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Nutritional status during pregnancy can impact fetal development, yet less is known about how alcohol may interact with nutritional status to influence infant outcomes. Pregnant women (n=196) completed 2, 24-hour dietary recalls and provided a venous blood sample to be analyzed for liver enzymes (GGT -gamma-glutamyl transferase; ALT -alanine transaminase; and AST -aspartate transferase), iron, ferritin, and zinc concentrations. Infants were assessed at 6 weeks of age. Women who consumed alcohol had significantly higher ferritin levels compared to non-drinkers (51.8 vs. 34.2). While 44% of women had ferritin <30 ug/L (an indicator of iron deficiency), and 24% of women were low in serum iron, and 72% were low in serum zinc. All six drinking measures for 1st trimester and previous week were significantly correlated with GGT and AST levels while 4 out of 6 alcohol measures were associated with levels of ALT and ferritin. At six weeks of age, nearly all physical measures differentiated infants with alcohol exposure from infants without exposure. Controlling for six covariates, maternal ferritin was significantly and inversely associated with infant head circumference (OFC) centile among infants with alcohol exposure. GGT was inversely associated with infant height and weight centile among unexposed infants. Seventy-four percent (74%) of mothers who consumed alcohol were found to be low in serum zinc, yet higher maternal zinc was associated with more dysmorphology. This may indicate that higher zinc status is not protecting the fetus from the teratogenic effects of alcohol. Prenatal alcohol exposure, ferritin, and zinc status influence infant growth and neurodevelopment., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Substance use is an escalating public health problem in South Africa resulting in risky behaviours and poor educational attainment among adolescents. There is a huge battle to overcome substance use among learners as more drugs become easily available with the mean age of drug experimentation reported to be at 12 years of age. It is important to continuously understand the trends in substance use in order to assess if there are positive changes and provide evidence for the development of context-specific effective interventions. This paper outlines the prevalence of substance use among selected high schools in a district in Limpopo province. Methods: To determine the prevalence of substance use among selected high school learners in a district in Limpopo Province, a cross-sectional school survey of 768 learners was conducted. Data was analysed using SPSS v 26. Descriptive analysis was used to describe the independent and dependent variables and Chi-Square test was used to investigate associations between demographic characteristics and substance use among high school learners. Results: The most abused substances by learners were alcohol (49%), cigarettes (20.8%) and marijuana (dagga/cannabis) (16.8%). In a lifetime, there was a significant difference (P < 0.05) in cigarette smoking with gender, school, and grade; with more use in males (14.2%) than females (7.6%); in urban schools (14.6) than peri-urban (6.7%) and more in Grade 12 (6.4%). There was a significant difference (P < 0.05) in alcohol use with more use in Grade 10 (12.6%) and varied use among male and female learners but cumulatively more alcohol use in females (27.7%). Drug use varied, with an overall high drug use in urban schools (20.7%). Conclusions: Substance use is rife among high school learners in the district and health promotion initiatives need to be tailored within the context of socio-demographic characteristics of learners including the multiple levels of influence such as peer pressure, poverty, unemployment and child headed families. Additional research is required to investigate the factors leading to a notable gradual increase in use among female learners and into the environmental and family settings of learners in influencing substance use. [ABSTRACT FROM AUTHOR]

Background: South Africa presents one of the riskiest patterns of alcohol consumption, with per capita consumption above the African regional average. Globally, there has been an increased focus on the potential of appointing lay counsellors to administer alcohol intervention strategies in resource-limited contexts. Given the increasing need for relevant and efficient intervention strategies in response to high-risk alcohol consumption, screening instruments such as the AUDIT-C have gained increased attention. Methods: This paper explores the experiences of 15 lay counsellors in response to the training received on how to administer the AUDIT-C instrument, as well as provide interventions such as brief advice or an appropriate referral, in the resource-limited South African township of Alexandra, Johannesburg. A focus group was facilitated for this purpose and, thereafter, a thematic content analysis was applied to identify the themes most central to the lay counsellors' experiences. Results: The research findings suggest that the lay counsellors perceived the training to be adequate in preparing them for administrating the AUDIT-C and for providing any relevant interventions, and that their confidence in administering the instrument developed as the project progressed. However, recruitment and administration challenges were experienced in primary healthcare and community settings, and lay counsellors perceived home visits to be more appropriate with respect to issues related to confidentiality and stigmatisation. Conclusion: Overall, while lay counsellors feel that the training they received on the tool and the tool itself is useful for effectively implementing the AUDIT-C in low-resource communities, the availability and efficiency of alcohol treatment services in Alexandra Township need to be improved. [ABSTRACT FROM AUTHOR]

Alcohol is a major contributing factor to the burden of road traffic crashes and injuries in South Africa. There has been an increase in political interest and engagement on the issue of drink-driving in recent months following government restrictions on the sale and public consumption of alcohol during the COVID-19 lockdowns along with proposed zero-tolerance drink-driving legislation. In this paper, we critically examine global research and experiences with the adoption of zero-tolerance approaches to drink-driving along with key South African contextual considerations to provide evidence-based and contextually relevant recommendations for advancing zero-tolerance drink-driving legislation in the country. There is significant evidence to support the adoption of zero-tolerance legislation but at a blood alcohol concentration (BAC) threshold limit for the general driving population set at 0.02 g/100 mL (rather than the zero-BAC limit proposed through the Road Traffic Amendment Bill) to allow for variance in testing. Recommendations centre on the proposed legislation incorporating a gradualist approach and its location within a broader zero-tolerance approach that includes other complementary interventions to enable implementation. Significance: • The recommended blood alcohol level of 0.02 g/100 mL is lower than the best practice limit recommended by the World Health Organization of 0.05 g/100 mL, following consideration of the road safety and general alcohol consumption challenges in South Africa and evidence of success from other similar country contexts. • Broad principles and recommendations are presented to support the sustainable adoption of zerotolerance drink-driving legislation in the country. [ABSTRACT FROM AUTHOR]

This paper assesses the levels of antiretroviral treatment (ART) adherence and mental health distress among study participants in a national behavioural HIV-sero prevalence study South Africa. The study was a cross-sectional population-based multi-stage stratified cluster random survey, (SABSSM V, 2017). Structured questionnaires were used to collect information on socio-demographics, HIV knowledge, perceptions, HIV testing and HIV treatment history. Study participants were tested for HIV infection, antiretroviral use, viral suppression, and ART drug resistance. A total of 2155 PLHIV aged 15 years or older who were on ART were included in the study. Incidence of either moderate or severe mental health distress was 19.7%. Self-reported ART adherence among study participants with no, mild, moderate, or severe mental distress was 82%, 83%, 86% and 78%, respectively. The adjusted odds ratio for ART non-adherence was 0.58 (95% CI 0.24; 1.40) for mild mental distress, 0.82 (95% CI 0.35; 1.91) for moderate mental distress and 2.19 (95% CI 1.14; 4.19) for severe mental distress groups compared to the no mental health distress group. The other factors that were associated with ART non-adherence in adjusted models included education level, alcohol use and province/region of residence. The study revealed that mental health remains a challenge to ART adherence in South Africa. To improve ART adherence, HIV continuum of care programs should include screening for mental health among people living with HIV. [ABSTRACT FROM AUTHOR]

Background: This paper assesses changes in the socioeconomic inequality in alcohol consumption by exploring whether alcohol consumption (current and binge drinkers) is more prevalent among the wealthier (pro-rich) or poorer (pro-poor) group over time. Methods: Data come from the 2008, 2010/11, 2012, and 2014/15 waves of the National Income Dynamics Study (NIDS). Various equity stratifiers (sex, age, race, and rural/urban) are used to analyze the prevalence of alcohol consumption and to investigate differences in socioeconomic inequalities. Changes in socioeconomic inequality in alcohol consumption between 2008 and 2014/15 were also assessed using the concentration index. Results: Current drinkers were more concentrated among richer South Africans, while binge drinkers were concentrated among the poorer population. For current drinkers, irrespective of sex, race, age, and urban, socioeconomic inequality in alcohol consumption had become less pro-rich between 2008 and 2014/15; while inequality in binge drinking, outside of the Asian/Indian and rural categories, had become less pro-poor between 2008 and 2014/15. Conclusion: The results show evidence that binge drinking is a bigger problem among those of low-SES, young individuals, male and African populations. This paper concludes that the SA government should continue to push forward policies aiming to reduce the prevalence of binge drinking., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Fontes Marx, London, Harker and Ataguba.)

