Material deprivation and unemployment affect coercive sex among young people in the urban slums of Blantyre,Malawi: A multi-level approach

We explore relations among material deprivation (measured by insufficient housing, food insecurity and poor healthcare access), socio-economic status (employment, income and education) and coercive sex. A binary logistic multi-level model is used in the estimation of data from a survey of 1071 young people aged 18–23 years, undertaken between June and July 2013, in the urban slums of Blantyre, Malawi. For young men, unemployment was associated with coercive sex (odds ratio [OR]=1.77, 95% confidence interval [CI]: 1.09–3.21) while material deprivation (OR=1.34, 95% CI: 0.75–2.39) was not. Young women in materially deprived households were more likely to report coercive sex (OR=1.37, 95% CI: 1.07–2.22) than in non-materially deprived households. Analysis of local indicators of deprivation is critical to inform the development of effective strategies to reduce coercive sex in urban slums in Malawi.     

Basic deprivation and involvement in risky sexual behaviour among out-of-school young people in a Lagos slum

Research has shown that in countries such as Nigeria many urban dwellers live in a state of squalour and lack the basic necessities of food, clothing and shelter. The present study set out to examine the association between forms of basic deprivation – such as food deprivation, high occupancy ratio as a form of shelter deprivation, and inadequate clothing – and two sexual outcomes – timing of onset of penetrative sex and involvement in multiple sexual partnerships. The study used survey data from a sample of 480 girls resident in Iwaya community. A survival analysis of the timing of onset of sex and a regression model for involvement in multiple sexual partnerships reveal that among the forms of deprivation explored, food deprivation is the only significant predictor of the timing of onset of sex and involvement in multiple sexual partnerships. The study concludes that the sexual activities of poor out-of-school girls are partly explained by their desire to overcome food deprivation and recommends that government and non-governmental-organisation programmes working with young people should address the problem of basic deprivation among adolescent girls.     

The participation of children and young people in decisions about UK service development

BACKGROUND: The involvement of children and young people in decisions regarding service development is well supported in government policy and underpinned by the UN Convention on the Rights of the Child. Information on the extent, nature and outcomes of children and young people's participation can inform further development in this area. METHODS: Systematic literature searches, plus contact with professional networks, were used to gather and review evidence on children and young people's participation. RESULTS: There is a rapidly developing body of information describing and analysing innovative practices in this field. However, there is also a smaller, but substantial, amount of evidence demonstrating the limited extent of current involvement. A good deal of guidance is now available about how to promote the involvement of children and young people. However, the basis of this advice is not always clear, and more evidence about children's views and their experience of participation in public decision-making is required. Issues identified as barriers to change included adult attitudes and intransigence, lack of training for key adults, lack of clarity leading to tokenism, the nature of organizations (i.e. their formality, complexity, bureaucracy and internal politics) and the short-term nature of much funding. The evidence suggests that good practice includes a listening culture among staff, clarity, flexibility, adequate resources, skills development and training for staff and participating children and young people, inclusion of marginalized groups, feedback and evaluation. There is only limited evidence that children and young people's involvement in public decision-making leads to more appropriate services, although there is evidence that participating children and young people benefit in terms of personal development and that staff and organizations learn more about their views. CONCLUSIONS: The value of the participation of children and young people in public decision-making is now well accepted, and is recognized in the standards set in the Children's National Service Framework. However, there is an urgent need for internal and external evaluations of children's involvement.     

The quality and effectiveness of interventions that target multiple risk factors among young people: a systematic review

Objective: To identify evaluations of interventions that target multiple risk factors in high‐risk young people, describe their characteristics, critique their methodological quality and summarise their effectiveness. Methods: A search of the literature published between 2009 and 2014 identified 13 evaluations of interventions that targeted multiple risk factors, compared to 95 evaluations that targeted single risk factors. The methodological adequacy of the 13 evaluation studies was analysed using the Quality Assessment Tool for Quantitative Studies and information regarding characteristics and intervention effectiveness was extracted and summarised. Results: There were very few outcome evaluation studies of interventions that targeted multiple risk factors, relative to single risk factors, among high‐risk young people. Of the identified studies, half were methodologically weak. Interventions delivered in community settings targeted a greater number of risk factors, while those delivered in a school or health setting reported a higher proportion of statistically significant outcomes. No economic analyses were conducted. Conclusions and Implications for Public Health: More methodologically rigorous evaluations of interventions targeting multiple risk factors among high‐risk young people are required, especially for those delivered in community settings. Four key areas for improvement are: i) more precisely defining the risk factors experienced by high‐risk young people; ii) achieving greater consistency across interventions; iii) standardising outcome measures; and iv) conducting economic analyses.     

