Marijuana use and its correlates among school-going Jamaican adolescents: a finding from a national survey

Introduction: The recent data indicate almost a fifth of Jamaican adolescents used marijuana in the past 30 days. To ensure the optimal allocation of resources, a country-specific understanding of factors associated with marijuana use among adolescents is essential. Therefore, this study aimed to address this gap among adolescents aged 13–17 years in Jamaica. Methods: We analyzed data from the recent Jamaica Global School-Based Student Health Survey conducted in 2017. The sample consists of school-going Jamaican adolescents of 7th−12th grades. The prevalence of recent marijuana use was assessed and compared across different demographics, substance use, and risk behaviors using bivariate and multivariable logistic regression analyses. Results: Older adolescents and men had a higher likelihood of recent marijuana use. Psychosocial risks, such as loneliness, frequent worry, suicidal ideation, physical attacks, and school absenteeism, were associated with higher marijuana usage. Parental smoking increased the odds, whereas strong parental support and awareness decreased it. Other substance uses, especially amphetamine and tobacco products, had strong associations with marijuana use. Early initiation of substances was associated with a higher risk of marijuana use. Sexually active adolescents, especially those initiated before the age of 14 years, had higher rates of marijuana use. Conclusion: The intricate link between harmful and supportive psychosomatic and risk behaviors with recent marijuana use highlights the importance of holistic interventions and policies focusing on emotional health, parental guidance, substance education, and sexual activity implications.publishedVersio

Predictors of Suicidal Thoughts and Attempts among School-Going Thai Adolescents: A Sex-Specific Structural Equation Modelling Analysis

Adolescent suicide is a growing public health concern in Thailand. Identifying predictors of suicidal behaviors is essential for targeted prevention strategies. Using Structural Equation Modeling, this study explores the predictors of suicidal thoughts and attempts among a sample of 5657 Thai adolescents in grades 7–12, typically representing the age group 13–17 years, with nearly equal proportions of males (47%) and females (53%) participants. Data from the Thailand Global School-based Student Health Survey (GSHS) 2021 were analyzed. Explanatory Factor Analysis (EFA) identified key constructs, followed by SEM stratified by sex to examine relationships between constructs and suicidal behaviors. Reliability and validity were assessed using Cronbach’s α and SEM fit indices. EFA identified five constructs: current substance use, history of violence, experiences of bullying, parental awareness, and poor mental health. SEM revealed poor mental health as a significant predictor for both sexes. Substance use, experiences of bullying, and a history of violence predicted suicidal behaviors in females. Parental vigilance was only a protective factor for males. The findings underscore the importance of gender-specific interventions and comprehensive mental health support to address the unique vulnerabilities of Thai adolescents, reducing suicidal thoughts and attempts.publishedVersio

Predictor of smoking cessation among school-going adolescents in Indonesia: a secondary analysis based on the transtheoretical model of behavioral change

Introduction: This study elucidates the complex journey of adolescents toward smoking cessation, investigating the association of relevant demographic factors, advertising, promotion, anti-cigarette messages, and individual knowledge and attitudes with being in different smoking cessation stages. Methods: Utilizing data from the 2019 Indonesia Global Youth Tobacco Survey, this secondary analysis included adolescents who reported ever smoking. The Transtheoretical Model (TTM) guided the categorization of the outcome variable into three smoking cessation stages based on the responses to two questions related to the intention and timing of the smoking cessation. This included contemplation, action, and maintenance stages. Multinomial logistic regression analyzed the associations between each independent variable and being in each stage of smoking cessation. The study comprised 3596 Indonesian adolescents from grades 7-12, of which 2484 responded to two questions related to intention and timing of smoking cessation and were included in regression analysis. Results: Findings indicate that males and those aged ≥16 were predominantly in contemplation phase. Early smoking initiation, usage of other tobacco products, and exposure to various forms of smoke increased the likelihood of being in contemplation and action phases. Parental smoking, school smoking exposure, and second-hand smoke were significant contemplation phase predictors. Exposure to tobacco advertising was linked to an increased likelihood of being in contemplation and action phases, whereas anti-cigarette messages showed no significant impact. Awareness of cigarette and second-hand smoke harms reduced the odds of being in the contemplation phase, while enjoying smoking and willingness to accept cigarettes from friends increased the odds of being in contemplation and action phases rather than in maintenance phase. Conclusion: Addressing age, gender, cultural influences, environmental factors, and attitudes towards smoking through tailored interventions is vital for aiding smoking cessation in Indonesian adolescents. Strengthened tobacco control in schools and public places is recommended to bolster these efforts. Longitudinal studies are required to explore the evolving patterns of smoking cessation behaviors over time, enhancing our understanding of the factors influencing sustained cessation.publishedVersio

The individual- and community-level women’s empowerment and utilization of maternity care services in Afghanistan: a multilevel cross-validation study

