3) the vetoing power of males over females‘ reproductive health choices in developing nations. The rationales for the study are primarily based on (1) females vulnerability in contracting HIV/AIDS and other STI. This research aims to elucidate information on the differentials in factors of contraceptive use between females whose first coital activity was < 16 years and 16+ years old and to provide a socio-demographic and reproductive health profile of these individuals.

Jamaica is classified into four health regions.5% who began at 16+ years old. The current paper extracted only females aged 15-49 years from 2002 Reproductive Health Survey (RHS) dataset to carry out this research. 32. In stage 2. James. which are females and ages. In 2002. which in turn was comprised of 80 households.6%. Using the 2001 Census sector (or sampling frame). with Region 4 being St. The 340 . The eligibility criterion for age was 15 to 49 years at last birthday. St.8% [12]. Thus. 565). There are two sets of inclusion criteria. the households were clustered into primary sampling units (PSUs). and each PSU constituted an ED.168 women of the reproductive ages.1%. The previous sampling frame was in need of updating. Andrew. Stratified random sampling was used to design the sampling frame from which the sample was drawn. Ann. St. St. Stage 1 was the use of a selection frame of 659 enumeration areas (or enumeration districts. St.5% of Jamaica compared to Region 2. a three-stage sampling design was used. and so this was performed between January and May 2002. Manchester and Clarendon. which constitute particular parishes (there are 14 parishes). Of those who responded (n=5.5% had first coitus before 16 years old compared with 67. Region 1 is composed of Kingston. with a response rate of 77. at 14. Elizabeth. Thomas and St. Mary and St. The 2001 Census showed that Region 1 comprised 46. Region 3 at 17. Region 2 comprises Portland. RHS collected data on Jamaican men ages 15-24 years as well as women 15-49 years old. EDs).A descriptive cross-sectional study was carried out by the National Family Planning Board (Reproductive Health Survey or RHS). Catherine. Region 3 is made up of Trelawny.6% and Region 4 at 21. The female sample for the 2002 RHS was 7. Hanover and Westmoreland. This was calculated based on probability proportion to size. the entire female sample for the 2002 RHS that responded to the survey was used for this study.

After which it was released to the University of the West Indies. and so this was carried out between January 2002 and May 2002. The data was weighted in order to represent the population of female aged 15 to 49 years in the nation [12]. bathroom and verandah). The new sampling frame formed the basis upon which the sampling size was computed for the interviewers to use. and interviewers were given particular ED(s) which they exhausted in a clockwise manner. Age is the number 341 . Modifications were made to the pre-tested instrument (questionnaire). Again. Mona. The data collection began on Saturday. who were trained by McFarlane Consultancy. pre-testing of the instrument was conducted between March 16 and 20. to carry out the survey. 2003. Measures Age at first sexual debut (or initiation or intercourse) was measured based on a respondent‘s answer to the question ―At what age did you have your first intercourse? Crowding is the total number of persons in a dwelling (excluding kitchen. after which the final exercise was carried out. 2002 and was completed on May 9. Validity and reliability of the data were conducted by many statisticians. Stage 3 was the final selection of one eligible female from each sampled household and this was done by the interviewer on visiting the household [12]. the sample was selected based on probability proportion to size of the four regions. Prior to the date of the final data collection. statistical agency. October 26. The instrument administered was a 35-page questionnaire. and university scholars before the data was used as the data are for national policy planning [12].previous sampling frame was in need of updating. 2002. Data Bank for use by scholars. The Statistical Institute of Jamaica (STATIN) provided the interviewers and supervisors.

Currently having sex is measured from ―Have you had sexual intercourse in the last 30 days?‖ (1=yes. 0 = otherwise. 0 = otherwise or no). and ―Are you currently single?‖ Age at menarche is measured from ―How old were you when your first period started (first started menstruation)?‖ Gynaecological examination is taken from ―Have you ever had a gynaecological examination?‖ (1 = yes. 0 = otherwise. 1 = semi-urban. funerals. and if the answer is yes ―Which method of contraception do you use?‖ Age at which began using contraception was taken from ―How old were you when you first used contraception? Area of residence is measured from ―In which area do you reside?‖ The options were rural. Subjective social class is measured from ―In which class do you belong?‖ The options are lower. ―Are you living with a common-law partner now? (that is. Pregnancy was assessed by ―Are you pregnant now?‖ (1=yes. a more or less steady partner with whom you have sexual relations?‖. middle or upper social hierarchy (1 = middle class. don‘t know and refused to 342 . Religiosity was evaluated from the question ―With what frequency do you attend religious services?‖ The options range from at least once per week to only on special occasions (such as weddings. no. christenings et cetera) (1=frequent attendance from response of at least once per week. semi-urban and urban (1 = rural. 0 = otherwise. 1 = upper class. Forced to have sexual relations was assessed from the question ―Were you forced to have sex at your first intercourse?‖ and the options were yes. and urban is the reference group). are you living as man and wife now with a partner to whom you are not legally married?)‖.of years a person is alive up to his/her last birthday (in years). 0 = otherwise. ―Do you have a visiting partner. Contraceptive method comes from the question ―Are you and your partner currently using a method of contraception? …‖. 0 = otherwise). 0 = no). 0 = otherwise). Education is measured from the question ―How many years did you attend school?‖ Marital status is measured from the following question ―Are you legally married now?‖. that is. reference group is lower class).

Stepwise logistic regression analyses were used to fit the one outcome measure (contraceptive use) by different sociodemographic as well as reproductive health variables. we used SUDDAN statistical software (Research Triangle Institute. All metric variables were tested for normality (age at first sexual debut. Age at first sexual debut. Statistical analyses Data were entered. age at first contraceptive use. Pearson Product Moment correlation was used to evaluate statistical association between age of first sexual intercourse and number of sexual partners for the sample. Chicago. only explanatory variables (i. and range). Where collinearity existed (r > 0. Chi-square analyses were used to examine two nonmetric variables (Table 13. Version 16.0 SPSS Inc. mean.answer (1= yes.4).5 was normalized by natural log. and years of schooling).7). this is 16 years old). standard deviation (SD). Early sexual debut is having sexual intercourse before the statutory legal age to do so (in Jamaica.4). To derive accurate tests of statistical significance. 343 . age. variables were entered independently into the model to determine those that should be retained during the final model construction [19].5.e. and years of schooling were used as continuous variables. USA). Thus. crowding. 0 = otherwise). Where skewness was found to be less than 0. Descriptive statistics were performed on particular sociodemographic characteristics of the sample (frequency. Independent sample t-test was used to examine differences in age at sexual debut between those who frequently attend churches and those who infrequently visit churches and F-statistic was employed for age of sexual debut and subjective social class (Table 13.5. the variable was used in its current form and a value more than 0. statistically significant variables) are shown in Table 13. IL. age at menarche. stored and retrieved using SPSS for Window.

P = 0. < 16 or 16+ years old).e.011).Research Triangle Park.4 forwards information on particular demographic variables by subjective social class of respondents controlled for by age at first coital activity (i.2 highlights particular reproductive health characteristic of studied population by age at first coital activity (< 16 years or 16+ years old). 7. Table 13. < 16 or 16+ years old).0. 75. A pvalue < 0.0. 344 . NC).6% had one sexual partner compared with 3.3% had their first sexual intercourse at most 13 years old.4% who had 2+ sexual partners.e. a significant statistical correlation was found between (1) age at first sexual intercourse and number of sexual partners in the last 4 weeks (rxy = . 51. and (2) age at first sexual intercourse and number of sexual partner in the last 12 weeks (rxy = . Table 13. and this adjusted for the survey‘s complex sampling design. Table 13.6% by at most 20 years old and 99% by at most 26 years old.7% at most 14 years old. Twenty one percentages of the respondents had no sexual partner.05 (two-tailed) was used to establish statistical significance. 92. P = 0.5% at most 15 years old. Of the studied respondents. On examination of age at first sexual intercourse and number of sexual partners for the past month and the former 3 months.037.006).4% by at most 16 years. 32.034.1 presents information on the demographic characteristic of the studied population by age at first coital activity (< 16 years or 16+ years old). 16.3 displays information on methods of contraception Method of contraception and when began using by age at first coital activity (i. Results Demographic characteristic of sample Table 13.

crowding was 1.8 persons (SD = 0.23.0001). Females who frequently attend church begins having sex at 17. P<0.4 years (SD = 3. P = 0. and provide detailed information on the differences on demographic profile and factor differentials in contraceptive 345 .2) for those in the wealthy socioeconomic stratum.e. Females in the lower socioeconomic stratum began having sex at 16. P<0. The current works concurs with the literature.5 years (SD = 2. On average.30) among females who were in the lower socioeconomic stratum compared with 1.9 persons (SD = 0.107).12.0 years (SD = 2. P<0.5) compared with 16.4.3 persons for those in the wealthy socioeconomic stratum – F-statistic = 252.4) for those in the middle class and 17. 1] and that the age of first sexual debut is associated with future reproductive health outcomes [1-6].43) for those in the middle stratum and 1.8 years (SD = 3. However. no statistical difference emerged among the subjective social classes and number of sexual partners (F = 2. Multivariate analyses Table 13.5 shows explanatory factors which account for contraceptive use among females in Jamaica aged 15-49 years based on age at first sexual activity that the individual is classified in (i.4 years for those infrequent female church attendees (t-test = .0001). < 16 or 16+ years old).56. Discussion A previous study had that ―Experiences at sexual debut may be linked to reproductive health later in life‖ [21.A significant statistical difference was found among the subjective social classes and age at first sexual intercourse (F = 187.0001.3) compared with 16.03. p.

statistics revealed that females are poorer and less employed compared with males [22. shared sanitary convenience.47) for the latter but not the former. in order to provide for themselves many females who are within the lower socioeconomic stratum become involved with older men who expose them to the same risk 346 . do Pap smear and gynaecological examination as well as utilize the pill as a method of contraception. currently in a sexual relationship. making young females within the lower socioeconomic stratum having different reproductive health outcome than those in the wealthy socioeconomic strata because of their socio-economic marginalized situation. On the other hand. This reality means that there is high economic dependence of females on males for financial survivability. In Jamaica.26. Many of these females commenced sex at an early age because of economic vulnerability. Factor differentials on contraceptive use emerged between the two cohorts. live in rural areas. and so they are likely to be engaged high-risk behaviours [21]. sexual partnerships in last 3 months and unemployed.07 – 1. These were social class (upper class: OR = 0.94) for those who begin < 16 years old but not for those 16+ and area of residence (Rural area: OR = 1. This research found that females whose first sexual intercourse happened before 16 years old were less likely to use a condom with a steady partner. but they were more likely to be in the lower socioeconomic stratum. have a lower educational level. 9%% CI = 0. use injection as a method of contraception. first sexual intercourse was forced. 23].55 – 0.72. Embedded in those findings is the fact that females who are in the upper socioeconomic stratum that commenced sexual intercourse before 16 years are engaged in riskier sexual practices than those in the lower class. 95% CI = 1.use between the two cohorts (females aged 15-49 years who began having sexual intercourse < 16 years and those who started at 16+ years).

males are able to dictate many things including reproductive health choices. the aforementioned arguments justify female who began sexual intercourse at most 15 years who are more likely to be in the lower class. and HPV. they will turn outside the household for financial assistance and oftentimes this is provided in visiting sexual unions in which the males are older. STIs. but those in the upper class are able to carry out safe abortions compared with those in the lower class because of access to financial resources. because females are in a socioeconomic vulnerable position and by extension poorer and marginalized. Simply put the adolescence years are about fun.of pregnancy. frolic. and where they consider their lives. In such unions. Money is important to women. With females in the lower socioeconomic stratum having more people in a dwelling area compared with those in the other socioeconomic strata. in those income class will bear children as an economic flows and/or some will have unsafe abortions. The work also showed a negative correlation between number of sexual partners and age at first coitus. sexual expression. indicating that younger females are more promiscuous and that this changes with age at they move into stable sexual unions. sexual freedom. Thus. inconsistent 347 . have multiple sexual partners and less educated were more likely to be engaged in sexual relationships. and forced into sexual activities. STIs and even HPV because of their lifestyle practices. Their economic vulnerabilities account for the rationale of using fewer condoms as a method of contraception because this is vetoed by the male. therefore. suggests that many of them would have abortions. The high risk sexual behaviour among upper class females whose first sexual intercourse was before 16 years. but the risky sexual behaviour of upper class females whose first sexual activity begins before 16 years old is not for the money as those in the lower socioeconomic strata. dwell in rural areas. unemployed. Females.

which is in keeping with the literature from other nations [2. if money matters. and in Jamaica a 348 . early sexual intercourse comes with less likeliness of a method of contraception. then rural females who begins having sexual intercourse at 16+ years would not be 1. with more people residing in rural areas and a sex ratio that is greater for females than males [22.condom usage and sexual carelessness. [21]. those in those whose families are in the wealthy strata would be more likely to use a method of contraception compared with those in the lower socioeconomic stratum. and 7% with a partner 10 or more years older‖. Embedded in these findings are inexperience and the euphoria surrounding first sexual activity as well as the age of the initiating partner that account for lower contraceptive use based on age at first sexual coital activity than money. 26].25]. 28% with a partner 5 to 10 years older. Or. It was revealed from the findings that those females who commenced sexual intercourse at older ages were more likely to use a particular method of contraception (pill) than condoms that expose them to STIs.3 times more likely to use a method of contraception compared with those in urban areas. which is because of ignorance. Rural poverty in Jamaica is about twice urban poverty. While money is associated with employment and other socioeconomic benefits. 21. it is not responsible for lower method of contraception among Jamaicans females. which seems to continue even in the adult years among wealthy females. HPV. 24. and not money. Embedded in this finding is the influence of knowledge of contraceptive with age. HIV/AIDS and pregnancies. but the reverse is true in Jamaica. According to Gomez et al. ―Sixty-five percent of women reported sexual initiation with a partner younger or less than 5 years older. Even though money is important to particular reproductive health outcomes (such as safe abortions).

when he claimed that people are prisoners of their lifestyle [27]. like the man [8. 349 . customs. and how older men can expose them to sexually transmitted infections. Abel-Smith is correct. Such an orientation and culture. The current work revealed that 42. The young females are culturized in sex. This finding provides evidence of the difficulty to change lifestyle practices as although the majority of people in Jamaica have been exposed to public health education and intervention programmes [12]. inconsistent contraceptive use and risky sexual practices. but that it is still possible over time. this has not significantly change their sexual behaviour as the age of sexual initiation continues to fall as well as an increase prevalence of HIV/AIDS among the populace. Embodied here is an understanding of the lifestyle of adolescents in regarding to sex. implies and dictates a diet of sex. knowledge. Even with age. which are capturing the attention and practices of young people. norms and early socialization are difficulty to change. Apart of the Caribbean culture is that a woman is not a woman without bearing children. inconsistent condom use and condom use is low among Jamaican women aged 15-49 years.study revealed that many young women began their sexually initiation with men at least 5 years older than them [12].5% of those who began having sex before 16 years old currently use a condom consistently with their steady partner and the figure was 2. 28]. suggesting that values. The media continues to glamorize sex and sexuality.5% more among those who started at 16+ years old. therefore. exposure and high accessibility to method of contraception and low cost of contraceptives. and this they see to explore as they become cognizant of sex during the adolescent years when there is growth and development of the body.

School is an agent of socialization. From the current research. and some will seek to practice this while attending school. on cable television. Like Gomez [21]. children are not only exposed to health and reproductive health education and subjects‘ trainings. The current findings revealed that 43% those whose first sexual activity started before 16 years old began using a method of contraception during school compared with 7% who started at 16+ years. in which people are provided the tools of socioeconomic survivability. With the glamorization of sex in the media. this study recognizing the importance of age and gender-based power differentials between the sexes regarding sex note that delaying sexual debut must understand those differences as well as the educational system. Dickson [7] opined that adolescent sexual behaviour is influenced by social factors. the current findings 350 . has become a place of indirectly promoting sex through sexual education and peers of different socioeconomic situations and background. It can be deduced from Dickson‘s work that educational system is able to change sexual practices and particular reproductive health outcome. During school. With there being an inverse association between age and contraceptive use [4-7. 10. the educational system has modified the use of contraception. it can be deduced that high contraceptive use is associated with sexual activities. This is reinforcing sex. but not increasing the age at sexual debut. lifestyle. sexuality and orientation of sex that is even covertly reinforced with reproductive health education in schools. Based on Bourne et al. 16]. many children are exposed to a diet of sex.‘s work [29] that ―Health education and health promotion are driven based on understanding lifestyle practices of a population‖ [29]. they are interfacing with other children of different socialization. values and orientations.

family is poor. 31]. The social and cultural values. [32] posited that this leaves immense psychological trauma which are sometimes are suicidal.provide some critical information that can be used for a new thrust into public health intervention programmes in the future that can be used to modify current practices. the perpetrators are normally friends. Such abase leave an indelible psychological scar for the adolescent and Lowe et al. Clearly.576). beliefs. One researcher found positive statistical correlations between poverty and not seeking medical care (R = 0. This matter becomes even more complex when the adolescent is found to be pregnant. lowly educated.5 times more females who had sex before 16 years were sexually assaulted compared to those who began at 16 years and older. As formal educational is not able to change the sexual practices and/or reproductive health behaviour of females because more than 55% of the sample have tertiary level education (or have attained this level) compared to only 9. a public health problem that emerged from the current paper is that 1. unemployed and religious. Outside of the obvious that many early sexual encounters among females at most 16 years is as a result of rape.6% who have at most primary level education. family members and/or acquaintances who carry out these acts against the physical vulnerable adolescents and children [30. and poverty 351 . orientation. suggesting that the sexual appetite of Jamaican males is exposing female adolescent and children to future psychological traumas as well as reproductive health problems. Another psychological matter which is a consequence of sexual assault of is aggression on the path of the victim [33]. and expectations of the society are such that formal education is not modifying the lifestyle practices that public health specialists and behaviouralists would want to change.

over time. therefore. which speaks to the embedded sex culture and the difficulty in changing this practice without structural and cultural changes.and unemployment (R = 0. Some of those issues can be explained by the economic deprivation in inner-city communities and the culture values. and how these may retard self autonomy of the females. making it difficult for public health practitioners to be effective in meeting their objectives without addressing those inadequacies and the social structure in the society. 38]. Thus public health practitioners need to recognize money and power as influencing reproductive health. which concurs with the literature [20. self-esteem and social isolation can. No or little access to money means less choices including abortion for females who become pregnant as a result of rape and the economic power of the perpetrator is also able to change the outcome of criminal conviction. low educational attainment. 37. indicating that economic vulnerable adolescents and their families are likely to see the young female doing unsafe abortion. The church which is a part of the social structure is delaying sexual intercourse among Jamaican females aged 15-49 years by one year. Research evidence demonstrates that the religiosity network in which the adolescent involved as well as the friends‘ religious positively lowers age at first coital activity [39]. influence public health intervention programmes [36]. particularly in the lower socioeconomic areas. With the number of churches in Jamaica. carrying the pregnancy to term and going into depression and/or other psychological traumas because of socioeconomic deprivation. The socio-economic consequences of poverty.48) [34]. Religiosity is associated with better sexual practice as it increased the age of first sexual intercourse. Again this reinforces the fact that delaying early sexual behaviour is also a future good as people will continue bad practices if they start early in life. it is paradoxical that age at first sexual intercourse continues to fall. beliefs 352 . particularly those young females who are from low socioeconomic background.

Although the same is not the case for females in the wealthy socioeconomic stratum. commodities and other support things for sex from older men. Clearly. Thus. One study demonstrates this aptly as the researchers found that ―…children are significantly more likely to become sexually active before age 14 if their mother had sex at an early age and if she has worked extensively‖ [40] Previous studies have demonstrated that many of the cases of sexual assault and rapes are perpetrated by acquaintances.and customs within the society as well as the sub-cultures and countercultures on sex and sexuality. values which were garnered during that period and its bearing on current practices.8 years among those in the wealthy stratum. This speaks to the early lifestyle practices. The adolescents are sometimes gullibly encourages to become involvement in sexual activities with family members. They are exchanging sex for good. those who starting having sex before 16 years old are currently engaged in risky sexual behaviour. and this is resulting in those females becoming engaged in transactional sex. a number of the sexual initiations occur as a result of this fact. household members and friends.5 years for those in the middle class and 17. the culture in inner-city communities coupled with crowding are fostering early sexual intercourse because those in the lower socioeconomic stratum commenced sexual intercourse on average at 16 years compared with 16. It can be deduced and extrapolated from those figures that men are using the economic vulnerability of young females against them. This is the difficulty that public health practice need to tackle. old habits are difficult to change. With the crowding being an issue in inner-city communities (or lower socioeconomic areas). With the crowding in inner-city communities 353 . those who began having sexual intercourse at most 15 years old as they are high sex risk takers even in the adults years.

suggesting that religion is a social control. This is captured in the current work which showed that educational attainment is not associated with usage of contraceptives. that adolescents who are friends of non-religious individual would not have this level of control and will initiate sexual intercourse early. yet those who started having sexual intercourse before 16 years were less likely to use a method of contraception. and whether those networks are among religious members or non-religious individuals.means that many of the rapes are perpetrated by non-household members by acquaintances in the area. Thus. in 2009. education cannot easily change peoples‘ behaviour and so it is about knowledge on a 354 . Such an argument implies that lifestyle behaviour is easily changeable. They opined that religiosity delay the transition of adolescents venturing into sexual activity. and this justifies the continuation of poor sexual practices in the future. Hardy and Raffaelli [38] provide an explanation for the previously mentioned situation. which is the fartherest from the reality. ―Knowledge about the prevalence of sexual risk behaviour (SRB) in adolescence is needed to prevent unwanted health consequences‖ [43]. The traditional approach to health behaviour modification was to give people knowledge about a particular issue. It is this explanation why public health practitioners need to address social institutions in thwarting a campaign that will foster better sexual practices of adults as early as childhood and during their adolescence years. those in the wealthy income stratum had the greatest prevalence of tertiary level education. It follows. On the contrary. The next issue is the associations of the adolescents. According to one group of researchers. therefore. The peer group influences the reproductive health outcome of people. practice or happenings within their sociophysical milieu and instruct them into a new path [42]. particularly children and/or adolescents as well as adults [41] and increases early sexual practices which in this case justify future sexual behaviour of adults.

this suggests that risky sexual behaviour which commenced early in life is likely to continue into adulthood. In the previous works. Cohen. People are not barrels in which they are fed a 355 . Although a group of scholars found that the women‘s level of education and that of her spouse and age determine contraceptive use.4%) compared to 2000 (23. values. social structures. this concurs and disagrees with those findings [45. They also found that more people were engaged in visiting and/or single unions compared with married and common law. This is capture in the Wilks et al. For the current work.‘s work [13] which found that in 2002 78. economic.3% of Jamaicans aged 15-74 years used a condom with their main partner and this fell to 43. opined that health promotion for Jamaicans must include social. 46]. cultural and media messages. despite its provision in imparting knowledge and behaviour medications. Bourne et al. and socialization. and the more people had 2+ sexual partner in 2008 (24. Education is not changing sexual practice as it relates to contraceptive use among Jamaica females. with 11. The current work that showed that adult women who began having sex at 16+ years were more likely to use a method of contraception than those who started before 16 years. Like Cohen et al.0%). and lifestyle choices [29]. [44].1% in 2008 although the percentage of Jamaicans with secondary-to-tertiary level education had increased. Again. social structure. people are prisoners to their culture.particular issue. Scribner and Farley [44] developed a model for behaviour change using structural modeling which addresses physical structures. which is supported by the literature [16. 45]. beliefs. age is a factor in contraceptive use. the authors recognizing the complexity of humans have coalesced a multidimensional apparatus to address behaviour change and not simply imparting knowledge or by formal education.3% having had tertiary level training. but the same cannot be said about education.

Hogan et al. Outside of this clarification. when they postulated that. which fashion their cultural development. Conclusion Early sexual initiation is influencing future health and reproductive health outcomes among Jamaican women aged 15-49 years old. identification and belief system.diet of information from external sources such as health educators to want them to carry out a particular action or cease one because the social and environmental factors influence behaviour. ―Social and environmental variables were found to affect contraceptive preparedness at 1st intercourse only. and beliefs impact on people behaviour and this include education. moral suasion or dictatorial stance. particularly contraceptive use [47]. sex and reproductive health matters. and any such similar public health intervention programmes that used force. the health care system and the health care educators because the symbols of the culture and ways of life are not supported by the health care educators. values. Despite reproductive health education 356 . but that this is not the case among female Jamaicans aged 15-49 years old whether sexual initiation was < 16 years or 16+ years old. physical milieu. and less contraceptive use. Those are the reasons why ―Morally unacceptable policies designed to pressure or compel people to limit their fertility have been shown to be unnecessary and thus have been abandoned. Embedded in the current findings is the value of the social environment in which these females live and grow. and not subsequent initiation of contraceptive practice‖ [47]. [47]. except in China‖ [48] as well as being ineffective in behaviour medication. particularly related with sexual practices. provided some clarifications to the social and other factors which are associated with contraceptive use. involvement in sexual unions. Those outcomes include more coital activity. There is cultural conflict among female Jamaicans. it is evident that the culture.

unemployed. the culture is clearly retarding good reproductive health practices and sexual lifestyle. and equally so is the risky sexual practices of affluent females who started having sex before 16 years old. There will be in social justice in society that does 357 . Because money is associated with better education. why do they not use a method of contraception?” [49] is to deny people of their social environment and the role of money in it. rural females whose first coitus began at 16+ years were more likely to use a method contraception compared with their urban counterparts. although fertility is lower and educational advancement is greater in urban than in rural areas. physical milieu.programmes in Jamaica. uneducated.‘s work which showed an increase in visiting unions and number of sexual concurrent partners between 2000 and 2008. social opportunities. which is embedded in Wilks et al. there is a lifestyle change occurring among females in rural areas which needs examination. sexuality and reproductive health matters. Clearly. and with the economic downturn in the Jamaican economy there will be greater promiscuity as women seek more assistance in sexual relationships. sexual autonomy of female Jamaicans will be further reduced. While legislation and policies that promote sexual autonomy are good. to asked the question ―If women are so keen to avoid pregnancy. good nutrition and sexual autonomy. Public health practitioners have not begun to address those realities in the communities and human rights of women will be thwarting because money is important in survivability. With the global economic downturn. the reality is money is power. particularly those in the lower socioeconomic stratum. and young because males will now have greater vetoing powers over sex. Sexual rights of women cannot be supported by merely ascribing it to them or penning social constructions in this regards in must be supported by economic independency. In Jamaica.

There is a need for structural changes in developing as well as developed nations to address many reproductive health matters. The findings which emerged from the current results are far reaching and can be used to guide new public health intervention programmes. In summary. delaying age at first sexual intercourse influences contraceptive use. Clearly. the reproductive health problems in Jamaica are structurally driven which care embedded in the cultural values that make it difficult for public health practitioners to address without including those issues in health education. It means that apart of the sexual lifestyle of females is justified by the economic situation in the communities [50. and unemployed females. communication and intervention programmes. and they are also some different to those of women in the reproductive ages 15-49 years old. The factors of method of contraception are not the same across the age cohort at which a female began having sexual intercourse. It also fosters good sexual practices in the future.not understand the factors which are associated with sexuality. rights and sexual justice. Such social and financial environments means that public health must begin to address the new reality as all the gains that have been accomplished in past decades will be erodes because of the increased economic vulnerability of peoples and economic marginalization of the poor. particularly among young. and the role of money in influencing health and reproductive health matters. sex will always be a part of their social existence and an issue that cannot be left unaddressed by public health policies makers within the current findings and the global economic downturn. uneducated. Because people are sexual being. Disclosures The authors report no conflict of interest with this work. 51]. nation and the world. 358 . by increase methods of contraception.

but to the researchers. Acknowledgement The authors thank the Data Bank in Sir Arthur Lewis Institute of Social and Economic Studies. none of the errors in this paper should be ascribed to the National Family Planning Board. and the National Family Planning Board for commissioning the survey. 359 .Disclaimer The researchers would like to note that while this study used secondary data from the Reproductive Health Survey. Mona. RHS) available for use in this study. Jamaica for making the dataset (2002 Reproductive Health Survey. the University of the West Indies.

. contraceptive use. Geneva: WHO. 9. University of the West Indies [distributors]. Paul C. Kingston. D. Santelli JS. New York: AGI. Correlates and consequences of early initiation of sexual intercourse. Of the West Indies Press. 11. Health in the Americas. Pisani E. 3. 13. Herbison P. Jamaica: Derek Gordon Databank. 2002. Zabin LS. Reproductive Health Survey. coercion. 30:271-275. Jamaica health and lifestyle survey 2007-8. 2001. In Their Own Right: Addressing the Sexual and Reproductive Health Needs of American Men. 4. et al. Francis CG.. Abma JC et al. Am J of Epidemiology 2005. Chevannes B. HIV infection. Current use of contraceptive method among women in a middle-income developing country. Pettifor AE. Charles CAD. Kingston.448-464. 18. 2007: pp. 16. Miller WC. van der Stratan A. 360 . McFarlane S. et al. Young age at first sexual intercourse and sexually transmitted infections in adolescents and young adults. Jamaica: National Family Planning Board [producer]. Open Access J of Contraception 2010. Halpern CT. 12. 2006. University of the West Indies. Lowry R. Richter DL. Ford CA. 24. Washington. 2002. Andersson-Ellstrom A. 9: 111. 62-76. In: Morgan O. Health issues in the Caribbean. Crawford TV. Slaymaker E. 17. Tulloch-Reid M. Jamaica: The Univer. Multiple sexual partners among U. Vital and Health Statistics. et al. Bain B. J Sch Health 1994. Cong L. No. 2008. Kingston: Tropical Medicine Research Institute. Learning to be a man: Culture. Mona. 2003. Age of sexual debut related to life-style and reproductive health factors in a group of Swedish teenage girls. Comprehensive cervical cancer control: A guide to essential practice. Acta Obstet Gynecol Scand 1996. Kingston: Ian Randle Publisher. Milsom I. Wilks R. Epidemiology and Social 2004. Silva P. Younger N. 18(10):1435-1442.References 1. 2. 2005. Dickson N. socialization and gender identity in five Caribbean communities. 14. 75:484–9. Pan American Health Organization (PAHO). 2002. Jamaica National Family Planning Board (NFPB). 2002 [Computer file]. Kingston. Forssman L. Kaestle CE. 316:29-33. Early age of first sex: A risk factors for HIV infection among women in Zimbabwe. Bhatt A.C. Series 23. and later regrets reported by a birth cohort. adolescents and young adults. Bourne PA. 8. Padian NS. BMC Public Health 2009. 2005: pp. 161(8):774-780. Dunbar MS. Family Planning Perspectives 1998.S. Age at first sex: Understanding recent trends in African demographic surveys. 5. and unwanted pregnancy among university students in China. World Health Organization (WHO). The Alan Guttmacher Institute (AGI). 1:39-49. ed. Shiboski SC. 6. Kerr-Campbell MD. Valois RF. Ono-Kihara M. Teenagers in the United States: sexual activity. HIV/AIDS – the rude awakening/stemming the tide. Early initiation of sexual activity: a risk factor for sexually transmitted disease. First sexual intercourse: Age. volume II – Countries. Coker AL. 80 (Suppl II):ii28-ii35. Ma Q. 15. National Family Planning Board. South-Bourne N. 64:372–7. Francis D. Brener ND. Zaba b. Sex Transm Infect 2004. and childbearing. Kingston: NFPB. 10. 2004. BMJ 1998. 2002. 7. 2007.

31. Caribbean Gender Ideologies: Introduction and Overview. Caribbean Portraits: essays on Gender Ideologies and Identities. inflation. Demographic statistics. Brown D. Jamaica: Ian Randle Publishers. 2010 from: http://www. HIV infection. Power. Le Franc E. Planning Institute of Jamaica (PIOJ). not seeking medical care. In: Barrow C. Hambleton I. Statistical Institute of Jamaica (STATIN). Kingston. 25. Mnyika KS. 24. Bourne PA. Berer M. Nutritional and health determinants of school failure and dropout in adolescent girls in Kingston. 1(3):99-109. 24(6):409-421. 12(23):6-13. Geneva: WHO. Buston K. 1989: pp. Williamson L. Fox K. 34. Jamaica Survey of Living Conditions.unicef. 2009. London: Pearson Education. Samms-Vaughan M. 33. Kingston. Hellberg D. 32. 1:51-59. West Indian Med J 2008. North American Journal of Medical Sciences 2009. planning and financing. health insurance on mortality in Jamaica. Bourne PA. 30. Economic and social survey. Interpersonal violence in three Caribbean countries: Barbados. Public Health Behaviour-Change Intervention Model for Jamaicans: Charting the Way Forward in Public Health. Ole-Kingori N: Determinants of high-risk sexual behaviour and condom use among adults in the Arusha region. Reynolds H. ed. unemployment. Holder-Nevins D. Kingston: PIOJ. and Trinidad and Tobago. 21. 27.html. 2009. International Centre for Research on Women: Washington DC. Age differences at sexual debut and subsequent reproductive health: Is there a link? Reproductive Health 2008. Kvale G. Klepp KI. McGrowder DA. Int J STD AIDS 1997. Beauvais H. 57(3):307-311. An introduction to health: Policy. Retrieved on August 26. Henry-Suchet J: Correlation between an early sexual debut. Abel-Smith B. 26. Barrow C. Jamaica. STATIN. World Health Organization (WHO). Hart G. 1994. Eur J Contracept Reprod Health Care 2000. Open Access J of Contraception 2010. Child Protection. 361 . Murray N. Young women under 16 years with experience of sexual intercourse: who becomes pregnant? J Epidemiol Community Health 2007. Jamaica. 1989-2008.org/jamaica/violence. 1990-2008. Charles CAD. money and autonomy in National Policies and Programmes. 28. Mardh PA. 22. Bourne PA. 35. Jamaica. sexual abuse and social support in Jamaican adolescents referred to a psychiatric service. Speizer IS. and reproductive health and behavioral factors: a multinational European study. Reproductive Health Matters 2003. selfreported illness. 36. Contraception usage among young adult men in a developing country. 1971-2009. World Health Statistics. Guaschino S. Rev Panama Salud Public 2008. 8:176-183. Lowe GA. 1970-2008. 2(2):56-61. 23. 1994. 2008. United Nations Children‘s Fund (UNICEF). 1988-2007. Tanzania. Gibson RC.xi-xxxviii 29. Statistical Institute of Jamaica.19. 5:8. 5:177-182. 61(3):221-225. Planning Institute of Jamaica (PIOJ). Impact of poverty. Asian Journal of Medical Sciences 2010. Kingston. Creatsas G. 20. Gomez AM. Walker et al. PIOJ. Christie CD. STATIN. 1989-2007.

