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Perkins JM, Kakuhikire B, Baguma C, Evans CQ, Rasmussen JD, Satinsky EN, Kyokunda V, Juliet M, Ninsiima I, Bangsberg DR, Tsai AC. Cigarette smoking and misperceived norms among adults in rural Uganda: a population-based study. Tob Control 2023; 32:652-656. [PMID: 34930809 PMCID: PMC9207154 DOI: 10.1136/tobaccocontrol-2021-056470] [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: 01/06/2021] [Accepted: 11/29/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Little is known about perceived norms about cigarette smoking in Uganda or the extent to which perceptions drive personal cigarette smoking behaviour. METHODS We conducted a cross-sectional study in 2016-2018 that targeted all adults who resided within eight villages in Rwampara District, southwestern Uganda. Personal cigarette smoking frequency was elicited by self-report. We also asked participants what they believed to be the cigarette smoking frequency of most other adult men and women in their villages (i.e., perceived norms). Frequent cigarette smoking was defined as 4+ times/week. We compared perceived norms to cigarette smoking frequency reports aggregated at the village level. We used multivariable Poisson regression to estimate the association between perceived norms and personal cigarette smoking behaviour. RESULTS Among 1626 participants (91% response rate), 92 of 719 men (13%) and 6 of 907 women (0.7%) reported frequent smoking. However, 1030 (63%) incorrectly believed most men in their villages smoked cigarettes frequently. Additionally, 116 (7%) incorrectly believed that most women in their villages smoked cigarettes frequently. These misperceptions were pervasive across social strata. Men who misperceived frequent cigarette smoking as the norm among other men in their villages were more likely to smoke frequently themselves (adjusted relative risk=1.49; 95% CI, 1.13 to 1.97). CONCLUSIONS Most adults overestimated cigarette smoking frequency among village peers. Men who incorrectly believed that frequent smoking was the norm were more likely to engage in frequent smoking themselves. Applying a 'social norms approach' intervention by promoting existing healthy norms may prevent smoking initiation or motivate reductions in smoking among men in rural Uganda.
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Affiliation(s)
- Jessica M Perkins
- Peabody College of Education and Human Development, Vanderbilt University, Nashville, Tennessee, USA
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bernard Kakuhikire
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Charles Baguma
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Claire Q Evans
- Peabody College of Education and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | | | - Emily N Satinsky
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Viola Kyokunda
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mercy Juliet
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Immaculate Ninsiima
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - David R Bangsberg
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
- Oregon Health & Science University - Portland State University School of Public Health, Portland, Oregon, USA
| | - Alexander C Tsai
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, MA, USA
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Zhang L, Mou Y, Zhang L. Promoting condom negotiation self-efficacy among young women in China: the effects of traditional sexual values and descriptive norms. HEALTH EDUCATION RESEARCH 2023; 38:220-229. [PMID: 36852888 DOI: 10.1093/her/cyad012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 01/09/2023] [Accepted: 02/18/2023] [Indexed: 05/24/2023]
Abstract
This study attempts to design effective messages to promote condom negotiation self-efficacy and safer sex intent among young women in China. An online experiment with 2 (descriptive norm: present versus absent) × 2 (traditional sexual value: high versus low) between-subjects factorial design was conducted on a purposive sample of 241 female Chinese college students. The results demonstrated that culturally tailored messages incorporating descriptive norms information on the popularity of condom negotiation can increase participants' self-efficacy (F(1,237) = 9.01, partial η2 = 0.04, P = 0.003) but not safer sex intent (F(1,237) = 2.80, partial η2 = 0.01, P = 0.096). Participants with a lower level of traditional sexual values had similar levels of condom negotiation self-efficacy as those with a higher level of values: F(1,237) = 2.85, partial η2 = 0.01, P = 0.09. There were no significant interaction effects of traditional sexual value and descriptive norm on condom negotiation self-efficacy and safer sex intent. The findings contribute to the cultural sensitivity perspective in health education in an Eastern context and have implications for public health practitioners and policymakers.
