ABSTRACT Background Caribbean adolescents often navigate layered psychosocial challenges, including stigma, violence, and limited access to culturally relevant mental health services. Despite art therapy’s proven efficacy, Caribbean youth remain underrepresented in art therapy research, particularly studies focused on visual symbolism and self-worth. Aims This study explores how adolescents in English-speaking Caribbean nations use visual art in community art therapy settings to express resilience and self-worth through metaphors and imagery. Methods Using an arts-based research (ABR) methodology, the study analyzed 30 artworks created by 52 adolescents (aged 14–17) across three five-session community art therapy programmes. A multidisciplinary team conducted visual coding and created reflective artworks as part of a thematic synthesis process. Results Four central themes emerged: (1) Emotional Expression and Identity Exploration; (2) Interpersonal Relationships and Environmental Connection; (3) Growth, Transition, and Aspirational Thinking; and (4) Creative Joy and Therapeutic Engagement. The adolescents used bold imagery, affirming language, and culturally grounded symbolism to explore emotions, relationships, and future-oriented narratives. Conclusions Community art therapy offers a powerful, culturally resonant medium for Caribbean youth to process emotional complexity and affirm self-worth. Visual metaphors served as tools of both expression and transformation, suggesting that artmaking fosters identity coherence and psychological resilience in ways that are developmentally and culturally appropriate. Implications for Practice/Policy/Future Research Findings support the development of culturally grounded, community art therapy programmes for adolescents. Future research should incorporate youth-led analysis, expand regional diversity, and explore long-term outcomes to inform policy and practice in adolescent mental health and art therapy. Plain-language summary Caribbean adolescents navigate complex psychosocial challenges, including limited access to culturally relevant mental health support. This study explores how community art therapy offers a space for self-expression, identity formation, and emotional resilience among youth in English-speaking Caribbean nations. Using an arts-based research approach, 30 artworks created by 52 adolescents aged 14–17 were analyzed through iterative visual coding, thematic synthesis, and arts-based responses by a multidisciplinary research team. Four central visual themes emerged: emotional expression and identity exploration, interpersonal relationships and environmental connection, growth and aspirational thinking, and creative joy as therapeutic engagement. Adolescents used symbolic imagery, vibrant colours, and metaphoric elements such as ladders, natural landscapes, and expressive faces to convey internal experiences and evolving self-perceptions. Visual narratives reflected a strong sense of relational belonging, cultural identity, and forward-looking resilience. Community art therapy enabled participants to externalise complex emotions and create narratives of self-worth. Artmaking was not only a tool for emotional processing but also a site for imaginative freedom, agency, and shared meaning. These findings highlight the value of integrating non-verbal, culturally responsive modalities into adolescent mental health care in the Caribbean. Art therapy in community settings supports adolescents in reclaiming identity, cultivating hope, and expressing strength through symbolic and relational language. This study contributes to a growing body of work advocating for decolonised, strength-based approaches to art therapy that reflect the lived experiences and cultural contexts of youth.

Understanding the behavioral determinants of adolescents' water consumption: A cross-country comparative study.

Excessive physical activity (PA) has been linked to increased risk for disordered eating behaviours and eating disorders. This study investigates the relationship between PA and disordered eating behaviours and attitudes (DEBAs) among Jamaican adolescents. This cross-sectional study included 521 adolescents, 12-19 years. Anthropometric measurements were collected, and adolescents completed questionnaires on disordered eating behaviours (EAT-26), physical activity, self-esteem and affect. Associations were assessed using sex-specific mixed-effect linear and logistic regression models. Participants reported exercising an average of 3 days per week. Adolescents who exercised for a longer duration had greater odds of having elevated EAT-26 scores (at least 1hour-OR=2.04; 95% CI=1.03, 4.06; p=.042), while a higher exercise frequency among males (3-5 days per week) was protective against DEBAs (OR 0.38; 95% CI=0.16, 0.88; p=.025). Female adolescents reported higher prevalence of elevated EAT-26 scores than males (p < .01). Increased negative affect increased odds of an elevated EAT-26 score. Exercise duration and frequency play a role in disordered eating behaviours in Jamaican adolescents and vary by gender. Our findings have implications for weight management interventions and policies, encouraging healthcare providers to monitor PA levels as well as negative affect in adolescents who display disordered eating behaviours.