Good Health Status of Rural Women in the Reproductive Ages. BMC Public Health 2009. Perspectives on Sexual and Reproductive Health 2006. Etokidem AJ. Bourne PA. 3rd. Research. Geckova AM. 1:85-91. 26:731-739. Astone NM. Sinding SW. 38(1):13-39. 34(4):924-947. Felson J. Hardy SA. Psychological and behavioural factors associated with sexual risk behaviour among Slovak students. Reijneveld SA. 2009.pdf (Accessed on April 1. Friends‘ religiosity and first sex. van Dijk JP. International Journal of Collaborative Research on Internal Medicine & Public Health. 44. 42. Adamczyk A. 2002.com/productdetails/Sex.SamplePgs. 146-154. Kowaleski-Jones L. Preventive Medicine. Rimer BK. Ravindran TKS. 2010). and Farley T. American Sexual Behaviour. 45. 48. Orosova O. 18(2): 204–208. Ebabua KJ. Kitagawa EM. 9:15. Ekabua JE. Glanz K. Open Access J Contraception 2010. CA: John Wiley and Sons. Pettingell S. 46. Family Practice 2001. Adolescent religiosity and sexuality: an investigation of reciprocal influences. Agan TU.newstrategist.1(6&7):167-185. 38. A structural model of health behavior: A pragmatic approach to explain and influence health behaviors at the population level. Jarcuska P. 30. 51. Reproductive Health Matters 2004. Social Science Research 2006. Balasubramanian P. Journal of Adolescence 2003. India. Health Behavior and Health Education: Theory. Factors influencing contraceptive use in Tehran. 43. Hogan DP. Family Planning Perspectives 1996. Menaghan EG. Cohen D. Lewis FM. ―Yes‖ to abortion but ―No‖ to sexual rights: The paradoxical reality of married women in rural Tamil Nadu. Rhule J. Health status and Medical Care-Seeking Behaviour of the poorest 20% in Jamaica. 28(1):13-18. Eisenberg ME. Social and environmental factors influencing contraceptive use among black adolescents. http://www. Bongaarts J. Fam Plann Prospect 1985. Farahani FKA and Hashemi MS. 2000. Sexual Initiation. Friends‘ influence on adolescents‘ first sexual intercourse. Iklaki U. 47. Scribner R. and Practice. 39. The determinants of first sex by age 14 in a high adolescent population. 50. 362 .1(5):132-155. 12(23):88-99. Skay C. 2009. Tehrani FR. Odusolu P. International Journal of Collaborative Research on Internal Medicine & Public Health. 40. A response to critics of family planning programs. 17(4):165-169.37. Int Perspec on Sexual and Reproductive Health 2009 35(1):39-44. Hu PN. Factors associated with contraceptive use and initiation of coital activity after childbirth. Sieving RE. 49. Raffaelli M. Mott FL. Kalina O. Bourne PA. 41. Fondell MM.

6) Yes 653 (36.4) 306 (8.3) Yes 120 (57. 0.0001 SD denotes standard deviation 363 .0001 Current age of respondents.7) Age at first coital activity mean (SD) 14.5) Middle 839 (46.8) 2352 (62.9) 3101 (83.40. 5 years (9. < 0.8) Semiurban 470 (26.2) 2799 (62.6) 668 (17.4) 127 (57.0) Partner main source of financial 0.48.02.2) Tertiary 739 (40.8) 1714 (38.05.979 support No 89 (42.8) Rural 1076 (59.4) Educational level 195.7 persons (0.0001 No 1380 (76. < 0.27.4) 1930 (51.4) Frequent church attendance 47.6) 93 (42.0001 Urban 265 (14. <0. mean (SD) 1.Table 13.1) Secondary 832 (45.01.7) Shared sanitary convenience 40.1 yrs (8.0) Social class 182.4) 1423 (37.36.1) 636 (17.0001 Lower 603 (33.6) Upper 369 (20.1 yrs (1. <0. < 0. Pvalue < 16 years old 16+ years old Characteristic n = 1811 n = 3754 n (%) n (%) Area of residence 19.0) Yes 414 (23.8 persons (0.9) 1096 (29. < 0.1) 29.0) Yes 522 (28.1: Demographic characteristics of studied population Age at first coital activity χ2.5) t=9.42) 1.8 yrs (26.3) 1560 (41. < 0.0001 No 1158 (63.0001 Crowding.9) 1938 (51.61.<0.0001 Primary and below 225 (12.3) t=-40. mean (SD) 30.0001 No 1289(71.3) 771 (20.4) t=10.0) 1156 (30.95.2 yrs) 33.9) Employed 71.1) 1816 (48.001. < 0.

0) Yes 485 (26.58.9) Seldom 29 (5.7) Yes 85 (4.02.1) 356 (9.0) Frequency of condom usage With steady partner Always 221 (42.488 16.7) 0.9) Yes 83 (4.6) 1318 (35.7) Missing 1291 (71.mean (SD) 1.1) 111 (10.78.0001 0.084 8.Table 13.7 person (0.9) 675 (18.1) Never had a steady partner 9 (1.0) Forced to have sex (first time had coital activity) No 1491 (82. 0.2) χ2.8) 3096 (82.073 22. 0.0001 82.0) 60 (5.22.3) 1302 (36.3) 2724 (72.5) 463 (45.5) Currently pregnant No 1725 (95.0) Most times 259 (49.1) 3072 (82.6) 172 (4. <0.7) 161 (4.9) Forced to have sex (ever) No 1321 (73. 0.4) 1 (0.3) In sexual union No 310 (17. 0. 0.481. 0.0001 2.0) Yes 1501 (82.1) Yes 1238 (68.9) 3367 (90.71.8) 59 (5.8) 493 (47. Pvalue 0.1) 789 (21.9 person (1.6) With non-steady partner Always 93 (18.2) 7923 (77. < 0.005.8) Number of sexual partners in last 3 months .2) Never 30 (5.9) Seldom 0 (0.6) 486 (12.0) Currently used method of contraception No 601 (34.002 64.4) Never 2 (0. < 0.6) 2730 (72.18.3) 3592 (95. < 0.2: Particular reproductive health characteristic of studied population Age at first coital activity < 16 years old 16+ years old Characteristic n = 1811 n = 3754 n (%) n (%) Want to be pregnant No 228 (12.98.9) 2965 (79.8) Never a non-steady partner 351 (68.3) Missing 1296 (71.076 t=3.19.7) Number of sexual partners in last month – mean (SD) 0.0) Yes 1151 (65.003 364 .23.0) 2 (0.6) Missing 1500 (82.8) Most times 41 (8.5) Yes 309 (17.0001 t=1.6) 66 (6.6) Had sex (in last 30 days) No 573 (31. 0.4) 0.4) 2436 (64.7) 7 (0.943 9.1 person (1.7) 2312 (64.7 person (0.

0.1) 20 (1. < 16 or 16+ years old) Age at first coital activity < 16 years 16+ years old old n = 1811 n = 3754 n (%) n (%) 216 (11.6) 4 (6.2) 380 (10. when began using.9) 258 (38.57. < 0.7) 22.4) 337 (18.5) 14 (0.3: Method of contraception.5) 969 (25.1) 42 (1.3) 4.009 In Out Both Gynaecological examination No Yes Pap Smear No Yes 33 (41.3) 251 (13.3) 447 (24.9) 5 (0.8) 420 (61.6) 19 (0.0) 9 (15.73. 0.8) 46 (78.9) 5 (0.1) 0 (0. Pvalue Characteristic Contraceptive method used (or using) Female sterilization (tubal ligation) Implant (Norplant) Injection Pill Morning after pill (ECP) IUD/coil Withdrawal Rhythm.3) 6 (0.8) 1090 (24. when you began using method of contraception 25.8) 32 (40.Table 13.9) 2 (0.1) 1 (0. gynaecological and Pap Smear examination by age at first coital activity (ie.2) 365 .0) 388 (10.033 1272 (57.1) 1474 (81.8) 0 (0.7) 1 (0.0) 5( χ2.0001 3423 (75. calendar Condom Foaming tablets/cream/jelly Other Were you in or out of school.22.1) 706 (42.3) 947 (42.1) 35 (1.9) 274 (15.1) 100 (2.

0001 0.6 21. P<0.6 79.8 72.7 45.6 44.555 No 94.5 16.4 77.6 22.6 45.647.006.8 57.7 16.2 42.28.0 18.0 39.4 24.003 < 0.3 1 Crowding mean (SD) 1.4: Particular demographic variables by subjective social class of respondents controlled for by age at first coital activity Subjective social class Subjective social class χ2.7 21. 0.3 38. 0.1 75.0 8.5 83.6 62.0001 No 69.39.3 32.6 72.405 No 18. 0.6 3.5 15.8 Yes 5.6 Rural 69. 0.22.1 8.0 4.18.0 Yes 60. 0.6 28.6 78.5 9.3 15.2 94.21. 0.3 83.4 37.20.8 63.72. 0.6 42.7 Tertiary 29.58.2 Forced to have sex (in life) 1. 0.8 Partner main source of financial 0.4 < 0.0 Employed 20.4 84.4 Semiurban 20.1 54.36.5 Currently pregnant 1.2 36.3 4. Pvalue Lower Middle Upper Lower Middle Upper Characteristic n = 603 n = 839 n = 369 % % % % % % Area of residence 71.Table 13.00012 .4 96.6 75. F-statistic = 537.4 36.4 57.81. P<0.7 3.7 59.9 82.5 44.7 95.0 11. 0.0001 0.4 55.2 42.0001.4 1 2 F-statistic = 209.9 19.8 58. 0. Pvalue 234. 0.7 39.36.6 19. 0.5 In sexual union 1.0001 Primary or below 20.756 support No 39.7 4.6 70.8 59.1 17.0001 248.8 1. 0.5 45.4 27.9 25.0 55.723 4.997 228.20.113 11.3 78.5 Yes 81.0001 Urban 9.8 1.7 Yes 27.0 44.4 20.6 15.9 1.3 96.8 5.0001 366 χ2.5 Yes 30.4 54. 0.6 Secondary 52.5 55.9 1.1 36.9 Educational level 78.6 52.0 21.0001 1.3 95.4 30.2 42.72.559.549 No 72.2 43.4 21.

07 .439.26 1.07 533.75 .14 1.09 0. P = 0.10 0. χ2 = 8. P = 0.63 -5.5: Logistic regression analyses: Explanatory variables of use of contraception by age at first coital activity (ie.14 0.0001 -2 Log likelihood = 1909.08 0.11.22 Wald Lower 7.33 105.00 0.02 1.01 0.55 – 0.00 .1% Correct classification of cases in sexual union = 90.69 0.72 0.00 0.11 Odds ratio 0.94 3.08 Std error 0.97 -1. χ2 = 7.96 .82 0.90 6.20 Std error 0. Overall correct classification = 77.4% Correct classification of cases not in sexual union = 52.03 - β coefficient -0.38 0.0001 -2 Log likelihood = 3737.3% Correct classification of cases in sexual union = 91.90.95.0 5.Table 13. < 16 or 16+ years old) Age at first coital activity ( < 16 years old)1 Age at first coital activity ( ≥ 16 years old)2 Dependent variable: Method of contraception Age of respondents Upper class Lower class (reference group) In sexual union (1=yes) Currently pregnant (1=yes) Rural Urban (references) Constant 1 β coefficient -0.0.80 CI (95%) 0.1.05 135.4% 2 Model chi-square = 951.97 9.51 0.10 29.33 1.93 1.08 CI (95%) 0.98 7.18 Wald Lower 32.40 Nagelkerke r-squared = 0.72 1.7% Correct classification of cases not in sexual union = 42.23 -0.98 0.74 7.87 – 6.412.47 - Model chi-square = 320.234 n = 1728 Hosmer and Lemeshow test.00 – 0.2% 367 . Overall correct classification = 74.0.319 n = 3588 Hosmer and Lemeshow test.11 Nagelkerke r-squared = 0.03 2.01 0.74.02 -0.01 0.03 1. P<0.44 Odds ratio 0. P<0.24 -4.01 1.37 0.22.46 0.

sexual and reproductive health matters. and they began using contraceptives on average at 24 years old. teenage pregnancy. abstinence and/or on consistency condom usage among young women.2 years later than those who infrequently visit church. 1 out of every 10 shared sanitary convenience. Of those whose sexual relations begin at 20+ years old. and general health status [6-8]. This study seeks to elucidate information on the reproductive health matters of those who whose first sexual engagement starts at 20+ years old. The new way of addressing the issues identified earlier is to examine those issues from the perspectives of those who wait until 20+ years old to have sexual intercourse.7 years. In Jamaica. 13 out of every 25 are frequent church attendees (at least once per week). unwanted pregnancies. 14 out of every 25 were in the upper class. 4 out of every 5 have never had a non-steady sexual partner. and rightfully so because of its association in explaining HIV/AIDS infection. statistics showed that the median age of first coitus among 368 . which is 1. 2 out of every 5 are married. particularly in Jamaica despite the amount received and spent on those programmes. sexual debut or sexual initiation) [1-5]. The current paper found that 9 in every 100 women aged 15-49 years commenced having sexual intercourse at least 20 years. sexual promiscuity. Introduction Health and reproductive health literature is filled with studies that have examined age at first sexual intercourse (or sexual relations. The new paradigm is on education and creating economic dependency and not first on safe sex. coitus.14 Reproductive health matters: Women whose first sexual intercourse occurred at 20+ years old The evidence is in that public health interventions have failed to effectively address HIV/AIDS infections and lowering the age at first sexual intercourse in the developing nations. Frequent church attendees on average start having sexual intercourse at 22.

Haiti. Guyana. The prevalence of sexually transmitted infections (STIs) has been on the rise over the decades in Jamaica [16]. Dominica Republic [10]. teenage pregnancies. unwanted pregnancies. particularly in Jamaica despite the amount received and spent on intervention 369 . it is just that a new avenue should be taken in understanding the phenomena. 17] and the wider developing nations [18]. and it is falling more during the adolescence years in Jamaica. Previous studies have examined reproductive health matters of adolescents and age at sexual debut [1-5.15]. China [12] and many other developing countries. First sexual intercourse during the adolescence years is not atypical to Jamaica as this is equally the case in Antigua and Barbuda.3 years in 1997 [9].14] as well as in the United States of America [3. Clearly. Given that most of these occur in individuals aged 15-44 years. 1 in 4 Jamaicans were under 25 years old [20]. 10. America [11]. the evidence is in that public health interventions have failed to effectively address HIV/AIDS infections and lowering the age at first sexual intercourse in the developing nations. the developing nations have been suffering from increased HIV/AIDS infections. of those females aged 15-24 years old. and lowering of the age at sexual intercourse.6% reporting never having sex and 67. China [12. yet plethora of studies which have been conducted have not resulted in a fundamental change in the public health problems previously identified. 19].8% had at least one sexual partner. The answers to changing those issues are not beyond us. For decades. particularly in Africa [13. only 24. particularly 50 percent among people less than 25 years old [19]. but there is none which investigated the reproductive health matters of those who commenced sexual intercourse at least 20 years old.0 years in 2001. which fell from 17. Trinidad and Tobago.females was 16. this is undoubtedly a public health concerns in many respects. Early sexual relation is an adolescent phenomenon. In 2007.

There are two sets of inclusion criteria. The new way of addressing the issues identified earlier is examine those issues from the perspectives of those who wait until 20+ years old. The current paper extracted 649 females who began having sexual intercourse at 20+ years old. The present study is therefore a part of larger initiative to change the old approach in examining reproductive health matters of adolescents in wanting to modify (1) age at first sexual intercourse. Since 1997. and (4) the role of church attendance influence sexual behaviour.programmes. Methods and material Sample This descriptive cross-sectional study used a secondary dataset from the National Family Planning Board (Reproductive Health Survey. 370 . the Reproductive Health Survey (RHS) collected data on Jamaican men ages 15-24 years as well as women 15-49 years old. the National Family Planning Board (NFPB) has been collecting information on women (ages 15-49 years) in Jamaica regarding contraception usage and/or reproductive health.168 women of the reproductive ages [9]. which are females and ages. The study population from which the current sample is drawn was 7. RHS). (3) currently used a method of contraception. The eligibility criterion for age was 15 to 49 years at last birthday. The current work will elucidate information on the reproductive health matters of women who delay their first sexual encounter until 20+ years old as this will offer some explanation that can be used to curb the reproductive health practices of those who commenced sexual intercourse during the adolescence years. This study emerged out of the wanting to provide answers to public health practitioners to change the old approach in viewing a problem that continues to reoccur in the developing nations. In 2002. (2) gynaecological examination.

The new sampling frame formed the basis upon which the sampling size was computed for the interviewers to use. The Statistical Institute of Jamaica (STATIN) provided the interviewers and supervisors. Using the 2001 Census sector (or sampling frame). a three-stage sampling design was used. Hanover and Westmoreland. The previous sampling frame was in need of updating. EDs). Stage 1 was the use of a selection frame of 659 enumeration areas (or enumeration districts. Andrew. The 2001 Census showed that Region 1 comprised 46.5% of Jamaica compared to Region 2. and each PSU constituted an ED. Prior to the date of the final data collection. St. Region 3 is made up of Trelawny. who were trained by McFarlane Consultancy. Ann. Region 1 is composed of Kingston. Region 3 at 17. St. The previous sampling frame was in need of updating.Stratified random sampling was used to design the sampling frame from which the sample was drawn. St. A total of 175 instruments 371 . Stage 3 was the final selection of one eligible female from each sampled household and this was done by the interviewer on visiting the household. Jamaica is classified into four health regions. with Region 4 being St. and so this was performed between January and May 2002. The data collection began on Saturday. Thomas and St. Mary and St. Region 2 comprises Portland. Manchester and Clarendon. In stage 2. to carry out the survey. and so this was carried out between January 2002 and May 2002. pre-testing of the instrument was conducted between March 16 and 20.6% and Region 4 at 21. This was calculated based on probability proportion to size. Elizabeth. the households were clustered into primary sampling units (PSUs). St. James. 2002.8% [9]. The instrument administered was a 35-page questionnaire. October 26. at 14. 2003.1%. Catherine. which in turn was comprised of 80 households. 2002 and was completed on May 9.

only explanatory variables (i. Thus. The data was weighted in order to represent the population of female aged 15 to 49 years in the nation [9].6% were given to eligible men. variables were entered independently into the model to determine those that should be retained during the final model construction.e. ordinary least square (OLS) regression was used to fit the data because the dependent variable (age at sexual debut) was a continuous one. Data Bank for use by scholars. Where collinearity existed (r > 0. Modifications were made to the pretested instrument (questionnaire). crowding. IL. Descriptive statistics were performed on particular sociodemographic characteristics of the sample (frequency. we used SUDDAN 372 .5. statistical agency. and range). Version 16. After which it was released to the University of the West Indies.3. age. To derive accurate tests of statistical significance. Validity and reliability of the data were conducted by many statisticians.were pre-tested. Mona. after which the final exercise was carried out. Statistical analyses Data were entered. and university scholars before the data was used as the data are for national policy planning. mean. Independent sample t-test was used to examine differences in age at sexual debut between those who frequently attend churches and those who infrequently visit churches and F-statistic for age of respondents by age at sexual debut. Finally. of which 40. and years of schooling).0 SPSS Inc. Stepwise multiple linear regression was used to fit the one outcome measure (age at first sexual debut) by different sociodemographic variables. Chicago.5 was normalized by natural log.7). standard deviation (SD). Where skewness was found to be less than 0. All metric variables were tested for normality (age at first sexual debut. USA). statistically significant variables) are shown in Table 14. the variable was used in its current form and a value more than 0. stored and retrieved using SPSS for Window. or another method.

A p-value < 0. ―Do you have a visiting partner. Measures Age at first sexual debut (or initiation or intercourse) was measured based on a respondent‘s answer to the question ―At what age did you have your first intercourse? Crowding is the total number of persons in a dwelling (excluding kitchen. and ―Are you currently single?‖ Age at menarche is measured from ―How old were you when your first period started (first started menstruation)?‖ Gynaecological examination is taken from ―Have you ever had a gynaecological examination?‖ (1 = yes. 0 = no). 0 = otherwise). NC). ―Are you living with a common-law partner now? (that is. Currently having sex is measured from ―Have you had sexual intercourse in the last 30 days?‖ (1=yes. and urban is the reference group). 0 = otherwise. Research Triangle Park. 0 = otherwise. Contraceptive method comes from the question ―Are you and your partner currently using a method of contraception? …‖. and if the answer is yes ―Which method of contraception do you use?‖ Age at which began using contraception was taken from ―How old were you when you first used contraception? Area of residence is measured from ―In which area do you reside?‖ The options were rural. Education is measured from the question ―How many years did you attend school?‖ Marital status is measured from the following question ―Are you legally married now?‖.statistical software (Research Triangle Institute. are you living as man and wife now with a partner to whom you are not legally married?)‖. that is. and this adjusted for the survey‘s complex sampling design.05 (two-tailed) was used to establish statistical significance. 1 = semiurban. Age is the number of years a person is alive up to his/her last birthday (in years). semi-urban and urban (1 = rural. bathroom and verandah). Pregnancy was assessed by ―Are 373 . a more or less steady partner with whom you have sexual relations?‖.

and the mean age at sexual debut was 22. age at first contraceptive use.4%). age at menarche. 0 = otherwise or no). Almost 89% of the sample had their first sexual encounter before 26 years old. are you living as man and wife now with partner to whom you are not legally married). don‘t know and refused to answer (1= yes. and years of schooling were used as continuous variables. None of the sample had their first sexual experience after 36 years old.1 years (SD = 2. In stable union measured (1) being legally married or (2) in a common-law union (are you living with a common-law partner now that is. 0 = otherwise). christenings et cetera) (1=frequent attendance from response of at least once per week.1 summarizes the demographic characteristics of the studied population. condom (29. The methods were pill (29. Marginally more of the sample indicated currently using a method of contraception (59.3% at least 30 years old.8 years). 0 = otherwise. Furthermore.you pregnant now?‖ (1=yes.3% at least 21 years and 2. 374 . Religiosity was evaluated from the question ―With what frequency do you attend religious services?‖ The options range from at least once per week to only on special occasions (such as weddings. 1 = upper class. 0 = otherwise. reference group is lower class). middle or upper social hierarchy (1 = middle class. 0 = otherwise). 59. Subjective social class is measured from ―In which class do you belong?‖ The options are lower. no.9%). female sterilization (22. Results Demographic characteristics of study population Table 14.4% of the population currently use a method of contraception. 57.2%).3%). Forced to have sexual relations was assessed from the question ―Were you forced to have sex at your first intercourse?‖ and the options were yes. funerals. Age at first sexual debut.

age at sexual debut and crowding (F statistic = 6.5). area of residence. raped. P < 0.1 children for those in the middle class (SD = 1.injection (9. gynaecological examination done in the last 12 months. R2 = 0. Multivariate analyses Age at sexual debut can be explained by 6 explanatory variables (F statistic = 38. R2 = 0.0001.4 children (SD = 2. education and in a stable union. years of schooling. Table 14.6) among those with tertiary level education (F statistic = 185. frequent church attendance. on average women in the lower social class had 2.2% of those in the lower class. and other.9 children (SD = 2.0001. P < 0.1) among those with secondary level education and 1.4). Those with primary or below education had 3.422. Bivariate analyses Of the sample. 375 .05.3) compared to 2. There exists a statistical association between educational levels and subjective social class (χ2 = 507.4) (F statistic = 319.0001).376. employment status. age at sexual debut. shared sanitary convenience. 42.7% remarked always. with a steady partner. Age at marriage can be explained by age of respondent. P < 0.3 presents information on marital status.3 children (SD = 2.0%). Seventy percentages of those in the upper class had tertiary level education compared to 52.7 children (1. 51. Table 14. Table 14. age of menarche.8) and 1.075.6% of those in the middle class and 37. area of residence. currently using a method of contraception.0001).9) compared to 2.0001). Of those who used a condom. crowding and age at marriage by frequency of church attendance.5 children for those in the upper class (SD = 1. These are age.7% mentioned most times and 5. P < 0. subjective social class. age of respondent.2).4. P < 0. number of live births.6% said seldom (Table 14. age began using method of contraception.48.9.

P < 0. educational attainment and in a stable union. subjective social class. This research concurs with Bourne and Charles‘ study that frequent church attendance is responsible for increased age at sexual debut among those who began having sexual intercourse at least 20 376 . 13 out of every 25 years are frequent church attendee (at least once per week). 1 out of every 10 shared sanitary convenience.3% of the variance in gynaecological examination in the last 12 months. According to Bourne and Charles [21].28. Discussion The current paper found that 9 in every 100 women aged 15-49 years commenced having sexual intercourse at least 20 years. 2 out of every 5 are married. church attendance is among the factors which account for young men‘s (aged 15-24 years) lowered age at first sexual intercourse. subjective social class and age at sexual debut (Model chi-square = 98. and they began using contraceptives on average at 24 years. 4 out of every 5 have never had a non-steady sexual partner.1% of the variance in currently using a method of contraception: In a stable union. Of those whose sexual relations begin at 20+ years old.021. Almost 75% of the data were correctly classified (Table 14. -2 Log likelihood = 611. Seventy-three percentage of the data were correctly classified (Table 14.6). employment status.Three explanatory variables account for 29.0001. Six variables emerged as statistically significant correlates of a women having had a gynaecological examination in the past 12 months (Model chi-square = 160. P < 0.48.7). age. 14 out of every 25 were in the upper class.18). The factors (area of residence.86). Among the factors that positively influences age at first sexual intercourse are frequency in church attendance. education and Pap smears in the last 12 months) account for 32. age of respondent. -2 log likelihood = 447.

One study which explored sexual initiation of persons within the age range of 15-44 years. It can be concluded that the cultural values and orientation of the churches that occasional attendance do not change women delaying sexual debut. 377 . [16] found that 8 out every 25 women aged 15-24 years had never had a sexual partner (or in the last 12 months). Furthermore. compared to the Catholics (within their 17th year) and those of other religion (18th year) [22]. This is also embedded in the current finding which showed that 4 out of every 5 women who delay having sexual intercourse at 20+ years old indicated that they have never had a non-steady partner. it follows that these females are seeking for stable than transitional sexual union that are likely to result in another sexual relationship. the cultural values of the church is such that frequent membership is more fostered in marriage and therefore accounts for why 29 out of every 50 women who frequently attend church are married compared to 10 out of every 50 of those who infrequently visit churches. Another justification which account for delaying age at sexual debut among women is a stable sexual union. Embedded in this finding is fact that women who starts in stable unions such as marriage or common-law sexual unions are least likely to search for such a union as in the case of women who are in visiting relationship. In this work. Thus. it was revealed that 13 out of every 25 women who delay sexual intercourse for 20+ years attend church on a regular basis. but that frequent attendance is one of the media that increase delaying age at sexual relations. those who are frequent church attendees on average commenced their sexual encounter age 22.2 years later than those who are infrequent attendees.years. It was also found that among the studied population. when Wilks et al. found that protestants (similar to those of non-religion) were more likely to have their first sexual initiation within their 16th year. suggesting that visiting union are more about sex than stable union.7 years which is 1.

Those individuals have less sexual autonomy. meaning that as more economic independency or family with economic resources have more sexual and 378 . and females being caught in the cycle of more such relationship for financial support because the last one offered less and they desire continuous assistance owing to their economic deprived status. Those in the sample have higher educational attainment are among the upper class. Like Marmot. The results of inconsistent condom usage are STIs. money matters for women health as well as their reproductive health and the age at which they begin having sexual intercourse. economic deprivation and the social settings among those who are poor is account for the early sexual relation. this explains the negative association between number of live births and age at sexual debut. unwanted pregnancies. and that 3out of every 25 are in the lower class. knowing the vulnerability of some females. Poverty. and have a greater sexual autonomy of their live than those in the lower class. less children. One scholar postulated that money is positively associated with health [23]. It was found that 14 out of every 25 women who begin having sexual relationship at 20+ years old are in the upper class. The current research found that women who delay sexual intercourse for 20+ years old is money. This work shows that educational level is positively associated with increased age at first sexual intercourse. but is appears that economic disparity accounts for the delaying of sexual intercourse.Another issue which emerged from current work about the studied population is subjective social class. males will dictate condom usage as a price for economic support. which fosters accessing higher level of education. advanced educational attainment and number of live births. suggesting that poverty increases people search for social relationship as a source of material goods. and sexual intercourse is left up to the male who wants this earlier than later and not for the purpose of desiring a stable union. Thus. Because those sexual unions are mainly visiting and/or transitional partnerships.

sharing sanitary convenience and living accommodations with other households. thus. ―In high-income countries. suggesting economic deprivation is retarding the real accomplishments which could have materialized in public health interventions if there were income equality among people and within countries. 2]. This paper revealed a positive statistical association between age at marriage and age at sexual debut. If Yan et al‘s postulations holds true in developing nations outside of China that ―Safe sexual behaviors include having a single sex partner and using condoms in every sexual encounter. which provides yet another argument for money in addressing health. and are able to way for stable 379 . reproductive health matters and sexual behaviour. this supports the finding that stable unions influence age at sexual intercourse and that money matters in reproductive health matters as well as sexual autonomy. and these behaviors also reduce risk of HIV/STDs. p.‖ [12. and less marriage occurred in this cohort compared with those in the middle socioeconomic strata and wealthy socioeconomic class. PAHO [25] noted that chronic poverty ‗enforced promiscuity‘ because of overcrowding. suggesting that women who delay sexual intercourse to 20+ years old are older meaning that they are more economic independent.reproductive rights which justifies them delaying sexual intercourse for a later time (20+ years). communicable diseases account for only 8% of years of life lost. 47]. In addition to the aforementioned. This is supported by the a World Health Organization‘s (WHO) postulation that stated. compared with 68% in low-income countries‖ [24. The Pan American Health Organization (PAHO) offered another angle to the discussion that culturally there is greater tolerance for premarital sexual relationships among those in the lower socioeconomic strata [25]. p. career oriented. then women in instable unions will continue to inconsistently use condoms as they are economically dependent on a male partner for some level of survivability.

and so their males‘ partners are more able to veto their reproductive rights and/or choices. it is also guiding health choices such as Papanicolaou (Pap) smear examination. This is reinforced in a World Health Organization‘s publication [26] which stated that ―All women who have had 380 . It was found that women who begin sexual relations at 20+ years old are 8% less likely to currently use a method of contraception as they seek family because of the stability of their unions. The reality here coupled with the current findings is that young females in economically vulnerable homes will not delay sexual intercourse as this provides survivability that cannot be found by the family unlike those in wealthy households. thereby placing them at greater risk for contracting HIV/STDs‖ [12. However. [16] found that 18% of women aged 15-74 years old in Jamaica had done a Pap smear in the last 12 months. p. embedded in Yan et al.‘s work is the fact that early sexual partnerships are more likely to be visiting. but in this study it was 32%. less knowledgeable and/or educated females.union in which they have an equal state in the union. This is reinforced by Yan et al [12] who stated that ―Adolescents typically engage in short-lived relationships that make them more likely than adults to have sex with multiple partners. and understanding of their bodies more so than the general female population. Money is not only influence risky sexual behaviour. 9]. more economically dependent young people. p. Wilks et al. 2] and that ―…attitudes to sex have an enormous influence on sexual behavior‖ [12. The high cervical screening among the studied population has something to do with their educational awareness. The economic dependency of females is accounting for early marriage among rural women as they seek the assistance for the male partner. Clearly the age at which a female commenced sexual intercourse may hold some explanation for her choice in currently using a method of contraception. income.

and this cannot be ignored in any intervention programme. The way forward should not be about abstinence (or ‗say no to sex‘) or consistency condom usage as the current paper should a road map on issues that account for why some women delay sexual intercourse. are frequent church attendance critical for increasing age at first sexual intercourse.2 times more likely to have this test. The thrust of any new 381 . Conclusion Females delaying their first sexual intercourse to 20+ years in Jamaica can provide a comprehensive insight into increasing age at sexual debut and a guide to public health practitioners in the way forwarding for intervention programmes. upper class). stable union. Money does matter in delaying the time at which women become engaged in sexual relations. and being employed was another critical factors that fosters having the test done. In summary. It was found that women in the upper class were almost 2 times more likely to had a gynaecological examination. Money increases women economic independency and it also does educational advancement. The current paper highlights that education.sexual intercourse are potentially at risk because they might have been infected with HPV [human papillomavirus].‖ It should be noted here that all the women are currently sexually active. and because of their awareness of cervical issues and their sexual practices account for the substantially greater percentage having done a Pap smear or gynaecological examination in the last 12 months. those with tertiary level education were 1. public health programmes which are not geared towards economic independency and educational advancement will be futile. income (or social class – ie. which must be included in public health intervention programmes that must be a part of the solutions in the way forward.

intervention programme that is geared towards changing sexual behaviour of Jamaican women should be on education and economic independency as those are the key tenants and not the current approach. 382 . Mona. Disclaimer The researcher would like to note that while this study used secondary data from the Reproductive Health Survey. and the National Family Planning Board for commissioning the survey. The new paradigm is on education and creating economic independence and not first on safe sex. RHS) available for use in this study. abstinence and/or on consistency condom usage or increasing knowledge about a reproductive or HIV/AIDS among young women. Jamaica for making the dataset (2002 Reproductive Health Survey. Acknowledgement The author thanks the Data Bank in Sir Arthur Lewis Institute of Social and Economic Studies. Disclosures The author report not conflict of interest with this work. none of the errors in this paper should be ascribed to the National Family Planning Board. the University of the West Indies. but to the researcher.

