Male  &      Older Adulthood in Jamaica:Health and Sex      Paul Andrew Bourne
Male  &      Older Adulthood in Jamaica:Health and Sex                 i
Male  &      Older Adulthood in Jamaica:Health and Sex        Paul Andrew Bourne                 ii
©Paul A. Bourne, 2011First Published in Jamaica, 2011 byPaul Andrew Bourne66 Long Wall DriveStony Hill,Kingston 9,St. Andr...
Brief ContentsPrefacePart One: Health, Health Care Utilisation and Mortality                                            1P...
ContentsPreface                                                                   viiiAcknowledgement                     ...
10 Socio-demographic determinants of health status of elderly with   self-reported diagnosed chronic medical conditions in...
Part Five: Retesting and refining theories on the association between illness, chronic illnessand poverty, and dichotomisa...
PrefaceThe discourse of men’s health in Jamaica is sparse, inadequate and requires impetus to providepolicy makers with sc...
The science of society, particularly among males, cannot be advanced with acomprehensively examination of matters surround...
The advancement of science is based on the questioning all established truths. Truths arenot continuous flows, indefinitel...
percent of the variance in life expectancy at birth of a male can be explained by self-reportedillness (in %). There is a ...
national samples to generalize about a population and more so when it comes to data collectedfrom males in regards to thei...
AcknowledgementI wish to thank a number of people who directly or indirectly contributed to the final text. Duringpursuing...
About the AuthorPaul A. Bourne is the Director of Socio-Medical Research Institute, Kingston, Jamaica. He isthe author of ...
Part One: Health, Health Care Utilisation   and Mortality                    1
Chapter1      Biosocial determinants of health and health seeking behaviour of male       youths in JamaicaThe current stu...
IntroductionThe Caribbean continues to grapple with an alarming crime problem. Scholars have found thatmuch of it is perpe...
Recently an entire book entitled “Health Issues in the Caribbean” [18] covered topicssuch as child health, reproductive he...
Materials and MethodsStudy populationThis study utilised secondary cross-sectional dataset for 2007 taken from the Jamaica...
Descriptive statistics were used to analyse the socio-demographic characteristics of the samples.Chi-square analyses were ...
interpretation of each significant variable. To derive accurate tests of statistical significance, theresearcher used SUDD...
Crowding: This is the total number of people in the household divided by the number of rooms,excluding verandah, kitchen a...
illness, 14.4 days (SD = 10.3 days); semi-urban areas, 6.5 days (SD = 5.8 days) and ruralrespondents, 4.7 days (SD = 2.5 d...
residence (χ2 = 83.5, P < 0.0001). Almost 30% of rural respondents were in the poorest 20%compared to 17.3% of those in se...
DiscussionThe current study found that 94 out of every 100 young males (ages 15-25 years) reported atleast good health sta...
the variability in poor health being explained by current self-reported illness. Hambleton andcolleague’s study [43] did n...
in the health care-seeking behaviour of young males, supporting the culture which stipulates thatmen are strong and should...
account for the unspecified health conditions identified by the current study, but there is nofinality of this fact withou...
individual’s income and his life expectancy and mortality. Clearly poverty is an influence onillness, and with ill-health ...
association between area of residence and self-reported illness and self-reported diagnosed healthconditions and social cl...
condition. This was established long ago by the WHO, and clearly the psychosocial challengesof life account for the health...
or illness, but more young males visited medical practitioners in the last 4-week period thanmales in Jamaica and equally ...
References  1. Harriott A. Police and crime control in Jamaica: Problems of reforming Ex-Colonial      Constabularies. Kin...
17. Abel, W. Substance use – health consequences. In: Morgan, O., ed. Health issues in the    Caribbean. Kingston: Ian Ran...
37. Grossman M. The demand for health - a theoretical and empirical investigation. New    York: National Bureau of Economi...
53. Stekelenburg J, Jager B, Kolk P, Westen E, Kwaak A, & Wolffers I: Health care seeking    behaviour and utilization of ...
Table 1.1: Arrested for Major Crimes By Age Group, 2005                                        Age Group of Persons Arrest...
Table 1.2. Demographic characteristic by area of residence, n = 607                                                    Are...
Table 1.3. Stepwise logistic regression: Health care-seeking behaviour by explanatory variables                           ...
Table 1.4. Stepwise logistic regression: Self-rated good health status by variables                                       ...
Table 1.5. Stepwise logistic regression: Self-rated poor health status by variables                                       ...
Chapter2      Self-rated health and health conditions of married and unmarried men       in JamaicaSince 1988, when Jamaic...
communicable diseases, disability, health care-delivery and health issues in the Caribbean, whichreinforces the claim of t...
population [20-22]. Using self-reported illness to measure health status in Jamaica, men’s healthwould be greater than wom...
It cannot be denied that the discourse on subjective wellbeing, using survey data, is basedon person’s judgement, and ther...
JSLC began in 1988 to collect data on the living conditions of Jamaicans in order to measuregovernment policies. These cro...
demographic, economic and biological variables; as well as 2) a correlation between self-reported health conditions (illne...
