Characteristics and Predictors of Heavy Episodic Drinking (HED) among Young People Aged 16-25: The International Alcohol Control Study (IAC), Tshwane, South Africa

Enhancing Alcohol-Related Research in Africa: Possibility for a Continental-Wide Alliance

Alcohol-related harms constitute a major public health concern in Africa, with high rates of alcohol consumption and associated negative health and social consequences. Despite this, there is a lack of comprehensive and coordinated research on alcohol use and related harms across the continent. This paper discusses common factors such as diverse traditions and cultures, prevailing low socioeconomic status, gendered approach, limited policy and weak regulation and compliance to existing alcohol control policies that contribute to alcohol-related problems, and the challenges facing alcohol-related research including limited research, isolated and uncoordinated research, and resource scarcity; it further proposes strategies for advancing a continental-wide alliance to enhance alcohol-related research in Africa. The alliance would bring together researchers, policymakers, and other stakeholders to collaborate on research projects, share data and resources, and develop evidence-based interventions to reduce alcohol-related harms. Furthermore, the paper outlines the potential benefits of such an alliance, including improved data collection and analysis, greater capacity building for researchers, and more effective policy and program development. The paper concludes that a continental-wide alliance on alcohol-related research in Africa has the potential to significantly enhance our understanding of alcohol use and related harms on the continent and to inform effective prevention and intervention strategies.

Project ASPIRE: A feasibility randomized controlled trial of a brief intervention for reducing risk of depression and alcohol-related harms among South African adolescents

OBJECTIVE

Brief interventions could reduce adolescents' risk of depression and alcohol-related harms, but evidence of their feasibility and acceptability for low-and middle-income countries is lacking. To address this gap, we conducted a feasibility trial of the ASPIRE intervention, a four-session multi-component counselling intervention for South African adolescents.

METHOD

We recruited 117 adolescents who met our inclusion criteria. Participants were randomly assigned to the ASPIRE intervention or a comparison condition. Outcomes were assessed at baseline, six-week, and three-month post-randomization time points. Primary outcomes were based on feasibility of study procedures and intervention delivery (assessed on seven predetermined progression criteria). Clinical outcomes (risk of depression and alcohol harms) were secondary.

RESULTS

Despite modifications to all study procedures arising from Covid-19 restrictions, five of the seven key progression criteria were fully met, including: feasibility of data collection and outcome measures, counsellor competencies, randomization and blinding, adverse advents, and acceptability of the intervention. The progression criterion for recruitment and intervention retention were not fully met.

CONCLUSION

Findings suggest that the ASPIRE intervention was generally feasible to deliver and acceptable to adolescents. However, modifications to the trial design and intervention delivery are needed to optimize the validity of a definitive randomized controlled trial of the ASPIRE intervention.

Measuring alcohol use among adolescents in Africa: A systematic scoping review of consumption, screening and assessment tools

ISSUES

Globally, adolescent drinking is a major public health concern. Alcohol measurements are influenced by local consumption practices, patterns and perceptions of alcohol-related harm. This is the first review to examine what tools are used to measure alcohol consumption, or screen for or assess harmful use in African adolescents, and how these tools take into account the local context.

APPROACH

A systematic scoping review was conducted in line with the Arksey and O'Malley framework. A search in MEDLINE, CINAHL, Global Health and the Cochrane Database covered the period of 2000-2020.

KEY FINDINGS

The search identified 121 papers across 25 African countries. A range of single- and multi-item tools were identified. Very few adaptations of existing questions were specified, and this search identified no tools developed by local researchers that were fundamentally different from established tools often designed in the USA or Europe. Inconsistencies were found in the use of cut-off scores; many studies used adult cut-off scores.

IMPLICATIONS AND CONCLUSION

The possible impact of African drinking practices and culture on the accuracy of alcohol screening tools is currently unknown, but is also not taken into account by most research. This, in combination with a limited geographical distribution of alcohol-related research across the continent and inconsistent use of age- and gender-specific cut-off scores, points towards probable inaccuracies in current data on adolescent alcohol use in Africa.

