Effects of tobacco use on non-adherence to antiretroviral therapy among HIV-positive patients in South Africa

This study aimed to estimate the relationship between tobacco use and non-adherence to antiretroviral therapy (ART) in a South African sample. Participants were 1 963 HIV patients who attended a primary care clinic in Pretoria (female = 68.5%; black African = 99.5%; median age = 37.0 years; tobacco users only = 8.6%, problem drinkers only = 14.9%, and tobacco users and problem drinkers = 10.5%). In adjusted logistic regression analysis, tobacco use only was not significantly associated with non-adherence to ART. Alcohol use only (OR: 1.72; CI: 1.26, 2.36) and tobacco use and problem drinking (OR: 2.31; CI: 1.60, 3.33) were highly associated with non-adherence to ART.     

Concurrent tobacco use and risky drinking in South Africa: Results from the South African National Health and Nutrition Examination Survey

The aim of this study was to examine socio-demographic and psychosocial correlates of concurrent tobacco use and risky drinking. We analysed data from the cross-sectional South African National Health and Nutrition Examination Survey (SANHANES-1) 2011–2012. The sample included 14 764 adolescents and adults aged 15 years and older. They responded to questions on tobacco and alcohol use, psychosocial, and socio-demographic indicators. Results indicate that 9.6% (16.8% among men and 3.5% among women) of South Africans were involved in concurrent tobacco use and risky drinking, 18.2% in current tobacco use only, and 20.3% in risky drinking only. In covariate adjusted analysis, being 25 to 64 years, being male, belonging to the coloured population group, residing in urban areas, having experienced three or more traumatic events, and poor self-rated health were associated with concurrent tobacco use and risky drinking. Findings suggest socio-demographic and health factors are important for public health interventions in addressing concurrent tobacco and alcohol use in South Africa.     

Sexual orientation and HIV risk among youth in South Africa: a brief report

This study investigated the prevalence of homosexual orientation and HIV risk in a population-based survey among youth in South Africa. A cross-sectional population-based household survey was conducted using a multi-stage stratified cluster sampling approach. The total sample included 1859 sexually experienced youth, aged 18–24, from four provinces (Eastern Cape, Gauteng, KwaZulu-Natal and Mpumalanga). Results indicate that 128 (4.9%) had had a homosexual experience. In a multivariate analysis, peer pressure and, for men, having been circumcised as an adult were associated with having had a homosexual experience. Having had a homosexual experience increased, but not significantly, HIV risk and HIV positive status.     

Screening and brief intervention of alcohol problems in primary care in South Africa: A brief report

The aim of this randomised controlled trial was to provide screening and brief intervention for alcohol problems in a primary care setting in South Africa. Outpatients were screened for hazardous or harmful alcohol use and were randomised into an experimental (one brief counselling session) or control group (received an alcohol health education leaflet). The study population of hazardous or harmful drinkers (N=140) consisted of 105 male and 35 female women, with a mean age of 30.4 years (SD=6.6). Among the 128 (91.4%) primary care outpatients who also attended the 6-month follow-up session, the time effects on the AUDIT scores were significant but the intervention effect on the AUDIT score was statistically not significant. It would seem that alcohol screening and the provision of an alcohol health education leaflet may in itself cause reduction in drinking.     

Sedentary behaviour and sleep problems among young,middle-aged,and older persons in South Africa: A brief report

The study aimed to investigate the relationship between sedentary behaviour and sleep problems in a large national community sample in South Africa. We analysed an existing cross-sectional population data set, the “South African National Health and Nutrition Examination Survey”. The sample included 13 555 individuals (median age 34.0 years, interquartile range 25, range 15–98 years). Overall, the study population engaged < 4 hours (49.5%), 4 – < 8 hours (37.2%), 8 – < 11 hours (9.7%), and 11 or more hours (3.6%) in sedentary time a day. The prevalence of sleeping problems was 6.4% and 6.7% in the less than 4 and less than 8 hours sedentary time categories, respectively. The prevalence of sleeping problems was 9.8% and 9.4% in the less than 11 hours and 11 or more hours sedentary time categories, respectively. In the final adjusted logistic regression model, among 50 years and older, the highest sedentary time category was associated with sleep problems, while there was no association in the younger (15–49 years) age group and in the overall model. This could mean that persons at older age with sedentary behaviour are at an increased risk of sleep problems.     