Male and older adulthood in Jamaica   health and sex
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Male and older adulthood in Jamaica   health and sex
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Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
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Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
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Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
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Male and older adulthood in Jamaica   health and sex
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Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
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Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
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Male and older adulthood in Jamaica   health and sex
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Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
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Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
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Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
Male and older adulthood in Jamaica   health and sex
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Male and older adulthood in Jamaica health and sex

  1. 1. Male & Older Adulthood in Jamaica:Health and Sex Paul Andrew Bourne
  2. 2. Male & Older Adulthood in Jamaica:Health and Sex i
  3. 3. Male & Older Adulthood in Jamaica:Health and Sex Paul Andrew Bourne ii
  4. 4. ©Paul A. Bourne, 2011First Published in Jamaica, 2011 byPaul Andrew Bourne66 Long Wall DriveStony Hill,Kingston 9,St. AndrewNational Library of Jamaica Cataloguing DataMale and older adulthood in Jamaica: Health and SexIncludes indexISBNBourne, Paul AndrewAll rights reserved. Published , 2011Cover designed by Paul Andrew Bourne iii
  5. 5. Brief ContentsPrefacePart One: Health, Health Care Utilisation and Mortality 1Part Two: Sexual Practices 330Part Three: Validity and reliability of surveyed data 492Part Four: Commercial Sex Trade & Multiple Partnership 518Part Five: Retesting and refining theories on the association between illness, chronic illness and poverty 598Part Six: Sex and older adulthood 644Part Seven: The Gender Health Discourse 652Part Eight: Sexual harassment in Jamaica 683Part Nine: Social support in older adulthood 778 iv
  6. 6. ContentsPreface viiiAcknowledgement xiiiAbout the author xivPart One: Health, Health Care Utilisation and Mortality 11 Biosocial determinants of health and health seeking behaviour of male youths in Jamaica 22 Self-rated health and health conditions of married and unmarried men in Jamaica 283 Predictors of Good Health Status of Rural Men in Jamaica 554 Good Health Status of Older and Oldest Elderly in Jamaica: Are there differences between rural and urban areas? 795 Gender differences in self-assessed health of young adults in an English-speaking Caribbean nation 1086 Health of males in Jamaica 1397 Modelling social determinants of self-evaluated health of poor older people in a middle-income developing nation 1678 Ill-males in an English-Speaking Caribbean Society 1929 The image of health status and quality of life in a Caribbean society 229 v
  7. 7. 10 Socio-demographic determinants of health status of elderly with self-reported diagnosed chronic medical conditions in Jamaica 24911 Decomposing Mortality Rates and Examining Health Status of the Elderly in Jamaica 27912 The validity of using self-reported illness to measure objective health 309Part Two: Sexual Practices 32913 Psychosocial correlates of condom usage in a developing country 33014 Young males who delay first coitus for the statutory age and beyond in Jamaica 35915 Young males whose first coitus began at most 15 years old 38316 Reproductive health matters among Infrequent versus Frequent young adult-male-church attendees 40717 Contraception usage among young adult men in a developing country 437Part Three: Validity and reliability of surveyed data 46118 The quality of sample surveys in a developing nation 46219 Paradoxes in self-evaluated health data in a developing country 493Part Four: Commercial Sex Trade & Multiple Partnership 51720 Males and Prostitution in St. Andrew, Jamaica: Behaviour and Practices 51821 Multiple sexual partnerships among young adults in a tropically developing nation: A public health challenge 566 vi
  8. 8. Part Five: Retesting and refining theories on the association between illness, chronic illnessand poverty, and dichotomisation of health 59822 Dichotomising poor self-reported health status: Using secondary cross-sectional survey data for Jamaica 59923 Retesting and refining theories on the association between illness, chronic illness and poverty: Are there other disparities? 619Part Six: Sex and older adulthood 64424 Active ageing: Sex and older adulthood 645Part Seven: The Gender Health Discourse 65325 Gendered health 654Part Eight: Sexual harassment in Jamaica 68426 Jamaica is without a National Sexual Harassment Policy: Challenges, Consequences, Health Problems and the Need for a National Policy Framework 68527 Sexual harassment and sexual harassment policy in Jamaica: The absence of a national sexual harassment policy, and the way forward 730Part Nine: Social support in older adulthood 77828 Social networks among late adult men in Jamaica 779 vii