6. Hirsch L. 8. Smith AMA. De Visser R. condoms and STDs among young people. American Sexual Behaviour. 1997:212-214. J B. Slaymaker. and reproductive health and behavioral factors: a multinational European study. et al. 7. Tucker JS.SamplePgs. Rosenthal DA. 17. Teenage Pregnancy: A study in three communities in Trinidad and Tobago. Maher. et al. E. Creatsas G. Younger N. Mardh PA. 29. Clarke LF.pdf (Accessed on April 1. Francis D. I. Lutalo. T. Fatusi AO. 100(7):119-7. Early age at first sexual intercourse and early pregnancy are risk factors for cervical cancer in developing countries. http://www. Jamaica National Family Planning Board (NFPB). Br J Cancer 2009. Mona. Radosh A. Transm. 2:42. Wu H. Nyirenda M. Moore JS. 2005. BMC Public Health 2009. Kingston: Tropical Medicine Research Institute. 85: i12-i19 2. 5:177-82. Personal and social factors influencing age at first sexual intercourse. Kasamba. Louie KS. Kingston: NFPB. Mushati P. Health Reports 2005. McGrath N. Jamaica health and lifestyle survey 2007-8. 16. Sexual initiation with older male partners and subsequent HIV risk behavior among female adolescents. Sex. RW. 383 . Wilks R. Eur J Contracept Reprod Health Care 2000. 34:200-208. 13. 85:i49-i55. University of the West Indies. Bwanika. et al. Sexual Initiation. et al. Sex Transm Infect 2009. Age at first sex in rural South Africa. Hallett T.16:339-42. 9:305. 10. 9. 28(4):319-333. Tulloch-Reid M. 3. Teijlingen ERV. Miller KS. 15. Paper presented at the Caribbean Health Research Conference 2007. 8. Kaiser J. Todd. Factors associated with self-reported first sexual intercourse in Scottish adolescents. State Council AIDS Working Committee Office and UN Theme Group on HIV/AIDS in China: A joint assessment of HIV/AIDS prevention. Predictors of early sexual initiation among a nationally representative sample of Nigerian adolescents. 12. Infect. 2002. Beijing 2005.References 1.newstrategist. McFarlane S. Trends in age at first sex in Uganda: evidence from Demographic and Health Survey data and longitudinal cohorts in Masaka and Rakai. et al. Chen W. 2008. Guaschino S. 85(Suppl 1):i34-i40. J (2009). Reproductive Health Survey. Sex. Multiple sex partner behavior in female undergraduate students in China: A multi-campus survey. 14. 11. Middlestadt S: Initiation of sexual intercourse among middle school adolescents: the influence of psychosocial factors. Sex Transm Infect 2009. Diaz M. Zimbabwe. Simkin L. D. J Adolesc Health 2004. 4. Family Planning Perspectives. 2008. Jamaica. BMC Public Health. 2010). Archives of Social Behavior 1999. Rawlins J. treatment and care in China (2005). 5. Measuring trends in age at first sex and age at marriage in Manicaland. Rotermann M. de Sanjose S. Correlation between early sexual debut. BMC Research Notes 2009. Yan H. Cremin I. Hosegood V.com/productdetails/Sex. Penfold SC. and Blum. Santelli JS.

American Sexual Behaviour. 23. Open Access J of Contraception 2010. Washington D. http://www. 2005: pp. Geneva: WHO. 1985. Sexual Initiation. Contraception usage among young adult men in a developing country. 2010). World health statistics. 2008. 2009. In: Morgan O. Health issues in the Caribbean. 26. 20. 22. Marmot M: The influence of Income on Health: Views of an Epidemiologist. 2002.C. Frederick J. Kingston: Ian Randle Publisher. 2005: pp. 21. Statistical Institute of Jamaica (STATIN). 2009. Kingston: STATIN. 2006 384 .pdf (Accessed on April 1. 21: 3146. Jackson J. 24. 2007. ed. Geneva: WHO. Issues affecting reproductive health in the Caribbean. Health issues in the Caribbean. et al.: PAHO. World Health Organization (WHO).newstrategist. Bourne PA. Kingston: Ian Randle Publisher. 19.com/productdetails/Sex. Hamilton P. Does money really matter? Or is it a marker for something else? Health Affairs. Perspectives on HIV/AIDS in the Caribbean. ed. Charles CAD.18. Douglas DL. In: Morgan O. World Health Organization (WHO).SamplePgs. 41-50. 25. 1:51-59. xv. Demographic statistics. Pan American Health Organization (PAHO). Comprehensive cervical cancer control: A guide to essential practice. Health of women in the Americas.

0 100.8 23. widowed) Single Social class Lower Middle Upper Age cohort (in years) 20-24 25-29 30-34 35-39 40-44 45-49 Educational level Primary or below Secondary Tertiary Area of residence Urban Semiurban Rural Frequent church attendance No Yes 385 n 578 70 611 38 244 405 437 212 561 86 0 649 261 83 140 153 12 82 201 366 41 109 149 149 124 77 32 127 482 145 223 281 307 342 % 89.3 16.7 86.6 62.3 22. separated.4 43.) Employed Pap smear (in last 12 months) No Yes Raped No Yes Had sex (in last 30 days) No Yes Marital status Married Common-law Visiting Previously in union (divorced.6 74.1: Demographic characteristic of study population.3 32. etc.3 34.3 0.0 19.4 6.Table 14.8 21.7 13. students.1 5.9 37.9 19.8 12.1 11.2 10.3 47.8 94.6 1.0 23.2 12.3 52.9 4.6 23.6 31.0 56.0 40. n= 649 Characteristic Shared sanitary convenience No Yes Want to be pregnant No Yes Employment status Unemployed (including sick.3 .4 67.

6 0.7 5.9 29.0 80.3 42.9 years (4.0 9. calendar Condom Frequent condom usage (with steady partner) Always Most times Seldom Never Frequent condom usage (with non-steady partner) Always Most times Seldom Never Never had a non-steady partner Age began using method of contraception. Rhythm or calendar Did not respond Current method of contraception Female sterilization Implant Injection Pill Emergency contraception IUD/Coil Diaphragm Withdrawal Rhythm.5 3.7 22.9 0.Table 14.4 0.0 yrs) 386 .7 0.3 95.0 29.6 59.4 3.0 5.9 4.7 51.3 2. mean (SD) n 249 365 22 4 2 621 81 1 33 109 1 10 2 14 7 107 61 74 8 0 14 6 0 7 114 % 40.2: Particular reproductive health matters Characteristic Currently using a method of contraception No Yes First method of contraception Condom Other (modern methods) Withdrawal.3 9.2 0.3 0.8 1.6 0.9 23.

5) -0.1) Middle 95 (30.26.3: Particular demographic characteristics of sample by church attendance.912.5) 198 (57.3) 22. divorced 66 (21.7y yrs (3.496. 0.9) Area of residence 17.5 persons (0.2) 14. sick.0) 36. 0.214.4) 23 (6.8) -0.1) Visiting 104 (33.4) Shared sanitary convenience 12. < 0. 0.812 Number of live births mean (SD) 2.0 children (2.9) 2.053.7) Yes 181 (61.0 yrs (7.7) Subjective social class 1.2) 137 (42.5) 87 (25.3) 38 (11.262 No 112 (38.9 yrs (26.9) -0.0001 Urban 90 (29.4) Single 5 (1.2) 121 (35.4 yrs (24.184.0) 0. Pvalue Characteristic Infrequent Frequent n (%) n (%) Marital status 141.6 yrs (3.9) 106 (31. 0. 0.5) Currently using method of contraception 1.5 yrs (3.818 Unemployed (including student.1 children (1.8) 184 (57.0) Raped 3.5) t-test.445 Lower 44 (4.6) 319 (93.0001 No 259 (84.3) 55 (16. 0.6) -0.1) 130 (38.168.0) Employment status 0.1) Semiurban 102 (33. 0.5) Separated.5) 166 (48.6 yrs (4.1) 13.4 yrs (3.0) Employed 193 (62. < 0.140.362 387 .1) -2.5) 14 (4.076 Crowding 1.777.1) -1. 0.165.9) 36 (10.4) Rural 115 (37.5) Yes 33 (10. n = 649 Frequent church attendance χ2.7) 198 (57.5 persons (0. 0.8) Common-law 69 (22.3) Yes 47 (15.0.239.1) 33.9) 212 (62. Pvalue Age at sexual debut 21.582. 0.889 Age of menarche 13.Table 14.0) 24.0001 Married 63 (20.029 Years of schooling 14.8 yrs (7.5) 1.6) 7 (2.831 Age began using method of contraception 23.2) 288 (84.8) 53 (15. < 0.6 yrs (4. etc) 114 (37.5 yrs (2.487.0001 Age 34. 0.617. <0.869 Age at marriage 32.0) Upper 168 (54.2 yrs (4. widowed.2) -5.075 No 273 (89.

64 0.26 -1.05.28 0.376.00 0.1.03 0.87 0.30 .03 0.14. P < 0.1.72 0.94 0.52 0.0.23 0.61 .01 .90 -0.45 . error 0.35 0.-0.54 Std.24 .Table 14.10 388 .23 -0.366 N = 612 Unstandardized coefficient 12.13 0.41 0.35 -0.-0.13 0.0.10 0. adjusted R2 = 0.07 0.17 .44 -0.0001 R2 = 0.09 -0.17 0.23 Beta CI (95%) 11.20 0.08 .4: Ordinary least square regression: Explanatory variables of age at sexual debut Dependent variable: Age at sexual debut Constant Age Frequent church attendance (1=yes) Number of Live Births Gynaecological exam (1=yes) Education (in years) In a stable union (1=yes) F statistic = 38.

Table 14.11 .16 2. P < 0.92 0.0001 R2 = 0.422.05 .32 .10 0.063 N = 612 Beta CI (95%) -38.39 0.99 -12.52 -0.42 -0.52 389 .1.18 0.05 4.85 0. adjusted R2 = 0.0.-2.42 2.12 0.21 .56 -6.075.88 0.15 2.18 Dependent variable: Age at marriage Constant Age In stable union (1=yes) Rural Urban (reference group) Age at sexual debut Crowding F statistic = 6.5: Ordinary least square regression: Explanatory variables of age at marriage Unstandardized coefficient -14.10 Std error 11.12 1.38 0.82 0.22 .9.30 .-1.80 -11.8.64 -7.

86 Nagelkerke r-squared = 0.973 Overall correct classification = 74. P = 0.61 Std.00 0.32 .26 0.04 0.92 1.48 -0.Table 14.64 -0.8% 390 . χ2 = 1.021 -2 Log likelihood = 447.0.5% Correct classification of cases of currently using a method of contraception = 92.291 Hosmer and Lemeshow test.30 0.37 0.09 0.48.21.95 0. error 0.53 1.6: Logistic regression analyses: Explanatory variables of currently using a method of contraception Dependent variable: Currently using a method of contraception In a stable union (1=yes) Middle class Lower class (reference group) Age at sexual debut Constant β coefficient 2.87 0.3% Correct classification of cases of not currently using a method of contraception = 47. P < 0.68 .99 Model chi-square = 98.84 CI (95%) 6.90 Odds ratio 11.85 .0.734.

95.5% 391 . n=603 Dependent variable: Gynaecological exam Rural Urban Upper class Lower class (reference group) Employment (1= employed) Age of respondent Years of schooling Pap smear in last 12 months Constant β coefficient -0.87 Odds ratio 0.15 1.21 0.26 2.99 1.2.07 .28.21 0.36 1.31 .38 – 6.45 0.1% Correct classification of cases of not currently using a method of contraception = 52. P = 0.00 1. χ2 = 5.0001 -2 Log likelihood = 611.48 1.00 1.00 1.04 .Table 14.363 -4.3% Correct classification of cases of currently using a method of contraception = 85.06 1.31 .76 0.3.42 Model chi-square = 160.25 0.20 Std.16 3.1.18 Nagelkerke r-squared = 0.0. P < 0.04 0. error 0.91 0.21 0.68 0.70 1.323 Hosmer and Lemeshow test.10 1.03 .02 0.653 Overall correct classification = 74.56 1.02 CI (95%) 0.7: Logistic regression analyses: Explanatory variables of those who had done a gynaecological examination in the last 12 months.1.06 0.

95%CI = 23. 95% CI = 1.29 – 1. (4) high church attendance. suggesting that sexual unions are highly based on sexual intercourse for gains (emotional and material) and that this can be used to guide policy formulation and intervention programmes. Biological sex is fundamentally a part of cohabitation among women aged 15 to 49 years who indicated being currently in an intimate union.63).02 – 1.99).88 – 0. Those differences can be used to guide policy intervention.27 – 38. and shape future research.20). had sex in the last 3 months.15 On sexual and non-intimate unions among the general reproductive population of women in Jamaica: A cross-sectional survey This study evaluates the demographic. (3) had sex in the last 3 months. 95% CI = 1.259 women in the reproductive ages obtained from a 2008 Reproductive Health Survey. and less likely to be educated (OR = 0. 95%CI = 0.37 – 2.76. 95% CI = 1. with emphasis on those who are in a sexual union or not in Jamaica. Eighteen out of every 25 women of the reproductive ages reported that they are currently in a sexual union.29.85. Those in a sexual union were older (OR = 1. did a HIV/AIDS test (OR = 1. 392 . reproductive and health characteristics of women aged 15-49 years old who are currently in a sexual union or not in intimate unions in Jamaica and difference in area of residence as well as factors which determine (1) good-to-very good health status. more likely to dwell in a crowded household (OR = 1. A secondary analysis of 8.6. and (5) physically forced to have sexual intercourse. method of contraception. Many differences emerged between women aged 15 to 49 years old who are currently in a sexual union compared with those who are not. 95%CI = 1.03. using a method of contraception on the last sexual activity (OR = 1.94.26). Multivariate analyses were used to established factors which account for particular dependent variables (health status.04). more likely to have had sexual relations in the last 3 months (OR = 29. (2) method of contraception. high church attendance. physically forced to have sexual intercourse and currently in an intimate union).01 – 1.99).

production. economic growth and economic development.2 These matters go against the principles of the 393 . especially during the adolescent years (80%). the mean age of sexual debut in Jamaica was 15. HIV/AIDS. health status. Jamaican policy makers have been using different designed sexual education programmes to address various reproductive health matters. despite the designed sexual education intervention programmes. But these matters affect many areas of the individual‘s life and/or that of a nation such as life expectancy. and therefore speak to their importance. in 1997.8 for females and 13. and most of the pregnancies were unplanned.1 much of which were forced and is seen as a direct link with violence. reproductive health issues persist on a yearly basis and as such justify the continuation of reproductive health research in an attempt to provide incessant answers on issues that affect people as well as the nation. In Caribbean nations. population compositions.5 for males. as well as one of the roots of sexual and reproductive health problems in the international community.Introduction Some people are inclined to assume that reproductive health matters are overly studied. quality of life. productivity. Inspite of their efforts.1 Two in every 5 Jamaican women have been pregnant prior to reaching the age of 20 years.1 Continuing. developing nations have not effectively address those challenges which persist on a yearly basis and so they cannot be set-aside to other sociomedical problems that may appear atop of the social and medical hierarchy of challenges. in 2002. mortality patterns. For years. other sexually transmitted infections and unwanted pregnancies are continuously rising as well as the lowering of the age of sexual debut. Furthermore. the Jamaican National Family Planning Board found that the median age at first sexual intercourse for women was 17.3 years and this fell to 16.0 years in 2002.

4 Those occurrences are likely to result in health situations relating to STIs and HIV. And this would 394 . it follows that reproductive health issues must be continuously studies as they affect many areas in the life of the individual and the nation that do not cease but progress and become problematic for nation building.‖3 STIs on the rise17-19 and that 22 out of every 25 Jamaicans aged 15-24 years have had sexual intercourse as well as 24. indicating a high degree of premarital sexual activities and inconsistent condom use within the context of reduced age at first sexual intercourse.2 Empirical evidence showed that the ―First sexual intercourse almost always take place outside of a formal union‖3 and with older men (for the females). males.5 Warren et al. as well as drug abuse.6 the high fertility population in Jamaica was women ages 14-24 years.4%.1% of Jamaicans aged 15-74 years indicated having at least 2 sexual partners (females. but only 34% of pregnancies were planned for.7 A study of some sub-Saharan African and South-East Asian nations show similar sexual behaviour and attitude of young people8 whereas one by Henry-Lee9 found that 66% of Jamaican women used method of contraception. as young adults are engaged in risky sexual practices. full respect for the integrity of the individuals involved should be of the utmost. 41.ICPD 1994.10.20 it follows that an investigation on the reproductive health matters of those in a sexual union versus those who do not is timely.0%).. which stipulates that when it comes to matters of sexual relations. With research showing the ―First sexual intercourse almost always take place outside of a formal union.11 Within the context of the lowered age of sexual debut in the world11-16 and the aforementioned identified reproductive health matters. This indicates that inconsistent contraceptive use is accounting for increased HIV/AIDS and STIs in Jamaica that is typical in the wider developing countries. 8.

material deprivation.7% of Jamaicans were aged 15-49 years. poverty. Statistics showed that in 2009.People who are already poor are the most likely to suffer financially from chronic diseases.1% of Jamaicans reported having had an illness in a 4-week period.8% for females and 17. with rural poverty being at least twice that of urban poverty and poverty being greater among females than males. which often deepen poverty and damage long term economic prospects. and the area of residence that they dwell. there is a poverty gender disparity as well as a poverty area of residence disproportionality in Jamaica.23 The percentage of population ages 15 to 49 years old.7% of females were between the ages of 15 to 49 years old.21 then females who reside in rural areas are more vulnerable to reduced sexual autonomy than their urban counterparts as they rely more on males for financial assistance than their urban or periurban counterparts because of low educational status. indicating that illness interfaces with poverty and other socio-economic challenges. The WHO noted this aptly when it stated that ―.2% for rural residents who are more likely to be in poverty compared to their male. In Jamaica.21 Clearly. 53. and urban or periurban counterparts.‖22 Statistics for revealed that 15. and material deprivation. and how policies can be better implemented to address the identified challenges which emerged. but no study has sought to elucidate whether there are differences in reproductive health matters among women in sexual union or not. is a substantial group which cannot be left unresearched moreso because of the prevalence of HIV/AIDS (8th leading cause of morality among Jamaican females for 2006 and 200723) virus and unwanted pregnancies among this 395 . low educational attainment and other issues. particularly women.provide invaluable insights into both cohorts. Poverty is associated with illness.. and 54. The World Health Organization (WHO) 22 postulated that 80% of chronic illnesses were in low and middle income countries. and this was 17..

RHS). This age cohort is a critical part of the productive age for employed. (4) high church attendance. Outside of poverty and the aforementioned reproductive health issues. with emphasis on those who are in a sexual union or not in Jamaica. EDs). and (5) physically forced to have sexual intercourse. Stratified random sampling was used to design the sampling frame from which the sample was drawn. (2) method of contraception. The current paper will evaluate the demographic. reproductive and health characteristics of women aged 15-49 years old who are in a sexual union or not in Jamaica and their area of residence as well as factors which determine (1) good-to-very good health status. This was calculated based on probability proportion to size. The study population was 8. a three-stage sampling design was used.cohort. Using the 2001 Census sector (or sampling frame). indicating its importance (or lack of) to production and development of the nation. Methods and materials Sample The current research used the dataset from a national descriptive cross-sectional survey. The survey was conducted by the National Family Planning Board in 2008 on Jamaican women among the reproductive ages and males aged 15-24 years old (2008 Reproductive Health Survey. (3) had sex in the last 3 months.259 women. Jamaica 396 . we still do not know about the reproductive health matters of women aged 15-49 years who are in a sexual union versus those in non-sexual unions because no study emerged than elucidate important on these cohorts. Stage 1 was the use of a selection frame of 659 enumeration areas (or enumeration districts. This study extracted only females aged 15-49 years from 2008 Reproductive Health Survey.

8%. statistical agency.1 397 . and each PSU constituted an ED. Andrew.1 In stage 2. the households were clustered into primary sampling units (PSUs). Mona. Catherine. at 14. The Statistical Institute of Jamaica (STATIN) provided the interviewers and supervisors. The instrument administered was a 35-page questionnaire. after which the final exercise was carried out.5% of Jamaica compared to Region 2.is classified into four health regions. The new sampling frame formed the basis upon which the sampling size was computed for the interviewers to use. The 2001 Census showed that Region 1 comprised 46. Region 2 comprises Portland. Modifications were made to the pre-tested instrument (questionnaire). The data was weighted in order to represent the population of female aged 15 to 49 years in the nation. St. Data Bank for use by scholars. St.6% and Region 4 at 21.1%. James. After which it was released to the University of the West Indies. Region 3 at 17. Region 1 is composed of Kingston. The previous sampling frame was in need of updating. with Region 4 being St. St. Mary and St. Ann. Hanover and Westmoreland. A total of 175 instruments were pre-tested. to carry out the survey. Thomas and St. and so this was performed between January and May 2002. and so this was carried out between January 2002 and May 2002. Validity and reliability of the data were conducted by many statisticians. Elizabeth. Manchester and Clarendon. who were trained by McFarlane Consultancy. and university scholars before the data was used as the data are for national policy planning. Region 3 is made up of Trelawny. The previous sampling frame was in need of updating. which in turn was comprised of 80 households. Stage 3 was the final selection of one eligible female from each sampled household and this was done by the interviewer on visiting the household. St.

Version 17.e. Age is 398 . and range). Finally. USA). bathroom and verandah). or another method. Research Triangle Park. NC). Chi-square was used to examine the statistical association between two non-metric variables. statistically significant variables) are shown in each Table. crowding. A p-value < 0. mean. Thus. Where collinearity existed (r > 0.0 (SPSS Inc. To derive accurate tests of statistical significance.5. variables were entered independently into the model to determine those that should be retained during the final model construction. we used SUDDAN statistical software (Research Triangle Institute. All metric variables were tested for normality (age at first sexual debut. and years of schooling). Measures Key variables: Age at first sexual debut (or initiation or intercourse) was measured based on a respondent‘s answer to the question ―At what age did you have your first intercourse? Crowding is the total number of persons in a dwelling (excluding kitchen. the variable was used in its current form and a value more than 0. IL.5 was normalized by natural log. Where skewness was found to be less than 0. only explanatory variables (i. standard deviation (SD).Statistical analyses Data were entered. Independent sample t-test was used to examine differences in age at sexual debut between those who frequently attend churches and those who infrequently visit churches and F-statistic was employed for age of respondents by age at sexual debut.05 (two-tailed) was used to establish statistical significance. Chicago. and this adjusted for the survey‘s complex sampling design.7). age. stored and retrieved using SPSS for Window. stepwise multiple logistic regression analyses were used to fit the data because the dependent variable is a dichotomous nominal measure. Descriptive statistics were performed on particular sociodemographic characteristics of the sample (frequency.

a more or less steady partner with whom you have sexual relations?‖. 0 = otherwise. no. 0 = otherwise). semiurban and urban (1 = rural. Currently having sex is measured from ―Have you had sexual intercourse in the last 30 days?‖ (1=yes.the number of years a person is alive up to his/her last birthday (in years). are you living as man and wife now with a partner to whom you are not legally married?)‖. 0 = otherwise. Pregnancy was assessed by ―Are you pregnant now?‖ (1=yes. funerals. Forced to have sexual relations was assessed from the question ―Were you forced to have sex at your first intercourse?‖ and the options were yes. that is. middle or upper social hierarchy (1 = middle class. and ―Are you currently single?‖ Age at menarche is measured from ―How old were you when your first period started (first started menstruation)?‖ Gynaecological examination is taken from ―Have you ever had a gynaecological examination?‖ (1 = yes. 0 = otherwise. 0 = otherwise or no). 0 = otherwise. Contraceptive method comes from the question ―Are you and your partner currently using a method of contraception? …‖. don‘t 399 . Education is measured from the question ―How many years did you attend school?‖ Marital status is measured from the following question ―Are you legally married now?‖. 1 = semi-urban. ―Are you living with a common-law partner now? (that is. reference group is lower class). Religiosity was evaluated from the question ―With what frequency do you attend religious services?‖ The options range from at least once per week to only on special occasions (such as weddings. ―Do you have a visiting partner. christenings et cetera) (1=frequent attendance from response of at least once per week. and urban is the reference group). Subjective social class is measured from ―In which class do you belong?‖ The options are lower. 0 = otherwise). 1 = upper class. 0 = no). and if the answer is yes ―Which method of contraception do you use?‖ Age at which began using contraception was taken from ―How old were you when you first used contraception? Area of residence is measured from ―In which area do you reside?‖ The options were rural.

age at first contraceptive use. and years of schooling were used as continuous variables.3% of those in the poorest 20% were in common-law or visiting relationship than married people compared with 46.0001).8% were in visiting relationships followed by common-law relationships (36. Table 15.53. Of those in a sexual union 38.5%) compared with those in other income quintiles.2 showed that women in a sexual union were less likely to report having 2+ sexual partners (6.5% were married women.0%) compared to those who were currently not in a sexual union (10. age at menarche.8% of those in the wealthiest 20% (χ2 = 347.2 depicts information on the reproductive health matters of the sample by those currently in or not in a sexual union.9 years early than those currently in a sexual union.2%) compared to those not in a sexual union. 0 = otherwise). Women who are in sexual unions enter in these unions 4 months earlier than those who were currently not in a sexual union. the latter were more likely to use a condom (56. However.1%) and 400 . Sexual union denotes the pairing of male and female for the purpose of reproductive matters.5 times more women aged 15-49 years were in a sexual union (71.7%) and 24.know and refused to answer (1= yes. The findings revealed that 2. but latter began having sexual relations 5.9%). However. Table 15. Age at first sexual debut. P < 0. Early sexual debut is having sexual intercourse before the statutory legal age to do so (in Jamaica.1 presents information on the demographic characteristics of sample by currently in or not in a sexual union. this is 16 years old). Figure 1 shows that respondents in the poorest 20% were most likely to be in sexual unions (74. Results Descriptive statistics: Table 15. 62.

4). periurban women begin having sexual intercourse the earliest (24. Multivariate analyses: Table 15.3 ± 23. However. The findings revealed that women who had sexual intercourse in the last 30 days were 7. Table 15. Based on the stepwise regression results eight variables emerged as statistical significant factors of method of contraception.7%) compared to those in a sexual union – condom usage (44. In addition to the aforementioned issue.3%). no statistical difference emerged in the self-rated health status between those in or not in a sexual union.5 shows the logistic regression of method of contraception.5%) than those in urban areas (29.5 years) and rural women (25.4% of method of contraception.2 times more likely as well as those in a sexual union (OR = 1.8.3 exhibits information on the demographic characteristic of sample by area of residence. However.7%) as well as rural locations (17.2 times more likely. 95% CI = 1. HIV/AIDS (14. In addition.4 – 2.1±28.4 time more likely.4 presents information on logistic regression analyses of explanatory variables for good-to-very good health status of sampled population. the employed were 1. The findings indicate that women in periurban areas were wealthier (33.reported having HIV/AIDS (25.3). and they explain 34.9 years). rural women enter in sexual unions 6 months earlier than periurban women and 7 months later than those who reside in urban zones (Table 15.5 years) compared to those in urban (28.7 times more likely to use a method of contraception the last time they had sexual relation. 401 . those in the wealthiest 20% were 1. Women in periurban areas were 18% less likely to report good-to-very good health compared to rural women. Table 15.6 ± 25. women who were physical forced into sexual intercourse were 37% less likely to report good-to-very good health status.1%). those who reported good-tovery good health status were 1.2%).

Twelve of the initial variables emerged as statistically significant factors explaining who are currently in or not in an intimate union (R2 = 59. women who indicated that they are currently in a sexual union were 73. those who were in sexual unions were 38% less likely to be physical forced into sexual relations compared to those who did not indicated being in a sexual union.03 . The findings revealed that seven variables emerged as statistical significant factors of high church attendance.Seven variables emerged as statistical significant factors explaining 63% of women aged 15-49 years having had sexual relations in the last 30 days (Table 15.1.8).6).8%). Furthermore.7%).7 shows explanatory variables of high church attendance. Women who reside in periurban areas were 1. common-law (36.0%).5%). and visiting relationships (38. Previous empirical studies revealed 402 . Using stepwise logistic regression. intimate unions (sexual unions) among women aged 15 to 49 years were 2. Rural women exhibited the greatest church attendance. nine variables emerged as statistically significant variables accounting for 24% of those who were physically forced into sexual relations (Table 15. Furthermore those who reported having had sexual intercourse in the last 30 days were 34% less likely to attend church on a regular basis (at least once per week).3. Table 15. 95% CI = 1.8 times more likely to have had sex in the last 30 days.9 shows variables that explain women who are currently in or not in a sexual union.5 times more likely than non-intimate unions (in 2008). The sexual unions were (1) marriage (24. Table 15. Furthermore. Discussion In Jamaica.3 times more likely to be physically forced into sexual relations compared to those in rural areas (OR = 1.68).

A dyadic of scholars (or group) found that. intimate unions commence at an early age in Jamaica.that many Jamaican males are in multiple sexual relationships and that 1 in every 3 males consistently used a condom with their steady intimate partners24-26. 28 Despite the history of millions of dollars spent on the HIV/AIDS virus.27. Statistics revealed that the mean age at first coitus among females Jamaicans in 2002 was 15. researchers found that the ―First sexual intercourse almost always take place outside of a formal union‖32 and with older men (for the females). particular Jamaica. reproductive health education and other sex education programmes in the Caribbean.8 years and 13.34 And that 1 in every 50 people in the Caribbean being infected with the HIV/AIDS virus.28 The World Health Organization (WHO) offered some explanation for the reproductive health issues which emerged in many nations when they opined that unsafe 403 . particularly HIV/AIDS. Previous studies have shown that in Antigua and Barbuda. one in six women between the ages of 15 and 24 become sexually active before the age of 15 years.5 years for males. Guyana. the virus has been increasing27. suggesting that females who are in sexual unions are exposed to sexually transmitted infections. Trinidad and Tobago and Dominica Republic.33 The intimate unions that people enter and/or remain in are accounting for many reproductive health matters such as HIV/AIDS and pregnancy.30. 35 embodied here is the resultant effect of intimate encounters. 31 However. AIDS being the main cause of deaths among people aged 15-44 years. Haiti. which is also typically the case in the United States29 as well as other developing nations. The aforementioned issue justifies statistics on the prevalence of the HIV/AIDS virus in Jamaica. 4 in every 5 adolescent women pregnancies were unplanned and 74% of females‘ ages 15-17 years old were sexually active compared to 47% of males of the same age. 2 in every 5 Jamaican women have been pregnant at least once.1 Clearly from the aforementioned finding.

which means that they are exposed to sexually transmitted infections (as well as human papillomavirus (HPV)).1%20 and within the context that rate of 404 . Knowing that women aged 15-49 years old who are involved in sexual unions want to have more children.1 The current work found that those who are currently in intimate unions (cohabiting unions) were 29.4 times more likely to want to have more children. pregnancy and other risky sexual issues. women in sexual unions (being it.35 Inspite of the prevalence of the HIV/AIDS virus and unwanted pregnancy. indicating not only premarital sexual relations. A study by Wilks and colleagues comparing results for 2000 and 2008 found that self-reported unemployment increased by 7. but also risky lifestyle practices. they are having to subscribing to the dictates of their partners because of economic vulnerability.2% of females aged 15-74 years old used a condom20.8 times more likely to use a method of contraception. which is supported by the literature. 1. common-law or marriage partnership) were not protecting themselves from the probability of contracting the virus as a study found that 43.3%) compared with those in the wealthiest 20% (40.9 times more likely to have sexual intercourse.6 times more likely to have done a HIV test than a those in non-intimate unions (non-cohabiting). 1.3% of Jamaican women aged 15-19 years old and about 66% of those aged 15-49 years reported using a condom in the last 30 days1 as well as 41.sexual practices are a part of risk factors which account for increased mortality and morbidity in the world. inconsistent condom usage is inevitable. but they were less likely to use a condom. Being less educated than their non-intimate counterparts and dwelling in crowded household. cervical cancers. 1. visiting.0%). mostly likely to be in the poorest 20% (62.9 One of the issues which emerged from this work is the fact that women aged 15-49 in intimate union years old were less educated and more likely to be employed than those in noncohabiting unions.

405 . Poverty is. Within the context that biological sex is a fundamental structural part of the social life of women in intimate unions (22 out of every 25 had sex in the last 30 days). this fact does not provide economic independency because the occupational type will be lower as a result of the lower level of education. the economic vulnerability of women in sexual unions means that they are handing the vetoing powers of their reproductive rights to their male counterparts in exchange for socioeconomic assistance or survivability. and how sexually transmitted infections can be easily transmitted because men are still dominating reproductive rights of women owing to their economic power. suggesting a likelihood of inconsistent condom usage among them and their sexual partners. accounting for the educational disparity between those in sexual union status and those current not in an intimate relationship. the economic dependency is fostering the reduced sexual autonomy of these people. Women who are currently in an intimate union although they are more likely to be employed compared with those who are currently not in a sexual union.unemployment is greater for female than males21. therefore. these highly sexed individuals coupled with data showing that 66% of them (Jamaican women) used a method of contraception. For the current work. and thereby creating other socioeconomic problems. Such an issue highlights the challenge of restoring sexual rights among women. It is this reality that justifies the high rates of contracting the HIV/AIDS virus because they desire more children. almost 10 in every 25 women aged 15-49 years old who are involved in sexual unions are in visiting cohabitations. 3 out of every 4 women in the poorest 20% were in intimate unions and 14 out of every 25 being unemployed. then economic vulnerability among these women denotes that the gains made in sex education is likely to be eroded because of material deprivation. Embedded in the current findings is the reality that cohabitation among Jamaican women is continuously changing because of money and material resources.