Purpose: This paper aims to estimate the effects of three socialization agents in the form of advertising exposure, parental influence and peer influence and effects of personal attitude on youth alcohol consumption behaviour in South Africa. Design/methodology/approach: A structural equation model was used to test the proposed conceptual model of four hypotheses based on the validated survey data gathered from 300 youth in Johannesburg, South Africa. Findings: Empirical results show that advertising, parental influence, peer influence and personal attitude has positive effects on youth alcohol consumption behaviour, with advertising and personal attitude exhibiting statistical significance on alcohol consumption behaviour. Research limitations/implications: The study involves only youthful demographic in the age range of 18–35 and hence suffers from generalizability. The cross-sectional design also limits the findings with respect to time. Practical implications: It provides policymakers insights into important factors to focus on changing drinking behaviour in South Africa. Social implications: It also improves the understanding of how consumer socialization agents and personal attitudes affect alcohol consumption of young people in South Africa and help deal with the problem through policy changes and social marketing interventions. Originality/value: To the best of the authors' knowledge, this study is the first to estimate three socialization agents and personal attitude of youth in alcohol consumption behaviour in an emerging market context. [ABSTRACT FROM AUTHOR]

In South Africa, little is known about alcohol consumption patterns, such as drinks consumed, container size, salience of alcohol price, affordability and availability, and perceptions of alcohol policies as potential predictors of heavy episodic alcohol (HED) use among young people. This paper examines predictors of HED among young people with specific consideration given to these alcohol consumption patterns. This study conducted in the Tshwane Metropole in 2014 employed multi-stage stratified cluster random sampling. Participants were between the ages 16-25 years. A structured questionnaire was used to collect data. Of the 287 (n = 678) participants who had used alcohol in the past six months and for whom we had complete consumption data, almost half were identified as heavy episodic drinkers (HEDs) and were significantly more likely to consume alcohol on a daily basis ( p = 0.001). Having nightclub as the primary drinking location ( p = 0.023) and drinking from a container size bigger than one standard drink ( p = 0.014) were significant predictors for HED. HEDs were also more likely to have a perception that most people consume alcohol ( p = 0.047). The results point to HED of alcohol among young people who drink in South Africa, highlighting the need for multicomponent interventions.

Objective: This paper assesses the usability of existing alcohol survey data in South Africa (SA) by documenting the type of data available, identifying what possible analyses could be done using these existing datasets in SA and exploring limitations of the datasets., Settings: A desktop review and in-depth semistructured interviews were used to identify existing alcohol surveys in SA and assess their usability., Participants: We interviewed 10 key researchers in alcohol policies and health economics in SA (four women and six men). It consisted of academic/researchers (n=6), government officials (n=3) and the alcohol industry (n=1)., Primary and Secondary Outcome Measures: The desktop review examined datasets for the level of the data, geographical coverage, the population surveyed, year of data collection, available covariables, analyses possible and limitations of the data. The 10 in-depth interviews with key researchers explored informant's perspective on the usability of existing alcohol datasets in SA., Results: In SA, alcohol data constraints are mainly attributed to accessibility restrictions on survey data, limited geographical coverage, lack of systematic and standardised measurement of alcohol, infrequency of surveys and the lack of transparency and public availability of industry data on production, distribution and consumption., Conclusion: The International Alcohol Control survey or a similar framework survey focusing on substance abuse should be considered for implementation at the national level. Also, alcohol research data funded by the taxpayers' money and alcohol industry data should be made publicly available., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Globally, alcohol consumption accounts for a substantial burden of disease, which translates into high social and economic costs. To address this burden, several policies (e.g. age and trading hour restrictions, increasing alcohol taxation) were implemented. Despite the existence of these policies evidence shows that alcohol misuse and alcohol-related harms have increased in South Africa over recent years. The objective of this paper is to assess progressivity and the changes in progressivity of alcohol expenditure at the household level in South Africa using datasets that span 15 years., Methods: Data come from the 1995, 2000, 2005/06 and 2010/11 South Africa Income Expenditure Survey. Distribution of spending on alcoholic beverages were analyzed using standard methodologies. Changes in progressivity between 1995 and 2000, and between 2005/06 and 2010/11 were also assessed using the Kakwani index., Results: Alcohol spending was regressive between 1995 and 2011 as the fraction of poorer households' expenditure spent on alcohol beverage exceeds that for the richest households. Also, the difference in Kakwani indexes of progressivity indicates that spending on alcoholic beverages has become less regressive between the same time periods., Conclusion: The results show no evidence that alcohol policy including taxation increased regressivity. Thus, there is an opportunity to further reduce the regressivity using coherent alcohol policies. This paper concludes that there is a need for further research to unpack why alcohol spending became less regressive over the years that goes beyond just looking at changes in the distribution of alcohol expenditure.

Background: The prevalence of alcohol consumption among males living in urban settlements in South Africa is high. This paper aims to measure socioeconomic inequalities in alcohol use among men residing in informal settlements and also to examine the factors associated with inequality in alcohol use among men living in informal settlements., Methods: The study uses data from the 2016 Study of South African Informal Settlements. Multiple correspondence analysis is used to calculate a wealth index as a measure of socioeconomic status. The Erreygers concentration index is employed to quantify the degree of socioeconomic inequality in alcohol use and decomposition analysis is conducted to assess the factors associated with inequality in alcohol use by men of various age groups., Results: There is a socioeconomic-related inequality in alcohol use in informal settlements that discriminates against poor men. Inequality is especially pronounced in the case of males aged 15-34 years and males aged 35-44 years. Wealth status makes the biggest contribution to socioeconomic inequality in alcohol use. The contribution of social determinants of health like marital status and employment status differ across age groups. Employment status contribute more to the alcohol use inequality among males aged 15-34 years while marital status contribute more to the alcohol use inequality among males aged 35-44 years. Being single substantially increases inequality in alcohol use., Conclusion: Inequality in alcohol use exists among both younger and older males and discriminate against the poor. Public policies aimed at promoting public health and the prevention of unhealthy behaviours should target younger and middle-aged men from socioeconomically disadvantaged groups. We also suggest policies that target single males in informal settlements.