  9. 9. PrefaceThe discourse of men’s health in Jamaica is sparse, inadequate and requires impetus to providepolicy makers with scientific findings to guide their efforts and set a flat form for truth seekingand germane information on various areas and subareas. There are some paradoxes in healthliterature, particularly among males in Jamaica, as they seek less health care, and they are lesslikely to report an illness. Yet, life expectancy for females is about 6 years more than that formales. Clearly, with age specific mortality rates being higher for males than that of females, thenwe cannot simply reply on self-rated (or reported) health data on this sex to formulate healthpolicies and interventions with more investigation of the data and data quality. The Jamaican male is culturalized to hide his feelings as well as suppress illness. Illnessis construed as weakness. The culture is such that males cannot openly speak about illness,sexual malfunctions (including abstinence from sexual intercourse, fathering children, erectiledysfunctions), and premature ejaculations as well as fears. These bar males from openly crying,airing frustrations and weakness, and by extension seeking medical care, particularly utilising theservices of psychiatrists and/or psychologists, “the shrink”. The Jamaica males, like many of hisEnglish-Speaking Caribbean counterparts, is labeled by the society in such a way that createpsychological pressures that are embedded in the psyche, and guide the perception, beliefs andpractices of these people. The cultured standards that are levied on Jamaican males are primarily responsible fortheir absence from health care utilisation, promiscuity, and fears of weakness. The fears ofweakness are so crippling the behaviours, practices and choices of males in regard health, healthcare utilisation, sexuality, power relations, fatherhood, masculinity and survivability. Theinterrelationships among the culture, behaviour, practices, socialization, choices, and specifictasks are fashioning new generations of males embodied in the cosmology of their parents,particularly fathers, inspite of the growing paradigm shifts that have been occurring globally andregionally. The dominance of the cultured standards, therefore, are disbarring any paradigm shift thathealth care administrators and policy makers would like to forge ahead for Jamaican males. TheJamaican male is captured in a maze (or a cobweb scenario) that is continuously perpetrated bythe socialization processes, which hold them hostage and make extremely difficult neededchanges. Based on international standards, the cultured standards in Jamaica are graduallyshifting in some genres, such as sexuality. However, the pace at which these shifts is occurring inthe society are so incremental that expenditure on behavioural modification programmes appearto be ineffective, and a waste of resources. viii
  10. 10. The science of society, particularly among males, cannot be advanced with acomprehensively examination of matters surround 1) health, health care utilisation and mortality,2) sexual practices, 3) commercial sex trade multiple partnership, and the 4) quality of data. Thecurrent text is concerned about advancing the science of male and older adulthood in Jamaica.This cannot be framed without scientific enquires on the aforementioned issues. The enquiresmust evaluate issues on youth, adults and older adulthood in regard health, health care utilisation,mortality, sexual practices, and commercial sex trade among males, particularly amongJamaicans, in order to provide the answers to the hidden questions. Science cannot indefinitelywait for history to provide conclusions and a set of propositions. It is the mother of invention,knowledge, theories, guidelines and thought. Therefore, scientists must continuously examine,explore and test hypotheses that will frame law, principles, theories and knowledge about howthings operate in the world. The knowledge gains through research provide the impetus forapplication and solutions of problems in everyday lives of people. My book explains how research studies attempt to provide crucial answers to questions ofimportance on males’ issues in Jamaica. In order to provide answers to questions of importance,I describe studies in details in a way that they can be understood by all readers. However, thereare some statistical technicalities that are embodied in each study that may be difficult tounderstand by some readers, but these can be overcome with a read of the entire section (orstudy). For some of the readers who seek to comprehensively understand the technicalities, I amrecommend reviewing an introductory text in statistics, and particular chapters in an advancedstatistical text such as multiple regressions, logistic regression and the calculations of odds ratio. Because I belief that the information presented in this volume should provide soundknowledge on the various topic, I examine the quality of data in order to assess whether theinformation are of the highest quality that can advance science the science of health, health careutilisation, mortality, and sexuality, particularly among males. The testing of hypotheses arecritical to the formation of knowledge, this thought cannot be so if the quality of data are poorand forms the basis upon which I test the data quality and quality of survey data in Jamaica. Toachieve the highest degree of knowledge, ALL the chapters herein are empirical studies that testdifferent hypotheses, which can now be used to set propositions and theories about Jamaicanmales. Within the context of the complexities of knowledge, a number of the chapters emergedout of discussions with colleagues as I sought to extend coverage of some themes becausedifferent perspective on issues. All the chapters are research studies, with the majority of thembeing published in peered reviewed journals. Thus, some of the chapters were co-authored withother Caribbean and non-Caribbean scholars. These themes, therefore, are embedded in thegreatest degree of scientific rigors, which will provide many truths on the diverse topics. ix
  11. 11. The advancement of science is based on the questioning all established truths. Truths arenot continuous flows, indefinitely over time. They are accepted, modified, or refuted over time.It is the continuous questioning of things that result in the testing of hypotheses, theestablishment of new set of propositions, theories and principles on the governing of what is.