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Swahn MH, Palmier J, Culbreth R, Bbosa GS, Natuhamya C, Matovu G, Kasirye R. Alcohol Use among Young Women in Kampala City: Comparing Self-Reported Survey Data with Presence of Urinary Ethyl Glucuronide Metabolite. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1256. [PMID: 39338138 PMCID: PMC11431470 DOI: 10.3390/ijerph21091256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 09/16/2024] [Accepted: 09/18/2024] [Indexed: 09/30/2024]
Abstract
This study sought to determine the level of concordance between self-reported alcohol use and the presence of its urinary ethyl glucuronide (EtG) metabolite in women living in urban Kampala. In 2023, we recruited 300 young women, ages 18 to 24 years, to participate in a prospective cohort study across three sites in urban Kampala (i.e., Banda, Bwaise, and Makindye) to examine the mechanistic pathways of mental illness. As part of the baseline assessment, participants were asked to complete a research assistant-administered survey and to provide a urine sample to screen for 16 different substances and/or their metabolites, including EtG. Overall, 58% (n = 174) reported to have ever consumed alcohol and 23% (n = 68) to have used it in the past month. Among the 300 women, 10% (n = 30) had EtG levels in their urine sample and of these, 40% (n = 12) reported to have never consumed alcohol, using a self-reported survey (p = 0.035). Recent alcohol use was relatively low among the women in this study. However, the discordance between self-reported alcohol use and the presence of EtG presents concerns about the accuracy of self-reported alcohol use. Additional research is needed to contextualize self-reported alcohol use, social desirability, and the implications for alcohol prevention and intervention strategies for young women in urban Kampala.
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Affiliation(s)
- Monica H. Swahn
- Health Promotion and Physical Education, Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, GA 30144, USA;
| | - Jane Palmier
- Health Promotion and Physical Education, Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, GA 30144, USA;
| | - Rachel Culbreth
- Toxicology Investigators Consortium, American College of Medical Toxicology, Phoenix, AZ 85028, USA;
| | - Godfrey S. Bbosa
- Department of Pharmacology & Therapeutics, Makerere University College of Health Sciences, P.O. Box 7072 Kampala, Uganda;
| | - Charles Natuhamya
- Uganda Youth Development Link, P.O. Box 12659 Kampala, Uganda; (C.N.); (G.M.); (R.K.)
| | - Gideon Matovu
- Uganda Youth Development Link, P.O. Box 12659 Kampala, Uganda; (C.N.); (G.M.); (R.K.)
| | - Rogers Kasirye
- Uganda Youth Development Link, P.O. Box 12659 Kampala, Uganda; (C.N.); (G.M.); (R.K.)
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Tutlam NT, Filiatreau LM, Byansi W, Brathwaite R, Nabunya P, Sensoy Bahar O, Namuwonge F, Ssewamala FM. The Impact of Family Economic Empowerment Intervention on Psychological Difficulties and Prosocial Behavior Among AIDS-Orphaned Children in Southern Uganda. J Adolesc Health 2023; 72:S51-S58. [PMID: 37062584 PMCID: PMC10159782 DOI: 10.1016/j.jadohealth.2023.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 09/22/2022] [Accepted: 01/03/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE Children orphaned by AIDS are more likely to have psychological and emotional problems compared to their counterparts. Poverty resulting from orphanhood is linked to the negative psychological outcomes experienced by AIDS-orphaned adolescents. No studies have investigated the impact of an economic empowerment intervention on child psychological and emotional problems and prosocial behavior. Therefore, we aimed to examine the impact of a family economic empowerment intervention on psychological difficulties and prosocial behavior among AIDS-orphaned adolescents. METHODS We analyzed data from a two-arm cluster randomized controlled trial conducted in 10 primary schools in southern Uganda. Schools were randomized to either bolstered usual care (n = 5 schools; 167 participants) or a family-economic empowerment intervention (Suubi-Maka; n = 5 schools; 179 individuals). We used t-test and multi-level mixed effects models to examine the impact of Suubi-Maka on psychological and behavioral outcomes. RESULTS No differences were observed between intervention and control groups in almost all the outcomes at baseline, 12 months, and 24 months. Simple main effects comparisons of 12 months versus baseline within each condition indicate modest to significant declines in emotional symptoms, hyperactivity, peer relationships (Δs = -1.00 to -2.11, all p < .001), and total difficulties (Δs = -4.85 to -4.89, both p < .001) across both groups. DISCUSSION Our analysis found no meaningful difference between intervention and control groups in child psychological difficulties and prosocial behavior postintervention. However, improvements were observed across both control and treatment groups following the intervention. Future studies should investigate the impact of different components of the intervention.
