BackgroundLittle has been done to improve the integration of drug use and HIV services in sub-Sah... more BackgroundLittle has been done to improve the integration of drug use and HIV services in sub-Saharan Africa where substance use and HIV epidemics often co-exist.
This study examined data collected from a sample of female sex workers (FSWs) during the first tw... more This study examined data collected from a sample of female sex workers (FSWs) during the first two years of a brief risk-reduction intervention for vulnerable populations that focused on substance use and HIV risk-related behaviours (2007-2009) as part of a rapid assessment and response evaluation study. In 2007, in collaboration with a local non-governmental organisation (NGO), an initiative was begun to roll out targeted harm reduction strategies for drug-using street based FSWs in Durban, South Africa. Data were collected on demographic characteristics, substance use and HIV risk behaviours to tailor these harm reduction strategies with participants. Over the first two years of the intervention, data were collected from 646 FSWs: 428 who reported being at low risk for HIV and 218 who reported being at high risk for HIV (defined as engaging in unprotected sex with sexual partners in the past 90 days). FSWs who had previously been diagnosed with HIV or a sexually transmitted disease (STD) were significantly less likely to report engaging in unprotected sex. Those who used over-the-counter or prescription (OTC/PRE) drugs reported engaging in unprotected sex significantly more often than FSWs who did not use these substances, while those who used heroin were less likely to report unprotected sex. The findings are encouraging in that those who are aware of their HIV status are less likely to engage in risky sexual behaviour, and therefore HIV testing and counselling is recommended. It indicates the need to identify strategies to encourage the likelihood of all FSWs, particularly those who are HIV-positive, to use condoms. It also encourages further research to investigate specific substances as possible predictors of high risk behaviours in high-risk populations of sex workers.
SAHARA J : journal of Social Aspects of HIV/AIDS Research Alliance / SAHARA , Human Sciences Research Council, 2008
This exploratory study examines the links between drug use and high-risk sexual practices and HIV... more This exploratory study examines the links between drug use and high-risk sexual practices and HIV in vulnerable drug-using populations in South Africa, including commercial sex workers (CSWs), men who have sex with men (MSM), injecting drug users (IDUs) and non-injecting drug users who are not CSWs or MSM (NIDUs). A rapid assessment ethnographic study was undertaken using observation, mapping, key informant interviews and focus groups in known 'hotspots' for drug use and sexual risk in Cape Town, Durban and Pretoria. Key informant (KI) and focus group interviews involved drug users and service providers. Purposeful snowball sampling and street intercepts were used to recruit drug users. Outcome measures included drug-related sexual HIV risk behaviour, and risk behaviour related to injection drug use, as well as issues related to service use. HIV testing of drug-using KIs was conducted using the SmartCheck Rapid HIV-1 Antibody Test. Non-injection drug use (mainly cannabis, me...
The rapid assessment aimed to describe drug use and sexual practices that place injection and non... more The rapid assessment aimed to describe drug use and sexual practices that place injection and noninjection drug users (IDUs/NIDUs) at risk for HIV in South Africa. The sample comprised 85 key-informant (KI) and focus-group (FG) interviewees in or serving locations with high levels of drug use in Cape Town, Durban, and Pretoria. HIV testing of drug-using KIs was conducted using the SmartCheck Rapid HIV-1 Antibody Test. The findings indicated that commonly used drugs had differing effects on sexual and drug-use practices. Risky injecting behaviors among IDUs were common, and most interviewees engaged in sex when on drugs, some without condoms. These behaviors were also influenced by trust in intimate relationships. Injection drug users seemed more knowledgeable about HIV transmission than NIDUs, and 20% of IDUs who agreed to HIV screening tested positive. Views about drug- and HIV-intervention services, accessibility, and their efficacy were mixed. The findings suggest greater synergy is needed between drug- and HIV-intervention sectors and that consideration should be given to making various risk-reduction strategies more accessible. The study's limitations have been noted.
International research has suggested that women in the criminal justice system carry a higher bur... more International research has suggested that women in the criminal justice system carry a higher burden of many illnesses than women in the community, especially mental health disorders, substance use disorders, sexually transmitted infections, and a history of violent victimization. Knowledge of these health disparities is often used to advocate for relevant screening and treatment services for women passing through criminal justice custody within US and European settings. However, almost all criminal justice health research has taken place in high-income countries, with little or no research taking place in other countries, especially in South Africa. This baseline analysis compares the health, substance use, and violent victimization of women who have ever been incarcerated to those who have not, in a cross-sectional sample of 720 young, vulnerable, substance-using women in Cape Town, South Africa. Results of univariate tests indicated that women who had ever been incarcerated had worse health, mental health, and sexually transmitted infection indicators and were more likely to report use of substances and to have been victims of physical and sexual assault than women who had never been incarcerated. Passing through the criminal justice system appears to be a marker for a variety of current and/or future health service needs among vulnerable South African women, suggesting that screening, prevention, and treatment referral efforts at the time of intersection with the criminal justice system may reduce health burden for these women.
