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West Indian Medical Journal

Print version ISSN 0043-3144

West Indian med. j. vol.58 no.2 Mona Mar. 2009




Adolescent ears: an avenue into their sexual and reproductive health values


Los oídos de los adolescentes: una vía para adentrarse en sus valores de salud reproductiva y sexual



D Holder-Nevins; D Eldemire-Shearer; A McCaw-Binns

Department of Community Health and Psychiatry, The University of the West Indies, Mona, Kingston 7, Jamaica, West Indies





OBJETIVES: This study sought to understand what sexual and reproductive health messages Jamaican adolescents get via Dancehall music and how themes in these messages can inform the development of a questionnaire for further exploration of the subject.
METHODS: Qualitative processes: key informant interviews, content analysis and focus group discussions were used to identify the themes heard in Dancehall songs to which adolescents listen. Adolescent investigators were utilized to enhance the communication flow among their peers while the adult investigator coordinated the analysis process. The data generated by each method were analysed manually and the themes used to inform development of a quantitative questionnaire for further study.
RESULTS:Of 43 songs identified by key informants, twenty-five were short-listed as Dancehall songs as they having met the criteria for conveying sexual and reproductive health and relationship themes. Most themes were gender specific with male specific messages relating to sexual roles and behaviours, physical sexual attributes and performance and sexuality related violence. Female specific messages were about female behaviours in a sexual relationship, financial stability and independence in relationships and physical sexual attributes. All themes were confirmed through focus group discussions and additional information gleaned about how adolescents perceived the meanings and context of some expressions in the songs analysed. These themes informed the development of a questionnaire in both language and content.
CONCLUSIONS: Gender specific issues about sexual relationships and performance, physical sexual attributes and sexual violence were common themes identified in Dancehall songs listed by adolescents. Focus group discussions confirmed adolescents' listenership to the themes and provided explanation of the perceived context and meaning of some messages.


OBJETIVOS: Este estudio busca entender que mensajes en relación con la salud reproductiva y sexual, reciben los adolescentes jamaicanos a través de la música de Dancehall, y cómo los temas en estos mensajes pueden informar el desarrollo de un cuestionario para una exploración posterior del asunto.
MÉTODO: Procesos cualitativos: se utilizaron entrevistas a informantes claves, análisis de contenidos, y discusiones de grupos focales (sesiones de grupo), a fin de identificar los temas divulgados por las canciones de Dancehall escuchadas por los adolescentes. Se usaron investigadores adolescentes para lograr un mejor flujo de la comunicación entre iguales, en tanto que el investigador adulto se encargaba de coordinar el proceso de análisis. Los datos generados por cada método fueron analizados manualmente y los temas fueron usados como base informativa para el desarrollo de un cuestionario cuantitativo para estudios posteriores.
RESULTADOS: De 43 canciones identificadas por los informantes claves, veintiséis fueron incluidas como canciones de Dancehall que satisfacían los criterios de trasmitir temas de relación y salud reproductiva y salud. La mayor parte de los temas específicos fueron específicamente de género con mensajes específicamente masculinos relacionados con los roles y comportamientos sexuales, el funcionamiento y los atributos sexuales físicos, y la violencia relacionada con la sexualidad. Los mensajes específicos del género femenino se referían a las conductas femeninas en una relación sexual, la estabilidad financiera y la independencia en las relaciones, así como los atributos sexuales físicos. Todos los temas fueron confirmados mediante discusiones de grupos focales, y se recogió información adicional acerca de cómo los adolescentes percibían los significados y el contexto de algunas expresiones en las canciones analizadas. Estos temas informaron el desarrollo de un cuestionario sobre lenguaje y contenido.
CONCLUSIONES: Los asuntos específicos de género, los aspectos del funcionamiento y relaciones en el sexo, atributos sexuales físicos y violencia sexual, fueron temas comunes identificados en las canciones de Dancehall señaladas por los adolescentes. Las sesiones en grupo confirmaron la audiencia adolescente de estos temas, y ofrecieron una explicación acerca del contexto y el significado percibido de algunos mensajes.




