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Steele B, Martin M, Sciarra A, Melendez-Torres GJ, Degli Esposti M, Humphreys DK. The Prevalence of Sexual Assault Among Higher Education Students: A Systematic Review With Meta-Analyses. TRAUMA, VIOLENCE & ABUSE 2024; 25:1885-1898. [PMID: 37728132 PMCID: PMC11155219 DOI: 10.1177/15248380231196119] [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] [Indexed: 09/21/2023]
Abstract
Sexual assault among higher education students has detrimental impacts on the health and educational outcomes of survivors. This systematic review aims to describe and synthesize the available quantitative evidence on sexual assault prevalence among this population. We searched Medline, EMBASE, Global Health, PsycINFO, Web of Science, ERIC, and CINAHL for studies published in English, French, Italian, and Spanish from database inception to August 2020 (updated May 2022). We screened studies using prespecified inclusion criteria for the population and context (registered higher education students), condition (self-reported sexual assault), and study design (quantitative survey). The Joanna Briggs Institute Critical Appraisal Checklist was used to assess study quality. Prevalence estimates disaggregated by type of sexual assault, gender identity, and world region were meta-analyzed using a random-effects model and reported following PRISMA guidance. We identified 131 articles, from 21 different countries. The meta-analyzed prevalence of sexual assault was 17.5% for women, 7.8% for men, and 18.1% for transgender and gender diverse people. Four types of sexual assault were identified: rape, attempted rape, forced sexual touching, and coercive sex. Forced sexual touching was the most common act experienced. The African Region had the highest prevalence estimates for women's sexual assault, and the Western Pacific region had the highest prevalence estimates for men's sexual assault. Higher education institutions, especially those outside of the United States, should commit to the implementation of surveys to monitor sexual assault prevalence and dedicate increased resources to supporting student survivors of sexual assault.
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Anguzu R, Walker RJ, Beyer KMM, Zhou Y, Babikako HM, Dickson-Gomez J, Cassidy LD. Spatial accessibility to health facilities among pregnant women with and without exposure to intimate partner violence in Uganda. BMC Pregnancy Childbirth 2023; 23:767. [PMID: 37924014 PMCID: PMC10623746 DOI: 10.1186/s12884-023-06084-5] [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: 03/24/2021] [Accepted: 10/25/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Poor physical access to health facilities could increase the likelihood of undetected intimate partner violence (IPV) during pregnancy. We aimed to determine sub-regional differences and associations between spatial accessibility to health facilities and IPV among pregnant women in Uganda. METHOD Weighted cross-sectional analyses were conducted using merged 2016 Uganda Demographic and Health Survey and 2014 Uganda Bureau of Statistics health facility datasets. Our study population were 986 women who self-reported being currently pregnant and responded to IPV items. Outcome was spatial accessibility computed as the near point linear distance [< 5 km (optimal) vs. ≥ 5 km (low)] between women's enumeration area and health facility according to government reference cutoffs. Primary independent variable (any IPV) was defined as exposure to at least one of physical, emotional, and sexual IPV forms. Logistic regression models were sequentially adjusted for covariates in blocks based on Andersen's behavioral model of healthcare utilization. Covariates included predisposing (maternal age, parity, residence, partner controlling behavior), enabling (wealth index, occupation, education, economic empowerment, ANC visit frequency), and need (wanted current pregnancy, difficulty getting treatment money, afraid of partner, and accepted partner abuse) factors. RESULTS Respondents' mean age was 26.1 years with ± 9.4 standard deviations (SD), mean number of ANC visits was 3.8 (± 1.5 SD) and 492/986 (49.9%) pregnant women experienced IPV. Median spatial accessibility to the nearest health facility was 4.1 km with interquartile range (IQR) from 0.2 to 329.1 km. Southwestern, and Teso subregions had the highest average percentage of pregnant women experiencing IPV (63.8-66.6%) while Karamoja subregion had the highest median spatial accessibility (7.0 to 9.3 km). In the adjusted analysis, pregnant women exposed to IPV had significantly higher odds of low spatial accessibility to nearest health facilities when compared to pregnant women without IPV exposure after controlling for enabling factors in Model 2 (aOR 1.6; 95%CI 1.2, 2.3) and need factors in Model 3 (aOR 1.5; 95%CI 1.1, 3.8). CONCLUSIONS Spatial accessibility to health facilities were significantly lower among pregnant women with IPV exposure when compared to those no IPV exposure. Improving proximity to the nearest health facilities with ANC presents an opportunity to intervene among pregnant women experiencing IPV. Focused response and prevention interventions for violence against pregnant women should target enabling and need factors.
