Promoting sexual and reproductive health among adolescents in southern and eastern Africa (PREPARE): project design and conceptual framework

Background: Young people in sub-Saharan Africa are affected by the HIV pandemic to a greater extent than young people elsewhere and effective HIV-preventive intervention programmes are urgently needed. The present article presents the rationale behind an EU-funded research project (PREPARE) examining effects of community-based (school delivered) interventions conducted in four sites in sub-Saharan Africa. One intervention focuses on changing beliefs and cognitions related to sexual practices (Mankweng, Limpopo, South Africa). Another promotes improved parent-offspring communication on sexuality (Kampala, Uganda). Two further interventions are more comprehensive aiming to promote healthy sexual practices. One of these (Western Cape, South Africa) also aims to reduce intimate partner violence while the other (Dar es Salaam, Tanzania) utilises school-based peer education. Methods/design: A modified Intervention Mapping approach is used to develop all programmes. Cluster randomised controlled trials of programmes delivered to school students aged 12–14 will be conducted in each study site. Schools will be randomly allocated (after matching or stratification) to intervention and delayed intervention arms. Baseline surveys at each site are followed by interventions and then by one (Kampala and Limpopo) or two (Western Cape and Dar es Salaam) post-intervention data collections. Questionnaires include questions common for all sites and are partly based on a set of social cognition models previously applied to the study of HIV-preventive behaviours. Data from all sites will be merged in order to compare prevalence and associations across sites on core variables. Power is set to .80 or higher and significance level to .05 or lower in order to detect intervention effects. Intraclass correlations will be estimated from previous surveys carried out at each site. Discussion: We expect PREPARE interventions to have an impact on hypothesized determinants of risky sexual behaviour and in Western Cape and Dar es Salaam to change sexual practices. Results from PREPARE will (i) identify modifiable cognitions and social processes related to risky sexual behaviour and (ii) identify promising intervention approaches among young adolescents in sub-Saharan cultures and contexts.publishedVersionPeer Reviewe

Distal and proximal family predictors of adolescents' smoking initiation and development: A longitudinal latent curve model analysis

<p>Abstract</p> <p>Background</p> <p>Studies on adolescent smoking indicate that the smoking behaviours of their parents, siblings and friends are significant micro-level predictors. Parents' socioeconomic status (SES) is an important macro-level predictor. We examined the longitudinal relationships between these predictors and the initiation and development of adolescents' smoking behaviour in Norway.</p> <p>Methods</p> <p>We employed data from <it>The Norwegian Longitudinal Health Behaviour Study (NLHB)</it>, in which participants were followed from the age of 13 to 30. We analysed data from the first 5 waves, covering the age span from 13 to 18, with latent curve modeling (LCM).</p> <p>Results</p> <p>Smoking rates increased from 3% to 31% from age 13 to age 18. Participants' smoking was strongly associated with their best friends' smoking. Parental SES, parents' smoking and older siblings' smoking predicted adolescents' initial level of smoking. Furthermore, the same variables predicted the development of smoking behaviour from age 13 to 18. Parents' and siblings' smoking behaviours acted as mediators of parents' SES on the smoking habits of adolescents.</p> <p>Conclusions</p> <p>Parents' SES was significantly associated, directly and indirectly, with both smoking initiation and development. Parental and older siblings' smoking behaviours were positively associated with both initiation and development of smoking behaviour in adolescents. There were no significant gender differences in these associations.</p

Effects of PREPARE, a Multi-component, School-Based HIV and Intimate Partner Violence (IPV) Prevention Programme on Adolescent Sexual Risk Behaviour and IPV : Cluster Randomised Controlled Trial