Correlates of illicit drug use among university students in Africa and the Caribbean

The goal of this study was to estimate the prevalence and correlates of illicit drug use (IDU) among university students from eight countries in Africa and three countries in the Caribbean. In a cross-sectional survey, data were collected from 7 017 undergraduate university students (mean age 21.1, SD = 2.7, age range of 18–30 years) from 11 countries. Overall, 17.2% and 3.5% reported infrequent (1–9 times) and frequent (10 or more times) IDU in the past 12 months. In multivariate logistic regression models, residing on or off campus on their own, living in an upper middle or high income country, current tobacco use, binge drinking, and having been in a physical fight in the past 12 months were associated with both frequent and infrequent IDU. In addition, higher intrinsic religiosity and older age was found to be protective from infrequent IDU and associated with never using illicit drugs. The influences on IDU identified may be utilised for the design and implementation of social intervention programmes to curtail IDU by college students.     

Acceptability and feasibility of a brief substance use intervention for adolescents in Cape Town,South Africa: A pilot study

Substance use is prevalent among South African adolescents, but few interventions exist to reduce risk of harm. This study assesses the feasibility, acceptability and preliminary effects of a brief intervention for reducing adolescent substance use and other risk behaviours. This single-arm feasibility test recruited 30 substance-using adolescents and their primary caregiver. Participants received separate interventions (2 sessions for adolescents, 1 session for caregivers), with a subsample randomly selected for post-intervention interviews. Feasibility was measured by the proportion of eligible adolescents who were enrolled and retained in the study. Interviews explored acceptability, and changes in outcomes from baseline to 1-month follow-up assessed preliminary effects of the intervention. Thirty of 43 (69.8%) eligible adolescents and their caregivers were enrolled, with 29 adolescents (96.7%) and 28 caregivers (93.3%) completing the intervention. Twenty-eight adolescents (93.3%) and 29 caregivers (96.7%) were retained at follow-up. Frequency of alcohol, cannabis use and delinquent-type behaviours decreased significantly from baseline to follow-up. Participants appreciated the intervention content and delivery and felt that it facilitated behaviour change. Suggestions for improving the intervention were provided. This study found that the intervention is feasible, acceptable and had promising effects on adolescent behaviour. Efficacy must be established with a randomised controlled trial.     

Tobacco Use Trends among Adolescents and Adults in South Africa

The purpose of this review is to synthesize the national prevalence data from eight surveys on tobacco use in South Africa over the past 13 years. Results from the national studies indicate that tobacco use among adults is on the decline in South Africa. The same applies to daily smoking and daily smokeless tobacco use among adolescents. However, onset of tobacco use and the prevalence of current smoking among adolescents seem not to have changed over the years. While exposure to tobacco smoke outside the home decreased from 56.5% in 1999 to 36.2% in 2002 among adolescents, exposure to tobacco smoke inside the home increased from 41.7% in 1999 to 73.3% in 2002. This change may be attributed to the introduction of the tobacco control act that from 2000 banned smoking in public places. The decline of overall daily smoking in South Africa may be attributed to the tobacco control strategy based on 1) rapidly increasing excise taxes on tobacco, and (2) comprehensive legislation, of which the most important features are banning all tobacco advertising and sponsorship, and prohibition of smoking in public and work places.     

Post-traumatic stress disorder and health risk behaviour among persons 15 years and older in South Africa

The aim of this study was to investigate the association between post-traumatic stress disorder (PTSD) and health risk behaviours among persons 15 years and older in South Africa. We analysed data from the South African National Health and Nutrition Examination Survey (SANHANES-1, 2012) (N = 15 201; mean age = 36.9 years, SD = 16.5; 2.1% with PSTD, 4.0% with partial PTSD). The survey included questions from validated measures of the following health risk behaviours: problem drinking, current tobacco use, physical activity, sedentary behaviour, vegetable consumption, and fast food and frequent soft drinks consumption. In adjusted logistic regression analysis, only self-reporting with PTSD was associated with problem drinking. The data did not yield significant association between PTSD status and any of the other health risk behaviours (tobacco use, low physical activity, and fast food consumption).     

