Cannabis and Amphetamine Use Among Adolescents in Five Asian Countries

Introduction: There has been a global increase in illicit drug use among young people. The aim of this study was to estimate the prevalence of lifetime cannabis and amphetamine use, as well as to explore factors associated with substance use among adolescents in five Asian countries: Iraq, Kuwait, Malaysia, Mongolia, and Vietnam.Methods: 38,941  school children (mean age 15.4 years, SD=1.5) completed the cross-sectional Global School-Based Student Health Survey (GSHS). Topics covered in the questionnaire included cannabis and amphetamine use. Personal, parental, and environmental attributes were explored as predictors of cannabis and amphetamine use. Logistic regression was used to assess the contribution of potential predictors on lifetime cannabis and lifetime amphetamine use.Results: Overall, the prevalence of lifetime cannabis use was 0.9% and lifetime amphetamine use was 1.0% among research participants. Cannabis use was influenced by male gender (Kuwait, Mongolia), parental smoking habits (Kuwait, Iraq), and current cigarette smoking in all countries. Amphetamine use was associated with suicidal ideation (Kuwait, Malaysia, Vietnam), school truancy (Malaysia, Mongolia, Vietnam), being a victim of physical assault (Kuwait, Mongolia), bullying victimization (Iraq, Malaysia, Vietnam), as well as anxiety and current cigarette use in all countries. Conclusions: Our preliminary results show the importance of personal attributes such as mental distress and environmental stressors on lifetime cannabis and lifetime amphetamine use. Future prospective studies are needed to identify causal relationships among personal attributes, parental attributes, environmental stressors, and illicit substance use

Helmet use and associated factors among motorcyclists in the Association of Southeast Asian Nations: Prevalence and effect of interventions

The Association of Southeast Asian Nations (ASEAN) is a collaborative group of 10 countries (Brunei Darussalam, Cambodia, Indonesia, Lao PDR, Malaysia, Myanmar, Philippines, Singapore, Thailand, Vietnam) located in South-East Asia. In most ASEAN countries, the majority of road users are motorcyclists. Globally, among the 20 countries with the greatest rate of motorcycle deaths per 100,000 population, six ASEAN countries are included. A review found that across ASEAN countries, a significant proportion of motorcycle drivers did not wear a helmet; this ranged from 11–20% in Indonesia, 35–66% in Cambodia, 25–97% in Laos, 24.2–67.2% in Malaysia, 44.2%–56.3% in Thailand, and 10–70.1% in Vietnam, while rates of non-use of helmets were higher in motorcycle passengers, ranging from 25% in Vietnam, 38.1% in Malaysia, 48–80% in Indonesia, 72–81% in Thailand, and 91% in Cambodia. The effect of the introduction of helmetuse legislation for drivers and passengers was evaluated in Thailand and Vietnam, and in both evaluations, significant increases in helmet use were found compared to prior the legislation in both countries. Multisectoral or community intervention programmes in localised areas and schools in Laos and Thailand also lead to significant increases in motorcycle helmet use. The effectiveness of the enforcement of helmet laws in ASEAN countries was rated an average of 7.2 (on a scale of 0 to 10, where 0 is not effective at all and 10 is highly effective), with the lowest (5) in Malaysia and the highest (10) in Brunei Duressalam. Stricter enforcement of mandatory helmet laws for two-wheeler riders (both drivers and pillion-riders) are needed. Keywords: helmet use, motorcycle, prevalence, interventions, Southeast Asia

The prevalence and social determinants of fruit and vegetable consumption among adults in Kenya: a cross-sectional national population-based survey, 2015