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Affiliation(s)
- Ronald Anguzu
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
- Center for Advancing Population Sciences (CAPS), Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - Rebekah J Walker
- Center for Advancing Population Sciences (CAPS), Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Kirsten M M Beyer
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
- Center for Advancing Population Sciences (CAPS), Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Yuhong Zhou
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Harriet M Babikako
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, New Mulago Gate Road, Kampala, Uganda
| | - Julia Dickson-Gomez
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Laura D Cassidy
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
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Alexander KA, Willie TC, McDonald-Mosley R, Campbell JC, Miller E, Decker MR. Associations Between Reproductive Coercion, Partner Violence, and Mental Health Symptoms Among Young Black Women in Baltimore, Maryland. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP9839-NP9863. [PMID: 31296104 PMCID: PMC6954344 DOI: 10.1177/0886260519860900] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This study examined the associations of reproductive coercion (RC) with mental health of Black adolescent and young adult women. We tested RC as a predictor of depression and post-traumatic stress disorder (PTSD) symptoms. We also explored the interaction of exposure to RC and physical and sexual intimate partner violence (IPV) as they relate to depression and PTSD symptoms. A primarily community-based convenience sample of 188 self-identified Black women, aged 18 to 25 years, in Baltimore, Maryland, completed computer-based cross-sectional surveys. Lifetime RC (37.8%) and IPV (48.9%) were prevalent in this sample. Nearly 10% of the young women reported experiencing RC without IPV; 38% of the sample reported experiencing both types of violence. Depression (69%) and PTSD (47.1%) symptoms were more prevalent among women with RC than among women without RC. Adjusted results revealed RC and IPV were independently associated with depression (adjusted odds ratioRC = 2.86, 95% CI = [1.38, 5.94] and adjusted odds ratioIPV = 5.15, 95% CI = [2.47, 10.76]). Similarly, RC and IPV were independently associated with PTSD (adjusted odds ratioRC = 2.41, 95% CI = [1.15, 5.08] and adjusted odds ratioIPV = 3.04, 95% CI = [1.39, 6.63]). Findings suggest that RC and IPV independently contribute to mental health morbidities among this population of women. Current policies in health care practice increasingly recommend provision of screening for IPV, including RC. These practices should extend to women receiving services in community-based settings, thus strengthening the linkage to referral for further mental health treatment and victim service support. In the context of the social burdens affecting young Black women's health, a comprehensive approach that integrates mental health and reproductive/sexual health care is essential for women reporting RC experiences.
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Affiliation(s)
| | | | | | | | | | - Michele R. Decker
- Bloomberg School of Public Health, Department of Population, Family, and Reproductive Health
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Hassen SM, Mohammed BH. Sexual Violence and Associated Factors Among Female Students at Debre Berhan University, Ethiopia. Cureus 2021; 13:e16189. [PMID: 34367795 PMCID: PMC8336661 DOI: 10.7759/cureus.16189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2021] [Indexed: 11/05/2022] Open
Abstract
Background and objective Sexual violence is a common and serious public health issue affecting millions of women at all stages of their lives. Studies have shown that women in Ethiopia are among the highly affected. There is no study in the literature as yet on the prevalence and factors associated with sexual violence among female students of Debre Berhan University (DBU), Ethiopia. In light of this, this study aimed to assess the prevalence of sexual violence and associated factors among female students at DBU. Methods A Cross-sectional institution-based study was conducted in May 2016 among female regular undergraduate students of DBU. Data was collected using a self-administered questionnaire. Descriptive, binary, and multivariable logistic regression analyses were carried out. Results A total of 627 female students completed the questionnaire (response rate: 91.5%). The mean (SD) age of the students was 20.7 (1.65) years. More than half (54.9%) of the students have been victims of sexual violence in their life. More than one-third (35.6%) of the students have experienced rape, attempted rape, or sexual harassment while they are in DBU. Sexual harassment was the most common form of sexual violence ever experienced by female students (51.8%) followed by attempted rape (12.8%) and rape (9.8%). More than half of the rape victims (35, 57.3%) did not share their experiences with anyone. Multiple logistic regression analyses revealed that Khat-chewing habit and marital status were significantly associated with rape. Conclusion Sexual violence, in general, is high among female students at DBU. Most of the sexual violence occurs outside of the campus and the perpetrators are mostly known to the victims and are trusted and loved by them. Further broad and longitudinal studies are needed to determine the predictors of the problem among female students at DBU and Ethiopia as a whole.