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Affiliation(s)
- Lin Zhang
- School of Media and Communication, Shanghai Jiao Tong University, 800 Dongchuan Road, Minhang District, Shanghai 200240, China
| | - Yi Mou
- School of Media and Communication, Shanghai Jiao Tong University, 800 Dongchuan Road, Minhang District, Shanghai 200240, China
| | - Lianshan Zhang
- School of Media and Communication, Shanghai Jiao Tong University, 800 Dongchuan Road, Minhang District, Shanghai 200240, China
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Perceptions About Local ART Adherence Norms and Personal Adherence Behavior Among Adults Living with HIV in Rural Uganda. AIDS Behav 2022; 26:1892-1904. [PMID: 35034237 DOI: 10.1007/s10461-021-03540-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 01/08/2023]
Abstract
Although misperceived norms often drive personal health behaviors, we do not know about this phenomenon in the context of antiretroviral therapy (ART) adherence. We conducted a cross-sectional study including all persons living with HIV (PLWH) on ART across eight villages in one parish in a rural region of southwestern Uganda. We used surveys to measure personal reports of ART adherence (not missing any doses of ART in the past 7 days was considered optimal adherence whereas missing doses was considered suboptimal adherence) and perceived norms about the local ART adherence norm (whether or not each individual thought 'most other PLWH on ART in this parish' missed any doses in the past 7 days). Multivariable Poisson regression models were used to estimate the association between perceived norms and personal adherence. Among 159 PLWH on ART (95% response rate), 142 (89%) reported no missed doses. However, 119 (75%) thought most individuals in this population of PLWH on ART were sub-optimally adherent. This misperception about the local ART adherence norm was prevalent in every subgroup of PLWH. Misperceiving the local ART adherence norm to be sub-optimal adherence was associated with a reduced likelihood of optimal adherence among married PLWH (adjusted relative risk [aRR] = 0.83; 95% confidence interval [CI] 0.71-0.97). The association was similar but imprecisely estimated for all PLWH (aRR = 0.91; 95% CI 0.82-1.01). Interventions to correct misperceived ART adherence norms as a stand-alone intervention or as a complement to other adherence promotion programs may influence ART adherence behavior and perhaps reduce HIV-related stigma.
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Perkins JM, Kakuhikire B, Baguma C, Meadows M, Evans CQ, Jurinsky J, Rasmussen JD, Satinsky EN, Ayebare P, Kyokunda V, Juliet M, Bangsberg DR, Tsai AC. Perceived and misperceived norms about khat and/or cannabis use among adults in southwest Uganda. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 101:103527. [PMID: 34890907 PMCID: PMC9272912 DOI: 10.1016/j.drugpo.2021.103527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 10/31/2021] [Accepted: 11/01/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Studies from high-income contexts have found evidence that norms about substance use are misperceived. The accuracy of perceived norms about khat and cannabis use in Uganda have not previously been described. METHODS We conducted a population-based study targeting all resident adults across eight villages in southwestern Uganda. Personal khat and/or cannabis use frequency was based on self-report. We measured perceived norms about substance use by eliciting individuals' perceptions about how often most other adult men and most other adult women in their villages used these substances. We compared perceived norms to aggregated village rates of use to assess the extent to which norms were misperceived. We used multivariable Poisson regression to estimate correlates of misperceived norms. RESULTS Among 1626 participants (91% response rate), only 29 men (4%) and 9 women (1%) reported any lifetime use of khat and/or cannabis. However, 695 participants (43%) did not think lifetime abstinence was the norm among men in their villages, and 256 participants (16%) did not think lifetime abstinence was the norm among women. Moreover, 219 participants (13%) incorrectly believed most men in their village regularly used khat and/or cannabis (≥4 times per week). Misperceived norms were present across subgroups and were correlated with larger social networks, symptoms of depression, loneliness, and younger age. CONCLUSION In this study of all adults across 8 villages in rural Uganda, many participants misperceived norms about khat and/or cannabis use. Providing accurate information about prevailing norms in the local population may help prevent initiation of khat and/or cannabis use among adults in this context.
