Prevalence and Correlates of Suicidal Ideation Among Students in sub-Saharan Africa

OBJECTIVES: To compare the prevalence and correlates of suicidal ideation among youth in sub-Saharan Africa and to evaluate differences in such prevalence and correlates of suicidal ideation to identify how risk behaviors vary by gender across country settings. METHODS: Analyses are based on the Global School-Based Student Health Survey (GSHS) conducted in Botswana (N=2197; 2005), Kenya (N=3691; 2003), Tanzania (N=2176; 2006), Uganda (N=3215; 2003) and Zambia (N=2257; 2004) of students primarily 13 to 16 years of age. Logistic regression analyses were computed to determine the associations between correlates (i.e., hunger, current alcohol use, problem drinking, bullying victimization, sadness, loneliness, worrying, having no close friends, missed school, illicit drug use, physical fights, physical attacks and early sexual initiation) and suicidal ideation for all students and between boys and girls. RESULTS: The results showed variability in the prevalence of suicidal ideation across these countries. Zambia had the highest prevalence of suicidal ideation (31.9%) among all students, followed by Kenya (27.9%), Botswana (23.1%), Uganda (19.6%) and Tanzania (11.2%). Sadness was the most commonly associated correlate of suicidal ideation among students. Sadness was significantly associated with suicidal ideation in Kenya, Tanzania and Uganda. Sadness remained significantly associated among boys and girls across the same countries. CONCLUSION: The associations between the risk factors examined and suicidal ideation have helped to increase the understanding of an ignored, but critical issue in Sub-Saharan Africa. There is an urgent need for additional research in this area in addition to greater suicide prevention efforts in sub-Saharan African countries

Alcohol Exposures, Alcohol Marketing, and Their Associations with Problem Drinking and Drunkenness among Youth Living in the Slums of Kampala, Uganda

This study determined the associations between alcohol use exposures, marketing, education, and problem drinking and drunkenness among youth living in the slums of Kampala. This cross-sectional study of youth was conducted in 2011 to quantify and describe high-risk behavior and exposures in a convenience sample (N=457) of urban youth living in the slums, 14–24 years of age, who were participating in a drop-in center for disadvantaged street youth. Logistic regression analyses were computed to determine associations between alcohol use exposures, marketing exposures, alcohol education, and problem drinking and drunkenness while controlling for possible confounders. Among participants, 30.2% reported problem drinking and 32.8% reported drunkenness. In multivariate analyses, obtaining free drinks was associated with problem drinking (AOR: 2.47; 95% CI =  1.23–4.96) and drunkenness (AOR: 2.40; 95% CI = 1.22–4.70) after controlling for potential confounders. Alcohol education measures were not significantly associated with either problem drinking or drunkenness in multivariate analyses. There are important associations between alcohol marketing and drinking among these youth. Moreover, the findings underscore the need for additional research related to the impact of alcohol marketing among vulnerable youth and also the need for policy regulations that restrict alcohol marketing that involve providing free alcohol directly to youth

Co-Occurring Physical Fighting and Suicide Attempts among U.S. High School Students: Examining Patterns of Early Alcohol Use Initiation and Current Binge Drinking

Introduction: A growing body of empirical research documents a significant co-occurrence of suicide attempts and interpersonal violence among youth. However, the potential role of early alcohol use initiation and current heavy alcohol use as correlates of this comorbidity has not been examined in a nationally representative sample of high school students. Methods: We based our analyses on cross-sectional data from the 2009 Youth Risk Behavior Survey, which includes a nationally representative sample (n=16,410) of high school students in grades 9 through 12 in the United States. Multinomial logistic regression analyses were conducted to test the associations between measures of alcohol use (early alcohol use initiation and heavy drinking) and comorbid suicidal and violent behavior while controlling for potential confounders. Results: Among high school students, 3.6% reported comorbid physical fighting and suicide attempt in the past year. Early alcohol use (prior to age 13) and heavy drinking (5 or more drinks in a row) were strongly associated with comorbid reports of physical fighting and suicide attempts (Adj. odds ratio [OR]=3.12; 95% confidence interval [CI]:2.49-3.89) and (Adj. OR=3.45; 95%CI:2.63-4.52). Conclusion: These findings underscore the importance of both early alcohol use initiation and heavy drinking as statistically significant correlates of comorbid fighting and suicide attempts among youth. While future research is needed to determine the temporal ordering between problem drinking and violent or suicidal behaviors, existing prevention programs may benefit from including components aimed at reducing and delaying alcohol use. [West J Emerg Med. 2013;14(4):341–346.