“What is now? Is based on a set of proposition of what is known on some matters. If thefundamental guiding principles change, then set of understanding will emerge to explain what is.Any discussion on health cannot go without examining the validity and reliability ofconceptualisation of health (absence of illness, mortality). Empirical evidence showed thatillness is related with poverty, making the debate on illness, a poverty one as well as the use ofconceptual frameworks. Poverty is well established as being associated with illness and chronic illness. Studieswhich have examined this phenomenon have done so using objective indices such as lifeexpectancy, infant mortality and general morality. This volume therefore evaluates (1) examinedsubjective indices such as self-reported illness and self-reported health, (2) re-tested the theoriesthat chronic illnesses are more likely to be greater in number among the poor and that illnessesare positively correlated with poverty, and (3) evaluated other social characteristics that accountfor the poverty-illness theory. Conceptual frameworks are not only forwarded in this book, they are tested to providetruths on findings and validity of data used to established facts. There is a longstanding discourseon whether self-reported health is a good measure of objective health. This has never beenempirical examined in Jamaica. Study text 1) examine the relationship between particularsubjective and objective indexes; 2) investigate the validity of a 4-week subjective index inmeasuring objective indexes; 3) evaluate the differences that exist between the measurement ofsubjective and objective indexes by the sexes; and 4) provide policy makers, other researchers,public health practitioners as well as social workers with research information with which can beused to inform their directions. Administrators, policy specialists, medical practitioners,researchers, scholars and the general populace have been using survey data and quoting findingswith testing of the accuracy of the results. In this volume having tested (Chapter 12) subjectiveand objective conceptualisation of health found that self-reported illness in a 4-week referenceperiod (subjective index of health) is a good measure of objective health than self-reportedillness for males and was a better measure for objective health for females. The discourse on the subjective versus the objective indexes of health wascomprehensively examined in chapter 12. The findings revealed that life expectancy at birth ofJamaicans and self-reported illness (assessed based on a 4-week period) are strongly negativelycorrelated with each other (correlation coefficient, r = - 0.731). Fifty-four percent of the variancein life expectancy at birth for the population of Jamaica can be explained by 1% change in self-reported illness. Disaggregating the results by gender revealed some variations in outcomes.There is a strong negative significant statistical correlation between life expectancy at birth of amale and self-reported illness of male (in %) - correlation coefficient, r = - 0.796. Sixty-three x
  12. 12. percent of the variance in life expectancy at birth of a male can be explained by self-reportedillness (in %). There is a negative moderate correlation between life expectancy at birth of afemale and self-reported illness of female (in %) – correlation coefficient = 0.683. Forty-sevenpercent of the variance in life expectancy at birth of a female can be accounted for by 1% changein self-reported illness females (in %). Although some finality can be used on subjective versus objective indexes of health inJamaica, there are some paradoxes in self-reported health data. Some of these paradoxes arehighlighted in this text (chapter 19), caution now must be used by researchers in interpreting self-reported health data collected from males, as they are clearly under-reporting illnesses and over-stating their health care-seeking behaviour. In spite of the paradoxes in the data, self-reportedhealth collected on females in Jamaica is of high quality. This denotes that the paradoxes withinthe health data have provided critical answers to males’ reluctance in visiting health carefacilities, their unwillingness to openly speak about illnesses and the fact that they haveconcealed information on their health. The paradox in income can be seen in the fact that while wealthy Jamaicans have moreincome and access to more socio-material and political resources, their health status is notgreater than the under-privileged, poor and poorest 20%. Additionally, the contribution ofincome to health status is minimal, which is not the case in the literature. It was expected thatJamaicans who sought more health care must have been experiencing more ill-health, but thiswas not the case. Having established that health data collected from males indicates a lowvalidity, with 49% of the sample being males, it follows that paradoxes identified in the currentstudy highlight the difficulties in interpreting health data in Jamaica. Therefore, a new approachis needed in soliciting information from males about their health status including who is used tocollect data. Sometimes, researchers and scholars rely on particular agencies (WHO, United Nations,ILO, World Bank, UNESCO, Statistical Agencies and Governmental Planning Agencies) forfindings (including statistical results). Those findings are treated as absolute truths, withouttesting (validation) by scholars. The Statistical agency of Jamaica opined that the population ofSt. Catherine can be used to represent that of the nation. This was used by a former colleague ofmine to examine older men’s health in Jamaica, using St. Catherine as the sample frame. Chapter19 of this work examines the validity of this finding. It is clear from the inconsistencies in thehealth data collected by the relevant agencies that the reliability of self-reported health data frommales will pose a problem in public health planning. Sample surveys are used for teaching healthcare professionals; examining health care staff requirements; community health care; planninghealth care; planning and determining the future care of patients; evaluation of public healthpolicies; health care interventions; the construction of community centres, hospitals and publicclinics; and clinical and health service provisions. Then there are two other issues that emergedfrom the present findings, firstly, as dichotomizing self-evaluated health for males loses some ofthe original information, and secondly, that a sample of St. Catherine is not the same as samplingthe nation, and so a sample from the parish of St. Catherine does not reliably reflect the detailedcharacteristics of the wider Jamaican population. Thus, care should be taken in the usage of sub- xi