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Affiliation(s)
- Nhial T Tutlam
- International Center for Child Health and Development, Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri
| | - Lindsey M Filiatreau
- International Center for Child Health and Development, Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri
| | - William Byansi
- Boston College, School of Social Work, Chestnut Hill, Massachusetts
| | - Rachel Brathwaite
- International Center for Child Health and Development, Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri
| | - Proscovia Nabunya
- International Center for Child Health and Development, Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development, Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri
| | - Flavia Namuwonge
- International Center for Child Health and Development Field Office, Masaka, Uganda
| | - Fred M Ssewamala
- International Center for Child Health and Development, Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri.
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Anyanwu MU. Psychological distress in adolescents: prevalence and its relation to high-risk behaviors among secondary school students in Mbarara Municipality, Uganda. BMC Psychol 2023; 11:5. [PMID: 36624544 PMCID: PMC9830719 DOI: 10.1186/s40359-023-01039-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Psychological distress among adolescents negatively affects their academic performance, relationships with family and friends, and ability to participate fully in the community. Stressful life events in low-income countries and risk-taking behavior of adolescents have raised concerns regarding the impact of psychological distress among adolescents. Therefore, the present study estimated the prevalence of psychological distress and examined the high-risk behaviors associated with psychological distress among Ugandan adolescents. METHODS A community based cross-sectional study was conducted among secondary school students in Mbarara Municipality, Uganda. Multistage cluster sampling was used to recruit 921 adolescents from 12 schools. Psychological distress was assessed using the 10-item Kessler Psychological Distress Scale (K10). Logistic regression was used with p-value estimating regression coefficient and 95% confidence interval for odds ratio and adjusted odds ratio (AOR). RESULTS The prevalence of psychological distress using the K10 was 57%. Logistic regression analyses showed that risky sexual behavior [AOR = 1.52; 95% confidence interval (CI) 1.02-2.28], substance use (AOR = 2.06; 95% CI 1.49-2.84) were associated with psychological distress. Students in mixed schools (comprising both sexes) (AOR = 1.94; 95% CI 1.19-3.15) and adolescents with chronic illness (AOR = 1.68; 95% CI 1.18-2.38) were more likely to report psychological distress. CONCLUSION The prevalence of psychological distress among school-going adolescents is high. Risky sexual behavior, substance use as well as chronic illness were associated with psychological distress. In addition, the type of school was significantly associated with psychological distress. The findings suggest the need for policy makers and stakeholders in health and education sectors to institute measures that will address mental health issues among adolescents.
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Affiliation(s)
- Michael U Anyanwu
- Department of Community Health, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda.
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Whitton A, Swahn MH, Culbreth R, Kasirye R. Attitudes and risky sexual behavior among youth in Kampala, Uganda: Empirical analyses of risk factors by gender. PEC INNOVATION 2022; 1:100090. [PMID: 36532298 PMCID: PMC9757820 DOI: 10.1016/j.pecinn.2022.100090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 09/06/2022] [Accepted: 10/03/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE This study sought to examine gender differences and the influence of peer and parental perceptions on sexual risk behaviors among an at-risk sample of youth living in Kampala, Uganda. METHODS Using the cross-sectional Kampala Youth Survey (2014) based in Kampala, Uganda (n = 1134), bivariate and multivariable logistic regressions were conducted to determine the odds of sexual risk behaviors based on peer and parental influence variables and gender. RESULTS The perceptions of peer, adult, and parental opinions on sexual activity were significantly associated with varying levels across all risky sexual behaviors explored. When indexed and adjusted for other variables, females compared to males were at increased odds of participating in 3-4 risky sexual behaviors (OR: 0.63, 95% CI: 0.44, 0.90) and 5-6 risky sexual behaviors (OR: 0.38, 95% CI: 0.21, 0.68) compared to zero risky sexual behaviors. CONCLUSIONS Adolescent sexual risk behaviors are subject to peer and parental influence and vary between genders. INNOVATION This study emphasizes the importance of peer influences in adolescent sexual risk behaviors. Many of these youth are orphans, which may explain the lack of association between parental influences and sexual risk behavior. School-based and community-based interventions may be effective at preventing risky sexual behaviors for this vulnerable population.
