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Palermo T, Logan-Greene P, Lima SM, Grooms K, Lillvis D. Systematic Review of the Impacts of US Social Safety Nets on Child Maltreatment. Am J Prev Med 2024:S0749-3797(24)00175-2. [PMID: 38844145 DOI: 10.1016/j.amepre.2024.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 05/29/2024] [Accepted: 05/29/2024] [Indexed: 07/14/2024]
Abstract
INTRODUCTION Children living in poverty are at an increased risk for maltreatment. Social safety net (SSN) programs with antipoverty objectives may reduce child maltreatment through pathways such as reduced food insecurity, lessened caregiver stress, and improved caregiving behaviors and ability to meet children's basic needs. The objective of this study is to conduct a systematic review of evidence on the ability of SSN programs to reduce child maltreatment in the United States (US). METHODS This systematic review was conducted using PRISMA protocol. Among studies published between 1996-2022, the initial search returned 1,873 articles, and 27 papers were included in the final analysis. Abstracts were identified primarily on June 24th, 2022, and extraction and synthesis of data was conducted in 2022-2023. RESULTS Of the 27 papers assessed, 16 studies found that SSN programs were protective against child maltreatment. Three of the reviewed studies found no effect of safety net programs, 4 studies presented mixed findings, and 4 studies found adverse impacts in terms of child maltreatment outcomes. When restricting to high-quality studies only, 10 out of 12 found protective impacts and none found adverse impacts on child maltreatment. DISCUSSION SSNs are associated with protective effects against child maltreatment. Expansion of SSN programs would likely have positive benefits beyond poverty-related objectives, including reducing incidence of child maltreatment.
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Affiliation(s)
- Tia Palermo
- Division of Health Services Policy and Practice, Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York.
| | | | - Sarah M Lima
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York
| | - Kaley Grooms
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Denise Lillvis
- Division of Health Services Policy and Practice, Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York
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Rogers K, Le Kirkegaard R, Wamoyi J, Grooms K, Essajee S, Palermo T. Systematic review of cash plus or bundled interventions targeting adolescents in Africa to reduce HIV risk. BMC Public Health 2024; 24:239. [PMID: 38245689 PMCID: PMC10799364 DOI: 10.1186/s12889-023-17565-9] [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: 07/21/2023] [Accepted: 12/21/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND HIV remains a leading cause of death for adolescents and young people aged 10-24 years. HIV prevention requires multisectoral approaches that target adolescents and young people, addressing HIV risk pathways (e.g., transactional sex, gender-based violence, and school attendance) through bundled interventions that combine economic strengthening, health capabilities, and gender equality education. However, best practices are unknown because evidence on multisectoral programming targeted to adolescents and combining these components has not been systematically reviewed. METHODS We conducted a systematic review to summarize the evidence on bundled interventions combining health and economic strengthening components for adolescents and young people and their effects on HIV/STI incidence and risk factors. We included studies from Africa published between 2005 and 2023, combining at least one economic strengthening and one health component, directed toward adolescents and young people aged 10-24 years. Included studies measured programmatic impacts on primary outcomes: HIV and STI incidence/prevalence; and mediators as secondary outcomes: sexual behaviours, sexual and reproductive health, school attendance, health-seeking behaviours, and violence. We conducted key word searches in PubMed, EMBASE, and Web of Science, imported titles/abstracts from the initial search, and reviewed them using the inclusion criteria. Full texts of selected articles were reviewed and information was extracted for analysis. Findings from the full texts identified were summarized. RESULTS We reviewed 58 studies, including 43 quantitative studies and 15 qualitative studies, evaluating 26 unique interventions. A majority of studies reviewed were conducted in Eastern and Southern Africa. Interventions reviewed showed a greater number of significant results in improving economic outcomes; mental health and psychosocial outcomes; sexual and reproductive health knowledge and services utilization; and HIV prevention knowledge and testing. They showed fewer significant results in improving outcomes related to HIV incidence/prevalence; sexual risk behaviours; gender-based violence; gender attitudes; education; STI incidence, prevalence and testing; and sexual debut. CONCLUSIONS Our review demonstrated the potential for bundled, multisectoral interventions for preventing HIV and facilitating safe transitions to adulthood. Findings have implications for designing HIV sensitive programmes on a larger scale, including how interventions may need to address multiple strata of the social ecological model to achieve success in the prevention of HIV and related pathways.