In many societies, adolescents envelop themselves in a sub-culture that gives them identity as well as privacy from adult intrusion. Language, mode of dress and music are common elements of adolescent subcultures worldwide. Often the lack of understanding among adults about adolescent issues and values result in anxiety about their safety and their future. The influence of the media on adolescents is a common source of discomfort among adults.

With respect to the music media, reports out of the United States of America (USA) state that girls and women prefer softer music while men and boys prefer heavier rock and rap music (1). There is also the claim that interpretation of sexual health issues in the media vary by gender and age, and that children may be protected by their lack of understanding of the real meaning of some sexual messages. Girls, it is believed, are more likely than boys to see media portrayals as real (2). There are no comparable details for the Caribbean. The need to understand the effect of the media on sexual health perceptions among different subgroups of adolescents is important to guide the development of appropriate health promotion messages. This is especially so given the impact of the HIV/AIDS epidemic in the region. In Jamaica, the 10–19-year age group has the highest rate of HIV infection in the population. Risky sexual behaviour is prevalent among the most productive and young age groups. Sexual activity starts at 13.4 years for boys and 15.9 years for girls (3).

Music in the West Indies

Music is a very important part of West Indian culture, often perceived as an avenue for socialization of the people. Each island is either known for or shares a particular kind of music with others. Jamaica, one of these islands, with a population of 2.7 million (4), is internationally associated with Reggae, which originated in the sixties and is identified by its heavy bass rhythm often matched by skillful satire. Dancehall music evolved in the nineties as a fusion of reggae and North American 'Rap'. Sexuality and violence are common themes in Dancehall music which have engendered negative comments from the society including concerns about its influence on adolescent values (5–7). To the Public Health practitioner, Dancehall music and its content are not simply about culture and language but whether many of the actions it promotes are enacted when the music stops playing. In view of the concerns about Dancehall music's impact on adolescents' values, it is necessary to explore these issues from the perspectives of adolescents themselves.

Qualitative process in Sexual and Reproductive Health research

Qualitative research methods have been used in public health to understand and inform public health problems and solutions. They are valuable in measuring variables in informal, natural settings. Methods like focus group discussion and qualitative interviews allow participants to express their views freely in a language and manner that make them feel comfortable and have been useful in sexual and reproductive health (SRH) research and intervention planning relative to adolescents' issues (8–10).

This paper documents qualitative processes and strategies employed to explore what messages Jamaican adolescents get via Dancehall and how themes in such messages were used to inform the development of a questionnaire for further exploration of the subject. The ethics committee of the Faculty of Medical Sciences, The University of the West Indies/ University Hospital of the West Indies, gave permission for conducting this study. Informed written consent was received from parents of children involved and children also signed assent forms.



Study design

The study had four phases. In the first phase, adolescent key informants were asked to identify what type of music they liked to listen to and the sources of their music. The information gleaned from informants was verified through media checks and this also served to identify Dancehall songs containing SRH themes. In phase three, the themes were used as the basis for age and gender specific focus group discussions with adolescents to explore these issues in more depth. In phase four, the results were used to inform the development of a quantitative instrument for a more comprehensive study of the subject. The phases are described in detail below.

Phase one – adolescent key informant interviews

One semi-urban low-income community with a population of approximately 2000 was conveniently selected as a laboratory to discuss Dancehall issues with adolescents. Two female (11 and 13 years) and two male (15 and 16 years) adolescents were identified by other adolescents in a youth club in this community as key informants on the subject of popular music.

The principal investigator (DHN) met with key informants and asked them to:

C List popular songs to which their peers and themselves listened and those that they liked, each month for one year. No specifications were given regarding the types of songs to include and they were assured that it was acceptable to include songs with explicit lyrics.

C Provide any available information about the content and artiste of each song in order to facilitate finding these songs in the media.

Phase two – Media checks

In phase two, a master list of songs reported over the period was used as a guide by the principal investigator to find and listen to recordings of the songs using different media sources. This was aimed at determining the lyrical content of these songs. Songs were short-listed if they were from the Dancehall category and had "sexual connotations" defined as including lyrics and innuendos that refer directly or indirectly to (a) sexual relationships of any kind (b) male or female sexual roles and relationships (c) sexual organs (d) condom use or HIV/AIDS.