Background: Alcohol and other drug (AOD) use among poor Black African and Coloured women in South Africa compounds their sexual risk for HIV. Given South Africa's history of ethnic disparities, ethnic differences in sex risk profiles may exist that should be taken into account when planning HIV risk reduction interventions. This paper aims to describe ethnic differences in AOD use and AOD-related sexual risks for HIV among vulnerable women from Cape Town, South Africa Method: Cross-sectional data on 720 AOD-using women (324 Black African; 396 Coloured) recruited from poor communities in Cape Town were examined for ethnic differences in AOD use and AOD-related sexual risk behavior. Results: Ethnic differences in patterns of AOD use were found; with self-reported drug problems, heavy episodic drinking and methamphetamine use being most prevalent among Coloured women and cannabis use being most likely among Black African women. However, more than half of Black African women reported drug-related problems and more than a third tested positive for recent methamphetamine use. More than a third of women reported being AOD-impaired and having unprotected sex during their last sexual encounter. Coloured women had four-fold greater odds of reporting that their last sexual episode was AOD-impaired and unprotected than Black African women. In addition, close to one in two women reported that their sexual partner was AOD-impaired at last sex, with Coloured women having three-fold greater odds of reporting that their partner was AOD-impaired at last sex than Black African women. Conclusions: Findings support the need to develop and test AOD risk reduction interventions for women from both ethnic groups. In addition, findings point to the need for tailored interventions that target the distinct profiles of AOD use and AOD-related sex risks for HIV among Black African and Coloured women. [ABSTRACT FROM AUTHOR]

This paper provides an overview of research on drinking behavior at a South African University. It describes new interventions, aimed to focus more positively on norms and the environment, and using Systemic Functional Grammar as a tool, provides a comparative linguistic analysis of the language used in 'public', alcohol-related texts before and after these interventions, in order to highlight the powerful effect of language in influencing attitudes to alcohol usage. After a brief discussion of these findings, some implications for practitioners are suggested. [ABSTRACT FROM AUTHOR]

Purpose - South Africa is among the world's highest levels of alcohol consumption per drinker. Liquor abuse is hence rampant and many drinkers engage in risky drinking regularly. The purpose of this paper is to discuss the problem of liquor abuse and seek to understand the degree to which respondents are aware of the alcohol problem in South Africa and whether they have experienced incidents of alcoholism, its impacts and in particular, the study seeks to determine the degree to which minors are exposed to liquor. Awareness of the seriousness of the problem is crucial to finding a lasting solution to it. Design/methodology/approach - This paper conducted a survey in five provinces of the socio-economic aspects of liquor abuse. These are Eastern Cape, Gauteng, Kwazulu Natal (KZN), Mpumalanga and Western Cape provinces. The paper intends to address whether there are: differences in liquor abuse between experiences of demographic (racial) groupings per province; differences in the knowledge of alcohol-related activities and impacts per province; and differences in exposure of minors to liquor-related violence per province. Findings - South Africans are generally aware of the liquor abuse problem and many have had personal experiences or know family members who have had personal experiences. Liquor abuse is associated strongly with negative social activities in the country. Among occupational groups, administrative officers in Gauteng and Mpumalanga are significantly associated with being transported by drunk drivers. Drinking at work is significantly associated with professionals in KZN. Originality/value - There are few studies that examine issues related to the problem of liquor abuse and the awareness of its seriousness. The findings could assist in understanding how to target education campaigns to inform the public of the problem of liquor abuse. [ABSTRACT FROM AUTHOR]

Background and aims Evidence suggests that adult per-capita alcohol consumption, as estimated from self-reports of nationally representative surveys, underestimates 'true' consumption, as measured as the sum of recorded and unrecorded consumption. The proportion of total adult alcohol per capita reported in representative surveys is usually labelled 'coverage'. The aim of the present paper was to estimate coverage for South Africa under different scenarios of alcohol use assessment and 'true' consumption. Design Five nationally representative surveys from South Africa were used to estimate the prevalence of drinking and the grams per day among current drinkers. All surveys used a complex multi-stage sampling frame that was accounted for by using survey weights. The total (recorded and unrecorded), the recorded and the adjusted total adult per-capita alcohol consumption in South Africa served as different estimates of the 'true' consumption. Setting South Africa. Participants Alcohol use information was assessed on a total of 8115, 16 398 and 13 181 adults (15 years or older) in surveys from the years 2003, 2005 and 2008, respectively. Two surveys in 2012 included 27 070 and 18 688 adults. Measurements Coverage of the alcohol use reported in the surveys was calculated, compared with the 'true' adult per-capita alcohol. Findings The survey data covered between 11.8% [2005; 95% uncertainty interval (UI) = 9.3-16.2%)] and 19.4% (2003; 95% UI = 14.9-24.2%) of the total alcohol used per capita. The highest coverage of 27.9% (95% UI = 22.4-36.8%) was observed when looking only at recorded alcohol in 2003. Conclusions Evidence from five nationally representative surveys assessing alcohol use suggests that less than 20% of the total adult per-capita alcohol consumption in South Africa is reported in surveys. [ABSTRACT FROM AUTHOR]

Background: South Africa is marked by high rates of both HIV and alcohol use, and there is a detrimental synergistic relationship between these two epidemics. The Institute of Medicine recommends integrated care for alcohol use treatment and HIV, but implementation of integrated services remains a challenge in South Africa. This protocol describes a study designed to evaluate trainer, provider-, and patient encounter-level outcomes relating to the national rollout of a cascade train-the-trainer model of task-sharing to build capacity of the HIV workforce to deliver Screening, Brief Intervention, and Referral to Treatment (SBIRT) to address risky alcohol use. Methods: This 5 year protocol consists of two phases. First, we will finalize development of a robust SBIRT train-the-trainer model, which will include an SBIRT Trainer Manual, Provider Resource Guide, fidelity observational coding system, case vignettes, and a curriculum for ongoing consultation sessions. Materials will be designed to build the capacity of novice trainers to train lay workers to deliver SBIRT with fidelity. Second, we will recruit 24–36 trainers and 900 providers in order to evaluate the effects of the SBIRT train-the-trainer model on trainer- (e.g., fidelity, knowledge), provider- (e.g., SBIRT attitudes, confidence, acceptability), and patient encounter- (e.g., proportion receiving screening, brief intervention, referral to treatment) level variables. Data on patient encounters will be tracked by providers on programmed tablets or scannable paper forms in real-time. Providers will report on SBIRT delivery on an ongoing basis over a 6-months period. Additionally, we will test the hypothesis that trainer-level factors will account for a substantial proportion of variability in provider-level factors which will, in turn, account for a substantial proportion of variability in patient encounter-level outcomes. Discussion: This protocol will allow us to take advantage of a unique national training initiative to gather comprehensive data on multi-level factors associated with the implementation of SBIRT in HIV service settings. In the long-term, this research can help to advance the implementation of integrated alcohol-HIV services, providing lessons that can extend to other low-and-middle income countries confronting dual epidemics. [ABSTRACT FROM AUTHOR]

