CICAD. Comparative Analysis of Student Drug Use in Caribbean Countries. A Report on Student Drug Use in 12 Caribbean Countries

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Comparative Analysis of

Student Drug Use

in Caribbean Countries

Antigua and Barbuda, Barbados, Dominica, Grenada, Guyana, Haiti, Jamaica, St. Kitts and Nevis, St. Lucia, St. Vincent and the Grenadines, Trinidad and Tobago and Suriname

A Report on Student Drug Use in 12 Caribbean Countries

CICAD

Inter-American Drug Abuse Control Commission Secretariat for Multidimensional Security

Comparativ e Analysis of S tudent D rug U se in C ar ibbean Countr ies

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OAS Catalogue-in Publication Data

Comparative analysis of student drug use in Caribbean Countries: Antigua and Barbuda, Barbados, Dominica, Grenada, Guyana, Haiti, Jamaica, St. Kitts and Nevis, St. Lucia, St. Vincent and the Grenadines, Trinidad and

Tobago, and Suriname: A Report on Student drug use in 12 Caribbean Countries OEA/Ser.L/XIV.6.4

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Acknowledgements

A publication of this nature and the accompanying studies that underpin it would not have been possible without the necessary financial resources that are required to sustain these activities. This project was made possible by a grant from the Bureau of International Narcotics and Law Enforcement Affairs (INL) of the US Department of State.

This report is the culmination of twelve separate studies in twelve countries. Each country had its own coordinator and team of interviewers with whom CICAD worked. In addition, a small group of persons were responsible for data entry in each country and for sending clean datasets to CICAD for the data processing and analysis. Before any activities took place in the individual countries permission had to be sought and received from school authorities in ministries of education and they were consulted for school enrollment data and other information so that a representative sample of students could be taken and the fieldwork logistics could be determined. In most cases all or most of this work was facilitated by local drug commissions or their

equivalent. Several persons contributed to the data analysis, the drafting and review of this report and its eventual publication.

As such, the persons who would have contributed in some way to this project are too numerous to mention here, but they can be assured that this report could not have been done had it not been for their support. CICAD appreciates the contributions and the support of drug commissions in Antigua and Barbuda, Barbados, Dominica, Grenada, Guyana, Haiti, Jamaica, St. Kitts and Nevis, St. Lucia, St. Vincent and the Grenadines, Trinidad and Tobago, and Suriname.

Antigua and Barbuda: Clarence Pilgrim, Chairman, National Drug Council (NDC), Ministry of Housing, Culture & Social Transformation, Norma Jeffrey-Dorsett, Substance Abuse Prevention Officer: Substance Abuse Prevention Division, Ministry Social Transformation.

Barbados: Tessa Chaderton-Shaw, Manager, and Jonathan Yearwood, Research and Information Officer, National Council on Substance Abuse (NCSA), Ministry of Home Affairs.

Dominica: Jacinta Bannis, Director, and Martha Jarvis Research Officer, National Drug Prevention Unit (NDPU), Ministry of Health.

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Grenada: Dave Alexander, Officer in Charge, Arthur Pierre, Drug Control Officer, Terrance Walters, Drug Control Officer, Drug Control Secretariat, Ministry of Education.

Guyana: Angela Johnson, Permanent Secretary, and Joseph Quamina, Head of Security, Ministry of Home Affairs. Shradhanand Hariprashad, Research Officer, Ministry of Health. Haiti: Mr. René Magloire, Minister of Justice & Public Safety, France Garilus, Director, Haitian Observatory on Drugs, Commission Nationale de Lutte contre la Drogue (CONALD).

Jamaica: Michael Tucker, Director, and Ellen Grizzle, Director of Information and Research, National Council on Drug Abuse (NCDA), Ministry of Health.

St. Kitts and Nevis: Eileen Maclachlan Moore, Director, Paula Hazel, Executive Officer, National Council on Drug Abuse Prevention (NACDAP ), Carolyn Brownbill, Counselors (and supervisor for school survey) Ministry of National Security.

St. Lucia: Elizabeth Serieux-Wilson, Coordinator, Substance abuse Advisory Council Secretariat (SAACS), Ministry of Health.

St. Vincent and the Grenadines: Lanceford Weeks, Permanent Secretary, and Amrie Morris, Psychologist, Ministry of Health and the Environment.

Suriname: Manodj Hindori, Chairman, National Anti Drug Council (NAR), Marie Bunwaree, Director, and Krisnadath Rambali, Policy Officer, Drug Demand Reduction Office, NAR, Ministry of Health.

Trinidad & Tobago: Margaret Farray, Permanent Secretary, Ministry of Social Development, Clarence Leach, Coordinator, National Alcohol and Drug Abuse Prevention Programme (NADAPP), Elizabeth Richards, Research Officer, NADAPP, Esther Best, Senior Administrative Officer, National Drug Council (NDC), Ministry of National Security.

There were a number of persons who provided invaluable statistical, technical and other support to this project. These include Daniel Sucazes (sampling), Alejandro Retamoso (data processing), and Ken-Garfield Douglas (editorial, data processing, and report writing).

Within CICAD, a number of persons at the Inter-American-Observatory on Drugs (OID) each made significant contributions in all areas of this project and to this report. Dr. Francisco Cumsille, Coordinator of the OID, Luis Adrian Noble, former statistician with the OID, Marya Hynes, Specialist in Drug Research, and Pernell Clarke, Specialist in Drug Research and

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Student Drug Use in 12 Caribbean Countries

A Critical Analysis for Policy Makers

Prologue

In the 2003 – 2004 hemispheric report1 of the Multilateral Evaluation Mechanism (MEM) there

are two statements which are difficult to refute. The first was about national drug information systems:

“To be able to confront a problem it is important to understand its dimensions and characteristics.”

The second statement was about statistics on drug consumption:

“Epidemiological research on the extent of drug use in national populations remain extremely limited although progress can be seen in many countries of the hemisphere”

These two statements taken together serve to strongly justify the work that has gone into the publishing of the information in this report which represents an important step forward in the generation of drug consumption statistics in the Caribbean.