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Affiliation(s)
- Kate Rogers
- Policy Research Solutions LLC and University at Buffalo, Buffalo, NY, USA.
| | | | - Joyce Wamoyi
- National Institute for Medical Research, Mwanza, Tanzania
| | - Kaley Grooms
- Policy Research Solutions LLC and University at Buffalo, Buffalo, NY, USA
| | | | - Tia Palermo
- Policy Research Solutions LLC and University at Buffalo, Buffalo, NY, USA
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Rudgard WE, Obiesie S, Desmond C, Casale M, Cluver L. Assessing the cost-effectiveness of economic strengthening and parenting support for preventing violence against adolescents in Mpumalanga Province, South Africa: An economic modelling study using non-randomised data. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001666. [PMID: 37590179 PMCID: PMC10434898 DOI: 10.1371/journal.pgph.0001666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/06/2023] [Indexed: 08/19/2023]
Abstract
There is limited evidence around the cost-effectiveness of interventions to reduce violence against children in low- and middle-income countries. We used a decision-analytic model to evaluate the cost-effectiveness of three intervention scenarios for reducing adolescent emotional, physical, and sexual abuse in Mpumalanga Province, South Africa. The intervention scenarios were: 1) Community grant outreach to link households to South Africa's Child Support Grant (CSG) if they are eligible, but not receiving it; 2) Group-based parenting support; and 3) Group-based parenting support 'plus' linkage to the CSG. We estimated average cost-effectiveness ratios (ACERs) for intervention scenarios over a ten-year time horizon, and compared them to a South Africa-specific willingness-to-pay (WTP) threshold (USD3390). Health effects were expressed in disability-adjusted life years (DALYs) averted. Our model considered four combinations of routine service versus trial-based costing, and population-average versus high prevalence of violence. Under routine service costing, ACERs for grant outreach and parenting support were below the WTP threshold when considering a population-average prevalence of violence USD2850 (Lower: USD1840-Upper: USD10,500) and USD2620 (USD1520-USD9800) per DALY averted, respectively; and a high prevalence of violence USD1320 (USD908-USD5180) and USD1340 (USD758-USD4910) per DALY averted, respectively. The incremental cost-effectiveness of parenting support plus grant linkage relative to parenting support alone was USD462 (USD346-USD1610) and USD225 (USD150-USD811) per DALY averted at a population-average and high prevalence of violence, respectively. Under trial-based costing, only the ACER for grant outreach was below the WTP threshold when considering a high prevalence of violence USD2580 (USD1640-USD9370) per DALY averted. Confidence intervals for all ACERs crossed the WTP threshold. In conclusion, grant outreach and parenting support are likely to be cost-effective intervention scenarios for reducing violence against adolescents if they apply routine service costing and reach high risk groups. Combining parenting support with grant linkage is likely to be more cost-effective than parenting support alone.
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Affiliation(s)
- William E. Rudgard
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Sopuruchukwu Obiesie
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Chris Desmond
- School of Economics and Finance, University of Witwatersrand, Johannesburg, South Africa
| | - Marisa Casale
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Wambiya EOA, Gourlay AJ, Mulwa S, Magut F, Mthiyane N, Orindi B, Chimbindi N, Kwaro D, Shahmanesh M, Floyd S, Birdthistle I, Ziraba A. Impact of DREAMS interventions on experiences of violence among adolescent girls and young women: Findings from population-based cohort studies in Kenya and South Africa. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001818. [PMID: 37163514 PMCID: PMC10171651 DOI: 10.1371/journal.pgph.0001818] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/16/2023] [Indexed: 05/12/2023]
Abstract
DREAMS aims to reduce HIV incidence among adolescent girls and young women (AGYW) by tackling drivers of HIV risk including gender-based violence. We evaluate the impact of DREAMS on recent experiences of violence perpetuated by men against AGYW. AGYW cohorts were randomly selected from demographic platforms in South Africa (rural KwaZulu-Natal) and Kenya (Nairobi informal settlements and rural Gem sub-county). AGYW aged 13-22 years were enrolled in 2017 (Nairobi, KwaZulu-Natal) or 2018 (Gem), with annual follow-up to 2019. We described proportions of AGYW who self-reported experiences of violence perpetrated by males in the 12 months preceding the interview, overall and by form (physical, sexual, emotional). We investigated associations with DREAMS (invitation to participate during 2017-2018) through multivariable propensity score-adjusted logistic regression and estimated the causal effect of DREAMS on experiences of violence, under counter-factual scenarios in which all versus no AGYW were DREAMS beneficiaries. Among 852, 1018 and 1712 AGYW followed-up in 2019 in Nairobi, Gem and KZN, respectively, proportions reporting any violence in 2019 were higher in Nairobi (29%) than Gem (18%) and KwaZulu-Natal (19%). By sub-type, emotional and physical violence were more frequently reported than sexual violence. We found no evidence of an impact attributable to DREAMS on overall levels of violence, in any setting. Nor was there evidence of impact on sub-types of violence, with one exception: an increase in physical violence in Nairobi if all, versus no, AGYW were DREAMS beneficiaries (16% vs 11%; +5% difference [95% CI: +0.2%, +10.0%]). Experiences of gender-based violence were common among AGYW, especially in urban settings, and DREAMS had no measurable impact on reducing violence within three years of implementation. Violence prevention programming that reaches more men and the broader community, sustained for longer periods, may yield greater gains in violence reduction than AGYW-focused programming. Additionally, more investment in implementation research is needed to bridge trial-based study findings from efficacy to population-level effectiveness.