Social Psychiatry and Psychiatric Epidemiology, 2006
Background This study examined this
relationship between eating disordered behaviors and
exposu... more Background This study examined this
relationship between eating disordered behaviors and
exposure to ideal-type media in a sample of South
African university students, who could be expected to
have reasonably high levels of media exposure. Possible
underlying reasons for this complex relationship
were also investigated. Method It examined the relationship
via both quantitative (using a questionnaire
that included the EAT-26 and a media composite
variable) and qualitative methods (interviews) in the
sample. Results In the quantitative part, sex and level
of media exposure significantly predicted scores on
the EAT-26. Women obtained scores that indicated
they were more ‘‘at risk’’ for anorexia nervosa than
men, especially women with higher levels of media
exposure. In the qualitative part of the study grounded
theory was used to explore how this relationship
was formed. Results indicated that numerous factors,
some related to the media, predispose women to
disordered eating behaviors. The interviewees were
then more likely to use ideal-type media heavily to
sustain their disordered eating behaviors. Heavy use
of the media led participants to attempt a number of
strategies to change their appearance to resemble
those in the media, with various degrees of success.
Conclusion The model developed by the qualitative
research indicated that the media are not necessarily
always the cause of pathological eating, but that they
interact with other factors in the development of
symptoms of anorexia nervosa for these women.
ABSTRACT Formative work to inform interventions aimed at addressing drug and sexual risk behaviou... more ABSTRACT Formative work to inform interventions aimed at addressing drug and sexual risk behaviours among men who have sex with men (MSM) in South Africa highlighted the need to target drug-using MSM with prevention interventions addressing both sexual and drug-related HIV risk. From 2007, in collaboration with two local NGOs, intervention activities were rolled out to vulnerable drug-using MSM. Over the first two years, 3475 drug-using MSM were reached through community outreach that promotes HIV/AIDS prevention and addresses drug risk behaviours and 745 among them were tested for HIV and received their results and 239 of them were referred from HCT to other services. Additionally, 66 individuals were trained to promote HIV/AIDS prevention services and 15 were trained in HCT. Twelve new targeted condom and lubrication services and 7 new HCT outlets were established. MSM reported a variety of high-risk activities including not using condoms for anal sex, having sex while under the influence of alcohol or drugs and sharing needles (among injection drug users). However, MSM were willing to develop risk reduction strategies. Year one and two of the intervention has demonstrated the willingness of the NGOs to broaden their service delivery, improved integration of drug treatment, HIV intervention and other services, and has shown positive results across a number of risk behaviours among MSM.
Research has shown a positive relationship between substance use and delinquent-type behaviours a... more Research has shown a positive relationship between substance use and delinquent-type behaviours among adolescents. The aim of this study is to explore the temporal relationships between these outcomes through secondary data analysis of a longitudinal study of high-school students’ risk behaviours. Two regression models were compared and
gender, socioeconomic status and repeating a grade were found to be consistent predictors
of delinquent-type behaviour. Alcohol (OR: 1.26, CI: 1.02–1.55, p ¼ 0.03) and drug use (OR: 1.10, CI: 1.03–1.16, p ¼ 0.002) in the ordinal regression models were significantly associated with delinquent-type behaviours at Time 2 only. A transition model use was then used to measure delinquent-type behaviours as predicted by the previous time period, and results
indicated that gender and delinquency were predictive of delinquency. Smoking also significantly interacted with delinquent-type behaviour to increase future risk of this behaviour. The findings point to the need for intervening early with adolescents who show delinquent-type behaviour.
Alcohol and other drug use, gender power inequities and violence are key contributors to sexual r... more Alcohol and other drug use, gender power inequities and violence are key contributors to sexual risks for HIV among South African men and women. Little is known about the intersection between these sex-risk behaviours among couples in established heterosexual relationships. We conducted 10 focus-group discussions with men and women in relationships of 1 year or longer recruited from shebeens (informal taverns) in Cape Town, South Africa. Participants described: high levels of alcohol consumption at shebeens; low levels of condom use with main and casual sex partners; gender roles disfavouring women's condom negotiating power that also promoted economic dependency on male partners; men often spending a portion of the household income on alcohol and other drugs and sex with others in shebeens; loss of household income driving women to trade sex to provide for their families; and sexual violence and the exploitation of women occurring in shebeens. Findings highlight how the social contexts of alcohol and other drug use, gender inequitable norms and gender violence promote HIV risk within established heterosexual relationships in South African communities. Evidence of this kind should inform the design of HIV-risk-reduction interventions tailored to heterosexual couples who drink alcohol in shebeens.