Background This study aimed to explore the relationship between women's empowerment and utilization of maternity care for married Afghan women aged 15–49 y in Afghanistan, assessing the convergence validity of the Survey-based Women's Empowerment Index in Afghanistan (SWEI-A). Methods The study used data from the 2015 Afghanistan Demographic Health Survey to examine the association of different domains of women's empowerment with the utilization of maternity care using multilevel Poisson regression at both individual and community levels. Results The utilization of maternity services was considerably higher among women with high scores compared with those with low scores in almost all domains of the SWEI-A, except for property owning, in which women with high scores appeared to have lower rates of utilization of such services compared with those with low scores. At the community level, those communities with high participation of women in the labor force were less likely to have adequate antenatal care (ANC), institutional delivery and postnatal care (PNC). Individual-level literacy was associated with higher utilization of ANC, institutional delivery and PNC, contrary to community-level literacy. Conclusions Except for property owning, the high score in almost all other domains was associated with higher utilization of maternity care, which indicates an acceptable level of convergence validity for the developed index (i.e. the SWEI-A) in measuring women's empowerment among married Afghan women aged 15–49 y.publishedVersio

Temporal changes and correlates of tobacco and E-cigarettes use among school-going students in Albania: insights from global youth tobacco surveys (2015–2020)

Tobacco use often starts during adolescence, with many adults beginning before 21. This study investigated the patterns and factors associated with tobacco and e-cigarette use among school-aged adolescents in Albania. Data were analyzed from two Albania Global Youth Tobacco Surveys (GYTS) conducted in 2015 and 2020. Participants included 7th-10th grade students (ages 12–16) who completed the survey (n = 9985). Descriptive statistics depicted demographic characteristics, tobacco, and e-cigarette use across survey years. Logistic regression assessed temporal changes and the odds of use across independent variables, adjusting for age and sex. From 2015 to 2020, tobacco and e-cigarette use among students aged 13–15 increased from 12.86 to 14.49% and from 6.8 to 8.8%, respectively. Cigarette smoking declined from 8.4 to 4.3%, but the use of other tobacco products nearly doubled, from 6.4 to 12.3%. Higher odds of use were found among males, older students, and those with more pocket money. Environmental factors like family, peer, and media exposure to smoking increased the likelihood of use. Anti-tobacco messages had no significant impact, while advertising strongly influenced usage. Knowledge of tobacco harms and anti-smoking attitudes correlated with lower odds of use. Increased availability of cigarettes near schools was linked to higher odds of tobacco use. The study highlights gaps in anti-tobacco messaging and the strong influence of advertising, underscoring the need for targeted and effective tobacco control strategies in Albania.publishedVersio

Suicide Attempt and Its Correlates Among School-Going Argentinian Adolescents with Suicidal Thoughts: Insights from a National Survey

A combination of personal, psychological, and environmental factors contributes to the risk of suicide attempts among those with suicidal thoughts and warrants further research. The study explored the associations of demographic, psychosocial, and behavioral factors with suicide attempts among a nationally representative of school-going Argentinian adolescents who have suicidal thoughts. The study analyzed the data from the Argentina Global School-based Students Survey 2018. The sample was restricted to adolescents with suicidal thoughts. The chi-square test was used to examine the association, and logistic regression determined the odds of suicide attempts across risk factors including demographic factors, psychosocial and environmental risks, as well as substance use and risk sex behaviors. In total, 11,962 (21.46%) of school-going Argentinian adolescents had suicidal thoughts, of whom 6033 (51.67%) had suicide attempts at least once in the last 12 months. Findings indicated that female adolescents had higher odds of attempts, paralleling global trends, while grade differences suggested a transitional phase’s significance. Among those with suicidal thoughts, psychosocial factors like loneliness, bullying, and school absenteeism played pivotal roles in enhancing the odds of suicide attempts. In addition, substance use, notably marijuana, amphetamines, alcohol, and early initiation were associated with a heightened risk of suicide attempts. Risky sexual behaviors, like early activity and multiple partners, were also associated with a higher likelihood of suicide attempts in suicide ideators. Emphasizing preventive measures targeting adolescents, particularly within school settings, is crucial for reducing suicide attempts among those experiencing suicidal thoughts.publishedVersio

Prevalence and correlates of sexual intercourse under influence of alcohol among Thai adolescents: Lessons from a nationwide school-based survey