This report is the synthesis of 12 separate but similar studies that were implemented in 12 countries between 2005 and 2007, using one of the protocols of CICAD’s Inter-American Drug Use Data System (SIDUC). The protocol outlines the methodology for implementing drug prevalence surveys among secondary school students. All except one of the surveys were implemented in 2005 and 2006. Guyana’s survey was done early in 2007.

While we have had a few published country reports of studies done in some of the countries, there are very few examples of published work that looks comparatively at drug use among groups of countries or the Caribbean region as a whole, and this type of analysis may be seen as an indication of the direction that the Inter- American Observatory on Drugs (OID) will be going in the future.

James Mack Executive Secretary

CICAD

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CHAPTER 1 Introduction

Adolescence is a time of significant physical, intellectual, emotional and social change. As children age and grow, they pass through several developmental stages and from the age of 13 to around 20, boys as well as girls are usually trying to solidify their identities. The experiences of younger teens are quite different from those of older teens and the experiences of older teens and those of boys differ from those of girls. These distinctions are especially important as they relate

to the choices teens make about smoking, drinking and using drugs2.

The development of children has several stages and from about 13 years of age, as adolescents are solidifying their identities, they are prone to experiment with minor delinquency and

rebellion3_{. Because of the rapid changes they are experiencing, adolescents are at the risk of}

developing substance abuse more quickly. Drug taking has been identified as one of the delinquent behaviors in which some adolescents engage. The use of drugs at an early age is a problem in itself, but it may also lead to or at least be associated with a set of other issues which may be detrimental to the health and well-being of young people. Several studies among the adolescent population as well as those among adults have shown clearly that there are very strong associations between persistent drug use and health related problems such as mental illness, academic difficulties, poor relationships with peers and family, and problems with the justice system which often lead to incarceration or some other sanction. Responding to these risks before

they become problems can be difficult4_.

Academic Problems

Research suggests that there is a relationship between academic performance and adolescent substance use. Students who use alcohol or illicit drugs have been shown to be at greater risk for

performing poorly in school, and vice versa5_{. One Caribbean study reported that students who}

reported repeating two or more courses were more likely to report a higher lifetime prevalence of

marijuana use6_{. There have been some reports of students using drugs while on their school}

premises and some previous studies do corroborate this pattern7. This level of alcohol, tobacco

and drug availability should alert authorities to the obvious potential and actual negative effects that these substances may have on the school environment as a whole, and more specifically on a student’s ability to perform well in the short term. Longer term effects may include gradual or

2_{Douglas, K-G (1999) Patterns of Substance Use and Abuse among Post Primary Students in Jamaica. Department of}

Social and Preventive Medicine, U.W.I, Mona, Jamaica

3_{http://www.childdevelopmentinfo.com/development/erickson.shtml}

4_{NIDA: Preventing Drug Abuse, A Research Based Guide for Parents Educators and Community Leaders} 5_{Bergen, H. A., Martin, G., Roeger, L., and Allison, S. (2005). Perceived academic performance and alcohol,}

tobacco, and marijuana use: Longitudinal relationships in young community adolescents. Addictive Behaviors, 30, 1563-1573.

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sudden reduction in grades, truancy, absenteeism, and reduced participation in activities related to learning.

Health Related Problems

Apart from the well-known physical effects of psychoactive substances on the body, there are some less direct and more medium and long term problems that are manifested through events such as vehicular accidents, suicides, homicides, and transmission of HIV/AIDS either through increased risky sex due to impaired judgment or through sharing of needles for intravenously administered substances. The available evidence however suggests that intravenous drug use is very rare in the Caribbean. There are also some mental health issues that have a strong association with substance abuse. These include depression, schizophrenia, generalized anxiety

disorder, apathy, short-term memory loss and impaired learning8_.

Delinquency

The relationship between drugs and crime and delinquency is one of the most well studied phenomena in the drugs field. It is generally accepted that there is an association between delinquency, crime and drugs but most previous studies have stopped short of declaring that

drugs cause crime. Paul Goldstein’s framework9_{on the linkages between drugs and violence is}

very informative in this regard and he proposes three classifications:

1. Psychopharmacological: Violence due to the direct acute effects of a psychoactive drug on the user

2. Economic-compulsive: Violence committed instrumentally to generate money to purchase expensive drugs

3. Systemic: Violence associated with the marketing of illicit drugs, such as turf wars, contract disputes etc.

Drug use, as well as the social context in which that use occurs, are etiological factors in a wide range of other social phenomena. Drug use is known to be causally related to a variety of physical and mental health problems, crime, poor school performance, family disruption, and the like. Previous research has also consistently found strong connections between drugs and violence.

With this in mind, the SIDUC methodology addresses the problems that confront this subset of the population by providing a tool that can be used to measure their drug use history, demographic characteristics and make an attempt to identify risk and protective factors. This approach therefore seeks to achieve the following broad objectives:

8_{National Institute of Mental Health, U S Department of Health and Human Services.} 9

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• To determine the lifetime, past year and past month prevalence of consumption of licit and illicit drugs

• To estimate the past year and past month incidence • To determine age of initiation

• To determine risk and protective factors and the perception of harm • To assess the relationship between drug use and risk factors

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CHAPTER 2 Methodology

The SIDUC survey of secondary school students utilizes a standardized methodology that was created by CICAD and developed through consensus by survey experts and practitioners in the hemisphere. The main objective of the uniformity of the approach is to allow the direct comparison of cross-sectional data from surveys that were implemented in different countries and at different times. As a result, the sampling procedures, data collection, the questionnaire, and data management methods are all the same (or comparably similar) in each of the countries included in this comparative study.