Phase three – Focus groups

In this phase, the SRH themes elucidated in phase two, informed the development of a discussion guide that was used to engage other adolescents in focussed discussions. Two adolescents, a 19-year old male and an 18-year old female were recruited and trained in the use of the focus group method. Adolescents were selected to moderate the focus groups instead of the adult researcher to minimize age barriers to free flowing discussion. The two youths were responsible for conducting six group discussions in three urban and three rural communities. These discussions aimed to clarify the music preferences of these adolescents, the extent to which they were listening to Dancehall songs and their interpretation of and perceptions of the SRH themes identified in songs analysed.

Participants were recruited through school and community contacts. Group size ranged from 6–12 persons. A discussion guide, developed from the themes identified earlier, was used to stimulate discussion. Males and females were grouped separately and the discussions moderated by persons of their gender. Participants were at liberty to sing parts of any song during the discussion as they deemed fit to reinforce any point they wanted to bring across. In addition, excerpts from selected songs on the list were played in the warm-up phase of the focus groups and later in the discussion to check what participants thought about some specific themes. Care was taken to select only the introductory parts of these songs in the warm-up phase to avoid exposure to the words if they were not heard before.

Two methods of data recording were utilized. Each discussion session was audiotaped after receiving permission from each group. A notetaker also made manual notes that included nonverbal reactions, group dynamics, layout of the room and seating arrangements.

Analysis of focus group data

Following each session, the audio recordings, supplemented by the manual notes, were used to generate a session script. Each script was perused by the principal investigator and compared with the audio to ensure that all of the discussion had been captured. This helped to develop familiarity with the various themes and tone of the discussions.

Three team members, the principal investigator and two adolescents, independently reviewed the scripts to identify emerging issues. The team then met to discuss meanings, clarify issues and agree on how emerging themes should be finally grouped. Themes, popular phrases, expressions and the lifestyle modelled by specific artistes/singers were high-lighted and grouped. The team then reached consensus on the SRH themes for further investigation.

Phase four – Developing relevant questions for quantitative instrument

The SRH themes and phrases from songs along with themes elucidated from the discussions as common messages in Dancehall were used to develop questions for the quantitative instrument. In some cases, phrases were used exactly as they appeared in the songs while in other instances only the themes in some songs were used to formulate questions.



Key informant interviews and media confirmation

Adolescent key informants (AKI) compiled a list of 43 'favourite' songs with brief explanations of the lyrical content. Recordings of all songs were found through different sources with compact discs (cd's) being the most popular source of recordings. Table 1 details the source of confirmation of the songs. Twenty-five songs were short-listed as falling in the Dancehall category and as having met the criteria for sexual and reproductive health and relationship connotations. Table 2 explains the common themes identified while Table 3 details gender specific themes contained in these songs.







Themes relating to having a sexual relationship and sexual satisfaction/performance or lack thereof were more common than others. Of ten songs heard on radio, eight had explicit phrases and words edited when compared with other recorded versions of the same songs. Unedited versions had very explicit sexual lyrics including expletives.

Focus groups

Twenty-eight boys and twenty-one girls from four communities in three parishes participated in the discussions. Male and female participants in the 10–12 and the 13–15-year age groups were enrolled in the same primary school and junior high school. The two older age groups consisted of youths who were either still in school or had graduated from various high schools.

All themes identified in the songs were confirmed in the focus groups. One new theme relating to violence against same sex relationship emerged. Girls in the youngest age group were less open in talking about the more explicit themes but were more inclined to sing the words of songs that contained the related themes.

Developing questions

The following are examples of how probes were done in the focus groups to assess participants' thoughts and desires relating to intimate relationships as promoted in some songs:

1. What are some things you hear in songs about male and female relationships (pause and wait for answers, then probe).

a. 'Like the type of girls men and boys like;' 'The type of men girls/women like;'

b. 'How should girlfriends/boyfriends show their love;'

c. 'What makes a man/boy a good man when it comes to relationships?'

2. Would you do some of these things that DJ's sing about? (Probe using examples based on the previous discussions).

There were gender specific comments about themes in some songs and a few of these comments and the tones accompanying them conveyed feelings of disgust. A 14-year old boy ridiculed female DJs for singing that a man must have a large sexual organ and a 13-year old girl thought that some songs refer too much to female private parts.

