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Biomedical subjects

Alan J Flisher

Publications and source records attributed to Alan J Flisher.

At least 19 recordsLinked to original sources
PubMed2006

Brief report: methods for collecting sexual behaviour information from South African adolescents--a comparison of paper versus personal digital assistant questionnaires.

Reporting bias in adolescent behavioural research may be overcome with the use of personal digital assistants (PDA) or other computer based technologies. However, there is little insight into the use of these tools among adolescents in low resource settings. We compared self-administered paper questionnaires with PDA questionnaires to collect sexual behaviour data from a sample of 11-19 year olds living in a periurban, Xhosa-speaking community in South Africa. There was a high level of agreement between sexual risk behaviour data collected via each method (kappas> or = 0.50). Data collected from the PDA questionnaires were more complete. Subjectively, adolescents found the use of PDA to be simple and confidential. PDA may be a useful method to collect sensitive, self-reported information from adolescents in resource-limited settings.

Adolescent↗
PubMed2006

Adolescent HIV prevalence, sexual risk, and willingness to participate in HIV vaccine trials.

PURPOSE: To determine human immunodeficiency virus (HIV) prevalence, sexual risk behaviors, and attitudes toward HIV vaccine trials among 11-19 year-olds in a peri-urban community near Cape Town, South Africa. METHODS: We performed HIV antibody testing on oral transudate, and assessed sexual risk behaviors and willingness to participate in HIV vaccine trials using self-administered questionnaires. RESULTS: Of the 510 adolescents selected, 356 (73%) participated. The HIV prevalence of the group was 10.6% (95% confidence interval [CI] 7.5-14.4). One-third of adolescents had experienced sexual debut, with a mean age of 14.6 years. Number of lifetime sexual partners was independently associated with HIV infection (odds ratio [OR] = 1.62; 95% CI 1.1-2.3). In a multivariate analysis, increasing age, female gender, and attending school were independently associated with having had sex. The majority of adolescents (79%) were willing to participate in an HIV vaccine trial. Increasing age and length of residence in the community were significantly associated with willingness to participate (OR = 1.19; 95% CI 1.01-1.4 and OR = 1.14; 95% CI 1.03-1.26, respectively). CONCLUSIONS: The prevalence of HIV and risk behavior among adolescents in this community is high. HIV vaccines are required that target preadolescents. HIV vaccine trials in adolescents in this setting will be facilitated by their willingness to participate.

AIDS Vaccines↗
PubMed2006

Substance use and sexual risk behavior among South African eighth grade students.

We examined the covariation of substance use and various sexual behaviors in 2204 students from one area of South Africa. There was an association between lifetime substance use and both sexual activity and certain sexual risk behaviors. At the most recent sexual encounter, there was an association between substance use and being unfamiliar with one's sexual partner, but no association between substance use and condom use.

Adolescent↗
PubMed2006

Process evaluation of the teacher training for an AIDS prevention programme.

This paper provides a process evaluation of a 6-day teacher training programme which forms part of a sexuality education project. The training aimed at providing teachers with the necessary knowledge and skills to effectively teach a 16-lesson Grade 8 (14 year olds) life skills curriculum consisting of participatory exercises on sexual reproductive health, human immunodeficiency virus (HIV), sexual decision-making, abstinence, consequences of sexual activity, safe sex practices, substance abuse and sexual violence. Questionnaires administered prior to the training, on completion of the training and at two follow-up time periods were analysed as well as participant observation notes. Findings indicate that teachers reported increased confidence and comfort in teaching the sexuality curriculum. However, many struggled with the transfer of sexual reproductive knowledge and facilitative teaching methods into the classroom context. This highlights the need for HIV education to form part of teacher trainee programmes. Ongoing support and engagement with teachers is needed to encourage alternative teaching practices.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Norms for mental health services in South Africa.

BACKGROUND: In the aftermath of apartheid, South Africa has inherited a fragmented, under-resourced and inequitable public sector mental health service. Attempts are being made to reform mental health services, in keeping with new health policy, which proposes the downscaling of psychiatric institutions and the development of community-based services. This study set out to develop a set of service norms for the care of people with severe psychiatric conditions (SPC) in South Africa, to assist the implementation of the new policy. METHODS: A national situation analysis of current public sector mental health services was conducted. A model was developed for estimating the mental health service resource needs of people with SPC. Following consultation with provincial stakeholders, a set of service norms were developed taking into account national indicators from the situation analysis (as a baseline level) and proposals of the model (as a target level). RESULTS: The study recommends an increase in the number of acute psychiatric beds in general hospitals; development of community-based residential care; redistribution of staff from hospital to community services, particularly in rural areas; and the development of information systems to monitor the transitions to community-based care. CONCLUSIONS: The norms proposals presented in this study express mental health service needs in terms of quantifiable service resource and utilisation levels. In doing so, the study attempts to make explicit the assumptions and values on which planning is based.