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Affiliation(s)
- Alaina Whitton
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Monica H. Swahn
- Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, GA, USA
| | - Rachel Culbreth
- Toxicology Investigators Consortium, American College of Medical Toxicology, Phoenix, AZ, USA
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Patterson AQ, Culbreth R, Kasirye R, Kebede S, Bitarabeho J, Swahn MH. Self-rated physical health, health-risk behaviors, and disparities: A cross-sectional study of youth in the slums of Kampala, Uganda. Glob Public Health 2022; 17:2962-2976. [PMID: 34882514 PMCID: PMC9177902 DOI: 10.1080/17441692.2021.2007974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 10/30/2021] [Indexed: 12/15/2022]
Abstract
Self-rated physical health (SRPH) has been extensively used to assess health status. In this study, we examine how youth living in the slums of Kampala perceive their physical health and the psychosocial correlates of poor health. Cross-sectional data from the 2014 Kampala Youth Survey (N = 1,134) of youth ages 12-18 years was used to conduct the analyses. Chi-square tests and logistic regression analyses were conducted to determine associations between SRPH, demographic and psychosocial characteristics. Overall, 72% of youth rated their health as 'excellent' or 'good.' Poor SRPH was associated with older age and lower education, but not with sex. Also, orphans (OR = 2.03; 95%CI:1.51-2.72), those who lived on the streets (OR=3.09; 95%CI:2.30-4.15), who did not have electricity (OR = 2.83;95%CI:2.12-3.78), who initiated alcohol use early (OR = 2.08; 95%CI:1.47-2.94), who frequently get drunk (OR = 5.67; 95%CI:2.69-11.96), who were HIV positive (OR = 2.18; 95%CI:1.47-3.23), who had been injured due to their drinking (OR = 2.09; 95%CI:1.44-3.03), who thought about hurting themselves (OR = 2.09; 95%CI:1.60-2.73), and those who often felt lonely (OR = 2.54; 95%CI:1.61-4.02) had higher odds of poor SRPH compared to their peers without these characteristics. Poor SRPH may serve as a marker for multiple health-risk behaviors and severe health disparities among youth in vulnerable and resource-limited settings.
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Affiliation(s)
- Annabel Q. Patterson
- Department of Population Health Sciences, School of Public Health, Georgia State University, PO Box 3984, Atlanta, Georgia 30302, USA
| | - Rachel Culbreth
- Department of Respiratory Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, PO Box 3984, Atlanta, Georgia 30302, USA
| | - Rogers Kasirye
- Uganda Youth Development Link, Sir Apollo Kaggwa Rd, PO Box 12659, Kampala, Uganda
| | | | - Jackson Bitarabeho
- Childen’s AIDS Fund Uganda, Plot 36, Ntinda II Road, P.O. Box 7633, Kampala, Uganda
| | - Monica H. Swahn
- Department of Population Health Sciences, School of Public Health, Georgia State University, PO Box 3984, Atlanta, Georgia 30302, USA
- Department of Health Promotion and Physical Education, Wellstar College of Health and Human Services, Kennesaw State University. 520 Parliament Garden Way, Kennesaw, GA 30144, USA
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Swahn MH, Nassaka J, Nabulya A, Palmier J, Vaught S. A Qualitative Assessment of Place and Mental Health: Perspectives of Young Women Ages 18-24 Living in the Urban Slums of Kampala, Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12935. [PMID: 36232235 PMCID: PMC9566181 DOI: 10.3390/ijerph191912935] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/04/2022] [Accepted: 10/04/2022] [Indexed: 06/16/2023]
Abstract
This paper examines the link between place and mental health using a qualitative assessment and focus group discussion with young women, ages 18 to 24 years of age, residing in three slums in Kampala, Uganda. The assessment, conducted in August of 2022, engaged 15 women who participated in Uganda Youth Development Drop-in center activities. The objective was to assess mental health and the link between place and mental health. Facilitated group discussions and photograph review yielded the following results. In terms of understanding their views of mental health and wellbeing, participants clearly focused on feelings. However, they also assessed resilience, the environment and a person's choice as relating to their mental health. Participants also found the physical spaces related to sports, education, worship, workplaces and green space to be linked to happiness. In terms of the attributes that were linked to sadness, participants listed the physical locations where drugs are sold, clubs for dancing and partying and also sanitation issues in the community. Participants frequently reported on the social environment and reflected on harassment, discrimination, alcohol use and criminal behavior that did not reflect a specific physical space, but rather the embedded social interactions they may face or observe by living in close proximity to hotspots for criminal activity. Given the dire shortages of mental health services and care that are available in this setting, a better understanding of young women's perceptions of place and mental health will be key for low-cost interventions and strategies to mitigate the contextual factors that may exacerbate mental illness.