To determine how self-esteem mediates the relationship between family support and initiation of sex for US-born Black Caribbean compared to African American adolescents. Secondary data analyses were performed on responses from 1170 adolescents from the National Survey of American Life-Adolescents supplement (2003-2004). Weighted descriptive statistics and logistic regression analyses were performed to examine whether initiation of sex on perceived family support is mediated by self-esteem. The study population consists of 360 Black Caribbean and 810 African American adolescents. Sexual initiation prevalence was higher for Black Caribbean adolescents (42.1%) than African American adolescents (36.75%). The adjusted odds ratio for Black Caribbean adolescents' initiation of sex was 0.85 (95% confidence interval [CI]: 0.16-4.51) compared to African American adolescents' 0.59 (95% CI: 0.35-1.00). Self-esteem represented a statistically significant mediation path and might be more important for African American adolescents' sexual health than the Black Caribbean. The unfounded mediating role of self-esteem between perceived family support and Black Caribbean adolescents' sexual initiation suggests possible influences of Black heterogeneity stemming from ethnic identity differences in sexual health decision-making.

PurposeNo known UK empirical research has investigated prospective associations between ambient air pollutants and conduct problems in adolescence. Ethnic minority children are disproportionately exposed to structural factors that could moderate any observed relationships. This prospective study examined whether exposure to PM2.5 and NO2 concentrations is associated with conduct problems in adolescence, and whether racism or ethnicity moderate such associations.MethodsLongitudinal associations between annual mean estimated PM2.5 and NO2 concentrations at the residential address and trajectories of conduct problems, and the potential influence of racism and ethnicity were examined school-based sample of 4775 participants (2002–2003 to 2005–2006) in London, using growth curve models.ResultsOverall, in the fully adjusted model, exposure to lower concentrations of PM2.5 and NO2 was associated with a decrease in conduct problems during adolescence, while exposure to higher concentrations was associated with a flattened trajectory of conduct symptoms. Racism amplified the effect of PM2.5 (β = 0.05 (95% CI 0.01 to 0.10, p < 0.01)) on adolescent trajectories of conduct problems over time. At higher concentrations of PM2.5, there was a divergence of trajectories of adolescent conduct problems between ethnic minority groups, with White British and Black Caribbean adolescents experiencing an increase in conduct problems over time.ConclusionThese findings suggest that the intersections between air pollution, ethnicity, and racism are important influences on the development of conduct problems in adolescence.

Wide participation in electronic surveys and reliable reporting of anthropometry can serve to reduce costs associated with monitoring of obesity among adolescents where resources are limited. We conducted a single school pilot study among Caribbean adolescents to assess use of electronic surveys and whether face to face encouragement could promote enrollment. In addition, we assessed students' ability to reliably report simple anthropometry. Students were provided with access to an electronic survey on anthropometry and food preferences regarding school-based food offerings. Responses to survey questions were presented as percentages. A sample of students also had their heights and weights measured after reporting these measures from memory. Intra-class correlation coefficients were used to assess reliability among measurers and Bland-Altman plots, consistency between student reported and recorded anthropometric measures and Support Vector Machine to assess robustness of anthropometry prediction models. Response rate to the electronic survey was low (9%). Students were able to interpret questions; open-ended options were inappropriately used 13% of the time. Post survey qualitative responses indicated displeasure with use of school-associated e-mail addresses. Concerns with confidentiality were expressed as well as preference for completion of surveys during school time. Students reliably reported anthropometry most measures fell within the 95% CI of Bland-Altman plots. SVM classified with a prediction accuracy of 95%. Estimates of overweight from recorded and reported measures were similar. Adolescents are able to report simple anthropometry, and this can be used to help with monitoring of growth and overweight. Although they are capable of competently completing electronic surveys, school-based email is an ineffective contact tool. In-person school-based contact and administration of surveys are preferred. Adolescents can reliably report simple anthropometry that can be utilized for estimation of overweight/obesity prevalence. This method can be widely applied.