Community Mental Health Services↗
PubMed2006

A systematic literature review of tobacco use among adults 15 years and older in sub-Saharan Africa.

BACKGROUND: Given that developing countries (and particularly women in these countries) are at increasing risk for tobacco use, the need for hard data to accurately monitor tobacco use in developing countries is needed. The purpose of this review is to synthesize the available prevalence data on current tobacco use among adults in sub-Saharan Africa (SSA). METHODS: Several databases were systematically searched for articles published in peer-reviewed journals at any time during the last century to mid-2005. The search resulted in the retrieval of 54 articles in which the current use of tobacco, cigarettes, cigars and snuff were reported. They were conducted in 14 of the 48 SSA countries. RESULTS: Cross-country comparisons revealed that the prevalence, and intensity (frequency and/or quantity) of tobacco use was higher among males compared to females across all countries. Certain racially classified social groups in South Africa were at increased risk for tobacco use. Males aged between 30 and 49 years used tobacco at higher rates than those younger or older than this age range. Among females, prevalence rates of smoked tobacco use increased steadily with age. There was no clear pattern regarding socio-economic status (SES) or urban/rural differences. The onset of tobacco use mostly occurs in late adolescence or early adulthood. CONCLUSIONS: While in many SSA countries the prevalence of tobacco use among adults is relatively low compared to developed and other developing countries, prevention, interventions and policies should work towards reducing these levels by targeting the at risk populations identified from this review.

Adolescent↗
PubMed2006

A pilot study of an intervention to prevent negative mental health consequences of forensic mortuary work.

This preliminary study investigated an intervention to mitigate mental health effects of forensic mortuary work. Fourteen peer-nominated opinion leaders at two mortuaries were trained in traumatic stress management methods. Effect was examined on variables assessing stress management and effects of traumatic stress. Sixty-two staff members participated. At baseline, opinion leaders did not differ from their colleagues on any variable. After intervention, opinion leaders had significantly better scores in comparison to coworkers in leisure repertoire, problem solving, and positive states of mind, but no difference in use of avoidance or social support, or in interpersonal relationships. Qualitative data suggests that opinion leaders had increased self-awareness, improved ability to tolerate unchangeable stressors, and increased belief in their ability to make changes.

Adult↗
PubMed2006

Sexual partners in a rural South African setting.

The study investigated sexual behaviors among 1573 rural South Africans in their early and late adolescents and young adults. The participants reported their number of sexual partners and behaviors related to sexual experience, including age of their first sexual experience, use of contraceptives, use of substances, and anal sex. The data from 630 adolescents with sexual experience (males: 362; females: 268) were analyzed to test three sequential models to predict the number of sexual partners from student characteristics (i.e., demographics, use of substances, sexual behaviors). Teenagers with early sexual experience and a history of substance-use tended to have multiple sexual partners, confirming the need for targeted HIV prevention interventions for young people in South Africa.

Adolescent↗
PubMed2006

Promoting sexual and reproductive health in early adolescence in South Africa and Tanzania: development of a theory- and evidence-based intervention programme.

AIMS: Action to prevent the spread of HIV among young people in Sub-Saharan Africa is needed urgently. In order to be effective, such action should be theory and evidence based and carefully adapted to local cultures and contexts. The present article describes the organization, theoretical basis, and methodological approach of a project that aims at developing and evaluating school-based interventions targeting adolescents aged 12-14 years. METHODS: Researchers from European and African universities have developed interventions that were conducted in three sites: Cape Town and Polokwane (South Africa) and Dar es Salaam (Tanzania). In each site the interventions were evaluated through large-scale field experiments with intervention schools and delayed intervention schools and with baseline and two follow-up data collections. Minimum sample sizes were estimated for each site based on local data and taking into account that the unit of allocation was schools and not individual students (the design effect). During the formative phase as well as within the field experiments, qualitative studies were also conducted. DISCUSSION: The interventions were developed consistent with the Intervention Mapping approach, and the theoretical framework was based on a modified version of the Theory of Planned Behaviour. The limitations of Western social cognition models were recognized, and the theoretical framework has therefore been expanded in two directions: towards integrating cultural processes and towards taking societal factors and constraints into account. CONCLUSION: The project will throw light on the application of social cognition models as well as the usefulness of the Intervention Mapping approach to intervention development in sub-Saharan Africa.

Adolescent↗
PubMed2006

Gender differences in depression and smoking among youth in Cape Town, South Africa.

