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

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

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

HIV counselling and testing utilisation and attitudes of male inmates in a South African prison

The Department of Correctional Services Policy on the management of HIV and AIDS for offenders include voluntary counselling and testing (VCT) for HIV as one of the priorities in the rehabilitation of inmates. The aim of this study was to determine factors associated with the utilisation of VCT services in the correctional centres in terms of level of satisfaction, their experiences and expectations, and motivating factors and barriers for VCT utilisation at Losperfontein Correctional Centre, South Africa. This was a case control study (cases being those who underwent testing and controls those who did not) examining predictors of HIV VCT utilisation among 200male adult sentenced inmates serving medium and maximum sentences. Results indicate that a poor health system (OR=0.34, 95%CI:0.23 - 0.50) was inversely associated with HIV testing acceptance in prison, while age, educational level, population group, marital status, length of incarceration and access to HIV testing in prison were not associated with HIV testing acceptance in prison. Half of the participants (50%) agreed that VCT services are accessible and are promoted at their correctional centre. Most were satisfied with different components of VCT services, ranging from 79% (fair to very good) for ‘the way he/she received you’ to 62% ‘clarified all your concerns’. This study demonstrated some challenges and benefits to the field of health promotion and HIV prevention in the correctionalcentres especially with regard to VCT services

The association of nutrition behaviors and physical activity with general and central obesity in Caribbean undergraduate students

Objective. To quantify the prevalence of obesity and obesity-related factors in a cross-sectional, observational study of Caribbean students using the results of three recent surveys of health behavior among undergraduates in Barbados, Grenada, and Jamaica. Methods. A total of 1578 Caribbean undergraduate students from Barbados, Grenada, and Jamaica (ages 18.30 years) completed questionnaires and had physical measurements recorded. Multivariable logistic regression was used to estimate odds ratios (ORs) for the association of nutrition behaviors with prevalence of obesity (body mass index ≥ 30 kg/m2); elevated waist-to-height ratio (W/ht) (> 0.50); and high waist circumference (WC) (> 88 cm in females, > 102 cm in males). Models were adjusted for age, year in university, socioeconomic status, and sex. Results. There was a higher prevalence of obesity (13% versus 10%), high WC (21% versus 7%), and high W/ht (35% versus 25%) in females relative to males. Compared to females, males had reduced odds of obesity (OR 0.46), high WC (OR 0.22), and high W/ht (OR 0.61) (P < 0.05 for all). Both females (46%) and males (24%) reported high levels of physical inactivity. Fruit and vegetable consumption was low (approximately two servings per day). Many students reported avoiding fatty foods (40%); this behavior was associated with high W/ht (OR 1.68), obesity (OR 1.90), and high WC (OR 1.82) (P < 0.05 for all). Irregular breakfast consumption, age, and year of study were also positively associated with obesity. Physical activity was not significantly associated with any obesity measure. Conclusions. There was a low prevalence of healthy behaviors and a high prevalence of obesity in this sample of Caribbean young adults

Correlates of physical activity among community-dwelling adults aged 50 or over in six low- and middle-income countries

Background: Considering that physical activity is associated with healthy ageing and helps to delay, prevent, or manage a plethora of non-communicable diseases in older adults, there is a need to investigate the factors that influence physical activity participation in this population. Thus, we investigated physical activity correlates among community-dwelling older adults (aged ≥50 years) in six low- and middle-income countries. Methods: Cross-sectional data were analyzed from the World Health Organization’s Study on Global Ageing and Adult Health. Physical activity was assessed by the Global Physical Activity Questionnaire. Participants were dichotomized into low (i.e., not meeting 150 minutes of moderate physical activity per week) and moderate-to-high physically active groups. Associations between physical activity and a range of correlates were examined using multivariable logistic regressions. Results: The overall prevalence (95%CI) of people not meeting recommended physical activity levels in 34,129 participants (mean age 62.4 years, 52.1% female) was 23.5% (22.3%-24.8%). In the multivariable analysis, older age and unemployment were significant sociodemographic correlates of low physical activity. Individuals with low body mass index (<18.5kg/m2), bodily pain, asthma, chronic back pain, chronic obstructive pulmonary disease, hearing problems, stroke, visual impairment, slow gait, and weak grip strength were less likely to meet physical activity targets in the overall sample (P<0.05). The associations varied widely between countries. Conclusion: Our data illustrates that a multitude of factors influence physical activity target achievement in older adults, which can inform future interventions across low- and middle-income countries to assist people of this age group to engage in regular physical activity. Future prospective cohort studies are also required to investigate the directionality and mediators of the relationships observed