The current work revealed that 22. it is for this very reason why women enter into sexual unions earlier than those in non-cohabiting unions.6 times more than periurban poverty. they commence sexual intercourse 5. but the contrary is the case. Almost 15 out of every 25 respondents dwelled in rural areas. Although women who are currently in sexual unions enter these 4 months earlier than those who are not in one. Because one in every 2 women aged 15-49 years old were unemployed rural residents. Continuing. Thus. and rural poverty was 1. Thus.3% more women aged 15-49 years who are in common-law or visiting unions were in the poorest 20% compared to those in the wealthiest 20% and that they had the lowest rate of involvement marriage than women in other income quintiles. Money (or the lack of it) explains the high cohabitation as women seek assistance from older males who are more accomplished financial. making them apart of the economically vulnerable group.9 times more than urban poverty. more likely to be unemployed and in the poorest 20%. this study is forward a perspective that intimate unions among Jamaican 406 .This is also offering some explanations why low-income and/or lowly educated women opt for intimate relationship than those in the wealthy income groups and their reproductive health matters are controlled by the male as intimate unions are used as an avenue of escape from economic challenges and material deprivation. the economic challenge will be greater in among rural women which are offset by assistance from different males. less educated. Delaying sexual intercourse does not mean that these women asexual compared to those not in intimate unions.9 years later. the role of gender in reproductive health choices as well as retardation of economics in reproductive choices of women. Those results have implication for theorizing on reproductive health intervention programmes. they were higher sexual being. rural poverty was 1.

though it is probably in the immediate prepubescent period that they begin to exhibit personal. choice of sexual activity and sexual freedom than those in intimate unions. therefore. This could be ascribed to culture in the Caribbean as emerged from Chevannes‘ work. 843 Jamaicans aged 15-74 years old revealed that 96.women aged 15-49 years old. the union may cease from operating.3% of females.‖36 Chevannes findings highlight the rationale behind the high prevalence of sexual relations among women aged 15-49 years old who are currently involved in an intimate union.36 The sexual relationship that is entered into by women aged 15-49 years is a byproduct of early socialization.2% of males had sex compared with 93. is for economic gains and thereby justifies the high prevalence of sexual intercourse in these relationships. they are more engaged in risky sexual practices that speaks to the disjoined between knowledge or education and sexual behaviour. Despite a greater degree of educated women being among those who are in non-sexual union. their sexual socialization would have begun in earnest. which revealed that subtly cohered into risky sexual practices in order to established there capacity to bear children following entering into puberty. Thus. Such information envelope the risky sexual lifestyle practices of those who are currently not in an intimate union. In 2007/08. suggesting that they fear for partnership dissolution because if the male becomes aware of their infidelity. Women in cohabiting union. Chevannes opined that ―By the time small children reach the age of seven or eight. despite their economic vulnerability. which is owing to their economic independency. 407 . a nationally representative probability survey of 2. and are in primary school. emotional interest in sex. they have more control over their reproductive health matters. This is captured into aptly in an ethnographic studies carried out in some Caribbean communities. are less likely to have multiple sexual partners (2+) and reported having HIV/AIDS.

but also with higher rates of mortality and intimate partnership.4% of females. 43 and the WHO39 opined that 80% of chronic illnesses were in low and middle income countries. therefore.4% of females. but it is also an explanation of the choices which are made by people. and of those aged 15-24 years old. This work ascertained that 25.4% of women who were in intimate unions were classified in the poorest 20% of socioeconomic income compared with 21. 36. Money (or. and justifies why those in the wealthiest 20% reported a greater good-to-very good health status in reference to those in the poorest 20%. choices on reproductive health matters and their current realities.40. which concurs with the literature. is fostering better health status as well as lifestyle practices of women. It is for this reason that periurban residents. Thus with poverty being greater in rural area. insufficient financial resource).20 Intimacy is not only a as a result of the socialization of the individual. This work unearths that material deprivation and socioeconomic challenges of women affect intimate unions. Women are making particular choices (or not) on reproductive health matters based on their socioeconomic situation. who are the wealthiest among the different area of residents. Another research found that poverty was greater among chronically ill people than the nonchronically ill. Poverty is not only associated with illness and ill-health. and these affect their entrance into sexual partners and intimate unions.1% of males had multiple partners to 15.9% of male sample had multiple sexual relationships (2+ partners) compared to 8.4% of those in non-intimate unions. and they are more likely to use a condom.38-42 Previous studies have shown that those in the lower socioeconomic status are less healthy than those in the wealthy socioeconomic groups41. 42 which is supported by the current findings. it is affecting health status of rural women and it is also influencing their reproductive health choices 408 .

This also holds true in non-married sexual unions which was found by scholars who stated that the ―First sexual intercourse almost always take place outside of a formal union‖32 with older men. A group of scholars. which is culturally based. Another reality which is occurring in Jamaica is the prevalence of multiple sexual relationships. which concurs with Burton and colleagues‘ study.as they are unable to effectively address those matters without the assistance of males.152 marriages that were entered into. The information provide an insight into the cultural disparity of marriage between the genders. and the reality that women enter into intimate unions with older men who are likely to be promiscuous and more financial secure. Chevannes noted that in the Caribbean males are given sexual freedom. and 44.‖37 The rationales for such behaviours are embedded in (1) the culture. sexual autonomy and sexual promiscuity is a part of the social setting36. using Grounded theory found that ―…96% of the mothers voiced a general distrust of men.1% of females less than 30 years old compared with 32.37 Statistics revealed that in 2008 of the 22. With the downturn in the global economy and its effect on the Jamaican economy.5% of males of the same ages. the new economic reality of material deprivation and economic hardship among women is creating increased premarital cohabitation. (2) economic vulnerability and (3) material deprivation. 94% of the females were less than 50 years compared to 89% for males. and this is known by women. thereby accounting for the higher indulgence into sexual unions. yet that distrust did not deter them from involvement in intimate unions. While women may distrust men because of their sexual promiscuity. and less commitment to marriage or the permanence of intimate unions. and this is not resulting in high condom usage among women in sexual unions. particular among men. 409 . the current work showed that low condom usage is higher in intimate relationships.

the risk associated with the choices made by women is enveloped within the disproportionate economic power between the genders.Using data which were collected in 2000 as part of the Ministry of Health‘s HIV/AIDS/STD Survey in Jamaica. Such issues correspond with high distrust of women for men. Gibbison24 opined that ―Males in general have multiple sexual partners and less than a third use condoms on a consistent basis with their regular sex partners. and creates a justification for the rationale of women subscribing to the culture instead of wanting an idealistic world. but do not militate against intimate unions or inconsistent condom usage because of the economic power of men. and understanding the sexual freedom on their male partners.…Clearly. This research is forwarding that sexual 410 . Douglas postulated that the major cause of mortality among women aged 15-44 years in the Caribbean is AIDS18 and Wilks et al forwarded that sexually transmitted infections (STI) is greater among males (18. 20 yet inconsistent condom usage and low condom usage is found among women who indicated being in an intimate union. and this means that they are likely to experience morality associated with economic vulnerability. Thus. The disproportionate economic power between the genders dictates reproductive health matters of women as the economic benefits outweigh the risk of HIV/AIDS or other sexually transmitted infections.4% of females.1%) than females (11.37 This research offers some explanation for the aforementioned issues as poverty is eroding the good lifestyle and sexual practices of women irrespective of knowing that their choices are risky.0%) and that 41% of males had 2+ partners compared to 8.‖ Chevannes‘ work showed that the cultural underpinnings in the Caribbean offers much reason for the lifestyle practices and choices of men and women. women in certain regions or subpopulations face an increased risk of contracting sexually transmitted infections due to the sexual choices of their partners.

Sexual unions are not merely about economic stability. and not because of sexual freedom. and provide some source of income because they are involved with older men who are able to offer assistance compared to younger men. knowing that the male is already involved in a sexual union (visiting or extra marital relationship) as a means of providing for themselves and children. The matter becomes even more complex in rural communities with less males.46 Another research. more women of the reproductive ages who are unemployed.44 It can be argued that lower prevalence of multiple sexual partners among women in intimate unions that the degree of emotional satisfaction would be greater as women sex is associate with higher emotional satisfaction. but this relates to emotional satisfaction and physical pleasure. There is another side to the discourse on intimate or non-intimate unions. of low educational attainment. Koo.45 Delbés & Gaymu study that reads ―The widowed have a less positive attitude towards life than married people. women enter into non-stable intimate unions (visiting unions) as a source of survivability.promiscuity among women as well as inconsistent condom usage and reduced sexual autonomy is associated with economic hardships. using a sample of 411 . Thus. It is this reality which justifies why 3 out of every 4 women in a sexual union were engaged in either common-law or visiting unions as these are easier to form. Rie & Park‘s study revealed that being married was a ‗good‘ cause for an increase in psychological and subjective wellbeing in old age. living with families who are unable to offer much financial assistance and they females are unable to move to urban centres because their families residing in those areas are living in inner city communities with little opportunities. which is emotional satisfaction and physical pleasure. in an attempt to address the economic hardship. they will engaged into those unions. Within the context of their socioeconomic realities. which is not an unexpected result.

not seeking medical care. morality and economic conditions in the nations.67). found that married individuals reported better subjective health . are providing economic opportunities for women aged 15-49 years as well as positive affective psychological conditions (emotional satisfaction) as explained by Soons and Kalmijn. unemployment. (4) positive correlation between poverty and inflation (R2 = 0. (5) negative statistical association between seeking medical care and inflation (R2 = 0. (2) positive association between not seeking medical care and unemployment (R2 = 0. and (6) a negative correlation between not seeking medical care and mortality (R2 = 0. With more material resources in married and common-law union.58).47 Other studies have shown that married people have a lower mortality risk in the healthy category than the ‗nonmarried‘48 which explains why they take less life-threatening risks49.51 Intimate unions.1049 Austrians from ages 14 years and over. poverty and death. (3) positive relationship between not seeking medical care and poverty (R2 = 0. which supports longer and better quality of life.58).73).3 ) than divorced persons (7.52 Because married women have more access to shared financial resources as a result of their male partners‘ resources as well as the stability of those unions.50 and are happier than non-married people.6) or singles (7.48). women in such relationship are able to seek more medical care.related quality of life index (8. Bourne‘s work has provided some insight into the justification for high negative affective conditions and poverty. A study by Bourne offered more of an explanation of interconnectedness among poverty. economic 412 . poverty and seeking sexual partnerships. many women seek this partnership. therefore.7). which accounts for better health and more productive contribution to economic growth.56).53 He found that there was a (1) positive statistical correlation between poverty and unemployment (R2 = 0.

economic independency and reproductive health freedom. particularly among women aged 15-49 years old in Jamaica. Poverty is greatest in rural zones. and while this is true. which are feature of Jamaican males. and acceptance of men‘s sexual promiscuity. but they are more likely to have 2+ sexual partners not use a condom on the last sexual encounter. Chevannes argued that the culture accounts for sexual expressions of males. more educated. more likely to currently not in an intimate unions. While poverty is retarding women‘s sexual autonomy. the economic power that men acquire from material resources explains their power over vulnerable women who seek financial assistance. These economically power women are more likely to reside in periurban areas.hardship and poor health. employed. Conclusion Biological sex is fundamentally structured into cohabitation between men and women. disparity in reproductive rights owing to gender differences. it can be extrapolated from that finding that sexual intercourse is used by women as a means of addressing economic and material deprivation. wealthier. As women who are economic independent. Thus. The current findings showed that those in the poorest 20% were most likely to be in intimate unions. which accounts for the lower health status 413 . educated and are able to seek medical care as well as decide what they want for life are engaged in more risky sexual practices than those who involved in intimate unions out of (or not) economic vulnerability. the positive affective psychological conditions which emerged from economic independency is equally creating challenges for policy makers. and clearly this is equally the case among economically power women. economics appears to be at the root of these behaviours as the sexual freedom of males in Caribbean as this is found to be the case among economically power women who between 14 and 50 years in Jamaica.

56 although this is not necessarily the case among Jamaican females as Bourne55 found that income does not reduce health conditions. meaning that employment and education provide women with the same power and choice over their reproductive rights and sexual freedom as those current had by men. which should be used to guide policy formulation and intervention programmes. a sex 414 . Even though biological sex is lower among women aged 15-49 years who are currently not in a romantic union. Involvement into sexual unions among women in the reproductive ages is highly based on sexual intercourse and economic gains.among the sample as well as cohabitation. and greater household crowding. positive affective psychological conditions. their greater degree of education is not influencing better sexual practices as they are more likely to have multiple sexual partners (2+) and less likely to use methods of contraception. wealthier and this provides them with economic independency. the gains to intimate unions decline. women who are currently not in intimate unions were more educated. sexual union is engaged into because of its gains (emotional satisfaction. Because poverty can reduce health status and sexual autonomy38.54 Those issues highlight the need to institute intervention programmes geared towards both those in sexual and not in romantic unions.55 and a group of researchers went further to say that money buys health. which explains their risky sexual practices and higher HIV infections. Thus. justifying the rationale why they are in highly sexed unions as a means of obtaining economic resources. sexual autonomy and choice of reproductive health matters than those in romantic unions. On the other hand. as women become economically independent. lower educational achievement and household crowding were found among those in intimate unions. and economic benefits). As such. The economic independency provides them with sexual freedom. lower educational attainment. Continuing.

adequate physical milieu. intimate unions that are entered into among women aged 15 to 49 years are driven by sexual intercourse and economic situation. this has not fundamentally affected the structure of intimate partnership because economics is important to entrance into sexual relationship. As such. and are entered into because of gains. live in periurban and rural areas as well as those in sexual unions. educational advancement. Disclosures The authors report no conflict of interest with this work. Poverty reduces the gains of an intervention programmes as it incapacities an individual from good nutrition. Those findings highlight a need to institute measures to alleviate gendered poverty and gendered economic inequality. particular those who are wealthy. But economics independency among women of the reproductive ages must be met by intervention programmes fashioned to address sexual promiscuity.education programmes must recognize these facts. which highlight the multisectoral approach that must be taken in order to establish sexual education or lifestyle intervention programmes because economic disparity is critical in a thrust against risky sexual practices and sexual autonomy. sexual freedom. women who are currently not in a sexual union were more likely to be more educated. use a condom. educated. a safe-sex social norm intervention programme needs to be developed for women aged 15 to 49 years old. Despite women distrust for men as a result of the cultured sexual freedom. long life and better choices. wealthier and these are responsibility for their economic independency. and risky sexual practices. unemployment and area of residence impinge on how women live58 dictate entrance into intimate partnership. 415 .57. poverty. In summary. On the contrary.58 As such. sexual autonomy and risky sexual practices.

the University of the West Indies. but to the researchers. 416 .Disclaimer The researchers would like to note that while this study used secondary data from the Reproductive Health Survey. RHS) available for use in this study. and the National Family Planning Board for commissioning the survey. none of the errors in this paper should be ascribed to the National Family Planning Board. Acknowledgement The authors thank the Data Bank in Sir Arthur Lewis Institute of Social and Economic Studies. Jamaica for making the dataset (Reproductive Health Survey. Mona.

Jackson J. Geneva: WHO. 2009. Fatusi AO. Kaiser J. Sexual Initiation. et al. 2002. Parkes A. NY: Family Care International. Hirsch L. ed. Biennial report 1998-1999. Moore JS. RW. Williamson LM. Perspectives on HIV/AIDS in the Caribbean. Radosh A. 7. http://www. World Health Organization (WHO). 18. Health issues in the Caribbean. 25(2). J Adolesc Health 2004. Kingston: Ian Randle Publisher. Predictors of early sexual initiation among a nationally representative sample of Nigerian adolescents. Gender Differences in Reproductive Health. Family Planning Perspectives. 11. World health statistics. Hamilton P. Smith AMA. 8. State Council AIDS Working Committee Office and UN Theme Group on HIV/AIDS in China: A joint assessment of HIV/AIDS prevention. Jamaica. 2:42. Fertility and family planning among young adults in Jamaica. 8. Family Care International. Simkin L. 1995 3. De Visser R. 9(17):213-220. New York. Miller KS. National Family Planning Board (NFPB). Early age at first sexual intercourse and early pregnancy are risk factors for cervical cancer in developing countries. USAID and Jamaica National Family Planning Board. Sexual attitudes and behavior among young adolescents in Jamaica. Henry-Lee A. 2000. 5. 14. Louie KS. Teijlingen ERV. Department of Health and Human Services. 14(4):137-141. Br J Cancer 2009. 2009. American Sexual Behaviour. Clarke LF. de Sanjose S. Rosenthal DA. Powell D. and Blum. Factors associated with self-reported first sexual intercourse in Scottish adolescents. 2005: pp. 34:200-208. Kingston: NFPB. Warren CW. 2005 2. Reproductive Health Matters 2001. Wight D. Tucker JS. Sexual initiation with older male partners and subsequent HIV risk behavior among female adolescents. 2010). Diaz M. Reproductive Health Survey. Douglas DL. Morris L. 29. xv. Personal and social factors influencing age at first sexual intercourse. 13. BMC Research Notes 2009. Reproductive health research at WHO: A new beginning. Penfold SC. International Family Planning Perspectives. Centre for Disease Control.SamplePgs. Beijing 2005. 17. Int Family Planning Perspectives 1988. Eggleston E. 1999. 417 . Framework for Action. Middlestadt S: Initiation of sexual intercourse among middle school adolescents: the influence of psychosocial factors. 6:3 9. 2008. 12. World Health Organization (WHO).pdf (Accessed on April 1. Women‘s reasons for discontinuing contraceptive use within 12 months: Jamaica. Petticrew M. 100(7):119-7. Commitments to Sexual and Reproductive Health and Rights for All. Hart GJ. Archives of Social Behavior 1999. In: Morgan O. 4. treatment and care in China (2005). 6. 16. 1997:212-214.References 1. Reproductive Health 2009. 28(4):319-333. BMC Public Health. Guttmacher. Santelli JS.newstrategist.com/productdetails/Sex. Jackson J and Hardee K. US Department of Health and Services (2006). Geneva: WHO. 10. Limits to modern contraceptive use among young women in developing countries: A systematic review of qualitative research. 15.

33. 21. 2007: pp. World Health Organization. 2005. Paper presented at the Caribbean Health Research Conference 2007. Geneva: WHO. Rawlins J. 2009. Wilks R. Lowry R. 1:51-59. 2007. Chen W. 23. socialization and gender identity in five Caribbean communities. McFarlane S. Planning Institute of Jamaica (PIOJ). Estacion A. Washington DC. Attitude towards intimate partner violence against women and risky sexual choices of Jamaican males. 25. Teenage Pregnancy: A study in three communities in Trinidad and Tobago. USAID and Jamaica National Family Planning Board. Kingston: STATIN. HIV/AIDS – the rude awakening/stemming the tide. Study shows Jamaican Girls Encounter Violent Sexual Relationships. 2001. et al. 2005. Zabin LS. American Sexual Behaviour. 39. Kingston: Tropical Medicine Research Institute. Crawford TV. 30. 29. Francis D. 2005: pp. Demographic statistics. Cherlin A. 22. volume II – Countries. Bourne PA. Brener ND. 31. Santelli JS. Crawford A. World health statistics. Kingston: Ian Randle Publisher. D. Sexual Initiation. 1(5):247-255. 2008. Advocates for Youth. Holder-Taylor C. 35. 2007.pdf (Accessed on April 1. 2008. 2009. The role of trust in lowincome mothers‘ intimate unions. Jamaica Observer (15 April 2009). Jamaica Observer. 9:305. adolescents and young adults. Younger N. Of the West Indies Press. Wu H. Geneva: WHO. World Health Organization (WHO). West Indian Med J 2007. Open Access J of Contraception 2010. Health issues in the Caribbean. Gender Differences in Reproductive Health. US Department of Health and Services (2006).19. 71(5):1107-1124.SamplePgs. 27. 30:271-275. Geneva: WHO. Burton LM. J Marriage Fam 2009. 32. 21: 3146. North Am J of Med Sci 2009.448-464. Multiple sex partner behavior in female undergraduate students in China: A multi-campus survey. 20. Health in the Americas. University of the West Indies. Bain B. Jamaica Survey of Living Conditions.C.. ed. Pan American Health Organization (PAHO). 26. 38. 2010. Bhatt A. Winn DM. 37. Family Planning Perspectives 1998. Statistical Institute of Jamaica (STATIN). Department of Health and Human Services.S. Washington. Preventing Chronic Diseases a vital investment. 2010). 2002.com/productdetails/Sex.newstrategist. Yan H. Mona. The influence of Income on Health: Views of an Epidemiologist. Jamaica. 418 . Kingston: PIOJ. Centre for Disease Control. 34. BMC Public Health 2009. 2008. Preventing Chronic Diseases a vital investment. Multiple sexual partners among U. Marmot M. Access to contraception by minors in Jamaica: a public concern. Contraception usage among young adult men in a developing country. Tulloch-Reid M. 36. Learning to be a man: Culture. 2001. http://www. Does money really matter? Or is it a marker for something else? Health Affairs. 2007. Chevannes B. 24. 62-76. In: Morgan O. Advocates for Youth. Ward M The reproductive and sexual health of Jamaican youth. McGrowder DA. World Health Organization (WHO). Charles CAD. STATIN. Statistical Institute of Jamaica (STATIN). 2009. 28. Jamaica health and lifestyle survey 2007-8. 56(1):66-71. Kingston. Gibbison GA. Jamaica: The Univer.

Waite LJ. Soons JPM. Health of Females in Jamaica: using two cross-sectional surveys. Bourne PA. Demography 2002. Pan American Health Organization. 48. Bourne PA. North Am J Med Sci. No. Marriage selection and mortality patterns: Inferences and fallacies. Umberson D. 2009. 81. 46. Aldershot: Gower Publishing Company Limited. Emotional satisfaction and physical pleasure in sexual unions: Time horizon. 2001. Eur J of Public Health 2000. 45. A Theory of Marriage: Part I. Bolitschek J. 56. not seeking medical care. 812-846. Tribl GG. Rie J. Gaymu J. Delbés C. Waitzman NJ. Demography 1997.1: 272-278. Joyner K. Kalmijn M. Journal of Political Economy. Health inequalities in Europe. Smith KR. Mackenbach JP. 42. Demography 1993. 63(1): 247-264. Becker GS. Soc Sci Med 1990. 1973.1(6&7):167-185. 4:S268-S270. 49. unemployment. 47. 2004. Family status and health behaviors: Social control as a dimension of social integration.40. Fox J ed. selfreported illness.1(5):132-155. 419 . 51. Smith JP. 34:159-70. The shock of widowed on the eve of old age: Male and female experience. Goldman N. inflation. Investment in health: Social and economic returns. Rosengerger A. Journal of Marriage and Family 2009. 30:189-208. 71(5):1141-1157. Journal of Health and Social Behavior 1987. 54. 58. Health status and Medical Care-Seeking Behaviour of the poorest 20% in Jamaica. sexual behavior. ed. 41. International Journal of Collaborative Research on Internal Medicine & Public Health. WHO. Bourne PA. 31(special issue):223-420. Age and gender differences in affect and subjective wellbeing. Rieder A. et al. Good Health Status of Rural Women in the Reproductive Ages. Is marriage more than cohabitation? Wellbeing differences in 30 European Countries. health insurance on mortality in Jamaica. Effects of socio-demographic variables on health-related quality of life determined by the quality of life index—German version. Geriatrics and Gerontology International. Svenson PG. Prause W. 43. Koo J. 2009. Washington DC: PAHO. Chronic illness and poverty in the Netherlands. Impact of poverty. Park K. Kington R. International Journal of Collaborative Research on Internal Medicine & Public Health. Demography 1994. 2005. 1989. Subjective wellbeing. 28:306-19. 53. 95:542-575. 1984. Demographic and Economic Correlates of Health in Old Age. 20:359-365. Holzinger B. 57. Scientific and Technical Publication. Diener E. and sexual exclusivity. 582. 2009. Stronks K. North American Journal of Medical Sciences 2009. 50. Double jeopardy: Interaction effects of martial and poverty status on the risk of mortality. Health inequalities in European Countries. 52. 44. (PAHO). 3: 885-914. 55. J of Marriage and Family 2001. Illsley R. 31:487-507. Human psychopharmacology Clinical and Expremental. 1(3):99-109. Van Agt HME. Rhule J. Bourne PA. Psychological Bulletin. 10:197-200. Saletu B.

Figure 1: Intimate unions (married. common-law and visiting) by population income quintiles 420 .

2) 1716 (20.<0.8) 0 (0.9) 2381 (28.6) 4857 (58.6) 5403 (65.5) 31.6) 4778 (57.8 (1.0 (3.0) 2646 (45. <0.5) 32.8) 382 (16.6) 1371 (57.36.6) 13.8) 5878 (71.0001 t=-8.5) 2283 (27.99.<0.4) 1037 (43.5) 1.0) 1344 (56. divorced & widowed Single High church attendance No Yes Employed No Yes Age enter into first sexual union Age at first contraceptive use Age of sexual debut Age of menarche Crowding Age of respondents 1198 (14.7) 2279 (38.1 (4.2) 18.8) 10.0) 0 (0.1: Demographic characteristics of sample by currently in or not in a sexual union Characteristic Sample Currently in or not in a sexual union Not in In sexual sexual union union n (%) n (%) 354 (14.09.0001 t=-4.837 421 .8) 1441 (17. 0.00.1) 16.6) 1344 (16.0001 2001 (24.1 (11. <0.1) 1625 (68.7 (0.3) 1627 (27.7 (0.4) 2158 (26.0) 544 (22.0001 1441 (24.0001 3232 (55.13.5) 2158 (36.6) 1.5) 1.3) 8259.2) 1192 (20.6 (0.0) 231.0 (5.8) 842 (14.7) 476 (20.5) 1735 (29.6) 1260 (52.4) 2856 (34.8) 3402 (41.2) 756 (31.Table 15.0) 18.9) 15.9) 1491 (25. P t= 2.9) 1121 (47.7) 3407 (58.0001 4143 (70.27. 0.8 (8.8) 13.6 (9.5) 28.2) 19. <0.4) 1247 (21.5) 12.3) 19.3) 1106 (18.0001 χ2 .< 0.40.0001 t=-18.82.7 (2.0 (1.<0.0) 1224 (14.29.0.6) NA NA 510 (21. P n (%) Area of residence Urban Periurban Rural Currently in a sexual union No Yes Income quintile Poorest 20% Second poor Middle Second wealthy Wealthiest 20% Marital status Married Common-law Visiting Separated.07.1) 2279 (27.5) 844 (14.8) 1668 (20.8) 18.4) 469 (19.0.9 (4.0) NA NA 30.3) 1037 (12.6 (4.0 (1.0) 0 (0.0) 0 (0.5) 123.017 t= 1.2) 1650 (20.2) 0.9 (8.8) t-test.0) 0 (0.0 (3.195 t=-31.4) 19.<0.9) 656 (27.7 (4.

0) 2179 (91.3) Yes 3560 (54.0.99.1) Withdrawal or natural method 139 (5.<0.8) 1404 (64.4) 132 (13.5) Physically forced to have sex 3.3) 469 (31. P Not in In a sexual sexual union union n (%) n (%) n (%) Had sex in last 30 days 4121.934 No 3898 (58.2) 3 (0.3) 2797 (63. <0.0) No response 22 (0.87.0) Yes 600 (8.4) 845 (58.0001 No 6815 (82.21.8) Pill 723 (28.3) Yes 4647 (64.5) 5665 (96.7) 833 (14.0001 Injection 393 (15.2) 422 .5) 5406 (92.6) Gynaecological examination 210. <0.0) 2850 (48.3) 1571 (27.3) 5045 (85.0001 No 4664 (56.8) Yes 1444 (17. <0.4) Yes 2780 (41.83.16.0) Ever done HIV test 467.7) 786 (13.5) 48 (4.5) 611 (25.8) 13 (1.Table 15.6) Have HIV/AIDS (self-reported) 155.6) Sexually abused 83. <0.5) Yes 3588 (43.2) Number of sexual partners in last 12 39.4) Yes 415 (5.0) 14 (0.07.3) 128 (9.1) 5408 (93.0001 months 1 6129 (93.9) 349 (6.7) 1216 (90.5) 472 (8.07.0001 No 3016 (45.8) 91 (5.0) 3028 (51.2) 294 (12.1) Emergency oral contraception 45 (1.4) Yes 5386 (65.7) 2175 (41.2) 769 (35.0) 721 (88.2: Reproductive health matters by currently in or not in a sexual union Currently in a sexual union Characteristic Sample χ2 .4) 242 (24.0001 No 7844 (95.7) Want to have more children 0. <0.4) 738 (31.5) 213 (3.0) Condom 1243 (48.7) 4178 (72.073 No 6622 (91.5) 1770 (74.007.3) 481 (31.7) 1011 (68.5) Currently used method of contraception 867.5) 1643 (69.3) 261 (16.0001 No 2580 (35.6) 605 (41.6) 89 (10.3) 3053 (58.3) 32 (2.3) 8 (1. <0.2) Last method of contraception 35.3) 5092 (86.57.5) 1600 (36.05.0001 No 2873 (34.0) 202 (8.8) 2087 (87.2) 2 (0.9) Other 5 (0. 0.<0.7) 2+ 438 (6.8) 559 (56.1) 684 (44.

8) 18.4) 0.7 (0.6) 86 (3.12.3) 21.2 (3.001 864 (18. <0. <0.17 <0.8) 24.6) 679 (56.1 (9. <0.4) 26 (2.0) 9 (1.5) 12.3 (9.0) 540 (39.86.6) 808 (35.4) 737 (15. 0.8) 429 (18.9) 0.9) 600 (50.6) 1.1) 1032 (21.4 (10.2) 148 (12.6 (0.9) 13.7 (0.6) 1739 (36. 0.5) 801 (35.06.4) 236 (10.3) 344 (28.6) 1.3) 33.83. <0.1) 1482 (64.36.7) 598 (49.0001 3074 (64.0001 5.9) 87 (24.69.5) 1475 (64.5) 616 (27.002 .0) 13 (0.1) 825 (17.7) 854 (71.04. P 319.5) 246 (41.5) 1.64.5) 403 (33.7) 3121 (65.0001 9.4) 293 (24.9) 356 (29.5) 31.8) 256 (21.8) 25.939 1657 (34.0001 831 (60.3) 7.1 (28.5) 345 (57.3 (23.0) 420 (18. <0.7) 178 (3.9) 551 (58.9) 705 (31.4) 634 (13.2) 395 (41. P 26.0001 4. <0.7) 111.6 (25.6 (4. divorced & widowed Single Want more children No Yes Age enter into first sexual union Age at first contraceptive use Age of sexual debut Age of menarche Crowding Age of respondents 172 (14.6) 1558 (40.9) F statistic. <0.0001 29.3) 1704 (35.5) 844 (70.7) 844 (70.3) 1049 (55.Table 15.4) 670 (55.1) 354 (29.8 (1.0) 19.1) 19.009 7.8) 415 (39.6) 2633 (55.0001 1320 (27.9 (1.4) 1220 (53.79.6) 783 (65.35.0001 1256 (26.3) 3 (0.3) 423 Periurban n (%) 407 (17.8) 582 (25.1 (4.7) 19.2) 937 (41.3: Demographic characteristic of sample by area of residence Area of residence Characteristic Urban n (%) Socioeconomic status Lower class Middle class Upper class High church attendance No Yes Employed No Yes Currently in a sexual union No Yes Have HIV/AIDS No Yes Don‘t know Had sex in last 30 days No Yes Health status Very good Good Moderate Poor Marital status Married Common-law Visiting Separated.5) 31. 0.9 (3.36. <0.13.0001 3039 (63.6) 656 (28.4) 234 (19.4) 1063 (46.5) 32.0 (1.22. 0.6) 167 (13.7) 3407 (71.8) Rural n (%) χ2.1) 1283 (26.7) 64.4) 535 (23. 0.9) 1260 (26.1) 28.94.1 (4.6) 187 (15.3) 89.0 (4.5) 12.4) 2290 (48.4) 18.7) 765 (33.5) 268 (74.8) 1111 (48.3) 18.835 1371 (28. 0.9) 827 (44.030 2298 (59.

97 1.84 1.44 1.08 1.1.25.02 0.200 0.70 8.01 .94 8.0.10 6.00 .48 1.42 Odds ratio 0.71 .08 0.95 1.42 0.85 Nagelkerke r-squared = 0.772 Overall correct classification = 71.232 0.01 0.198 -0.463 0.13 0.08 Wald statistic 5.82 1.26 1.02 0.63 1.05 .0. P<0.1.97 -0.52 6.96 1.1.04 1.10 13.9% Correct classification of cases not in good-to-very good health status = 60.13 .87.95 .00 0.18 n = 5781 Hosmer and Lemeshow test.22 57.1. χ2 = 4.08 .042 0.49 Model chi-square = 198.82 1.Table 15.4: Logistic regression analyses: Explanatory variables of good-to-very good health status Explanatory variables β coefficient Periurban Reference group (rural area) Physically forced to have sex (1=yes) Currently using method of contraception Age of sexual debut Years of schooling Age Employed (1=yes) Logged fertility Wealthiest 20% Second poor Reference group (poorest 20%) -0.22 0.0001 -2 Log likelihood = 4133.045 0. P = 0.24 1.05 0.1.80 1.70 .49 .044 -0.213 0.0.08 0.0.0% 424 .08 0.45 5.00 CI (95%) 0.03 .05 0.59 6.9% Correct classification of cases in good-to-very good health status = 97.09 0.32 4. error 0.13 0.195 Std.364 0.1.

87.73 0.19 0.9% Correct classification of cases in good-to-very good health status = 97.13 294.31.94 .1.41 Model chi-square = 1021.0001 -2 Log likelihood = 3530.00 1.9.Table 15.50 69.19 0.59 1.25 4.60 -0.80 0.81 Nagelkerke r-squared = 0.00 1.1.08 0.02 .85 17.29 4.5: Logistic regression analyses: Explanatory variables of method of contraception Wald statistic Odds ratio Explanatory variable Had sex in last 30 days (1=yes) Age Employed (1=yes) Logged fertility Wealthiest %20 Reference group (1=poorest 20%) Visiting Reference group (1=single) Health status (1=good-to-very good) Currently in a sexual union (1=yes) Constant β coefficient Std.60 1.43 1.344 n = 5781 Hosmer and Lemeshow test.79 7.10 6.89 .31 1.90 1.772 Overall correct classification = 71.27 0.1.66 0.83 6.01 0. P<0. error CI (95%) 2.47 1.35 1.07 .12 0.96 1.92 0. P = 0.0% 425 .23 1.07 .21 0.2.30 0.05 0.61 0.95 1.22 1.09 0.1.06 .9% Correct classification of cases not in good-to-very good health status = 60.2.38 .02 .34 5.66 0.14 0.09 0.74 94.82 0.21 2.04 -0.0. χ2 = 4.