A rapid assessment was undertaken with drug using commercial sex workers (CSWs) to investigate pr... more A rapid assessment was undertaken with drug using commercial sex workers (CSWs) to investigate practices putting them at risk for contracting HIV. It included key informant (KI) (N = 67) and focus group (N = 10) interviews in locations with a high prevalence of drug use in Cape Town, Durban and Pretoria, South Africa. HIV testing of KIs was conducted. Cocaine, Ecstasy, heroin and methaqualone are used by CSWs prior to, during and after sex. Drugs enhance the sexual experience and prolong sex sessions. Interviews revealed inconsistent condom use among CSWs together with other risky sexual practices such as needle sharing. Among CSWs who agreed to HIV testing, 34% tested positive. Barriers to accessing drug treatment and HIV treatment and preventive services were identified. Interventions recognizing the role of drug abuse in HIV transmission should be prioritized, and issues of access to services, stigma and power relations must be considered.
Background
Adolescent substance use is a major problem, in and of itself and because it acts as ... more Background
Adolescent substance use is a major problem, in and of itself and because it acts as a risk factor for other problem behaviours. As substance use during adolescence can lead to adverse and often long-term health and social consequences, it is important to intervene early on in order to prevent progression to more severe problems. Brief interventions have been shown to reduce problematic substance use among adolescents and are especially useful for individuals who have moderately risky patterns of substance use. Such interventions can be conducted in school settings. This review set out to evaluate the effectiveness of brief school-based interventions for adolescent substance use.
Objectives
To evaluate the effectiveness of brief school-based interventions on reducing substance use and other behavioural outcomes among adolescents compared to another intervention or assessment-only conditions.
Search methods
We searched 10 electronic databases and six websites on evidence-based interventions, and the reference lists of included studies and reviews, from 1966 to March 2013. We also contacted authors and organisations to identify any additional studies.
Selection criteria
We included randomised controlled trials that evaluated the effects of brief school-based interventions for substance-using adolescents. The primary outcomes were reduction or cessation of substance use. The secondary outcomes were engagement in criminal activity and engagement in delinquent or problem behaviours related to substance use.
Data collection and analysis
We used the standard methodological procedures outlined by The Cochrane Collaboration, including the GRADE approach for evaluating the quality of evidence.
Main results
Six studies involving 1139 participants were included in this review. Overall the quality of evidence was moderate in the information provision comparison, and low or very low in the assessment only comparison. Reasons for downgrading the quality included risk of bias of the included studies, imprecision and inconsistency. Our findings suggested that compared to information provision only, brief interventions (BIs) did not have a significant effect on any substance use (three studies, 732 participants, standardised mean difference (SMD) -0.06; 95% confidence interval (CI) -0.20 to 0.09) or delinquent-type behaviour outcomes among adolescents (two studies, 531 participants, SMD -0.26; 95% CI -0.54 to 0.02). When compared to assessment-only controls, BIs had some significant effects on substance use and delinquent-type or problem behaviours, but high levels of heterogeneity existed between studies and it was not always possible to pool the results. When the comparison was with assessment-only conditions, studies of individual interventions that measured BI effectiveness reported significantly reduced substance use in general and in two studies reduced frequency of alcohol use specifically. When the data were pooled, BIs reduced cannabis frequency (SMD -0.22; 95% CI -0.45 to -0.02) across three studies (n= 407). Cannabis quantity was also reduced by BIs in comparison to assessment only (SMD -60.27; 95% CI -66.59 to -53.95) in one
study (n = 179). However, the evidence for studies that compared brief interventions to assessment-only conditions was generally of low quality. Brief interventions also had mixed effects on participants’ delinquent or problem behaviours.
Authors’ conclusions
There was limited quality evidence that brief school-based interventions were more effective in reducing substance use than the assessment-only condition, but were similar to information provision. There is some evidence for the effectiveness of BI in reducing adolescent substance use, particularly cannabis, when compared to assessment only. However, it is premature to make definitive statements about the effectiveness of brief school-based interventions for reducing adolescent substance use. Further high quality studies examining the relative effectiveness of BIs for substance use and other problem behaviours need to be conducted, particularly in low and middle-income countries.
BackgroundLittle has been done to improve the integration of drug use and HIV services in sub-Sah... more BackgroundLittle has been done to improve the integration of drug use and HIV services in sub-Saharan Africa where substance use and HIV epidemics often co-exist.