Population

The population targeted for this survey includes students in secondary level (or high) schools in forms 2, 4 and 6 (this is similar to grades 8, 10 and 12 in the USA school system). Generally, it would be expected that the corresponding ages would be 13, 15 and 17, but this rule can be adapted to suit the realities of the particular country. For instance, countries with very low levels

of students at the 6th_{form level would have included students at the 5}th_{form level.}

Sampling

The sample frame for this survey contains all students enrolled in 2nd, 4th and 6th forms in all

secondary schools in a particular geographic location such as a city, urban locale, rural locale, or the entire nation. The data presented in this report represents national level data for the sample frame for all of the participating countries and the classes included meant that students who are 13, 15, and 17 years of age were included in the sample frame. The last age group however was modified to 16 years of age because in the Caribbean, most of the school systems normally see a

dramatic drop in the number of students in the classes corresponding to the 6th_{form. This does}

not mean that there are not students above 16 in the sample, but the overall numbers are significantly smaller. In addition, the delineation between age groups by grade is not always reflected in the reality of the classrooms. A final adjustment was made in the database, and analyses were performed on age categories of 14 years old or less, 15 – 16 years old, and 17 years and older.

The information used to define the sample frames were taken from complete lists of student enrollment for the grades required in all schools in the country. The information includes the actual or average number of students in each of the class rooms in the relevant grades. The final sampling unit is the classroom and a number of these classes are randomly selected. All of the students in the selected classrooms are included in the final sample. Class samples are therefore nationally representative and the information collected on the sample frame allows the results of the surveys to be expanded to the general student population in the selected grades by using an expansion factor.

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Data Collection

Data is collected from the sample of students by applying a pre-coded, self-administered questionnaire that has a core standard section to ensure the comparability discussed earlier. Survey leaders in individual countries are free to add modules to explore issues of interest to them. To ensure the quality as well as the anonymity of responses, SIDUC recommends that data collection occurs in surroundings familiar to the students—which in all cases was their classrooms—and with minimal or no involvement of teachers in the administration of the questionnaire. This type of fieldwork requires a well-trained team of persons for implementation, particularly since, this group of persons serve as the main point of contact with the student. The team usually consists of a project leader, supervisors, and facilitators—each with a clearly articulated set of responsibilities.

The questionnaire consists of a standard set of questions that are arranged as follows: · Basic socio-demographic information

· Beliefs about future academic performance · Discipline and academic problems

· Opinion on harms associated with the consumption of drugs · Prevalence of substance use and patterns of consumption · Incidence of substance use

· Frequency of use

Data Entry and Analysis

The data from these studies was transcribed using a customized Microsoft Excel spreadsheet that was formatted to allow double entry for cleaning and verification. This data is then imported into

SPSS10_{for processing using univariate and bi-variate analysis.}

Because of differences in the age and gender distribution from country to country a statistical adjustment was made using a direct standardization method so that the prevalence, incidence and other estimates can be directly compared and are not affected by these two variables.

Definitions of Terms

Throughout this report certain terms have been used to describe the prevalence of substance use. These definitions are:

· Never - those who have never used the substance

· Lifetime prevalence – is the percentage of students who have used the substance at least

once anytime in the past.

· Last year or past year prevalence – is the percentage of students who had used the

substance at least once during the one year period prior to the administration of the survey.

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· Last month or past month prevalence – is the percentage of students who had used the

substance at least once during the one month period prior to the administration of the survey (also referred to as current prevalence).

Behavioral Problems at School

For the purpose of this study, problems at school are identified using two main indicators—the number of occasions that students are disciplined for behavioral problems and the number of years repeated during the course of their studies. When asked about the number of times they were disciplined, responses categories were ‘never’, ‘few times’ and ‘frequently’. The options given for number of years repeated during the course of studies were ‘none’ or ‘one or more’ times.

Definitions of Substances

The drug categories used in this report are identical to the categories used in the questionnaire and follow the descriptions and examples provided to students in the questionnaire within each country of administration.

Empirical Association

Empirical association between demographic variables and drug use do not imply causal relationships. The tables presented are particularly useful for the purposes of identifying demographic sub-groups with relatively high or low rates of drug use regardless of the underlying causes of drug use. Given the size of the national samples and the rigorous sampling methods employed, differences of more than a few percentage points can quite confidently be considered significant and of concern.

Limitations

This comparative report is based on a combination of datasets from different studies in 12 countries. Not all of the studies occurred at the same time, so strictly speaking the data spans a period of about 2 years between the oldest and the most recent study. The effect of natural changes over time is therefore a factor that can affect the comparability of the results in this report. There is not enough time series data from the participating countries to determine an adjustment factor to compensate for this.

The samples of students taken in each country had different age and gender distributions. A direct method was used to standardize the data based on these two variables.

Self report surveys rely on the truthfulness of respondents, their memory of things that have occurred in the past, and their level of comprehension of the questions in the questionnaire. Each

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one or all of these things can contribute to inaccuracies in the data. The questionnaire was designed in such a way as to detect intentional dishonesty by respondents among other things. Data transcription is another potential source of error. The data entry that was done for all of the surveys in the countries analyzed here was done using double data entry into a standard data entry template using Microsoft Excel. The spreadsheet also included built in verification macros and data validation settings to minimize data entry errors.

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CHAPTER 3 Results

Description of Sample

The samples of students taken in the individual countries yielded an overall total of 38, 534 students, all of which are included in this comparative analysis. Weighting resulted in an effective population size of 170,580 nationally represented students across the region. The largest individual sample was taken in Haiti (10,638 students) while the smallest was taken in St. Vincent and the Grenadines (1,018). For the most part all other country sample sizes was close to or above recommended 2000-3000 students based on the standardized methodology.

TABLE 1: Sample Sizes and Distribution of Students by Gender.

Percentage Distribution of Sample by Gender Country Sample Size Weighted

Population

Males Females

Antigua and Barbuda 2,057 2,057 42.39 57.61 Barbados 2,220 11,053 46.90 53.10 Dominica 2,369 2,369 44.76 55.24 Grenada 3,088 3,088 54.17 45.83 Guyana 2,461 19,616 39.25 60.75 Haiti 10,638 10,638 50.29 49.71 Jamaica 4,536 61,981 48.81 51.19 St. Kitts and Nevis 2,100 2,100 47.60 52.40 St. Lucia 2,072 2,072 40.76 59.24 St. Vincent and the Grenadines 1,018 4,913 36.52 63.48 Suriname 2,066 11,209 44.99 55.01 Trinidad and Tobago 3,909 39,484 44.84 55.16

Total 38,534 170,580 46.67 53.33

The figures in table 1 show the sample sizes and effective weighted population in each of the twelve countries along with the gender distribution of the sample. It is evident that the gender distribution varies from country to country, and because of this, a statistical adjustment was made to correct this problem to facilitate the calculation of prevalence and other estimates and increase the comparability of the results. The largest variations were reflected in the data from Guyana and St Vincent and the Grenadines where more than six of every ten respondents were females. The distribution is shown below in figure 1.

