Adolescent health series - Alcohol, tobacco, and other drug use among adolescents in sub-Saharan Africa: A narrative review

Alcohol education in Ugandan primary schools: teaching approaches and learners' perspectives

BACKGROUND

Alcohol use is a major health concern in Uganda, affecting children and adolescents directly through their own consumption or indirectly through other's drinking. Schools have an opportunity to improve knowledge and address attitudes towards alcohol. While curriculum-based alcohol education is a widely used educational approach, there is limited research on its delivery and effectiveness in Ugandan primary schools. This study explored teachers' and learners' perspectives on alcohol education in Ugandan primary schools, focusing on teaching methods and key content areas.

METHODS

This qualitative study was conducted in six purposively sampled primary schools in Mbale, Eastern Uganda. We conducted two focus group discussions in each school, a total of twelve, with 7-8 learners per group, aged 11-13 and a total of twelve key informant interviews with the teachers. The data was coded in NVivo and analysed using reflexive thematic analysis.

RESULTS

Alcohol education was primarily integrated into science lessons in Ugandan primary schools. Four main topics were covered during the lessons: what alcohol is and how it is made; the effects of alcohol use; why people drink; and, how to avoid it. The dangers of alcohol use were strongly emphasized by the teachers and the children were advised to avoid places and people including children that use alcohol. Teachers often used moralising and didactic methods of teaching to underline their message against alcohol use.

CONCLUSION

This study shows that teachers considered alcohol education as an important topic aiming to teach children about the dangers and negative effects of alcohol use.

Sexual and reproductive health knowledge and behaviors and prevalence of sexually transmitted infections among adolescents and young adults from Angola

BACKGROUND AND OBJECTIVE

There is little information on sexual and reproductive health knowledge (SRHK) and practices in Angola and no data on the prevalence of sexually transmitted infections. The objective of this study was to assess the SRHK and behaviors, and estimate the prevalence of four sexually transmitted infections (STIs) among adolescents and young adults from 4 municipalities in Benguela province, Angola prior to an educational intervention.

MATERIAL AND METHODS

We performed a cross-sectional study to assess SRHK and sexual behavior using a structured questionnaire among adolescents and young adults aged 15 to 25 years old from two urban and two rural municipalities of Benguela province. We also evaluated the prevalence of human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B virus (HBV) and syphilis using rapid tests.

RESULTS

A total of 1400 youths were included in the study. Overall, 818 (58.4%) participants had adequate SRHK. Urban origin [odds ratio (OR) 1.52, 95% confidence interval (CI) 1.35-2.04], older age (OR 1.14, 95% CI 1.09-1.20), being female (OR 2.06, 95% CI 1.57-2.71) and having journals and internet as the main sources of information (OR 1.37, 95% CI 1.00-1.86 and OR 2.33, 95% CI 1.69-3.21, respectively) were significantly associated to a good SRHK in the multivariate analysis. Four hundred and fifty-three [45.9% of those who have had sexual intercourse (n = 986)] reported risky sexual behavior. We observed that risky sexual behavior was associated with male gender (OR 2.89 95% CI 2.13-3.92, P< .001). Prevalence of STI was: 5 (0.35%) for HIV, 190 (13.6%) for HBV, 4 (0.3%) for HCV, and 20 (1.4%) for syphilis.

CONCLUSION

SRHK was higher than expected although in-depth knowledge was uncommon, especially in men from rural areas with lack of access to journals or the internet. Unsafe sexual behavior was widespread among our sample. Prevalence of HBV was higher than expected. Sexual education campaigns using both digital and non-digital approaches should be focused on reaching the young population dispersed in rural areas where internet connection is difficult and should be accompanied by HBV vaccination promotion.

Age verification and underage accessibility of official alcohol companies' websites and brand pages on Facebook and Instagram

BACKGROUND

Digital alcohol marketing increases alcohol consumption among underage persons. The study aimed to assess the effectiveness of age verification measures on three digital sites: official alcohol company websites and their associated brand pages on Facebook and Instagram in Nigeria.