Many studies have examined significant factors associated with school delinquency among adolescents, including relationship violence, property damage, and other serious threats to students’ safety. However, students’ coping behaviors after being victims of or witnesses to violence and other forms of delinquency have not been thoroughly examined. This study contributes to the existing body of knowledge by identifying significant factors at the individual, family, and school levels that affect 226 Caribbean students’ actual reporting of school delinquency to school personnel. The data for this study were obtained from the Caribbean Youth Violence Survey, which studied middle and high school students in five Caribbean countries. The findings of hierarchical multiple regression analyses indicated that female students were more likely than male students to report delinquent behaviors. Family cohesion and family disorganization significantly decreased students’ reporting behaviors after they experienced or witnessed school delinquency. On the other hand, school bonding significantly increased students’ reporting behaviors. This paper concludes with practical implications and future research agendas for developing a comprehensive mechanism to address the dynamics of multidimensional factors that influence students’ active coping behaviors for dealing with school delinquency.

Objectives Church members are a significant but under-researched source of informal support particularly among adolescents. Church-based support networks are a long-standing and significant feature of religious involvement for Black Americans that provides tangible and psychosocial resources helpful for navigating life challenges. However, questions concerning the role of church support for Black adolescents in the United States are under-researched, especially potential ethnic group differences.

The National Survey on American Life – Adolescent Supplemental data was designed to lay the foundation for future research in early identification of mental disorders for adults. The inclusion of social conditions adds to this detailed measure of mental health and provides a wealth of information that can be observed about mental well-being in adolescents. In particular, we used this data set to explore the interplay between self-perception and family relationships based on the absence of a biological father among African-American and Caribbean adolescents. This study provides a quantitative analysis of the difference between the perceived self and familial factors for those with a stepfather and those without a stepfather. As evident in the findings, those with a stepfather reported to have higher self-esteem, a more positive perception of self, and a more uplifting family model compared to those without a stepfather. These findings were detected by noting the significance values for a one-way ANOVA and observing the mean differences among the selected variables. Some discrepancy did exist, however; self-esteem with regards to education was reported to be lower for adolescents with a stepfather than without. This could be attributed to an overachievement mentality by those from single parent homes, alluding to the idea that adolescents without stepfathers possess intrinsic motivation and have the drive to attain a higher education. The data showed the presence of a father figure enhances self-perception and familial support, but not academic motivation.

ABSTRACT This paper explores whether family transitions among descendants of post second-world-war immigrants are converging towards those of white British young adults by examining family formation expectations among 16–21 year-olds collected within the 2009–2015 waves of Understanding Society. The paper asks: Do current adolescents’ cohabitation, marriage and parenthood expectations differ by ethnic group? Are differences similar for men and women? Are ethnic differences mediated by individual or parental socio-economic characteristics? We find that expectations for marriage and parenthood are unanimously high, but that there is greater uncertainty among white British and black Caribbean adolescents as to the age at which these transitions will occur. We find large ethnic differences in expectations for cohabitation, especially for women. There is evidence for a divergence in expectations within the south-Asian community. Second-generation Indians have lower expectations for marriage and higher expectations for cohabitation than second-generation Bangladeshis or Pakistanis. Ethnic group differences remain when religiosity, parental background and individual characteristics are controlled. Further research is required regarding the mechanisms which underlie the differential transmission of family formation attitudes across ethnic minority groups.

The aim of this study was to assess the association between parental involvement and mental health among adolescents in five Caribbean countries: Antigua and Barbuda, Bahamas, Saint Kitts and Nevis, Jamaica and Trinidad, and Tobago. Data were from the cross-sectional Global School-Based Student Health Survey (GSHS) which sampled 10 063 adolescents (mean age 14.3 years, SD = 1.3) from 2009 to 2013. In multivariable logistic regression analyses (adjusted for age, sex, and socioeconomic status), bullied, having close friends and peer support, and higher levels of parental involvement were negatively associated with loneliness, anxiety, and suicidal ideation in all five countries. In Jamaica, parental involvement was not associated with suicide attempt. Parental involvement interventions for improving mental health among the Caribbean adolescents should consider peer influences.

Although family social support has been linked to numerous psychological, behavioral, and academic outcomes for Black adolescents, little research investigates the family support networks of these youths. Using nationally representative data from the National Survey of American Life Adolescent Supplement (NSAL-A), this study examines the family social support exchanges of African American and Black Caribbean adolescents. We focus specifically on the frequency of instrumental and emotional support provided by and offered to adolescents and the sociodemographic and family correlates of this support. Findings indicate that both African American and Black Caribbean adolescents provide and receive a substantial amount of support from family, though there is significant variation by age, gender, income, ethnicity, region, and country of origin within and across these populations. Further, subjective family closeness was related to both the receipt and provision of support. Overall, findings affirm the importance of investigating adolescent family support networks, as well as examining ethnic differences within the U.S. Black population.