A syndemic of psychosocial and mental health problems in Liberia: Examining the link to transactional sex among young pregnant women

ABSTRACT

Transactional sex may be a driver of the rising HIV epidemic in Liberia, especially among young women. The goal of this study was to explore the independent and additive effects of psychosocial conditions on engagement in transactional sex among 191 pregnant women in Monrovia, Liberia. Between March and August 2016, women receiving prenatal services completed a cross-sectional structured questionnaire. These data were used to examine the independent and additive effects of exposure to trauma, depression, post-traumatic stress disorder symptoms, and intimate partner violence on transactional sex. Overall, the results are in support of our hypothesis that these psychosocial conditions cluster together and are independently associated with transactional sex. Multivariate logistic regression analysis demonstrated an additive effect of the number of psychosocial conditions experienced on transactional sex. Women experiencing 2 psychosocial conditions had 5.96 greater odds of engaging in transactional sex compared to women reporting 0 conditions (AOR: 5.96, 95% CI: 2.22–15.99), and women experiencing 3 or 4 psychosocial conditions had 11.91 greater odds of engaging in transactional sex compared to women report 0 conditions (AOR: 11.91, 95% CI: 4.12–34.45). Our results demonstrate the need for comprehensive HIV prevention programming inclusive of mental health support and IPV prevention for Liberian women.     

The normalisation of cannabis use among young people: Symbolic boundary work in focus groups

This paper analyses ‘techniques of neutralisation’ among young people discussing cannabis in focus group interviews. The paper is based on data from focus group interviews with young Danes followed from when they were 14–15 years old in 2004 until they were 18–19 years old in 2008. In this period, the participants' attitudes towards cannabis undergo a radical change from being negative and sceptical into being predominantly positive and accepting; a change we describe as a ‘normalisation’ of cannabis use. Four techniques of neutralisation are identified in this process. First, the participants redefine the setting of cannabis use, simultaneously creating a new type of togetherness: relaxed social intoxication. Second, the effects of cannabis use are transformed from being ‘strange’ and ‘unpredictable’ to being ‘controllable’ by the individual user. Third, participants change their classification of cannabis in relation to other substances. While 14–15 year olds draw a clear dividing-line between alcohol and illegal drugs (including cannabis), 18–19 year olds put cannabis on the same footing as alcohol but differentiate it from ‘hard’ drugs. Fourth, participants dichotomise cannabis use into spontaneous, social use, which they accept, and habitual, individual use which most of them reject. In combination, these four techniques of neutralisation turn cannabis into a normal drug: not normal in the sense that everybody uses it but normal in the sense that cannabis use is seen as legitimate by both users and non-users.     

The weight of place: a multilevel analysis of gender, neighborhood material deprivation, and body mass index among Canadian adults

This study examined the impact of neighborhood material deprivation on gender differences in body mass index (BMI) for urban Canadians. Data from a national health survey of adults (Canadian Community Health Survey Cycles 1.1/2.1) were combined with census tract-level neighborhood data from the 2001 census. Using multilevel analysis we found that living in neighborhoods with higher material deprivation was associated with higher BMI. Compared to women living in the most affluent neighborhoods, women living in the most deprived neighborhoods had a BMI score 1.8 points higher. For women 1.65 m in height (5'4' inches), this translated into a 4.8 kg or 11 lb difference. For men, living in affluent neighborhoods was associated with higher BMI (7 lb) relative to men living in deprived neighborhoods. The relative disadvantage for men living in pockets of affluence and women living in pockets of poverty persisted after adjusting for age, married and visible minority status, educational level, self-perceived stress, sense of belonging, and lifestyle factors, including smoking, exercise, diet, and chronic health conditions. The implication of these disparate findings for men and women is that interventions that lead to healthy weight control may need to be gender responsive. Our findings also suggest that what we traditionally have thought to be triggering factors for weight gain and maintenance of unhealthy BMI-lifestyle and behavioral factors-are not sufficient explanations. Indeed, these factors account for only a portion of the explanation of why neighborhood stress is associated with BMI. Cultural attitudes about the body that pressure women to meet the thin ideal which can lead to an unhealthy cycle of dieting and, subsequent weight gain, and the general acceptability of the heavier male need to be challenged. Education and intervention within a public health framework remain important targets for producing healthy weight.     