Alcohol Marketing, Drunkenness, and Problem Drinking among Zambian Youth: Findings from the 2004 Global School-Based Student Health Survey

This study examines the associations between alcohol marketing strategies, alcohol education including knowledge about dangers of alcohol and refusal of alcohol, and drinking prevalence, problem drinking, and drunkenness. Analyses are based on the Global School-Based Student Health Survey (GSHS) conducted in Zambia (2004) of students primarily 11 to 16 years of age (N = 2257). Four statistical models were computed to test the associations between alcohol marketing and education and alcohol use, while controlling for possible confounding factors. Alcohol marketing, specifically through providing free alcohol through a company representative, was associated with drunkenness (AOR = 1.49; 95% CI: 1.09–2.02) and problem drinking (AOR = 1.41; 95% CI: 1.06–1.87) among youth after controlling for demographic characteristics, risky behaviors, and alcohol education. However, alcohol education was not associated with drunkenness or problem drinking. These findings underscore the importance of restricting alcohol marketing practices as an important policy strategy for reducing alcohol use and its dire consequences among vulnerable youth

The Prevalence of Very Frequent Physical Fighting among Boys and Girls in 27 Countries and Cities: Regional and Gender Differences

Objective. Using nationally representative data, this study examined the prevalence of very frequent physical fighting (≥12 times per year) among youth in 27 countries and cities. Frequent physical fighting has rarely been reported in the previous literature despite the implications for research and practice. Methods. Analyses were based on theGlobal School-based StudentHealth Survey (2003–2008) and the 2009 US Youth Risk Behavior Survey. Multinomial regression analyses were conducted to determine gender differences in frequent fighting. Countrieswere categorized into five regions (Sub-Saharan Africa, Central and South America,Asia, Eastern Mediterranean, and the United States), and one-way ANOVA tests were used to determine regional differences. Results. The prevalence of frequent fighting was highest in Zambia (7.7%) and lowest inMyanmar (0.5%). Gender differences were found in 20 countries, with boys beingmore likely to report frequent fighting than girls. The prevalence of frequent fighting varied by region ((3, 22) = 4.78, = .01), with the Eastern Mediterranean having a significantly higher prevalence of frequent fighting than Asia ( \u3c .01). Conclusion.The prevalence of frequent fighting varies by gender in many countries and varies across world regions.More cross-national research is needed to better understand the sociocultural context of frequent fighting and to inform youth violence prevention efforts

Correlates of Suicide Ideation and Attempt among Youth Living in the Slums of Kampala

While suicidal behavior is recognized as a growing public health problem world-wide, little is known about the prevalence and risk factors for suicidal behaviors among street and slum youth in Africa, and in Uganda, specifically. The number of youth who live on the streets and in the slums of Kampala appears to be growing rapidly, but their mental health needs have not been documented, which has hampered resource allocation and service implementation. This study of youth, ages 14–24, was conducted in May and June of 2011, to assess the prevalence and correlates of suicidal behavior. Participants (N = 457) were recruited for a 30-minute interviewer-administered survey through eight drop-in centers operated by the Uganda Youth Development Link for youth in need of services. Bivariate and multivariate logistic regression analyses were computed to determine associations between psychosocial correlates and suicide ideation and suicide attempt. Reporting both parents deceased Adj.OR = 2.36; 95% CI: 1.23–4.52), parental neglect due to alcohol use (Adj.OR = 2.09; 95% CI: 1.16–3.77), trading sex for food, shelter or money (Adj.OR = 1.95; 95% CI: 1.09–3.51), sadnesss (Adj.OR = 2.42; 95% CI: 1.20–4.89), loneliness (Adj.OR = 2.67; 95% CI: 1.12–6.40) and expectations of dying prior to age 30 (Adj.OR = 2.54; 95% CI: 1.53–4.23) were significantly associated with suicide ideation in multivariate analyses. Parental neglect due to alcohol use (Adj.OR = 2.04; 95% CI: 1.11–3.76), sadness (Adj.OR = 2.42; 95% CI: 1.30–7.87), and expectations of dying prior to age 30 (Adj.OR = 2.18; 95% CI: 1.25–3.79) were significantly associated with suicide attempt in multivariate analyses. Given the dire circumstances of this vulnerable population, increased services and primary prevention efforts to address the risk factors for suicidal behavior are urgently needed

Alcohol marketing and drunkenness among students in the Philippines: findings from the nationally representative Global School-based Student Health Survey

BACKGROUND: A largely unaddressed issue in lower income countries and the Philippines, in particular, is the role of alcohol marketing and its potential link to early alcohol use among youth. This study examines the associations between exposures to alcohol marketing and Filipino youths’ drinking prevalence and drunkenness. METHODS: Cross-sectional analyses were used to examine the Global School-based Student Health Survey (GSHS) conducted in Philippines (2011). The self-administered questionnaires were completed by students primarily 13 to 16 years of age (N = 5290). Three statistical models were computed to test the associations between alcohol marketing and alcohol use, while controlling for possible confounding factors. RESULTS: Alcohol marketing, specifically through providing free alcohol through a company representative, was associated with drunkenness (AOR: 1.84; 95% CI = 1.06–3.21) among youths after controlling for demographic and psychosocial characteristics, peer environment, and risky behaviors. In addition, seeing alcohol ads in newspapers and magazines (AOR: 1.65, 95% CI = 1.05–2.58) and seeing ads at sports events, concerts or fairs (AOR: 1.50, 95% CI = 1.06–2.12) were significantly associated with increased reports of drunkenness. CONCLUSIONS: There are significant associations between alcohol marketing exposure and increased alcohol use and drunkenness among youth in the Philippines. These findings highlight the need to put policies into effect that restrict alcohol marketing practices as an important prevention strategy for reducing alcohol use and its dire consequences among vulnerable youth