  13. 13. national samples to generalize about a population and more so when it comes to data collectedfrom males in regards to their health. Even the dichotomisation of health (using illness or self-rated health status) was tested inthis text. One of the purposes of this volume is not to merely provide findings on health,particularly among males in Jamaica, but to validate the results, and if needs be provideclarifications on established truths. Truths can be empirically resulted and validated withexperiences. I wanted to provide truths in men’s health and sexual expressions in Jamaica, so Iopted to verified many of the established set of propositions as well as forward new perspectivesbased on the emerged findings. The findings of the current study show that the choice of cut-offfor the dichotomisation of self-reported health status marginally matters for age, marital status,and area of residence. These findings concur with Finnas et al.’s work [18] (Chapter 23).However, social class matters for males. The odds ratios for males at the different social classes,when moderate heath status is added to poor health status, changed substantially. This suggeststhat the dichotomisation of self-reporting for males will not shift and will produce a differentresult from if only poor or very poor were the cut-offs for self-reported health status. A discourse on men’s health and issues cannot conclude with an examination of sexualharassment, and men’s roles in this phenomenon. Chapters 26 and 27 evaluate sexual harassmentin Jamaica, health problems, consequences and implications.LAYOUT OF THE BOOKThis volume comprises 28 chapters, which is ideal for the general populace, administrators,sociologists, health demographers, public health practitioners, medical practitioners,undergraduate or graduate courses in health, health care utilisation, sexuality, sexual expressions,and health behaviour, particularly among males. Chapter 22 is highly statistical, so beforereading this one I am recommending reviewing the calculations of odds ratio and theirinterpretations. Even without this understanding, some general knowledge can still be had onreading the chapter. By for a comprehensive understanding of the text, undergraduate andgraduate students may require to do some course (or training) in advanced statistics. Paul Andrew Bourne Director Socio-Medical Research Institute 2011 xii
  14. 14. AcknowledgementI wish to thank a number of people who directly or indirectly contributed to the final text. Duringpursuing a master of science in Demography, I accidentally can on a work written by ProfessorDenise Eldemire-Shearer (formerly Denise Eldemire) that examined issues on aged Jamaicans. Iwas intrigued by the work, wanted to know more on ageing and so my interest became a passionfor knowledge on the subject. The discourse outlined in Professor Dr. Eldemire-Shearer’spublication lead me to other works. The urged was such that in a week I had read more than 10published works on ageing, particularly in the Caribbean. This began a love affair with ageingstudies. The question emerged was how could a demographer study ageing. In answering thisquestion, I search and extensively read over 20 studies published in journals entitledDemography and Population Studies. During this search, I thought that this could be my thesis to complete a master indemography. Professor C. Uche, tested my readings on the subject before he hesitantly acceptedthe possible of such a study. The passion for the area (ageing) was so strong that even when Iwas asked to select a new area that I opted for another supervisor, Professor Patricia Anderson.Professor Anderson believed that the topic was researched, guided the focus of the paper, andthen set me on my way with some junior academics (Dr. Sharon Priestley and Mr. JulianDevonish). Dr. Priestley (at the time Ms. Priestley) and Mr. Julian Devonish say the completionof the work. From the completed thesis, I was encouraged by Dr. I. Solan (a mathematician in theDepartment of Mathematics and Computer Science, the University of the West Indies, Mona) tothink of submitting an article for publication. This was followed up with two papers sent to theWest Indian Medical Journal. Subsequently, the articles were published after some adjustments.In order to meet the specified requirements of the journal, the papers went through extensivedrafts, redrafts, literature search, focus and reading of latest studies on ageing. The reading onageing deepens my interests in ageing and health, which later followed plethora of publicationsin the areas and related matters. The writing of this book is, therefore, in response to the aforementioned persons, myinterest in ageing and family members. I am undoubtedly indebted to all the named persons, thesuggestions from friends that I am able to collate the materials into a text. Thank you, all. xiii
  15. 15. About the AuthorPaul A. Bourne is the Director of Socio-Medical Research Institute, Kingston, Jamaica. He isthe author of Growing Old in Jamaica: Population Ageing and Senior Citizens’ Wellbeing, and ASimple Guide to the Analysis of Quantitative Data. An Introduction with hypotheses,illustrations and references, and coauthored Probing Jamaica’s Political Culture, volume 1: MainTrends in the July – August 2006 Leadership and Governance Survey, and A landscapeAssessment of Political Corruption in Jamaica. Dr. Bourne has taught at different level in theJamaican educational system (Primary, John Mills Junior High (formerly John Mills All Age);Vauxhall High (formerly Vauxhall Comprehensive High); Kingston College; Oberlin High,Gaynstead High; University of the West Indies, Mona Campus; Moneague Teachers’ College;Browns Town Community College, St. Mary’s College, and Young Women’s ChristianAcademy (YWCA). His numerous publications focused on 1) health, 2) health care utilisation,3) ageing, 4) validity and reliability of survey data, 5) sexual behaviour and 6) Trust. Some ofthe publication are shown in scientific journals such as North American Journal of MedicalSciences, International Journal of Collaborative Research on Internal Medicine and PublicHealth, Healthmed, Journal of Men’s Health, West Indian Medical Journal, Rural and RemoteHealth, Journal of Clinical and Diagnostic Research, Patient Related Outcome Measures,Accred Qual Assur: J for Quality, Comparability and Reliability in Chemical Measurement ,African Journal of Primary Health Care and Family Medicine, Research and Reports inTropical Medicine, Journal of Biomedical Sciences and Engineering, Open Access Journal ofContraception and Current Research Journal of Social Sciences. Dr. Bourne has served on manyeditorial boards, and reviews plethora of articles on various subjects.Contact information: Dr. Paul A. Bourne, Director, Socio-Medical Research Institute, 66 LongWall, Stony Hill, Kingston 9, St. Andrew, Jamaica, West Indies.Email: paulbourne1@yahoo.com or paulbourne1@gmail.com. Tel: (876) 457-6990 xiv