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Affiliation(s)
- Jessica M Perkins
- Peabody College, Vanderbilt University, 230 Appleton Place, Nashville, TN 37203, USA; Vanderbilt Institute of Global Health, 2525 West End Avenue, Nashville, TN 37203, USA.
| | - Bernard Kakuhikire
- Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda
| | - Charles Baguma
- Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda
| | - Meredith Meadows
- Peabody College, Vanderbilt University, 230 Appleton Place, Nashville, TN 37203, USA
| | - Claire Q Evans
- Peabody College, Vanderbilt University, 230 Appleton Place, Nashville, TN 37203, USA
| | - Jordan Jurinsky
- Peabody College, Vanderbilt University, 230 Appleton Place, Nashville, TN 37203, USA
| | | | - Emily N Satinsky
- Center for Global Health, Massachusetts General Hospital, 125 Nashua St, Boston, MA 02114, USA
| | - Patience Ayebare
- Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda
| | - Viola Kyokunda
- Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda
| | - Mercy Juliet
- Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda
| | - David R Bangsberg
- Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda; Oregon Health & Science University-Portland State University School of Public Health, 1880 SW 6th Ave, Portland, OR 97201, USA
| | - Alexander C Tsai
- Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda; Center for Global Health, Massachusetts General Hospital, 125 Nashua St, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA; Mongan Institute, Massachusetts General Hospital, 100 Cambridge St Suite 1600, Boston, MA 02114, USA
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Perkins JM, Kakuhikire B, Baguma C, Jurinsky J, Rasmussen JD, Satinsky EN, Namara E, Ahereza P, Kyokunda V, Perkins HW, Hahn JA, Bangsberg DR, Tsai AC. Overestimation of alcohol consumption norms as a driver of alcohol consumption: a whole-population network study of men across eight villages in rural, southwestern Uganda. Addiction 2022; 117:68-81. [PMID: 34159646 PMCID: PMC8759576 DOI: 10.1111/add.15615] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/20/2021] [Accepted: 05/09/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS Little is known about how perceived norms about alcohol consumption may influence high alcohol consumption rates in Uganda. This study estimated the accuracy of perceived norms about men's alcohol consumption and estimated the association between perceived norms and personal alcohol consumption. DESIGN Cross-sectional, whole-population, sociocentric social network study. SETTING Eight rural villages in Rwampara District, southwestern Uganda in 2016-18. PARTICIPANTS A total of 719 men aged 18 years and older (representing 91% of permanent resident men). MEASUREMENTS Self-reported frequent (≥ 4 days per week) and heavy alcohol consumption (six or more drinks on one occasion, more than three occasions of intoxication, or spending an excessive amount on alcohol). Participants also reported whether they thought most other men in their village engaged in frequent and heavy alcohol consumption (perceived norms). Using the network study design, we calculated alcohol consumption behavior within villages and social networks. Perceived norms were compared with aggregated self-reports. Multivariable Poisson regression models were used to estimate the association between perceived norms and individual behavior. FINDINGS Throughout villages, frequent and heavy alcohol consumption ranged from 7 to 37%. However, 527 (74%) participants perceived, contrary to fact, that most other men in their villages frequently consumed alcohol, and 576 (81%) perceived that most others heavily consumed alcohol. Overestimation of alcohol consumption by others was pervasive among socio-demographic subgroups and was present irrespective of the actual consumption behavior at the village level and within social networks. Men who misperceived these alcohol consumption behaviors as being common were more likely to engage in frequent [adjusted relative risk (aRR) = 3.98; 95% confidence interval (CI) = 1.69-9.34) and heavy (aRR = 4.75; 95% CI = 2.33-9.69) alcohol consumption themselves. CONCLUSIONS Most men in eight rural Ugandan villages incorrectly thought that frequent and heavy alcohol consumption were common among men in their villages. These misperceived norms had a strong positive association with individual drinking behavior.
