—from Epidemiological Bulletin, Vol. 22 No. 2, June 2001—

Tobacco Use in the English-speaking Caribbean

Introduction
Consumption of tobacco is a risk factor for multiple diseases. Tobacco use causes disability and mortality that generates a burden of disease so great that control of the substance is a public health priority for most of the countries of the world. Timely action to control smoking can only be possible if up-to-date health information systems are capable of providing accurate, effective information for decision-making.

Although the English-speaking Caribbean countries show lower rates of tobacco use than those found in Latin or North American countries, evidence exists that smoking is responsible for at least 10% of all the deaths that occur in these countries. In addition, it is foreseen that mortality will increase as a consequence of the progressive increase in the demand for tobacco in the Caribbean market.

This document presents a first review of the epidemiological information on tobacco use that has been produced to date in the English-speaking Caribbean. It was prepared based on information from studies conducted during the last decade (Table 1).

Prevalence of tobacco use
General Population
Five countries of the English-speaking Caribbean have information available on use of tobacco from household surveys (Table 2). Barbados in 1992 and Saint Vincent and the Grenadines in 1997 reported on lifetime prevalence and prevalence of current use of tobacco in both sexes. Due to the different age ranges used in the samples of both studies and the different time periods in which the studies were done, these data are not comparable. Three more countries, Dominica, Guyana, and Jamaica present the prevalence of tobacco use in the last year. However, though it is known that these studies were conducted in the end of the 1990s, they do not report the date of implementation, the age range of the sample, nor results presented by sex.

Adolescents and Young Adults
Data on tobacco use in the population of adolescents and young adults comes mainly from school samples. These samples tend to exclude certain groups of youth at risk for tobacco use. Therefore, the data should be regarded as under- estimations of the real prevalence. There are five studies available. Two of them were carried out in several countries and the data from those studies are presented together and not for each country individually.

It is difficult to compare the reported data because two of the studies present data of lifetime prevalence (Table 3) while two others report prevalence of use in the last year and another the prevalence of current use (Table 4). In addition, the age range of the samples varies from one country to the next.

The study conducted in 2000 (11) in nine countries reports the lifetime prevalence. Results show that 14.6% of boys and 8.7% of girls had used tobacco at some point in their lives. Data on consumption of chewed tobacco revealed that 2.2% of the population in Antigua and Barbuda in 1996 and 8% in the British Virgin Islands in 1999 chewed tobacco over the last month.

In Barbados more than one third of the young people sampled between the ages of 13 and 15 years of age declare to have used tobacco some time in their lives, but only 1% declares daily consumption. This means that most of the young smokers have a pattern of use that can be considered experimental. Practically the entire population of students interviewed in Barbados perceives that tobacco use is harmful to health and they cite this as the main reason why 60% of smokers want to stop smoking. A smaller proportion knows that exposure to tobacco smoke in the environment generates additional health risks.

Age of initiation of tobacco use
The available information is not adequate to specify a pattern regarding the age of initiation of tobacco use that is applicable to all the Caribbean countries (Table 5). In Saint Vincent and the Grenadines most of the population has consumed tobacco at least a few times in their life before 11 years of age. In Barbados, youngsters initiate tobacco use at an earlier age. In this country, nearly three fourths of the young people between 13 and 15 years surveyed in 2000 recount that close friends encouraged their initiation. Analyzing differences by sex, in both countries males initiate use of tobacco earlier than females, although this trend is not very pronounced.

Conclusions
The methodological differences of these studies can only lead to approximate conclusions. In summary, differences include different sampling coverage (i.e. age ranges), different instruments utilized and consequently differences in the indicators produced, as well as a diversity of years in which the studies were implemented. Despite these limitations, it is noteworthy that, although the prevalence of tobacco use is comparatively lower in the Caribbean than it is in countries of Latin America, at least one-fifth of the general population of the Caribbean has consumed tobacco at some point during their lifetime.3 Moreover, more than a tenth of the population of the English-speaking Caribbean are current consumers, meaning they have consumed tobacco during the last month.