  16. 16. Part One: Health, Health Care Utilisation and Mortality 1
  17. 17. Chapter1 Biosocial determinants of health and health seeking behaviour of male youths in JamaicaThe current study aims to provide an understanding of the health of young males (ages 15-25years) which has been primarily lacking in the Caribbean, and in particular Jamaica. This studyutilised secondary cross-sectional dataset for 2007 taken from the Jamaica Survey of LivingConditions (JSLC). The questionnaire was modelled from the World Bank’s Living StandardsMeasurement Study (LSMS) household survey. The current study extracted 607 respondents (15-25 years) from a sample of 6,783 respondents. SPSS for Windows 16.0 (SPSS Inc; Chicago, IL,USA) was used to store, retrieve and analyse the data. A p-value of < 0.05 (two-tailed) was usedto indicate statistical significance. Four variables emerged as statistical significant correlates ofhealth status: self-reported illness, OR = 16950, 95% CI = 46.4-6187362.9; self-reported injury,OR = 114643.2, 95% CI = 100.2-131124116.9; crowding, OR = 0.2, 95% CI = 0.09-0.59 andhead of household, OR = 0.001, 95% CI = 0.0-0.2. None of the identified variables emerged assignificant correlates of the good self-rated health status of male youths - Model χ2= 16.284(8),P < 0.061. Of the variables identified, 1 emerged as a correlate of poor self-rated health status –self-reported illness – OR = 42.2, 95% CI = 2.6-693.2. Poverty is substantially a ruralphenomenon. Almost 30% of rural respondents were classified as being in the poorest 20%,compared to 17.3% of those in semi-urban and 8.7% in urban areas. At the same time, nostatistical association existed between area of residence and self-reported health status, self-reported injury, self-reported diagnosed health conditions and poor health status. The currentstudy does not concur with the established finding that poverty is more common among thechronically ill than among those who are not chronically ill. However, it supports the literaturethat current illness is primarily a response to males’ willingness to utilize health care. Theimplications for these findings are far-reaching, and public health practitioners now have aplatform upon which they can fashion interventions, health education and future research on thisvulnerable age cohort in Jamaica. 2
  18. 18. IntroductionThe Caribbean continues to grapple with an alarming crime problem. Scholars have found thatmuch of it is perpetrated by young males (≤ 30 years of age) [1-8]. Statistics showed that 67.6%of those arrested for major crimes in Jamaica (i.e. murder, shooting, robbery, house-breaking,rape and carnal abuse) were 16-30 years old, and that young males accounted for more than 80%of the numbers (Table 1.1). Bearing this out, for the period 1999-2002, statistics in Jamaicarevealed that more than 50% of those treated for gunshot wounds in the Accident and Emergencydepartments at public hospitals were 10-29 years of age, with the figures being relatively thesame for males and females. A recently conducted study by Powell, Bourne and Waller [9] foundthat 44% of Jamaicans indicated that ‘crime and violence’ was their most pressing problem, aphenomenon which extends to many other Caribbean nations such as Barbados, Trinidad andTobago, and Guyana [1-8]. The social realities of the crime problem in the region justify (1)studies on crime and violence, and (2) an inquiry into the fear of crime and victimization. Understandably, there are many studies on crime, violence and the fear of crime andvictimization in the Caribbean, but there are also other concerns such as substance abuse, sexualpractices, the survivability of young people, and male marginalization. Those issues have beenstudied and re-studied [10-18], sometimes yearly, but in addition to crime which is a narrowedaspect of the broad social issues that continue to challenge Caribbean peoples, there is a need toexpand research into this social problem. Studies continue to examine crimes, violence and thefear of crime and victimization, and rightfully so in the region and little attention if any has beenplaced on men’s health, and in particular young men’s health in the region, except in the area ofreproductive health and sexual practices [19-21]. 3
  19. 19. Recently an entire book entitled “Health Issues in the Caribbean” [18] covered topicssuch as child health, reproductive health, the elderly, chronic non-communicable diseases,disability, health care-delivery and health issues in the Caribbean, reinforcing the claim of thelack of research on men’s health and young males’ health. A study by Bourne [21] examined“Demographic shifts in the health conditions of adolescents 10-19 years, Jamaica”, whichprovided pertinent information on this cohort, but again men’s health or young males’ health wasnot the emphasis; neither did it capture most of those who attested for crimes, nor those who areinfluenced by crime and violence. With crime being such a dominant social problem and the factthat it is perpetrated by mostly young males, there is the tendency to become overindulgent inthis discourse. However, research conducted by Powell, Bourne and Waller [9] found that only18% of Jamaicans indicated that they have been victims of crime and violence in the last 12months. Clearly, there is an obvious need to expand the research, from crime, violence, fear andvictimization to health status, health conditions and health care-seeking behaviour among theyouth. Apart from being the perpetrators of crime and violence, how is their (1) health status, (2)health care-seeking behaviour and (3) how are the health conditions among young males (15 –25 years)? The current study aims to provide an understanding of the health of young males (ages15-25 years) which has been primarily lacking in the Caribbean, in particular in Jamaica. What isinfluencing their health care seeking behaviour? Those questions cannot be answered from theperspective of a general study on health or the health care-seeking behaviour of Jamaicans [22],as without disaggregating the results, pertinent information is lost on the this cohort because itwould be general findings on the populace. 4