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Affiliation(s)
- Monica H. Swahn
- Health Promotion and Physical Education, Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, GA 30144, USA
| | | | - Anna Nabulya
- Uganda Youth Development Link, Kampala P.O. Box 12659, Uganda
| | - Jane Palmier
- Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, GA 30144, USA
| | - Seneca Vaught
- Interdisciplinary Studies, Radow College of Humanities and Social Sciences, Kennesaw State University, Kennesaw, GA 30144, USA
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Swahn MH, Culbreth R, Fodeman A, Cottrell-Daniels C, Tumwesigye NM, Jernigan DH, Kasirye R, Obot I. Heavy drinking and problem drinking among youth in Uganda: A structural equation model of alcohol marketing, advertisement perceptions and social norms. Drug Alcohol Rev 2022; 41:1444-1456. [PMID: 35761763 PMCID: PMC9546093 DOI: 10.1111/dar.13497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 05/05/2022] [Accepted: 05/08/2022] [Indexed: 11/30/2022]
Abstract
Introduction To determine the role of alcohol marketing, perceptions of marketing and social norms on heavy alcohol use and problem drinking among vulnerable youth in Uganda. Methods The Kampala Youth Survey is a cross‐sectional study conducted in 2014 with service‐seeking youth (ages 12–18 years) living in the slums of Kampala (n = 1134) who were participating in Uganda Youth Development Link drop‐in centres. Survey measures assessed perceptions of alcohol advertisements, social norms regarding alcohol use, heavy alcohol use and problem drinking. Factor analyses and structural equation models were computed to determine the predictors (e.g. social norms and alcohol marketing exposure) for drinking amounts, heavy drinking and problem drinking. Results Alcohol marketing allure, perceptions of adults' alcohol attitudes and respondent's male gender were significantly predictive of heavy drinking. Similarly, in addition to drinking amount and heaviness, only alcohol marketing exposure and friends' alcohol attitudes, as well as respondent's own attitudes about alcohol, significantly predicted variation in problem drinking. Discussion and Conclusions Alcohol marketing exposure and allure are significant predictors of heavy drinking and problem drinking among youth in Uganda. Prevention programs that reduce exposure to and allure of alcohol marketing may prove promising for reducing alcohol use and related problems among these vulnerable youth in a low‐resource setting.
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Affiliation(s)
- Monica H Swahn
- Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, USA.,School of Public Health, Georgia State University, Atlanta, USA
| | - Rachel Culbreth
- Byrdine F. Lewis School of Nursing and Health Professions, Georgia State University, Atlanta, USA
| | - Ari Fodeman
- College of Arts and Sciences, Georgia State University, Atlanta, USA
| | | | | | | | | | - Isidore Obot
- Centre for Research and Information on Substance Abuse, Uyo, Nigeria
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Perry EW, Culbreth R, Self-Brown S, Gilmore AK, Kasirye R, Musuya T, Ndetei D, Swahn MH. Violence Exposure, Self-Reported Mental Health Concerns and Use of Alcohol and Drugs for Coping among Youth in the Slums of Kampala, Uganda. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2022; 53:83-110. [PMID: 38577222 PMCID: PMC10989775 DOI: 10.1080/00207411.2022.2073755] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study aimed to a) compute the prevalence of violence exposure types, polyvictimization, and self-reported depression, anxiety, and using substances to cope among youth ages 12 to 18 years living on the streets or in the slums of Kampala, Uganda, (b) examine the independent associations among orphan status, violence exposure types, and self-reported mental health concerns, and c) explore the association between polyvictimization and mental health concerns. Data are from a 2014 cross-sectional survey of service-seeking youth ages 12 to 18 years (N = 1134) in Kampala, Uganda. Violence exposure types explored in this study were: witnessing family physical violence, direct physical abuse by a parent, any rape history, and physical dating violence. We used descriptive statistics and multivariable logistic regression to test study objectives. Over half of the sample (60.5%) reported experiencing at least one type of violence exposure; many youth endorsed self-reported depression (57.8%), anxiety (76.8%), and substance use to cope (37.0%). Exposure to violence was associated with higher odds for self-reported depression, anxiety, and using substances to cope. These findings underscore the urgent need to implement evidence-based interventions among this young, underserved population and their families to prevent violence, improve mental health outcomes, and promote resilience.
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Affiliation(s)
| | - Rachel Culbreth
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA USA
| | | | - Amanda K Gilmore
- School of Public Health, National Center for Sexual Violence Prevention, Georgia State University, Atlanta, GA USA
| | | | - Tina Musuya
- Center for Domestic Violence Prevention, Kampala, Uganda
| | - David Ndetei
- Department of Psychiatry, University of Nairobi, Africa Mental Health Foundation, Nairobi, Kenya
| | - Monica H Swahn
- Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, GA USA, School of Public Health, Georgia State University, Atlanta, GA USA
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