1. Global Journal of Medical research: FDiseasesVolume 14 Issue 2 Version 1.0 Year 2014Type: Double Blind Peer Reviewed International Research JournalPublisher: Global Journals Inc. (USA)Online ISSN: 2249-4618 & Print ISSN: 0975-5888Non-Communicable Diseases and Health Indices of Adoles-centsin Jamaica: A National PerspectiveBy Paul Andrew Bourne, Cynthia Francis, Charlene Sharpe-Pryce,Ang ela Hudson-Davis, Ikhalfani Solan, Olive Watson-Colem an & Joan Rh uleUniversity of Technology, Jam aicaAbstract-Introduction:Of all human deaths in the world, in 2008, 63 percent are owing to non-communicablediseases (NCDs) of which 80 percent are in developing countries. In Jamaica for2008, 50 percent of deaths occur to NCDs, especially among women and older people. Theadolescence period is rarely seen for it contributory role to NCDs, which is the rationale for fewresearch in the area among this cohort in English-speaking Caribbean. This study fills the gap inthe literature by examining NCDs among adolescents.Objectives:The objectives are to examine the adolescence period as it relates to NCDs, evaluatehealth indices in this period and determine the prevalance of NCDs as well as disaggregateNCDs by socio-demographic characteristics.Keywords:adolescents, cardiovasuclar diseases, chronic condition, developing nations, health,jamaica, lifestyle practices, non-communicable diseases.GJMR-FClassification :NLMC Code: WS 200, WG 120Non-CommunicableDiseasesandHealthIndicesofAdoles-centsinJamaicaANationalPerspectiveStrictly as per the compliance and regulations of: 2014. Paul Andrew Bourne, Cynthia Francis, Charlene Sharpe-Pryce, Angela Hudson-Davis, Ikhalfani Solan, Olive Watson-Coleman & Joan Rhule. This is a research/review paper, distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License http:// creativecommons. org/ licenses/by-nc/3.0/), permitting all non-commercial use,distribution, and reproduction inany medium, provided the original work is properly cited.

2. Non-Communicable Diseases and HealthIndices of Adolescents in Jamaica: A NationalPerspectivePaul Andrew Bourne , Cynthia Francis , Charlene Sharpe-Pryce , Angela Hudson-Davis , IkhalfaniSolan , Olive Watson-Coleman & Joan Rhule Abstract- Introduction: Of all human deaths in the world, in2008, 63 percent are owing to non-communicable diseases(NCDs) of which 80 percent are in developing countries. InJamaica for 2008, 50 percent of deaths occur to NCDs,especially among women and older people. The adolescenceperiod is rarely seen for it contributory role to NCDs, which isthe rationale for few research in the area among this cohort inEnglish-speaking Caribbean. This study fills the gap in theliterature by examining NCDs among adolescents.Objectives: The objectives are to examine the adolescenceperiod as it relates to NCDs, evaluate health indices in thisperiod and determine the prevalance of NCDs as well asdisaggregate NCDs by socio-demographic characteristics.Materials and methods: A sample of 1,394 respondents ages10 to 19 years from a national probability survey is used forthis study. The data are taken from the Jamaica Survey ofLiving Conditions, which is a modification of the World BanksHousehold Living Standards Survey.Results: The prevalence rate for NCDs among adolescents inJamaica is 2.7 percent, 7 percent report having an illness andamong those with an illness, 48.7 percent have NCDs(diabetes, 4.0 percent; hypertension, 1.3; Other NCDs, 43.4percent). Diabetes begins in middle adolescence among poorrural females and hypertension starts in late adolescentamong affluent urban females.Conclusion: The findings herein warrant public healthinterventions that are specialized to the sociodemographicand health realities of adolescents.Keywords: adolescents, cardiovasuclar diseases,chronic condition, developing nations, health, jamaica,lifestyle practices, non-communicable diseases.on-communicable diseases (NCDs) havereached an epidemic stage in developingcountries. This perspective is embedded in theWorld Health Organizations (WHO) statistics,:AuthorI.IntroductionSocio-Medical Research Institute, Jamaica.e-mail: paulbourne1@yahoo.comAuthor:University of Technology, Jamaica.:AuthorChair, Department of History, Northern Caribbean University,Mandeville, Jamaica.AuthorCapella University, USA.:Author :Department of Mathematics and Computer Science, SouthCarolina State University, USA.Author:Southern Connecticut State University, USA.whichshow that 80 percentof NCDs are in the developingnations and that they account for 60 percentof allmortalities [1]. NCDs, therefore, singly account for mosthuman deaths than any other happeningsand thiswarrants public health recognition as well asinterventions. On disaggregating NCDs,Unwin andAlberti [2] opine that these deaths are mostly associatedwith working agedpeople, women and that [the]incidences in younger adults are substantially higher inthe poor countries of the