  20. 20. Materials and MethodsStudy populationThis study utilised secondary cross-sectional dataset for 2007 taken from the Jamaica Survey ofLiving Conditions (JSLC). The JSLC is a joint publication from the Planning Institute of Jamaica(PIOJ) and the Statistical Institute of Jamaica (STATIN) for analysis [23-25]. The JSLC began in1988 to collect data on the living conditions of Jamaicans in order to measure governmentpolicies. These cross-sectional surveys were conducted between May and October of each yearacross the 14 parishes of Jamaica. The current study extracted 607 respondents (15-25 years)from a sample of 6,783 respondents [26, 27]. The JSLC used a stratified random probabilitysampling technique to draw the original sample of respondents. The non-response rates were26.2%. The JSLC survey used a complex design with multiple stratifications to ensure that itrepresented the population, marital status, area of residence and social class. The sample wasweighted to reflect the population of Jamaica [23-25].Study instrumentThe JSLC used an administered questionnaire where respondents were asked to recall detailedinformation on particular activities. The questionnaire was modelled using the World Bank’sLiving Standards Measurement Study (LSMS) household survey [23]. There are somemodifications to the LSMS, as JSLC is more focused on policy impacts. The questionnairecovers demographic variables, health, immunization of children 0–59 months, education, dailyexpenses, non-food consumption expenditure, housing conditions, inventory of durable goodsand social assistance. Interviewers are trained to collect the data from household members.Statistical methods 5
  21. 21. Descriptive statistics were used to analyse the socio-demographic characteristics of the samples.Chi-square analyses were used to examine the association between non-metric variables for areaof residence, and gender of respondents. T-test statistics and Analysis of Variance were used toevaluate metric and either a dichotomous or non-dichotomous variable respectively. Logisticregression analyses examined 1) the association between good health status and some socio-demographic, economic and biological variables, as well as 2) a correlation between self-reported health conditions (illnesses, dysfunctions or ailments) and some socio-demographic,economic and biological variables. SPSS for Windows 16.0 (SPSS Inc; Chicago, IL, USA) wasused to store, retrieve and analyse the data. A p-value of < 0.05 (two-tailed) was used to indicatestatistical significance. The only selection criterion for this study was based on the males being 15-25 years old.For the model, the selection criteria were based on 1) the literature review; 2) low correlations,and 3) non-response rate. The correlation matrix was examined in order to ascertain ifautocorrelation and/or multicollinearity existed between variables. Based on Cohen & Holliday[28, 29] correlation can be low (weak) - from 0 to 0.39; moderate – 0.4-0.69, and strong – 0.7-1.0. This was used to exclude (or allow) a variable in the model. Where collinearity existed (r >0.7), the variables were entered independently into the model to help determine which oneshould be retained in the final model construction. This was used to exclude or include somevariables, and was based on the variables’ contribution to the predictive power of the model andits goodness of fit. Such an approach was utilised in order to reduce multicollinearity and/orautocorrelation between or among the independent variables [30-36]. Forward stepwise logisticregression technique was used to determine the magnitude (or contribution) of each statisticallysignificant variable in comparison with the others, and the Odds Ratios (OR) aided the 6
  22. 22. interpretation of each significant variable. To derive accurate tests of statistical significance, theresearcher used SUDDAN statistical software (Research Triangle Institute, Research TrianglePark, NC), and this adjusted for the survey’s complex sampling design.MeasureAge is a continuous variable which is the number of years alive since birth (using last birthday):from 15 to 25 years.Self-reported illness (or self-reported dysfunction): The question was asked: “Have you had anillness such as influenza, asthma, et cetera in the past 4-week period?”Health conditions (i.e. parent-reported illness or parent-reported dysfunction): The question wasasked: “Is this a diagnosed recurring illness?” The answering options are: Yes, Influenza; Yes,Diarrhoea; Yes, Asthma; Yes, Diabetes; Yes, Hypertension; Yes, Arthritis; Yes, Other; and No.Self-rated health status: “How is your health in general?” And the options were: Very good;Good; Fair; Poor and Very Poor.Medical care-seeking behaviour was taken from the question ‘Has a health care practitioner,healer or pharmacist been visited in the last 4 weeks?’ with there being two options: Yes or No.Self-rated health status: “How is your health in general?” And the options were: Very good;Good; Fair; Poor and Very poor. For this study the construct was categorized into 3 groups – (i)Good; (ii) Fair, and (iii) Poor. A binary variable was later created from this variable (1=good andfair 0=otherwise).Social hierarchy: This variable was measured based on income quintile: The upper classes werethose in the wealthy quintiles (quintiles 4 and 5), the middle class was quintile 3, and the poorwere those in lower quintiles (quintiles 1 and 2). 7