Developing the quantitative instrument

The results of the different data sources guided the framing of questions for further study. One such question for males was as follows:

Some DJs sing about how a man should behave when it comes to girls/women or other men. Which of the following things have you ever heard in any DJ music?

C A man/boy should have many women/girls
C A man/boy should know how to 'turn on'/romance a woman
C A man/boy should get sex in return for gifts or favours he gives his woman/girl.
C A good man has a large penis and can satisfy a woman/girl
C A corresponding question included for females is:

Some DJs sing about how a woman/girl should be or behave when it comes to men: Which of the following things have you ever heard in DJ music about how women should be or behave when it comes to men/boys?

C A woman/girl should have more than one man/boyfriend
C A woman/girl should know how to romance/turn on a man
C A woman/girl should know how to satisfy a man with sex
C A woman/girl should know how to avoid pregnancy
C A woman/girl should give her man/boyfriend sex if he gives her things
C A woman/girl should have a tight vagina
C A woman/girl should only have relationship with men/boys who have money, house and cars?



This study was aimed at using qualitative methods to clarify SRH themes in Jamaican Dancehall and how these are perceived by adolescents. There is evidence to support the belief that cultural and social factors whether obvious or not, can influence reproductive health decisions (11). The content of dance hall songs reviewed in this study may not reflect the views of many Jamaicans but provide evidence of some of the beliefs about sexuality in Jamaica to which adolescents are exposed.

There were both limitations and benefits in using adolescent investigators. Firstly, adolescents were open in discussing sexual issues with their peers. The moderators' previous knowledge of the music and its content helped them to easily put things in context. This also caused a communication barrier since the moderators did not probe in depth on some issues because of their previous experience. To a novice, understanding the language of Dancehall requires multiple methods of orientation to the music

Cooper has written about the skillful use of language and imagery by dancehall artistes (12). This was evident in this investigation, but more importantly, the average adolescent seemed naturally able to interpret these imageries. Some images used initially eluded the principal investigator and had to be explained by adolescent members of the team. One example is the use of the term 'Shirley biscuit', a snack item which has been used in dancehall lyrics to refer to 'oral sex'.

Multiple approaches were justified in trying to understand the messages conveyed by many popular songs. For example, to the novice listening to and understanding some songs played on radio pose some difficulty without other knowledge of the songs. Some versions of songs played via this medium had explicit sections of the lyrics replaced with 'beep' sounds to make them fit for airplay. This however makes it difficult to understand the true meaning of some of these songs, especially when sung at a very fast pace. However, adolescents unlike adults often have no such difficulty.

There are two implications to this. Firstly, parents who are more likely to hear these songs on the radio, are less likely to understand the true meaning of the lyrics and less likely to provide guidance. The beeps may actually entice listeners to seek the unedited versions to fill in the blanks and to stimulate sales. Songs with beeps however, may not be influencing the values of younger adolescents who do not understand the real message without access to the unedited versions.

This experience has reinforced the belief that studying popular culture and its influence on adolescents must include adolescents themselves as investigators. However, these young investigators must be cautioned on making assumptions about what they hear and rely more on probing even what they think they understand.

One basic principle in doing research on human subjects is that physical and psychological well-being of participants must be ensured as any discomfort or pain is a breach of the rights of such persons (13). In the present study, the phrasing of questions was a sensitive issue that could cause discomfort. This was minimized by getting adolescents to discuss what they heard in the songs. Questions developed to probe these issues are prefaced with information about the usual practice of DJs, without making participants feel they were being blamed for thinking about these themes. Younger girls were more reluctant to talk about what they felt, but felt more comfortable singing the songs, reinforcing the value of age and gender specific groups in the information gathering exercise.

In summary, qualitative methods are useful tools to assess the perspectives of adolescents about SRH themes in local music or other aspects of popular culture. These methods help clarify cultural expressions and identify important themes. Adolescents can play a key role in helping to unravel the codes and meanings of their subculture, better than depending on adults alone to do this.



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13. Devlin E. Human research must protect participants. Network 2001: 21: 4–9.


Dr D Holder-Nevins
Department of Community Health and Psychiatry, The University of the West Indies
Mona, Kingston 7, Jamaica, West Indies.
Fax: (876)