Similar to what is observed in other countries of the Region of the Americas, it has been shown that tobacco use in males is substantially greater than in females. In Barbados, tobacco use is more than five times more prevalent in males than in females and in Saint Vincent and the Grenadines approximately four times greater in males than females.

With respect to the adolescent school-age population between 12 and 18 years, the data indicate that around 2% habitually smoke tobacco, while little more than 10% have smoked at some point in their lives. The proportion of tobacco consumption of males is almost twice as great as that of females.

If a firm conclusion can be drawn from this review of the studies in the English-speaking Caribbean, it is that there is a lack of adequate information on tobacco consumption for decision-making on policies for the prevention and control of smoking. In light of this situation, thirteen countries of the Caribbean are conducting a common survey as part of the Global Youth Tobacco Survey (GYTS). The purpose of this survey is to measure tobacco use among youth and to learn about their attitudes about tobacco and exposure to preventive programs. A companion article in this issue of the Bulletin presents the status of the GYTS implementation in the Americas (Click here to read this article). Although the implementation of the GYTS represents one response to this lack of available information, a greater effort is required to gather epidemiological knowledge of the problem in samples of the general population as well as specific populations such as health workers. Strengthening the Surveillance Systems of Smoking that facilitate this task is another priority.

References:
(1) Ministry of Health (1996) Adolescent Health Survey Analysis, Antigua and Barbuda. Government of Antigua & Barbuda
(2) Ministry of Health (1992) Barbados Risk Factor Survey. Washington D.C: Panamerican Health Organization, World Health Organization, Caribbean Program Coordinator.
(3) Warren, W.; Riley, L.; Asma, S.; Eriksen, M.; Green, L.; Blanton, C.; Loo, C.; Batchelor, S.; Yach, D. (2000) Tobacco use by youth: a surveillance report from the global youth tobacco survey. Geneva: World Health Organization.
(4) Ministry of Health Adolescent Health Survey in Dominica. Government of Dominica (unpublished)
(5) Carter, R. (1997) Youth in the organization of Eastern Caribbean states: The Grenada study. Ministry of Health and Environment. St George’s Grenada, W.I.
(6) CPC (2001) Tobacco or Health in the Caribbean. Trinidad & Tobago Antigua & Barbuda, Bahamas, Belize, Barbados, British Virgin Islands, Dominica, Grenada, Guyana, Montserrat, Saint Lucia, St. Kitts & Nevis, Suriname. (unpublished). Bridgetown: Caribbean Program Coordinator.
(7) Ministry of Health Adolescent Health Survey in Jamaica Government of Jamaica (unpublished)
(8) CPC (2001) Tobacco or Health in the Caribbean. Trinidad & Tobago Antigua & Barbuda, Bahamas, Belize, Barbados, British Virgin Islands, Dominica, Grenada, Guyana, Montserrat, Saint Lucia, St. Kitts & Nevis, Suriname. (unpublished). Bridgetown: Caribbean Program Coordinator.
(9) Ministry of Health Adolescent Health Survey in San Kitts y Navis Government of San Kitts and Nevis (unpublished)
(10) PAHO (1997) Risk Factor Survey in St. Vincent. Washington D.C: Panamerican Health Organization/Systems Caribbean Limited.
(11) PAHO/WHO (2000) A portrait of adolescent health in The Caribbean. Washington. D.C: Panamerican Health Organization
(12) CPC (1998) Caribbean Adolescent Health Survey: Antigua & Barbuda, Dominica, Grenada, Jamaica. Washington D.C: Panamerican Health Organization/Caribbean Program Coordinator.

Source: Prepared by Dr. Maritza Rojas from PAHO’s Mental Health Program, Division of Health Promotion and Protection (HPP/HPM), Dr. Beverley Barnett from PAHO’s Caribbean Program Coordination (CPC), Heather Selin and Dr. Armando Peruga from HPP/HPM.

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Epidemiological Bulletin, Vol. 22 No. 2, June 2001