8% 426 .75 1.82 101.19 Overall correct classification = 88.1.30 0.81 13.11 Constant -1.53 .Table 15.2.12 0.37 2.21 -1.6: Logistic regression analyses: Explanatory variables of had sex in last 3 months Explanatory variables β coefficient Gynaecological exam (1=yes) Age High church attendance (1=once per wk) Second poor Reference group (poorest 20%) Visiting Reference group (Single) Currently used method contraception Currently in a sexual union (1=yes) Std.89 38.69 Nagelkerke r-squared = 0.14 1.0001 -2 Log likelihood = 2097.66 1.0.12 0.70 0. P<0. χ2 = 11.57 9.0.66.9. P = 0.8% Correct classification of cases not in had sex in last 3 months = 68.32 295.08 .9% Correct classification of cases in had sex in last 3 months = 95.40 53.13 86.29 1.47 0.76 11.16 0.24 .13 0.0.68 1.03 -0. error Wald statistic Odds ratio CI (95%) 0.30 -0.22 .00 7.35 0.00 0.94 .0.97 0.77 0.39 0.25 0.15 6.86 1.96 .75 714.01 0.28 5.63 n = 5781 Hosmer and Lemeshow test.50 0.99 0.01 4.99 Model chi-square = 2005.47 73.31.

error 0.84 15.09 0.11 0.0.06 0.29 13.12 0.01 0.11 1.5% Correct classification of cases not in high church attendance = 85.02 .81 Overall correct classification = 74.10 .0.09 1. P < 0.02 0.10 0.66 0.1.66 . P = 0.1.19 -0.0.16.42 -1.0001 -2 Log likelihood = 3814.81 0.05 9.00 0.25 0.26 1.09 79.45 Std.0. χ2 = 4.0.42 5.71 346.11 7.20 Explanatory variables Peri-Urban Urban Reference group (rural) Age of sexual debut Years of school Age Common-law Visiting Separated.3% 427 .0.0.1.51 .05 1.09 1.46.20 .15 0.97 0.16 0.04 -1.73 39.83 0.64 Nagelkerke r-squared = 0.12 CI (95%) 0.28 n = 5781 Hosmer and Lemeshow test.06 1.03 .15 10.64 1.80 0.00 1.11 0.10 .13 0.86 Model chi-square = 811.30 318.99 0.11 -2.04 -2.04 0.05 0.35 -0.58 Odds ratio 0.Table 15.05 0.02 .13 0.7: Logistic regression analyses: Explanatory variables of high church attendance Wald statistic 4.69 .63 0.6% Correct classification of cases in high church attendance = 53.22 -0.34 0.02 0. divorced & widowed Reference group (single) Currently used method contraception Had sex in last 30 days (1=yes) Constant β coefficient -0.50 .

0% Correct classification of cases in physically forced to have sex = 100.29 1.93 0.84 0.96 1.50 1.98 1.01 8.65 0.89 1.1.01 .32 1.98 0.62 0.47 -0.66 14.1.25 0.12 0.04 0.63 1.52 -0.49 .1.0001 -2 Log likelihood = 215.0.00 .01 0.36 16.08 -0.47 -0.19 .1.1.97 Model chi-square = 70.8: Logistic regression analyses: Explanatory variables of physically forced to have sex Explanatory variable PeriUrban Reference group (rural) Gynaecological exam (1=yes) Age of menarche Age of sexual debut Age Logged fertility Visiting Reference group (single) Health status (1=good-to-very good) Currently in a sexual union (1=yes) Constant 0.12 0.54 Overall correct classification = 91.47 8.0.36.08 1.0.95 .68 1.50 1.03 0.37 Nagelkerke r-squared = 0.62 0. P<0.99.15 .88 .30 9.72 Odds ratio CI (95%) 1.24 n = 5781 Hosmer and Lemeshow test.82 β coefficient 0. χ2 = 6.96 0.00 0.0.40 0.40 0.04 0.13 Wald statistic 4.13 0.15 0.27 Std.0% Correct classification of cases not in physically forced to have sex = 100.68 11.Table 15.14 4.08 -0.46 . error 0.80 0.00 1.35 0.0% 428 .03 .29 4. P = 0.16 0.

65 .798 0.06 -0.09 19.01 0.78 .554 0.01 0.038 0.1.08 0.0.1.763 0.02 .64 – 0.95 0.10 0.11 0.001 0.12 .79 – 1.41 0.09 3.88 .25 -0.26 1.27 .03 0.00 1.39 24.08 19.045 <0.23 Std.0001 0.19 0.91 1.05 0.86 0.35 0.031 <0.0001 <0.068 <0.94 .66 12.47 0.70 0.10 1.12 0.88 0.75 0.03 0.01 18.0001 <0.03 0.17 0.007 0.0001 0.38.12 0.71 .48 1.99 1.05 CI (95%) 0.001 0.47 Nagelkerke r-squared = 0.07 3.40 -0.13 0.60 0.77 149.12 0.03 1.60 – 0.01 0.203 β coefficient -0.55 4.29 0.01 -1.11 0.29 . error 0.04 1.0001 -2 Log likelihood = 1633.02 0.06 29.09 Model chi-square = 1672.03 0.Table 15.1.22 0.01 -0.30 0.982 0.1% Correct classification of cases not in sexual union = 82.00 1.30 1.97 – 1.03 0.06 3.1.00 1.22 -0.80 0.11 0.9 0.99 0.72– 2.005 <0.00 1.07 0.30 – 0.0% 429 .86 0.83 12.36 -0.1.1.30 7.37 .16 Wald statistic 4. P = 0.57 10.2.0001 0.08 0.16 -0.37 -0.26 3.28 -0.74 – 0.1.10 0.56 0.71 0.9: Logistic regression: Explanatory variables of currently in a sexual union Characteristic Years of schooling Age Crowding High church attendance (1=yes) Age of menarche Had sex in last 30 days Age of sexual debut Good-to-very good health status (1=yes) Did HIV/AIDS test Physically forced to have sexual intercourse Periurban Urban Reference group (Rural) Currently used method of contraception Like to have more children Wealthiest 20% Second wealthy Middle class Second poor Reference group (Poorest 20%) Age began using contraception Age into first sexual union Gynaecological examination Employed (1=yes) Number of sexual partners in last 12 months Constant 0.63 1.13 0.13 0.263 0.4% Correct classification of cases in sexual union = 91.63 .59 .44 0.02 0.94 1.00 – 1.96.62 <0.00 .13 2.152 Odds ratio 0.034 0.99 0.85 0.80 1.34 713.0001 0.02 0.14 23.97 .1.07 0.47 -0.1.13 0. χ2 = 5.64 -0. P < 0.35 4.0001 0.63 0.99 1.953 <0.02 0.37 0.57 1.03 1.0001 0.00 -0.29 0.05 P 0.833 -2.1.88 1.26 1.99 0.81 0.44 0.25 1.12 0.1.65 Overall correct classification = 89.81.19 0.59 n = 5781 Hosmer and Lemeshow test.76 1.

and area of residence. SD = 3.1 Embedded in this finding is the lowering of premarital sexual relations with the passing of time. church attendance. forced sexual activity. age of first menarche. and continues to be 430 . statistics revealed that the median age at first sexual intercourse for Jamaican women was 17. Public health policies have failed to effectively address the reduction in age at first sexual intercourse of women in Jamaica. and the reproductive health problems associated with early sexual debut among women aged 15-49 years.4 years.4 years). On average. Eleven variables emerged as statistically significant predictors of age of first sexual relations (F-statistic = 176.8 years with 80% of the subjects having had their first sexual encounter before their 19th birthday. HIV.2. HPV. SD = 2. The main objective of this paper was to test a hypothesis of socioeconomic variables which explains age at first sexual intercourse of Jamaican women aged 15-49 years.0001): Age began using method of contraception. subjective social class.16 Sociodemographic correlates of age at sexual debut among women of the reproductive years in a middle-income developing nation Early sexual debut poses both health and social risks.4 years. marital status. Introduction In 1997. Early sexual debut poses both health (STIs. which justifies this study.2 years) than those who did not (16. crowding. education. pregnancy) and social (school drop-outs) risks. those who frequently attended church start having sexual intercourse 12 months later (17. The mean age at first sexual intercourse of the sample was 16.3 years and this fell to 16. employment. and this study shows a need for a multifactorial approach to intervention.0 years in 2002. shared sanitary convenience. Only 11% of those who had their first sexual intercourse were forced to do so. P < 0.

a public health concern among several nations.5 for males. unsafe abortions. psychological trauma and the socioeconomic challenges for the society in the future. This is embedded in statistics which showed that only 43. which makes it a public health problem worth studying.5 431 . Almost 2 in every 5 Jamaican women have been pregnant at least once prior to reaching the age of 20. as well as one of the roots of sexual and reproductive health problems in the international community. as well as drug abuse.2 Such problem goes against the principles of the ICPD 1994.2 ―First sexual intercourse almost always take place outside of a formal union‖3 and with older men (for the females) 4. most of pregnancies are unplanned. human papillomavirus (HPV) and genital or anal ulceration. but also risky lifestyle practices and the likely to the spread of HIV/AIDS and other sexually transmitted infections. which stipulates that when it comes to matters of sexual relations. 1 The average age at first sexual initiation in Jamaica is 15.3% of Jamaican women aged 15-19 years old and about 66% of women aged 15-49 years reported using a condom in the last 30 days1. this occurrence is likely to result in health situations relating to STIs and HIV. indicating not only premarital sexual relations. particularly in Jamaica. especially during the adolescent years (80%).8 for females and 13.1 much of which is forced and is seen as a direct link with violence. full respect for the integrity of the individuals involved should be of the utmost.1 The lowering of the age at sexual debut further goes beyond unwanted pregnancies to health problems such as cervical cancers.1 Inconsistent contraceptive use coupled with the continuous lowering of the age of sexual relations offers an explanation of the failure of public health programmes to effectively address sexual behaviour of females in many developing countries.

Early sexual debut.7 Although teenage fertility is not actively condoned in the Caribbean. but the practice continues. inconsistent condom usage and teenage pregnancy are not atypical in the developing world.6 the churches and family planning interventions have been actively campaigning against this practice as well as early sexual debut. A study of some sub-Saharan African and South-East Asian nations show similar sexual behaviour and attitude of young people.10 A study by Henry-Lee11 showed that 66% of Jamaican women used contraceptives.16 Ninety-five percentages of adolescent females‘ sexual partners were 17+ years old compared to 78. It can be extrapolated from the afore432 .14.13 In Antigua and Barbuda. do not frown upon this practice. Crawford and colleagues found that of the sample of adolescents. Guyana. particularly with regard to premarital sex of adolescents.8 According to Warren et al. 4 in every 5 adolescent women pregnancies were unplanned and 74% of females ages 15-17 years old were sexually active compared to 47% of males of the same age. Haiti.Inspite of the reality of the lowering of age at first sexual debut. the developing societies. Trinidad and Tobago and Dominica Republic. in particular Jamaica.9 the high fertility population in Jamaica was women ages 14-24 years. 16 2 in every 5 Jamaican women have been pregnant at least once. McGrowder and Crawford. more specifically Jamaica. indicating a high degree of premarital sexual activities and inconsistent condom use within the context of reduced age at first sexual intercourse. 15 According to Crawford. as young adults are engaged in risky sexual practices. Moreover. one in six women between the ages of 15 and 24 became sexually active before the age of 15 years.2% of adolescent males.6. none of the females were having sexual intercourse with males within their age cohort compared to 39% of adolescent males.. but only 34% of pregnancies were planned indicating that inconsistent contraceptive use is accounting for increased HIV/AIDS and STIs in Jamaica and on a wider scale in other developing countries.12.

the said study pointed out that young individuals who resided with both parents encountered sexual initiation later than those in other family situations.. it was seen that protestants (similar to those of non-religion) were more likely to have their first sexual initiation within their 16th year.20 added to the afore-mentioned factors which are also associated with age at first sexual initiation. when compared to the Catholics (within their 17th year) and those of other religion (18th year). which found self-efficacy. gender. condom access. in particular Jamaica. positive attitude to family planning use.‘s work added more variables to the existing body of literature on age at first sexual debut. They found that the perception of greater physical maturity.070 adolescents who were never married. alcohol and drug use.18 Penfold et al. school life (enjoyment). religion. poor academic performance and gender to be factors that explain sexual initiation among middle-school. 19 using a sample of 4. Penfold et al.4 In addition to the factor of religion. Fatusi and Blum‘s work concurs with some of the findings of an earlier study. expectations of earlier autonomy among gender. selfesteem. found that family (parental monitoring). Rosenthal et al. and higher level of religiosity were associated with age at first sexual debut.4 Another study conducted by Fatusi and Blum. and informal sexual health intervention were associated with self-reported first sexual intercourse. norms about having sexual intercourse. 433 .17 using a sample of 2. inner city youth. alcohol use. In a study which looks at sexual initiation of persons within the age range of 15-44 years.mentioned findings that premarital sexual relations are on the rise in developing nations. found that condom efficacy. and the use of illicit drugs to be statistically associated with age at first sexual debut among high schoolers. and the lowering of age at first sexual intercourse among young women in the developing world is a public health concern.379 Scottish adolescents.

Methods Sample This descriptive cross-sectional study used a secondary dataset from the National Family Planning Board (Reproductive Health Survey. and age at first sexual debut23-25. There are two sets of inclusion criteria. RHS). and other malignant neoplasm are among the 10 leading causes of mortality among Jamaican women. shared sanitary convenience. the National Family Planning Board (NFPB) has been collecting information on women (aged 15-49 years) in Jamaica regarding contraception usage and/or reproductive health. It explored variables relating to early sexual debut such as age of menarche. religion. subjective social class. forced sexual experience. the increased risk 22 of cervical cancers. the relationship between cervical cancer and STI. Since 1997. contraception.26 The main objective of this paper was to elucidate the socioeconomic variables which explain age at first sexual initiation of Jamaican women (ages 15-49 years). 434 . education. In this study. marital status. The issue of factors explaining age at first sexual initiation is unresearched in Jamaica. The eligibility criterion for age was 15 to 49 years at last birthday.Inspite of the lowering of age at first sexual relations and statistics showing that HIV. we seek to elucidate correlates which account for age at sexual debut of women aged 15-49 years in Jamaica. employment status. crowding. in particular human papillomavirus (HPV). Most studies that have examined factors associated with age at first sexual intercourse have used young people between ages 10-30 years. 21 as well as the direct association between early age of sexual debut. which are females and ages. This study is not far fetched as a previous study in Europe used ages 16-44 years. and area of residence among women in the reproductive years.

the Reproductive Health Survey (RHS) collected data on Jamaican men ages 15-24 years as well as women 15-49 years old. Stage 3 was the final selection of one eligible female from each sampled household and this was done by the interviewer on visiting the household. Andrew. and each PSU constituted an ED. Jamaica is classified into four health regions. The 2001 Census showed that Region 1 comprised 46. Elizabeth. a three-stage sampling design was used. St. James. The current paper extracted only females aged 15-49 years from 2002 Reproductive Health Survey to carry out this research. Region 2 comprises Portland. and so this was carried out between January 2002 and May 2002. Stage 1 was the use of a selection frame of 659 enumeration areas (or enumeration districts. Region 3 is made up of Trelawny. St. The study population was 7.1%. and so this was performed between January and May 2002. Using the 2001 Census sector (or sampling frame). with Region 4 being St. Manchester and Clarendon. EDs).5% of Jamaica compared to Region 2.1 In stage 2. The new sampling frame formed the basis upon which the sampling size was computed for the interviewers to use.8%. Hanover and Westmoreland. Ann. This was calculated based on probability proportion to size. The previous sampling frame was in need of updating. St. at 14. The previous sampling frame was in need of updating.6% and Region 4 at 21. Thomas and St.168 women of the reproductive ages. Mary and St. Catherine. which in turn was comprised of 80 households. Stratified random sampling was used to design the sampling frame from which the sample was drawn. St. Region 3 at 17. the households were clustered into primary sampling units (PSUs). 435 . Region 1 is composed of Kingston.In 2002.

The Statistical Institute of Jamaica (STATIN) provided the interviewers and supervisors, who were trained by McFarlane Consultancy, to carry out the survey. The instrument administered was a 35-page questionnaire. The data collection began on Saturday, October 26, 2002 and was completed on May 9, 2003. Prior to the date of the final data collection, pre-testing of the instrument was conducted between March 16 and 20, 2002. A total of 175 instruments were pre-tested.. Modifications were made to the pre-tested instrument (questionnaire), after which the final exercise was carried out. Validity and reliability of the data were conducted by many statisticians, statistical agency, and university scholars before the data was used as the data are for national policy planning. After which it was released to the University of the West Indies, Mona, Data Bank for use by scholars. The data was weighted in order to represent the population of female aged 15 to 49 years in the nation.1 Statistical analyses Data were entered, stored and retrieved using SPSS for Window, Version 16.0 (SPSS Inc; Chicago, IL, USA). Descriptive statistics were performed on particular sociodemographic characteristics of the sample (frequency, mean, standard deviation (SD), and range). All metric variables were tested for normality (age at first sexual debut, crowding, age, and years of schooling). Where skewness was found to be less than 0.5, the variable was used in its current form and a value more than 0.5 was normalized by natural log, or another method. Independent sample t-test was used to examine differences in age at sexual debut between those who frequently attend churches and those who infrequently visit churches and F-statistic was employed for age of respondents by age at sexual debut. Finally, ordinary least square (OLS) regression was used to fit the data because the dependent variable (age at sexual debut) was a
436

continuous one. Stepwise multiple linear regression was used to fit the one outcome measure (age at first sexual debut) by different sociodemographic variables. Thus, only explanatory variables (i.e. statistically significant variables) are shown in Table 16.3. Where collinearity existed (r > 0.7), variables were entered independently into the model to determine those that should be retained during the final model construction.27 To derive accurate tests of statistical significance, we used SUDDAN statistical software (Research Triangle Institute, Research Triangle Park, NC), and this adjusted for the survey‘s complex sampling design. A p-value < 0.05 (two-tailed) was used to establish statistical significance. Measures Age at first sexual debut (or initiation or intercourse) was measured based on a respondent‘s answer to the question ―At what age did you have your first intercourse? Crowding is the total number of persons in a dwelling (excluding kitchen, bathroom and verandah). Age is the number of years a person is alive up to his/her last birthday (in years). Contraceptive method comes from the question ―Are you and your partner currently using a method of contraception? …‖, and if the answer is yes ―Which method of contraception do you use?‖ Age at which began using contraception was taken from ―How old were you when you first used contraception? Area of residence is measured from ―In which area do you reside?‖ The options were rural, semi-urban and urban (1 = rural, 0 = otherwise; 1 = semi-urban, 0 = otherwise, and urban is the reference group). Currently having sex is measured from ―Have you had sexual intercourse in the last 30 days?‖ (1=yes, 0 = otherwise). Education is measured from the question ―How many years did you attend school?‖ Marital status is measured from the following question ―Are you legally married now?‖, ―Are you living with a common-law partner now? (that is, are you living as man
437

and wife now with a partner to whom you are not legally married?)‖, ―Do you have a visiting partner, that is, a more or less steady partner with whom you have sexual relations?‖, and ―Are you currently single?‖ Age at menarche is measured from ―How old were you when your first period started (first started menstruation)?‖ Gynaecological examination is taken from ―Have you ever had a gynaecological examination?‖ (1 = yes, 0 = no). Pregnancy was assessed by ―Are you pregnant now?‖ (1=yes, 0 = otherwise or no). Religiosity was evaluated from the question ―With what frequency do you attend religious services?‖ The options range from at least once per week to only on special occasions (such as weddings, funerals, christenings et cetera) (1=frequent attendance from response of at least once per week, 0 = otherwise). Subjective social class is measured from ―In which class do you belong?‖ The options are lower, middle or upper social hierarchy (1 = middle class, 0 = otherwise; 1 = upper class, 0 = otherwise; reference group is lower class). Forced to have sexual relations was assessed from the question ―Were you forced to have sex at your first intercourse?‖ and the options were yes, no, don‘t know and refused to answer (1= yes, 0 = otherwise). Age at first sexual debut, age at menarche, age at first contraceptive use, and years of schooling were used as continuous variables. Early sexual debut is having sexual intercourse before the statutory legal age to do so (in Jamaica, this is 16 years old).

Result
Table 16.1 presents the demographic characteristics of the sample, which comprises 7,168 respondents (women who are ages 15-49 years at their last birthday). Most of the women in the survey have been pregnant (84.3%) prior to this study and (4.4%) were pregnant at the time of the study. Only 40.6% of the sample indicated that they had wanted to become pregnant, when
438

they realized they were. The mean age of menarche was 13.5 years (SD = 4.4 years), with the median age of first sexual relations being 16.0 years (Range = 36 years). The mean age at which the sample began using a contraceptive method was 19.8 years (SD = 4.3 years). Twenty-five percentages of women began having sex at 15 years, fifty percentages at 16 years and seventyfive percentages at 18 years. One-half of the sample indicated that they began learning about sex education at 13.0 years (Range: 10, 29 years). The mean age for those who had their first sexual intercourse was 15.2 years (SD = 5.9). One-half of the sample stated that they were dating their partners for 2 years (Range: 0, 15 years) prior to their first sexual encounter. Almost 38% of the sample attended church at least once per week; 19% at least once per month and 7.3% attended church even on special occasions such as christening, wedding, funerals or graduation. Eight-four percent (84%) of those who were married were living with their husbands at the time of this study, five percent (5%) of those who have been pregnant had still births, 12.1% had miscarriages, and 11.4% have been forced to have sexual relations with another person. Fifty-six percentages of the respondents are currently using a contraceptive to prevent pregnancy. The study also shows that the condom was the most prevalent contraceptive method (40.5%) among the respondents. This result was followed by the pill (32.9%), tubal ligation (23.8%) and injection (22.9%). Figure 16.1 provides information on the relations between the respondents and the persons with whom they (respondents) had her first sexual encounter. Majority of the sample indicated that they used a contraceptive method on their first sexual relations (64.1%). These methods include the condom (95.1%); rhythm or knaus-ogino method (2.3%); pill (1.9%);
439

injection and intra-uterine device (0.1%) each. Two percent of the sample who had an abortion did so once (13.6%), twice (2.4%), thrice (0.8%) and four times (0.0%). The reasons given for the abortion were risk to mother‘s health (22.5%); risk of birth defects (2.9%); financial challenges (29.4%); unwanted pregnancy by mother (12.7%); unwanted pregnancy by partner (4.9%); the absence of a partner (2.0%) and other issues (22.5%). Thirty-five percentage of the respondents indicated that they became pregnant while attending school, of which 28.3% continued their education after the birth of their child. When the respondents were asked ‗How many weeks after _________ birth of [last child] did you resume sexual relations?, 25% of them said 2 weeks, 50% indicated 3 weeks and 75% claimed at most 14 weeks. Two-thirds of the sample used private health care facilities (private clinician, 64.6%; private hospitals, 0.7% and private clinics, 1.3%) when compared with 31.1% of those who used public/government facilities (public hospitals, 8.9%; government clinics, 22.2%). Frequent attendees to church begin having sexual relations on average (mean) at 17.4 years (SD = 3.2) compared to 16.4 years (SD = 2.4 years) for non-frequent attendees – t-test = 12.6, P < 0.0001. A significant statistical difference emerged among age at sexual relations of residence of particular geographical areas (F-statistic = 32.4, P < 0.0001). On average rural women began having sexual intercourse at 16.5 years (SD = 2.6 years) compared to 1.7 years (should this be 17.4 years or another year) (SD = 2.9 years) for residence of semi-urban areas and 17.2 years (SD = 3.0) for those in urban zones.

440

Table 16.2 shows information on the age of the respondents and age at sexual debut. Statistical difference was found among the age of respondents and age at sexual debut of the studied population (F statistic = 47.3, P < 0.0001). Table 16.3 examines factors that are associated with the age of first sexual relations of women ages 15 to 49 years in Jamaica. Using multiple regressions analyses, of the 17 variables that were tested in the model, 11 variables emerged as statistically significant predictors of age of first sexual relations (F-statistic [11, 5720] = 176.2, P-value < 0.0001). The factors explained 27.8% of the variability in age of first sexual relations.

Discussion
The sociodemographic related evidence of early sexual initiation has been put forward in this study and shows consonance with the literature. It is realized that sexual intercourse at an early age is usually by someone older and who is outside of a union. The risk associated with this factor is that ―older male partner presents a greater HIV transmission risk because they are more likely than adolescent men to have had multiple partners; to have had varied sexual and drug use experience and to be infected with HIV.‖5 Sometimes the young female is persuaded by the their older male perpetrators or partner, from using condom because of varying personal ideologies and are therefore, less likely to use condom at first sexual intercourse (82%),5 unlike the findings of this study (64.1%). This not only result in STIs but also unwanted pregnancy (which affects more than 80 million people worldwide
28

), thus the high possibility of school drop-out, most

times after receiving up to approximately 12 years of formal education (similar to the findings of this study). Where females are persuaded from using condom at first sexual intercourse, this may
441

be explained by the fact that males tend to be more casual about sexual relations and are more willing to emphasize sexual aspects than their female counterparts, who are more likely to romanticize sexual relationships. This view point bears consistency with the findings of this study, whereby drop-outs were more prevalent among those who became pregnant while attending school (35%) when compared to those who continued their education after the pregnancy (28.3%). Other schools of thought postulated that sexual activity and pregnancy among adolescents or teenagers in Jamaica, Guatemala, and Latin America have been thought to be associated with poor education, poverty and other social factors.10, 29,
30

The current findings highlighted that rural women on

average began having sex 8 months earlier than other women (at 16.5 years) that is the age in which they would be in grades 10 and/or 11. Those grades are pivotal for the completion of secondary level education, which means that lower level education will be greater among rural women than those in other geographic areas. It is this lowered age of sexual debut and ignorance of contraception that accounts for higher fertility and unwanted pregnancies among rural women. Research has shown that at least 120 million women would have used contraceptives if information was available.2 Therefore, ―the lack of knowledge and available options

undermines the right of couples and individuals to exercise control over their fertility and to have children in health and by choice‖.2 Knowledge about contraception and the various services available regarding its access is considered an obligation of national governments, especially from a human rights perspective.31 In Jamaica, many youths lack accurate sexual health information, especially with regard to the possibility of pregnancy at first intercourse; protection against STIs via the correct use of the correct contraceptives; the effectiveness of oral
442

contraceptives against pregnancy; fallacies relating to contraceptive methods.32 Such asymmetric information result in unintended pregnancies, STIs, and abortion. Where abortion is illegal and access to contraception is limited, more than half of the pregnancies end in abortion.28 Take for instance, in the cases of Chile, Hungary, Russia, Turkey, Czech Republic, abortion rates declined significantly owing to access to modern forms of contraception.28 Similarly, in Canada, access to user-friendly reproductive health services, high quality sex education and the increase use of oral contraception has resulted in a decline in teen pregnancy rate.33 In Jamaica, a research by McNeil concurs with the aforementioned studies that teenage pregnancy fell by 14.6% (from 1997 to 2000) because of sex education programmes, training, counseling, skills training and increased contraceptive use.34 Many scholars view early pregnancies as a potential population problem as this increases the chance of larger family size. This has contributed to 30% birth in islands such as St. Kitts and Nevis, Dominica, St. Lucia and 32% for Jamaica.35 In an effort to avoid poor education or school drop-outs, pregnancies are sometimes interrupted (induced abortion), which is about 60% among the average teenager.14 In South Africa, a study found that 32% of pregnant teenagers complete high school,36 suggesting and agreeing that medical or surgical abortions reduce the probability of poor educational attainment. Another study shows that ―adolescent girls contribute 55% of all clandestine abortions‖ in Nigeria.37 While abortion still remains a public policy and public health debate, in some countries it is considered a human right (Sweden),
31

legal (Guyana and Haiti

and illegal (Jamaica, Nicaragua and Chile). The reality is ―Over 19 million women globally resort to unsafe abortion each year, largely among the world‘s poorest and most vulnerable women, especially young women‖,38 indicating that the illegality of abortion does not abate its practices, but it becomes a public health concern. In Jamaica, abortion is considered a serious
443

offence under the Offences Against the Person Act 1973, Section 73, 39 and this goes to reducing their reproductive health choice and open avenues of them seeking the service in unsafe conditions. The reality is, with poverty being greater in rural areas and among females in Jamaica,40 unwanted pregnancies which are arising from ignorance of contraception and earlier sexual initiation means that educational disparity and income inequality if not abated will see a higher fertility, adoption and unsafe abortions among those women. Worldwide, ―more than half a million women die every year from pregnancy-related causes‖.2 Many deaths resulted from approximately 20 million unsafe abortions that occur yearly, especially among adolescent girls and young women in developing countries.2 In many developing countries, abortion (if unsafe) is considered a common cause of maternal mortality, hence a serious social problem.31 Nevertheless, ―a lack of access to safe and legal abortions is an obstacle to their enjoyment of human rights‖.31 The goal of the World Summit on Social Development (WSSD) Declaration and Programme of Action 1995, the ICPD 1994 and the World Conference on Human Rights (WCHR), Declaration and Programme of Action 1993 is to ―…….reduce maternal mortality and morbidity and greatly reduce the number of deaths from unsafe abortion‖.2 Women in Jamaica like other Caribbean islands (such as Antigua and Barbuda, Haiti, Guyana, Trinidad and Tobago and Dominica Republic) show a similar age of sexual debut. One in six women in other Caribbean nations between the ages of 15 and 24 became sexually active before the age of 15 years,
14,15

and 1 in 4 women in Jamaica begin at 15 years, and this is even

lower among non-frequent religious women (14.7 years). The current research shows a marginal difference in the Crawford, McGrowder and Crawford‘s16 which had that the mean age of sexual
444

debut for female was 15.8 years in Jamaica. Disaggregating the age at which women aged 15-49 years had their first sexual intercourse, we found that the mean age at sexual debut was lowest for women aged 15-19 years old (15.2 years (SD = 1.6)) compared to other aged women. While Crawford, McGrowder and Crawford found that much of earlier sexual debut was out of violence, this research disagrees as we found that only 11.4% of those who have had earlier sexual intercourse were raped,16 which indicates that the majority of first sexual debut was a consensual act although by statutes all sexual relations below 16 years is a rape.41 A study in New Zealand found that 7% of first sexual intercourse was forced,
42

which is marginally

lower than that of Jamaica. The time difference may account for this dissimilarity as Dickson et al.‘s work
42

was in 1993-1994, while the current paper used data for 2004. Moreover, ―First

sexual intercourse almost always took place outside of a formal union‖3 and with older men (for the females).4 We found that the majority of first sexual relations took place with a boy friend in a visiting relationship with the respondent. Based on the foregoing, ―The timing of sexual debut among adolescents is influenced by a wide range of factors including: age, gender, poverty, family structure, educational level, pubertal timing, socio-economic status, self-efficacy, peer influences, religiosity, knowledge and perceived risk of sexually transmitted infections, parenting practices and parental supervision, community, media and health inequalities‖.43 Outside of those factors which explain early first coitus in the developing nations, particularly the Caribbean is the masculine orientation and culture.44 Research demonstrates that the role of culture in the socialization of children is critical to fashioning the adult, and as soon as females begin to grow breast and to menstruate there is a

445

perception of womanhood. During this growth and development process, the female adolescents‘ physiology of reproduction sometimes begins in order to establish womanhood. The validity of recall of age of first sexual intercourse has been established by a group of researchers in 1997. They found that the test-retest correlations for the recall of age at first sexual relations was 0.85 for females and 0.91 for males,45 which indicates the validity of usage of recall data to measure the phenomenon. Hence, there is legitimacy in the use of cross-sectional survey data to examine age at first sexual intercourse in Jamaica, and the findings therefore provide invaluable insight into the attitude, behaviour and practices of women in Jamaica and those factors which are associated with age at first sexual debut. The current paper, therefore, have added variables to the literature: gender, ethnicity, income, mother‘s education, family structure, interpersonal relationship and other socioeconomic conditions are associated with age at first sexual intercourse.46-48 It also concurs with other studies that sexual activity is no longer strongly predicted by marriage49-52 as the majority of women who had their first sexual experience, engaged in such activity with a boy friend, stranger or mere acquaintance (87 out of every 100 women). With the low condom usage on first sexual intercourse found in this research, young women are open to the risk of STI, pregnancy and psychological challenges of early sexual relations, and therefore this justifies the rationale for wanting to modify sexual practices of adolescents.53,54 While the current reality of age at first sexual intercourse in Jamaica appears low, this is equally the case in other nations as we found that 80% of a recent cohort of youths who had sex did so become 20 years.55 The image that is embodied in these figures is the sexual complaints which are likely to result from the adult sexual decision that will be taken by adolescents, 56, 57
446

and the possible life changing situations that are likely to result from a sexual encounter. Clearly, the current public health intervention programmes in Jamaica, as well as other geopolitical areas in the world are not reaching adolescents as they are have committed (under the ICPD 1994), and by extension have failed to reduce the lowering of age of first sexual intercourse. With the factors which emerged from the current paper as accounting for age at first sexual intercourse, as well as those from other studies,
58-60

like McGrath and colleagues,

61

we believe that a

multisectoral approach is needed to address these growing public health and legislative problems – not as a single variable (age at first sexual intercourse) but other factors that are purported in the reviewed studies, 62-64 as well as the evidentiary support of Jamaica. Within the context of lowered age at first sexual intercourse of Jamaican women as well as the association between forced sexual relations and early age of sexual debut, 65 this would be contributing to the current public health problems of teenage pregnancies, high fertility, STIs, increased maternal and child mortality, and psychologically challenged young people as they undergo the difficulty of the experience.66-68 Clearly, this study highlighted the finding that the average age at first sexual debut for Jamaican women (median age was 16.0 years) was lower than that of women in rural South African (median age was 18.5 years)69 and eastern Zimbabwe (median age was 18.5 years).70 A study, using European women ages 16-44, found that the average age of first sexual debut was less than 16 years, and offers little solace for public health practitioners in Jamaica.23 Although South Africa had the highest HIV infection rate in the world69 and an age at first sexual debut lower than that of Jamaican women, public health specialists need to use the current findings to ensure that the premarital sexual relations, inconsistent condom use and STI infections, especially HIV, do not reach the levels of those in South Africa as previous studies have shown
447

the association between age at first sexual intercourse and having an STI.70 The rationale for this prescriptive recommendation for public health specialists is embedded in the association between early sexual debut and sexually transmitted infections as well as evidence which shows that STIs are a gateway to complications such as pelvic inflammatory infections, infertility, ectopic pregnancy, fetal abnormality and HIV/AIDS.70-72 Those are not the only issues of concerns at age at first sexual debut as many studies have shown that gender, illicit drugs, age at menarche, religiosity, area of residence and other factors are associated with this

phenomenon.19,20,22,25,69,70,73 This study concurs with the literature and added more variables such as age at contraceptive use, forced sexual relations, employment status, shared sanitary convenience, area of residence, and marital status, indicating that multi-variables are associated with age at first sexual initiation of Jamaican women.