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Figure 1

Distribution of Sample by Gender

0 10 20 30 40 50 60 70 Antig ua & Barb uda Barb ados Dom inica Gren ada Guy ana Haiti Jam aica St. K itts and Nevis St. L ucia St. V ince nt & the Gre nadi nes Surin ame Trinid ad & Toba go Total Males Females

Table 2 and figure 2 show the distribution of the sample by age category. The age categories are used in this way to make the SIDUC survey results comparable with those from other regions such as those in Europe. It is clear that the age distribution is very uneven from country to country and from age group to age group. The overall distribution showed that just over third were 14 years or less (39%) or 15-16 years (37%) with about a quarter (24%) being 17 years and older. Notable differences were seen in Haiti and Suriname where more than four of every ten students were 17 year and over.

TABLE 2: Distribution of Sample by Age Group.

Country Distribution of Sample by Age Group

14 or less 15 – 16 17 or more

Antigua and Barbuda 45.14 33.94 20.92

Barbados 51.16 43.78 5.06 Dominica 42.60 37.09 20.31 Grenada 36.54 44.37 19.09 Guyana 41.70 47.70 10.60 Haiti 30.34 28.42 41.24 Jamaica 39.74 37.53 22.73

St. Kitts and Nevis 49.88 40.09 10.03

St. Lucia 40.09 46.70 13.22

St. Vincent and the Grenadines 40.37 44.60 15.03

Suriname 23.01 35.89 41.10

Trinidad and Tobago 47.33 33.04 19.63

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Figure 2

As was mentioned before, due to the differences in gender and age distribution among the countries, the direct method was used to standardize the indicators shown in this report.

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Alcohol

Alcohol is a substance that has a very intimate association with the Caribbean region in terms of both its history as well as its culture—the Caribbean being historically a major producer of sugar cane and rum. Its use is generally accepted as a norm for adults in many social settings

and as a part of their diet11_{. Given this context, and the well-documented consequences of}

both casual and problem drinking, it is essential for policy makers to get some idea of how this substance is used among young persons.

Prevalence

Table 3 shows the prevalence of alcohol use in each country. The overall average lifetime prevalence was 68.90% and ranged from a low of 47.72% in Haiti to 86.20% in St Lucia. All other countries with the exception of Suriname, Guyana, Jamaica, St Kitts and Nevis and St Vincent and the Grenadines reported lifetime prevalence well above the overall average (more than 70%).

Prevalence of use in the past year ranges from a low of 26.91% in Haiti to a high of 73.64% in St. Lucia. Haiti’s results almost make it an outlier since the country with the next lowest past year prevalence is Suriname with 44.78%. The results for this group of countries could easily be classified into low (less than 40%), average (40 to 60%), and high (more than 60%) prevalence groups. Only Haiti would be included in the ‘low’ group, while Dominica, St. Lucia and Trinidad and Tobago would be classified as high prevalence countries (in terms of past year prevalence).

TABLE 3: Prevalence of Alcohol Use

Country Lifetime Prevalence Past Year Prevalence Past Month Prevalence

St. Kitts and Nevis 64.77 45.41 30.04 St. Lucia 86.20 73.64 61.95 St. Vincent and the Grenadines 65.34 46.38 33.21

Suriname 61.15 44.78 31.80

Average 68.90 51.00 36.70

The results for past month prevalence—current use--mimic the past year prevalence results. Here again, Haiti has the lowest prevalence (18.27%) and St. Lucia has the highest with 61.95%. Interestingly, a higher percentage of the school students of the high prevalence countries

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(Dominica, St. Lucia, and Trinidad and Tobago) reported alcohol consumption in the past month greater than the percentage of the students in Haiti who reported ever using alcohol in their lives. As with past year prevalence, 42% of all countries reported past month prevalence higher than the reported overall average past month prevalence.

When these results are disaggregated by gender, an interesting picture emerges (table 4 and figure 3). In the majority of countries there appears to be the expected pattern where alcohol prevalence among males is higher than that among females. However, a surprising number of countries have results that show lifetime, past year and past month prevalence rates for females that are higher than that of males. Antigua and Barbuda, Barbados, St. Kitts and Nevis, and Trinidad and Tobago are the four countries where this situation exists for lifetime prevalence and as shown in Table 4, this pattern remained the same for past year and past month prevalence for Barbados and St. Kitts.

Using the before mentioned categorization, in four countries males had high past year prevalence (more than 60%)—Dominica, Grenada, St Lucia and Trinidad and Tobago— compared to three countries where females had high prevalence—Dominica, St Lucia and Trinidad and Tobago.

TABLE 4: Alcohol Prevalence by Gender

Country Lifetime Prevalence Past Year Prevalence Past Month Prevalence Males Females Males Females Males Females

Antigua and Barbuda 69.96 72.07 47.73 50.46 32.36 30.44 Barbados 72.77 78.02 52.94 56.26 33.62 35.37 Dominica 81.50 79.06 68.85 63.66 54.51 49.08 Grenada 84.28 77.78 64.87 53.87 44.74 35.12 Guyana 67.68 55.34 53.40 40.42 41.30 32.94 Haiti 52.06 44.02 31.21 23.25 21.00 15.94 Jamaica 69.76 62.47 51.97 42.81 36.73 30.53 St. Kitts and Nevis 63.06 66.22 42.85 47.59 28.91 31.00 St. Lucia 87.99 84.67 75.59 71.98 65.56 58.88 St. Vincent and the Grenadines 71.98 59.67 53.89 39.98 39.35 27.97 Suriname 66.27 56.78 50.84 39.61 37.31 27.10 Trinidad and Tobago 80.82 83.16 66.23 66.91 51.98 45.03