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Affiliation(s)
- Elvis Omondi Achach Wambiya
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
- Health and Systems for Health, African Population and Health Research Center, Nairobi, Kenya
| | - Annabelle J. Gourlay
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sarah Mulwa
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Faith Magut
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Nondumiso Mthiyane
- Clinical Research Department, Africa Health Research Institute, Durban, South Africa
- Institute for Global Health, University College London, London, United Kingdom
| | - Benedict Orindi
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Center for Geographic Medicine Research, Kilifi, Kenya
| | - Natsayi Chimbindi
- Clinical Research Department, Africa Health Research Institute, Durban, South Africa
- Institute for Global Health, University College London, London, United Kingdom
- University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Daniel Kwaro
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Maryam Shahmanesh
- Clinical Research Department, Africa Health Research Institute, Durban, South Africa
- Institute for Global Health, University College London, London, United Kingdom
- University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Sian Floyd
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Isolde Birdthistle
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Abdhalah Ziraba
- Health and Systems for Health, African Population and Health Research Center, Nairobi, Kenya
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Cluver LD, Zhou S, Orkin M, Rudgard W, Meinck F, Langwenya N, Vicari M, Edun O, Sherr L, Toska E. Impacts of intimate partner violence and sexual abuse on antiretroviral adherence among adolescents living with HIV in South Africa. AIDS 2023; 37:503-511. [PMID: 36695360 PMCID: PMC9894135 DOI: 10.1097/qad.0000000000003440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE We are failing to reach 95-95-95 for adolescents living with HIV (ALHIV). Sexual abuse and intimate partner violence (IPV) may impact antiretroviral therapy (ART) adherence, with high rates of 17.4 and 29.7%, respectively, across the southern sub-Saharan African region. However, evidence on their associations with adolescent ART adherence remains limited, with only three cross-sectional studies globally. DESIGN A prospective cohort of ALHIV (sample N = 980, 55% female individuals, baseline mean age 13.6 years) were recruited from 53 health facilities in South Africa's Eastern Cape Province and responded to a structured questionnaire at 18-month and 36-month follow-up (2015-2016, 2017-2018). METHODS A repeated-measures random effects model assessed multivariable associations of self-reported sexual abuse and IPV with past-week ART adherence, controlling for individual, socioeconomic, and HIV-related factors. Past-week adherence was defined based on currently taking ART and not having missed any doses in the past 7 days (including weekends). We further fitted a moderation model by sex. RESULTS Fifty-one percent of adolescents reported consistent ART adherence at both time points. Exposure to IPV was associated with lower odds of self-reported ART adherence (aOR 0.39, 95% CI 0.21-0.72, P = 0.003), as was sexual abuse (aOR 0.54, 95% CI 0.29-0.99, P = 0.048). The marginal predicted probability of ART adherence for adolescents with no exposure to either IPV or sexual abuse was 72% (95% CI 70-74%) compared with 38% (95% CI 20-56%) for adolescents with exposure to both IPV and sexual abuse. Moderation results showed similar associations between sexual violence and ART adherence by sex. CONCLUSION Sexual violence prevention and postviolence care may be essential components of supporting adolescent ART adherence. Integration of HIV and violence prevention services will require accessible services and simple referral systems.