Unhealthy food choices and consumption, coupled with sedentary lifestyles among consumers, intensify public health concerns regarding the quadruple disease burden, despite Primary Health Care (PHC) policy. However, the current relationship between consumer knowledge about healthy foods and following a healthy lifestyle needs to be explored. Our study, therefore, aimed to determine the association between consumers' subjective and objective knowledge about healthy foods and various healthy lifestyle choices. A cross-sectional survey was conducted among employed consumers (N = 157) from South African corporate settings. We used structural equation modelling (SEM) to determine associations between subjective and objective knowledge about healthy foods and healthy lifestyle choices. Our findings showed that most participants scored high on making healthy lifestyle choices relating to avoiding smoking (69.5%) and limiting drinking alcohol (68.7%) but less so for food and sleep (44.4%) while neglecting exercise, relaxation (13.7%), and choices that require dedicated effort (25.2%). On average, participants had high levels of subjective (mean = 3.59; 5-point Likert scale) knowledge and objective knowledge about healthy foods (88.4−95.9% correct responses). However, their objective knowledge about weight and cholesterol had severe deficiencies (36.7%). SEM confirmed an association between subjective knowledge and most healthy lifestyle choice categories, while income contributed to dedicated effort lifestyle choices. By contrast, objective knowledge did not associate with such choices. Our structural model suggests that subjective knowledge about healthy foods contributes to healthy lifestyle choices. Therefore, subjective knowledge and the objective knowledge deficiencies we identified among corporate consumers can serve as a valuable starting point for informed education to promote PHC policy and healthy lifestyle choices. [ABSTRACT FROM AUTHOR]

Background: Transactional sex is a risk factor for HIV infection. Alcohol use may increase the risk of transactional sex. No nationally-representative studies have examined the relationship between multiple dimensions of alcohol use and transactional sex in women in South Africa. The aim of the study was to examine the relationship between alcohol dependence, binge drinking and frequency of drinking in the past month and transactional sex in adult women in South Africa. Methods: A cross-sectional study using multi-stage, cluster sampling collected data from a nationally representative sample of 5,969 women aged 16–55 years in 2012. The analysis conducted for this paper was restricted to women reporting sexual activity in the past 12 months (n = 3,594). Transactional sex was defined as having received money/gifts in exchange for sex with any sex partner in the past year. Alcohol use measures included: alcohol dependence (≥2 positive responses to the CAGE questionnaire); binge drinking (≥4 drinks for women on one occasion); and drinking frequency in the previous month. Logistic regression models were built to test the hypotheses that each dimension of alcohol use was associated with transactional sex. Results: About 6.3% (n = 225) of sexually active women reported transactional sex. Almost a third (30.6%) of sexually active women had ever drunk alcohol, and 19.2% were current (past month) drinkers. Among lifetime drinkers, 28.0% were alcohol dependent and 56.6% were binge drinkers. Alcohol dependent women were twice as likely to report transactional sex (AOR 2.0, 95% CI 1.1–4.3, p<0.05) than those not alcohol dependent. Binge drinkers were 3.1 times more likely to have had transactional sex (95% CI 1.5–6.6, p<0.01) than non-binge drinkers. There was no significant relationship between frequency of drinking in the past month and transactional sex. Conclusion: Alcohol dependency and binge drinking are significantly associated with transactional sex in South African women. HIV prevention programmes need to target these women, and address both their alcohol use, as well as the HIV risks associated with transactional sex. [ABSTRACT FROM AUTHOR]

Background: The use of alcohol amongst first-year students in institutions of higher learning is problematic as it often leads to social and academic problems, for instance high dropout rates and high-risk sexual behaviour. Research on first-year students' opinions regarding their own use of alcohol at the University of Limpopo, Medunsa Campus, was seen as pertinent as this institution trains medical doctors, dentists and other health professionals. The findings could inform appropriate interventions by policy-makers at the institution. This paper presents the qualitative data nested from a larger study on alcohol use among first-year medical students. Methods: A sample of 217 first-year students was obtained, to whom a questionnaire was administered which included open-ended questions formulated from discussions with a focus group of eight first-year students. The open-ended questions were formulated in a manner that allowed participants to give an account of their experience and opinions related to the drinking of alcohol. Thematic content analysis was used to analyse qualitative data. Results: The participants comprised 90 (41.5%) females, 13 (6%) White, 196 (90.3%) Black, 4 (1.8%) Asian and 4 (1.8%) Coloured students. The study revealed substantive views relating to first-year students' opinions and experiences of alcohol consumption. Themes gleaned from the interpretation were awareness, physical location of the campus, economic opportunities, health considerations, identity, belief in alcohol use, and interventions. Conclusion: The results indicate that first-year students have varying opinions and experiences concerning alcohol consumption at the University of Limpopo (Medunsa campus). Social identity and peer pressure are motivating factors in students' use of alcohol. [ABSTRACT FROM AUTHOR]

South Africa has the highest rate of fetal alcohol syndrome (FAS) in the world. While efforts have been made to curb the high rate of FAS, little is known about situational factors that may contribute to alcohol use during pregnancy. In the current paper, we focus on the role of food insecurity and its relationship to alcohol use among pregnant women. Women completed computer-assisted interviews. Generalized linear modeling was used in all analyses. Women attending alcohol-serving establishments in a township in Cape Town, South Africa were recruited for the study. Five hundred sixty women were sampled and 95 women reported being pregnant. High levels of alcohol use were reported among pregnant women: 65 % of women consumed alcohol at least every month and 29 % consumed alcohol as often as two to three times per week. Thirty-four percent of the women reported having six or more drinks per occasion on at least a weekly basis. The majority (87 %) of pregnant women reported experiencing some form of food insecurity (e.g., food unavailable, eating less) in the past month. Alcohol use was significantly associated with food insecurity, even when controlling for relevant demographic variables. Intervention with pregnant women who consume alcohol is urgently needed. Future research should focus on understanding the intersection of food insecurity and alcohol, and how the experience of food insecurity may contribute to greater rates of alcohol use and abuse among pregnant women.

Background: This paper examines the degree of agreement among simple dichotomous self-report, validated screening results, and biochemical screening results of prenatal alcohol and other drug use among pregnant women. Method: Secondary analysis was conducted on a cohort of pregnant women 16 years or older, presenting for prenatal care in the greater Cape Town, South Africa. Dichotomous verbal screening is a standard of care, and pregnant patients reporting alcohol and other drug use in dichotomous verbal screenings were asked to engage in screening using the Alcohol Smoking and Substance Involvement Screening Test (ASSIST) and urinalysis. Results: Significant agreements between dichotomous and ASSIST scores were observed (K = 0.73–0.76). A higher rate of self-reported (36.9%) alcohol use was detected, relative to urine screening (19.6%) with a predictive value of 34.9; while underreporting of illicit substance use was observed (3.6% self-report vs. 8.8% urine screening) with an overall predictive value of 50.0. Conclusion: Dichotomous verbal screening was considered valid after comparison with the ASSIST; however, combined use with urine screenings can be recommended especially for identifying illicit substance use in order to accurately detect alcohol and other drug use in pregnancy, so that women can be identified and referred for appropriate interventions where needed. [ABSTRACT FROM AUTHOR]

Background: This study was designed to give a bibliometric overview of research productivity in alcohol and substance use prevention in Africa as a response to international efforts to prevent alcohol and substance use. Methods: Original research articles authored or coauthored by investigators from African countries on alcohol and substance use prevention during the period of 2008-2018 were retrieved from Web of Science (WoS), EBSCOhost, and PubMed and reviewed. Keywords related to alcohol and substance use were used to retrieve relevant literature. Results: Our search returned 3600 hits, with 34 articles retained. Included articles were conducted in 12 countries across the five regions in Africa (Central, East, North, South, and West) and spreading over 11 years, 2008-2018. The annual published articles showed a significant rise from 2008 to 2018 with South Africa ranked number one, with a total of 9 (31%) published articles followed by Kenya 4 (13.8%). Bronwyn Myers from South Africa and Atwoli et al. from Kenya were the most prolific authors. Age and gender were the most reported risk factors in the selected studies. The most active institutions in alcohol and substance use prevention research are The Medical Research Council of South Africa, Stellenbosch University, and Moi University. Conclusions: There were few collaborations among Africans themselves, yet these collaborations would enhance future alcohol and substance use prevention research productivity. Currently, a broad spectrum of substance use prevention interventions has been implemented throughout the African continent, ranging from individual to community-based interventions. [ABSTRACT FROM AUTHOR]