OBJECTIVE: Gender differences in the association between depression and smoking has received inconsistent support among youth in national samples in the United States and other countries. However, the examination of depression and smoking among South African male and female youth has not been sufficiently studied. This paper examines gender differences in the association between depression, racially classified social group (RCSG) status, social amenities, and grade level with smoking among South African youth in Cape Town. DESIGN: Six-hundred twenty students completed a questionnaire on socio-demographic characteristics, smoking, and depression. Separate logistic regression procedures were conducted by gender to assess significant variations in correlates of ever smoker versus never smoker status and current smoker versus nonsmoker status. Variables included in the models were Beck Depression Inventory scores, RCSG, social amenities, and grade level. RESULTS: Primary analyses revealed that among girls, mild and severe depression were significant predictors of ever smoking status. In addition, girls who suffered from mild, moderate, and severe forms of depression were more likely to be current smokers than nonsmokers. Among boys, depression was not a significant predictor of smoking status. CONCLUSIONS: The results support the need to incorporate mental health education strategies into smoking intervention programs, especially among school girls in Cape Town, South Africa.

Adolescent↗
PubMed2006

Rasch modeling of the structure of health risk behavior in South african adolescents.

The study used Rasch analysis to investigate the presence of a syndrome of health risk behavior in South African adolescents. A total of 2186 in-school adolescents participated in the study (males = 1077; females = 1119; age range = 12-16 years; median = 13 years). The data are baseline from a longitudinal study of a leisure-based drug abuse and HIV/AIDS prevention program at Mitchell's Plain in Cape Town, South Africa. The adolescents completed a self-report measure on various health risk vulnerabilities, including use of alcohol, tobacco and other drugs (ATOD), co-occurrence of penetrative sex with use of ATOD, health related self-efficacy, personal beliefs about health, peer perceptions, and use of contraceptives. The Rasch analysis calibrated data on 50 items from the aforesaid conceptually distinct health risk domains. Infit and Outfit mean square statistics and principal components analysis of the standardized residuals suggested a fit of the data to the unidimensional Rasch measurement model. The findings support a syndrome view of health risk in teenagers as proposed by problem behavior theory.

Adolescent↗
PubMed2006

Injury-related behaviour among South African high-school students at six sites.

OBJECTIVES: To document and compare prevalence rates of adolescent injury-related risk behaviours at six sites in South Africa. DESIGN: The identical self-administered instrument was used at all sites. Prevalence rates (with 95% confidence intervals) were calculated taking the multistage cluster sampling strategy into account. SETTING AND SUBJECTS: In Cape Town, Durban, Port Elizabeth and Mankweng participants were drawn from either grades 8 or 9, and grade 11, while in Queenstown and Umtata they were drawn from grade 11 only. We selected 39 schools in Cape Town and Durban, 33 in Port Elizabeth and 20 in each of the rural areas. OUTCOME MEASURES: Road-related risk behaviour, violence, and suicide attempts. RESULTS: Across the sites there were high rates of risk behaviour in all domains. For example, in the 12 months preceding the survey an estimated 52.8% of grade 11 males in Cape Town had travelled in the front seat of a motor vehicle without a seatbelt, 33.0% of grade 8 males in Mankweng had bullied others, while 44.5% of the same group had been bullied, and 18.6% of females in Port Elizabeth had attempted suicide. Rates were lower in rural areas for behaviour involving motor vehicles, but there were no consistent urban-rural findings for violence-related behaviour. Females were at higher risk of suicidal behaviour and males were at higher risk of other injury-related behaviour. CONCLUSIONS: There is a need for effective interventions to reduce the extent of injury-related risk behaviour in adolescents in urban and rural settings.

Adolescent↗
PubMed2006

Secular trends in risk behaviour of Cape Town grade 8 students.

OBJECTIVE: To compare prevalence rates of selected risk behaviours and age of first intercourse of grade 8 students in Cape Town between 1997 and 2004. DESIGN: Cross-sectional surveys in 1997 and 2004. Survival analysis was used to estimate the cumulative incidence of first intercourse. The log-rank statistic was used to compare the survival distributions. When comparing data from the two studies we used a logistic regression model with the factors year, race and age group to test the difference in reported risk behaviours between 1997 and 2004 within each gender. SETTING: Public high schools in Cape Town. SUBJECTS: Multistage cluster samples of 1 437 and 6 266 grade 8 students in 1997 and 2004 respectively. OUTCOME MEASURES: Ever having had sexual intercourse; for those that had, whether any method was used to prevent pregnancy or disease at last intercourse, and (if so) what was used; use of tobacco, alcohol and marijuana; violence-related behaviours; and suicidal behaviour. RESULTS: There was a significant delay in first intercourse in 2004 compared with 1997. For males, levels of condom use were lower in 2004 than in 1997, while for females levels of injectable contraceptive use were lower. There were significant increases in past month use of cigarettes for males and marijuana for both genders. Rates of perpetration of violence behaviour remained stable or decreased from 1997 to 2004, while the rate of suicidal behaviour for males increased. CONCLUSIONS: School-based interventions that address sexual risk behaviours should be expanded to include other risk behaviours.

