Trends in alcohol prevalence, age of initiation and association with alcohol-related harm among South African youth: Implications for policy

Objectives. To understand alcohol use trends and alcohol-related harm among youth in South Africa (SA) between 1998 and 2008, and discuss implications for the current alcohol policy process.Methods. A review was conducted of 4 national prevalence and 2 sentinel surveillance studies. Data were extracted to Epi Info (version 7) and chi-square analyses undertaken.Results. Lifetime alcohol use remained stable but high at 20 - 25% and 49.1 - 49.6% according to South African Demographic and Health Survey (SADHS) and Youth Risk Behaviour Survey (YRBS) data, respectively. Age of initiation remained stable; 12% of adolescents initiated alcohol use prior to age 13 years. Significant gender differences existed with more males having ever consumed alcohol, engaged in binge drinking, and driven or walked under the influence of alcohol (DUI and WUI, respectively). Binge drinking among females increased significantly from 27% to 36% (SADHS) and 18% to 27% (YRBS). DUI and WUI increased. Homicide/violence, suicide and unintentional deaths were significantly associated with blood alcohol concentration (BAC).Conclusions. Although SA has made significant strides in alcohol control and prevention of alcohol-related harm over the past decade, early alcohol initiation remains a concern and binge drinking is increasing, especially among females. Significant associations exist between BAC and alcohol-related fatalities. Findings imply that regulatory policies are inadequate; additional efforts are required to ensure that control strategies translate into a reduction in harmful alcohol use by SA youth.S Afr Med J 2012;102(7):609-61

Trends in alcohol prevalence, age of initiation and association with alcohol-related harm among South African youth: Implications for policy

Objectives. To understand alcohol use trends and alcohol-related harm among youth in South Africa (SA) between 1998 and 2008, and discuss implications for the current alcohol policy process. Methods. A review was conducted of 4 national prevalence and 2 sentinel surveillance studies. Data were extracted to Epi Info (version 7) and chi-square analyses undertaken. Results. Lifetime alcohol use remained stable but high at 20 - 25% and 49.1 - 49.6% according to South African Demographic and Health Survey (SADHS) and Youth Risk Behaviour Survey (YRBS) data, respectively. Age of initiation remained stable; 12% of adolescents initiated alcohol use prior to age 13 years. Significant gender differences existed with more males having ever consumed alcohol, engaged in binge drinking, and driven or walked under the influence of alcohol (DUI and WUI, respectively). Binge drinking among females increased significantly from 27% to 36% (SADHS) and 18% to 27% (YRBS). DUI and WUI increased. Homicide/violence, suicide and unintentional deaths were significantly associated with blood alcohol concentration (BAC). Conclusions. Although SA has made significant strides in alcohol control and prevention of alcohol-related harm over the past decade, early alcohol initiation remains a concern and binge drinking is increasing, especially among females. Significant associations exist between BAC and alcohol-related fatalities. Findings imply that regulatory policies are inadequate; additional efforts are required to ensure that control strategies translate into a reduction in harmful alcohol use by SA youth

Addressing adolescent alcohol use in South Africa

Excessive alcohol consumption constitutes a significant public health problem for South Africans. Alcohol use by South African (SA)adolescents is characterised mainly by binge/heavy episodic drinking. Levels of binge drinking have been high, but relatively stable, amongmales since 2002, while there has been a significant increase in binge drinking by females since then. Binge drinking is a major risk factorfor a range of alcohol-related harms in SA, including traffic-related accidents and deaths, interpersonal violence, fetal alcohol spectrumdisorder (FASD), crime, sexual risk behaviour, HIV, tuberculosis and the resultant burden of all of these on the economy. Clinicians mayplay a key role in addressing adolescent alcohol use and alcohol-related harm. Such a role may involve screening, brief interventions andreferrals to treatment. There are several assessment, screening and diagnostic tools to detect alcohol use and misuse, specifically amongadolescents. Furthermore, various pharmacological and psychological approaches are available to treat adolescent alcohol problems. Specialissues to consider when dealing with alcohol use problems among adolescents in SA include recognising the risk factors, and acknowledgingand addressing the harms associated with alcohol use (including sexual risk behaviour and FASD) and the possible existence of comorbidmental health problems