METHODS

We created three fictitious age profiles (14, 16, and 18 years) on the three digital sites. Using a smartphone and desktop computer, we assessed the presence of age verification on 15 official alcohol companies' websites, 66 alcohol brand pages on Facebook, and 72 on Instagram. We assessed whether the fictitious underage profiles could interact with content on brand pages.

FINDINGS

Only three of 15 alcohol companies' websites included age verification. Two websites required entering the date of birth, while one required clicking a yes/no box to confirm being above 18 years old. Only one website blocked multiple attempts to gain access using an underage profile. Only 24 of 66 official alcohol brand pages on Facebook activated age verification. Underage users aged 14 and 16 could interact with posts and follow 42 alcohol brand pages on Facebook. Only 22 of 72 alcohol brand pages on Instagram had age verification. Users aged 14 and 16 could interact with posts and follow 50 alcohol brand pages on Instagram.

CONCLUSION

Underage persons can access and interact with alcohol content on alcohol companies' websites and brand pages on Facebook and Instagram in Nigeria. A regulatory framework for restricting underage access to alcohol marketing on digital platforms is required in Nigeria.

Tobacco control research on the African continent: a 22-year literature review and network analysis

OBJECTIVE

Describe the landscape of tobacco-related topics, funders and institutional networks in Africa.

DATA SOURCES

We searched PubMed, Embase and African Index Medicus for published articles from January 1996 to August 2018 in any language.

STUDY SELECTION

Two researchers independently reviewed titles and abstracts for a focus on nicotine or tobacco product(s) and describe data or recommendations specific to Africa. Ultimately, 818 articles were identified.

DATA EXTRACTION

Three independent coders conducted qualitative analyses of articles and extracted funders, study populations, countries of research focus, research topics, tobacco products, study design and data source. A bibliometric analysis estimated coauthorship networks between the countries of authors' primary institutional affiliation.

DATA SYNTHESIS

All 54 African countries were represented in two or more articles. The coauthorship network included 2714 unique authors representing 90 countries. Most articles employed a cross-sectional study design with primary data collection, focused on cigarettes and studied use behaviour. Few articles examined tobacco farming or interventions for cessation or prevention. The most frequently cited funder was the US National Institutes of Health (27.2%). A range of coauthorship patterns existed between African institutions with some coauthoring with one institution while others coauthored with 761 institutions in other African countries.

CONCLUSIONS

The literature review identified the need for implementation research for tobacco control interventions and policies, economic and development impacts of tobacco use research, and tobacco industry and tobacco production and farming research. Numbers of research collaborations between institutions in Africa vary, suggesting the need for regional institutional capacity building.

Substance use among young people in sub-Saharan Africa: a systematic review and meta-analysis

Background

The use of substances such as alcohol, tobacco, khat, or drugs among young people is becoming a public health concern globally, with particularly high prevalence rates in low and middle-income settings, where socio-cultural and economic factors contribute to distinct challenges in addressing this problem. This review aimed to summarize the current literature on the prevalence of substance use among young people in sub-Saharan Africa (SSA) and identify gaps in the current body of literature.

Methods

Seven databases and Google were searched for studies reporting on substance use prevalence among young people (aged 10-24 years) in SSA, published between January 2010 and May 2024. Observational studies were included, assessed for methodological quality, and checked for the presence of heterogeneity and publication bias using standard methods. A random effect model was used to estimate the pooled proportions for substance use among young people.

Results

The literature search identified 1,889 hits from the databases and Google. Among these 60 eligible studies involving 83,859 respondents were included in the review. The overall lifetime, 12-month, and current prevalence of any substance use among young people in SSA was found to be 21.0% (95% CI= 18.0, 24.0), 18% (95% CI=10,27), and 15% (95% CI=12,18), respectively. Among young people from SSA, alcohol use problem was the most prevalent (40%), followed by khat use (25%), stimulant use (20%), and cigarette smoking (16%). Other substances used by a smaller proportion of young people included cannabis, cocaine, inhalants, sedatives, shisha, hallucinogens, steroids, and mastics. The prevalence of substance use problems was higher among males compared to females, highest in the southern African region followed by Western and Eastern regions, and in community-based studies compared to institutional-based studies.