Perceptions of alcohol risk among people on antiretroviral treatment in South Africa: a qualitative study

This study explored perceptions of alcohol abuse risk among people on antiretroviral treatment (ART) who self-identified as alcohol users. Twenty six people receiving ART from an out-patient setting were interviewed on their alcohol abuse risk perception. Data were thematically analysed. Findings suggest participants developed routines to drink alcohol around the times they took their antiretroviral medications to reduce adverse impact. They also reported alcohol abuse risk reduction strategies such as reducing alcohol use because of the event of an HIV positive diagnosis and/or getting on antiretroviral treatment, and alcohol use reduction following health education or counselling by health care staff. These findings suggest a need for alcohol interventions tailored to ART patients.     

Spirituality and Religion in Antiretroviral Therapy (ART) in Kwazulu-natal,South Africa: A Longitudinal Study

This study assesses the effects of spirituality and religion in health outcomes of patients on ART in KwaZulu-Natal, South Africa. Participants were 735 patients who attended three HIV clinics for ART over a period of 20 months as follows: 519 after 6 months on antiretroviral therapy (ART), 557 after 12 and 499 after 20 months on ART. They completed the Duke Religion Index each visit. Factors associated with spirituality/religiousness included fewer mental health problems (lower depressive symptoms, lower alcohol use), CD4 cell counts, adherence to ART, better certain health related quality of life outcomes (physical, psychological and environmental), social support and internalized HIV/AIDS stigma. Further research could examine the feasibility of including spirituality and religion in the assessment and providing support interventions for HIV patients.     

Alcohol use and problem drinking in South Africa: Results from a national-population-based survey 2014-2015

The aim of this study was to estimate the pattern of alcohol use among South African adults by their socio-demographic and health status indicators. We analysed data from a 2014–2015 South African national population-based survey which sampled 22 752 adults (mean age 37.1 years, SD?=?17.6, age range of 15–109 years). Results indicate 3.9% were hazardous or harmful alcohol users. In adjusted logistic regression analysis, both men and women who self-reported to use tobacco, and women to have hypertension, were at higher risk for harmful alcohol use. Age and socioeconomic status moderated harmful alcohol use among men so that those in middle age (35–49 years) and with above average household income were at lower risk for hazardous or harmful alcohol use. Socio-demographic factors appear to primarily influence risk for hazardous or harmful alcohol use among South African adults.     

Factors shaping condom use among South African university students: a thematic analysis

This study aimed to investigate contextual influences on condom use by South African university students. Twenty one-to-one, semi-structured interviews were conducted with male and female South African undergraduates. The data were thematically analysed. Results revealed that condom use was transient and often unrelated to disease prevention. Condom use was impeded by closer perceived intimacy, gender dynamics, and social stigma against proposing use of condoms in a presumably committed relationship. Public health policies regarding condom, pill and injection pricing / promotion, and religious toleration also hampered condom use, by encouraging a preference over hormonal contraception or proscribing contraceptive measures altogether. The results provide a basis for considering the impact of immediate and wider social contexts on condom use, as proposed by socio-ecological models of HIV risk behaviour.     

Alcohol Use in Three Different Inner Cities in South Africa: AUDIT-C and CAGE

The aim of the present study was to describe the frequency of risky drinking among a general urban population survey (n=1379) in South Africa with the help of (Alcohol Use Disorders Identification Test) AUDIT-C scores, CAGE (Cut down, Annoyed, Guilty, Eye-opener) scores and compare the scores with calculated risky drinking in terms of weekly alcohol consumption or heavy episodic drinking. Results indicate 44.4% for men and 25.4% for women as hazardous or harmful drinkers and using the CAGE 44.7% (55% among men and 35.5% among women). AUDIT-C and CAGE cases were more likely to be women than men and were also more likely among Coloureds and Whites than Black Africans and Indians or Asians. This study showed a greater sensitivity of AUDIT to CAGE.     