  23. 23. Crowding: This is the total number of people in the household divided by the number of rooms,excluding verandah, kitchen and bathroom.Area of residence is a non-binary variable. 1= urban, 0=otherwise 1=semi-urban, 0=otherwise Reference group is rural areaResultsThe sample was 607 respondents (15-25 years): dwelling in urban areas, 33.9%; semi-urban,20.9%; rural, 45.2%; injured in last 4-week period, 2.4%; self-evaluated illness (in last 4-weekperiod), 3.3%; health care-seeking behaviour, 68.0%; primary or below education, 64.5%;tertiary level education, 6.5%; household heads, 8.9%; very good self-rated health status, 49.2%;good self-rated health status, 44.9%; moderate self-rated health status, 4.6%; poor self-ratedhealth status, 1.0%; and very poor health status, 0.3%. Of those who reported an illness, 75.5%stated the typology of health conditions: influenza, 6.7%; diarrhoea, 13.3%; asthma, 6.7%;hypertension, 6.7%; and other (unspecified), 66.7%. The mean age of the sample was 19.6 years(SD = 3.2 years). The median length of illness (in days) was 5 (range = 1, 28) and the number ofvisits to a health care practitioner was 1 time (range = 1, 3). Of the 8.9% of those who were heads of households, 29.6% were 24 years old; 18.5%were 22 years old; 14.8% were 23 years old; 13.0% were 25 years old; 11.1% were 19 years old;3.7% were 21, 20 and 17 years old; and .9% were 16 years old. Furthermore, a statisticaldifference existed between those who were and those who were not heads of households (Fstatistic = 48.6, P < 0.0001): mean age of those who were household heads was 22.4 years (SD =2.3 years) compared to those who were not household heads (19.4 years ± 3.1 years). There is a statistical difference between the mean length of illness (in days) and area ofresidence (F statistic = 5.706, P = 0.011). Those in urban areas recorded the greater length of 8
  24. 24. illness, 14.4 days (SD = 10.3 days); semi-urban areas, 6.5 days (SD = 5.8 days) and ruralrespondents, 4.7 days (SD = 2.5 days). Furthermore, a statistical difference was found betweentotal annual household expenditure among the social classes (F-statistic = 64.870, P < 0.0001.The mean annual household expenditure for the sample was USD 8,994.04 (SD = USD6716.46). However, those young males in households of the poorest 20% had an annualhousehold expenditure which was 3.3 times less than those in the households of the wealthiest20% (USD 15,152.73 ± 10,179.74), with the following annual household expenditures beingpoor, USD 6,311.23 ± 2,645.72; middle class households, USD 8,522.97 ± 3,656.07; andwealthy, USD 10,812.74 ± 5,573.11. No statistical difference was found between the annual household expenditure of thosewith illness (USD 11,091.18 ± 13,898.55) and those who did not report an illness (USD 9,001.44± 6,433.52) – t-test = 1.320, P = 0.187. A statistical association existed between household heads and areas of residence (χ2 =6.864, P = 0.032). Almost 7% of those who dwelled in rural areas were household headscompared to 6.3% of those living in semi-urban areas and 13.1% of those who resided in urbanareas. There is no significant statistical association between (1) self-reported illness and socialstanding (χ2 = 1.315, P = 0.859), (2) self-reported injury and social standing (χ2 = 2.640, P =0.620), and (3) self-reported diagnosed health conditions and social standing (χ2 = 12.80, P =0.687). Table 1.2 highlights information on the demographic characteristics of the sample by areaof residence. A significant statistical association was found between social standing and area of 9
  25. 25. residence (χ2 = 83.5, P < 0.0001). Almost 30% of rural respondents were in the poorest 20%compared to 17.3% of those in semi-urban areas and 8.7% in urban areas.Multivariate analyses Table 1.3 shows information on factors that are correlated with the health care-seekingbehaviour of the sample. Using stepwise logistic regression, 4 variables emerged as statisticalsignificant correlates of health status: self-reported illness, OR = 16950, 95% CI = 46.4-6187362.9; self-reported injury, OR = 114643.2, 95% CI = 100.2-131124116.9; crowding, OR =0.2, 95% CI = 0.09-0.59 and head of household, OR = 0.001, 95% CI = 0.0-0.2. The modelexplains 86.4% of the variability in the health care-seeking behaviour of respondents, and it is agood fit for the data - Model χ2= 123.91(8), P < 0.0001, Hosmer and Lemeshow goodness of fitχ2=37.781, P = 0.778. Concurrently, 55.1% of the variability in health care-seeking behaviour isaccounted for by self-reported illness, and self-reported injury accounted for 26.2%. Table 1.4 highlights the possible factors of self-rated good health status of the sample.None of the identified variables emerged as significant correlates of good self-rated health statusof male youths - Model χ2= 16.284(8), P < 0.061. Almost 95% of the respondents were used toestablished the model, and it was found that the model is a good fit for the data - Hosmer andLemeshow goodness of fit χ2=5.301 (8), P = 0.725. Table 1.5 examines possible factors that are correlated with poor self-reported healthstatus of respondents. Ninety-three percent of the sample was used to establish the model. Of thevariables identified, 1 emerged as a correlate of poor self-rated health status – self-reportedillness – OR = 42.2, 95% CI = 2.6-693.2. The model was a good fit for the data - Model χ2=123.91(8), P < 0.0001; Hosmer and Lemeshow goodness of fit χ2=1.206 (8), P =0.997. 10
  26. 26. DiscussionThe current study found that 94 out of every 100 young males (ages 15-25 years) reported atleast good health status. Only 1.3% of the sample indicated poor health status. However, 3.3%indicated having had an illness in the last 4 weeks and 2.4% were injured in the same period oftime. Almost 1 in every 100 young males had reported an acute condition compared to 2 inevery 100 who reported a chronic condition. Of those who reported an illness (n=15), 66.7%indicated other and 6.7% said hypertension. The prevalence of hypertension among young maleswas 2 in every 1,000 persons. Sixty-eight percent of the sample had visited a health carepractitioner in the last 4 weeks; 83% purchased the prescribed medication; 15% had healthinsurance coverage; 58.8% visited a public hospital for treatment compared to 5.9% who used aprivate hospital, 11.8% who utilised public health care centres and 29.4% who attended a privatehealth care centre. Concurrently, the median length of time in illness was 5 days, with themedian number of visits to a health care practitioner being 1. In addition to the afore-mentionedfindings, 27% of poo