Alcohol and other substance use among a sample of young people in the Solomon Islands

Objective: Investigate alcohol and other substance use, with a focus on harmful alcohol use patterns, among young people in the Solomon Islands. Methods: A structured, interviewer‐administered questionnaire was administered to respondents aged 15–24 years across four of the country's provinces in late 2015. Results: Four hundred young people completed the questionnaire across urban, peri‐urban and rural communities. The most common substances ever used by participants were betel nut (94%), licit/store‐bought and/or illicit alcohol (79%) and tobacco (76%). Lifetime and recent substance use was particularly common among male respondents; e.g. 89% of male participants reported ever using any alcohol versus 54% of females (p<0.001). Harmful alcohol use patterns were common. Conclusions: Our sample generally reported higher levels of substance use compared to previous research in the Solomon Islands, including in relation to the country's relatively recent (2012/13) Household Income and Expenditure Survey. Implications for public health: Our study made considerable advances in addressing key knowledge gaps regarding alcohol and other substance use among young people in the Solomon Islands. Evidence‐based initiatives to address early initiation of alcohol and other substance use and the progression to more problematic use patterns among young people in the Solomon Islands need to be explored.     

Constructions of lesbian,gay, bisexual and queer identities among young people in contemporary Australia

This paper focuses on young people's construction of lesbian, gay, bisexual and queer (LGBQ) identities in contemporary Australia. Through the perspectives of young people, it seeks to position their understanding of LGBQ identities alongside current theoretical and empirical debates about the individual and social significance attached to these identity frames. In this qualitative study, 28 young people (aged 18 to 26 years) shared their stories of identifying as LGBQ through online, face-to-face or telephone interviews. The findings highlight how varying elements of LGBQ identities continue to have currency within this group and how young people adopt and refer to these terms interchangeably and in tandem. This is balanced alongside an awareness of both the limitations of lesbian, gay, bisexual and queer identity categories and of the homophobic discourses informing these subject positions. The paper concludes by arguing that health and social care professionals have a integral role to play in supporting LGBQ youth through a process of co-authorship – to work in partnership to construct more enabling self-stories that transcend restrictive identity frames.     

War and HIV: Sex and gender differences in risk behaviour among young men and women in post-conflict Gulu District,Northern Uganda

Despite growing knowledge of the dynamics of HIV infection during conflict, far less is known about the period that follows cessation of hostilities and its implications for population health. This study sought to fill a lacuna in epidemiological evidence by examining HIV infection and related vulnerabilities of young people living in resource-scarce, post-emergency transit camps that are now home to thousands of displaced people following two decades of war in northern Uganda. In 2010, a cross-sectional demographic and behavioural survey was conducted with 384 transit camp residents aged 15–29 years old in Gulu District. Biological specimens were collected for rapid and confirmatory HIV testing. Separate multivariable logistic regression models by sex identified risk factors for HIV infection. HIV prevalence was 15.6% (95% confidence interval [CI]: 10.8%, 21.6%) among females and 9.9% (95% CI: 6.1%, 15.0%) among males. The strongest correlate of HIV infection among men was a non-consensual sexual debut (adjusted odds ratio [AOR] 3.24; 95% CI: 1.37–7.67), and having practiced dry sex (AOR 7.62; 95% CI: 1.56–16.95) was the strongest correlate among women. Conflict-affected men and women experience vulnerability to HIV infection in different ways than may have originally been understood. Post-conflict programme planners must therefore design and implement contextualised, evidence-based responses to HIV that are sensitive to gender and cultural issues.     