This study examines black adolescents’ reports of the most helpful types of social support that they receive from and provide to family members, and whether family support exchanges vary by ethnicity (African American vs. Black Caribbean) and gender. Data for this study are from the National Survey of American Life Adolescent Supplement (NSAL-A), a national, probability sample of African American and Black Caribbean youth (ages 13–17). Overall, youth reported financial support, followed by emotional assistance and practical support as the most helpful types of support that they received. Practical and emotional assistance characterized the most commonly reported types of support that they provided to family members. Black Caribbean adolescents were more likely than African American adolescents to report financial and practical assistance as the most helpful types of support that they received from family members; no ethnic differences were observed in the provision of support to relatives. There were no significant gender differences in the receipt of support, but adolescent girls reported greater involvement in providing emotional support and caregiving than adolescent boys. The results of this paper reveal that African American and Black Caribbean adolescents are involved in a complex pattern of reciprocal support exchanges with their extended family members. Study findings also reinforce the importance of research focused on racial/ethnic and gender differences in family support exchanges in order to develop a more nuanced understanding of family support behaviors within these groups.

The 12-item general health questionnaire (GHQ-12) was used in the Longitudinal Study of Young People in England (LSYPE; N = 15,770) to collect measures on adolescent mental health. Given the debate in current literature regarding the dimensionality of the GHQ-12, this study examined the cultural sensitivity of the instrument at the item level for each of the 7 major ethnic groups within the database. This study used a hybrid approach of ordinal logistic regression and item response theory (IRT) to examine the presence of differential item functioning (DIF) on the questionnaire. Results demonstrated that uniform, nonuniform, and overall DIF were present on items between White and Asian adolescents (7 items), White and Black Caribbean adolescents (1 item), and White and Black African adolescents (7 items), however all McFadden's pseudo R² effect size estimates indicated that the DIF was negligible. Overall, there were cumulative small scale level effects for the Mixed/Biracial, Asian, and Black African groups, but in each case the bias was only marginal. Findings demonstrate that the GHQ-12 can be considered culturally sensitive for adolescents from diverse ethnic groups in England, but follow-up studies are necessary. Implications for future education and health policies as well as the use of IR-based approaches for psychological instruments are discussed. (PsycINFO Database Record

A neglected area of study in adolescent development is family functioning in relation to adolescents’ sense of self and academic success. This study investigates students’ perceptions of their levels of family functioning (cohesiveness and adaptability) as it relates to their academic self-efficacy and school engagement, and answers the following questions: (1) Are there any significant differences in the academic self-efficacy beliefs and school engagement of Caribbean adolescents based on levels of family cohesion and family adaptability? (2) To what extent does the combination of family cohesion and family adaptability predict the academic self-efficacy and school engagement of Caribbean adolescents? Data were collected from a sample of 523 adolescents (197 males and 326 females) aged 17–19 years, enroled in postsecondary institutions in two Anglophone Caribbean countries (Barbados and St. Lucia). Results indicated that adolescents from families with balanced cohesion held significantly higher academic self-efficacy beliefs and school engagement levels than those from families with low cohesion. Regression analyses indicated that the family functioning model significantly predicted academic self-efficacy and school engagement. Interpretation of these results are discussed.

Sex, violence, and drugs among Latin American and Caribbean adolescents: Do engaged parents make a difference?

Abstract Drawing on the social development model, the authors examine family risk and protective factors thought to influence problem behaviors among adolescents. They estimate the impact of family risk and protective factors on a variety of antisocial and health risk behaviors. Data are drawn from a sample of nearly 2,500 adolescents attending high‐risk schools in Trinidad and Tobago, a developing nation in the eastern Caribbean. The findings show that certain family risk factors play a more consistent role in shaping adolescent problem behaviors than others. In particular, adult history of antisocial behavior and parental attitudes favorable toward antisocial behavior and substance use emerge as the most robust risk factors. In accordance with previous research, family protective factors exerted only a minimal influence on behavioral outcomes. This finding confirms the need for additional theory and research on the protective factors that help reduce problem behavior among adolescents, particularly in developing nations.