Young South Africans, especially women, are at high risk of HIV. We evaluated the effects of PREPARE, a multi-component, school-based HIV prevention intervention to delay sexual debut, increase condom use and decrease intimate partner violence (IPV) among young adolescents. We conducted a cluster RCT among Grade eights in 42 high schools. The intervention comprised education sessions, a school health service and a school sexual violence prevention programme. Participants completed questionnaires at baseline, 6 and 12 months. Regression was undertaken to provide ORs or coefficients adjusted for clustering. Of 6244 sampled adolescents, 55.3 % participated. At 12 months there were no differences between intervention and control arms in sexual risk behaviours. Participants in the intervention arm were less likely to report IPV victimisation (35.1 vs. 40.9 %; OR 0.77, 95 % CI 0.61-0.99; t(40) = 2.14) suggesting the intervention shaped intimate partnerships into safer ones, potentially lowering the risk for HIV

Dimensionality and measurement invariance in the Satisfaction with Life Scale in Norway

Purpose Results from previous studies examining the dimensionality and factorial invariance of the Satisfaction with Life Scale (SWLS) are inconsistent and often based on small samples. This study examines the factorial structure and factorial invariance of the SWLS in a Norwegian sample. Methods Confirmatory factor analysis (AMOS) was conducted to explore dimensionality and test for measurement invariance in factor structure, factor loadings, intercepts, and residual variance across gender and four age groups in a large (N = 4,984), nationally representative sample of Norwegian men and women (15–79 years). Results The data supported a modified unidimensional structure. Factor loadings could be constrained to equality between the sexes, indicating metric invariance between genders. Further testing indicated invariance also at the strong and strict levels, thus allowing analyses involving group means. The SWLS was shown to be sensitive to age, however, at the strong and strict levels of invariance testing. Conclusion In conclusion, the results in this Norwegian study seem to confirm that a unidimensional structure is acceptable, but that a modified single-factor model with correlations between error terms of items 4 and 5 is preferred. Additionally, comparisons may be made between the genders. Caution must be exerted when comparing age groups

SMOKING HABITS AMONG SECONDARY SCHOOL STUDENTS IN SELECTED DISTRICTS IN ZIMBABWE. GENDER, URBAN/RURAL AND SOCIAL CLASS DIFFERENCES

Objective To examine the relationship between smoking habits and indicators of socioeconomic status, the urban/rural dimension and gender among secondary school students from selected districts in Zimbabwe. Design A two-stage stratified random sample of students was drawn. Schools were stratified by school type and students were stratified by gender and grade. Setting The data collections took place in schools by trained personnel from Department of Psychiatry, University of Zimbabwe. Subjects A total of 3500 students were sampled. Questionnaires were completed by 3308 students. After exclusion of incomplete and inconsistent questionnaires, the material consisted of questionnaires from 3061 students (87.5%). Results Only 0.9% reported to be daily smokers, 2.1% smoked weekly (but not daily), and 19.8% smoked more seldom. The increase in the prevalence of smokers across age groups proved to be small. Smoking (daily, weekly and more seldom combined) is more common among male students (27.6%) than among female students (17.5%). The risk of being a smoker increases with increasing socioeconomic status. According to the students' proxy reports, more fathers (25.5%) than mothers (8.7%) were tobacco users (smoking, sniffing or chewing tobacco). Among mothers, being a tobacco user (as reported by their offspring) increases with higher education, occupational status and with having their son or daughter in a private school. Among fathers there is no association between indicators of socioeconomic status and use of tobacco. This indicates that the population being surveyed has reached a stage in the diffusion process where tobacco use is becoming less fashionable among high status segments of the adult male population. Conclusion A rather modest income in large groups may explain the low prevalence of daily and weekly smoking among secondary school students in the districts covered by the present survey. The proportion of experimental smokers is, however, high. A future increase in the income level may therefore lead to a marked increase in tobacco consumption. In order to prevent this, there is an urgent need for developing intervention strategies which are relevant to the Zimbabwean culture and societal context. Smoking among young women deserves special attention. (Southern Af. J. of Child and Adolescent Mental Health, 2000, 12(2): 125-144

The public’s attitudes towards tobacco sales prohibitions: Evidence from a nationally representative survey in the former Soviet state of Georgia