Risk factors for alcohol use among adolescents: The context of township high schools in Tshwane, South Africa

Background

Risk factors for alcohol use originate from many interconnected factors to an interplay of social and physical environments. However, there is a scarcity of data on the contextual risk factors of alcohol use among the adolescents regarding high schools located in townships in South Africa. This study aimed to determine the risk factors for alcohol use among adolescents attending selected township high schools in Tshwane, South Africa.

Method

A validated researcher-administered questionnaire was used to collect data on the demographics, as well as current alcohol use, types, quantity, and frequency among adolescents (n = 403) in the three high schools. Data were analyzed using STATA 17.

Results

The response rate was 97%, with the mean age of 16 ± 2 years for the adolescents. Forty-eight % (48%) of the adolescents reported current alcohol use, which was associated with sex, age, number of children, school grade, repeated grade, spare time job and types, having a pocket money to school, child social grant, transport mode to school, and smoking. The odds of current alcohol use were higher for adolescents in grade 10 [AOR = 6.71; 95% CI: 3.16-14.24], grade 11 [AOR = 4.45; 95% CI: 2.21], grade 12 [AOR = 3.05; 95% CI: 1.47-6.31], repeating a grade [AOR =2 .20; 95% CI: 1.32-3.67), and working during a spare time [AOR = 2.91; 95% CI: 1.33-6.37]. Both sexes had higher odds of alcohol use in the ages of 15-17 and 18-21 years, than adolescents aged 13-14 years.

Conclusion

Key risk factors for alcohol use among learners were sex, age, school grade, repeated grade, and working during a spare time. More evidence-based interventions that would have a greater impact in addressing alcohol use among adolescents, such as focusing on availability, marketing, and taxation of alcoholic beverages, are necessary.

Did COVID-19-Related Alcohol Sales Restrictions Reduce Alcohol Consumption? Findings from a National Online Survey in South Africa

BACKGROUND

South Africa has a high prevalence of heavy episodic drinking (HED). Due to the high levels of alcohol misuse and violence, public hospital intensive care units were often overrun during the COVID-19 pandemic. This research investigated alcohol intake behaviour change during differing levels of lockdown restrictions, which included bans on alcohol sales.

METHODS

A self-reported Facebook survey ran from July to November 2020. The questions included socio-demographics, income, alcohol intake, purchasing behaviour, and reasoning. Chi-square tests/Fisher's exact test for categorical data, Student's t-test for normal continuous data, and the Mann-Whitney U test for non-normal data were applied. Multiple logistic regression was run for HED versus moderate drinkers.

RESULTS

A total of 798 participants took part in the survey, of which 68.4% were female. Nearly 50% of participants fell into the HED category and the majority bought alcohol illegally during restrictions. HED respondents who drank more alcohol than usual during restrictions reported that they felt stressed, needed to relax, and were bored.

CONCLUSIONS

Policies intended to increase the pricing of alcohol may have the potential to reduce alcohol intake. Reducing stress and anxiety may be key to curtailing HED during emergency situations.

Prevalence and Demographic Correlates of Substance Use among Adults with Mental Illness in Eastern Cape, South Africa: A Cross-Sectional Study

This study reports on the prevalence and demographic correlates of substance use among individuals with mental illness in the Eastern Cape, South Africa. This cross-sectional study was conducted in the Outpatient Clinic of a large hospital in the Eastern Cape, South Africa. A pre-validated tool on alcohol and psychoactive drug use was administered to 390 individuals with mental illness. Multivariable logistic regression models were fitted to explore the demographic correlates of alcohol and psychoactive drug use. Of the total participants (N = 390), 64.4% and 33.3% reported lifetime (ever used) and past-year use of alcohol, respectively, but the prevalence of risky alcohol use was 18.5%. After adjusting for relevant covariates, only male sex, younger age, and rural residence remained significantly associated with risky alcohol use. The prevalence of ever-use and past-year use of psychoactive substances was 39.7% and 17.4%, respectively. The most common substance ever used was cannabis (37.4%). Male sex, younger age, owning a business, and being unemployed were significantly associated with higher odds of lifetime and past-year use of psychoactive substances. Findings highlight the need for dedicated infrastructure and staff training in the management of these dual diagnoses in the region.