Introduction: low fruit and vegetable consumption contributes significantly to the burden of disease. The study aimed to assess the prevalence and correlates of fruit and vegetable (FAV) consumption among adults in a national survey in Kenya. Methods: a national cross-sectional study based on a stratified cluster random sampling was conducted in 2015. The total sample included 4479 individuals 18-69 years, (females = 60.0%; median age 38.0 years, Inter Quartile Range 23) from Kenya. Sociodemographics, health risk behaviour and anthropometric data were collected using the WHO-STEPS questionnaire. Results: on average, participants had 0.78 servings of fruits a day, 1.31 servings of vegetables a day, and 2.09 servings of FAV. Only 12.4% of respondents had two or more servings of fruit a day, 7.4% had three or more servings of vegetables a day and 94.0% had less than five servings of FAV a day. In adjusted logistic regression analysis, higher education (Odds Ratio=OR: 1.68, Confidence Interval = CI: 1.18, 2.39), greater wealth (OR: 1.61, CI: 1.04, 2.48), and being a Kikuyu (OR: 2.17, CI: 1.46, 3.23) or Luo (OR: 1.58, CI: 1.05, 2.37) were associated with two or more servings of fruits daily. Urban residence (OR: 0.44, CI: 0.23, 0.82) and being male (OR: 0.72, CI: 0.53, 0.98) decreased the odds, and older age (OR: 1.68, CI: 1.05, 2.69) and being Luo (OR: 2.84, CI: 1.53, 5.27) increased the odds of having three or more servings of vegetables daily. Being male (OR: 0.71, CI: 0.52, 0.99) and being Luo (OR: 0.40, CI: 0.23, 0.70) decreased the odds and urban residence (OR: 2.50, CI: 1.27, 4.96) increased the odds of inadequate (< five servings) FAV consumption. Conclusion: a high prevalence of inadequate FAV consumption was found, and risk factors identified, such as being female, lower education, urban residence, and not being Luo, that may help in guiding strategies to increase FAV consumption

Seatbelt use among university students from 26 low-, middle- and high-income countries

The aim of this study was to estimate the prevalence of self-reported seatbelt use and sociodemographic, health risk behaviour and social-legal correlates among university students in 26 low-, middle- and high-income countries. Using anonymous questionnaires, data were collected from 16 770 undergraduate university students (mean age 20.9, SD=2.9) from 23 universities in 26 countries across Asia, Africa and the Americas. Results indicate that the percentage of university students reporting to be inconsistently using a seatbelt were 54.7% for all countries, 56.0% for men and 53.7% for women. In multivariate logistic regression, younger age, poorer family background, living in a low-income or lower-middle-income country, having no national seatbelt law or a law that does not apply to all occupants, poor attitudes towards seatbelt use, not always following the speed limit, having depressive symptoms, drug use, and low physical activity were associated with self-reported inconsistent seatbelt use. High selfreported inconsistent seatbelt use was found and several risk factors were identified which can be utilised in seatbelt use promotion programmes.Keywords: seatbelt use, traffic-related behaviour, health risk behaviour, depression, legislation, university students, multi-countr

Obesity and health problems among South African healthcare workers: do healthcare workers take care of themselves?

Background: Obesity has reached epidemic proportions globally. In South Africa, 56% of white men, 49% of black men and 75% of black women have been reported to be overweight or obese. The focus of this study is on South African healthcare workers (HCW), because they are considered role models for health for patients and their communities. Objectives: The objective was to determine the prevalence of obesity and obesity-related health problems among HCW and to compare these variables between medical and nonmedical staff at one selected public hospital in South Africa. Methods: A questionnaire was distributed to 200 respondents from a balanced pool of randomly selected HCW (100 medical staff and 100 nonmedical staff). Self-reported body mass index (BMI), obesity-related health problems and perceptions about body weight were assessed. Results: Seventy-three per cent of the HCW were overweight or obese, and half of them had never tried to lose weight. Females and older HCW were more obese than men and younger counterparts. There was no difference in BMI distribution between medical and nonmedical staff. About one-third of HCW reported that they suffered from obesity-related noncommunicable diseases (NCDs; hypertension 20% and diabetes 10%) and stress (32.5%). The majority of HCW had an inaccurate perception of their own weight. Conclusion: South African HCW have a high prevalence of obesity-related NCDs. A health promotion programme targeting HCW is urgently needed to encourage weight control, urge the prevention of obesity-related NCDs and change selfperceptions of body weight, in order to improve their own health and make them better role models for the general public. Keywords: obesity, obesity-related diseases, health problems, noncommunicable diseases, healthcare workers, self-perception, hospita

The severity of violence against women by intimate partners and associations with perpetrator alcohol and drug use in the Vhembe district, South Africa