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Affiliation(s)
- Jessica M. Perkins
- Peabody College of Education and Human Development, Vanderbilt University, Nashville, TN, USA,Vanderbilt Institute of Global Health, Vanderbilt University Medical Center, Nashville, TN, USA,Corresponding author: Dr. Jessica M. Perkins, , Phone: (615) 875-3289, Fax: 615-343-2661
| | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jordan Jurinsky
- Peabody College of Education and Human Development, Vanderbilt University, Nashville, TN, USA
| | | | - Emily N. Satinsky
- Center for Global Health, Massachusetts General Hospital, Boston MA USA
| | | | - Phionah Ahereza
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Viola Kyokunda
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Judith A. Hahn
- University of California at San Francisco, San Francisco, CA, USA
| | - David R. Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda,Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| | - Alexander C. Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda,Center for Global Health, Massachusetts General Hospital, Boston MA USA,Harvard Medical School, Boston, MA, USA,Mongan Institute, Massachusetts General Hospital, Boston MA USA
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Villalobos-Gallegos L, Medina-Mora ME, Marín-Navarrete R, Magis-Rodriguez C, Ruiz-Velasco Acosta S. Testing the Synergistic Effects of Depression, Anxiety, and Substance Use in Unsafe Sex: a Cross-sectional Study. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-020-00291-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Esie P, Osypuk TL, Schuler SR, Bates LM. Social norms and the association between intimate partner violence and depression in rural Bangladesh-a multilevel analysis. Soc Psychiatry Psychiatr Epidemiol 2021; 56:2217-2226. [PMID: 33687499 PMCID: PMC9680914 DOI: 10.1007/s00127-021-02044-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Intimate partner violence (IPV) is highly prevalent globally and associated with adverse mental health outcomes among women. In IPV-endemic contexts like Bangladesh, previous research has found no association between low levels of IPV and depression. Although IPV and attitudes justifying IPV against women are highly prevalent in this context, nothing is known about how related contextual norms affect associations between individual-level IPV exposure and depression. The present study examines if village-level IPV norms, characterized using village-level (Level 2) prevalence of a) IPV-justifying attitudes (injunctive norms) and b) physical IPV (descriptive norms), modifies the individual-level (Level 1) associations between the severity of recent IPV and major depressive episode (MDE) among women in rural Bangladesh. METHODS Data were drawn from a nationally-representative sample consisting of 3290 women from 77 villages. Multilevel models tested cross-level interactions between village-level IPV norms and recently experienced individual-level IPV on the association with past 30-day MDE. RESULTS The prevalence of IPV was 44.4% (range: 9.6-76.2% across villages) and attitudes justifying IPV ranged from 1.6% to 49.8% across villages. The prevalence of MDE was 16.8%. The risk of MDE at low levels of IPV severity (versus none) was greater in villages with the least tolerant attitudes toward IPV compared to villages where IPV was more normative, e.g., interaction RR = 1.42 (95% CI: 0.64, 3.15) for low physical IPV frequency and injunctive norms. CONCLUSIONS The association between IPV and depression may be modified by contextual-level IPV norms, whereby it is exacerbated in low-normative contexts.
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Affiliation(s)
- Precious Esie
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Theresa L. Osypuk
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | | | - Lisa M. Bates
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
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Pincock K. Relationality, religion and resistance: teenage girlhood and sexual agency in Tanzania. CULTURE, HEALTH & SEXUALITY 2020; 22:1282-1298. [PMID: 31633444 DOI: 10.1080/13691058.2019.1674921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 09/27/2019] [Indexed: 06/10/2023]
Abstract
Drawing on ethnographic fieldwork in rural Tanzania, this paper shows that teenage girls' opportunities for sexual agency are shaped through assemblages of normative girlhood and appropriate sexuality. Whilst girls themselves negotiate and resist the disempowering affects of such assemblages, as shown through vignettes which illustrate the experiences of three girls who were involved in the education project where fieldwork took place, their capacity to do so is linked to the broader networks of relationships within which girls were situated. Taking friendships and religious affiliation as examples, I show how relationships can generate the conditions for girls to resist assemblages of norms and expectations that structure sexuality and girlhood - but may also reinforce them. This paper counters prevailing narratives on teenage girls' sexual agency in developing countries as inherently lacking, requiring external recuperation in the form of education and 'empowerment', and explores the implications of a relational framing for interventions which seek to genuinely expand girls' sexual agency.
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Affiliation(s)
- Kate Pincock
- Department of International Development, University of Oxford, Oxford, UK
- Gender and Adolescence: Global Evidence. Overseas Development Institute, London, UK
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Fast D, Bukusi D, Moyer E. The knife's edge: Masculinities and precarity in East Africa. Soc Sci Med 2020; 258:113097. [PMID: 32540514 DOI: 10.1016/j.socscimed.2020.113097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/26/2020] [Accepted: 05/29/2020] [Indexed: 11/16/2022]
Abstract
In our field sites and clinical practice in East Africa, we regularly encounter men who have become overwhelmed by "thinking too many thoughts" and "gone crazy from confusion," brought about by the problems of life created by deepening social, economic and political precarity. Across diverse settings, many African men continue to be enmeshed in social and material obligations and expectations that position them as economic consumers and providers for those they care for and love. When these gendered obligations, expectations and fantasies are left unfulfilled, this sense of failure can be embodied to produce particular kinds of health effects. Namely, men may become plagued by troublesome and confusing thoughts, leading them in some cases to "give up on" (as our research subjects put it) pursuing work and education, to become immersed in problematic drug and alcohol use, and even to take their own lives. While these afflictions can be glossed using the language of depression, anxiety, addiction and suicide, such medicalizing frames may obscure more nuanced social, structural and affective diagnoses of what is happening to men across Africa and globally. Anthropology provides us with alternative frames through which to understand how psychological wounds are made-and healed.