Conclusions

In SSA, over a fourth of young people use at least one substance in their lifetime, with higher rates among males than females and in community-based compared to institution-based studies. These results emphasize the need for interventions targeting the wider young population and those in specific subgroups identified as being at higher risk of substance use. This approach allows for the provision of tailored support and resources to those who need it most while also promoting positive health outcomes for the entire population of young people in the region.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022366774, identifier CRD42022366774.

Prevalence of substance and hazardous alcohol use and their association with risky sexual behaviour among youth: findings from a population-based survey in Zimbabwe

OBJECTIVES

Hazardous drinking (HD) and substance use (SU) can lead to disinhibited behaviour and are both growing public health problems among Southern African youths. We investigated the prevalence of SU and HD and their association with risky sexual behaviour among youth in Zimbabwe.

DESIGN

Data analysis from a population-based survey conducted between October 2021 and June 2022 to ascertain the outcomes of a cluster randomised trial (CHIEDZA: Trial registration number:NCT03719521). Trial Stage: Post-results.

SETTING

24 communities in three provinces in Zimbabwe.

PARTICIPANTS

Youth aged 18-24 years living in randomly selected households.

OUTCOME MEASURES

HD was defined as an Alcohol Use Disorders Identification Test score ≥8, SU was defined as ever use of ≥1 commonly used substances in the local setting.

RESULTS

Of 17 585 participants eligible for this analysis, 61% were women and the median age was 20 (IQR: 19-22) years. Overall, 4.5% and 7.0% of participants reported HD and SU, respectively. Men had a substantially higher prevalence than women of HD (8.2% vs 1.9%) and SU (15.1% vs 1.5%). Among men, after adjusting for socio-demographic factors, we found increased odds of having >1 sexual partner in those who engaged in SU (adjusted OR (aOR)=2.67, 95% CI: 2.21 to 3.22), HD (aOR=3.40, 95% CI: 2.71 to 4.26) and concurrent HD and SU (aOR=4.57,95% CI: 3.59 to 5.81) compared with those who did not engage in HD or SU. Similarly, there were increased odds of receiving/providing transactional sex among men who engaged in SU (aOR=2.51, 95% CI: 1.68 to 3.74), HD (aOR=3.60, 95% CI: 2.24 to 5.79), and concurrent HD and SU (aOR=7.74, 95% CI: 5.44 to 11.0). SU was associated with 22% increased odds of inconsistent condom use in men (aOR=1.22, 95% CI: 1.03 to 1.47). In women, the odds of having >1 sexual partner and having transactional sex were also increased among those who engaged in SU and HD.

CONCLUSION

SU and HD are associated with sexual behaviours that increase the risk of HIV acquisition in youth. Sexual and reproductive health interventions must consider HD and SU as potential drivers of risky sexual behaviour in youths.

Alcohol and other drug use patterns and services in an integrated refugee settlement in Northern Zambia: a formative research study

BACKGROUND

Evidence on patterns of alcohol and other drug (AOD) use and how to effectively deliver services to address AOD use in humanitarian settings is limited. This study aimed to qualitatively explore the patterns of AOD use among Congolese refugees in Mantapala Refugee Settlement and members of the surrounding host community and identify potential appropriate intervention and implementation approaches to address AOD use disorders among conflict-affected populations.

METHODS

Fifty free listing interviews, 25 key informant interviews, and four focus group discussions were conducted among refugees, host community members, humanitarian implementing agency staff, and refugee incentive workers. These participants were selected based on their knowledge of AOD use and related problems in the settlement and the surrounding host community in northern Zambia.

RESULTS

Cannabis and home-brewed alcohol were the substances that were perceived to be most commonly used and have the greatest impact on the community. Participants reported that self-medication, boredom, and relief of daily stressors associated with lack of housing, safety, and employment were reasons that people used AODs. Participants recommended that programming include components to address the underlying causes of AOD use, such as livelihood activities. Stigma due to the criminalization of and societal ideals and religious beliefs regarding AOD use was identified as a substantial barrier to accessing and seeking treatment.