Objectives. Black Caribbean and Black African adolescents in England face academic and social challenges that might predisposition them to engaging in more risky behavior. This study explored the growth trajectories of risky behavior among adolescents in England over 3 years (14/15, 15/16, and 16/17 years of age) to determine the extent to which ethnic groups differed.Design. Data were taken from the Longitudinal Study of Young People in England database (N = 15,770). This database contained eight different ethnic groups. Risky behavior was defined by an 8-item scale that represented three classes of risky behavior. Individual theta scores for risky behavior were calculated for individuals at each time point and modeled over time. Interaction terms between sex, year, ethnicity, and class were also examined.Results. Findings confirmed previous research that showed ethnic group differences in means. They also demonstrated that there are differences in slopes as well, even after controlling for class. In fact, class appeared to have a reverse effect on the risky behavior of black adolescents. Further, Black adolescent groups were not engaging in higher levels of risky behavior as compared to white adolescents (the dominant population). In actuality, Mixed adolescents engaged in the highest levels of risky behavior which was a notable finding given that the Mixed group has recently began to receive a more focused attention by scholars and the government of England.Conclusion. It is important that social workers and policy-makers recognize ethnicity in making general preventative decisions for adolescents. Second, class does not have a common effect on adolescent problem behaviors as often believed. Finally, black adolescents’ communities might contain important protective factors that ought to be extensively explored. Conversely, Mixed adolescents’ communities might contain more risk factors that ought to be addressed.

states that have legalized medical marijuana also have a greater percentage of adolescents who consider the drug to be less risky (3). The exact nature of this association is to be determined but should impact on the policy decisions related to substance abuse by groups like CARIAD. The evaluation by Reid et al of the effectiveness of CARIAD in meeting its training objectives to educate health and allied professionals about alcohol and drug use, and increase awareness of addiction issues in the Caribbean is included among the articles presented in this special edition of the Journal (4). As the cultural norms of the society change, it will continue to influence drug usage. This will not only be for adolescents but also young adults, particularly those engaged in academic pursuits. Undergraduate students and their substance use are also featured in this issue, where WhitehorneSmith et al investigated the drug use practices of medical/ health students (5). This has added to the empirically based research on drug use in this particular group across the Caribbean and Latin America and indicates that the trend in adolescent substance use continues into adulthood, with alcohol being the most commonly abused substance. The relatively high prevalence of alcohol use among Caribbean adolescents and adults, along with its relationship with emotional anguish, will continue to present a significant public health challenge for lowand middle-income countries. Through organizations such as CARIAD and the National Council on Drug Abuse (NCDA) in Jamaica, contextand culture-specific strategies to decrease the physical availability of alcohol and other drugs need to be implemented to reduce adolescent and young adult drug use (6). Substance abuse has become associated with a myriad of medical, psychiatric, social/family, employment, and legal problems internationally and similarly in Jamaica and the wider Caribbean. In terms of the relationship between substance abuse and violence and offending behaviour, substances not only impact on community violence but also violence in the home and in institutions. Substance use contributes more to the public health burden of the cycle of domestic violence more than any other risk factor (7). Longman-Mills et al have studied the relationship between physical abuse during childhood and experiencing psychological distress and substance abuse among university students (8). The authors were able to identify that experiencing physical abuse increases the likelihood of having higher levels of psychological distress and becoming a From: Department of Community Health and Psychiatry, The University of the West Indies, Kingston 7, Jamaica.

Potential connections between the self-esteem of adolescents and their parents’ employment status have been revealed in the literature. This cross-sectional study examines the relation of gender, age, and parental employment status to academic and global self-esteem of 369 fourth to upper sixth form Caribbean secondary school adolescents. Their ages ranged from 13 to 18 years old (M=15.52, SD=1.21), 223 were females and 146 were males. The participants completed a questionnaire that assessed academic and global self-esteem. Pearson product moment correlation coefficient, Independent t-tests and Multiple Regressions were used to analyse the data obtained from the sample. Results indicated no significant differences in self-esteem between male and female adolescents. With regard to age, the 16-18 year old age group had higher levels of academic self-esteem than the 13-15 year olds. Adolescents of unemployed parents had the highest academic and global self-esteem. However, multiple regression analyses did not reveal any predictive relationships. These findings are discussed with due consideration of earlier research and their implications for the psychology of Caribbean people.