This study examined data collected from a sample of female sex workers (FSWs) during the first tw... more This study examined data collected from a sample of female sex workers (FSWs) during the first two years of a brief risk-reduction intervention for vulnerable populations that focused on substance use and HIV risk-related behaviours (2007-2009) as part of a rapid assessment and response evaluation study. In 2007, in collaboration with a local non-governmental organisation (NGO), an initiative was begun to roll out targeted harm reduction strategies for drug-using street based FSWs in Durban, South Africa. Data were collected on demographic characteristics, substance use and HIV risk behaviours to tailor these harm reduction strategies with participants. Over the first two years of the intervention, data were collected from 646 FSWs: 428 who reported being at low risk for HIV and 218 who reported being at high risk for HIV (defined as engaging in unprotected sex with sexual partners in the past 90 days). FSWs who had previously been diagnosed with HIV or a sexually transmitted disease (STD) were significantly less likely to report engaging in unprotected sex. Those who used over-the-counter or prescription (OTC/PRE) drugs reported engaging in unprotected sex significantly more often than FSWs who did not use these substances, while those who used heroin were less likely to report unprotected sex. The findings are encouraging in that those who are aware of their HIV status are less likely to engage in risky sexual behaviour, and therefore HIV testing and counselling is recommended. It indicates the need to identify strategies to encourage the likelihood of all FSWs, particularly those who are HIV-positive, to use condoms. It also encourages further research to investigate specific substances as possible predictors of high risk behaviours in high-risk populations of sex workers.
SAHARA J : journal of Social Aspects of HIV/AIDS Research Alliance / SAHARA , Human Sciences Research Council, 2008
This exploratory study examines the links between drug use and high-risk sexual practices and HIV... more This exploratory study examines the links between drug use and high-risk sexual practices and HIV in vulnerable drug-using populations in South Africa, including commercial sex workers (CSWs), men who have sex with men (MSM), injecting drug users (IDUs) and non-injecting drug users who are not CSWs or MSM (NIDUs). A rapid assessment ethnographic study was undertaken using observation, mapping, key informant interviews and focus groups in known 'hotspots' for drug use and sexual risk in Cape Town, Durban and Pretoria. Key informant (KI) and focus group interviews involved drug users and service providers. Purposeful snowball sampling and street intercepts were used to recruit drug users. Outcome measures included drug-related sexual HIV risk behaviour, and risk behaviour related to injection drug use, as well as issues related to service use. HIV testing of drug-using KIs was conducted using the SmartCheck Rapid HIV-1 Antibody Test. Non-injection drug use (mainly cannabis, me...
The rapid assessment aimed to describe drug use and sexual practices that place injection and non... more The rapid assessment aimed to describe drug use and sexual practices that place injection and noninjection drug users (IDUs/NIDUs) at risk for HIV in South Africa. The sample comprised 85 key-informant (KI) and focus-group (FG) interviewees in or serving locations with high levels of drug use in Cape Town, Durban, and Pretoria. HIV testing of drug-using KIs was conducted using the SmartCheck Rapid HIV-1 Antibody Test. The findings indicated that commonly used drugs had differing effects on sexual and drug-use practices. Risky injecting behaviors among IDUs were common, and most interviewees engaged in sex when on drugs, some without condoms. These behaviors were also influenced by trust in intimate relationships. Injection drug users seemed more knowledgeable about HIV transmission than NIDUs, and 20% of IDUs who agreed to HIV screening tested positive. Views about drug- and HIV-intervention services, accessibility, and their efficacy were mixed. The findings suggest greater synergy is needed between drug- and HIV-intervention sectors and that consideration should be given to making various risk-reduction strategies more accessible. The study's limitations have been noted.
International research has suggested that women in the criminal justice system carry a higher bur... more International research has suggested that women in the criminal justice system carry a higher burden of many illnesses than women in the community, especially mental health disorders, substance use disorders, sexually transmitted infections, and a history of violent victimization. Knowledge of these health disparities is often used to advocate for relevant screening and treatment services for women passing through criminal justice custody within US and European settings. However, almost all criminal justice health research has taken place in high-income countries, with little or no research taking place in other countries, especially in South Africa. This baseline analysis compares the health, substance use, and violent victimization of women who have ever been incarcerated to those who have not, in a cross-sectional sample of 720 young, vulnerable, substance-using women in Cape Town, South Africa. Results of univariate tests indicated that women who had ever been incarcerated had worse health, mental health, and sexually transmitted infection indicators and were more likely to report use of substances and to have been victims of physical and sexual assault than women who had never been incarcerated. Passing through the criminal justice system appears to be a marker for a variety of current and/or future health service needs among vulnerable South African women, suggesting that screening, prevention, and treatment referral efforts at the time of intersection with the criminal justice system may reduce health burden for these women.