Depression symptoms: Their association with socio-demographic factors and health among adults in South Africa

The aim of this study was to assess depression symptoms and socio-demographic and health correlates in a recent (2014-2015) national population-based survey of South Africa adults (n = 22 752; females =57.5%; mean age 37.1 years, SD = 17.6). The participants reported on their socio-demographic variables, health statuses, and experience of depression symptoms the previous four weeks. About 13% of the sample scored positive for depression symptoms. In adjusted logistic regression analysis, being female, older age, being long term sick or disabled, having two or more pain disorders, having been diagnosed with diabetes, and having smoked regularly were associated with high risk for depression symptoms. Being a student, having below or average household income, and having exercised three or more times a week was associated with lower risk for depression symptoms.     

The Marikana Violence in South Africa: A Brief Psychodynamic Extrapolation

This study applies psychoanalytic concepts in making sense of the individual, group and collective factors that may have contributed towards the Marikana violence. Speculatively, individual factors might include the death instinct, repetition compulsion, and intra-psychic splitting. Related group dynamics such as identification with the aggressor, group and projective identification might be relevant as would the collective psychological influences of history of oppression, severe trans-generational traumatisation, and mystical cultural interpretations in a divided society. Further public truth, reconciliation and forgiveness processes in addition to other integrative forms of healing are proposed.     

Social determinants of subjective well-being among young adults living in the Eastern Cape,South Africa

We investigated the relationships between certain social determinants (age, gender, marital status, education, income, and employment) and subjective well-being (SWB) in a young adult population in the Eastern Cape Province in South Africa. The participants consisted of 977 persons aged 18 to 40 years living in the historically deprived Eastern Cape, South Africa (females = 48%; age range = 18 to 40; rural dwellers = 15%). We measured their SWB utilising the World Health Organization (Ten) Well-Being Scale. Results following analysis of variance showed that age, education, and income were predictors of SWB. Higher SWB was associated with being older, having a higher level of formal education, and having a higher level of income. However, employment status did not have a significant relationship with SWB, suggesting the relative importance of other social indicators of social functioning in this population.     

Concurrent alcohol and tobacco use among school-going adolescents in Namibia: Prevalence and risk factors

The aim of this study was to investigate the prevalence and risk factors for concurrent alcohol and tobacco use among school-going adolescents in Namibia. Data were from a sample of 4 531 Namibian middle school children (females = 53.1%; mean age = 15.8 years, SD = 1.8 years). They completed the Namibia Global School-based Student Health Survey (GSHS) in 2013. Overall, 74.4% of alcohol users in the past month were frequent tobacco users; whereas 40.5% of tobacco users in the past month were frequent alcohol users. Compared to students who were neither alcohol nor tobacco users (63.1%), concurrent alcohol and tobacco users were more likely to self-report with a lack of parent support, to have used illicit drugs, to have engaged in school truancy, to be sedentary in behaviour, to have engaged in a physical fight, and to have had two or more sexual partners. Substance use prevention and treatment programmes with adolescents should routinely address their risk for comorbid tobacco and alcohol use.     

A two-year follow-up investigation of parenting and peer influences on tobacco use onset among Italian early adolescents

The aim of this study was to investigate the influence of peer and family influences on tobacco use onset among Italian early adolescents at two-year follow-up. Participants were 161 adolescents aged 11 to 12 (M = 11.14, SD = 0.39; 49% female) living in the northwest of Italy. Multiple logistic regressions were used. Results indicated that increases in positive family climate were negatively associated with lifetime smoking among non-smokers at two-year follow-up. Additionally, parental knowledge of child daily activities decreased lifetime smoking at two-year follow-up. Moderation analyses revealed that parental knowledge reduced the effect of peers' influence on youth smoking onset at two-year follow-up. This study underlined the influence of parenting practices in preventing early smoking initiation in Italy.