A critical factor for understanding negative health outcomes is acknowledging the synergistic quality that clusters of health problems create. An important step in addressing clusters of health problems involves gaining an awareness of the contextual factors that connect them. This paper considers the intersection of 3 mutually reinforcing health problems: alcohol use, interpersonal violence (IPV), and HIV infection among pregnant women residing in South Africa. We explore how SAVA (substance abuse, violence and AIDS) - a syndemics related theory - underscores the dire need to intervene in various areas of psycho-social health and general well-being. Based on World Health Organization data, we highlight the remarkably high rates of alcohol use, IPV, and HIV infection among South African women compared with women residing in other countries around the world. We conclude by highlighting the need for improved recognition of the intersection of these epidemics and for improved surveillance of the prevalence of alcohol use among pregnant women. Finally, based on the literature reviewed, we provide recommendations for future interventions.

Background: HIV-positive pregnant women who drink put their children at risk of both HIV and fetal alcohol spectrum disorders. The province of KwaZulu-Natal (KZN) has the highest prevalence of HIV in South Africa, but has not before been considered an area of high alcohol consumption among women. This paper analyzes a large sample of HIV+ pregnant women in KZN to examine alcohol consumption in that population., Methods: Data came from assessments of women enrolled in Prevention of Mother-To-Child Transmission programs at 8 clinics in KZN. Descriptive statistics and logistic regressions were used to examine the prevalence and correlates of alcohol consumption and binge drinking., Results: Of 1201 women assessed, 18% reported drinking during pregnancy, and 67% of drinkers usually binged when drinking (had 3+ drinks in one sitting). Over one-third of drinkers binged twice a month or more. Women living in urban and peri-urban locations were more likely to drink, as were those with indicators of higher economic status and greater social engagement. Married women were less likely to drink, while women who had poorer mental health, used tobacco, or had a greater history of sexual risk-taking were more likely to drink., Conclusion: Health care workers in KZN should be aware that pregnant women who drink are likely to do so at a level that is dangerous for their babies. Some factors associated with drinking indicate social/environmental influences that need to be counteracted by greater dissemination of information about the dangers of drinking, and greater support for abstinence or moderation., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Background: Alcohol consumption accounts for over 4% of the global burden of disease and an even higher figure in developing countries. Several policies have been proposed to curb the negative impact of alcohol misuse. Apart from South Africa, which has witnessed a rapid development in alcohol policy, such policies are poorly developed in most African countries. South Africa uses taxation as a policy lever, in line with international evidence, to reduce alcohol consumption. However, the problem of alcohol abuse still exists., Objective: The objective of this article is to present an analysis of alcohol tax incidence for the first time in South Africa. This was done for each category of alcohol tax (wines, spirits, beer and traditional brew [sorghum beer]) and for alcohol tax as a whole. The paper also uses the results to point to the areas where a greater understanding of the issues surrounding alcohol abuse needs to be developed., Methods: Data were drawn from the 2005/06 South African Income and Expenditure Survey. Reported expenditures on alcohol beverages were used to obtain the tax component paid by households. This was done under certain assumptions relating to alcohol content and the price per litre of alcohol. Per adult equivalent consumption expenditure was used as the measure of relative living standards and concentration curves and Kakwani indices to assess relative progressivity of alcohol taxes. Statistical dominance tests were also performed., Results: Most sorghum beer and malt beer drinkers were in the poorer quintiles. The reverse was the case for wines and spirits. Overall, alcohol tax in South Africa was regressive (Kakwani index -0.353). The individual categories were found to be regressive. The most regressive tax was that on sorghum beer (Kakwani index -1.01); the least regressive was that on spirits (Kakwani index -0.09), although this was not statistically significant at conventional levels. These results were confirmed by the test of dominance., Conclusion: In South Africa, there has been a renewed interest in addressing the problem of rising alcohol abuse, but the extent to which this will translate into meaningful policies is unclear. The use of an excise tax is increasingly being recognized by economists as a way to get around some of the negative effects of abusive alcohol consumption. However, this study indicates that alcohol taxes are regressive in South Africa.

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COVID-19-related alcohol sales bans and stay-at-home orders prompted the alcohol industry in South Africa to increase their online alcohol sales promotions. We investigated changes in alcohol-related behaviour and the drivers of illegal alcohol sales through a self-reported Facebook survey that ran from July to November 2020. Questions included socio-demographics and comparison of alcohol purchasing behaviour and intake during 2019 and 2020. Statistical tests were applied to find associations between illegal alcohol purchasing and alcohol-related behaviours. A total of 792 participants took part in the survey, 69.7% of whom were female. During lockdown periods, most participants (55.3%) bought alcohol illegally from illegal outlets or friends. Online alcohol-delivery marketing increased by 20 percentage points from 2019 to 2020, with participants stating that they saw a lot of advertisements per day and 80% of persons under 25 years were not asked to verify their age in 2020 upon delivery. Home-brewed beer and vodka intake increased in 2020 during the alcohol sales bans. Men from the Western Cape who engaged in daily or weekly heavy episodic drinking were more prone to purchase alcohol illegally. The Western Cape, which is South Africa’s most prolific wine-producing region, had the highest odds of people buying alcohol illegally, with wine being found to be the most frequently bought alcohol online and consumed by these participants. There is a need for further research into the differences in alcohol-related behaviour affecting illegal alcohol purchasing according to income group, proximity to alcohol producers and underage alcohol sales and marketing through online applications. Significance: • Alcohol sales bans have the potential to reduce and stop the alcohol intake of moderate drinkers, but may make heavy episodic drinkers drink more than usual. • During COVID-19 lockdown, illegal alcohol sales were taking place through unlicenced alcohol outlets and friends, and not through licenced online applications. • Unlicenced alcohol outlets need to be addressed to prevent future illegal alcohol sales. • Stricter regulations aimed at legal online alcohol sales applications should be put in place to prevent alcohol sales to minors and those who have already consumed too much alcohol. • There should be a ban on marketing of addictive substances, such as alcohol. [ABSTRACT FROM AUTHOR]

We explored the association between household alcohol use and behavior problems among South-African children, using data from the Asenze study, a population-based cohort of South African children and their caregivers. Household alcohol use and child behavior were assessed when children were 6–8 years old. To examine the association, we performed linear regressions. The sample included 1383 children with complete data under the care of 1251 adults. Children living in a household where self-reported caregiver alcohol use was scored as hazardous (4.6%) had higher levels of problem behavior (β = 1.94, 95% CI 0.06–3.82). There were no statistically significant associations between reported hazardous alcohol use by another member of the household (14.5%) and child problem behavior. Hazardous household alcohol use was associated with child problem behavior and this effect appeared to be mainly driven by primary caregiver use. [ABSTRACT FROM AUTHOR]