world than in the rich, whichconcurs with the work of the WHO. There areimplications of Unwin and Albertis perspective andthese include lowered production, increase medicationand health care visitations for Caribbean peoplebecause of chronic noncommunicable diseases.The Caribbean region, which is a part ofdeveloping world, subscribes to the NCDsprofile hasoutlined by the WHO. In fact, Hospedaleset al.wentfurther than the WHO to postulate that NCDs in theCaribbean Community (CARICOM) have the highestburden in the Americas[3]. Such a perspective supportsthe NCDs epidemic in the Caribbean region;warrantsresearchin the area and provide a rationale for themany studies that have been conducted since the lastdecade in the region on different NCDs [3-14].Theplethora of studies on NCDs also includes one onchildren, which is conducted by Bourne [15]. Usingnational probability data for Jamaica, Bourne finds thatsome NCDs in children have increased by over 100percentin a 5-year period, chief among them beingdiabetes[15]. While this finding offers some insights intothe coverage of NCDs among Caribbean peoples, thosecases would not be relating to lifestyle practices of thepatients but more in keeping with biological deficiencyincluding lifestyle practices of the mothers.N19Volume XIV Issue II Version IGlobal Journal of Medical Research 2014 Global Journals Inc. (US)( D ) Year F 2014 3. Non-Communicable Diseases and Health Indices of Adolescents in Jamaica: A National PerspectiveBournes work [15] paints a gloomed picture ofthe NCDs epidemic, particularly diabetes, in children.Although NCDs is substantially an adult, woman andrural area phenomena [4, 16], reported cases amongchildren and the percent increases in the last 5 years areastronomical in Jamaica [15]. In research of theliterature, we find a research that examines health andlifestyle practices of Jamaicans ages 15-74 years. Inthat work, depression, diabetes mellitus, highcholesterol and obesity are synonymous with womenand rural residents [14]: depression (men, 14.8 percent;women, 25.6 percent); diabetes (men, 6.4 percent;women, 9.3 percent); high cholesterol (men, 7.5percent; women, 15.6 percent), and obesity (men, 12.3percent; women, 37.5 percent). Among those ages 15-24 years old, 1.2 percent report having diabetesmellitus, 6.3 percent hypertension, and high cholesterol4.0 percent and 20.4 percent notes having depression[14]. Within the context of the aforementioned studiedsample, children and adolescents are excluded andmean that none, from a national perspective onJamaican adolescents, is in the literature. However,other studies in different parts of the globe find thatthree quarters of adolescents who remain obese inadulthood had a high probability of developingneoplasm, diabetes and stroke [16-19]. Those studieshighlight the risk factors associated with poor lifestylepractices among adolescents and how these translateinto NCDs at older ages. One study went as far as tohighlight the percentage of adolescents who areoverweight [20] and another research indicates that theyare two times more likely to develop cardiovasculardiseases and seven times more likely of havingatherosclerosis diseases[21]. Clearly, the prevalence ofNCDs in developing countries is primarily owing to poorlifestyle practices during adolescence, which the WHOstates is accounted for more than half of the cases [22].There is a paucity of information on the prevalence ofparticular NCDs among adolescents in the Caribbean.In fact, the prevalence of high blood pressure among is4.5 percent [23]; diabetes 25 percent [24]; 70 percent ofobese adolescents are at risk of cardiovascular diseaseon or before 20 years of age [25]; 10 percentadolescents have chronic lung diseases (asthma) [26],and leukaemia is the most common malignant amongEuropean young people under 15 years (47 per 1million) [27]. The high risk factors are well documentedin the literature on NCDs in developing countries [28];and with the previous mentioned statistics, a clearaccount of NCDs in developing world can be had andjustifiable rationales for intervention programmes [29].Although the Caribbean has the highest rate of NCDs inthe Americas [3], the NCDs epidemic in the regionextends beyond this locality to Africa [30]. It is notsurprising therefore that an articleis entitled Noncommunicable diseases: a race against time [31];because this is summarizes the challenges of NCDs inthe developing world, especially the Caribbean. Toclarify their perspective that NCDs is the highest for theCaribbean in the America, Hospedales et al. [3] opinethat amputations resulting from Diabetic-related issuesare the highest in Barbados compared to the rest of theworld, and that diabetes is 600 percenthigher inTrinidad and Tobago compared to North America, whichoffers a rationale for plethora of studies on NCDs in theregion.Although adolescents only constitute 20 percentof Jamaicas population [32], lifestyle practices duringthe adolescence period the invincible era accountsfor most of the mortality in later lifeordeaths by NCDs.Statistics reveal that 65 percentof all deaths in the worldin 2008 are owing to NCDs of which the majority (80percent) are in developing countries [33, 34], indicatingthat the lifestyle practices of people in low-to-middleincome countries during the adolescence period extentbeyond individual to societal and global burdens.Although Jamaica is an English-speaking middleincome developing country in the Caribbean, between48 and 55percentof all deaths are because ofNCDs[32],especially among women and elderly people[13,15], this does not warrant a non-research perspectiveon the matter from an adolescent vantage point. Healthissues in the Caribbean region have focused rightfullyso on teenage pregnancy,crime and violence, otherreproductive health mattersand substance use (orabuse) [35-40]; but the gateway period to the NCDs isleft substantially unexplored. With the literature showingthat the adolescence period is the gatewayto theprevalence of NCDs in the developing world[34];hence, it is fitting to study this age cohort as it relates toNCDs and health status. In an extensive search of theliterature, we did not find one article that singlyexamined NCDs and general health of adolescents.TheWorld Health Assembly has gone as far as to support aresolution that its members must institute measures toaddress issues relating to young people as it relates toNCDs [41]; yet, few studieshavebeen published on theEnglish-speaking Caribbean and/or Latin Americaregiononthe NCDs in the adolescence period[42-44].Of the three articles that we identify, two are on Jamaica:The firstis a cross-sectional study of 276 adolescentsages 14-19 years from grades 9 to 12 from 5 of the 14parishes in Jamaica [42]. The purpose of theresearch,lead by Barrett et al, wass to examine risk factorsamong the respondents as it relates to Type 2 diabetes(T2D) and cardiovascular diseases(CVD).The secondstudyused a national probability cross-sectional data onJamaica for adolescents ages10-19 years, aims to( F ) Volume XIV Issue II Version I Year 2014Global Journal of Medical Research 2014 Global Journals Inc. (US)20evaluate demographic shifts in health conditions and thetypology of health conditions experienced by this agecohort [43]. The study by Baldwin et al, covered theLatin America and the Caribbean young people aged 4. Non-Communicable Diseases and Health Indices of Adolescents in Jamaica: A National Perspective10-24 years; but primarily focused onfour NCDsthat arecardiovascular disease, cancers, diabetes, and chronicrespiratory diseases. Furthermore, the study assessedthe populations behavioral risk factors such as tobaccousage, alcohol consumption, unhealthy diet, and lackphysical inactivity [44]. The literature therefore lacksasingle study that is a national probability study on NCDsand health status of adolescents aged 10-19 years. Theobjectives of this study are:to examine the adolescenceperiod as it relates to NCDs; evaluate health indices inthis period,and determine the prevalance of NCDs aswell as disaggregate NCDs by socio-demographiccharacteristics.II.Materials and MethodsOn a yearly basis, the Planning Institute ofJamaica (PIOJ) and the Statistical Institute of Jamaica(STATIN),two governmental agencies, conduct nationalprobability surveyscalled the Jamaica Survey of LivingConditions (JSLC), which seeks to guide policyformulations.The JSLC is cross-sectional descriptivesurveys, whichusesstratified random samplingtechniques. It collects data on householdscharacteristics, health, education, expenditureondurableand non-durable goods, utilities, etc), socialprogrammes, and other information.The survey iscollected using a standardized instrument (i.e.,questionnaire) that on average takes approximately 45minutes to complete by each respondent. The JSLC ismodeled afterthe World Banks Living StandardsMeasurement Study (LSMS) household survey [45].There are some modifications to the LSMS, as JSLC ismore focused on policy impacts and therefore this isreflected in the collected data.According to the JSLC [45], the sample isweighted to reflect the population of Jamaica. Thehouseholds in the JSLC are interviewed on an annualbasis for a period of up to four years, after which a newrepresentative sampling frame is redesign and drawn.Adetailed presentation of the sampling techniques are inother published works [14, 15]. The data are entered,stored and retrieved in the Statistical Packages for theSocial Sciences (SPSS) for Windows, Version 21.0. Forthis study, descriptive statistics are performed for thesocio-demographic characteristics of the sample; thebivariate analyses are chi-square and analysis ofvariance (ANOVA).Statistical significance wasdetermined using a p value < 5% (i.e., 95% confidenceinterval).III.Definition of VariablesHealth:This is defined as the self-rated