Conclusion
Public health policies have failed to effectively increase the age at first sexual intercourse for women in Jamaica. This study shows that a multisectorial philosophy to the intervention is needed in order to address the multidimensional nature of the factors which are associated with age at first sexual debut. Sexual intercourse is commonly initiated in the adolescence years, and with the increased risk of sexually transmitted infections, teenage pregnancy and adoption with early sexual initiation, the public health consequences will be dire if they are felt unabated or the age at sexual debut allowed to fall lower than current value. Disclosures The author report no conflict of interest with this work.
448

Disclaimer
The researcher would like to note that while this study used secondary data from the Reproductive Health Survey, none of the errors in this paper should be ascribed to the National Family Planning Board, but to the researcher.

Acknowledgement
The author thank the Data Bank in Sir Arthur Lewis Institute of Social and Economic Studies, the University of the West Indies, Mona, Jamaica for making the dataset (2002 Reproductive Health Survey, RHS) available for use in this study, and the National Family Planning Board for commissioning the survey.

449

References
[1] Jamaica, National Family Planning Board (NFPB). Reproductive Health Survey, 2002. Kingston: NFPB; 2005 [2] Family Care International. Commitments to Sexual and Reproductive Health and Rights for All. Framework for Action. New York, NY: Family Care International; 1995 [3] US Department of Health and Services (2006). Gender Differences in Reproductive Health. Department of Health and Human Services, Centre for Disease Control, USAID and Jamaica National Family Planning Board. [4] Sexual Initiation. American Sexual Behaviour. http://www.newstrategist.com/productdetails/Sex.SamplePgs.pdf (Accessed on April 1, 2010). [5] Miller KS, Clarke LF, Moore JS. Sexual initiation with older male partners and subsequent HIV risk behavior among female adolescents. Family Planning Perspectives; 29, 1997:212-214. [6] Drayton VLC. Contraceptive use among Jamaican teenage mothers. Pan Am H Public Health 2002; 11(3):150-157. [7] Jagdeo T. The dynamics of adolescents fertility in the Caribbean. St. John‘s, Antigua: Caribbean Family Planning Affiliation; 1992. [8] Williamson LM, Parkes A, Wight D, Petticrew M, Hart GJ. Limits to modern contraceptive use among young women in developing countries: A systematic review of qualitative research. Reproductive Health 2009; 6:3 [9] Warren CW, Powell D, Morris L, Jackson J, Hamilton P. Fertility and family planning among young adults in Jamaica. Int Family Planning Perspectives 1988; 14(4):137-141. [10] Eggleston E, Jackson J and Hardee K. Sexual attitudes and behavior among young adolescents in Jamaica. Guttmacher. International Family Planning Perspectives; 25(2), 1999. [11] Henry-Lee A. Women‘s reasons for discontinuing contraceptive use within 12 months: Jamaica. Reproductive Health Matters 2001;9(17):213-220. [12] World Health Organization (WHO). Reproductive health research at WHO: A new beginning. Biennial report 1998-1999. Geneva: WHO; 2000. [13] World Health Organization (WHO). World health statistics, 2009. Geneva: WHO; 2009. [14] Rawlins J. Teenage Pregnancy: A study in three communities in Trinidad and Tobago. Paper presented at the Caribbean Health Research Conference 2007, Jamaica. [15] Jamaica Observer. Study shows Jamaican Girls Encounter Violent Sexual Relationships. Jamaica Observer (15 April 2009). [16] Crawford TV, McGrowder DA, Crawford A. Access to contraception by minors in Jamaica: a public concern. North Am J of Med Sci 2009; 1(5):247-255. [17] Fatusi AO, and Blum, RW. Predictors of early sexual initiation among a nationally representative sample of Nigerian adolescents. BMC Public Health; 8, 2008. [18] Santelli JS, Kaiser J, Hirsch L, Radosh A, Simkin L, Middlestadt S: Initiation of sexual intercourse among middle school adolescents: the influence of psychosocial factors. J Adolesc Health 2004, 34:200-208. [19] Penfold SC, Teijlingen ERV, Tucker JS. Factors associated with self-reported first sexual intercourse in Scottish adolescents. BMC Research Notes 2009; 2:42.

450

[20] Rosenthal DA, Smith AMA, De Visser R. Personal and social factors influencing age at first sexual intercourse. Archives of Social Behavior 1999; 28(4):319-333. [21] Statistical Institute of Jamaica (STATIN). Demographic statistics, 2007. Kingston: STATIN; 2008. [22] Louie KS, de Sanjose S, Diaz M, et al. Early age at first sexual intercourse and early pregnancy are risk factors for cervical cancer in developing countries. Br J Cancer 2009; 100(7):119-7. [23] Population Reference Bureau. Preventing cervical cancer worldwide. Washington, D.C: Population Reference Bureau; 2004. [24] Pan American Health Organization (PAHO). A situational analysis of cervical cancer in Latin American and the Caribbean. Washington, D.C: PAHO; 2004. [25] Kahn JA et al., Mediators of the association between age of first sexual intercourse and subsequent human papillomavirus infection, Pediatrics, 2002, 109(01). [26] Mardh PA, Creatsas G, Guaschino S, et al. Correlation between early sexual debut, and reproductive health and behavioral factors: a multinational European study. Eur J Contracept Reprod Health Care 2000; 5:177-82. [27] Polit DF. Data analysis and statistics from nursing research. Stamford: Appleton & Lange Publisher; 1996. [28] Population Action International. Contraceptive use helps reduce the incidence of abortion. Fact Sheet. Washington DC., Population Action International. [29] Alan Gunmacher Institute. Women and reproductive health in Latin America and the Caribbean. Women, families and the future. NY: The Institute, 1994. [30] Castro MT. Guatemala: Encuesta Nacional de Salud Materno Infantil, 1995. Demographic and Health Survey. MD: Macro International, 1996. [31] Ministry of Foreign Affairs. Sweden‘s International Policy on Sexual and Reproductive Health and Rights. Stockholm: Ministry of Foreign Affairs, Sweden; 2006. [32] Ward M The reproductive and sexual health of Jamaican youth. Advocates for Youth. Washington DC., Advocates for Youth; 2001. [33] McKay A. Adolescent sexual and reproductive health in Canada: A report card in 2004. The Canadian Journal of Human Sexuality; 13(2), 2004:67-81. [34] McNeil P. Coping with teenage pregnancy. In: Morgan O. ed. Health issues in the Caribbean 2005; pp. 51- 57. [35] Rawlins J. Parent-Child interaction and teenage pregnancy. Master of Science Degree Thesis. University of the West Indies, Jamaica; 1981. [36] Cooper D, Dickson K, Blanchard K, et al. Medical abortion: The possibilities for introduction in the public sector in South Africa. Reproductive Health Matters 2005;13:35-43. [37] Bankole A, Oye-Adeniran BA, Singh S, et al. Unwanted pregnancy and induced abortion in Nigeria: causes and consequences. New York: Guttmacher Institute; 2006 [38] Reproductive Health Matters. Consensus statement. Medical abortion: Expanding access to safe abortion and saving women‘s lives. Reproductive Health Matters 2005;13(26):11-12. [39] Jamaica Laws. Offences Against the Person Act, 1973. Kingston: Jamaica Government Printery;1973. [40] Planning Institute of Jamaica (PIOJ), Statistical Institute of Jamaica (STATIN). Jamaica Survey of Living Conditions, 2007. Kingston: PIOJ, STATIN: 2008.
451

Resnick M. Learning to be a man: Culture. 1986.S. [53] Brindis CD et al. [57] Slaymaker. Sex. E. Aneshensel CS. 1991. Journal of Marriage and the Family. J.109–130. Maher. Sexual initiation among adolescent girls and boys: trends and differentials in sub-Saharan Africa. 38:1–10. [56] Woo JST. [46] Upchurch DM. 2001. Bwanika. Intimate Matters: A Historyof Sexuality in America. Sexuality Across the Life Course. [48] Udry JR and Campbell BC. J B.5:571-582. [47] DeLamater J. Todd. Herbison P. BMC Public Health 2008. Age at first sexual intercourse and the timing of marriage and childbirth. 12. Madden PA. 32:41–53. Heath AC. J Adolesc Health 2000. [61] McGrath N. The social control of sexuality. Kasamba. Gender and ethnic differences in the timing of first sexual intercourse. [58] Gupta N. Martin NG. [60] Fatusi AO. Blum R: Influences on adolescents‘ decision to postpone sexual intercourse: a survival analysis of virginity among youths aged 13 to 18 years. Lutalo. in: Rossi AS. and later regrets reported by a birth cohort. DC: Child Trends. coercion. Jamaica: The Univer. Statham DJ. U. pp. The consistency of recall age at first sexual intercourse. Blum RW. Adolescent Sex. 1988. D. The J of Sexual Medicine 2008. 2004. Transm. 30(3):121–127. 7: 263– 290. ed. The transition to adulthood. 2009. Annual Review of Sociology. Age of first sexual intercourse and acculturation: Effects on adult sexual responding. First sexual intercourse: age. [42] Dickson N. and Childbearing:A Review of Recent Evidence. 1981. 1997. Lopman BA. Ireland M.316:39-30. I. NewYork: The Alan Guttmacher Institute. Philadelphia:Temple University Press. Brotto LA. BMJ 1998. Age at first sex and HIV infection in rural Zimbabwe.29:1-7. Kingston: Jamaica Government Printery. 2004. 26:42-48 [44] Chevannes B. [43] Lammers C... et al. [59] Hallett TB. [45] Dunne MP. Lewis JJ. Dangerous Passage: The SocialControl of Sexuality in Women‘s Adolescence. Infect. 1998. Mahy M. University of California. 1995. J of Biosocial Science 1997. Nyirenda M. [51] Hogan DP and Astone NM. Newell M-L. Levey-Storms. 8. Trends in age at first sex in Uganda: evidence from Demographic and Health Survey data and longitudinal cohorts in Masaka and Rakai. San Francisco: Center for Reproductive Health Policy Research. Sex Transm Infect 2009 85: i49-i55 452 . 53(3):719–732. Child Care and Protect Act. Stud Fam Plann 2007. New York: Harper and Row. No. Washington. T. Age at first sex in rural South Africa. [55] Henshaw SK. 1994. 1994. socialization and gender identity in five Caribbean communities. [50] Nathanson CA. Institute for Health Policy Studies. Chicago: University of Chicago Press. [49] D‘Emilio J and Freedman ES. Kingston. Predictors of early sexual initiation among a nationally representative sample of Nigerian adolescents. Getting started on sexual behavior. Silva P. teenage pregnancy statistics. Sucoff CA. Complex Terrain: Charting a Course of Action to Prevent Adolescent Pregnancy..[41] Jamaica Laws. of the West Indies Press. Paul C. 85: i12-i19. Arch Sex Behav 2003. 1991. [52] Miller BC and Heaton TB. [54] Moore KA et al. Family Planning Perspectives. Hosegood V. Contraception. Annual Review of Sociology. Pangan T.

AIDS 2008. Sturm AW. 1:14. Trichomonas vaginalis. Nyirenda M. Newell M-L. Hosegood V. et al. Boler T. Lewis-Gess JK. [68] Majaraj RG. et al. Renwick S. Garnett GP. Nyamukapa CA. Child and Adolescent Psychiatry and Mental Health 2009. The influence of early sexual debut and sexual violence on adolescent pregnancy: A matched case-control study in Jamaica. Hallett T. [65] Baumgartner JN. Zimbabwe. [73] Cremin I. et al. 161:774780. Sex Transm Infect 2009. HIV infection and reproductive health in teenage women orphaned and made vulnerable by AIDS in Zimbabwe. 85(suppl 1):49-55. Henrich C. 2006. 2002: 519-530. Kerndt P. [67] Caminis A. JK. et al. [64] Gregson S. AIDS Care 2005. 2009. [69] McGrath N. 27(6). Ruchkin V. Psychosocial predictors of sexual initiation and high-risk sexual behaviors in early adolescence. Floyd S. 85(Suppl 1):34-40. Predictors of Risky Sexual Behavior in African American Adolescent Girls: Implications for Prevention Interventions. 3:10. Semin Neonatol 2000. Sarett-Cuasay. and African-Americans Emerg Infect Dis 2001. [72] Sorvillo F. Sawyer MK. Nunes P. Ries. 5:255-69. adverse pregnancy outcome and neonatal infection. Sexually transmitted infections. Age at first sex in rural South Africa. 17:785–94. Health risk behaviours among adolescents in the Englishspeaking Caribbean: a review. Tucker H. Morris MK. Guttmacher Institute. Ford CA. K. [71] Moodley P. [70] Kaestle CE. EJ. Measuring trends in age at first sex and age at marriage in Manicaland. Girl power: the impact of girls‘ education on HIV and sexual behaviour. Child and Adolescent Psychiatry and Mental Health 2007. [66] Bachanas PJ. Johannesburg: ActionAid International. Young age at first sexual intercourse and sexual transmitted infections in adolescents and young adults.7:927-32. 35(1).[62] Hargreaves J. et al. Geary CW. Am J Epidemiol 2005. Miller WC. Smith L. From affected to infected? Orphanhood and HIV risk among female adolescents in urban Zimbabwe. Sirl. 453 . Journal of Pediatric Psychology. Halpern CT. Wedderburn M. Mushati P. Machingura A. [63] Birdthistle IJ. HIV. Sex Tansm Infect 2009. 22:759–66.

max age 36 years) 454 . Demographic characteristic of studied population.2 Unemployed (including students) 4143 57.2 Anemia 438 18.4 No 5707 86. 168 n % Characteristic Shared sanitary convenience with other household No 5907 82.3 years) Age at sexual debut median (Range) 16.2 Visiting 1959 27.0 Hepatitis B 6 0.1.0 (0.8 Heart disease 94 4.8 Middle 3079 43. n = 7.0 Currently pregnant Yes 288 4.2 No.3 Not currently in union 1934 27.Table 16.0 Socioeconomic class Lower 1705 23.8 Main source of financial support Partner 4129 57.3 years (9.3 No 985 15.1 Employment status Employed 3025 42.6 Ever been pregnant Yes 5301 84. 14) Years of schooling mean (SD) 13.0 Rural 3945 55.9 Yes 1219 17.4 No 6219 94.0 Pelvic inflammatory disease 125 5.4 Urinary tract infection 800 34.0 Upper 2384 33.0 years (29 years.5 Common-law 1733 24. of pregnancies that resulted in live births median (range) 2.0 Semi-urban 2079 29.6 Other 3039 42.4 Marital status Legally married 1542 21.3 Asthma 587 25.3 Area of residence Urban 1144 16.8 Health conditions Diabetes 284 12.7 Forced to have sex Yes 747 11.0 years (3.0 years) Age mean (SD) 31.

Person with whom respondents had their first sexual relations 455 .1.Figure 16.

8 (2.1) 40 – 44 17.8 (2. P < 0.2 (1.8) 1 SD denotes standard deviation F statistic = 47.Table 16.2. Age cohort of respondents by age at sexual debut Age at sexual debut (in years) Age cohort of respondents (in years) Mean (SD1) 15 – 19 15.6) 20 – 24 16.0) 25 – 29 16.1 (3.2 (2.3.0001 456 .4) 30 – 34 17.1 (2.9) 35 – 39 17.2) 45 – 49 17.0) Sample 16.2 (3.2 (3.

325 -0. n = 5.735 -0.206 .852 .002 0.048 -0.141 .003 0.511 0.0.0.489 0.0.027 .0.364 .069 -0.001 457 .179 0.175 0.560 -0.347 0.8.021 0.001 -0.504 .0.0.452 0.659 0. Multiple linear regression analyses: Explanatory variables of age at first sexual debut.820 .481 0.048 0.Table 16.266 0.856 .732 Explanatory variable Constant Age began using contraceptive method Years of schooling Lower class (reference group) Upper class Forced sexual relations (1= yes) Frequent church attendance (1= once or less per week) Crowding Employment status (1= employed) Age of first menarche Shared sanitary convenience (1=yes) Married or common-law union Urban area (reference group) Rural NA – Not applicable β Coefficient 8.579 0.3.283 0.409 0.377 0.006 0.035 -0.654 0.250 .0.190 R2 NA 0.166 CI (95%) 7.009 0.385 .003 0.147 -0.240 .005 0.0.0.0.315 .903 0.650 0.0.

The majority of participants used some method of contraception (64%).83.70). the number of partners (OR = 1. and to provide information for policymakers. Maureen D.29. reproductive health issues are of critical importance to Jamaica.95-2. Charles.21-1. Introduction This article aims to explore the use of contraceptives among women in Jamaica in order to correct a paucity of information in the academic literature. currently having sex (OR = 2.17 Current use of contraceptive method among women in a middle-income developing country Paul A.35.98-0. The findings are far-reaching and can be used to aid policy formulation and intervention.95). The multivariate analysis suggests that the explanatory variables for the method of contraception used are age (OR = 0.32). This study examines the use of contraceptives among women and the factors that influence these women to use contraceptives. social class (OR = 0.57-2. being in a relationship (OR = 3. 95% CI: 0.02-1. 95% CI: 1. 95% CI: 0. the age at which the women began using a contraceptive (OR = 0. 95% CI: 0.D. public health practitioners and educators.02). 95% CI: 1. 95% CI: 2.98.99.17).98-1. Therefore. being currently pregnant (OR = 0.73-0.00) and crowding (OR = 1.16. 95% CI: 0. 95% CI: 1. Kerr-Campbell & Cynthia G. 95% CI: 1. Christopher A.00-0.85. and (2) the public health 458 .02). The rationales which influence this research are (1) the lack of a comprehensive study on contraceptive use.80-4.01. Bourne.99). the rural-urban dichotomy (OR = 1. Francis Jamaica is a middle income developing country with an increasing population and public resource constraints. The most popular method of contraception was a condom (32%).40.60).

as well as (5) the piecemeal approach to the study of contraceptive use in Jamaica. Their decisionmaking was strongly influenced by friends.2 The use of contraceptives is also related to the length of birth intervals. family and social norms. Some 61% of the women used an unreliable method or no contraceptive at all. The most important forms of support these females received were from partners and parents1. and 27% of the variance in behaviour among women. the provision of personalized care and comfort of the women. coupled with family planning self efficacy. the use of contraceptives is a protective factor against short birth intervals. The mean age of first sexual intercourse has been falling since 1997 and this is coupled with (1) increased contraceptive use. It should be noted that some adolescent and young adult females who engaged in unplanned sexual intercourse underestimated the risk of pregnancy and did not use contraceptives consistently. and (4) increased HIV in the young adult population. The lack of knowledge and inaccessible sources of contraception also influenced the women‘s use of contraceptives. accounted for 65% of the outcome for intent to use oral contraceptives. These are. The most frequent reason reported by these women for non-use of contraceptives in their first sexual intercourse was that it was unplanned. However.concerns which have arisen in the past decade. (3) increased teenage pregnancy. The prevention of pregnancy was deemed to be the responsibility of the women. College women having their first experience of sexual intercourse did so at an older age than men. the information provided.4 A study of women‘s views on family planning services suggests that they find several factors important. the technical quality of care and the organization of the service. (3) increased premarital sexual relations.3 The variables of the theories of planned behaviour. 459 . A review of the literature connecting the length of birth intervals to the use of contraceptives reveals mixed findings. the providers showing empathy and respecting the women‘s autonomy.

the use of contraceptives is low.6 However. it may delay the onset of the disease. which influence its use among religious people shaped by the history and politics of their particular religion. because many women engage in the clandestine use of contraceptives. These women need contraceptive counselling which is tailored to improve their decision-making and choice of contraception. Women with bipolar disorder use contraception sub-optimally. the views of these women sometimes have little influence. The encouragement wives receive from their social networks about the use of contraceptives does not influence the use of contraceptives by their husbands.11 The use of contraceptives among women is not only related to illness but also to religious factors.10 Although knowledge of contraception is high among HIV sero-discordant couples. even with the encouragement of their female friends. dealing with women‘s use of contraceptives. some women who were experiencing domestic violence in their relationship with men stated that violence was not an important factor influencing their use of contraception.9 A review of the studies dealing with oral contraceptives and multiple sclerosis (MS) suggests that the use of oral contraceptives does not increase the risk of MS. On the contrary. This failure occurs because the donor and the policy-makers of the target country define 460 . Religions differ in their dictates about contraception.8 Similarly. Moving from the clinic to their homes. women who are depressed are more likely to choose an ineffective method of contraception. the promotion of reproductive health by the international donor community sometimes does not work. Gender difference is an important factor.7 Illness also influences women‘s use of contraceptives.12 Given the range of factors outlined above.Another important factor is the provider‘s ability and willingness to communicate in the language of the women5.

Ann.1%. the Reproductive Health Survey (RHS) collected data on women ages 15-49 years and men 15-24 years.168 women. Region 2 comprises Portland. and some of the factors that influence them to use these methods of contraception. Thomas and St. St. 14. James. Catherine.8%. The priorities and values of the donors and policy-makers are at odds. representing a response rate of 91. The purpose of this article is to understand the methods of contraception used by Jamaican women. Jamaica is classified into four health regions. with Region 4 being St. The current paper extracted the sample of only women (ages 15-49 years) given the nature of the research. The 2001 Census showed that region 1 comprised 46. Hanover and Westmoreland.reproductive health differently. Stratified random sampling was used to design the sampling frame from which the sample was drawn. St. Manchester and Clarendon. Using the 2001 Census sector (or sampling frame). St. Region 3 is made up of Trelawny.5% of Jamaica. 14 461 . compared to Region 2. EDs). a three-stage sampling design was used. because cultural factors drive contraceptive use away from the expected outcome of the donors13. This was calculated based on probability proportion to size. Region 1 consists of Kingston. Mary and St. Elizabeth. Region 3. St. Stage 1 was the use of a selection frame of 659 enumeration areas (or enumeration districts. 21. The sample was 7. 17.6% and Region 4. The data collection method used in the current paper is outlined below. Methods Since 1997. the National Family Planning Board (NFPB) has been collecting information on women (ages 15-49 years) in Jamaica regarding contraception usage and/or reproductive health. In 2002.8%. Andrew.

7). with each PSU constituting an ED. Stage 3 was the final selection of one eligible female this was done by the interviewer on visiting the household. USA). IL. The previous sampling frame was in need of updating. 2002 and was completed on May 9. and so this was carried out between January 2002 and May 2002. The interviewers administered a 35-page questionnaire.15 To derive accurate tests of statistical significance. we used SUDDAN statistical 462 . pregnancy. variables were entered independently into the model to determine those that should be retained during the final model construction. 2003. in particular sociodemographic variables. The new sampling frame formed the basis upon which the sampling size was computed for the interviewers to use. pregnancy. Pap smears. contraception. Where collinearity existed (r > 0. gynaecological examinations and reasons for choices.Stage 2 saw the clustering of households into primary sampling units (PSUs). who were trained by McFarlane Consultancy to carry out the survey. which in turn consisted of 80 households. Frequencies and means were computed on the basis of sociodemographic characteristics. The data collection began on Saturday. and gynaecological examination. and Pap smear tests done during the same period. Version 16. We also performed χ2 tests to compare associations. The Statistical Institute of Jamaica (STATIN) provided the interviewers and supervisors. Stepwise multiple logistic regressions were used to analyze factors that explained gynaecological examinations undergone in the last 12-month period. health conditions.14 Statistical methods We used the Statistical Packages for the Social Sciences (SPSS) for Windows.0 (SPSS Inc. Chicago. October 26. The data was weighted in order to represent the population of women ages 15 to 49 years in the nation.

Contraceptive method comes from the question ―Are you and your partner currently using a method of contraception? …‖. middle or upper social hierarchy. 463 . are you living as man and wife now with a partner to whom you are not legally married?)‖. Subjective social class is measured from ―In which class do you belong?‖ The options are lower. bathroom and verandah). ―Do you have a visiting partner. Currently having sex is measured from ―Have you had sexual intercourse in the last 30 days?‖ Education is measured from the question ―How many years did you attend school?‖ Marital status is measured from the following question ―Are you legally married now?‖. semi-urban and urban. christenings et cetera). and ―Are you currently single?‖ Age at first sexual intercourse is measured from ―At what age did you have your first intercourse?‖ Gynaecological examination is taken from ―Have you ever had a gynaecological examination?‖ Pregnancy was assessed by ―Are you pregnant now?‖ Religiosity was evaluated from the question ―With what frequency do you attend religious services?‖ The options range from at least once per week to only on special occasions (such as weddings. NC). Research Triangle Park. a more or less steady partner with whom you have sexual relations?‖. and this was adjusted for the survey‘s complex sampling design. Age is the number of years a person is alive up to his/her last birthday (in years).software (Research Triangle Institute. funerals. Measure Crowding is the total number of persons in a dwelling (excluding kitchen. ―Are you living with a common-law partner now? (that is. and if the answer is yes ―Which method of contraception do you use?‖ Age at which began using contraception was taken from ―How old were you when you first used contraception? Area of residence is measured from ―In which area do you reside?‖ The options were rural. that is.

Ki woman is currently in a sexual union i. ASi. Fi. Cwi = f(Ai. and the parameter εi is the model‘s error term. ARi. Ri denotes religiosity of woman i.Analytic Model Using logistic regression. Ki. Mi. GNi means gynaecological examination in the last 12 months. Ni is number of sexual partners of woman i. The variables used in this econometric model are based on the literature as well as the dataset. 464 . Si represents currently having sex (woman i). SSi is social class of woman i. Ui. means employment status of woman i. Wi represents crowding in household of woman i. Pi denotes current pregnancy status of woman i. Fi is forced to have sex (woman i). and this study used Grossman‘s model16 which established the use of econometric analysis to determine the use of health demand. this study seeks to examine factors associated with the method of contraception usage among women in Jamaica. SSi. ASi is age of first sexual intercourse of woman i. GNi. The current research will use the theoretical framework of Grossman‘s econometric analysis to examine factors associated with the method of contraception usage among women ages 15-49 years in Jamaica. Grossman‘s model has been modified and used by many scholars to examine health. Ni. health outcome and other health-related issues. Different social factors influence women‘s choices and their decision to use a method of contraception. Ai is age of woman i. Pi. woman i. Ri. Ti εi) Eqn [1] where Cwi denotes method of conception usage among women i. Mi denotes age of first menstruation of woman i. We will test the hypothesis that the methods of contraception usage among women ages 15-49 years are determined by particular sociodemographic variables (Equation [1]). EDi represents educational level of woman i. Wi. EDi. Ti denotes age at which contraceptive use for woman began i. ARi indicates area of residence of woman i. Si. Ui.

2. Result Table 17. 4. 16.3% had previously been pregnant. 18.168 women ages 15 to 49 years. 9.0 years (SD = 9. Pi. The mean age of the sample was 31. ages 20-24 years. 35-39 years. from the logistic regression analyses. Si. εi) Eqn [2] To make more sense of the function (Equation [2]). Currently.2% at least one abortion and 5. and most of them were currently using a method of contraception (64%). Ti. Wi. ages 40-44 years. Ni.4%.3 years). 13. Ki.3%. The sample was 7. SSi. 16.P is the probability of currently not using a method of contraception.1%.4%. β1-10 means the coefficient of each variable from 1 to 10. we can rewrite it into an equation (Equation [3]): Log (P/1-P) = α + β1Ai + β2SSi + β3ARi + β4Pi + β5Ki + β6Wi + β7Ni + β8 + β9Si + β10Ti + εi Eqn [3] Where P denotes the probability of currently using a method of contraception and 1.8% and ages 45-49 years. Cwi = f(Ai. we can write equation [2] to represent the function that explains the method of contraception for women ages 15-49 years in Jamaica. 30-34 years. The predictive power of the model was tested using the ‗omnibus test of model‘ and Hosmer and Lemeshow‘s17 technique was used to examine the model‘s goodness of fit. ARi.4% at least one stillbirth.2%.4% of the sample was pregnant and 84.1 presents sociodemographic information on the sample. α represents the constant.Using the data to test the hypothesis (Equation [1]). 12. ages 25-29 years. A detailed description of the age cohort of the sample revealed that 13.8% of the women were 15-19 years. Almost 16% had at least one miscarriage. Half of the sample began using a method of contraception at 19 years 465 .

2% reported that they had never done so. 26. Regarding women with a steady partner. diaphragm (4. When the sample 466 .5% indicated that they desired to be pregnant sometime in the future.1%). Of those who responded to the method of contraception. and 57% said they commenced after leaving school. calendar or Billings. 63.1% said that they had done this more than two times in their lives. and injection (10%). 24% provided information on the frequency of use of condoms with this/these person/s: Forty-nine percent of them indicated that they always used a condom. and to this 14. 26. When the respondents were asked ―Are you and your partner currently using a method of contraception or doing something to prevent pregnancy‖. 48% remarked most times. female tubal ligation (10. This question was followed by ―Are you and your partner also using a second method of contraception‖. 44.4%). Almost 62% of the respondents indicated that they had asked their partners to use a condom. Twenty-six percent of the sex workers indicated that they began while they were in school. and 4. Only 2.0%). 6.0% said seldom and 0. Of those with non-steady partners.4%).3%). 0. 5% of women said that they insisted that their partners did not use a condom during sexual intercourse. The methods were withdrawal (65. Twenty-three percent of the respondents indicated that they had had multiple partners. rhythm.(range = 33 years: 11.1%) and other (2. On the other hand. 44).1% claimed most times.4% of the women in the sample were sex workers (being paid for sex – money or goods in exchange for sex).1% of the women reported that they refused to do so. 20.7% said seldom and 23.4% indicated that they always used a condom with their partners. pill (2.8% indicated yes.9% remarked never. it was revealed that most respondents used a condom (62%) followed by the pill (14. and 9.5%.6% indicated yes.

(95% CI: 0.was asked ―Are you and your partner also using a second method at the same time for either sexually transmitted disease prevention or contraception‖. and the results can change with time. Multivariate analyses Table 17.3%). they are 2% less likely to use a method of contraception (OR = 0. and other. eight variables emerged as statistically significant variables of women ages 15-49 years who are currently using a method of contraception. Limitations of the study One of the fundamental limitations of this study is the cross-sectional nature of the data collection.99).6% indicated yes. 95% CI: 0. The older the women become.75.0001.87. although social policy formulation relies on this research 467 . condom (7.3 presents information on frequency of condom use (with a non-steady partner) by age group. Women (ages 15-49) who are in the upper class are 17% less likely to use a method of contraception in reference to those in the lower class (OR = 0.98 – 0. Table 17.2 presents information on particular demographic characteristics of the sample by age group. A cross-sectional study cannot be used to establish causality or predictability. and if they are pregnant they are 99% less likely to use a method of contraception. Hosmer and Lemeshow goodness of fit χ2 = 2. The methods were withdrawal (65.5%). Table 17.730.5% of the sample (Table 17.83. 14.98.5). Hence.5 provides information on factors that explain the method of contraception usage of women ages 15 to 49 years.95). P = 0.4 presents information on frequency of condom use (with a steady partner) by age group. The model had statistically significant predictive power (model χ2 (df = 9) = 1684. Table 17. P-value < 0. and correctly classified 78. Using stepwise logistic regression analyses.94).

which is a very high rate of usage for a developing country. using a sample of 212 respondents from clinics in Montego Bay (Jamaica) who had sexually transmitted infections. 44. Tanzania. age at which individual began using contraception and crowding. 48. Some 5% of the respondents stated that they desired to become pregnant. Almost 60% of the respondents indicated that they had had sex in the last 30 days. whether or not in a sexual union.3% 21 and this increased to 64% in 2007.3% consistently used a condom and 23.9% indicated that they had never used a condom.0%) and 73. Despite those limitations. Norman [22] found that only 19% reported consistently using a condom. the study [23] found that 43% reported using a condom the last time they had sexual intercourse. statistics revealed that the prevalence of women currently using contraceptives in Jamaica was 50. consistency of use among those with a steady partner was relatively low (always. Using data from Kenya.9% of the respondents indicated that they had never had a non-steady partner. subjective social class. number of sexual partners. Current methods of contraception used by the female or her partner were explained by age of respondent. 49. area of residence. and 58% were primarily financially supported by their partner(s). The current paper 468 . In 1997.design. currently having sex (in the last 30 days). Of those who had a non-steady partner. In another research. currently pregnant. policy-makers should be cognizant of the aforementioned issues in designing interventions and strategic frameworks. most times. Discussion The current paper found that although 64% of the sample indicated that they or their partner used a method of contraception. and Trinidad and Tobago.4%. cross-sectional data design is still a good way to collect social science data on a population. The majority of women reported using a contraceptive.

revealed a higher consistency prevalence of condom usage than the aforementioned studies.4% had sexual intercourse.4% of Jamaican women used a condom most times with their current partner. and on average they were having sex with 6. 7. The current work provides information which shows that 21. The reality which emerged from the current research is that a 469 . The assertiveness of the women in asking their men to use a condom is something that should be further encouraged within the national family planning strategy. the mean age of the first sexual intercourse for women between the ages of 15-19 years was 7. and the 62% of the respondents who declared that they asked their partner to use a condom.2 years of age. Although the mean age of the first sexual intercourse was 15. and 75.2 % of them having at least one abortion.4% of adolescents (ages 15-19 years) desired to become pregnant. This low rate of abortion reported is consistent with the relatively high use of contraceptives reported by the women.4% did so with non-steady partner. 51.7% of women between the ages of 15-19 years had been pregnant in the past. rather than joining the moral panic against abortion that sometimes infuses national discussions of family planning.5% of these women experienced a miscarriage and stillbirth. Taking the possibility of underreporting into account.7 years of age. some of them were having it twice a month. the reported low use of abortion as a method of contraception contradicts recent media reports of widespread abortion in Jamaica. and that 8 out of every 10 had been pregnant. and the fierce activism of the church lobby against legalizing abortion. with only 2. 35. Some 21.6 men in 90 days. The present work showed that 1 in every 2 Jamaican woman between the ages of 15-19 years had sexual intercourse in the last 30 days. Furthermore. and showed that almost 92.4% of young women (ages 15-19 years) were forced into having sexual relations.