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Affiliation(s)
- Lucie D. Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Psychiatry and Mental Health and Centre for Social Science Research
| | - Siyanai Zhou
- Centre for Social Sciences Research, Faculty of Humanities
- Division of Socio-Behavioural Sciences, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town
| | - Mark Orkin
- Wits/Medical Research Council Development Pathways to Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - William Rudgard
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Franziska Meinck
- School of Social and Political Science, University of Edinburgh, Scotland, United Kingdom
- School of Public Health, University of the Witwatersrand, Johannesburg
- North-West University, Optentia Research Focus Area, Vanderbijlpark, South Africa
| | - Nontokozo Langwenya
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Centre for Social Sciences Research, Faculty of Humanities
| | | | - Olanrewaju Edun
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| | - Elona Toska
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Centre for Social Sciences Research, Faculty of Humanities
- Faculty of Humanities, Department of Sociology, University of Cape Town, Cape Town, South Africa
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Ybarra ML. Now Is the Time to Invest in Child and Adolescent Sexual Violence Prevention Programming. JAMA Netw Open 2022; 5:e2240901. [PMID: 36346636 DOI: 10.1001/jamanetworkopen.2022.40901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Michele L Ybarra
- Center for Innovative Public Health Research, San Clemente, California
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Piolanti A, Jouriles EN, Foran HM. Assessment of Psychosocial Programs to Prevent Sexual Violence During Adolescence: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2240895. [PMID: 36346627 PMCID: PMC9644260 DOI: 10.1001/jamanetworkopen.2022.40895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
IMPORTANCE Sexual violence is a public health problem that affects adolescents globally. To our knowledge, no meta-analysis of prevention programs for adolescent sexual violence has been conducted. OBJECTIVE To perform a systematic review and meta-analysis of randomized clinical trials evaluating the efficacy of psychosocial programs for preventing sexual violence during adolescence. DATA SOURCES Peer-reviewed articles published in English were searched in PsycINFO, ERIC, PsycArticles, PubMed, and Web of Science databases through December 2021. STUDY SELECTION Studies were included if they were randomized clinical trials assessing the efficacy of a psychosocial prevention program targeting sexual violence and delivered to adolescents aged 10 to 19 years. DATA EXTRACTION AND SYNTHESIS Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify studies. The quality of individual studies was assessed with the Revised Cochrane Collaboration Risk of Bias tool. A random-effects model was used to pool odds ratios (ORs). Exploratory subgroup and metaregression analyses were performed to evaluate the associations between moderators and effect sizes. MAIN OUTCOMES AND MEASURES Primary outcomes were perpetration of sexual violence, experience of sexual violence, and a composite measure of any perpetration or experience of sexual violence. RESULTS Data were analyzed from 20 trials involving 37 294 adolescents. Compared with control conditions, prevention programs were associated with a significant reduction in the perpetration (OR, 0.83; 95% CI, 0.73-0.95; P = .005) and experience (OR, 0.87; 95% CI, 0.78-0.98; P = .02) of sexual violence, as well as a 13% significant reduction of any sexual violence (OR, 0.87; 95% CI, 0.78-0.97; P = .009). Exploratory analyses of the combination of program setting and participant age indicated that programs that were delivered in school settings and targeted at adolescents aged 15 to 19 years yielded significantly larger effect sizes (Cochran Q = 4.8; P = .03) compared with programs that were either delivered outside of a school setting or targeted younger adolescents. Quality assessment of trials revealed concerns of risk of bias across several included studies. CONCLUSIONS AND RELEVANCE In this meta-analysis, evidence suggested that prevention programs were associated with reducing adolescent sexual violence, especially when implemented at school with older adolescents. However, there is need for additional high-quality research. Prevention of adolescent sexual violence remains understudied compared with other similarly important public health prevention targets.