health status ofan individualGood health:Is a binary variable where 1 = at leastgood self-rated health status and 0 = otherwise.Age:This is the total number of years lived since birth,measured from one birthday to the nextHealth-careSeeking Behavior(or visits to medicalprofessional):This is derived from the question Haveyou sought medical attention in the last four weeks(using the survey period), where 1=yes and0=otherwise.Age groups:Adolescents are individuals ages 10 to 19years old, with early adolescence being 10-12years;middle adolescence, 13-15 years old; and lateadolescence being 16+ years old.Other NCDs:These include malignant neoplasms,ischaemic and other heart diseases, and highcholesterol.Health Insurance Coverage:This is a binary measure, inwhich 1 denotes self-reported ownership of privateand/or public health insurance coverage and 0 isotherwise.Length of illness:The number of days an individualreport that he/she experiences ill-health due to NCDs.Purchased prescribed medications:This is an individualreporting that he(she) filled the prescription that he(she)received on visit to the health care practitioner(s).Health indices: For this paper, this concept is measuredusing illness (or self-reported illness), health-careseeking behavior (or health care utilization), healthinsurance coverage, and health insurance utilization.Non-communicable Disease(NCD):A disease that isnon-infectiousFigure 1depicts a bar graph showing percentof those with chronic noncommunicable diseases bygender of the respondents. Of those with chronicnoncommunicable diseases (n=37), 62.2 (n=23)percentare females. Among the female who indicatehaving a chronic noncommunicable disease, 13.0percenthave diabetes, 4.4 percenthave hypertensionand 82.6 percenthave other chronic noncommunicableconditions.All the males, on the other hand, reporthaving other chronic noncommunicable diseases.21Volume XIV Issue II Version IGlobal Journal of Medical Research 2014 Global Journals Inc. (US)( D ) Year F 2014 5. Non-Communicable Diseases and Health Indices of Adolescents in Jamaica: A National PerspectiveFigure 1: Chronic non-communicable diseases by gender of respondentsTable 1summarizes the socio-demographics ofthe sampled population. Marginally more of the sampledrespondents are in their late adolescence (35.7 percent),51.8 percentare females, and 51.1 percentreside inrural areas. The majority of the respondents currentlylive with their biological mother (76 percent) comparedto 37.4 percentwho reside with their biological father.Table 1: Socio-demographic characteristics of sampled population, n = 1, 394CharacteristicsFrequency (Percent)Age cohortEarly Adolescence463 (33.2)Middle Adolescence433 (31.1)Late Adolescence498 (35.7)GenderMale672 (48.2)Female722 (51.8)Area of residenceUrba n394 (28.3)Peri Urban287 (20.6)Rural713 (51.1)Population Income Quintile1320 (23.0)2328 (23.5)3287 (20.6)4263 (18.9)5196 (14.1)Biological parent lives in household( F ) Volume XIV Issue II Version I Year 2014Global Journal of Medical Research 2014 Global Journals Inc. (US)22Father 277 (37.4)Mother 562 (76.0)Received Social AssistanceYes 232 (17.3)No 1108 (82.7) 6. Non-Communicable Diseases and Health Indices of Adolescents in Jamaica: A National PerspectiveTable 2 presents percenton self-reportedillness, health status and non-communicable diseasesofthe sampled respondents. Three percentof thesampled respondents report having non-communicableconditions(NCDs). The majority of those with NCDs,report having Other conditions (43.4 percent) comparedto 4.0 percenthaving diabetes and 1.3 percenthavinghypertension.In fact, none of the respondents reporthaving arthritis (or arthritic pains).:Health Indices, n = 1, 394Table 2CharacteristicsFrequency (Percent)Self-reported illnessYes89 (6.6)No1251 (93.4)Self-reported healthstatusVery Good631 (47.2)Good601 (45.0)Fair84 (6.3)Poor20 (1.5)Self-reported ConditionsNon-communicable diseases (NCDs)Diabetes3 (4.0)Hypertension1 (1.3)OthersConditions33 (43.4)Infectious diseases39 (51.3)Health Insurance CoverageNo1123 (85.3)Yes194 (14.7)Health-Care Seeking BehaviorNo43 (46.2)Yes50 (53.8)Health Care Facility UtilizationPrivate23 (46.0)Public26 (53.1)Of thos e who report having at least one non-communicabledisease, 33.3 percentof those withdiabetes are in their early adolescence compared to33.3 percent with other conditions. Two in every threerespondents with diabetes indicate purchasing theprescribed medication compared to none with Otherconditions and all with hypertension. All therespondents who indicate having diabetes are femalesas well as those with hypertension compared to 57.6percentof those with Other conditions (Table 3).However, the majoritiy of the diabetics are poor females(66.6percent) from rural areas compared to affluenturban females who are hypertensive(100 percent). Astatistical association exists between purchasedprescribed medications and typology of NCDs (P