Social Psychiatry and Psychiatric Epidemiology, 2006
Background This study examined this
relationship between eating disordered behaviors and
exposu... more Background This study examined this
relationship between eating disordered behaviors and
exposure to ideal-type media in a sample of South
African university students, who could be expected to
have reasonably high levels of media exposure. Possible
underlying reasons for this complex relationship
were also investigated. Method It examined the relationship
via both quantitative (using a questionnaire
that included the EAT-26 and a media composite
variable) and qualitative methods (interviews) in the
sample. Results In the quantitative part, sex and level
of media exposure significantly predicted scores on
the EAT-26. Women obtained scores that indicated
they were more ‘‘at risk’’ for anorexia nervosa than
men, especially women with higher levels of media
exposure. In the qualitative part of the study grounded
theory was used to explore how this relationship
was formed. Results indicated that numerous factors,
some related to the media, predispose women to
disordered eating behaviors. The interviewees were
then more likely to use ideal-type media heavily to
sustain their disordered eating behaviors. Heavy use
of the media led participants to attempt a number of
strategies to change their appearance to resemble
those in the media, with various degrees of success.
Conclusion The model developed by the qualitative
research indicated that the media are not necessarily
always the cause of pathological eating, but that they
interact with other factors in the development of
symptoms of anorexia nervosa for these women.
ABSTRACT Formative work to inform interventions aimed at addressing drug and sexual risk behaviou... more ABSTRACT Formative work to inform interventions aimed at addressing drug and sexual risk behaviours among men who have sex with men (MSM) in South Africa highlighted the need to target drug-using MSM with prevention interventions addressing both sexual and drug-related HIV risk. From 2007, in collaboration with two local NGOs, intervention activities were rolled out to vulnerable drug-using MSM. Over the first two years, 3475 drug-using MSM were reached through community outreach that promotes HIV/AIDS prevention and addresses drug risk behaviours and 745 among them were tested for HIV and received their results and 239 of them were referred from HCT to other services. Additionally, 66 individuals were trained to promote HIV/AIDS prevention services and 15 were trained in HCT. Twelve new targeted condom and lubrication services and 7 new HCT outlets were established. MSM reported a variety of high-risk activities including not using condoms for anal sex, having sex while under the influence of alcohol or drugs and sharing needles (among injection drug users). However, MSM were willing to develop risk reduction strategies. Year one and two of the intervention has demonstrated the willingness of the NGOs to broaden their service delivery, improved integration of drug treatment, HIV intervention and other services, and has shown positive results across a number of risk behaviours among MSM.
Research has shown a positive relationship between substance use and delinquent-type behaviours a... more Research has shown a positive relationship between substance use and delinquent-type behaviours among adolescents. The aim of this study is to explore the temporal relationships between these outcomes through secondary data analysis of a longitudinal study of high-school students’ risk behaviours. Two regression models were compared and
gender, socioeconomic status and repeating a grade were found to be consistent predictors
of delinquent-type behaviour. Alcohol (OR: 1.26, CI: 1.02–1.55, p ¼ 0.03) and drug use (OR: 1.10, CI: 1.03–1.16, p ¼ 0.002) in the ordinal regression models were significantly associated with delinquent-type behaviours at Time 2 only. A transition model use was then used to measure delinquent-type behaviours as predicted by the previous time period, and results
indicated that gender and delinquency were predictive of delinquency. Smoking also significantly interacted with delinquent-type behaviour to increase future risk of this behaviour. The findings point to the need for intervening early with adolescents who show delinquent-type behaviour.
Alcohol and other drug use, gender power inequities and violence are key contributors to sexual r... more Alcohol and other drug use, gender power inequities and violence are key contributors to sexual risks for HIV among South African men and women. Little is known about the intersection between these sex-risk behaviours among couples in established heterosexual relationships. We conducted 10 focus-group discussions with men and women in relationships of 1 year or longer recruited from shebeens (informal taverns) in Cape Town, South Africa. Participants described: high levels of alcohol consumption at shebeens; low levels of condom use with main and casual sex partners; gender roles disfavouring women's condom negotiating power that also promoted economic dependency on male partners; men often spending a portion of the household income on alcohol and other drugs and sex with others in shebeens; loss of household income driving women to trade sex to provide for their families; and sexual violence and the exploitation of women occurring in shebeens. Findings highlight how the social contexts of alcohol and other drug use, gender inequitable norms and gender violence promote HIV risk within established heterosexual relationships in South African communities. Evidence of this kind should inform the design of HIV-risk-reduction interventions tailored to heterosexual couples who drink alcohol in shebeens.