Manufacturing homemade alcohol in the City of Tshwane, South Africa

This study aimed to determine the prevalence of home-based manufacturing of alcoholic beverages in townships/peri-urban households and to examine whether certain characteristics (such as household, demographics and drinking behaviour of participants who reported brewing of alcohol in their homes) predicted home brewing of alcohol. The study utilized data from South African arm of International Alcohol Control study conducted in the city of Tshwane. A household survey used multi-stage stratified cluster random sampling. Homemade alcohol was defined as participants who reported home-based alcohol brewing at their homes. Stata Version 14.0 was used for analyses. Nine percent of the sample reported brewing of alcohol in their households. Race, employment of the main income earners and number of eligible members in the household have predicted homebased alcohol brewing. The study raised important questions about the prevalence of home brewing of alcohol in the city of Tshwane as it might be a common practice in other cities. Keywords: Homemade alcohol, alcohol brewing, South Afric

Psychosocial factors associated with early initiation and frequency of antenatal care (ANC) visits in a rural and urban setting in South Africa: a cross-sectional survey

Background: Late booking and infrequent antenatal care (ANC) are common but avoidable patient-related risk factors for maternal deaths in South Africa. The aim of the study was to examine the association of psychosocial factors with early initiation of ANC and adequate frequency of attendance of ANC clinics among women in an urban and rural location in South Africa. Methods: Data from a 2006 cross-sectional household survey of 363 women from the rural Western Cape and 466 women from urban Gauteng provinces of South Africa for risk of alcohol-exposed pregnancy were analysed. We examined associations between psychosocial variables (self-esteem, cultural influences, religiosity, social capital, social support, pregnancy desire (wanted versus unwanted pregnancy), partner characteristics and mental health) and both early ANC first visit (before 16 weeks) and adequate frequency of ANC visits (4 or more visits) for respondents’ last pregnancy. Results: Overall prevalence among urban women of early ANC initiation was 46 % and 84 % for adequate ANC frequency. Overall prevalence among rural women of early ANC initiation was 45 % and 78 % for adequate ANC frequency. After adjusting for clustering, psychosocial factors associated with early ANC initiation in the urban site were being employed (OR 1.6; 95 % CI 1.0–2.5) and wanted pregnancy (OR 1.8; 95 % CI 1.1–3.0). For the rural site, early ANC initiation was significantly associated with being married (OR 1.93; 95 % CI 1.0–3.6) but inversely associated with high religiosity (OR 0.5; 95 % CI 0.3–0.8). Adequate frequency of ANC attendance in the rural site was associated with wanted pregnancy (OR 4.2; 95 % CI 1.9–9.3) and the father of the child being present in the respondent’s life (OR 3.0; 95 % CI 1.0–9.0) but inversely associated with having a previous miscarriage (OR 0.4; 95 % CI 0.2–0.8). There were no significant associations between adequate ANC attendance and the psychosocial factors in the urban site. Conclusion: The majority of women from both sites attended ANC frequently but less than 50 % initiated ANC before the recommended 16 weeks gestational age. Interventions to reduce prevalence of late ANC booking and inadequate ANC attendance should engage religious leaders, address unintended pregnancy through family planning education and involve male partners in women’s reproductive health

Reliability and factor structure of the audit among male and female bar patrons in a rural area of South Africa

We assessed the reliability and dimensional structure of the Alcohol Use Disorders Identification Test (AUDIT) among bar patrons in a rural area of South Africa. In total, 406 bar patrons completed a questionnaire containing the AUDIT, and demographic and psychosocial measures. The participants consisted of 314 (77.3%) males and 92 (22.6%) females. Their combined mean age was 30.0 years (SD = 8.45). The data were analysed using Confirmatory Factor Analysis (CFA) and Cronbach’s alpha reliability analysis which were conducted separately for males and females. We found that Cronbach’s alpha for the AUDIT was 0.81 and 0.72 for the males and females, respectively. CFA supported a two-factor and three-factor model for the males but failed to support a one-factor, two-factor, or three-factor model for the females. The results suggest that the AUDIT is highly reliable, but that potential gender differences in its factor structure should be considered, particularly when applied in new contexts.Keywords: AUDIT; South Africa; Bar patron