The paper explores the complex role of drinking in Sweet Home Farm (an informal settlement) through an examination of its contextual setting and its spatial characteristics. It examines, through a social-spatial ethnographic method and focus on a series of case studies, how shebeens are positioned in terms of their relationship to urban settlement, their role in providing publicly accessible venues within an over-crowed slum and influence on drinking outcomes. Our analysis of space focuses on the context of the informal settlement as an (un)regulated space which permits emergent spatial expressions and arrangements. Through a detail examination of four case studies, we consider the intimate configuration and organisation (place) of specific venues. From the perspective of place, the analysis examines the use (and non-use) of equipment/objects and internal architecture to define the character of particular typologies of establishments and their positioning vis-a-vis market niches. We reflect on the role and impact of shebeens on life within Sweet Home Farm, both in terms of providing space for socialisation and in supporting diverse cultures of drinking and business forms. [ABSTRACT FROM AUTHOR]

The occurrence of high rates of alcohol consumption in a context of high HIV prevalence in South Africa poses a significant health challenge for this country. This paper aims to answer three questions that could further our knowledge regarding the links between alcohol use and HIV infection: (a) "Are problem drinkers more likely to have multiple concurrent partners than those who are not?"; (b) "Are condoms applied less effectively and less consistently by problem drinkers compared to those who are not?"; (c) "Are the female sexual partners of problem drinkers different from those who are not?" Two cross-sectional HIV bio-behavioural surveillance surveys using Respondent-Driven Sampling were conducted in two peri-urban settings on the outskirts of Cape Town, South Africa. Eight hundred and forty-eight men aged 25-55 years who have multiple, concurrent female sexual partners were recruited. Problem drinkers had a score of ≥3 on the CAGE questionnaire. Questions enquired about partner numbers, condom use and partner traits. Multivariate logistic regression models were developed to determine significant associations between outcome variables and problem drinking. Fifty-eight percent of men were problem drinkers. Compared to non-problem drinkers, problem drinkers were significantly more likely to report having any symptom of a STI; not using condoms due to drinking; inconsistent condom use with all partner types; that their most recent once-off partner was unemployed; having met their most recent partner at an alcohol-serving venue; and having had a once-off sexual relationship. Alcohol may fuel once-off sexual encounters, often characterised by transactional sex and women's limited authority to negotiate sex and condom use; factors that can facilitate transmission of HIV. HIV prevention interventions specifically targeting drinkers, the contexts in which problem drinking occurs and multiple sexual partnering are urgently needed.

This paper examines the way gender shaped the health behaviours, health care experiences and narratives of HIV-positive men initiating antiretroviral treatment in South Africa. We conducted participant observation and in-depth, semi-structured interviews with eight men enrolled in a public HIV treatment programme in a rural health district in KwaZulu-Natal. We also interviewed their family members and programme staff. The study found that men's narratives and experiences of antiretroviral therapy (ART) were complex. Descriptions of control and coping juxtaposed with low self-esteem and guilt. Improvements in health following treatment increased optimism about the future but were readily undermined by men's concerns about being unable to meet strongly gendered expectations in relation to family and work. Alcohol use and abuse by men themselves or by family members was found to be an important issue influencing disclosure, uptake and adherence. Given messages discouraging alcohol use during treatment, men reported self-imposed delays to enrolment while they tried to stop or reduce alcohol use, although none had sought advice or professional help in doing so. Men also felt very threatened by alcohol abuse by family members fearing accidental disclose, insults and violence. With regards to health providers, men held strong views as to appropriate and professional behaviour by programme staff, particularly regarding confidentiality. As ART programmes in Africa become established and evolve, we not only need to identify barriers to men's access and adherence but monitor their health and treatment experiences. These findings suggest that the issue of alcohol and ART warrants further investigation. Additional training for primary health care providers and counsellors on health promotion with men may be useful.

This paper presents an analysis of the relationship between cultural orientation and home- brewed alcohol use among adolescents in a rural setting. The study involved 1263 students from 30 high schools in Mankweng District in Limpopo Province of South Africa. Boys formed 48% of the sample. Means ages were 16.7 and 16.0 years for boys and girls respectively. A 16 item scale focusing on language, mass media and music preferences was constructed to measure cultural orientations. There was an integration of western and traditional/local activities by respondents who reported having used home-brewed alcohol in the past 12 months. In some respects the sample had western tendencies i.e. English newspapers were read more than no-English newspapers and funky music tended to be preferred to traditional South African music, while in others the reverse was true i.e. Radio Thobela (a radio station that uses vernacular languages) was listened to more than Radio Metro (a radio station that uses English language only). There were significant differences between boys and girls in the use of western media. Older adolescents (18 years or older) used more home brewed alcohol than the younger ones. The concept of culture and its associations with alcohol use invites a critical view on cultural values among adolescents. The positive association with home-brewed alcohol use among secondary school students in our sample has been demonstrated for an orientation towards external cultural influence. Educators and learners need to increase their consciousness on the problematic side of cultural import.

There are few studies of HIV risk behavior among men who have sex with men (MSM) in sub-Saharan Africa. We conducted a behavioral survey of MSM in peri-urban "township" communities in Gauteng province, South Africa. Between October 2004 and March 2005, 199 MSM completed an interviewer administered pen-and-paper standardized questionnaire. The sample was 94% black, 83% identified as gay, and 12% as bisexual. Among those reporting sex with other men in the prior six months (n = 147), 59% reported unprotected anal intercourse (UAI). Increased risk of UAI was associated with both regular drinking (adjusted odds ratio (OR) 4.1, 95% confidence interval (CI) 1.4, 12.6) regular drinking to intoxication (OR 2.6, 95% CI 1.0, 6.8), and reporting symptoms of rectal trauma resulting from anal intercourse (AI; OR 4.3, 95% CI 1.8, 10.4). Decreased risk of UAI was associated with the exclusive use of lubricants that are latex-compatible for AI (OR 0.3, 95% CI 0.1, 0.7). Township MSM in South Africa are at high risk of HIV infection. Targeted sexual health and risk reduction interventions that address the link between alcohol use and HIV risk are urgently needed.

Background: Alcohol is a risk factor for the leading causes of mortality and morbidity among young people globally. Youth drinking, initiated in early adolescence and continued into early adulthood, is influenced by maternal socio-demographic factors and maternal education. Limited prospective data exists in South Africa on the prevalence of alcohol use during adolescence and adolescent and maternal socio-demographic correlates. Objective: To examine the prevalence of lifetime alcohol use during early (13 years) and late (18 years) adolescence in Soweto, South Africa, and its association with child and maternal socio-demographic factors. Methods: Data on alcohol use in early adolescence (age 13 years) and late adolescence (age 18 years) were collected using self-completed pen and paper and self-completed computer-based questionnaires, respectively. Univariate analyses were conducted on child (gender and number of school years repeated by grade 7), maternal socio-demographic correlates (education, marital status, and age), and household socioeconomic status (SES). Bivariate logistic regression analyses examined associations between alcohol use and all child and maternal socio-demographic factors. Multivariate logistic regression analyses were conducted on all the variables found to be significantly (p<0.10) associated with alcohol use to examine the predictive value on alcohol use at early and late adolescence. Results: Lifetime alcohol use increased from 22% at early adolescence to 66% at late adolescence. In multivariate analyses, gender, maternal education, and SES predicted lifetime alcohol use at early adolescence, while gender, maternal education, marital status, and SES were predictive of the same at late adolescence. Conclusion: This study aids researchers and practitioners to identify maternal and child socio-demographic risk profiles for alcohol use to inform policies and programmes. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to assess the impact of a series of brief interventions (BIs) on anti-natal alcohol consumption of women from a disadvantaged and high-risk background attending state health clinics in a rural district, Western Cape Province, South Africa. A pragmatic cluster randomised trial design was followed. All pregnant women, who were less than 20 weeks pregnant and more than 15 years of age, were eligible for the study. The intervention comprised a comprehensive assessment for current and lifetime alcohol use plus information (control group) or comprehensive assessment plus four BI sessions over the pregnancy period (intervention group). The Alcohol Use Disorders Identification Test (AUDIT) was completed pre- and post-intervention. Although both groups demonstrated declines in AUDIT scores, findings showed a statistically significant difference in the total AUDIT scores between the intervention and control groups post-intervention (F = 9.54, p = 0.002). The difference was two units (SE = 0.6). The follow-up rate was 92% (N = 179 of the original 194 eligible women). The impact of BIs is shown to be a powerful tool. Information and an understanding, supportive attitude seem to be crucial agents for behaviour change. [ABSTRACT FROM AUTHOR]