A rapid assessment was undertaken with drug using commercial sex workers (CSWs) to investigate pr... more A rapid assessment was undertaken with drug using commercial sex workers (CSWs) to investigate practices putting them at risk for contracting HIV. It included key informant (KI) (N = 67) and focus group (N = 10) interviews in locations with a high prevalence of drug use in Cape Town, Durban and Pretoria, South Africa. HIV testing of KIs was conducted. Cocaine, Ecstasy, heroin and methaqualone are used by CSWs prior to, during and after sex. Drugs enhance the sexual experience and prolong sex sessions. Interviews revealed inconsistent condom use among CSWs together with other risky sexual practices such as needle sharing. Among CSWs who agreed to HIV testing, 34% tested positive. Barriers to accessing drug treatment and HIV treatment and preventive services were identified. Interventions recognizing the role of drug abuse in HIV transmission should be prioritized, and issues of access to services, stigma and power relations must be considered.
Background
Adolescent substance use is a major problem, in and of itself and because it acts as ... more Background
Adolescent substance use is a major problem, in and of itself and because it acts as a risk factor for other problem behaviours. As substance use during adolescence can lead to adverse and often long-term health and social consequences, it is important to intervene early on in order to prevent progression to more severe problems. Brief interventions have been shown to reduce problematic substance use among adolescents and are especially useful for individuals who have moderately risky patterns of substance use. Such interventions can be conducted in school settings. This review set out to evaluate the effectiveness of brief school-based interventions for adolescent substance use.
Objectives
To evaluate the effectiveness of brief school-based interventions on reducing substance use and other behavioural outcomes among adolescents compared to another intervention or assessment-only conditions.
Search methods
We searched 10 electronic databases and six websites on evidence-based interventions, and the reference lists of included studies and reviews, from 1966 to March 2013. We also contacted authors and organisations to identify any additional studies.
Selection criteria
We included randomised controlled trials that evaluated the effects of brief school-based interventions for substance-using adolescents. The primary outcomes were reduction or cessation of substance use. The secondary outcomes were engagement in criminal activity and engagement in delinquent or problem behaviours related to substance use.
Data collection and analysis
We used the standard methodological procedures outlined by The Cochrane Collaboration, including the GRADE approach for evaluating the quality of evidence.
Main results
Six studies involving 1139 participants were included in this review. Overall the quality of evidence was moderate in the information provision comparison, and low or very low in the assessment only comparison. Reasons for downgrading the quality included risk of bias of the included studies, imprecision and inconsistency. Our findings suggested that compared to information provision only, brief interventions (BIs) did not have a significant effect on any substance use (three studies, 732 participants, standardised mean difference (SMD) -0.06; 95% confidence interval (CI) -0.20 to 0.09) or delinquent-type behaviour outcomes among adolescents (two studies, 531 participants, SMD -0.26; 95% CI -0.54 to 0.02). When compared to assessment-only controls, BIs had some significant effects on substance use and delinquent-type or problem behaviours, but high levels of heterogeneity existed between studies and it was not always possible to pool the results. When the comparison was with assessment-only conditions, studies of individual interventions that measured BI effectiveness reported significantly reduced substance use in general and in two studies reduced frequency of alcohol use specifically. When the data were pooled, BIs reduced cannabis frequency (SMD -0.22; 95% CI -0.45 to -0.02) across three studies (n= 407). Cannabis quantity was also reduced by BIs in comparison to assessment only (SMD -60.27; 95% CI -66.59 to -53.95) in one
study (n = 179). However, the evidence for studies that compared brief interventions to assessment-only conditions was generally of low quality. Brief interventions also had mixed effects on participants’ delinquent or problem behaviours.
Authors’ conclusions
There was limited quality evidence that brief school-based interventions were more effective in reducing substance use than the assessment-only condition, but were similar to information provision. There is some evidence for the effectiveness of BI in reducing adolescent substance use, particularly cannabis, when compared to assessment only. However, it is premature to make definitive statements about the effectiveness of brief school-based interventions for reducing adolescent substance use. Further high quality studies examining the relative effectiveness of BIs for substance use and other problem behaviours need to be conducted, particularly in low and middle-income countries.
Uploads
Papers by Tara Carney
relationship between eating disordered behaviors and
exposure to ideal-type media in a sample of South
African university students, who could be expected to
have reasonably high levels of media exposure. Possible
underlying reasons for this complex relationship
were also investigated. Method It examined the relationship
via both quantitative (using a questionnaire
that included the EAT-26 and a media composite
variable) and qualitative methods (interviews) in the
sample. Results In the quantitative part, sex and level
of media exposure significantly predicted scores on
the EAT-26. Women obtained scores that indicated
they were more ‘‘at risk’’ for anorexia nervosa than
men, especially women with higher levels of media
exposure. In the qualitative part of the study grounded
theory was used to explore how this relationship
was formed. Results indicated that numerous factors,
some related to the media, predispose women to
disordered eating behaviors. The interviewees were
then more likely to use ideal-type media heavily to
sustain their disordered eating behaviors. Heavy use
of the media led participants to attempt a number of
strategies to change their appearance to resemble
those in the media, with various degrees of success.