Adolescent Health Series - alcohol, tobacco, and other drug use among adolescents in sub-Saharan Africa : A narrative review

Abstract: Alcohol, tobacco, and other drug (ATOD) use by adolescents are major contributors to death and disability in sub-Saharan Africa (SSA). This paper reviews the extent of adolescents’ ATOD use, risk and protective factors, and studies evaluating prevention interventions for adolescents in SSA. It also describes the harms associated with adolescents’ ATOD use in SSA, which mainly include interpersonal violence, sexual risk behaviours, and negative academic outcomes. We use the socio-ecological model as our framework for understanding ATOD use risk and protective factors at individual, interpersonal, peer/school, and societal/structural levels. We used two strategies to find literature evaluating ATOD interventions for adolescents in SSA: (a) we sought systematic reviews of adolescent ATOD interventions in SSA covering the period 2000–2020; and (b) we used a comprehensive evidence review strategy and searched for studies that had evaluated ATOD interventions in all SSA countries between 2000 and 2020. Only two community interventions (a brief intervention and an HIV prevention intervention), out of four that were identified, were partially effective in reducing adolescent ATOD. Furthermore, only one school-based intervention (HealthWise), out of the six that we uncovered, had any effect on ATOD use among adolescents. Possible reasons why many interventions were not effective include methodological limitations, involvement of non-evidence- based education-only approaches in some studies, and shortcomings in adaptations of evidence-based interventions. The scale of ATOD and related problems is disproportionate to the number of evaluated interventions to address them in SSA. More ATOD interventions need to be developed and evaluated in well-powered and well-designed studies

Rarity and limited geographical coverage of individual level alcohol interventions in sub Saharan Africa: findings from a scoping review

Introduction: A previous review on brief alcohol interventions in sub-Sahara Africa showed most of the interventions were implemented in East and Southern Africa. We carried a scoping review to assess the current amount and types of alcohol interventions in SSA. Methods: We searched six databases (MEDLINE, EMBASE, Global Health, Africa-wide, CINAHL and PsycINFO) for publications prior to June 2018. We used the search terms for alcohol use, alcohol intervention and African countries’ names. We identified 59 papers on alcohol interventions of which 26 were eligible for inclusion in the final analysis. Results: Of the 26 eligible papers, 18(69 %) were carried out in South Africa. Majority 15(58%) of the interventions were randomized clinical trial, followed by seven (27%) quasi-experimental and evaluation of the intervention and five (19%) cluster randomized trials. Most of the studies targeted patients and pregnant women. Only a few studies focused on sex workers and students. Conclusions: Our findings show that the assessment of effectiveness of individual level alcohol interventions is rare in SSA. In addition, these interventions were polarized in two countries. There is an urgent need for an evidence base on the effectiveness of alcohol interventions commensurate with the scope of the problem in SSA

Psychosocial Factors Related to the Intergenerational Transmission of Externalizing Behaviors in Early Midlife

Background: To study the intergenerational transmission of externalizing behaviors. Methods: Participants came from a community-based random sample of residents in two upstate New York counties (N = 548). Data were collected from mothers at mean age 40 and from their children from adolescence (mean age = 14, SD = 2.8) to early midlife (mean age = 43, SD = 2.8) at seven time points. Structural equation modeling (SEM) was used to study the psychosocial factors as related to externalizing behaviors in early midlife. Results: First, maternal externalizing behaviors were indirectly associated with the offspring\u27s externalizing behaviors through the offspring\u27s substance use in adolescence, the offspring\u27s partner\u27s smoking patterns, and the offspring\u27s marital conflict. Second, maternal cigarette smoking was indirectly associated with the offspring\u27s externalizing behaviors through the offspring\u27s substance use in adolescence, the offspring\u27s partner\u27s cigarette smoking, and the offspring\u27s marital conflict. Third, maternal marital conflict had an indirect effect on the offspring\u27s externalizing behaviors, mediated by offspring marital conflict. Conclusions: The finding that externalizing behaviors can be transmitted from parent to child informs the need for family-based interventions that are appropriate to adolescents

Tobacco use and nicotine dependence among people living with HIV who drink heavily in South Africa: a cross-sectional baseline study

Abstract