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Affiliation(s)
- Semira Mehammed Hassen
- Obstetrics and Gynecology, School of Nursing, The University of Hong Kong, Hong Kong, HKG
| | - Bedru Hussen Mohammed
- Epidemiology and Public Health, School of Public Health, The University of Hong Kong, Hong Kong, HKG
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Gender Based Violence against Women in Sub-Saharan Africa: A Systematic Review and Meta-Analysis of Cross-Sectional Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030903. [PMID: 32024080 PMCID: PMC7037605 DOI: 10.3390/ijerph17030903] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/24/2020] [Accepted: 01/28/2020] [Indexed: 11/25/2022]
Abstract
This study aimed to systematically review studies that examined the prevalence of gender based violence (GBV) that included intimate partner violence (IPV) and non-IPV among women in sub-Saharan Africa (SSA). This evidence is an important aspect to work towards achieving the Sustainable Development Goals (SDG’s) target of eliminating all forms of violence in SSA. The Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines were followed. Ovid Medline, CINAHL, Cochrane Central, Embase, Scopus and Web of Science were used to source articles with stringent eligibility criteria. Studies on GBV in SSA countries that were published in English from 2008 to 2019 were included. A random effect meta-analysis was used. Fifty-eight studies met the inclusion criteria. The pooled prevalence of IPV among women was 44%, the past year-pooled prevalence of IPV was 35.5% and non-IPV pooled prevalence was 14%. The highest prevalence rates of IPV that were reported included emotional (29.40%), physical (25.87%) and sexual (18.75%) violence. The sub-regional analysis found that women residing in Western (30%) and Eastern (25%) African regions experienced higher levels of emotional violence. Integrated mitigation measures to reduce GBV in SSA should focus mainly on IPV in order to achieve the SDG’s that will lead to sustainable changes in women’s health.
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Beyene AS, Chojenta C, Roba HS, Melka AS, Loxton D. Gender-based violence among female youths in educational institutions of Sub-Saharan Africa: a systematic review and meta-analysis. Syst Rev 2019; 8:59. [PMID: 30803436 PMCID: PMC6388495 DOI: 10.1186/s13643-019-0969-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 01/28/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Gender-based violence is a public health issue. The prevalence of gender-based violence is high in Sub-Saharan Africa. Therefore, this study aims to produce an overall summary estimate on the prevalence of gender-based violence according to different types and its risk factors among female youths in educational institutions of Sub-Saharan Africa. METHODS Studies published in English between 2000 and 2017 were identified by searching electronic databases such as MEDLINE, CINAHL, EMBASE, PsychINFO, and other relevant data bases. Three reviewers independently extracted the data and assessed the quality of studies using the Loney guidelines. The pooled prevalence of gender-based violence and type of GBV was computed using STATA software version 14, and between studies heterogeneity was tested using Cochran's Q test and I2 statistics. Meta-regression analyses were done to identify factors associated with GBV estimates. RESULTS A total of 1377 articles were produced from different databases, and a final 24 articles were included in the review. The overall prevalence of gender-based violence ranged from 42.3% in Nigeria to 67.7% in Ethiopia. The lifetime prevalence of sexual violence ranged from 4.3 to 76.4%, physical violence ranged from 7.4 to 66.1%, and emotional violence prevalence ranged from 26.1 to 50.8%. The overall pooled prevalence of lifetime GBV (n = 7 studies) was 52.83% [95% CI 39.54-65.90%, I2 = 99.1, P < 0.00]. The pooled estimate of sexual violence (n = 23), 26.22% [95% CI 19.48-33.57%, I2 = 99.39, P < 0.00], physical violence (n = 9), 18.86% [95% CI 10.96-28.3%, I2 = 98.98, P < 0.00], and emotional violence (n = 5), 27.06% [95% CI19.57-35.28%], I2 = 97.1, P < 0.00]. The review showed that gender-based violence was significantly associated with place of residence, witnessing parental violence, substance abuse, marital status, and educational status. CONCLUSIONS The overall prevalence of overall gender-based violence, sexual, physical, and emotional violence was high in Sub-Saharan Africa. The lowest prevalence of GBV was observed in Nigeria, and it was highest in Ethiopia. However, the results should be interpreted with caution because of high between studies heterogeneity. Evidence from the review part revealed GBV was significantly associated with place of residence, witnessing parental violence, substance abuse, marital status, and educational status. The Sub-Saharan African countries should develop a comprehensive educational institution-based prevention strategy and effective interventions to mitigate gender-based violence and to specifically achieve the SDG5. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD4201073260.