武汉市青少年男男性接触者药物滥用及影响因素

目的 了解武汉市青少年男男性接触者药物滥用流行特征及其影响因素。方法 通过同伴推荐、互联网宣传、外展活动的组织以及自愿咨询检测方法,于2013年5月-11月在武汉市对青少年男男性接触者(YMSM)进行匿名问卷调查。结果 397名YMSM中,22.9%(91/397)吸食过兴奋类药物,18.7%(17/91)经常吸食;药物滥用YMSM平均年龄为(21.8±2.2)岁,35.2%(32/91)药物滥用YMSM来自学生群体。82.4%(75/91)YMSM在吸食药物后与同性发生过性行为。42.7%(32/75)报告每次均使用安全套。本次调查人群艾滋病病毒(HIV)总体感染率为6.8%(27/397),其中药物滥用者HIV感染率为12.1%(11/91),高于无药物滥用YMSM中HIV感染率为5.2%(16/308)(χ²=5.290,P=0.021)。活动场所为网吧(OR=1.798,95% CI=1.001~3.229),首次喜欢同性年龄在≤15岁的YMSM(OR=1.917,95% CI=1.126~3.266)更可能滥用药物。结论 药物滥用YMSM人群中HIV感染者比例较大,对药物滥用的YMSM人群应重点干预。     

Nae job,nae future: young people and health in a context of unemployment*

There is increasing concern about the health, particularly mental health, of young people and the factors that affect it. Drawing on data from the West of Scotland Twenty-07 Study: Health in the Community, this paper describes the pattern of health in a cohort of about 1000 young people between the ages of 15 and 21, within a context of their experience and expectations of unemployment. Contrary to assumptions of healthiness, high levels of poor physical and mental health were found, with a third of males and two-fifths of females exhibiting evidence of psychological morbidity at age 18. Poorer mental health was strongly linked to the experience of unemployment and being at home, the latter predominantly involving females. This effect was confirmed in multivariate analysis, which controlled for prior health. In addition, an expectation of being unemployed in the future was associated with poorer mental health. For many young people entering the labour market, the prospects of limited employment opportunities and associated risks to health are a major public health concern. In setting their needs firmly on the policy agenda, and planning appropriate services, these broader social issues should not be forgotten.     

Love,lifestyles and the risk of AIDS: The moral worlds of young people in Bobo‐Dioulasso,Burkina Faso

The HIV epidemic has had a profound impact on people's everyday life in most African societies. A large proportion of all new HIV infections involves young people between 15 and 25 years. The objective of this paper is to explore local moral worlds of young people in Bobo‐Dioulasso, Burkina Faso, and discuss how the HIVS epidemic affects their reflections on their everyday life and their perceptions of sexual relationships. Based on anthropological fieldwork, including focus‐group discussions, in‐depth interviews and participant observation, a total of 57 young people between 15 and 25 years were followed over a 3‐month period. Using the notion of ‘lifestyle’, the paper shows how structural factors of unemployment and poverty paired with global discourse on AIDS present the young people with frustrations and quandaries in relation to their hopes and images of love, faithfulness and modern living. The data shows that the HIV epidemic contributes to and accelerates their feeling of living in a risk society and of being at risk. In order to cope with these uncertainties and contingencies, local discourses of trust and fidelity become extremely important and to most young people HIV prevention is synonymous with finding a faithful partner and/or using condoms.     

2015－2017年绵阳市年轻男男性行为者安全套使用及影响因素

目的 了解年轻男男性行为者(young men who have sex with men, YMSM)安全套使用现状,分析影响因素。 方法 2015年9月－2017年6月,以四川省绵阳市15～24岁YMSM为对象,用滚雪球抽样法招募调查对象,进行安全套使用、社会及性行为等调查和血清学检测。安全套使用影响因素单因素分析用χ²检验,多因素分析用非条件logistic回归。 结果 共回收有效问卷362份,近6个月安全套每次使用率男性肛交55.31%、商业性伴42.11%、固定性伴49.38%、偶然性伴58.10%,异性性伴39.29%。不使用安全套26.83%因自己、46.34%因性伴不愿意,其原因固定性伴29.27%、不舒服23.17%、没必要14.63%。艾滋病病毒抗体阳性率随近6个月肛交安全套使用频率降低呈上升趋势(χ²_趋势=16.82,P=0.000)。多因素分析显示,干部职员(OR=16.058,OR95%CI: 1.95～132.55)、对自己性取向自豪(OR=100.82,OR 95%CI:8.68～1170.39)、近1年接受宣传材料发放(OR=5.37,OR 95%CI: 1.12～25.72)、防治知识来源宣传材料(OR=4.07,OR 95%CI: 1.05～15.81)、性伴不使用安全套采取劝说处理(OR=3.889,OR95%CI: 8.14～293.10)、性伴相处坚持主张(OR=16.058,OR 95%CI: 1.03～14.70)、近6个月肛交每次准备安全套(OR=12.01,OR 95%CI: 3.18～45.43)是安全套使用促进因素。 结论 YMSM安全套使用率不高,性伴制约作用明显,预防服务、身份认同、意愿坚持等与其相关,应针对性开展行为干预。     