Adolescent↗
PubMed2005

The assessment of need for mental health services.

BACKGROUND: The field of psychiatric epidemiology has yielded several large and important studies of the prevalence of psychiatric disorders. These surveys have been enhanced by the inclusion of methodologies that reflect the needs for care of the population in question. Clinical studies of psychiatric disorders and unmet needs have focussed on identifying needs and correlating them with service evaluation and satisfaction measures. The association between prevalence, service use and unmet need requires review in order to establish whether there are trends and consistent findings. METHOD: Peer-reviewed studies involving the assessment of need up to the present were included. These were of two broad groups: population-based studies and clinical studies. Studies based on outcome measures, review articles, and child psychiatry, old age, and intellectual disability samples were excluded. We conducted a search of MEDLINE and PSYCHINFO using the key words, "mental health needs","assessment of need", and "needs assessment". In addition, we hand-searched key journals and sought personal communication with researchers in the field. RESULTS: A total of 14 population studies and 19 clinical studies were retrieved. The percentage of the general population who reported at least one need for care ranged from 9.5% to 13.8%. The numbers of needs in psychiatric patients ranged from 3.3 to 8.6. Correlates of unmet need include: unemployment, single status, low quality of life and high disability scores, and the presence of certain psychiatric diagnoses, such as affective psychosis and personality disorders. Higher rates of met need and service satisfaction are correlated with a longer duration of service contact. CONCLUSION: The assessment of need to date has been established either by service use data to make inferences about unmet need, by asking limited guided questions about needs, or by using established needs assessment instruments. The high prevalence of psychiatric disorders and the weak correlation between disorder and unmet need require a combined approach towards service development.

Cross-Cultural Comparison↗
PubMed2005

Epidemiological measurement of children's and adolescents' exposure to community violence: working with the current state of the science.

A number of measures have been used in epidemiological studies of children's exposure to community violence, yet the quality of these instruments is not uniformly good. This paper undertakes a systematic review of the most commonly used (or most promising) self-report or interview-administered instruments, with regard to their conceptual bases and psychometric properties. Based on the review, recommendations are made for working with the current state of the science in order to move the field forward. A key recommendation is for sounder conceptualization of work in the field and greater transparency in the reporting of research, in order to facilitate the comparability of studies.

Adolescent↗
PubMed2005

Introducing HIV/AIDS to South African health sciences students.

Given the burden of HIV/AIDS in South Africa, there is a need to introduce students to the issues health professionals face about the disease. We developed an introductory peer-led workshop on HIV/AIDS for first year students covering a range of biomedical and social issues. To evaluate the workshops, volunteer students were randomly allocated to participate in one of the workshops or not. At follow-up, students who participated in the workshops showed positive changes in their attitudes and skills regarding HIV. They were also more likely to feel empathy towards HIV-infected people and be more comfortable with the prospect of working with HIV-infected patients, compared to controls. This programme represents a platform for introducing a 'golden thread' of HIV/AIDS into health sciences curricula in countries profoundly affected by the epidemic.

Attitude of Health Personnel↗
PubMed2005

Written parental consent in school-based HIV/AIDS prevention research.

OBJECTIVES: We examined the process of obtaining "active," written parental consent for a school-based HIV/AIDS prevention project in a South African high school by investigating (1) parental consent form return rates, (2) parents' recall and knowledge of the research, and (3) the extent to which this consent procedure represented parents' wishes about their child's involvement in the research. METHODS: This cross-sectional descriptive study comprised interviews with parents of children in grades eight and nine in a poor, periurban settlement in Cape Town. RESULTS: Within 2 weeks, 94% of 258 parents responded to a letter requesting written consent and of those, 93% consented, but subsequent interviews showed that 65% remembered seeing the consent form. At the end of the interview, 99% consented to their child's participation. CONCLUSIONS: These findings challenge many of the assumptions underlying active written parental consent. However, they should not be used to deny adolescents at high risk of HIV infection the opportunity to participate in prevention trials. Rather, researchers together with the communities in which the research is undertaken need to decide on appropriate informed consent strategies.

Adolescent↗