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Affiliation(s)
- Addisu Shunu Beyene
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia. .,School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
| | - Catherine Chojenta
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Hirbo Shore Roba
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Alemu Sufa Melka
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Deborah Loxton
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
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Violence Exposure and Mental Health of College Students in the United States. Behav Sci (Basel) 2018; 8:bs8060053. [PMID: 29882926 PMCID: PMC6027217 DOI: 10.3390/bs8060053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/03/2018] [Accepted: 05/20/2018] [Indexed: 11/16/2022] Open
Abstract
Background: Despite the well-established link between exposure to violence and mental health problems, less is known about this association among college students. The current study aimed to investigate the association between history of exposure to violence and mental health of American college students. Methods: Healthy Mind Study (HMS, 2016⁻2017) is a national online survey of 41,898 adult college students. The independent variable was lifetime history of exposure to violence (psychological, physical, and sexual). The dependent variables were anxiety, depression, and suicidality. Race, age, gender, sexual orientation, parental education, financial stress, transfer status, enrollment status, and graduate status were covariates. Linear and logistic regression models were used for data analysis. Results: History of exposure to violence was associated with all three aspects of poor mental health, namely general anxiety, depression, and suicidality. These associations were independent of covariates and type of abuse. Conclusions: There is a need to address various mental health needs of college students who have experienced various forms of violence. College students who screen positive for history of violence exposure should be evaluated for anxiety, depression, and suicidal behaviors.
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Psychological Predictors of Sexual Intimate Partner Violence against Black and Hispanic Women. Behav Sci (Basel) 2017; 8:bs8010003. [PMID: 29280969 PMCID: PMC5791021 DOI: 10.3390/bs8010003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 12/19/2017] [Accepted: 12/20/2017] [Indexed: 11/16/2022] Open
Abstract
Background: Although various types of intimate partner violence (IPV) tend to co-occur, risk factors of each type of IPV may differ. At the same time, most of the existing literature on risk factors of IPV among minorities has used a cross-sectional design and has focused on physical rather than sexual IPV. We conducted the current study to compare Black and Hispanic women for psychological predators of change in sexual IPV over time. Methods: Using data from the Fragile Families and Child Wellbeing Study (FFCWS), this study followed 561 Black and 475 Hispanic women with their male partners for four years. Independent variables included male partners' depression, anxiety, problem alcohol use, and male-to-female physical and psychological IPV perpetration. The dependent variable was sexual IPV reported by female partners, measured at baseline, two years, and four years later. Covariates included age, income, marital status and educational level. We used a multi-group latent growth curve model (LGCM) to explain intercept, linear, and quadratic slopes, which represent the baseline, and linear and curvilinear trajectories of male-to-female sexual IPV, where groups were defined based on ethnicity. Results: Psychological IPV was associated with sexual IPV at baseline among both ethnic groups. The male partner's depression was a risk factor for an increase in sexual IPV over time among Black but not Hispanic women. Anxiety, problem alcohol use and physical IPV did not have an effect on the baseline or change in sexual IPV over time. Psychological IPV was not associated with an increase in sexual IPV over time in either ethnic groups. Conclusions: There is a need for screening of sexual IPV in the presence of psychological IPV among minority women. There is also a need for screening and treatment of male partners' depression as a strategy to reduce sexual IPV among Black women.