Substance use is cited as a major contributing factor to intimate partner violence in South Africa. The aim of the study was to assess the association between the frequency and severity of several types of intimate partner violence against women, who have been granted a protection order, and the use of alcohol and illicit drug use by perpetrators. Using systematic sampling, 268 women (18 years and older), who had consecutively received a protection order in the Vhembe district in South Africa, were assessed by a research assistant. The results indicate that these women reported perpetrators 34% of whom did not have a drinking problem and no drug use in the past three months, 31.3% with problem drinking only, 4.1% drug use only, and 30.6% with problem drinking and drug use in the past three months. Multivariate logistic regression found that having a partner with problem drinking only (OR = 4.14, CI = 2.02–8.51) and having a partner with problem drinking and drug use (OR = 2.77, CI = 1.36–5.65) were associated with greater physical intimate partner violence. Having a partner with problem drinking and drug use (OR = 2.80, CI = 1.35–5.79) was associated with an increased psychological intimate partner abuse. Problem drinking and drug use among male partners is a strong determinant of physical intimate partner violence among battered women in South Africa. Intimate partner violence prevention measures should address reduction of problem drinking and drug use among men.Keywords: physical violence, psychological abuse, stalking, intimate partner, problem drinking, drug use, South Afric

Extent of alcohol use and mental health (depressive and post- traumatic stress disorder symptoms) in undergraduate univer- sity students from 26 low-, middle- and high-income countries

Objective. To estimate if there is a non-linear association between varying levels of alcohol use and poor mental health (depressive and post-traumatic stress disorder (PTSD) symptoms) in university students from low-, middle- and high-income countries.  Methods. Using anonymous questionnaires, data were collected from 19 238 undergraduate university students (mean age 20.8; standard deviation (SD) 2.8) from 27 universities in 26 countries across Asia, Africa and the Americas. Alcohol use was assessed in terms of number of drinks in the past 2 weeks and number of drinks per episode, and measures of depression and PTSD symptoms were administered.  Results. The proportion of students with elevated depression scores was 12.3%, 16.9%, and 11.5% for non-drinkers, moderate drinkers, and heavy drinkers, respectively, while the proportion of students with high PTSD symptoms was 20.6%, 20.4% and 23.1% for non-drinkers, moderate drinkers, and heavy drinkers, respectively. Logistic regression found that non-drinkers and heavy drinkers had a lower odds than moderate drinkers to have severe depression, after adjusting for sociodemographic variables, social support and subjective health status. Further, heavy, more frequent drinkers and more frequent binge drinkers had a higher odds to have elevated PTSD symptoms than moderate and non-drinkers, after adjusting for sociodemographic variables, social support and subjective health status.  Conclusion. The results suggest a reverse U-shaped association between recent alcohol use volume and frequency and depressive symptoms (unlike that previously identified), and a J-shaped association between binge drinking frequency and depressive symptoms and alcohol use and PTSD symptoms

Knowledge, attitudes and management of alcohol problems in general practice in rural South Africa

Background: There has been increasing emphasis on the role of primary health care in the prevention and management of alcohol-related harm. The aim of this study was to determine attitudes to and management of alcohol problems in general practice in rural South Africa. Methods: A total of 61 general practitioners (GPs) were interviewed with the aid of a structured questionnaire (response rate 50%) in two rural districts. Results: The results indicate that 51% of the GPs felt that alcohol is an important issue in general practice. GPs were able to discriminate accurately between cases of problem drinking and alcohol dependence. GPs who reported high levels of alcohol-related education and training were more prepared to counsel problem drinkers, expressed more therapeutic commitment in their role and reported more appropriate management of these patients than did GPs with lower levels of Continuing Medical Education (CME) experience. Alcohol problems are recognised as an important problem in general practice, and improved training could increase the identification and management of alcohol problems in primary care. GPs rated the most critical barriers to alcohol interventions as competency training, role endorsement, not being adequately reimbursed, health policy not supporting prevention and their own alcohol problem. Conclusion: Alcohol problems are recognised as an important problem in general practice, and improved training, adequate reimbursement and health policy support could increase the identification and management of alcohol problems in primary care. South African Family Practice Vol. 50 (1) 2008: pp. 66-66

Effect of exposure to clinic-based health education interventions on behavioural intention to prevent mother-to-child transmission of HIV infection