Regarding women with one steady partner.little over 50% of women are mostly supported financially by their partners. More than half of these participants do not use a condom with multiple partners.24 Despite the relatively high use of contraceptives among the women. further research is required to explore this critically important health issue.4% stated that they always used a condom. It does not cease there. This concurs with the literature which shows high promiscuity.25-27 Less than 50% of the women with multiple partners who responded to the question about condom use indicated that they always used a condom. with some young women engaging in promiscuity. which increases their risk of contracting sexually transmitted infections (STIs). This is not peculiar to Jamaica as it was also found to be the case in Sub-Saharan Africa. which means that the males are still able to determine. but they were having sexual intercourse with multiple partners. contraceptive usage. and the removal of spousal authorization (male) was associated with increased contraceptive usage. Women as young as 7 years of age are having sexual intercourse. There is currently a public health problem as adolescents (ages 15-19 years) had more multiple sexual partners in the last 3 months than other women. premarital sexual activity and high fertility among young adults. which leaves them vulnerable to STIs if their male partner is unfaithful. or veto. as 36 out of every 100 young women (ages 15-19 years) have been pregnant. only 44. A number of young adult women in Jamaica were not only having premarital sexual relations. what emerged from the current work gives rise to many public health and other concerns. since only 24% of the women with multiple partners provided information about condom use. 470 . and 21 out of every 100 adolescents between the ages of 15-19 years are forced into sexual activities. which means that there would be a high fertility rate or prevalence of adoption among these individuals. However.

with the remaining 68% using. knowledge and practice. Embedded in these findings is an explanation 471 .6%). and inconsistent condom usage. Only 32 % of these women used a condom. and 62% of the women asserted that their men used a condom. implants and other methods. emergency contraceptives. tubal ligation. Failure to consistently use a condom exposes one to HIV and/or STIs. HIV serodiscordant couples is a reality. promiscuity. the breakdown of the data between women with steady and unsteady partners indicated that inconsistent condom use is high among Jamaican women. injection.34-37 Economic challenges. More women ages 15-19 years used a method of contraception to avoid being pregnant (64%) than to prevent STIs (14. Embedded in this finding is the disconnect between awareness. exposes many of these individuals to an HIV positive partner. although the overall use of contraceptives among the women was relatively high (64%). as was noted by USAID and other scholars. IUD. among those who are currently using a method of contraception. are among the reasons why women‘s reproductive health issues can be vetoed by males. It is this inconsistent contraceptive usage. and men‘s economic supremacy. It is clear from the current findings that women are exposing themselves to STIs by premarital sexual relations. the rhythm method. there is a greater concern for preventing an unwanted pregnancy than for contracting STIs. the data suggests that among the women who responded about the method of contraception used.28-33 Only 56. in descending order of importance. the withdrawal method. Young women having sex as early as 7 years.Therefore. indicating that contraception is more about preventing pregnancy then STIs. that explains the HIV/AIDs epidemic in Jamaica and other developing countries.1% of the sample stated their choice of contraceptives. in particular condom utilization. and becoming pregnant between 15-19 years. Overall. the pill.

and that poverty retards information on contraceptives and their usage. The lack of material power and economic independence means that some women will find it extremely difficult to dictate. with increased knowledge. this work found that 67.23. the number of young adult-women who are still having unplanned pregnancies is still higher than in 1988. 41 Women who are involved in a relationship are more likely to use a method of contraception. wider access to contraception and increased public health education campaigns. the problems of inconsistent condom usage. as this is often based on the decision of the male partner. and 35. and that a condom is consistently used in sexual intercourse. Henry-Lee38 opined that 34% of pregnancies in Jamaica are planned.40 Warren and his colleagues‘ work was in 1988 and the current research found that 56% of women of the same age had already been pregnant.1% of women ages 20-24 years.7% of those 15-19 years have already been pregnant. Another study found that 80% of adolescent pregnancies39 were unplanned. The public health concern is not only with increased pregnancies among young women. Warren et al. and the disparity between the widespread knowledge of HIV and continued inconsistent condom usage. which reemphasizes the heavy involvement of this age cohort in premarital sexual activities and sometimes promiscuity. Women in urban areas are more likely to use a method of 472 . Despite the difference in years between 1988 and now. opined that 40% of all females aged 14-24 years and 61% of those who are sexually experienced have been pregnant.of why condom usage and other contraceptive methods are inconsistently used by both women and men. insisting that their male partners have an HIV test. It is possible that these women are not ready to get pregnant or they believe their partner may not be ideal for them. the increased incidence of HIV28. but promiscuity. Disaggregating the age cohort (15-24 years).

there is a positive relationship between crowding and use of contraceptives. as a second method among young women. and that 1 in every 50 Caribbean nationals was infected with HIV/AIDS. but there are also some new ones. Jamaica has been struggling with premarital sexual relations and adolescent pregnancy for many decades42 and this continues unabated. the Jamaican Ministry of Health used the Jamaica Reproductive 473 . the younger the age at which the women start to use a method of contraception.43 early sexual relations of women ages 15-19 years. it is useful to encourage the early use of contraceptives. or rural women may be influenced by the culture of having a lot of children to help with agricultural work. promiscuity among women ages 15-19 years. and children may be seen as retirement planning. It is possible that rural women may have a lower level of education. Therefore. given the higher level of poverty in rural areas. and there are not enough professional women in the rural areas compared to urban areas. frequency of sexual relations in a 30-day period and the percentage of women ages 1539 years who want to become pregnant. However. It is possible that these women are not ready to have children. pregnancies and HIV/AIDS infections in the Caribbean and sub-Saharan African nations. the more likely it is that they are using one currently. There is no denying that inconsistent condom use accounts for high fertility. in particular the condom. Similarly. Clearly.18-20 Women currently having sex and those with multiple partners tend to use a method of contraception. Added to the old issues are increased HIV prevalence among young adults. the prevalence of young women who are forced to have sexual relations. the issues are old. Douglas43 opined that the major cause of mortality among women of 15-44 years in the Caribbean is AIDS.contraception than rural women. In contemporary Jamaica. In 2000.

and (6) designing a programme to financially empower those in the lower class. The respondents indicated that they left contraceptive decisions to their partner as ―he looks after me‖.47 In addition to the aforementioned. 93%. 94%). 60% of Jamaican students (ages 15+ years) have had sexual relations. among other data sources.Health Survey for 1997.44 New data indicate that the issues are more diverse than in 1997 and therefore a new policy framework is needed for 2005 and beyond. (4) identifying new areas for contraception inquiry. A multifaceted approach must be taken to address the new realities in Jamaica. as well as to provide the same group with educational empowerment. A study conducted in Mexico City on a group of young females who had unplanned pregnancies emphasized the rationale of financial empowerment in contraceptive decision-making. the new findings should be used to effectively frame policies to address the new realities. and reduce sexually transmitted infections46 and the risk of transmission among young women and men in developing countries. post-secondary. orphans and young people. to write a ‗Strategic Framework for Reproductive Health Programme for 2000-2005‘. and this must include (1) an intervention programme to address the information needs of adolescents. (5) formulation of an intact condom usage campaign. the disadvantaged. (3) a sensitization campaign against male supremacy in vetoing reproductive health choices of females. HIV/AIDS45 and abortions. Wilks et al.‘s findings revealed that 97% of those in the lower social hierarchy have had sexual intercourse. It is an absolute that consistent condom usage can stem the rise in teenage pregnancies. and to make reproductive health services more young people friendly (2) post-intervention surveys to assess the effectiveness of implemented measures. as have 99% of those with primary or lower education level (secondary.48 indicating the males‘ vetoing power in reproductive 474 . compared to 96% of the middle class and 95% of the upper social hierarchy.

suggests that 44% of the women used a condom in the former group and 49% used a condom in the latter group. social class. the rural-urban dichotomy. currently having sex. The most popular method of contraception among the women was condoms. the age at which the women began using a contraceptive. the University of the West Indies. Despite the relatively high use of contraceptives among the women. These explanatory factors are age.health decisions. the number of partners. 475 . a breakdown of the data on women in a steady relationship and women with multiple partners. and the National Family Planning Board for commissioning the survey. Mona. none of the errors in this paper should be ascribed to the National Family Planning Board. There are several explanatory variables for contraceptive use among the women. and the justification for their involvement in women‘s reproductive health matters. being in a relationship. Jamaica for making the dataset (Jamaica Survey of Living Conditions. These findings have implications for the spread of STIs. Conflict of interest The authors have no conflict of interest to report. 2002) available for use in this study. Conclusion The majority of participants used some method of contraception. being currently pregnant. Disclaimer The researchers would like to note that while this study used secondary data from the Reproductive Health Survey. and crowding. but to the researchers. Acknowledgement The authors thank the Data Bank in Sir Arthur Lewis Institute of Social and Economic Studies.

48(3): 462-479. 2009. 40(3):413-429. community milieu. Use of contraceptive methods among women treated for bipolar disorder. Ahmed Y. [8] da Silva Magalhaes PV. 476 . 1972. Darj E. Chiasson MA. Allen S. The demand for health . History. Knowledge. Perspectives on Sexual and Reproductive Health 2009. Stamford: Appleton & Lange Publisher. 1996. Dissertation Abstracts International: Section B: The Sciences and Engineering 2009. Akinlo A. Association between symptoms of depression and contraceptive method choices among low income women at urban reproductive health centers. Studies in Family Planning 2009. Kayitenkore K. Blust S. Journal of the American College Health Association 1975. ethnicity and language. LaVeist TA. Archives of Women‘s Mental Health 2009. Tsui AO. Tyden T. Perspectives on Sexual and Reproductive Health 2009. Koenig MA. Yabiku ST. Oni GO. [14] National Family Planning Board. and Christian-Muslim Differentials in contraceptive use in Sub-Saharan Africa. Data analysis and statistics for nursing research. 40(3): 205214. Correa N. [13] Waller KA. [10] Alonso A. Journal of Family Violence 2010. 24(2):106-111. Men‘s social networks and contraception in Ghana. Myint Y. New York: National Bureau of Economic Research. [9] Garbers S. 41(3): 173-180.References [1] Ekstrand M. [2] Needle RH. Women‘s perspectives on family planning service quality: An exploration of difference by race. 2005. 18 (9):1449-1456. [7] Ogunjuyiqbe Po. [3] Yeakey MP. Tichacek A. Maternal and Child Health Journal 2010. How contraceptive use affects birth intervals: results of a literature review. 2002 (Jamaica). Effective contraceptive use: An exploration of theory-based influences. Reproductive Health Survey. 286 (1): 73-75. Journal of the Scientific Study of Religion 2009. Clark CJ. An illusion of power: Qualitative perspectives on abortion decision-making among teenage women in Sweden. Journal of Women‘s Health. Ramachandran DV. 24(4): 575-585. Journal of the Nuerological Sciences 2009. Oakley D. 69 (12B):7452. Fawcett L. The relationship between first sexual intercourse and ways of handling contraception among college students. Health Education Research 2009. 25(2): 123-130. Chomba E. Violence against women as a factor in unmet need for contraception in Southwest Nigeria. 12(3):183-185. and concerns about contraceptive Methods among sero-discordant couples Rwanda and Zambia. Stephenson R. Larsson M. [16] Grossman M. Karita E. Vwalika B. Tsui AO. [5] Becker D. [11] Grabbe K. [4] Peyman N. Vwalika C. [12] Agadjanian V. Sonenstein FL. Kapczinski F. Understanding policymakers‘ perspectives. Agadjanian V. 41 93): 158165. Tobier N.a theoretical and empirical investigation. Oral contraceptives and the risk of multiple sclerosis: A review of Epidemiologic evidence. Kauer-Sant‘Anna M. [15] Polit DF. 14910:102-109. Journal of Biosocial Science 2008. [6] Avogno W. Kingston: NFPB. use. Creanga AA. KLassen AC.

[17] Homer D. Washington DC: Population Action International.. HIV prevention knowledge base: Emerging areas. Pebley AR.14:584-590. Widyantoro N. Kingston: NFPB. Economic and social survey of Jamaica. HIV prevention for serodiscordant couples. [35]. Garweed. Predictors of consistent condom use: A hierarchical analysis of adults from Kenya. [29] Population Action International (2007). D. STATIN. [18] Planning Institute of Jamaica. Lee. [20] Planning Institute of Jamaica (PIOJ). [21] National Family Planning Board (NFPB)..17(8):999-1002. 2009. Marum E. 2009.com/prevention/knowledgebase. 2007 volume IICountries. Statistical Institute of Jamaica. in Rawlins.12(23):155-165. 1989-2008. [19] Statistical Institute of Jamaica (STATIN). [25] Feyisetan B. Women‘s Health in the EnglishSpeaking Caribbean: The Case of Trinidad and Tobago. Tanzania and Trinidad. Tazhmoye (2006). B.. Studies in Family Planning 1989. (PIOJ). and prevention strategies of HIV-discordant couples in Uganda. AIDS 2008.22(5:617-24. STATIN. A Measure of Survival. Calculating Women‘s Sexual and Reproductive Risk.77(3):339-344. Spousal veto over family planning services. Factors influencing condom use among sexually transmitted infection clinic patients in Montego Bay. [24] Cook RJ. [23] Nnedu ON.2007. et al. Meeting the contraceptive needs of unmarried young people: Attitudes of formal and informal sector providers in Vietiane Municipality.C: PAHO. R. Maine D. Journal of Social and Economic Studies. [30] World Health Organization (WHO). Int J of STD & AIDS. [33] Thomas. Joan and Crawford. Tara (2006). Am J of Public Health 1987. Lemeshow S. et al. Kingston: PIOJ.12(23):29-39. ―Peer initiatives for adolescent reproductive health projects in Indonesia. J. [36] Bunnel R. Campbell-Forrester S. Musinguzi J. [31] Rawlins. 2nd edn. 477 . E. Washington. 1988-2007.448-464. Lao PDR. and Boisson. 2009. H. Journal of Social and Economic Studies. Joan and Crawford. Washington DC. [34] USAID. (2003). Opio A. Tazhmoye (2006). 2006:1-31. 2000. Bunnel R. 1990-2007. Reproductive Health Matters 2004.. McCorvey S.. challenges.2005. Advocates for Youth. et al. [28] Pan American Health Organization (PAHO). [27] Sychareun V. Jamaica Survey of Living Conditions. Wagner.1:45-50. 2003. Cazal-Gamelisky. www. Nassozi J. 1989-2008. Demographic Statistics. Reproductive Health Matters 2004.. John Wiley & Sons Inc. 55(4). New York. 2006:1-31. The Open Reproductive Science J 2008. Premarital sexuality in urban Nigeria. 1989-2007. Health in the Americas. Reproductive Health Survey 2002.aidstarone.1991-2008. Living with discordance: Knowledge. Women‘s Health in the English-Speaking Caribbean: The Case of Trinidad and Tobago.. Kingston: PIOJ. 55(4). Kingston. World health statistics.20(6):343-354. [32] Camara. [26] Hull TH. Hasmi E. (STATIN). Youth Reproductive and Sexual Health in Jamaica. Jamaica. [22] Norman LR. R. pp. HIV transmission risk behavior among HIV-infected adults in Uganda: Results of nationally representative survey. AIDS Care 2005. Geneva: WHO. Applied Logistic Regression. New York: USAID.

2005:pp.[37] Dunkle K. [46] Carey RF. Health issues in the Caribbean. Perspectives on HIV/AIDS in the Caribbean. HIV prevalence and related behaviors among sex workers in Jamaica. BMJ 2008. Cates W. 478 . Kingston: Tropical Medicine Research Institute. [40] Warren DP. Jamaica health and lifestyle survey 2007-8. Morris L. 2000. Kingston: MoH. Access to contraception by minors in Jamaica: a public health concern. McGrowder DA. [41] Duncan J.14 (4):137-141. Tulloch-Reid M. Kingston: Ian Randle. Hamilton P. Drayton VLC. Grant Y.9(17):213-220. Biennial Report 1998-1999. [43] Douglas DL. Rev Panam Salud Publica 2002. Younger N. University of the West Indies. Jackson J. Francis D. Sex Transm Dis 1999. [38] Henry-Lee A. Mona.2000: p. In: Morgan O (ed).26:216-20. Fertility and family planning among young adults in Jamaica. Crawford A. 2008.336(7637):184. [39] Crawford TV. Karita E. Sexually Transmitted Disease 2010. McFarlane S. Strategic framework for reproductive health within the Family Health programme 2000-2005.11(3):150-157. et al. [47] Wilks R. Lytle CD. Stephenson R. Geneva: WHO.1(5):247-255. et al. Contraceptive use among Jamaican teenage mothers. xv-xxi. [48] World Health Organization (WHO). [44] Jamaican Ministry of Health (MoH). [42].37:2183-91. Cyr WH.31. Implications of laboratory tests of condom integrity. New heterosexually transmitted HIV infections in married or cohabiting couples in urban Zambia and Rwanda: An analysis of survey and clinical data. Reproductive Health Matters 2001. Women‘s reasons for discontinuing contraceptive use within 12 months: Jamaica. Are condoms the answer to rising rates of non-HIV sexually transmitted infections? Yes. North Am J of Med Scie 2009. Reproductive health research at WHO: a new beginning. Gebre Y. Int Family Planning Perspectives 1988. [45] Steiner MJ. The Lancet 2008.

0 Semi-urban 2079 29.2 Are of residence Urban 1144 16.0 years (3.8 Middle 3079 43.0 Rural 3945 55.6 No 5707 88.0 Only on special occasions (weddings.8 No 2879 40.4 No 6219 94. 14) (range) Years of schooling mean (SD) 13. mean =15.1. of pregnancies that resulted in live births median 2. 1631 22.8 At least once a month 1368 19.3 No 985 15.1 Less than once a month 861 12.2 Employment status Unemployed 4143 57.2 Visiting 1959 27.8 Employed 3025 42.Table 17.3 Not currently in union 1934 27.0 years) Age mean (SD) 31. n = 7.3 years (9. Sociodemographic characteristic of sample.2 No.49).3 years) Age of first sexual intercourse median (range) 17.0 (0.8 No 2282 36.4 Currently having sex (in the last 30 days) Yes 4289 59.0 Socioeconomic class Lower 1705 23.2 yrs (SD =5.0 Currently pregnant Yes 288 4.0 (15.6 Ever been pregnant Yes 5301 84.5 Common-law 1733 24.0 Upper 2384 33.1 Marital status Legally married 1542 21.168 n % Characteristic Religiosity At least once a week 2707 37.7 christening) Does not attend at all 524 7.7 Forced to have sex Yes 747 11.3 No response 77 1.8) 479 .2 Currently using a method of contraception Yes 4027 63. funerals.

P <0.0 (3. P <0.001 χ2 = 11.8 66.8.9 (8.9) 3.4 18.6.2 (3.1 95.3) 1.2) 6.7) 1.5.2) 2.6 83.4) 3.5 (6. P <0.4 21.Table 17.9 61.7 (11. P < 0.8 62.5 (6.071 9.6 36.8.4 51.5.0 (3.9) 17. P < 0.7 67.9) 19.8 (8.2) 1.7 (4.8 66.4 91.001 χ2 = 2497.5 19.2) 1.7) 21.6 (21. P = 0.4) 20.0 (9.3 93.8 21.1 18.0 69.126 Age group Characteristic 15-19 yrs 20-24 yrs 25-29 yrs 30-34 yrs 35-39 yrs % % % % % Currently pregnant Yes Ever been pregnant Yes Forced to have sex Yes Currently having sex (in the last 30 days) Yes Currently using a method of contraception Yes Want to be pregnant Yes Ever had sexual intercourse Yes Age at first sexual intercourse mean (SD) in years Frequency of sexual intercourse in last 30 days Mean (SD) No. of men had sexual intercourse with (in last 3 months) Age at first contraceptive use (in years) P 40-44 yrs % 0.6 (4.2 64.4) 15.2.0001 F = 198.6.8 99.7) 2.2 (13.0 97.1 (9.4 51.001 F = 11416.6 19.2) 1. P < 0.4) 20.001 χ2 = 75.0001 480 .1 66.4 16.2 (13.001 χ2 = 1289.1.0 17.9 64.9 (4.1.1 23.0001 F = 0.7 (11.1 96.9 94. P < 0.9 7.3 (4.5 (6.6) 45-49 yrs % 0.9 18. P < 0.3 67.1 (13.1 64.001 χ2 = 37. n= 7.2 53.0 17.1 (5.7.0001 F = 5.7 (7.5 31.9 56.9 (1. P < 0.0) 5.3) 2. Particular demographic characteristics by age group of respondents.0 71.9 11.6.2 100.4) 5. P <0.5 (6.7 21.4 (4.7 35.3) 6.7.3 35.5) 3.2 (3.7 15.8 (2.0) 2.9) 22.5) χ2 = 92.6 99.8 (5.8 16.6 98.3) χ2 = 111.8) 1.8 15.4 7.6) 3.

0 7.2 6.9 1748 Total 481 .2 5.2 332 % 14.4 338 % 10.0 6.9 72.5 0.9 6.6 0.9 77.2 73.9 0.3: Frequency of condom use (with non-steady partner) by age group.0 3.Table 17.4 8.0 0.644 15-19 yrs 20-24 yrs 25-29 yrs 30-34 yrs 35-39 yrs 40-44 yrs 45-49 yrs % 11.3 229 % 13.3 0.9 0. n = 1.2 0.7 266 % 12.9 175 % 9. P = 0.8 7.3 70. n χ2 = 20.3 6.3 85 12.0 5.6 6.3 74.8 323 % 14.9 6.9 76.5 4.0 6.1 75.9.748 Age group Frequency of condom usage Always Most of the time Seldom Never Never had non-steady partner Total.5 73.0 7.8 0.6 9.

1 0.8 38.0 1767 482 .9 5.0 6.7 0.4 273 40-44 yrs % 54.7 0.4 0.3 0.6 343 % 43.0 0. P < 0.6 0.7 8.Table 17.4 48.2 1.0001 15-19 yrs 20-24 yrs 25-29 yrs 30-34 yrs 35-39 yrs % 49.0 48.7 0. n = 1.0 0.8 0.0 86 Total % 44.4 5.9 54.9 332 % 41.5 8.3: Frequency of condom use (with steady partner) by age group. n χ2 = 63.2 5.2 38.3 231 % 38.5 49.3 323 % 42.767 Age group Frequency of condom use Always Most of the time Seldom Never Never no steady partner Total.3 0.4 0.6.4 43.4: Table 17.5 0.5 6.2 50.0 0.7 2.6 179 45-49 yrs % 55.0 4.

001 483 .80 .00 .5% Correct classification of cases that currently use a method of contraception = 91.60 R2 0.8% Correct classification of cases that are not currently using a method of contraception = 54.98 .99** 1.75 P-value < 0.158 0.32 0.005 2Log likelihood = 5588.4*** CI (95%) 0.01*** 2.95 2.95 .114 0.83** 3.5.29*** 1.85*** 0.4. Logistic regression: Explanatory variables on method of contraception usage of women (ages 15 – 49 years) in Jamaica.1.0.05.2.00 0.0. **P < 0.02 1.006 0.358 Model χ2 (df = 9) = 1684.02 .98 .0001 Overall correct classification = 78.02 1.002 0.034 0.00 1.00 1.35*** 1. ***P < 0.002 0.73 .99 0.98*** 1.001 0.2% *P < 0.17 0.57 .70 1.01.16* 0. n = 6.1.043 Explanatory variable Age Lower class (reference group) Upper class In union Urban (reference group) Rural Currently pregnant Currently having sex Number of partners Age at which began using contraception Crowding Odds ratio 0.036 0.2.0.21 – 1.0 R2 = 0.Table 17.

5 years older than them. age when the person began using contraception and age of person with whom they first had sexual intercourse.06 – 24. 95% CI = 0.38). (2) the socio-demographic characteristics of the study population.09. The early initiation of adolescent females into commercial sex work cannot be left unaddressed as the prevalence rate is high.02 – 0. and other negative terminologies.36). age at first sexual intercourse (OR = 0.18 Females with multiple sexual partners and their reproductive health matters: A comprehensive analysis of women aged 15-49 years in a developing nation For millennia. 95% CI = 1. females with multiple sexual partners have been called names including whores. sexually promiscuous. 484 . alleviate and rectify such a practice by many school aged females. prostitutes.21). (4) the prevalence of those who were sexually assaulted. However. Currently using a method of contraception can be explained by social class (middle class. On average females’ first sexual encounter was with males at least 9. Odds ratio (OR) = 0. (5) the age cohort of females who were raped. OR = 0. 95% CI = 0. years of schooling.59).08. Serious efforts are needed to comprehend. and (6) factors which account for current contraceptive usage. age of first intercourse. 95% CI = 0. Fifty-seven percent of the study population had more than 11 sexual partners. (3) any associations between age of respondent.68 – 1. OR = 5. and marital status (married or common-law. there is a gap in the literature regarding their comprehensive reproductive health matters.90. The aims of the current paper are to elucidate (1) the reproductive health matters of females who have multiple sexual partners. employment status (employed.01 – 0.07. age of menarche.

Introduction For millennia. females with multiple sexual partners have been called names including whores. sexually promiscuous. It is well established that sexual promiscuity. they must first understand the cohort in question. The reality is that people who are promiscuous and infrequently use condoms have a greater probability of contracting sexually transmitted infections. teenage pregnancies and abortions in the developing world [1-8]. according to Wilks et al. Before public health practitioners can commence any elaborate health intervention programmes to address the reproductive health matters of a population or a sub-population. Unlike some disciplines which are more concerned about the social behaviour of this cohort. prostitutes. in particular HIV/AIDS and the human papillomavirus (HPV) [9]. needs a comprehensive knowledge of the reproductive health matters of all individuals. Studies which have examined commercial sex workers [10-12] are not the same as an inquiry into the health status. there are people who do not exchange sexual favours for money or any other transferable commodity. Irrespective of the social construction that is used to label these individuals. in seeking to promote a healthy lifestyle. public health. a sub-set of those with multiple sexual partners and not the other way around. health care-seeking behaviour and reproductive health matters of those with multiple sex partners. A commercial sex worker is. In 2007/08. and other negative terminologies. While a commercial sex worker has multiple sexual partners. low condom usage and early sexual initiation account for some of the increase in HIV/AIDS. using a sample 485 . [13]. This provides a rationale for the importance of understanding those who have multiple sexual partners (commercial or otherwise). they do exist and must be planned for among the female population. therefore. the reality is.

[13] found that more females of ages 15-24 years had multiple sexual partners (15. In Kenya in 1999 it was estimated that 6. While there were no statistics on the prevalence of commercial sex workers in Jamaica.of 2. 8.848 randomly sampled Jamaicans aged 15-74 years.9% of women nationally were engaged in commercial sex activities (exchanging sex for money. factors associated with the odds of having multiple sexual partners. However. and violence against these individuals [12.1% of those with multiple sexual partners [13] are commercial sex workers. 2. STIs. 486 .4%. whereas only 25% indicated that they never had sexual relations. Wilks et al.1% indicated having at least 2 sexual partners (females. the rationale for multiple sexual partners and the increased risk of contracting human papillomavirus [13. unwanted pregnancies [10. males. 4554 years (2.16]. using figures from the Reproductive Health Survey for 2002.6%).1%). 17-20]. risk factors. HIV/AIDS.0%). 35-44 years (6.2%). While the aforementioned information provides pertinent material that can be used to understand promiscuity in females at a particular age cohort. they found that 24. gifts or favours).15]. suggesting the potency of more information.2%) compared to females aged 25-34 years (11. in particular condom usage. and that 41% of young females (ages 15-24 years) were reporting having sex once per week.2% of Jamaican women aged 15-49 years were involved in the commercial sex trade [14].12. Studies which have examined commercial sex workers have researched reproductive health matters. ever having had sexual intercourse. 55-64 years (1.0%) and 65-74 years (0. there are substantially more females who have had multiple sexual partners compared to those who are engaged in the commercial sex trade.6%). not all of the 24. The literature showed that studies on females with multiple sexual partners have limited their inquiry to age and gender composition. Clearly. reproductive health goes beyond this. 41.

In 2002. years of schooling. Methods The current paper extracted a sample of 225 respondents who indicated having had multiple sex partners. The only inclusion/exclusion criterion for this study was having two or more sexual partners. age of menarche. (2) sociodemographic characteristics of the study population. 2002 conducted by the National Family Planning Board. the Reproductive Health Survey (RHS) collected data on women ages 15-49 years and men 15-24 years. and this research seeks to fill the void. (5) age cohort of females who were raped. therefore. the National Family Planning Board (NFPB) has been collecting information on women (ages 15-49 years) in Jamaica regarding contraception usage and/or reproductive health. and (6) factors which account for current contraceptive usage. (4) prevalence of those who were sexually assaulted. age of first intercourse. and (6) factors which account for current method of contraception. There is. (3) associations between age of respondent. Since 1997.The empirical evidence on females with multiple sexual partners has omitted in a single study the (1) reproductive health matters of females who have multiple sexual partners. The aims of the current paper are to elucidate (1) reproductive health matters of females who have multiple sexual partners. The current paper extracted the sample of only 487 . age of first intercourse. We used data from the Reproductive Health Survey. years of schooling. age of menarche. (4) prevalence of those who were sexually assaulted. (3) associations between age of respondent. (2) socio-demographic characteristics of the study population. age when the person began using contraception and age of person with whom they first had sexual intercourse. age when the person began using contraception and age of person with whom they first had sexual intercourse. (5) age cohort of females who were raped. a gap in the literature.

October 26. a three-stage sampling design was used. 2003. The new sampling frame formed the basis upon which the sampling size was computed for the interviewers to use. St. Stage 1 was the use of a selection frame of 659 enumeration areas (or enumeration districts. Manchester and Clarendon. compared to Region 2. Hanover and Westmoreland. The data was weighted in order to represent the population of women ages 15 to 49 years in the nation [14].women (ages 15-49 years) given the nature of the research. which in turn consisted of 80 households. St. Region 1 consists of Kingston. Andrew. This was calculated based on probability proportion to size. Ann. 17. with each PSU constituting an ED. who were trained by McFarlane Consultancy to carry out the survey. Region 3 is made up of Trelawny. and so this was carried out between January 2002 and May 2002. and this was done by the interviewer on visiting the household. St. The data collection began on Saturday. with Region 4 being St. Stage 3 was the final selection of one eligible female. 14. The 2001 Census showed that region 1 comprised 46. Stratified random sampling was used to design the sampling frame from which the sample was drawn. The interviewers administered a 35-page questionnaire. The Statistical Institute of Jamaica (STATIN) provided the interviewers and supervisors. Stage 2 saw the clustering of households into primary sampling units (PSUs). Region 3.168 women. The previous sampling frame was in need of updating. representing a response rate of 91.8%. 488 . EDs). St. The sample was 7. Jamaica is classified into four health regions. 21. Mary and St.5% of Jamaica.1%. Thomas and St. Catherine. Using the 2001 Census sector (or sampling frame). James. Region 2 comprises Portland. Elizabeth.6% and Region 4.8% [14]. 2002 and was completed on May 9.

We also performed χ2 tests to compare associations in non-metric variables and Pearson‘s Product Moment Correlation for metric variables. and other variables. Contraceptive method comes from the question ―Are you and your partner currently using a method of contraception? …‖. Where collinearity existed (r > 0. USA). and this was adjusted for the survey‘s complex sampling design. ―Are you living with a common-law partner now? 489 . Frequencies and means were computed on the basis of sociodemographic characteristics. NC). To derive accurate tests of statistical significance. we used SUDDAN statistical software (Research Triangle Institute. Measures Crowding is the total number of persons in a dwelling (excluding kitchen. Chicago. Research Triangle Park. semi-urban and urban. variables were entered independently into the model to determine those that should be retained during the final model construction [21]. Multiple logistic regressions were used to analyze factors that explained current method of contraception. Age is the number of years a person is alive up to his/her last birthday (in years). bathroom and verandah). IL.Statistical methods We used the Statistical Packages for the Social Sciences (SPSS) for Windows.7).0 (SPSS Inc. Currently having sex is measured from ―Have you had sexual intercourse in the last 30 days?‖ Education is measured from the question ―How many years did you attend school?‖ Marital status is measured from the following question ―Are you legally married now?‖. and if the answer is yes ―Which method of contraception do you use?‖ Age at which the person began using contraception was taken from ―How old were you when you first used contraception? Area of residence is measured from ―In which area do you reside?‖ The options were rural. Version 16.

490 . middle or upper social hierarchy. are you living as man and wife now with a partner to whom you are not legally married?)‖. that is. funerals.1). Figure 18. Grossman‘s model has been modified and used by many scholars to examine health.8% of those with 4 sexual partners. Results A significant statistical association existed between number of sexual partners and commercial sexual encounter (χ2 = 39. Subjective social class is measured from ―In which class do you belong?‖ The options are lower.0001. 3.1 shows that 69. and this study used Grossman‘s model [22] which established the use of econometric analysis to determine the use of health demand. this study seeks to examine factors associated with the method of contraception usage among females with multiple sexual partners in Jamaica. health outcome and other health-related issues.2% of females with 2 sexual partners were paid for the sexual encounter compared to 11. Figure 18.4. ―Do you have a visiting partner. christenings et cetera).(that is.5% of those with 3 sexual partners. and 11. P < 0. Analytic Model Using logistic regression. Different social factors influence women‘s choices and their decision to use a method of contraception. and ―Are you currently single?‖ Age at first sexual intercourse is measured from ―At what age did you have your first intercourse?‖ Gynaecological examination is taken from ―Have you ever had a gynaecological examination?‖ Pregnancy was assessed by ―Are you pregnant now?‖ Religiosity was evaluated from the question ―With what frequency do you attend religious services?‖ The options range from at least once per week to only on special occasions (such as weddings. a more or less steady partner with whom you have sexual relations?‖.5% of those with 11+ sexual partners.