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Affiliation(s)
- Danya Fast
- Department of Medicine, University of British Columbia, Vancouver, Canada; Department of Anthropology, University of Amsterdam, Amsterdam, the Netherlands.
| | - David Bukusi
- Department of Anthropology, University of Amsterdam, Amsterdam, the Netherlands; Kenyatta National Hospital, Nairobi, Kenya
| | - Eileen Moyer
- Department of Anthropology, University of Amsterdam, Amsterdam, the Netherlands
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Perkins JM, Krezanoski P, Takada S, Kakuhikire B, Batwala V, Tsai AC, Christakis NA, Bangsberg DR. Social norms, misperceptions, and mosquito net use: a population-based, cross-sectional study in rural Uganda. Malar J 2019; 18:189. [PMID: 31159821 PMCID: PMC6547474 DOI: 10.1186/s12936-019-2798-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 05/03/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Mosquito net use is an essential part of malaria prevention. Although previous research has shown that many people sleep under a mosquito net in endemic areas, it is unknown whether people underestimate how common it is to sleep under a net every night. Furthermore, perceived social norms about whether most others sleep under a mosquito net every night may contribute to personally sleeping under a net, given decades of research showing that people often mimic others' behaviours. METHODS Population-based data were collected from 1669 adults across eight villages in one rural parish in southwestern Uganda. Individuals' perception about whether most adults in their community sleep under a mosquito net every night was compared with whether daily mosquito net use was the actual norm in their community to identify the extent of norm misperception. The association between whether an individual perceived daily mosquito net use to be the norm and personal mosquito net use was assessed while adjusting for the ratio of nets:people in the household and other factors. RESULTS Although the majority (65%) of participants reported sleeping under a mosquito net every night (and 75% did so among the 86% of people with at least one net), one-quarter of participants thought that most adults in their community did not sleep under a mosquito net every night. Another 8% were unsure how many nights per week most adults in their community sleep under a mosquito net. Participants who perceived that daily mosquito net use was the norm were 2.94 times more likely to report personally sleeping under a mosquito net every night (95% CI 2.09-4.14, p < 0.001) compared to participants who thought doing so was not normative, adjusting for other factors. CONCLUSIONS Results suggest an opportunity for anti-malarial interventions to reduce misperceptions about mosquito net use norms and emphasize the commonness of daily mosquito net use in malaria-endemic regions. If people correctly perceive most others to sleep under a net every night, then they may personally do so when possible and support others to do so too.
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Affiliation(s)
- Jessica M Perkins
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, TN, 37203, USA.
- Vanderbilt Institute of Global Health, Vanderbilt University Medical Center, Nashville, TN, 37203, USA.