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Affiliation(s)
- Antonio Piolanti
- Health Psychology Unit, Institute of Psychology, Universität Klagenfurt, Klagenfurt, Austria
| | | | - Heather M. Foran
- Health Psychology Unit, Institute of Psychology, Universität Klagenfurt, Klagenfurt, Austria
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Prencipe L, Houweling TAJ, van Lenthe FJ, Kajula L, Palermo T. Effects of Adolescent-Focused Integrated Social Protection on Depression: A Pragmatic Cluster-Randomized Controlled Trial of Tanzania's Cash Plus Intervention. Am J Epidemiol 2022; 191:1601-1613. [PMID: 35581169 PMCID: PMC9437816 DOI: 10.1093/aje/kwac093] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 03/29/2022] [Accepted: 05/12/2022] [Indexed: 01/29/2023] Open
Abstract
We assessed the impacts of Tanzania's adolescent-focused Cash Plus intervention on depression. In this pragmatic cluster-randomized controlled trial, 130 villages were randomly allocated to an intervention or control arm (1:1). Youth aged 14-19 years living in households receiving governmental cash transfers were invited to participate. The intervention included an intensive period (a 12-session course) and an aftercare period (9 months of mentoring, productive grants, and strengthened health services). We examined intervention impacts on a depressive symptoms scale (10-item Center for Epidemiologic Studies Depression Scale score (range, 0-30)) and rates of depressive symptomatology (score ≥10 points on the scale), recorded at study baseline (April-June 2017), midline (May-July 2018), and endline (June-August 2019). Using intention-to-treat methodology, we employed logistic and generalized linear models to estimate effects for binary and continuous outcomes, respectively. Quantile regression was used to estimate effects across the scale. From 2,458 baseline participants, 941 intervention and 992 control adolescents were reinterviewed at both follow-ups. At endline, the intervention reduced the odds of depressive symptomatology (adjusted odds ratio = 0.67, 95% confidence interval: 0.52, 0.86), with an undetectable mean scale difference (risk difference = -0.36, 95% confidence interval: -0.84, 0.11). Quantile regression results demonstrated an intervention effect along the upper distribution of the scale. Integration of multisectoral initiatives within existing social protection systems shows potential to improve mental health among youth in low-resource settings.
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Affiliation(s)
- Leah Prencipe
- Correspondence to Leah Prencipe, Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands (e-mail: )
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Waidler J, Gilbert U, Mulokozi A, Palermo T. A "Plus" Model for Safe Transitions to Adulthood: Impacts of an Integrated Intervention Layered onto A National Social Protection Program on Sexual Behavior and Health Seeking among Tanzania's Youth. Stud Fam Plann 2022; 53:233-258. [PMID: 35315072 DOI: 10.1111/sifp.12190] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Poverty is a structural driver of risky sexual behaviors. While cash transfers can mitigate some of this risk, complementary interventions have been posited as a way to further reduce multidimensional vulnerability. We examine the impacts of a multicomponent intervention targeted to Tanzanian adolescents on their sexual behaviors and reproductive health. The intervention comprised livelihood and life skills training, mentoring, and health facilities' strengthening. Data come from a cluster randomized controlled trial, where one study arm received the intervention and the other was randomized to control, but both arms participated in a government cash transfer program. Among 1,933 adolescents interviewed over three rounds, we found increases in contraceptive and HIV knowledge. The program also increased health seeking and HIV testing among boys, but slightly reduced age at sexual debut among girls. There were no impacts on contraceptive use, number of sexual partners, or pregnancy. Findings support the value of an adolescent intervention, and the fact that it was delivered within a social protection platform suggests a potential for scalability. Additional efforts are required to delay sexual debut and reduce the number of sexual partners and pregnancy, possibly through addressing supply-side barriers and social norms, or through additional linkages to economic opportunities.
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Affiliation(s)
- Jennifer Waidler
- UNICEF Office of Research-Innocenti, Via degli Alfani 58 50121, Florence, Italy
| | - Ulrike Gilbert
- UNICEF Tanzania, Karume Road, Dar es Salaam, United Republic of Tanzania
| | - Aroldia Mulokozi
- Tanzania Commission for AIDS (TACAIDS), Dar es Salaam, United Republic of Tanzania
| | - Tia Palermo
- Department of Epidemiology at Environmental Health, University of New York at Buffalo, Buffalo, NY, 14214-8001, USA
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Sherr L, Cluver L, Desmond C, Dhaliwal M, Webb D, Aber JL. Accelerating achievement for Africa's adolescents - an innovative initiative. PSYCHOL HEALTH MED 2022; 27:1-13. [PMID: 36471485 DOI: 10.1080/13548506.2022.2147962] [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: 12/12/2022]
Affiliation(s)
- Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| | - Lucie Cluver
- Department of Social Policy & Intervention, University of Oxford, Oxford, UK.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Chris Desmond
- Centre for Rural Health, University of Kwa-Zulu Natal, Durban, South Africa
| | - Mandeep Dhaliwal
- HIV and Health Group, United Nations Development Programme (UNDP), New York, USA
| | - Douglas Webb
- Health and Innovative Financing, HIV and Health Group, United Nations Development Programme (UNDP), New York, USA
| | - J Lawrence Aber
- Steinhardt School of Culture, Education, and Human Development, New York University New York, NY, United States
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