Conclusion The model developed by the qualitative
research indicated that the media are not necessarily
always the cause of pathological eating, but that they
interact with other factors in the development of
symptoms of anorexia nervosa for these women.
gender, socioeconomic status and repeating a grade were found to be consistent predictors
of delinquent-type behaviour. Alcohol (OR: 1.26, CI: 1.02–1.55, p ¼ 0.03) and drug use (OR: 1.10, CI: 1.03–1.16, p ¼ 0.002) in the ordinal regression models were significantly associated with delinquent-type behaviours at Time 2 only. A transition model use was then used to measure delinquent-type behaviours as predicted by the previous time period, and results
indicated that gender and delinquency were predictive of delinquency. Smoking also significantly interacted with delinquent-type behaviour to increase future risk of this behaviour. The findings point to the need for intervening early with adolescents who show delinquent-type behaviour.
Adolescent substance use is a major problem, in and of itself and because it acts as a risk factor for other problem behaviours. As substance use during adolescence can lead to adverse and often long-term health and social consequences, it is important to intervene early on in order to prevent progression to more severe problems. Brief interventions have been shown to reduce problematic substance use among adolescents and are especially useful for individuals who have moderately risky patterns of substance use. Such interventions can be conducted in school settings. This review set out to evaluate the effectiveness of brief school-based interventions for adolescent substance use.
Objectives
To evaluate the effectiveness of brief school-based interventions on reducing substance use and other behavioural outcomes among adolescents compared to another intervention or assessment-only conditions.
Search methods
We searched 10 electronic databases and six websites on evidence-based interventions, and the reference lists of included studies and reviews, from 1966 to March 2013. We also contacted authors and organisations to identify any additional studies.
Selection criteria
We included randomised controlled trials that evaluated the effects of brief school-based interventions for substance-using adolescents. The primary outcomes were reduction or cessation of substance use. The secondary outcomes were engagement in criminal activity and engagement in delinquent or problem behaviours related to substance use.
Data collection and analysis
We used the standard methodological procedures outlined by The Cochrane Collaboration, including the GRADE approach for evaluating the quality of evidence.
Main results
Six studies involving 1139 participants were included in this review. Overall the quality of evidence was moderate in the information provision comparison, and low or very low in the assessment only comparison. Reasons for downgrading the quality included risk of bias of the included studies, imprecision and inconsistency. Our findings suggested that compared to information provision only, brief interventions (BIs) did not have a significant effect on any substance use (three studies, 732 participants, standardised mean difference (SMD) -0.06; 95% confidence interval (CI) -0.20 to 0.09) or delinquent-type behaviour outcomes among adolescents (two studies, 531 participants, SMD -0.26; 95% CI -0.54 to 0.02). When compared to assessment-only controls, BIs had some significant effects on substance use and delinquent-type or problem behaviours, but high levels of heterogeneity existed between studies and it was not always possible to pool the results. When the comparison was with assessment-only conditions, studies of individual interventions that measured BI effectiveness reported significantly reduced substance use in general and in two studies reduced frequency of alcohol use specifically. When the data were pooled, BIs reduced cannabis frequency (SMD -0.22; 95% CI -0.45 to -0.02) across three studies (n= 407). Cannabis quantity was also reduced by BIs in comparison to assessment only (SMD -60.27; 95% CI -66.59 to -53.95) in one
study (n = 179). However, the evidence for studies that compared brief interventions to assessment-only conditions was generally of low quality. Brief interventions also had mixed effects on participants’ delinquent or problem behaviours.
Authors’ conclusions
There was limited quality evidence that brief school-based interventions were more effective in reducing substance use than the assessment-only condition, but were similar to information provision. There is some evidence for the effectiveness of BI in reducing adolescent substance use, particularly cannabis, when compared to assessment only. However, it is premature to make definitive statements about the effectiveness of brief school-based interventions for reducing adolescent substance use. Further high quality studies examining the relative effectiveness of BIs for substance use and other problem behaviours need to be conducted, particularly in low and middle-income countries.
relationship between eating disordered behaviors and
exposure to ideal-type media in a sample of South
African university students, who could be expected to
have reasonably high levels of media exposure. Possible
underlying reasons for this complex relationship
were also investigated. Method It examined the relationship
via both quantitative (using a questionnaire
that included the EAT-26 and a media composite
variable) and qualitative methods (interviews) in the
sample. Results In the quantitative part, sex and level
of media exposure significantly predicted scores on
the EAT-26. Women obtained scores that indicated
they were more ‘‘at risk’’ for anorexia nervosa than
men, especially women with higher levels of media
exposure. In the qualitative part of the study grounded
theory was used to explore how this relationship
was formed. Results indicated that numerous factors,
some related to the media, predispose women to
disordered eating behaviors. The interviewees were
then more likely to use ideal-type media heavily to
sustain their disordered eating behaviors. Heavy use
of the media led participants to attempt a number of
strategies to change their appearance to resemble
those in the media, with various degrees of success.