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Le MTH, Holton S, Nguyen HT, Wolfe R, Fisher J. Poly-victimisation and health risk behaviours, symptoms of mental health problems and suicidal thoughts and plans among adolescents in Vietnam. Int J Ment Health Syst 2016; 10:66. [PMID: 27766114 PMCID: PMC5057246 DOI: 10.1186/s13033-016-0099-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 10/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Limited evidence is available about poly-victimisation (exposure to multiple forms of victimisation) and mental health among adolescents in low and lower-middle-income countries. The aim of this study was to examine the associations between lifetime exposure to poly-victimisation, health risk behaviours, symptoms of common mental health problems and suicidal ideas in the previous year among high school students in Vietnam. METHODS Participants were high school students in rural and urban districts of Hanoi, Vietnam. The data source was an anonymously-completed structured self-report survey. Lifetime exposure to poly-victimisation was assessed using the juvenile victimisation questionnaire revised 2 (JVQ R-2); mental health symptoms by the depression, anxiety and stress scale-21 (DASS-21); involvement in health risk behaviours and previous year suicidal thoughts and plans by questions adapted from the 2013 youth risk behaviour survey. Data were collected between October, 2013 and January, 2014 and were analysed using generalised structural equation modelling. RESULTS In total 1616/1745 (92.6 %) eligible students provided complete data. Prior year suicidal thoughts were reported by 21.4 % (95 % CI 18.5-24.5 %) of the female respondents and 7.9 % (95 % CI 6.2-9.8 %) of the male respondents. Prior year suicidal plans were reported by 7.8 % (95 % CI 5.9-9.8 %) of the girls and 4.0 % (95 % CI 2.7-5.3 %) of the boys. Poly-victimisation was associated with increased likelihood of involvement in health risk behaviours and symptoms of common mental health problems among both sexes, which increased adolescents' risk of having suicidal ideas in the previous year. Compared to non-victims or victims of fewer forms, poly-victims were also more likely to report suicidal thoughts and plans among both girls and boys (p < 0.05). CONCLUSIONS Overall, the results revealed that poly-victimisation was associated with increased involvement in health risk behaviours, poorer mental health and increased risks of suicidal ideas among Vietnamese adolescents. Suicidal ideas were prevalent among the students. Interventions to assist victims of violence and prevention of violence, especially poly-victimisation, among adolescents in Vietnam is therefore important.
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Affiliation(s)
- Minh T H Le
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, 6th Floor, the Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004 Australia
| | - Sara Holton
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, 6th Floor, the Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004 Australia
| | - Huong T Nguyen
- Faculty of Social Sciences, Behaviours and Health Education, Hanoi School of Public Health, 138 Giang Vo street, Ba Dinh district, Hanoi, Vietnam
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Level 6, the Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004 Australia
| | - Jane Fisher
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, 6th Floor, the Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004 Australia
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Tusiime S, Musinguzi G, Tinkitina B, Mwebaza N, Kisa R, Anguzu R, Kiwanuka N. Prevalence of sexual coercion and its association with unwanted pregnancies among young pregnant females in Kampala, Uganda: a facility based cross-sectional study. BMC Womens Health 2015; 15:79. [PMID: 26403674 PMCID: PMC4582936 DOI: 10.1186/s12905-015-0235-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 09/14/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Sexual coercion is associated with sexually transmitted infections and unwanted pregnancies with consequential unsafe abortions and increased maternal morbidity and mortality. Current literature focuses mainly on its risk factors but less on its resultant deleterious health effects. We conducted a study to determine the prevalence of sexual coercion and its association with unwanted pregnancies among young pregnant women. METHODS In a cross-sectional study, four hundred and sixteen (416) consenting pregnant females aged 15-24 years attending antenatal clinics in Lubaga division Kampala district in Uganda were enrolled using systematic sampling. Quantitative and qualitative data on sexual coercion were collected by female interviewers. Adjusted Prevalence Proportion Ratios (Adj. PPRs) of unwanted pregnancy and associated 95 % confidence intervals were estimated by generalized linear models with log link function and Poisson family distribution using robust variance estimator. Quantitative data were analyzed using Stata version 10.0, while qualitative data were analyzed using manifest content analysis. RESULTS Prevalence of sexual coercion was 24 % and was higher among those who had non consensual sexual debut (29.0 %) compared with those who had consensual sexual debut (22.6 %). The prevalence of unwanted pregnancy was 18.3 % and was higher among participants who had been sexually coerced relative to their counterparts (p < 0.001). History of sexual coercion in the past 12 months and non consensual sexual debut were associated with unwanted pregnancy [adj.PPR = 2.23, 95 % CI: (1.49-3.32)] and 1.72, 95 % CI: (1.16- 2.54)] respectively. Qualitative results indicated that different forms/contexts of sexual coercion, such as deception, transactional sex and physical force influenced unwanted pregnancies. DISCUSSION This study highlights that a quarter of our participants in our quantitative study had experienced sexual coercion in the past twelve months and nearly a third of these, had history of non consensual sexual debut. Unwanted pregnancy was higher among the sexually coerced and those who had non consensual sexual debut. CONCLUSION Sexual coercion among pregnant women aged 15-24 years in Kampala, Uganda is high and is significantly associated with unwanted pregnancy. Comprehensive sex education targeting young people (<25 years), along with availability and access to youth friendly centers may be useful in addressing sexual coercion and its negative outcomes.