凉山州农村未婚青少年偶遇性行为与HIV感染的监测分析

凉山州少数民族地区商业性行为较少,未采取安全措施的偶遇性行为更为常见[1],且存在多性伴现象[2].为探讨凉山州偶遇性行为对HIV传播的影响,2011年凉山州新增设农村未婚青少年人群综合监测哨点,现将结果分析如下.1.对象与方法:按照户籍登记,选择监测点所在县农村辖区内1872名15～25岁常住农村未婚青少年.按距离县城"较远"和"较近"将调查村分为2个层次,采用分层整群抽样方法各抽取5个村,获得知情同意后,对每县10个村共计400名符合入选条件的调查对象进行问卷调查,并采集5 ml静脉血.使用酶免试剂(ELISA-1)进行HIV抗体初筛检测,初筛阳性者使用另一种酶免试剂(ELISA-2)复检,两次检测结果均呈阳性则判定HIV抗体哨点监测阳性.采用EpiData 3.1软件建立数据库并录入数据,SPSS 18.0软件进行数据的描述和分析.     

The experiences of young people with obesity in secondary school: some implications for the healthy school agenda

In 1995, the World Health Organisation launched a Global School Health Initiative to reduce health risks among young people. In the UK, the National Healthy School Programme (HSP) developed as part of a wider government commitment to promoting social inclusion. One of the key issues to be tackled by the programme is childhood obesity, for obesity is widely argued to be a public health problem for which a solution needs to be found. However, the assumption that obesity is necessarily problematic and that a higher body weight leads to health problems and social exclusion, is not without challenge. Critics of anti-obesity campaigns question the significance of weight per se and highlight the potential implications of discrediting not only fatness, but also the people who are seen as fat. This paper therefore explores the experiences of young people with obesity within the secondary school environment in relation to areas of concern prioritised by the HSP. The paper draws upon data from a qualitative research study involving 18 children and young people, between the ages of 10 and 17. Data were generated in focus group discussions and individual interview with participants of a community-based obesity intervention programme in South Yorkshire, UK. Data collection took place in 2005, and thematic analysis of the data was undertaken. Findings suggest that the issues prioritised in the HSP, particularly physical exercise and healthy eating, present challenges to young people with obesity and can reinforce their vulnerability to bullying in schools and contribute to their social exclusion. It concludes that social exclusion is a process experienced by, and pertinent to, children and young people, which has meaning for their experiences of, and during, childhood and youth. The whole-school approach of the HSP may fail to adequately address the experiences of marginalised and vulnerable groups of young people within schools, challenging and undermining the social inclusion agenda in which the programme is grounded and contributing to the construction of undesirable, fat, young bodies.     

The relationship between intimate partner violence and probable depression among adolescent girls and young women in Lilongwe,Malawi

ABSTRACT

This analysis estimates prevalence of intimate partner violence (IPV) and its association with probable depression among adolescent girls and young women (AGYW) in Lilongwe, Malawi, and whether partner’s controlling behaviour modifies this relationship. Baseline data was utilised from the Girl Power-Malawi study of 1000 15–24-year-old AGYW in Lilongwe. Emotional, physical, and sexual IPV experiences with a current or recent partner were measured using the modified Conflict Tactics Scale. Probable depression was measured by scoring ≥10 on the Centre for Epidemiologic Studies-Short Depression Scale (CES-D-10). Generalised linear models with log-link and binomial distribution estimated prevalence ratios (PR) and 95% confidence intervals (CI) for the association between IPV types and probable depression. Partner’s controlling behaviour was examined as an effect modifier. Participants’ mean age was 19.2 years, with 70% never-married. IPV prevalence varied for emotional (59%), physical (36%), sexual (46%), and all forms (20%). Prevalence of probable depression was 47%. AGYW who experienced each IPV type had a higher prevalence of probable depression: physical (PR:1.54, CI:1.28–1.86), sexual (1.46, CI:1.21–1.75), emotional (1.37, CI:1.14–1.64), all forms (1.72, CI:1.41–2.09). IPV and probable depression were prevalent and strongly associated, especially among AGYW reporting controlling behaviour. Interventions addressing IPV and controlling behaviour may positively impact depression among AGYW.