| | - Paul Krezanoski
- Department of Medicine, University of California San Francisco, San Francisco, USA
| | - Sae Takada
- National Clinician Scholars Program UCLA, Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California Los Angeles, Los Angeles, USA
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy, San Diego, CA, USA
| | | | - Vincent Batwala
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Alexander C Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda
- Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, USA
| | | | - David R Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda
- Oregon Health & Science University, Portland State University School of Public Health, Portland, OR, USA
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Fang L, Chuang DM, Al-Raes M. Social support, mental health needs, and HIV risk behaviors: a gender-specific, correlation study. BMC Public Health 2019; 19:651. [PMID: 31138239 PMCID: PMC6540559 DOI: 10.1186/s12889-019-6985-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 05/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The HIV/AIDS epidemic continues to threaten the health and wellbeing of millions in the United States and worldwide. Syndemic theory suggests that HIV/AIDS can cooccur with other afflictions. As close to 20% of US adults live with a mental health condition, it is critical to understand the correlation between HIV risk behaviors and mental health needs, as well as protective factors such as social support in intervening the association between mental distress and HIV risk behaviors. Furthermore, as past research has shown mixed results concerning the function of social support on HIV risks by gender, it is important to conduct a gender-specific analysis. METHODS To assess the relationship between mental health needs, social support, and HIV risk behaviors, and to assess if social support can be a buffer, weakening the effect of mental health needs on HIV risk, in 2018, we analyzed representative, cross-sectional data from 2016 BRFSS collected from 33,705 individuals from four states in the United States, stratified by gender. Weighted logistic regression analyses, adjusted for age, race, marital status, education, and annual income, assessed the correlation between mental health needs, social support, and HIV risk behaviors. Furthermore, interaction analyses were performed to see if social support modifies the slope of mental health needs as a function of HIV risk behaviors. RESULTS For both genders, the odds of participating in HIV risk behaviors increase with mental health needs and decrease with the level of social support. Furthermore, social support mitigates the association between mental health needs and HIV risk behavior involvement for males, as males receiving high level of social support have least odds of HIV risk behaviors relative to males receiving low level of social support. Notably, for females, social support does not serve as a buffer against HIV risk behaviors when their mental health needs increase. CONCLUSION The study contributes to the knowledge base of HIV prevention and highlights the important role of mental health and social support against HIV risk behaviors when developing gender-specific prevention strategies.
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Affiliation(s)
- Lin Fang
- University of Toronto, Factor-Inwentash Faculty of Social Work, 246 Bloor St West, Toronto, Ontario M5S1V4 Canada
| | - Deng-Min Chuang
- University of Toronto, Factor-Inwentash Faculty of Social Work, 246 Bloor St West, Toronto, Ontario M5S1V4 Canada
| | - Maria Al-Raes
- University of Toronto, Factor-Inwentash Faculty of Social Work, 246 Bloor St West, Toronto, Ontario M5S1V4 Canada
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Harling G, Gumede D, Shahmanesh M, Pillay D, Bärnighausen TW, Tanser F. Sources of social support and sexual behaviour advice for young adults in rural South Africa. BMJ Glob Health 2018; 3:e000955. [PMID: 30498588 PMCID: PMC6254751 DOI: 10.1136/bmjgh-2018-000955] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 09/18/2018] [Accepted: 09/22/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction While young people in sub-Saharan Africa (SSA) are at greatest risk of HIV acquisition, uptake of HIV prevention interventions among them has been limited. Interventions delivered through social connections have changed behaviour in many settings, but not to date in SSA. There is little systematic evidence on whom young SSA adults turn to for advice. We therefore conducted an exploratory cross-sectional study from whom young rural South Africans received support and sexual behaviour-specific advice. Methods We asked 119 18–34 year olds in rural KwaZulu-Natal about the important people in their lives who provided emotional, informational, financial, physical, social or other support. We also asked whether they had discussed sex or HIV prevention with each contact named. We used descriptive statistics and logistic regression to analyse support and advice provision patterns. Results Respondents named 394 important contacts, each providing a mean of 1.7 types of support. Most contacts were relatives, same-gender friends or romantic partners. Relatives provided most informational, financial and physical support; friends and partners more social support and sexual advice. Respondents reported discussing sexual matters with 60% of contacts. Sources of support changed with age, from friends and parents, towards siblings and partners. Discussion Sexual health interventions for young adults in rural South Africa may be able to harness friend and same-generation kin social ties through which sex is already discussed, and parental ties through which other forms of support are transmitted. The gender-segregated nature of social connections may require separate interventions for men and women.
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Affiliation(s)
- Guy Harling
- Institute for Global Health, University College London, London, UK.,Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
| | - Dumile Gumede
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
| | - Maryam Shahmanesh
- Institute for Global Health, University College London, London, UK.,Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
| | - Deenan Pillay
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa.,Division of Infection and Immunity, University College London, London, UK
| | - Till W Bärnighausen
- Institute for Global Health, University College London, London, UK.,Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa.,Department of Global Health and Development, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Frank Tanser
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa.,School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.,Centre for the AIDS Programme of Research in South Africa - CAPRISA, University of KwaZulu-Natal, Congella, South Africa
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