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Affiliation(s)
- Suzan Tusiime
- School of Public Health Makerere University College of Health Sciences, P.O BOX 7072, Kampala, Uganda.
| | - Geofrey Musinguzi
- School of Public Health Makerere University College of Health Sciences, P.O BOX 7072, Kampala, Uganda.
| | - Benjamin Tinkitina
- School of Public Health Makerere University College of Health Sciences, P.O BOX 7072, Kampala, Uganda.
| | - Norah Mwebaza
- School of Biomedical Sciences Makerere University College of Health Sciences, P.O BOX 7072, Kampala, Uganda.
| | - Rose Kisa
- School of Public Health Makerere University College of Health Sciences, P.O BOX 7072, Kampala, Uganda.
| | - Ronald Anguzu
- School of Public Health Makerere University College of Health Sciences, P.O BOX 7072, Kampala, Uganda.
| | - Noah Kiwanuka
- School of Public Health Makerere University College of Health Sciences, P.O BOX 7072, Kampala, Uganda.
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Raheel H. Depression and Associated Factors among Adolescent Females in Riyadh, Kingdom of Saudi Arabia, A Cross-sectional Study. Int J Prev Med 2015; 6:90. [PMID: 26445637 PMCID: PMC4593237 DOI: 10.4103/2008-7802.165156] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 03/29/2015] [Indexed: 11/27/2022] Open
Abstract
Background: Adolescents who suffer from depression early in life, have an increase in suicidal tendency, anxiety, conduct disorders, substance abuse, and continue to be depressed, later on in life. This study was conducted to identify the prevalence and correlates of depression among adolescent girls in Riyadh city in order to carry out early intervention. Methods: A cross-sectional, school-based survey was conducted among 1028 adolescent girls aged 15–19 years in secondary schools of Riyadh city. Riyadh was divided into clusters and within each cluster, both public and private schools were enrolled. From the selected schools students from grade 10–12 were surveyed. Survey was conducted using a structured questionnaire including the beck depression inventory-II, and questions exploring the correlates of depression. Results: About 30% of participants were found to be depressed. Depression was more prevalent among female adolescents whose household income was <12,000 Saudi Riyal/month (odds ratio [OR] 2.17, confidence interval [CI] 0.97–6.84), did not have a good relationship with peers and family members (OR 4.63, CI 2.56–8.41), lived with single parent or alone (OR 1.77, CI 0.97–3.23), been emotionally abused (OR 3.45, CI 2.56–8.41), and those who had been subjected to physical violence, at least once (OR 3.34, CI 1.89–5.91). Conclusions: Strategies need to be developed to identify early signs and symptoms of depression among Saudi female adolescents. Training can be given to groups of students to help their peers, and also to the teachers to identify, and help students identify early signs of depression and provide them with better-coping strategies to combat progression of depression and anxiety among such adolescents.
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Affiliation(s)
- Hafsa Raheel
- Department of Family and Community Medicine, King Saud University, King Khalid Hospital, Riyadh, KSA
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Bingenheimer JB, Reed E. Risk for coerced sex among female youth in Ghana: roles of family context, school enrollment and relationship experience. INTERNATIONAL PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2014; 40:184-95. [PMID: 25565346 PMCID: PMC4493860 DOI: 10.1363/4018414] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
CONTEXT A better understanding is needed of the variables that may influence the risk of experiencing coerced sex among adolescent females in Sub-Saharan Africa. METHODS Data were collected from 700 female respondents who were interviewed in 2010 and 2012 waves of a longitudinal study of behavioral risk for HIV infection among youth aged 13-14 or 18-19 and living in two towns in southeastern Ghana. A series of logistic regression models examined the influences of household composition and wealth, four family process variables (behavioral control, relationship quality, financial support, conflict), school enrollment and relationship experience on females' risk of experiencing coerced sex. RESULTS Eighteen percent of respondents reported having experienced coerced sex prior to Wave 1, and 13% experienced it between Waves 1 and 2. In both cross-sectional and prospective models, the variable with the strongest association with having experienced coerced sex was having ever had a boyfriend (fully adjusted odds ratios, 4.5 and 2.6, respectively). In cross-sectional analyses, parental behavioral control was negatively associated with risk for coerced sex, while parental conflict was positively associated; these associations were not significant in the prospective analyses. Having a boyfriend appears to be the primary predictor of coerced sex among young females, beyond any influence of family, school or other household variables. CONCLUSIONS More research is needed to understand the context of females' relationships with boyfriends in an effort to reduce the risk of sexual coercion and to promote the prevention of sexual violence perpetrated by males within these relationships.