Correlates and Contexts of High-Risk Sexual Behaviors Among Youth in the Slums of Kampala: Implications for HIV Prevention and Program Development

Globally, HIV remains a critical public health issue with almost 40 million people currently living with HIV worldwide and millions who have died of AIDS since the start of the epidemic. As HIV affects the health of individuals, it also adversely impacts families, communities, and the development and stability of nations. Many of the countries hardest hit by HIV are resource-poor and suffer from other health issues and challenges. In Uganda, HIV prevalence among adults is still high and two-thirds of the urban population live in slum communities in the densely populated capital city of Kampala where lack of basic services negatively affects health and quality of life. The rapid growth of urban slums in the region is a cause for concern and data is limited on the health and risk behaviors of adolescents who live in these slums. Studies show that disease burden and premature death among adults can be associated with behaviors or conditions that began during adolescence. Youth who live on the streets and in the slums face much of the burden related to poverty, lack of family support, risk of HIV and other health issues. The three dissertation studies aimed to examine the drivers, contexts and patterns of high-risk and protective sexual behaviors which is critical for program development and interventions among understudied vulnerable youth and to complement the biomedical interventions that have greatly impacted the epidemic, but have not been able to achieve zero new infections. Using data from Kampala, the studies specifically aimed to: 1) examine the impact of individual level correlates of consistent condom use among sexually-active slum youth were examined to address and eliminate barriers to condom use in this sub-population of youth. Results showed that consistent condom use was low and was associated with condom use at sexual debut, no alcohol use before sex, condom use planning and self-efficacy; 2) examine the individual and community-level factors for engaging in multiple sexual partnerships among sexually active slum youth and whether sexual behaviors of the youth vary across the slum locations. We found a high prevalence of multiple sexual partnerships and that early sexual debut, alcohol use in the past year, alcohol use before sex and transactional sex were associated with multiple sexual partnerships. We also found that risk behaviors, including early sexual debut, alcohol use, and transactional sex varied greatly across the slum locations; 3) explore patterns of sexual risk behaviors and examine risk behavior and parental factors associated with these patterns. A latent class analysis was used to empirically identify three distinct classes of youth based on a set of their sexual risk behaviors, and examine the role of parental influence on the classes of sexual risk behavior. We found using alcohol before sex was a highly significant for youth in the high-risk class. Parental living status was also significantly associated with both the high risk and medium risk classes. The findings show that sexual risk classes have different behavioral and parental characteristics. The three studies highlight the need for tailored, targeted, multi-pronged programs, rather than a silo approach, to address multiple risk patterns, for effective HIV and STI prevention

www.mdpi.com/journal/ijerph Correlates of Suicide Ideation and Attempt among Youth Living in the Slums of Kampala

Abstract: While suicidal behavior is recognized as a growing public health problem world-wide, little is known about the prevalence and risk factors for suicidal behaviors among street and slum youth in Africa, and in Uganda, specifically. The number of youth who live on the streets and in the slums of Kampala appears to be growing rapidly, but their mental health needs have not been documented, which has hampered resource allocation and service implementation. This study of youth, ages 14–24, was conducted i

Features of alcohol advertisements across five urban slums in Kampala, Uganda: pilot testing a container-based approach

Background: Despite the high prevalence of alcohol use and marketing in many settings across sub-Saharan Africa, few studies have systematically sought to assess alcohol marketing exposure, particularly in vulnerable areas such as urban slums where alcohol is often highly prevalent but where educational programs and alcohol prevention messages are scarce. Objective: To pilot test the development and implementation of environmental scans of alcohol advertisements in five urban slums across different areas of Kampala, Uganda: Bwaise, Kamwokya, Makindye, Nakulabye, and Nateete. Methods: Each of the five scans was conducted in geographical circles, within a 500-m radius of a Uganda Youth Development Link (UYDEL) drop-in Center using a container-based approach. Using a Garmin GPS with photo capabilities and a tablet for data entry, teams of at least two trained researchers walked the main roads within the target area and gathered information about each alcohol advertisement including its location, type, size, and placement and other characteristics. Data with the GPS coordinates, photos and descriptive details of the adverts were merged for analyses. Results: A total of 235 alcohol adverts were found across all five data collection sites reflecting 32 different brands. The majority of the adverts (85.8%) were smaller and medium sizes placed by restaurants and bars, stores and kiosks, and liquor stores. The most frequently noted types of alcohol in the adverts were spirits (50.6%) and beer (30.6%). Recommendations: The pilot test of the methodology we developed indicated that implementation was feasible, although challenges were noted. Since monitoring alcohol marketing is key for addressing underage alcohol use and harm, the advantages and disadvantages of the approach we developed are discussed. Future research needs to strengthen and simplify strategies for monitoring alcohol marketing in low-resource settings such as urban slums which have unique features that need to be considered. Meanwhile, the findings may yield valuable information for stakeholders and to guide intervention developments and alcohol marketing policy to protect youth