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Figure 3

Past Year Prevalence of Alcohol by Gender

47.73 52.94 68.85 64.87 53.4 31.21 51.97 42.85 75.59 53.89 50.84 66.23 50.46 56.26 63.66 53.87 40.42 23.25 42.81 47.59 71.98 39.98 39.61 66.91 0 10 20 30 40 50 60 70 80 Antig ua & Bar buda Barb ados Dom inica Gre nada Guy ana Haiti Jam aica St. K itts and Nev is St. L ucia St. V ince nt & the Gre nadi nes Surin ame Trini dad & Tob ago Males Females

Examining the results of alcohol prevalence among the different age groups is particularly important for the target population that was sampled. This allows us to explore how alcohol use could possibly develop from one age cohort to another without having to rely on more expensive longitudinal study designs. The results in tables 5 and 6, and figure 4 show that there is a positive relationship between age and prevalence of alcohol use in all of the countries surveyed. This means that as age increased, the prevalence of alcohol use also increased resulting in higher prevalence among the older students.

It is interesting to note that the differences in past year prevalence between the age groups are more pronounced between the youngest cohort (14 or less) and the middle cohort (15–16 years). This may indicate that there is either more experimenting or a higher incidence of alcohol use (or both) among the younger cohort of students. Jamaica is the only country that does not strictly follow the same pattern as the other countries. The past year prevalence of alcohol use of the 17 years and older cohort is slightly less than the 15-16 years old cohort (53.05% versus 55.16%). Otherwise, the pattern remains consistent.

The data showed that the differences between the 15-16 year olds and the younger cohort ranged from 12-19 percentage points except in the case of Haiti and Suriname which were 6 percentage points and 9 percentage points respectively. In the case of differences between the 17 years and older cohort and the 15-16 year olds, this was less pronounced and ranged from 1.4-13 percentage points with Jamaica and Trinidad and Tobago being notable exceptions with higher

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TABLE 5: Past Year Alcohol Prevalence by Age Group Past Year Prevalence Country

14 years or less

15 – 16 years 17 years or more

Suriname 36.86 46.18 56.96

Average 43.05 57.49 61.14

Figure 4

Past Year Prevalence of Alcohol Use by Age Group

0 10 20 30 40 50 60 70 80 90 Antigua & B arbu da

Barbados Dom inica Gren ada Guy ana Haiti Jam aica St. K itts and Nev is St. L ucia St. V incen t & th e Gr enadi nes Surina me Trini dad & To bago

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TABLE 6: Past Month Alcohol Prevalence by Age Group Past Month Prevalence Country

14 years or

less 15 – 16 years 17 years or more

St. Lucia 52.55 64.00 75.74

Suriname 25.06 31.34 44.93

Average 29.49 41.00 46.54

In the case of past month prevalence, the data showed that the differences between the 15-16 year olds and the younger cohort ranged from 10-15 percentage points except in the case of Guyana (9 percentage points), Haiti (3.5 percentage points) and Suriname (6 percentage points). In the case of differences between the 17 years and older cohort and the 15-16 year olds, six counties— Antigua, St Lucia, St Vincent and Suriname, Grenada and Dominica—reported differences of 8-14 percentage points with all other countries reporting negligible differences. Note also that more than half (52.55%) of the students in St. Lucia in the age group 14 years or less reported that they had consumed alcohol in the past month.

Incidence

The incidence measure in this report refers to the cumulative incidence, which for our purposes provides an estimate of the probability that a student will consume alcohol for the first time during a typical one year period. Haiti and Grenada are the only two of the twelve countries surveyed that did not collect incidence data as seen in table 7 and figure 5. As expected, the incidence rates that were calculated are very much in line with the corresponding prevalence rates such that higher incidence countries also reported higher prevalence rates.

In St. Lucia for example, the probability that a student consumed alcohol for the first time during the one-year period before the survey was estimated to be 67.41%, while in Dominica and Trinidad and Tobago the corresponding rates were relatively high at 59.95% and 57.89% respectively. Estimated incidence rates for all other countries were below 50% and ranged from 37.41% in Suriname to 49.73% in Barbados. The average past year incidence rate for the entire group of countries was 48.84%.

It is very interesting to note that the probability that a student in Suriname will initiate the use of alcohol during a one year period (37.41%) was almost half that of a student in St. Lucia

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(67.41%). The past month incidence showed the same pattern among the countries—St Lucia, Dominica and Trinidad and Tobago reporting the highest past month prevalence.

TABLE 7: Past Year and Past Month Alcohol Incidence Incidence

Country Past Year Past Month

Antigua and Barbuda 44.72 27.56

Barbados 49.73 28.78 Dominica 59.95 42.62 Grenada - - Guyana 39.47 19.34 Haiti - - Jamaica 42.88 26.13

St. Kitts and Nevis 42.23 24.70

St. Lucia 67.41 51.70

St. Vincent and the Grenadines 45.23 23.38

Suriname 37.41 22.27

Trinidad and Tobago 57.89 36.51

Average 48.84 27.39

Figure 5

Past Year Incidence of Alcohol Use

44.72 49.73 59.95 39.47 42.88 42.23 67.41 45.23 37.41 57.89 0 10 20 30 40 50 60 70 80 Antigua & Barbuda

Barbados Dominica Guyana Jamaica St. Kitts and Nevis

St. Lucia St. Vincent & the Grenadines

Suriname Trinidad & Tobago

Age of First Use of Alcohol

The average age of first use of alcohol ranged from 10.88 years old in Barbados to 13.34 years old in Suriname. Most of the countries’ results indicate an average age of first use of just over 11

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years of age (Guyana, Haiti and Suriname being notable exceptions). The mean age of first use of alcohol across the region (for those countries reporting) was 10.84 years with a median of 12 years. For males the overall mean was 11.51 years compared to 11.77 years for females. The overall median was also 12 years for both groups (table 8 and figure 6).