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Affiliation(s)
- Jeffrey B Bingenheimer
- Assistant professor, Department of Prevention and Community Health, Milken Institute for Public Health, George Washington University, Washington, DC,
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14
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Choudhry V, Östergren PO, Ambresin AE, Kyagaba E, Agardh A. Giving or receiving something for sex: a cross-sectional study of transactional sex among Ugandan university students. PLoS One 2014; 9:e112431. [PMID: 25386901 PMCID: PMC4227706 DOI: 10.1371/journal.pone.0112431] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 10/03/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study sought to determine the prevalence of transactional sex among university students in Uganda and to assess the possible relationship between transactional sex and sexual coercion, physical violence, mental health, and alcohol use. METHODS In 2010, 1954 undergraduate students at a Ugandan university responded to a self-administered questionnaire that assessed mental health, substance use, physical violence and sexual behaviors including sexual coercion and transactional sex. The prevalence of transactional sex was assessed and logistic regression analysis was performed to measure the associations between various risk factors and reporting transactional sex. RESULTS Approximately 25% of the study sample reported having taken part in transactional sex, with more women reporting having accepted money, gifts or some compensation for sex, while more men reporting having paid, given a gift or otherwise compensated for sex. Sexual coercion in men and women was significantly associated with having accepted money, gifts or some compensation for sex. Men who were victims of physical violence in the last 12 months had higher probability of having accepted money, gifts or some compensation for sex than other men. Women who were victims of sexual coercion reported greater likelihood of having paid, given a gift or otherwise compensated for sex. Respondents who had been victims of physical violence in last 12 months, engaged in heavy episodic drinking and had poor mental health status were more likely to have paid, given a gift or otherwise compensated for sex. CONCLUSIONS University students in Uganda are at high risk of transactional sex. Young men and women may be equally vulnerable to the risks and consequences of transactional sex and should be included in program initiatives to prevent transactional sex. The role of sexual coercion, physical violence, mental health, and alcohol use should be considered when designing interventions for countering transactional sex.
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Affiliation(s)
- Vikas Choudhry
- Division of Social Medicine and Global Health, Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
- * E-mail:
| | - Per-Olof Östergren
- Division of Social Medicine and Global Health, Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Anne-Emmanuelle Ambresin
- Multidisciplinary unit for Adolescent Health, Department of Pediatrics, Lausanne University Hospital- CHUV, Lausanne, Switzerland
| | - Emmanuel Kyagaba
- Department of Dean of Students, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Anette Agardh
- Division of Social Medicine and Global Health, Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
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15
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Song Y, Ji CY, Agardh A. Sexual coercion and health-risk behaviors among urban Chinese high school students. Glob Health Action 2014; 7:24418. [PMID: 24836445 PMCID: PMC4023105 DOI: 10.3402/gha.v7.24418] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 04/15/2014] [Accepted: 04/19/2014] [Indexed: 11/30/2022] Open
Abstract
Objective To determine the association between health-risk behaviors and a history of sexual coercion among urban Chinese high school students. Design A cross-sectional study was performed among 109,754 high school students who participated in the 2005 Chinese Youth Risk Behavior Survey. Data were analyzed for 5,215 students who had experienced sexual intercourse (1,483 girls, 3,732 boys). Multivariate logistic regression was used to determine the relationship between sexual coercion and the related covariates, and data were stratified by gender. Results Of those students who had had sexual intercourse, 40.9% of the females and 29.6% of the males experienced sexual coercion (p<0.01). When analyses controlled for demographic characteristics, in the study sample, that is, students who had sexual intercourse, drug use (odds ratios [OR], 2.44), attempted suicide (OR, 2.30), physical abuse (OR, 1.74), binge drinking (OR, 1.62), verbal abuse (OR, 1.29), experience of being drunk (OR, 0.68), and smoking of cigarettes (OR, 0.52) were related to a history of sexual coercion. Patterns of health-risk behaviors also differed among female and male students who had experienced sexual coercion. Conclusions Sexual coercion is associated with health-risk behaviors. Initiatives to reduce the harm associated with sexual coercion among high school students are needed.