HIV and AIDS incidence among infants in South Africa is on the increase.The uptake of prevention of motherto- child transmission (PMTCT) interventions is often said to be dependent on the beliefs and educational needs of those requiring PMTCT services.This study therefore sought to examine the effect of clinic-based health education interventions (HEI) on behavioural intention of PMTCT among 300 pregnant women from 4 primary health care clinics in Tshilidzini Hospital catchments area, South Africa. An interview schedule was used to obtain information regarding participants' demographic characteristics, level of exposure to clinic-based HEI, salient beliefs and behavioural intention on PMTCT.The major findings included that approximately 85% of the participants had heard of PMTCT.There was very little association between frequency of antenatal clinic (ANC) visits and level of exposure to PMTCT information. Condom use had the lowest set of salient belief scores. Control belief was the most common belief contributing to behavioural intention. Generally, the association between PMTCT salient beliefs and behavioural intention was weak. Clinic-based HEI had an impact on behavioural intention of HIV testing, normative belief of regular ANC visit and nevirapine use.The vital contribution of alternative PMTCT information sources such as the radio and television was observed. Enhancing initiatives that empower women, and a better coordination of the existing HEI through better implementation of health education strategy may strengthen the prevailing moderate PMTCT intention in the area investigated. Keywords: PMTCT, HIV/AIDS, health education intervention, vertical transmission, nevirapine, behavioural intention, theory of planned behaviour. Résumé Le cas de VIH/SIDA augmente parmi les bébés en Afrique du Sud. L'assimilation des interpositions de prévention de transmission mère á enfant (PMTCT) est souvent vu d'être dépendante de croyances et de besoins éducatifs de ceux qui ont besoin des services PMTCT. Cette étude a pour but de vérifier l'effet des interpositions de l'éducation sanitaire clinique-basées (HEI) sur l'intention comportementale de PMTCT auprès de 300 femmes enceintes originaires de 4 services de santé primaire dans les bassins de captation de l'hôpital Tshilidzini, en Afrique du Sud. Un barème d'entretien a été utilisé pour obtenir des informations concernant les caractéristiques démographiques des participants, le niveau d'être exposé aux HEI clinique-basées, les croyances principales et l'intention comportementale sur les PMTCT. Les résultats principaux ont démontré qu'approximativement 85% de participants avaient déjà entendu parlé de PMTCT. Il y a eu une association très étroite entre la fréquence de visites antenatales et le niveau d'être exposé à l'information de PMTCT. L'utilisation du préservatif avait les résultats de croyances principales les plus bas. La croyance de commande était la croyance la plus commune qui contribue à l'intention comportementale. En général, l'association entre les croyances principales des PMTCT et l'intention comportementale était faible. Les HEI clinique-basées avaient un impact sur l'intention comportementale du dépistage de VIH, la croyance normative des visites antenatales régulières et la prise du nevirapine. La contribution primordiale des sources alternatives d'informations sur les PMTCT comme la radio et la télévision a été observée. Rehausser les initiatives vers le développement des femmes et la coordination meilleure de HEI qui existent à travers une meilleure mise en oeuvre de la stratégie de l'éducation sanitaire pourraient renforcer l'actuelle intention modérée des PMTCT dans le lieu en question. Mots clés: PMTCT,VIH/SIDA, interposition de l'éducation sanitaire, infection verticale, nevirapine, intention comportementale, théorie d'un comportement prévu

Mental health and HIV sexual risk behaviour among University of Limpopo students

Background. Little attention has been paid to the role of poor mental health among young people with regard to HIV risk behaviour and HIV prevention in Africa. Objective. To determine the association between mental health, substance use and HIV sexual risk behaviour among a sample of university students in South Africa. Methods. A cross-sectional survey was conducted among undergraduate students who were recruited conveniently from public campus venues at the University of Limpopo Medical University of Southern Africa (Medunsa) campus. The sample included 722 university students (57.6% men and 42.4% women) with a mean age of 21.7 years (standard deviation ±8.8). Results. Of the 722 students, 39.5% reported depression, 23.4% screened positive for post-traumatic stress disorder (PTSD), 22% reported hazardous or harmful alcohol use, 33% reported ≥2 sexual partners in the past 12 months, 50% reported inconsistent condom use, 46% reported unknown HIV status of a sexual partner and 20% reported alcohol use in the context of sex in the past 3 months. In multivariate analysis, HIV risk behaviour was associated with, among men, hazardous or harmful alcohol use and having screened positive for PTSD, and among women, being in the 4th or more year of study and current cannabis use. Conclusion. Poor mental health, including substance use, was found to be associated with HIV risk behaviour. Co-ordinated mental health and sexual and reproductive health services that meet the needs of university students would be desirable