Conclusion The model developed by the qualitative
research indicated that the media are not necessarily
always the cause of pathological eating, but that they
interact with other factors in the development of
symptoms of anorexia nervosa for these women.
gender, socioeconomic status and repeating a grade were found to be consistent predictors
of delinquent-type behaviour. Alcohol (OR: 1.26, CI: 1.02–1.55, p ¼ 0.03) and drug use (OR: 1.10, CI: 1.03–1.16, p ¼ 0.002) in the ordinal regression models were significantly associated with delinquent-type behaviours at Time 2 only. A transition model use was then used to measure delinquent-type behaviours as predicted by the previous time period, and results
indicated that gender and delinquency were predictive of delinquency. Smoking also significantly interacted with delinquent-type behaviour to increase future risk of this behaviour. The findings point to the need for intervening early with adolescents who show delinquent-type behaviour.
Adolescent substance use is a major problem, in and of itself and because it acts as a risk factor for other problem behaviours. As substance use during adolescence can lead to adverse and often long-term health and social consequences, it is important to intervene early on in order to prevent progression to more severe problems. Brief interventions have been shown to reduce problematic substance use among adolescents and are especially useful for individuals who have moderately risky patterns of substance use. Such interventions can be conducted in school settings. This review set out to evaluate the effectiveness of brief school-based interventions for adolescent substance use.
Objectives
To evaluate the effectiveness of brief school-based interventions on reducing substance use and other behavioural outcomes among adolescents compared to another intervention or assessment-only conditions.
Search methods
We searched 10 electronic databases and six websites on evidence-based interventions, and the reference lists of included studies and reviews, from 1966 to March 2013. We also contacted authors and organisations to identify any additional studies.
Selection criteria
We included randomised controlled trials that evaluated the effects of brief school-based interventions for substance-using adolescents. The primary outcomes were reduction or cessation of substance use. The secondary outcomes were engagement in criminal activity and engagement in delinquent or problem behaviours related to substance use.
Data collection and analysis
We used the standard methodological procedures outlined by The Cochrane Collaboration, including the GRADE approach for evaluating the quality of evidence.
Main results
Six studies involving 1139 participants were included in this review. Overall the quality of evidence was moderate in the information provision comparison, and low or very low in the assessment only comparison. Reasons for downgrading the quality included risk of bias of the included studies, imprecision and inconsistency. Our findings suggested that compared to information provision only, brief interventions (BIs) did not have a significant effect on any substance use (three studies, 732 participants, standardised mean difference (SMD) -0.06; 95% confidence interval (CI) -0.20 to 0.09) or delinquent-type behaviour outcomes among adolescents (two studies, 531 participants, SMD -0.26; 95% CI -0.54 to 0.02). When compared to assessment-only controls, BIs had some significant effects on substance use and delinquent-type or problem behaviours, but high levels of heterogeneity existed between studies and it was not always possible to pool the results. When the comparison was with assessment-only conditions, studies of individual interventions that measured BI effectiveness reported significantly reduced substance use in general and in two studies reduced frequency of alcohol use specifically. When the data were pooled, BIs reduced cannabis frequency (SMD -0.22; 95% CI -0.45 to -0.02) across three studies (n= 407). Cannabis quantity was also reduced by BIs in comparison to assessment only (SMD -60.27; 95% CI -66.59 to -53.95) in one
study (n = 179). However, the evidence for studies that compared brief interventions to assessment-only conditions was generally of low quality. Brief interventions also had mixed effects on participants’ delinquent or problem behaviours.
Authors’ conclusions
There was limited quality evidence that brief school-based interventions were more effective in reducing substance use than the assessment-only condition, but were similar to information provision. There is some evidence for the effectiveness of BI in reducing adolescent substance use, particularly cannabis, when compared to assessment only. However, it is premature to make definitive statements about the effectiveness of brief school-based interventions for reducing adolescent substance use. Further high quality studies examining the relative effectiveness of BIs for substance use and other problem behaviours need to be conducted, particularly in low and middle-income countries.