Background: The African Esophageal Squamous Cell Carcinoma (ESCC) corridor, which spans from Ethiopia down to South Africa, is an esophageal cancer hotspot. Disproportionately high incidence and mortality rates of esophageal cancer have been reported from this region. The aim of this study was to systematically assess the evidence on environmental and life-style risk factors associated with ESCC in African populations. Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and carried out a comprehensive search of all African published studies up to March 2023 using PubMed, Embase, Scopus, and African Index Medicus databases. Results: We identified 45 studies with measures of association [odds ratio (OR), relative risk (RR), and 95% confidence intervals (95%CI)], which reported on several environmental and lifestyle risk factors for ESCC in Africa. We performed a meta-analysis on 38 studies investigating tobacco, alcohol use, combined tobacco and alcohol use, polycyclic aromatic hydrocarbon exposure, hot food and beverages consumption (which served as a proxy for esophageal injury through exposure to high temperature), and poor oral health. We found significant associations between all the risk factors and ESCC development. Analysis of fruit and vegetable consumption showed a protective effect. Using population attributable fraction (PAF) analysis, we calculated the proportion of ESCC attributable to tobacco (18%), alcohol use (12%), combined tobacco and alcohol use (18%), polycyclic aromatic hydrocarbon exposure (12%), hot food and beverages intake (16%), poor oral health (37%), and fruit and vegetable consumption (-12%). Conclusions: Tobacco smoking and alcohol consumption were the most studied risk factors overall. Areas where there is an emerging body of evidence include hot food and beverages and oral health. Concurrently, new avenues of research are also emerging in PAH exposure, and diet as risk factors. Our results point to a multifactorial etiology of ESCC in African populations with further evidence on prevention potential. [ABSTRACT FROM AUTHOR]

Background: Alcohol use and risky drinking are significant public health problem globally. Young people, including university students, are among the most affected populations. We conducted the study to determine the prevalence and correlates of alcohol use and risky drinking among undergraduate students in the Faculty of Health Sciences at the University of the Witwatersrand, South Africa. Methods: We conducted a cross-sectional study using an anonymous, self-administered online survey in REDCap. The survey questionnaire consisted of socio demographic, and alcohol use questions using the risky drinking identification screening tool (AUDIT-C). We performed descriptive statistics, bivariate and multivariable logistic regression to determine factors associated with alcohol use and risky drinking. The p-value of < 0.05 was considered statistically significant. Results: The response rate was 15.7%. Most participants were female (69.6%) and majority of the participants were White (38.1%). The prevalence of lifetime use of alcohol was 79.1%, and among the lifetime users; 70.2% reported alcohol use in the last 12-months, 37.1% reported alcohol use in the last 30 days. The prevalence of risky drinking was 54.8% among lifetime drinkers. Factors significantly associated with current alcohol use were siblings alcohol use (aOR = 1.79, 95% CI: 1.02–3.15) and parents alcohol use (aOR = 2.58, 95% CI: 1.39–4.80), white race (aOR = 5.70, 95% CI: 3.12–10.41), and always or daily exposure to alcohol marketing in the media (aOR = 3.31, 95% CI: 1.07–10.24). Factors associated with risky drinking were: Indian/Asian race (aOR = 2.82, 95% CI: 1.09–7.31), White race (aOR = 2.15, 95% CI: 1.14–4.04), and exposure to alcohol marketing in the media as follows, most of the time (aOR = 3.42, 95% CI: 1.29–9.04) and Always/daily exposure (aOR = 3.31, 95% CI: 1.07–10.24). Conclusion: The reported alcohol use and risky drinking were common amongst undergraduate students at Wits university. There is an urgent need to design, pilot and adapt targeted interventions for this population group. [ABSTRACT FROM AUTHOR]

This paper discusses the investigation of opinions of black adolescents living in Esikhawini Township near Empangeni in regard to alcohol use and abuse among black youth. The reasons black adolescents give for drinking and their perceptions of social, psychological and environmental factors contributing to alcohol use among black adolescents, are also discussed. The methodology employed was a descriptive survey. Data gathering was from the adolescents or pupils aged 12 years to 19 years, who attended the two Senior Secondary School in the Esikhawini Township. The results indicate that both sexes of black adolescents have positive attitudes about drinking alcohol. They say nothing is wrong with it. The peer group is seen as the natural environment for drinking and they give numerous reasons for drinking alcohol. They have misconceptions that they will outgrow drinking of alcohol. They claim that they have easy access to alcoholic beverages in the black township of Esikhawini. The only negative aspect expressed by black adolescents was that it was awful to see a young person drunk, but they do not seem to relate the drunk behaviour with the drinking that leads to it. Finally the following implications are drawn: It is necessary to develop targeted community health education programmes aimed at peer group drinking. The education programmes should be planned and implemented to correct the reasons and excuses adolescents have about drinking. These education programmes need to be evaluated periodically to assess their effect.

There is an alarming tide of cardiovascular and metabolic disease (CMD) sweeping across Africa. This may be a result of an increasingly urbanized lifestyle characterized by the growing consumption of processed and calorie-dense food, combined with physical inactivity and more sedentary behaviour. While the link between lifestyle and public health has been extensively studied in Caucasian and African American populations, few studies have been conducted in Africa. This paper describes the detailed methods for Phase 1 of the AWI-Gen study that were used to capture phenotype data and assess the associated risk factors and end points for CMD in persons over the age of 40 years in sub-Saharan Africa (SSA). We developed a population-based cross-sectional study of disease burden and phenotype in Africans, across six centres in SSA. These centres are in West Africa (Nanoro, Burkina Faso, and Navrongo, Ghana), in East Africa (Nairobi, Kenya) and in South Africa (Agincourt, Dikgale and Soweto). A total of 10,702 individuals between the ages of 40 and 60 years were recruited into the study across the six centres, plus an additional 1021 participants over the age of 60 years from the Agincourt centre. We collected socio-demographic, anthropometric, medical history, diet, physical activity, fat distribution and alcohol/tobacco consumption data from participants. Blood samples were collected for disease-related biomarker assays, and genomic DNA extraction for genome-wide association studies. Urine samples were collected to assess kidney function. The study provides base-line data for the development of a series of cohorts with a second wave of data collection in Phase 2 of the study. These data will provide valuable insights into the genetic and environmental influences on CMD on the African continent. [ABSTRACT FROM AUTHOR]