TABLE 8: Average Age of First Use of Alcohol by Gender Average Age of First Use of

Alcohol

Country Overall

Average

Antigua and Barbuda 11.28 11.20 11.39 Barbados 10.88 10.86 10.90 Dominica 11.54 11.17 11.85 Grenada 11.16 10.86 11.39 Guyana 12.28 11.87 12.25 Haiti 13.17 13.22 12.79 Jamaica 11.71 11.22 12.02

St. Kitts and Nevis 11.30 11.09 11.19 St. Lucia 11.32 10.93 11.46 St. Vincent and the Grenadines 11.83 11.64 11.74 Suriname 13.34 13.35 13.01 Trinidad and Tobago 11.07 10.69 11.20

Average 10.84 11.51 11.77

Figure 6

Average Age of First Use of Alcohol by Gender

0 2 4 6 8 10 12 14 16 Antigua & B arbuda Barb ados Dom inica Grenada Guya na _Haiti Jam aica St. K itts a nd N evis St. Lu cia St. V incen t & the Gre nad ines Surina me Trini dad & Tobago Aver age Males Females

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A gender analysis of these results shows that except for two countries (Suriname and Haiti), there is a consistent pattern where boys initiate use of alcohol before girls (figure 6). In all cases however, the difference is less than one year so the gender gap is not very large. As mentioned earlier, Suriname and Haiti are the only 2 countries in the group where the results indicate that girls initiate use of alcohol at a slightly earlier age than boys. The average age of first use for girls in Haiti is 12.79 years and for boys it is 13.22 years. The corresponding numbers for Suriname are 13.01 years and 13.35 years respectively.

Alcohol and Behavioral Problems

Table 9 and figure 7 show the relationship between past-year prevalence of alcohol use and behavioral problems. Students were asked about the number of discipline or behavior problems that they have experienced during their school years and the responses were categorized as ‘none’, ‘few times’ and ‘frequently’. The results indicate that there is a consistent positive relationship between past year prevalence and behavioral problems. This relationship is such that

as the number of behavioral problems increase so too does prevalence of alcohol use*. The only

country where some inconsistency appeared was in St. Vincent and the Grenadines where prevalence in the group with frequent behavior problems was slightly less than that with a few behavioral problems.

The average difference in past year prevalence overall between those who never had behavioral problems and those who frequently had behavioral problems was 24 percentage points. The difference between these two groups ranged from a low of 10 percentage points in Haiti to a high of 41 percentage points in Barbados and St Kitts and Nevis. Other notable differences were observed for Guyana (38 percentage points), Grenada (28 percentage points), Suriname (25 percentage points) and St Lucia (24 percentage points).

TABLE 9: Alcohol Use and Behavioral Problems

Past year Prevalence of Alcohol Use by Behavioral Problems During School

Years Country

Never Few Times Frequently

Antigua and Barbuda 44.29 54.78 56.63 Barbados 41.60 59.30 82.91 Dominica 58.72 72.79 80.58 Grenada 50.96 64.80 78.58 Guyana 37.73 59.60 76.10 Haiti 25.35 33.80 35.52 Jamaica 44.84 53.99 58.01 St. Kitts and Nevis 33.05 51.25 74.36 St. Lucia 64.58 80.47 89.02 St. Vincent and the Grenadines 38.50 54.52 53.22 Suriname 39.57 62.61 64.22 Trinidad and Tobago 60.56 77.00 83.65

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Figure 7

Past Year Prevalence of Alcohol Use by Behavioural Problems

0 10 20 30 40 50 60 70 80 90 100 Antig ua & Bar buda Barba dos Dom inica Grena da Guy ana Haiti Jam aica St. K itts and Nev is St. Lu cia St. V incen t & th e Gr enad ines Surina me Trini dad & Tob ago

Never Few Times Frequently

Binge Drinking

One of the behaviors that this group of surveys attempted to measure was the consumption of large quantities of alcoholic drinks (5 or more) in one sitting, also known as binge drinking, heavy drinking, heavy episodic drinking and other phrases.

This behavior is currently under debate as to how it should be defined. According to the Journal

of Studies on Alcohol and Drugs12_{, clinicians and researchers have been using the term ‘binge’ to}

represent very different situations and scenarios and it has recommended a definition for accepted manuscripts which insists that 2 distinct conditions must be present in order to define drinking patterns as binge drinking. Firstly, there must be prolonged repeated use of alcohol (usually two or more days) to the point of intoxication and secondly the individual must give up their usual activities to do this.

This is a very strict definition of binge drinking, and this could not be measured with this study’s dataset. For the purposes of this report a variation of the generally accepted definition used in some countries will be adapted. Binge drinking will be defined as the consumption of five or

12

Guidance for authors on the policy of the Journal of Studies on Alcohol and Drugs regarding the appropriate use of the term "binge". http://www.jsad.com/jsad/static/binge.html July 01, 2010.

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more drinks in one sitting at least once in the previous 2 weeks. We will also define heavy binge drinking as four or more binge drinking episodes in 2 weeks.

The results of this comparative study indicate that binge drinking among current users of alcohol (i.e. those who consumed in the last 30 days) was high. Proportions ranged from a low of 25.6% in Guyana to a high of 51.8% in Suriname (see Table 10). This represents quite a stark difference between two countries that share a border and have several common demographic characteristics. Reported levels indicate that Suriname, Dominica, St. Kitts and Nevis, Barbados and St. Vincent and the Grenadines are the countries where more than 40% of current drinkers were binge drinkers. Antigua and Barbuda, Trinidad and Tobago, Jamaica and St. Lucia report lower levels of binge drinking all below 36%.

The pattern among countries changes in relation to heavy binge drinking. Dominica (14.8%), Barbados (13.1%) and Jamaica (10.8%) are the countries with the highest prevalence of heavy binge drinking among current drinkers. Guyana (6.2%), Trinidad and Tobago (8%), Antigua and Barbuda (8.5%), and St Lucia (8.6%) are the countries with the lowest rates. Guyana reported the lowest levels of both binge drinking and heavy binge drinking while at the other extreme, Dominica reports the highest rates of heavy binge drinking and Suriname reports the highest binge drinking rates.

