The objective of this paper is to address the scarcity of research on alcohol marketing exposure and underage drinking in sub-Saharan Africa. This study examines perceptions of alcohol advertisements and perceived peer, adult, and parental attitudes regarding alcohol use and intentions to drink among vulnerable youth. The Kampala Youth Survey is a cross-sectional study conducted in 2014 with service-seeking youth (ages 12-18 years) living in the slums of Kampala (n=1,134) who were participating in Uganda Youth Development Link drop-in centers. Survey measures assessed perceptions of alcohol ads, social norms regarding alcohol use, and intentions to drink alcohol. Chi-square tests and structural equation modeling analyses were computed. Among participants, 32% reported intentions to drink alcohol. In fully adjusted multivariable models, current drinking status (AdjOR=5.13; 95%CI:3.93, 6.72) and perceived attractive alcohol ads (AdjOR=3.71; 95%CI:2.88, 4.78) were most strongly associated with the intention to drink. Analyses examining social norms as a moderator between perceptions of alcohol ads and intention to drink found that peer networks that disapproved of drinking were protective against intent to drink. Perceived alcohol advertisement effectiveness and peer networks supportive of alcohol use are associated with intentions to drink among both boys and girls in Kampala and are not buffered by parental disapproval of drinking. Reducing exposure to alcohol marketing and developing prevention programs that strengthen peer networks disapproving of underage alcohol use and reduce exposure to alcohol marketing may be promising strategies among these vulnerable youth.
Stronger alcohol policies predict decreased alcohol consumption and binge drinking in the United States. We examined the relationship between the strength of states' alcohol policies and alcoholic cirrhosis mortality rates.We used the Alcohol Policy Scale (APS), a validated assessment of policies of the 50 US states and Washington DC, to quantify the efficacy and implementation of 29 policies. State APS scores (theoretical range, 0-100) for each year from 1999 through 2008 were compared with age-adjusted alcoholic cirrhosis death rates that occurred 3 years later. We used Poisson regression accounting for state-level clustering and adjusting for race/ethnicity, college education, insurance status, household income, religiosity, policing rates, and urbanization.Age-adjusted alcoholic cirrhosis mortality rates varied significantly across states; they were highest among males, among residents in states in the West census region, and in states with a high proportion of American Indians/Alaska Natives (AI/ANs). Higher APS scores were associated with lower mortality rates among females (adjusted incidence rate ratio [IRR], 0.91 per 10-point increase in APS score; 95% confidence interval [95% CI], 0.84-0.99) but not among males (adjusted IRR, 0.97; 95% CI, 0.90-1.04). Among non-AI/AN decedents, higher APS scores were also associated with lower alcoholic cirrhosis mortality rates among both sexes combined (adjusted IRR, 0.89; 95% CI, 0.82-0.97). Policies were more strongly associated with lower mortality rates among those living in the Northeast and West census regions than in other regions.Stronger alcohol policy environments are associated with lower alcoholic cirrhosis mortality rates. Future studies should identify underlying reasons for racial/ethnic and regional differences in this relationship.
Harmful alcohol use is a leading risk factor for injury-related death and disability in low- and middle-income countries (LMICs). Brief negotiational interventions (BNIs) in emergency departments (EDs) effectively reduce alcohol intake and re-injury rates. However, most BNIs are developed in high-income countries, with limited evidence of their effectiveness in LMICs. To address this gap, we culturally adapted a BNI for alcohol-related injury patients at Kilimanjaro Christian Medical Centre (KCMC), a tertiary hospital in Tanzania. Our study followed the ADAPT guidance to culturally adapt an existing high-income country BNI for use in the KCMC, a tertiary hospital in Tanzania. The adaptation included: 1) a systematic review of effective alcohol harm reduction interventions in similar settings; 2) consultations with local and international healthcare professionals experienced in counseling and substance abuse treatment; 3) group discussions to refine goals and finalize adaptations. The adapted BNI protocol and assessment scales ensured intervention fidelity. At KCMC, 30% of injury patients screened positive for alcohol use disorder (AUD), with a five-fold increased risk of injury, primarily from road traffic accidents and violence. A systematic review highlighted limited data on patient-level interventions in low-resource settings. Our adapted BNI, ‘ Punguza Pombe Kwa Afya Yako (PPKAY)’, based on the FRAMES model, showed high feasibility and acceptability, with 84% of interventions achieving ≥80% adherence and 98% patient satisfaction. PPKAY is the first culturally adapted alcohol BNI for injury patients in an African ED. Our study demonstrates our approach to adapting substance use interventions for use in low resource settings and shows that cultural adaptation of alcohol use interventions is feasible, beneficial and empowering for our team. Our study lays a framework and method for other low resourced settings to integrate cultural adaptation into the implementation of a BNI in low resource EDs.
The Rainbow Family of Living Light (RFLL), a large communal group with no centralized authority, has held an annual gathering on U.S. federal land for the past 34 years. In 2005, RFLL held its annual gathering in the Monongahela National Forest in West Virginia. Surveillance for injuries was established at nearby emergency departments and participants were asked to complete a health and risk assessment. We found that the majority of injuries resulted from outdoor activities and were not associated with violence. Assessments indicate that this is a medically underserved population and that participants would benefit from preventive and crisis services. We recommend early collaborative planning with RFLL members to reduce the potential for burden on local emergency departments and to meet the health care needs of this group. Future host communities should consider providing minor care, health screening, and information or referral services near the main gathering site.
Africa is the second-largest continent by population.1 With 54 countries across five geographical regions (Northern, Western, Middle, Eastern, and Southern Africa), the continent boasts great geographical, cultural, and population diversity. Breast cancer (BC) exhibits substantial variability across African populations. BC has become a serious health concern globally. According to the Global Cancer Observatory, BC is the second-leading cause of cancer death and the most common cancer type among women worldwide, occurring in 24% of all women (approximately 2.1 million cases in 2018).2 Although relatively low (Fig (Fig1),1), BC incidence in Africa is rising rapidly, especially in sub-Saharan Africa (SSA).3,4 The 2030 BC burden in SSA is projected to be twice the 2012 BC burden.4 SSA encompasses multiple low- and middle-income countries (LMICs), which have low gross domestic product per capita and human development index; many of these countries are in West Africa (WA) (Table (Table11).5
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FIG 1
Estimated age-standardized BC incidence rates per 100,000 people in countries in WA. All data presented were obtained from 2018 GLOBOCAN reports. BC, breast cancer; GLOBOCAN, Global Cancer Observatory; WA, West Africa.