BACKGROUND: In the Caucasus region country of Georgia, no data on public opinion regarding tobacco sales restrictions have been available until now. The aim of the study is to provide data from a nationally representative sample including non-smokers, ex-smokers and current smokers, on their level of support for restricting tobacco sales. METHODS: 1,588 people aged 13-70 were interviewed at home about their level of agreement with eight possible tobacco sales restrictions, which were combined to create a dichotomous scale indicating low agreement (agree with none to three of eight restrictions) or high agreement (agree with four or more of eight restrictions). Levels of agreement were analyzed by demographic segments defined by age, gender, education and income and by tobacco use status. RESULTS: Across all eight forms of tobacco sales restrictions, the average support for tobacco sales restrictions was 85.2% which is a high level of support. Among smokers, 71% of women and 87% of men indicated a high level of agreement for restricted tobacco sales; among occasional smokers 54% and 55% respectively. Above 95% of female and male ex-smokers and never smokers expressed high level of agreement with sales restrictions. After adjustment for other predictors, agreement was significantly associated with age (more agreement with higher age) and smoking status (more agreement among never-smokers, less in current smokers), while there were no significant differences in agreement by gender, education, and income. DISCUSSION: It is of high importance for Georgia to fully implement the Framework Convention on Tobacco Control, including strong sales restrictions, and there is good evidence of public support for doing so. CONCLUSION: The present findings indicate to Georgian public health authorities that the support for tightened tobacco sales restrictions is high

Ставлення громадськості до заборони продажу тютюну: результати національно-репрезентативного опитування з колишньої радянської республіки Грузія

BACKGROUND: In the Caucasus region country of Georgia, no data on public opinion regarding tobacco sales restrictions have been available until now. The aim of the study is to provide data from a nationally representative sample including non-smokers, ex-smokers and current smokers, on their level of support for restricting tobacco sales. METHODS: 1,588 people aged 13-70 were interviewed at home about their level of agreement with eight possible tobacco sales restrictions, which were combined to create a dichotomous scale indicating low agreement (agree with none to three of eight restrictions) or high agreement (agree with four or more of eight restrictions). Levels of agreement were analyzed by demographic segments defined by age, gender, education and income and by tobacco use status. RESULTS: Across all eight forms of tobacco sales restrictions, the average support for tobacco sales restrictions was 85.2% which is a high level of support. Among smokers, 71% of women and 87% of men indicated a high level of agreement for restricted tobacco sales; among occasional smokers 54% and 55% respectively. Above 95% of female and male ex-smokers and never smokers expressed high level of agreement with sales restrictions. After adjustment for other predictors, agreement was significantly associated with age (more agreement with higher age) and smoking status (more agreement among never-smokers, less in current smokers), while there were no significant differences in agreement by gender, education, and income. DISCUSSION: It is of high importance for Georgia to fully implement the Framework Convention on Tobacco Control, including strong sales restrictions, and there is good evidence of public support for doing so. CONCLUSION: The present findings indicate to Georgian public health authorities that the support for tightened tobacco sales restrictions is high. KEYWORDS: tobacco; tobacco control; tobacco control policy; public attitude; sales restriction; tobacco sales restriction; youth access; law; FCTC.АКТУАЛЬНОСТЬ: В стране кавказского региона Грузии до настоящего времени не было результатов исследований об отношении общественности к ограничению продаж табачных изделий. Целью данного исследования является получение сведений по национально-репрезентативной выборке, включающей некурящих, бывших курильщиков и нынешних курильщиков, об уровне поддержки ограничений продажи табака. МЕТОДЫ: 1588 человек 13-70 лет были опрошены у них дома об их согласии с восьмью возможными ограничениями продаж, эти ответы затем были скомбинированы для получения дихотомической переменной, противопоставляющей низкий уровень согласия (от нуля до трех из восьми ограничений) и высокий уровень (согласие с четырьмя и более из восьми ограничений). Уровень согласия сопоставляли по демографическим группам, определяемым возрастом, полом, образованием и уровнем доходов, а также в зависимости от курительного статуса. РЕЗУЛЬТАТЫ: Средний уровень согласия при сравнении восьми вариантов ограничений продаж табака составил 85,2%, что составляет высокий уровень поддержки. Среди курильщиков 71% женщин и 87% мужчин обозначили высокий уровень поддержки ограничений продаж, среди эпизодических курильщиков 54% и 55% соответственно. Среди бывших курильщиков и некурящих более 95% респондентов сообщили о высоком уровне поддержки ограничений продаж табака. После учета других факторов, уровень согласия определялся возрастом (большая поддержка выражалась людьми старшего возраста) и курительным статусом (более высокий уровень согласия выражали никогда не курившие, меньший – нынешние курильщики), при этом не было существенных различий в зависимости от пола, образования и уровня доходов. ОБСУЖДЕНИЕ: Важно, чтобы Грузия полностью выполнила требования Рамочной Конвенции по контролю над табаком, включая ограничения продаж, и данное исследование свидетельствует об общественной поддержки этих действий. ЗАКЛЮЧЕНИЕ: Полученные результаты указывают органам здравоохранения Грузии на высокую поддержку ужесточения ограничений продаж. КЛЮЧЕВЫЕ СЛОВА: табак; контроль над табаком; политика контроля над табаком; отношение общественности; ограничение продаж; ограничение продажи табака; доступ молодежи; РКБТ