Table 10: Prevalence of Binge Drinking by Country*

Binge Drinking: Percentage of Current Drinkers Consuming 5 or More Alcoholic Drinks in the Past 2 Weeks

Country

Never Once 2- 3

times times 4 – 5 than 5 More times

Cumulative proportion of binge

Antigua and Barbuda 51.6 10.6 12.1 2.6 5.9 31.2 Barbados 48.0 15.4 14.6 3.9 9.2 43.1 Dominica 48.4 18.3 15.4 6.0 8.8 48.5 Grenada - - - - Guyana 43.5 13.0 6.4 3.1 3.1 25.6 Haiti - - - - Jamaica 42.2 14.3 10.7 4.9 5.9 35.8 St. Kitts and Nevis 42.5 20.7 15.7 4.1 5.5 46.0 St. Lucia 51.6 13.3 11.0 3.4 5.2 32.9 St. Vincent and the Grenadines 55.8 20.8 12.8 2.8 7.4 43.8 Suriname 29.4 24.1 18.0 4.7 5.0 51.8 Trinidad and Tobago 64.3 13.1 10.2 3.7 4.3 31.3

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Cigarettes

Tobacco is one of the most widely used addictive substances in the world and also one of the leading causes of death. The addictive component of tobacco is nicotine, and it is consumed mainly by smoking cigarettes, cigars or by directly chewing the tobacco. According to the World Health Organization (WHO), tobacco use is one of the biggest health threats the world has ever faced. The WHO website also lists the following key facts:

• There are more than one billion smokers in the world

• Globally, the use of tobacco products is increasing, although it is decreasing in high income countries

• The epidemic is shifting to the developing world • Tobacco use kills 5.4 million people a year

• It is a risk factor for 6 of the 8 leading causes of death in the world

• 100 million deaths were caused by tobacco in the 20th_century

• Unchecked, tobacco-related deaths will increase to more than 8 million a year by 2030 and 81% of those deaths will occur in the developing world.

The 1994 report of the US Surgeon General13_{indicated that teens who smoke are three times}

more likely than nonsmokers to use alcohol, eight times more likely to use marijuana, and 22 times more likely to use cocaine. Smoking is associated with a host of other risky behaviors, such as fighting and engaging in unprotected sex.

The students in these Caribbean surveys were asked about their use of cigarettes, and table 11 shows the estimates of prevalence in all 12 countries. The lifetime prevalence rates indicate that a wide range of values were reported by the countries surveyed. Grenada is the country with the highest reported rate of lifetime prevalence (34.53%) along with Suriname (33.06%), Dominica (30.69%) and Trinidad and Tobago (28.86%).

Past Year Prevalence was similarly high for Suriname (14.15%), Dominica (13.22%), Trinidad and Tobago (11.36%), and Grenada (10.75%). The overall average past year prevalence was 9.45% and most all other countries reported prevalence rates less than this with the exception of St Lucia (11.31%). The lowest prevalence was reported by Haiti (3.25%), St Kitts and Nevis (4%) and Antigua and Barbuda (4.47%). The low past year prevalence rates among these countries were as low as the overall average past month prevalence.

Table 11 indicates that smoking in the past month (current users) has a relatively low prevalence among students in the 12 countries surveyed. Dominica (7.76%), Suriname (7.15%), St. Lucia (5.97%), and Grenada (5.45%) are the only countries with past month prevalence rates that are greater than 5%. The lowest prevalence was reported by Haiti (1.49%) and St Kitts and Nevis (1.98%).

13

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TABLE 11: Prevalence of Cigarette Use

Country Lifetime

Prevalence Prevalence Past Year Past Month Prevalence

St. Lucia 27.84 11.31 5.97

Suriname 33.06 14.15 7.15

Average 25.60 9.45 4.94

Cigarette Use and Gender

Lifetime prevalence for males was high for Suriname (41.57%), Grenada (40.35%), Dominica (38.39%), St Lucia (34.43%) and Trinidad and Tobago (33.98). The lowest prevalence was reported for Haiti at 11.47%. Likewise among females, the highest lifetime prevalence was reported for Grenada (29.56%) and Suriname (25.79%). Females in Haiti, like their male counterparts, reported the lowest prevalence (7.25%).

Past year prevalence among males and females showed similar patterns to lifetime prevalence. A notable difference was Barbados, where females reported a higher prevalence than males (3 percentage points difference). Low prevalence rates among both females and males were reported for Haiti, St Kitts and Nevis, and Antigua and Barbuda.

Table 12 shows the past month prevalence of cigarette use among males and females. In some of the countries it appears that the overall prevalence rates are largely driven by males. For example, in Dominica, Guyana, St. Vincent and the Grenadines and Suriname, the prevalence rates of male students are more than twice that of female students. In all other countries except Barbados, there is also a gender disparity, though less pronounced, that shows more males reporting current use than females. Barbados on the other hand is the only country where there appears to be a higher proportion of female students (3.81%) than male student (3.49%) report past month cigarette use.

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TABLE 12: Cigarette Prevalence by Gender

Country Lifetime Prevalence Past Year Prevalence Past Month Prevalence Males Females Males Females Males Females

Antigua and Barbuda 19.29 15.61 5.18 3.86 2.52 1.17 Barbados 22.63 20.46 6.94 9.37 3.49 3.81 Dominica 38.39 24.12 17.84 9.28 10.96 5.04 Grenada 40.35 29.56 12.42 9.31 6.82 4.27 Guyana 23.81 12.42 8.31 4.22 5.88 2.64 Haiti 11.47 7.25 4.47 2.22 1.98 1.08 Jamaica 25.62 23.75 8.42 8.32 4.68 4.24 St. Kitts and Nevis 14.46 9.56 4.6 3.49 2.08 1.9 St. Lucia 34.43 22.22 14.06 8.97 7.06 5.03 St. Vincent and the Grenadines 26.31 16.5 7.48 3.69 4.37 1.2 Suriname 41.57 25.79 19.27 9.78 10.79 4.04 Trinidad and Tobago 33.98 24.5 13.62 9.44 7.29 4.18 Average 27.69 19.31 10.22 6.83 5.66 3.22

Cigarette Use and Age

It is clear from table 13 and figure 8 that the students in the older age groups report higher rates of prevalence of cigarette use. Antigua and Barbuda and Trinidad and Tobago are the only two countries where the 15-16 age group report the highest prevalence when compared to the other two age groups. Prevalence rates reported by the students in the 14 or less age group in most cases are less than half of the rates of the 17 and over age group. Students who were 17 years and over reported notably higher prevalence that those in the younger age brackets.