14.8% were in rural areas (χ2 = 13.1 shows that on average females‘ first sexual encounter was with males at least 9.3% of the currently sexually active females used a condom the last time (χ2 = 34. P < 0.5 years older than them. Almost 29% of the sample indicated that they had been sexually assaulted during their lifetime. Table 18. 46% reported after leaving school and 23% remarked both. while 51% indicated that they were sexually assaulted on their first sexual encounter.4% ages 2529 years. Almost 33% of the study population was 15-24 years of age. 8.8% were in semi-urban areas and 65. 31% indicated during school. and 19. 16% between 610 times.The socio-demographic characteristics of the study population are presented in Table 18. 32% had done this between 2-5 times. Of the 54% of the respondents who indicated being currently sexually active (in the last 30 days).09. 20. Half of the commercial sex workers indicated that they had been sexually assaulted. Table 18. P < 491 .2 presents information on the number of sexual partners. and 44% at least 11 times.7% aged 40-44 years and 4.1. compared to 16. 10.76. 25. When the commercial sex workers were asked when they began this activity. Of those who had indicated being commercial sex workers. P = 0. 48.2% stated they were sexually assaulted on their first sexual encounter. and condom usage was relatively inconsistent.9% ages 30-34 years. There was no significant statistical association between age cohort of study population and those who reported being forced (or not forced) to have sexual intercourse (χ2 = 16.5% were in urban zones. Furthermore.3. Fifty-seven percent of the study population had more than 11 sexual partners.001).0001). condom usage and frequency of condom usage with steady and non-steady partners.2% ages 35-39 years.9% aged 45-49 years.

7% were commercial sex workers. OR = 5. 23.3 presents information on age of respondent. and marital status (married or common-law. OR = 0. 12.1%. 21. information can be provided on those who indicated being sexually assaulted by age cohort: 15-19 years. P = 0.90. 492 . and 11. years of schooling.021). 3. 11.4% had done a Pap smear. and 44-49 years.09. The model had statistically significant predictive power (model (Chi-square (17) = 30. P < 0. Hosmer and Lemeshow goodness of fit test. 12.68 – 1.38). 12. Table 18.1%. four variables emerged as statistically significant factors of method of contraception. 95% CI = 0.3%. employment status (employed. 95% CI = 0.3% of the sample.03 – 0. Based on Table 18.80).1%. age when the person began using contraception and age of person with whom they had their first sexual intercourse.0. Method of contraception can be accounted for by social class (lower class.2% of method of contraception among those who indicated having multiple sexual partners. a positive statistical correlation existed between age of respondent and age of person with whom the individual had their first sexual intercourse (r = 0. 95% CI = 0. age at first sexual intercourse (OR = 0.07.1%.4 presents information on possible factors which account for using a method of contraception.01.28. age of first intercourse. 95% CI = 1.15). 25-29 years.2%.79.3.02 – 0. χ2 = 4. Using logistic regression analyses. P = 0. 30-34 years. Four factors account for 34. age of menarche. However. 27.06 – 24.32.6% reported having a pelvic or urinary tract infection. and correctly classified 97. Almost 17% of the sample shared sanitary conveniences. Multivariate analyses Table 18.36).0%. Odds ratio (OR) = 0. 35-39 years.60).177). 12. 20-24 years.21). 40-44 years.

among those with post-secondary education. forecast. female sexual promiscuity is higher in rural areas. Discussion This study revealed that sexual promiscuity is associated with the risk of sexual violence as 29 out of every 100 females who had multiple sexual partners were sexually assaulted and the figure is as high as 1 in every 2 among those who are commercial sex workers. establish trends and causality.8% were in semi-urban areas and 65.7 times more likely than lower class women to have multiple sexual partners. 48. Almost 12% of sexually promiscuous female Jamaicans were commercial sex workers. Method of contraception can be accounted 493 . however. Using a nationally representative crosssectional data denotes that the work can be used to generalize about the population of females who indicated having multiple sexual partners (2+). and was extracted from a cross-sectional survey.3% of the currently sexually active females used a condom the last time. 8.Limitations of study This study examines females with multiple sexual partners and their reproductive health matters. middle class. middle class women were 1.7 times more than urban women compared to rural women. Continuing. rural women were 1.5% were in urban zones. Three out of every 4 women in the sample were middle-to-upper class respondents.8% were in rural areas. it cannot be used to make predictions. 25. Furthermore. and those in visiting unions.9 times more likely than semi-urban women to have multiple sexual partners and this was 3. Of the 54% of respondents who indicated being currently sexually active (in last 30 days). There is a high level of inconsistent condom usage among the sample with a non-steady partner compared to their steady sexual partners.

Hence.2% of the females aged 1549 years in Jamaica [37]. STIs.for by social class. this justifies the present work which found an inverse statistical association between age of sexual debut and method of contraception. A study by Eversley and Newstetter [23] found that ―…females who are exposed to multiple partners do have a significantly higher 494 . employment status. and cost of caring for high school dropouts.6% compared to 56% among females with steady partners and 46% among those with non-steady partners. suggesting that the percentage of females with multiple sexual partners in this research is less than that observed in female undergraduate students in China (5. Inconsistent condom usage among female undergraduate students with multiple sexual partners was 38. female Jamaicans were having first coitus almost 3 years earlier than Chinese undergraduate women [17]. This means that women who become engaged in later sexual activities are more likely to involved less risky sexual practices. However. age at first sexual intercourse. and that encouraging later sexual debut will reduce fertility. Another difference which emerged in the comparison was inconsistent condom usage. The high percentage of inconsistent condom usage among promiscuous females demonstrates that need for urgent public health intervention to address the pending public health problems which may surface from the current realities. There were clear dissimilarities between the survey of female undergraduate students in China and the current paper. The risk behaviour among females in this research highlights the fact that policy-makers need to use the empirical evidence provided herein to formulate preventative strategies targeted at this group. The percentage of the current paper population represents 3. and marital status (married or common-law).31%) [17].

particularly Jamaica [10]. early sexual initiation among Jamaican females accounts for the multiple sexual relationships. but not limited to the individual. males who initiate sexual intercourse with adolescent females were about 10 years older. which opens these vulnerable females to various sexually transmitted infections. In this study. So they are not only older and sexually more experienced. and the human papillomavirus (HPV) [9]. who offer material resources to these vulnerable individuals.. Within the context of this study. Clearly embedded in the findings of the current research is the high rate of sexual violence against women in commercial sex work. and this extends to the wider society [20]. sexually transmitted infections. It is this reality which public health practitioners must evaluate when deciding not to immediately address future public health problems associated with multiple sexual partners. Sexual violence against women commenced with forced sexual encounters during their adolescent years by older men. females with multiple sexual partners. The costs of sexually transmitted infections are enormous. it follows that many adolescent females would be 10% less likely to use a method of protection against sexually transmitted infection. Thus.chance of encountering a male in a high risk category.‖ which speaks to a justification for the high HIV/AIDS prevalence in the developing nations. sexual violence. in particular HIV/AIDS. The socio-economic challenges faced by many Jamaica.. include how to avoid the temptations of being lured by sexual predators. in particular those who are poor. and this within the context of the increasing HIV/AIDs means that adolescent promiscuity must be lowered. but they have more material resources compared to the adolescent females. early sexual initiation. and to a lesser extent. 495 . and sexual promiscuity. which found an inverse association between age at first sexual encounter and method of contraception use.

The poor are held in a vicious cycle 496 . and (4) economic challenges faced by many families. illicit drug use or any other factors [20]. Whether it is early sexual initiation. therefore. Previous studies have established a direct association between education and health status. One of the findings which emerged from this work is the percentage of females who commence commercial sex work during school. Early sexual initiation. With sexual initiation beginning during adolescent years. the reality in Jamaica is that 33 out of every 100 females who indicated having multiple sexual partners were between 15 and 24 years (16 out of every 100 aged 15-19 years). and so despite one‘s willingness. many realities are circumvented. multiple sexual partners are the outcome in our day. during the encounter for adolescents. With the high percentage of commercial sex workers who commence their craft during school. byproducts of socio-economic ills of the Jamaican society.altered. Beside the evident enjoyment from the sexual coitus. and other factors and health [24-35]. (3) social decay in the general society. the economic hardship of females in Jamaica is eroding this reality. [20]. (2) sex traders recruiting school girls. 3 in every 10 commercial sex workers in Jamaica admitted that this began during school years. which speaks to (1) the social pressure of peer groups in regard to sexual initiation. and discouraged. and most of the individuals resided in rural area. this speaks to the economic cost of survivability and how it plays a role in influencing adolescents in such activities. with post-secondary education. and even though education opens possible opportunities for the recipient. Poverty hampers economic freedom and choice. multiple sexual partners and sexual promiscuity are. Based on the findings. they must be made aware of the risk factors associated with multiple sexual partners and promiscuity.

although they receive gifts. a part of the survivability strategy of females is to rely on males for financial support. which along with unemployment is higher in rural Jamaica. the economic difficulty is accounting for rural females having many sexual partners. sees more multiple sex partners in those zones. Furthermore. creating sexual promiscuity as can be demonstrated by the current findings. Poverty does not only have an impact on illness. With the reality that the prevalence rate of poverty.1 times more likely to use a method of contraception. Economic deprivation is. married women or females in common-law unions were 91% less likely to use a method of contraception as against leaving it up to the male to make the decision. Still. 497 . Statistics showed that unemployment among females is greater than that for males [37]. and with the context that poverty is greater for the former group than the latter and among rural residents [36]. males who have economic power. for being with males in a sexual relationship. Thus. some of these females. because they do not want the males to withdraw the needed material and other forms of support. unemployed females give males vetoing power over reproductive health. it causes pre-mature deaths. money. Previous studies have established that there is a statistical association between poverty and illness [38-43]. [36]. it is not construed as commercial sex work.of continuous poverty. since 1990. as this is in keeping with the needed assistance. This research found that employed females with multiple sexual partners were 5. are more likely to be employed and receive greater emoluments. therefore. In this work. material items and other articles. It should not be surprising that poverty. is at least twice as high in rural as in urban areas. are still able to wield this power. It is the opportunity cost of his economic provision for the household. even over their spouses. and on the onset of health conditions poverty could extend to the family.

and syphilis. is having multiple sex partners.48). which often deepen poverty and damage long term economic prospects‖ [44]. low development. the price of poverty is not the same as contracting some sexually transmitted infections such as gonorrhea. and with the reality that poverty affects mortality. in particular rural dwellers. high rates of pregnancy and social degradation of the community [44]. and this is more the case among adolescents.lower quality of life. the alleviation from poverty for females.51). Chlamydia. not seeking medical care (in %) and prevalence of poverty (in %. Another by-product of poverty is multiple partner relationships. While some sexually transmitted infections can be fatal. The WHO [44] opined that 80% of chronic illnesses were in low and middle income countries. Although the individual does not compute the cost of promiscuity in this manner. People have a desire to live. the consequences can be devastating for the individual as well as the society. When poverty is coalesced with unemployment. the burden of escaping poverty is such that the consequences of certain actions are sometimes not considered. 498 . a moderate and direct correlation existed between the prevalence of poverty (in %) and unemployment (R2 = 0. which points to a high condom usage among the study population. as females use these to reduce the cost of unemployment. According to Bourne [45]. and the prevalence of poverty and mortality (R2 = 0..58). The WHO captures this aptly ―. the use of a condom reduces this probability. poverty and material deprivation. lower life (and unhealthy life) expectancy. While multiple sexual relations increase the risk of sexually transmitted infections. R2 = 0.. and the direct association between poverty and unemployment.People who are already poor are the most likely to suffer financially from chronic diseases. suggesting that illness interfaces with poverty and other socio-economic challenges.

Embedded in those finding is the incapacitating power of economic dependency over women sexual freedom and autonomy.Outside of the aforementioned issues on women aged 15-49 years who indicated having multiple sexual partners. Ojanlatva and Essen‘s research that social factors are related with contraceptive use. Married women. changes the dynamics of contraceptive use and opens an avenue of risky sexual practices as some of those who are engaged in sexual promiscuity are married women. the present findings highlight that changes in women conditions to life (employment. Ojanlatva and Essen [46]. This research showed that four social factors account for 34. 499 . lower subjective social status and age at first sexual debut negatively associated with reduced method of contraception. the current paper highlights some variables which account for their contraceptive use. women in the lower socioeconomic status were 68% less likely to use a method of contraception in reference to those in the wealthy stratum. which concurs with previous studies [46-49]. Again. Thus. 18 out of every 25 women aged 15-49 years old who had multiple sexual partners used a method of contraception. particularly marriage. and that those who were employed were 5. married respondents) contributed the most to the reduction in contraceptive use. And that marital status (ie. Like a study done by Degni.2% of choice of using a method of contraception. it showed that only employment status positively influences increased contraceptive use. In this study. While the current work concurs with Degni. a stable union. and this study examined factors which account for this choice. marital and subjective social statuses) influence contraceptive use (or non-use). mainly from changes to their life status [46].1 times more likely to use a method of contraception. and how money and economic opportunities influence choices over their reproductive health matters.

However. None of those social factors were found to be associated with positive contraceptive use among the current sample. and different explanation for increased contraceptive use among women of the reproductive years who are engaged in multiple sexual partnerships.17). While those in the present sample were more likely to use a method of contraception (20 out of every 25) compared with women of the reproductive ages (17 out of every 25).73–0. those in the poor income class were 17% less likely to use a method of contraception. (2) number of living children. Clearly. Bourne et al. and (4) place of residence positively affect their contraceptive use. While married women who are engaged in multiple sexual partnerships were less likely to use a method of contraception in the current paper. [49]. which examined the effect of selected socio-cultural and supply factors on contraceptive use as reported by married women of reproductive ages found that (1) woman‘s age. another research using data from the Pakistan Demographic and Health Survey of 1990-91. poverty is a retarding factor influencing contraceptive use of women aged 15-49 years who indicated having multiple partnerships compared to general population of women aged 15-49 years. educational level was not statistical associated with contraceptive use which is contrary to previous studies [47.83. 95% CI: 1.95).57–2. 95% CI: 0. According to Bourne et al. while this work found that women in the same socioeconomic 500 . 50]. women with multiple sexual partners were about two times more likely to use a method of contraception (OR = 1.Previous studies have established that the education of the wife [47] or the women‘s education level and their husbands' level of education [50] as having an effect on contraceptive use. disaggregating the former group provides invaluable information on those in promiscuous relationships.85. [49]. Using a sample of national probability sample of Jamaican women in the reproductive ages. that those in the lower socioeconomic stratum were 17% less likely to do so (OR = 0. (3) education.

It can be deduced from the aforementioned findings that women in multiple sexual relationships who infrequently used a condom is highly exposed to more disease causing pathogens. It can be extrapolated from the findings that poverty will cripple good sexual practices. measures would be overstating needed approaches for among women in steady sexual unions. A previous study found that ―…inconsistent pill or condom use was associated mainly with partnership‖ [51].0% of females [13]. they found that 18. Continuing. By using condom usage (ie.3% of the males reported having had a STI compared with 11.4% of females of the same age. 501 . Likewise the moderate consistency of condom use with non-steady sexual partners denotes that women would be exposed to HIV/AIDS and other sexually transmitted infections because of their sexual expression and involvement with older men. and these men engaged in risky sexual practices with other women in the past. The current work showed that women begin their sexual debut with men that were about 10 years their seniors.stratum were 68% less likely to use a method of contraception. and justifying women involvement in multiple sexual partnerships and inconsistent contraceptive uses. [13] which found that 41% of males aged 15-74 years indicated having multiple partners (2+) compared with 8. The aforementioned proposition can be supported by a study conducted by Wilks et al. 17 out of every 25 women of the reproductive ages who indicated their involvement in multiple relationships) for family planning interventions. It was revealed that inconsistent condom usage was lesser among women with their steady partners (11 out of every 25) than with non-steady partners (14 out of every 25). and this work provides further clarity to that finding.

in the lower socioeconomic class. Efforts to change polygamy. and so appropriate measures can be modeled based on the lessons emerged from the research. and other forms of multiple sexual partnerships cannot commence with negative critiques of those people. but with a comprehensive analysis of those involved in order to provide an understanding of practices. and merely providing intervention programmes which are not multisectorial. those in married or common-unions were less likely to use a method of contraception. particularly to address the economic gender and area socioeconomic disparities. will not effectively address this public health challenge (multiple concurrent partnerships). Clearly. people who shared sanitary convenience were less likely to used a method of contraception as well as those in the upper class. 502 . and these provide understanding of the nature of measures which are needed to address this public health phenomenon. quasi-polygamy. Those findings highlight the complexities of women aged 15-49 years old who are engaged in multiple sexual partnerships. 20 out of 25 currently used a method of contraception. The present research found that 14 out of 25 females who indicated having had multiple sexual partners (2+) in the last 12 months resided in rural areas.Conclusion Labelling females who have multiple sexual partners as whores. prostitutes and commercial sex workers is not providing an understanding of the key components which account for the behaviour. economics play a large part in promiscuity among females in Jamaica. 18 out of every 25 were pregnant. 17 out of every 25 used a condom on the last sexual encounter. in visiting sexual unions. and that the lessons to be learnt by public health practitioners to ameliorate this practice will be overlooked if they become concerned with the stereotype.

sexual autonomy and risky sexual practices among women in their reproductive years. these suggest that they would be more likely to be less educated. and cannot be allowed to continue as it infringes on the basic rights of women. Bourne and Rhule‘s work can provide some explanation for the (1) inconsistent condom usage. but it is also retarding their human and reproductive rights. and that the opportunity costs of poverty are (1) risky sexual practices. Poverty is more than eroding the quality of life of women in Jamaica. (4) age of sexual debut. (2) poor sexual reproductive health choices. Bourne and Rhule [29] found that poverty was synonymous with rural areas. multiple partnerships cannot be addressed by merely using sex education programmes in or out of school and interventions that do not coalesce the multidimensional nature of the issues which are highlighted in this research. females and ill people. and (3) sexual promiscuity for financial economic gains.Using cross-sectional survey data. Poverty is. This study showed that sexual promiscuity is not positively influencing good sexual practices of women who indicated having 2+ sexual partners as only 17 out of every 25 of them used a condom on the last sexual encounter which was the same for the female reproductive population of Jamaicans [14]. As such. (2) rural females. Rural poverty is twice greater than urban poverty in Jamaica [36] and within the context of this study that found that rural women aged 15-49 years were more likely to be engaged in sexual promiscuity and from the lower socioeconomic class. and (5) lower socioeconomic status of women in multiple sexual partnerships as poverty incapacitates not only health status but also reproductive health choices. 503 . particularly incomegender disparity and more opportunities for women in rural areas. therefore. and that 11 out of every 25 consistently used a condom with their steady partners and 14 out of every 25 consistently used a condom with non-steady sexual partners. silently tranquilizing the sexual freedom and choices of women. (3) high pregnancies.

but to the researcher. Acknowledgement The author thank the Data Bank in Sir Arthur Lewis Institute of Social and Economic Studies.In summary. the early initiation of adolescent females into commercial sex work cannot be left unaddressed as the prevalence rate is high. a multilevel approach is needed to address multiple sexual partnerships among females in Jamaica. The present findings are far reaching. Disclaimer The researcher would like to note that while this study used secondary data from the Reproductive Health Survey. Jamaica for making the dataset available for use in this study. none of the errors in this paper should be ascribed to the National Family Planning Board. Serious efforts are needed to comprehend. which is engaged in many school-aged females. Clearly. public health practitioners need to institute measures to address the multiple sexual relationships among those from middle to upper class more than the lower class women as the ratio is alarming high among the former than the latter group. Conflict of interest The author has no conflict of interest to report. but should not be taken as the totality of the research necessary for understanding this phenomenon. alleviate and rectify such a practice. and the National Family Planning Board for commissioning the survey. the University of the West Indies. Mona. Furthermore. 504 .

9:305. 31:272-279. Tropical Medicine Research Institute. Am J Epidemiol 2005. 13. 12:58-67. numbers of clients and associated risks: An exploratory survey. Wilks R. 8. Yan H. Why multiple sexual partners? Lancet 2009. Weller S. 14. 17. Technical Report.References 1. 64:372-377. Age of sexual debut related to life-style and reproductive health factors in a group of Swedish teenage girls. Tulloch-Reid M. Multiple sex partner behavior in female undergraduate students in China: A multi-campus survey. HIV prevalence and related behaviors among sex workers in Jamaica. 37:306-310. et al. Factors associated with condom use in the male population of Mexico City. Fam Plann Perspect 1999. Reproductive Health Matters 2004. Kingston: Epidemiology Research Unit. Correlates of sexual activity and inconsistent condom use among high-school girls in Dominica. Elmore-Meegan M. University of the West Indies. 1999-2001. Oxford: Update Software. Correlates and consequences of early initiation of sexual intercourse. Case histories from the Drop-in Centre Clinics. Coker AL. The Cochrane Library. Younger N. Indian J Community Med 2001. 18. 2003. Kaestle CE. 4. Reproductive Health Survey 2002. 12:5057. 11. Forssman L. 7. Issue 2. Norman LR. Mona. Kishore J. 505 . 6. Sex workers in Kenya. Int J of STD & AIDS 2003 14:584-590. Otis J. In: Jayasree AK. Quiterio-Trenado M. 2. Determinants of sexual activity and its relation to cervical cancer risk among South African women. The effectiveness of condoms in reducing heterosexual transmission of HIV. Shelton JD. India. 161:774-780. et al. Agala CB. et al. Weller SC. Cruz-Valdez A. Hernandez-Giron CA. Kingston: NFPB. 16. 15. Miller WC. 2008. Alary M. Searching for justice for body and self in a coercive environment: Sex work in Kerala. Int J of STD & AIDS 1999. 12. 10:112117. Valois RF. et al. India. 374:367-369. 2005. Chen W. Milsorn I. et al. National Family Planning Board (NFPB). Grant Y. Hoffman M. 26:192-917. West India Med J 2007. 7. Andersson-Ellstrom A. J Sch Health 1994. 5. BMC Public Health 2009. 10. Conroy RM. Young age at first sexual intercourse and sexually transmitted infections in adolescents and young adults. 9. Duncan J. et al. Reproductive Health Matters 2004. Cooper D. Halpern CT. Searching for justice for body and self in a coercive environment: Sex work in Kerala. Sexually Transmitted Diseases 2010. Davis K. Davis KR. Carrara H. Thiruvananthapuram and Thrissur: Foundation for Integrated Research in Mental Health. George C. Gebre Y. Condom effectiveness in reducing heterosexual HIV transmission. Health status and health seeking behaviour of male workers in Delhi. 56:433-438. 12:58-67. Jamaica Health and Lifestyle Survey 20072008. et al. Wu H. Richter DL. Joshi TK. BMC Public Health. 75:484-489. Predictors of consistent condom use: A hierarchical analysis of adults from Kenya. 2007. Reproductive Health Matters 2004. 3. Jayasree AK. Acta Obstet Gynecol Scand 1996. Tanzania and Trinidad.

Jamaica Survey of Living Conditions. Inter J of Soc Psychiatry 2004. LeFranc E. 1996. Brener ND. Copenhagen: World Health Organization. 1: 86-95. 26. 1:132-155. Medical Sociology: Modelling Well-being for elderly People in Jamaica. 9: 1280.19. Van Doornum GJ. Good Health Status of Rural Women in the Reproductive Ages. Bourne PA. Multiple sexual partners among U. New York: National Bureau of Economic Research. J Rural and Remote Health 2009. et al. A theoretical framework of good health status of Jamaicans: using econometric analysis to model good health status over the life course. J Rural and Remote Health 2009. Smith JP.who. 50:43-53. 9:1116. Demography 1997. 1989. 2009). 5:750. Hutchinson G. Regional distribution and incidence of human papillomavirus infections among heterosexual men and women with multiple sexual partners: A prospective study. et al. Bain BC. Int Conf AIDS 1989. Social Determinants of Health. 24. Planning Institute of Jamaica (PIOJ).2007. Statistical Institute of Jamaica (STATIN). Tucker MB. 32. 29. Genitourin Med 1994. Inter J Collaborative Research on Internal Medicine & Public Health. Wilkinson RG. Discussion paper for the Commission on Social Determinants of Health DRAFT April 2007. Polit DF. A Conceptual Framework for Analysis and Action on the Social Determinants of Health.pdf (Accessed April 29. 57:596-04. The demand for health . Rural health in Jamaica: Examining and refining the predictive factors of good health status of rural residents. Prins M. 1972. 1:211-219. 20.a theoretical and empirical investigation. Stamford: Appleton & Lange Publisher. 2nd ed. Bourne PA. 2:18-27. The Solid Facts. McGrowder DA. adolescents and young adults.int/social_determinants/resources/csdh_framework_action_05_07. Rhule J. Fam Planning Perspective 1998. Bourne PA. 1990-2008. Data analysis and statistics for nursing research. West Indian Med J 2008. 34. Irwin A. Newstetter A. Kingston: PIOJ & STATIN. Bourne PA. 57:476-81. Social determinants of self-evaluated good health status of rural men in Jamaica. 2009. Demographic and Economic Correlates of Health in Old Age. 2003. North Am J of Med Sci. Eversley RB. 30:271-275. 2009. 35. 28. Available from http://www. Santelli JS. 70:240-246. 33. 2009. 34:159-70. Wyatt GE.S. Bourne PA. Grossman M. Good Health Status of Older and Oldest Elderly in Jamaica: Are there differences between rural and urban areas? Open Geriatric Medicine J. 36. Simeon DT. 21. West Indian Med J 2008. and health status of the old-old-to-oldest-old in Jamaica: a comparative analysis. Juffermans LH. 22. Bourne PA. AIDS risk among women with multiple sexual partners: HIV risk screening data from a family planning population. North Am J of Med Sci. Social and Health determinants of well-being and life satisfaction in Jamaica. Kington R. 25. Health Determinants: Using Secondary Data to Model Predictors of Wellbeing of Jamaicans. Bourne PA. Marmot M. Lowry R. 506 . 23. 2009. Solar O. Bourne PA. 31. An epidemiological transition of health conditions. 27. 30.

WHO. Bourne PA. Pakistan. Van Agt HME. Open Access Journal of Contraception 2010:1 39–49. 2002. Chronic illness and poverty in the Netherlands. 1:99-109. selfreported illness. South-Bourne N. 50. Degni F. American Journal of Applied Sciences 1 (4): 332-337. health insurance on mortality in Jamaica. No. Alpu O.37.56-60. 10:197-200. 1991-2009. World Health Organization (WHO). Scientific and Technical Publication. Factors influencing contraceptive use in Tehran Fam Pract 2003. 43. Bourne PA. Journal of Health & Population in Developing Countries. Kerr-Campbell MD. No. Investment in health: Social and economic returns. Does money really matter? Or is it a marker for something else? Health Affairs. 49. Ojanlatva A. United States. 46. and health: Some research findings. 41. In: Pan American Health Organisation. 507 . In: Equity and health: Views from Pan American Sanitary Bureau. Occasional Publication. 8. 45. 2005. Marmot M. 2004. Perspectives on Sexual and Reproductive Health 2008. Preventing Chronic Diseases a vital investment. not seeking medical care. Factors Associated with Contraceptive Choice and Inconsistent Method Use. Frost J. D'Souza RM. Crawford TV. 2001. The influence of Income on Health: Views of an Epidemiologist. Washington DC: PAHO. equity. Health and economic growth. Kurt G. 44. Impact of poverty. Planning Institute of Jamaica (PIOJ). Equity and health: Views from the Pan American Sanitary Bureau. The Effect of Socio-economic and Demographic Factors on contraceptive Use and Induced Abortion in Turkey. Washington DC. North Am J of Med Sci 2009. 42. Farahani FKA. Mackenbach JP. Occasional Publication No. Pan American Health Organization (PAHO). Occasional publication No. Francis CG. 43(3): 379-390 47. 21: 3146. 2001. Wagstaff A Poverty. US. Darroch JE. Stronks K. 20(4): 493 51. Geneva: WHO. Eur J of Public Health 2000. 39. Pan American Health Organization. Pan American Health Organization (PAHO). Finland. Hashemi MS. 2001: pp. 582. inflation. Factors associated with married Iranian Women‘s contraceptive use in Turku. 2004. WHO. Essen B. Factors influencing the use of contraception in an urban slum in Karachi. Washington DC: PAHO. unemployment. Economic and Social Survey Jamaica 1990-2008.40(2):94-104. Tehrani FR. Iranian Studies 2010. 8. 265-269. 40. Charles CAD. Equity and health: Views from the Pan American Sanitary Bureau. 8. Alleyne GAO. Kingston: PIOJ. 2003 48. Washington DC. 2001: pp. 38. Current use of contraceptive method among women in a middle-income developing country.

Figure 18. Paid (or not paid) for sex by number of sexual partners 508 .1.

8 13. christening) Does not attend at all No response Marital status Legally married Common-law Visiting Divorced. funerals.7 72.4 0. separated.7 years) 25.6 46.9 32.2 63.6 47.1 70.3 27.6 years (8.6 36.2 24.5 53.3 98.7 years) 16.Table 18.9 29.0 19.1 27.0 years (2.3 8.6 5.5 19.9 29.4 77.1 28.1. n = 225 Characteristic Religiosity At least once a week At least once a month Less than once a month Only on special occasions (weddings.1 1.9 21.6 11.0 42.8 22.9 56.4 15. Sociodemographic characteristic of sample. widowed Single Currently pregnant Yes No Ever been pregnant Yes No Ever been forced to have sex Yes No Not sure Currently having sex (in the last 30 days) Yes No Currently using a method of contraception Yes No Employment status Unemployed Employed Area of residence Urban Semi-urban Rural Socioeconomic class Lower Middle Upper Years of schooling mean (SD) Age mean (SD) Age of first sexual intercourse mean (SD) Age of person had first sexual intercourse with mean (SD) n 56 49 30 62 25 3 18 44 107 44 12 3 221 160 62 65 157 1 120 104 175 50 143 82 34 65 126 95 56 74 % 24.3 1.7 years (19 years) 509 .

8 No 77 34. Number of sexual partners.3 Currently using a condom Yes 148 65.0 Seldom 1 1.4 10 1 0.3 Most times 30 37.Table 18. n = 225 n % Characteristic Number of sexual partners (in last 12 months) 2 84 37.4 510 .2 4 3 1.5 Seldom 8 5.3 3 5 2.3 Never 6 7. condom usage and frequency of condom usage by study population.1 Most times 66 48.5 Frequency of condom usage with non-steady partner Always 44 54.9 Never 2 1.2.2 Frequency of condom usage with steady partner Always 60 44.4 11+ 129 57.4 7 3 1.

511 .500(**) 0.814 195 -0.441 224 1 223 -0.147 223 -0.000 181 0.282(*) 0.798 69 Age at first intercourse 0.Table 18.015 74 Age began using contraception Age of whom you had sexual intercourse 1 195 0.000 167 -0.017 0.009 0.056 0.031 0. age of menarche.029 0.741 74 1 182 0. ** Correlation is significant at the 0.000 195 0.898 222 0.097 0.039 0.643 194 -0.813 69 1 74 * Correlation is significant at the 0.450 182 0.563(**) 0. age of first intercourse.169(*) 0. age began using contraception and age of person whom you had first sexual intercourse with Age Years of schooling Age of menarche Age at first intercourse Age began using contraception Age of whom you had sexual intercourse Age of respondent Years of schooling Age of menarche 1 225 -.052 0.3.111 0. Age of respondent.023 182 0.05 level (2-tailed).345 74 1 224 0.291(** ) 0. years of schooling.01 level (2-tailed).033 0.

7% *P < 0.00 0.25 -0.15 0.08 1.61.74 0.93 Nagelkerke r-squared = 0.10 1.001 512 .18 1.58 0.342 Hosmer and Lemeshow test.75 Wald statistic 2.21 0.10 0.86 -1.1.85 .07 1.85 1.42 1.07 .50 1.43 0.1.07 0.38 Model chi-square (17) = 30.1.30 0.05.4.16.1.0.79 8.11 .12 0.2.20 0.25 0.62 -0.03 .35 0.32 .96 1.56 0.07 3.62 0.74 0.32* 0.60 0.10.18 -1.1.01 .07* 0.47 1.45 0.75 .02 .78 .35 0.5% Correct classification of cases of condom usage at first sexual intercourse = 97.14 0.73 1.01.68 .83.79 0.04 0.021 -2 Log likelihood = 82.10.94 0.01 . P = 0.89 .13 4.36 0.53 1.0.78 0.10 0.85 -2. χ2 = 4.07 -0.09** 95% CI 0.17 0.36 0.80 .89 1. ***P < 0.79.1.58 2.43 3.01 .85 .50 0.80 0.4: Logistic regression analyses: Variables of currently using a method of contraception Variable Forced into sexual encounter(1=yes) Semi-urban Rural Urban (reference group) Lower class Middle class Upper class (reference group) Pelvic or urinary tract infection Age at first sexual encounter Shared sanitary convenience (1=yes) Frequent church attendance (1=at least one per week) Employed (1=yes) Age of respondents Years of schooling Age at menarche Age began using contraceptive method Crowding Pap Smear (1=yes) Married or common-law union 1 β Coefficient -1.13 -2.02 0.70 0.44 Std Error 0.60 0.00 1. P < 0.92 0.Table 18.16 1.51 0. **P < 0.12 1.16 5.38 -1.04 0.1.0.19 0.24.70 0.59 0.90 6.02 1.80 Overall correct classification = 88.15 0.04 0.3% Correct classification of cases of not using condom at first sexual intercourse = 16.33 2.11 0.31 0.52 Odds ratio 0.11 0.29 .56 -0.90* 1.06 .05 0.45 10.

95% CI = 0.00). university students. 513 . suggesting that many rapes are under-reported by females and as such something must be done to address this silent killer. teenage mothers and males. While a plethora of research exists on the value of some information.25 – 0.52). frequent church attendees (OR = 0. and shared sanitary conveniences (OR = 0. 95% CI = 1. Aims: The present study seeks to elucidate information on reproductive health matters regarding those who were sexually assaulted on their first sexual encounter.43. young adults. young adults. which has been used to guide policy formulation. 95% CI = 1. adolescents. women.55. minors. adolescents. Four variables emerged as statistically significant predictors of current contraceptive usage in this sample: age at first sexual initiation (OR = 1. and about 15% of perpetrators (men) did use a condom. 95% CI = 0.26. women. Ten in every 100 females of reproductive age in Jamaica have been raped.03 – 1.19 Sexually assaulted females on their sexual debut: Reproductive health matters Previous studies which have examined reproductive health matters or sexual relations have reported on the general population.31). but little is known of such issues among females who were sexually assaulted on their first sexual encounter. and factors which influence their current method of contraception. teenage mothers and males.77).16. commercial sex workers. commercial sex workers. university students. Introduction Previous studies which have examined reproductive health matters and/or sexual relations have reported on the general population. minors.1-12 but little is known of such issues