CONCLUSIONS

Our study's findings indicate the need for services to address AOD use in Mantapala Refugee Settlement. Interventions should consider the social and structural determinants of AOD use.

Decline in youth drinking in high-income settings: Implications for public health in low-income countries

Declining drinking among youth in many high-income countries has attracted scholarly attention and debates. Still, researchers are yet to globalize such research or examine its public health implications for low-resource settings. This commentary has two interrelated purposes. First, using evidence from Nigeria, it highlights how declining youth drinking in high-income countries may impact public health in low-income countries. Second, it highlights the necessity for research to examine youth drinking behaviours simultaneously worldwide. The declining drinking trends among young people in high-income countries have occurred simultaneously with global alcohol corporations being more aggressive in low-income countries like Nigeria. Relatedly, alcohol corporations may employ evidence regarding declines in drinking to argue against implementing stringent policies or other effective interventions in Nigeria (and other low-income settings), claiming their apparent success in the falling drinking trends in high-income settings. The article argues that research on the drinking decline among young people should be globalized because without commensurate attempts to examine their drinking behaviours/trends worldwide simultaneously, public and/or global health may be harmed for the reasons explored in this article.

Prevalence of, and factors associated with, alcohol use disorder among young adults (aged 15-24 years) living with HIV/AIDS in low-income and middle-income countries: protocol for a systematic review

INTRODUCTION

Alcohol use is a global driver of HIV infection and disease progression, mediated through risky behaviour and poor antiretroviral adherence. Most studies about the burden of alcohol use among people living with HIV (PLWH)/AIDS have been done in adult populations, but less is known about young people with HIV, especially in low-income and middle-income countries (LMICs), despite the high level of alcohol use in these settings. The aim of this review is to collate evidence on the prevalence of, and factors associated with, alcohol use disorder (AUD) among young adults (aged 15-24 years) living with HIV/AIDS in LMICs.

METHODS AND ANALYSIS

Two experienced librarians will conduct an independent article search in PubMed, PsycINFO, Embase and Web of Science databases, using relevant Medical Subject Headings terms and Boolean operators ('AND', 'OR'). We will include English-language articles that were published in peer-reviewed journals from 1 January 2000, to 25 July 2022, that documented the prevalence of AUD among young people (15-24 years) living with HIV in LMICs. We shall exclude systematic review articles and qualitative studies. Two independent reviewers will screen the articles for eligibility and data will be extracted onto a preset Excel spreadsheet. Data analysis will be done using Stata V.14.0. Heterogeneity will be assessed by use of the I2 statistic and data will be pooled in meta-analyses where appropriate. Publication bias will be assessed using the funnel plot.

ETHICS AND DISSEMINATION

Ethical approval is not needed as this systematic review will be based on published studies. Findings from this study will be disseminated via submission for publication in a peer-reviewed journal, at conference presentations, and made available to health professionals, scientists and policy makers. Our data set can be made available on request.

REGISTRATION DETAILS

PROSPERO, CRD42022308955.

Perinatal alcohol use among young women living with HIV in South Africa: Context, experiences, and implications for interventions

Perinatal alcohol use is common in South Africa, including among young women living with HIV (WLHIV), but there are few insights into the drivers of alcohol use in this population. Following the completion of a pilot trial of a peer support intervention for WLHIV aged 16-24 years in Cape Town, we purposively selected participants who had reported perinatal alcohol use at ≥1 study visits to complete a qualitative in-depth interview exploring their experiences of substance use. Of 119 women enrolled, 28 reported alcohol use, and 24 were interviewed, with ≥1/3 reporting drinking throughout their pregnancy. Women described living in a community where heavy perinatal alcohol consumption is normalised, including among their peers, leading to social pressure. Despite being aware of the risks of perinatal alcohol use, women described a disconnect between public health messaging and their experiences. Although most acknowledged the negative effects of alcohol in their lives, self-efficacy to reduce consumption was diminished by peer influences and the lack of formal employment and opportunities for recreation. These findings provide insights into the drivers of perinatal alcohol use in this setting, and suggest that without meaningful community-level changes, including employment opportunities and alternatives for socialising, interventions may have limited impact.