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Affiliation(s)
- Yi Song
- Department of Child, Adolescent and Women's Health, Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China; Division of Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Cheng-Ye Ji
- Department of Child, Adolescent and Women's Health, Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China;
| | - Anette Agardh
- Division of Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Lund, Sweden
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16
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Mehra D, Östergren PO, Ekman B, Agardh A. Inconsistent condom use among Ugandan university students from a gender perspective: a cross-sectional study. Glob Health Action 2014; 7:22942. [PMID: 24725363 PMCID: PMC3984407 DOI: 10.3402/gha.v7.22942] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 02/26/2014] [Accepted: 03/04/2014] [Indexed: 11/22/2022] Open
Abstract
Background Feminization of the HIV/AIDS epidemic has been a prominent phenomenon in sub-Saharan Africa. Inconsistent condom use among young people is one of the major risk factors in the continued propagation of the epidemic. Therefore, it is of importance to increase knowledge of gender aspects of condom use among young people. Objective To investigate whether gender differences regarding individual and social factors determine the association between condom efficacy and inconsistent condom use with a new sex partner, among Ugandan university students. Design In 2010, 1954 Ugandan students participated in a cross-sectional survey, conducted at Mbarara University of Science and Technology in southwestern Uganda. A self-administered questionnaire assessed socio-demographic factors, alcohol consumption, sexual behaviors (including condom use and condom efficacy), and peer norms. The data were stratified by sex and examined by multivariate logistic regression analysis. Results A total of 1,179 (60.3%) students reported having had their sexual debut. Of these, 231 (37.4%) males and 209 (49.2%) females reported inconsistent condom use with a new sex partner. Students with low condom efficacy had a higher risk of inconsistent condom use with a new sex partner, even after adjusting for the potential confounders. A synergistic effect was observed between being a female and low condom efficacy with inconsistent condom use. Conclusion The association between inconsistent condom use and low condom efficacy was found among both males and females, but females were found to be at a higher risk of inconsistent condom use compared to their male counterparts. Therefore, gender power relations should be addressed in policies and interventions aiming at increasing condom use among young people in sub-Saharan settings. Programs could be designed with intervention strategies that focus on interactive and participatory educational activities and youth-friendly counseling of young people, which in turn may improve their interpersonal communication and condom negotiation skills with their partners.
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Affiliation(s)
- Devika Mehra
- Division of Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden;
| | - Per-Olof Östergren
- Division of Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Björn Ekman
- Division of Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Anette Agardh
- Division of Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
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Murray LK, Familiar I, Skavenski S, Jere E, Cohen J, Imasiku M, Mayeya J, Bass JK, Bolton P. An evaluation of trauma focused cognitive behavioral therapy for children in Zambia. CHILD ABUSE & NEGLECT 2013; 37:1175-85. [PMID: 23768939 PMCID: PMC3823750 DOI: 10.1016/j.chiabu.2013.04.017] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 04/17/2013] [Accepted: 04/23/2013] [Indexed: 05/31/2023]
Abstract
To monitor and evaluate the feasibility of implementing Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) to address trauma and stress-related symptoms in orphans and vulnerable children (OVC) in Zambia as part of ongoing programming within a non-governmental organization (NGO). As part of ongoing programming, voluntary care-workers administered locally validated assessments to identify children who met criteria for moderate to severe trauma symptomatology. Local lay counselors implemented TF-CBT with identified families, while participating in ongoing supervision. Fifty-eight children and adolescents aged 5-18 completed the TF-CBT treatment, with pre- and post-assessments. The mean number of traumas reported by the treatment completers (N=58) was 4.11. Post assessments showed significant reductions in severity of trauma symptoms (p<0.0001), and severity of shame symptoms (p<0.0001). Our results suggest that TF-CBT is a feasible treatment option in Zambia for OVC. A decrease in symptoms suggests that a controlled trial is warranted. Implementation factors monitored suggest that it is feasible to integrate and evaluate evidence-based mental health assessments and intervention into programmatic services run by an NGO in low/middle resource countries. Results also support the effectiveness of implementation strategies such as task shifting, and the Apprenticeship Model of training and supervision.
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Affiliation(s)
- Laura K Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, 8th Floor, 624 N. Broadway, Baltimore, MD, 21205, ; ; ;
| | - Itziar Familiar
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, 8th Floor, 624 N. Broadway, Baltimore, MD, 21205, ; ; ;
| | - Stephanie Skavenski
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, 8th Floor, 624 N. Broadway, Baltimore, MD, 21205, ; ; ;
| | - Elizabeth Jere
- Catholic Relief Services, Zambia, Longolongo Rd. Lusaka, Zambia 10101,
| | - Judy Cohen
- Drexel University College of Medicine, Allegheny General Hospital, Department of Psychiatry, Four Allegheny Center, 8th Floor, Pittsburgh, PA 15212, USA,
| | | | - John Mayeya
- Ministry of Health, City Airport Road, Lusaka, ZAMBIA
| | - Judith K Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, 8th Floor, 624 N. Broadway, Baltimore, MD, 21205, ; ; ;
| | - Paul Bolton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, 8 Floor, Baltimore, MD 21205
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