To the best of our knowledge, this is the first study to examine asbestos awareness and associated socio-demographics in Saint Kitts and Nevis. The results of this study may provide policy makers with useful information on asbestos awareness in Saint Kitts and Nevis. The results can also be used to inform governments, public health officials and other stakeholders about public health interventions, awareness raising and policy initiatives related to asbestos.
In this nationwide online cross-sectional survey, we examined the knowledge and attitudes of 1,009 adults about asbestos. We found that >70% of participants considered asbestos exposure to be a general public concern and that it was the government’s duty to prevent it. However, only 54% of respondents considered a total asbestos ban to be the best option to prevent asbestos exposure. Proponents of a total asbestos ban were those with a higher level of asbestos knowledge. As reflected in the average asbestos knowledge score of 3.65, respondents correctly answered an average of 52.1% of the questions on asbestos hazards, exposure scenarios and adverse health outcomes. A lack of adequate knowledge about asbestos can hamper campaigns to ban asbestos, even where asbestos exposure is already a public concern.
However, a high proportion (70%) of respondents agreed that exposure to asbestos is a common public concern in Saint Kitts and Nevis. A similar proportion (71%) of respondents agreed that it is government’s duty to prevent exposure to asbestos. In most countries, the health sector is a critical area of government responsibility . State health departments and related agencies are responsible for monitoring, protecting and improving the health of residents and citizens . Many residents and citizens of the country of Saint Kitts and Nevis also consider the government to be the responsible party for protecting the health and welfare of the people . Residents of St Kitts and Nevis may also feel that the government has the resources and expertise to identify, remove and prevent exposure to asbestos, while the general public does not have that expertise.
When asked about the best option to avoid exposure to asbestos (Question 10), the possible answers were: (a) to ban the use and importation of all asbestos products and materials into St Kitts and Nevis, (b) to wear personal protective equipment and (c) I don’t know. While the majority of respondents agreed that asbestos exposure was a general public concern and that its prevention was a government duty, only 54% of respondents chose a total ban as the best option to prevent asbestos exposure. Of the remaining participants, 13% chose wearing personal protective equipment as the best option and 33% chose “I don’t know”. This finding suggests that people may lack awareness of the pros and cons of possible solutions. You may not know anyone who has been diagnosed with an asbestos-related disease. Oversight of solutions to prevent asbestos exposure could also be due to scarcity or lack of epidemiological data and diagnosis of asbestos-related diseases . Even among people who are aware of the dangers of asbestos, the cost, durability and performance of alternatives to asbestos can deter people from selecting asbestos ban as the best option . However, our results showed that higher levels of asbestos knowledge were associated with attitudes towards an asbestos ban: people with higher levels of asbestos knowledge were more likely to choose a total ban as the best option for eliminating exposure risks. More knowledge about asbestos could help people understand the difference between banning asbestos and wearing personal protective equipment as a solution to preventing asbestos-related diseases.
We found that knowledge of asbestos was significantly related to age, education, area of residence and occupation. In particular, higher levels of asbestos knowledge were found among those ≥ 30 years of age with higher education living in St Kitts and working in government. While age was a significant predictor in our study, it was not significant in a previous study in Turkey . However, age is related to the accessibility of higher education in Saint Kitts and Nevis. University enrollment is expensive for most Kittitians and Nevisians, and it is difficult to attain a higher level of education into later life once one has saved enough money to secure a loan or university education abroad or through the Remote pay learning over the Internet. Meanwhile, our findings that educational level and residential area are significant factors are consistent with the Turkish study, which recruited 760 hospitalized patients and their families, and reported higher levels of asbestos knowledge and awareness among those living in an urban area who graduated had a university and were employed or retired .