Data from: Attitudes towards smoking restrictions and tobacco advertisement bans in Georgia

BACKGROUND: The level of public support for restrictions on tobacco use is an important element in a nation’s response to the need for tobacco control. However, no data have been available from Georgia on public opinion regarding smoking restrictions in public places, and on bans on tobacco advertisement, sponsorship and promotion. METHODS: 1,588 respondents aged 13-70 were interviewed at home about their level of agreement with eight possible smoking restrictions, used to calculate a dichotomous scale indicating high versus low level of agreement with restrictions. RESULTS: In all demographic segments, and among tobacco users, a majority of respondents indicated a high level of agreement with restrictions, ranging from a low of 51% in the 13-25 age group to a high of 98% in the 56-70 age group. Logistic regression with all demographic variables entered showed that agreement with restrictions rose significantly with age and was significantly higher among never smokers compared to daily smokers. Across all items, the average public support for smoking restrictions and tobacco advertisement bans was 84.9%. DISCUSSION: This study provides good quality evidence of a high level of public support in Georgia for strong smoking restrictions and the total ban of tobacco ads and sponsorship, even among daily smokers. CONCLUSION: This study demonstrates a methodology for gathering national public opinion data to influence policies towards implementation of stronger smoking control measures. Therein lies the relevance of this study beyond the borders of Georgia

Data from: Attitudes towards smoking restrictions and tobacco advertisement bans in Georgia

BACKGROUND: The level of public support for restrictions on tobacco use is an important element in a nation’s response to the need for tobacco control. However, no data have been available from Georgia on public opinion regarding smoking restrictions in public places, and on bans on tobacco advertisement, sponsorship and promotion. METHODS: 1,588 respondents aged 13-70 were interviewed at home about their level of agreement with eight possible smoking restrictions, used to calculate a dichotomous scale indicating high versus low level of agreement with restrictions. RESULTS: In all demographic segments, and among tobacco users, a majority of respondents indicated a high level of agreement with restrictions, ranging from a low of 51% in the 13-25 age group to a high of 98% in the 56-70 age group. Logistic regression with all demographic variables entered showed that agreement with restrictions rose significantly with age and was significantly higher among never smokers compared to daily smokers. Across all items, the average public support for smoking restrictions and tobacco advertisement bans was 84.9%. DISCUSSION: This study provides good quality evidence of a high level of public support in Georgia for strong smoking restrictions and the total ban of tobacco ads and sponsorship, even among daily smokers. CONCLUSION: This study demonstrates a methodology for gathering national public opinion data to influence policies towards implementation of stronger smoking control measures. Therein lies the relevance of this study beyond the borders of Georgia