TABLE 13: Past Year and Past Month Cigarette Prevalence by Age Group

Past Year Prevalence Past Month Prevalence 14 years

or less 15 – 16 years 17 years or more 14 years or less 15 – 16 years 17 years or more

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Figure 8

Last Year Prevalence of Cigarette Use by Age Group

0 5 10 15 20 25 Antigu a & B arbuda Barb ados Dom inica Gre nada Guy ana Haiti Jama ica St. K itts an d Ne vis St. Lu cia St. V ince nt & the Gre nadi nes Surin ame Trinid ad & Toba go

14 years old or less 15 – 16 years old 17 years old or more

Incidence

Table 14 shows the results of estimates for past year and past month incidence of cigarette use for all countries except Haiti and Grenada. Suriname, St. Lucia, and Dominica are the only countries that report past year incidence rates that are greater than 10%. There is a broad range among the remaining 7 countries from 3.31% in St. Kitts and Nevis to 9.31% in Jamaica. The average overall past year incidence was 7.79%. Past month incidence was relatively low among countries. Rates ranged from a low of less than one percent in Antigua and Barbuda and St. Kitts and Nevis to 3.78% in Jamaica. The average overall past month incidence was 2.88%.

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TABLE 14: Past Year and Past Month Cigarette Incidence Incidence

Country Past Year Past Month

Antigua and Barbuda 4.00 0.97

Barbados 7.23 2.27 Dominica 10.12 3.06 Grenada - - Guyana 5.06 1.79 Haiti - - Jamaica 9.31 3.78

St. Kitts and Nevis 3.31 0.89

St. Lucia 10.48 3.44

St. Vincent and the Grenadines 4.96 1.36

Suriname 10.56 3.41

Trinidad and Tobago 8.05 2.47

Average 7.79 2.88

Age of First Use of Cigarettes

Table 15 and figure 9 shows the average age of first use of cigarettes for the 12 countries. There is a very uniform set of results from country to country and from gender to gender. Most students initiate cigarette use between 10 and 12 years of age. Haiti and Suriname have a slightly higher average age of first use which falls around 13 years old. The average age of first use of cigarettes ranged from 10.7 years old in Grenada to 13.4 years old in Haiti.

Most of the countries’ results indicate an average age of first use of just over 11 years of age (with only Haiti and Suriname being notable exceptions). The mean age of first use of cigarette across the region (for those countries reporting) was 11.92 years with a median of 12 years. For males the overall mean was 11.75 years compared to 12.11 years for females. The overall median was also 12 years for both groups (table 15).

TABLE 15: Average Age of First Use of Cigarettes by Gender Average Age of First Use of

Cigarettes by Gender

Country Overall

Average

Suriname 12.93 12.86 13.02

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Figure 9

Average Age of First Use of Cigarettes by Gender

0 2 4 6 8 10 12 14 16 Antig ua & Bar buda Barbados Dom inica Grena da Guy ana Haiti Jam aica St. K itts & Nevis St. L ucia St. V incen t & th e Gr enad ines Surina me Trini dad & Tob ago Males Females

Cigarette Use and Behavioral Problems

The association between prevalence and behavioral problems comes out very clearly in the results shown in table 16 and figure 10. In all countries, the past year prevalence of cigarettes use is higher in students with higher frequencies of behavioral problems. Students who reported frequently having behavioral problems were significantly more likely to report higher prevalence of cigarette use (both past month and past year), p<0.05.

The average difference in past year prevalence overall between those who never had a behavioral problem and those who frequently had behavioral problems was 18 percentage points. The difference between these two groups ranged from a low of 6 percentage points in Haiti to a high of 30 percentage points in St Lucia. Other notable differences were observed for Dominica (27 percentage points), Grenada (28 percentage points), Suriname (22 percentage points) and Trinidad and Tobago (25 percentage points).

Similarly, the average difference in past month prevalence overall between those who never had a behavioral problem and those who frequently had behavioral problems was 14 percentage points. The difference between these two groups ranged from a low of 5 percentage points in St Kitts to a high of 24 percentage points in Trinidad and Tobago. The other notable differences were observed for Dominica (21 percentage points), Grenada (20 percentage points), St Lucia (20 percentage points) and Jamaica (15 percentage points).

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TABLE 16: Past Year and Past Month Prevalence of Cigarette Use by Behavioral Problems Past Year Prevalence by Behavioral

Problems During School Years Behavioral Problems During School Past Month Prevalence by Years

Never Few Times Frequently Never Few Times Frequently

Average 4.95 11.4 22.75 2.45 6.23 16.65

Figure 10

Past Year Prevalence of Cigarette Use by Number of Behavioural Problems

0 5 10 15 20 25 30 35 40 Antig ua & Bar buda Barb ados Dom inica Gren ada Guya na Haiti Jam aica St. Kit ts and Nev is St. L ucia St. V ince nt & the Gren adin es Surin ame Trin idad & To bago

CICAD. Comparative Analysis of Student Drug Use in Caribbean Countries. A Report on Student Drug Use in 12 Caribbean Countries

Comparative Analysis of

Student Drug Use

in Caribbean Countries

A Report on Student Drug Use in 12 Caribbean Countries

CICAD

Contents

Acknowledgements

Student Drug Use in 12 Caribbean Countries

A Critical Analysis for Policy Makers

Prologue

CHAPTER 1

Introduction

CHAPTER 2

Methodology

CHAPTER 3

Results

Alcohol

Cigarettes