Educational level is one of the most important predictors of health literacy [34, 35]. A higher level of education reflects a greater ability to understand, search for, and acquire scientific information and skills. Health literacy is also higher among people living in urban areas than in rural areas . As the legislative and commercial capital, St. Kitts is considered more urban than Nevis. Another possible factor in our finding that Kittitians were more informed and aware about asbestos was a series of news reports of suspected asbestos exposure in government institutions (e.g. National Information and Communications Technology Centre). Schools (e.g. Irishtown Primary School and Cayon High School) , and public facilities (e.g. water pipes). For example, on Saturday, April 26, 2014, the Department of Education released a statement to inform parents and guardians of students at Basseterre High School in St. Kitts that there would be no classes on Monday, April 28 . It has been speculated that the secondary school’s temporary closure was due to asbestos contamination, which was becoming a widespread problem in the region . In another incident, in 2019 the government announced and implemented an island-wide project on St Kitts to replace the asbestos pipes in the existing water transportation system with polyvinyl chloride pipes . It is likely because of these occasional instances of suspected asbestos exposure in government buildings, institutions and facilities that the government employees in our sample were generally more aware of asbestos than those working in the private sector.
We found no significant gender difference in participants’ responses to questions about whether the general public should be concerned about asbestos in their daily lives or whether it is the government’s duty to prevent asbestos exposure. However, we found a significant gender difference in responses to the best option to avoid exposure to asbestos. A higher proportion of women than men agreed that the best option for asbestos exposure was a total asbestos ban. Women have more experience of living environment changes (e.g., the need to manage resources), leading them to be more concerned about environmental hazards and more willing to adopt pro-environmental behaviors (e.g., being plastic-free ) and to actively engage in environmental health spending . St Kitts and Nevis is a matriarchal society and almost half of all households (47%) are headed by single women . The eventual closure of the asbestos-contaminated St. Kitts school may have increased the concerns of parents, and particularly mothers, about possible exposure to asbestos in schools.
Now is the time to raise awareness of asbestos hazards and ban asbestos in St Kitts and Nevis. The first policy recommended by the World Health Organization to eliminate asbestos-related diseases is to stop using all types of asbestos . A ban on the production, export and import of asbestos would significantly reduce asbestos-related mortality worldwide, not only in occupational settings but also in households and other non-occupational settings . St. Kitts and Nevis does not produce asbestos. Therefore, the Government of Saint Kitts and Nevis should take proactive measures to reduce the incidence and mortality from asbestos-related diseases, including adopting and ratifying ILO Convention No. 162 and the Basel Convention, and conducting extensive awareness campaigns to prevent asbestos exposure.
There were a number of limitations in our study. First, the study design was cross-sectional and no causal conclusions should be drawn. Second, participants completed the questionnaires anonymously over the internet and we had difficulty reaching certain types of participants, e.g. B. Adults without internet access, illiterate people, elderly people with low technological competence. This may have introduced a selection bias, with more health-conscious and more conscientious respondents choosing to participate in the study. If so, this limitation could mean reduced generalizability of the results to the general population. In the initial stages of study development, we had planned to conduct formal face-to-face questionnaire interviews, but when the COVID-19 pandemic hit, many governments, including St Kitts and Nevis, imposed movement restrictions. These were not just limited to international air travel, but also included stay-at-home and social-distancing guidelines. We had no choice but to implement and conduct the survey online. Third, due to the questionnaire structure, respondents did not have to justify their decision not to ban asbestos imports. However, we could see that residents with higher asbestos knowledge had higher chances of opting for a total asbestos ban and vice versa. This result indicates that participants who are not knowledgeable about asbestos would not choose banning asbestos as the best option to avoid exposure.
Currently, the country’s political will and policies are not geared towards an asbestos ban. Many people are unaware of the intangible costs of asbestos, particularly asbestos-related illness and death. The lack of appropriate tools and equipment to detect asbestos and asbestos-related diseases hampers the promotion of the asbestos hazard. Small and underfunded countries engaged in international trade are particularly vulnerable to economic pressure from powerful asbestos-exporting countries. The failure of countries to ban asbestos reflects the enormous power of the asbestos industry and its political allies, acting against the interests of public health and placing short-term gains ahead of human well-being [46, 47].