Objectives Having sex under the influence of alcohol is a risky behavior and this study explored its prevalence and correlates among school-going Thai adolescents. Methods The data from the 2021 Thailand Global School-based Student Health Survey (GSHS), including a nationally representative sample of students in grades 7–12th, was used to extract the relevant variables including demographic, psychosocial, substance use, and risky sex behaviors. Logistic regression was used to assess the odds of engaging in sex while intoxicated across the independent variables while accounting for age and sex differences. Results Approximately 30.45 % of respondents reported alcohol intoxication and 37.75 % reported engaging in sexual intercourse while intoxicated at least once. Older adolescents (>14 years), males, and those in 11 and 12 grades were more likely to engage in sexual intercourse while intoxicated. Psychosocial factors such as loneliness and anxiety-induced insomnia were associated with increased likelihood, particularly among females. Substance use, including marijuana and amphetamine use, as well as cigarette smoking, correlated with higher odds of engaging in sexual intercourse while intoxicated. Both genders who engaged in sex while intoxicated reported having multiple sexual partners, with males more likely to use condoms. Conclusions The intricate relationship between poor mental health, substance use, and risky sex behaviors along with their association with sex under alcohol influence emphasizes the need for a holistic approach to address the common risk factors and implement effective school-based screening strategies to identify the risk groups, educate them, and prevent the burden of risky sex under alcohol intoxication.publishedVersio

イランに住むアフガニスタン女性における適切な出産前ケアに対する障壁と関連要因に関する研究：ミクストメソッド研究

京都大学新制・課程博士博士(社会健康医学)甲第23119号社医博第115号新制||社医||11(附属図書館)京都大学大学院医学研究科社会健康医学系専攻(主査)教授 近藤 尚己, 教授 万代 昌紀, 教授 川上 浩司学位規則第4条第1項該当Doctor of Public HealthKyoto UniversityDFA

Intimate Partner Violence and Children Under 5 Morbidities and Mortality in Afghanistan: Findings From a National Survey

Limited knowledge exists concerning the prevalence and drivers of intimate partner violence (IPV) against Afghan women and its association with child morbidity and mortality in Afghanistan. The study used data from the 2015 Afghanistan Demographic and Health Survey (ADHS 2015). The prevalence and associated sociodemographic factors of IPV were described by analyzing the data from Afghan women aged 15 to 49 years selected for the IPV module in ADHS 2015 (n = 24,070) whose children under 5 (n = 22,927) were included in the further analysis to estimate the morbidity and mortality of children and its association with IPV. It appeared that more than half of the Afghan women aged 15 to 49 years experienced IPV in the past year. Illiteracy (odds ratio [OR] = 1.69; 95% CI: 1.19, 2.39), living in rural areas (OR = 1.47; [1.19, 1.82]) being from the Pashtun, Tajik, Uzbek, and Pashai ethnic backgrounds were associated with a higher risk of IPV exposure. In general, the likelihood of child mortality within the first 5 years was higher among children born to mothers exposed to IPV, particularly physical and sexual even after adjustment for sociodemographic inequalities, the number of antenatal care, and marriage age. In addition, the odds of diarrhea, acute respiratory infection, and fever in the past 2 weeks were significantly higher among the children of victimized mothers in both adjusted and unadjusted models. Moreover, low birth weight and small birth size were more likely to be observed among the children of a mother who either experienced sexual or physical violence. The findings emphasized the elevated risk of morbidity and mortality among children under 5 born to mothers exposed to IPV and incorporating IPV screening into maternity and child care could reduce these adverse outcomes among Afghan women.publishedVersio

The association of child marriage with morbidities and mortality among children under 5 years in Afghanistan: findings from a national survey

Background There is still a gap in knowledge of the impact that child marriage could have on the mortality and morbidity of children in Afghanistan. This study used the data from the latest Afghanistan demographic health survey conducted in 2015 (ADHS) to address this gap and advance the current knowledge. Methods A secondary analysis of the 2015 ADHS, including the births in the past 5 years to ever-married women aged 15–24 years old, was carried out. Logistic regression analyses were employed to examine the association of child marriage (< 18y) with morbidities (diarrhea, acute respiratory infection, and fever in the last 2 weeks), mortality (neonatal, infant, child), and size at birth among the children under 5 born to women aged 15–24 years, before and after adjusting for the effect of sociodemographic and structural inequalities. Results Approximately two-thirds of births in the past 5 years belong to 15–24 years old mothers who married at ages < 18. The majority of them were born to mothers residing in rural areas (75.67%) with no education (51.68%) from poor households (39.39%). As compared to the births to women married at ages ≥ 18, there was a significantly higher likelihood of neonatal mortality among births to women married at ages < 18 (crude OR = 2.30, 95% CI: 1.52–3.49 & adjusted OR = 1.94, 95% CI: 1.25–3.01) and higher infant mortality among the births to the women married at ages ≤ 14y (crude OR = 1.94, 95% CI: 1.06–3.53). However, it disappeared for neonatal mortality after adjustment for adequacy of antenatal care (ANC) and infant mortality after adjustment for sociodemographic inequalities. Conclusion Although the births to women married as a child (< 18) were more likely to die at an early age, this association disappeared after adjustment for the adequacy of ANC. Given the unavoidable practice of child marriage in Afghanistan, this finding emphasizes the importance of providing adequate ANC for young brides to prevent child mortality. In addition, strong global advocacy is required to empower and support young Afghan women in negotiating their reproductive and maternity rights with their partners by reducing social and gender-based inequalities.publishedVersio