We assessed the prevalence of reported alcohol use and its association with multimorbidity among adults aged 40 years and above in a rural, transitioning South African setting. Findings could potentially inform alcohol interventions integration in the prevention and treatment of chronic conditions. We analysed data from the first wave of The Health and Ageing in Africa—a longitudinal Study in an INDEPTH community (HAALSI) nested within the Agincourt Health and Demographic Surveillance Systems, conducted between November 2014 and November 2015 (n = 5059). We computed descriptive statistics and performed univariate analysis to determine factors independently associated with multimorbidity. Age, Body Mass Index, education, sex, and household wealth status and variables with a p-value < 0.20 in univariate analysis were included in multivariable Modified Poisson regression models. Any factors with a p-value of < 0.05 in the final models were considered statistically significant. The first wave of HAALSI was completed by 5059 participants aged 40 years and above and included 2714 (53.6%) females. The prevalence of reported ever alcohol use was 44.6% (n = 2253) and of these 51.9% (n = 1171) reported alcohol use in the last 30 days. The prevalence of HIV multimorbidity was 59.6% (3014/5059) and for multimorbidity without HIV 52.5% (2657/5059). Alcohol use was associated with HIV multimorbidity among all participants (RR: 1.05, 95% CI: 1.02–1.08), and separately for males (RR: 1.05, 95% CI: 1.00–1.10) and females (RR: 1.06, 95%CI: 1.02–1.11). Similarly, alcohol use was associated with multimorbidity without HIV among all participants (RR: 1.05, 95% CI: 1.02–1.09), and separately for males (RR: 1.06, 95% CI: 1.00–1.12) and females (RR: 1.06, 95% CI: 1.01–1.11). Reported alcohol use was common and associated with HIV multimorbidity and multimorbidity without HIV among older adults in rural northeast South Africa. There is a need to integrate Screening, Brief Interventions, and Referral for alcohol Treatment in the existing prevention and treatment of multimorbidity in South Africa. [ABSTRACT FROM AUTHOR]

We assessed pathways between sexual minority stigma and condomless anal intercourse (CAI) among two samples of Black South African men who have sex with other men (MSM). Two cross-sectional surveys were conducted in Tshwane, South Africa; one among 199 Black MSM and another among 480 Black MSM. Men reported on external and internalized experiences of sexual minority stigma, mental health, alcohol use, information-motivation-behavioral skills (IMB) model constructs, and CAI. Structural equation modeling was used to test whether external and internalized stigma were directly and indirectly associated with CAI. In both studies, external stigma and internalized stigma were associated with CAI through IMB model constructs. These results suggest a pathway through which stigma contributes to HIV risk. For HIV prevention efforts to be effective, strengthening safer sex motivation and thus decreasing sexual risk behavior likely requires reducing sexual minority stigma that MSM experience and internalize. [ABSTRACT FROM AUTHOR]

Introduction: High alcohol availability is related to increased alcohol consumption and harms. Existing quantitative research provides potential explanations for this relationship but there is little understanding of how people experience local alcohol availability. This is the first review to synthesise qualitative research exploring the relationship between alcohol availability and other factors in local alcohol environments. Methods: The scoping review includes qualitative studies exploring community‐level alcohol availability and other factors, facilitating the purchase and consumption of alcohol. We included studies focusing on children and adolescents as well as adults. Study findings were brought together using thematic analysis and the socio‐environmental context model, which explains how certain environments may facilitate drinking. Results: The review includes 34 articles. The majority of studies were conducted since 2012. Most studies were conducted in the United Kingdom, Australia and South Africa. The physical availability of alcohol and proximity to local amenities and temporal aspects, like late night opening hours, may be linked to social factors, such as normalisation of drinking and permissive drinking environments. The review highlights the importance of social and cultural factors in shaping interactions with local alcohol environments. Discussion and Conclusion: This qualitative scoping review advances understanding of the pathways linking alcohol availability and alcohol harms by showing that availability, accessibility and visibility of alcohol may contribute towards permissive drinking environments. Further research is needed to better understand how people experience alcohol availability in their local environment and how this can inform alcohol control policies. [ABSTRACT FROM AUTHOR]

Background: Low birthweight (LBW) as well as early childhood stunting are risk factors for increased childhood morbidity in low-and middle-income countries (LMIC). The Covid 19 pandemic has exacerbated food insecurity and unemployment globally, prompting concerns for maternal and child health. Objectives: We used data from the great recession of 2008 to examine the relationship between household food security and other risk factors with LBW and stunting using a longitudinal sample of South African women and their offspring. Methods: Food security indicators, alcohol use, blood pressure and other characteristics were examined in relation to LBW (≤ 2500 g), stunting (height for age ≤ 2SD) and severe stunting (height for age ≤ 3SD). Regression modelling with clustering at maternal ID level were employed to adjust for maternal characteristics and women who gave birth more than once during the reference period. Results: Birthweight data were available for 1173 children and height for age 1216 children. The prevalence of LBW was 14.7% while stunting and severe stunting was 17.8% and 14.5%. Child hunger in the household, maternal hypertension and alcohol use were associated with low birthweight. Food expenditure below the Stats SA poverty line and low dietary diversity was associated with stunting and severe stunting respectively. Maternal height and low birthweight were associated with both stunting and severe stunting. Conclusions for Practice: Interventions that can improve household food security and nutritional status during the periconceptional and antenatal period may reduce the prevalence of low birthweight and subsequent stunting in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has substantially affected the lives of young people living in sub-Saharan Africa (SSA), leading to poorer short-term mental health outcomes. However, longitudinal data investigating changes in mental health from pre-COVID levels and their predictors are lacking. Our longitudinal sample comprised N = 233 young people (mean age: 17.8 years at baseline, 55.6% female) living in a deprived neighbourhood near Cape Town, South Africa. Symptoms of depression (PHQ-9), anxiety (GAD-7) and alcohol use (AUDIT) were assessed during two waves of data collection, pre-pandemic (2018/19) and via phone interviews in June to October 2020, during South Africa's first COVID wave and subsequent case decline. Latent change score models were used to investigate predictors of changes in mental health. Controlling for baseline levels, we found increases in depression and anxiety but not alcohol use symptoms during the COVID-19 pandemic. Higher baseline symptoms were associated with smaller increases on all measures. Socio-economic deprivation (lack of household income, food insecurity) before and during COVID were associated with higher anxiety and depression symptom increases. Having had more positive experiences during COVID was associated with lower post-COVID onset anxiety and depression increases, and marginally with less alcohol use, while negative experiences (household arguments, worries) were linked to stronger symptom increases. Overall, in a sample of young people from an adverse environment in South Africa, we found increased mental health difficulties during the COVID-19 pandemic, though higher baseline symptoms did not necessarily predict stronger increases. Several factors pre- and post-COVID onset were identified that could be relevant for determining risk and resilience. In the long term, it will be key to address these structural drivers of well-being and to ensure mental health needs of young people are being met to support SSA countries in building back successfully from COVID-19 and preparing for future shock events. [ABSTRACT FROM AUTHOR]

Little is known about gender effects of alcohol and drug use (AOD) among people living with HIV (PLWH) in resource-limited settings. Using multilevel models, we tested whether gender moderated the effect of Khanya, a cognitive-behavioral therapy-based intervention addressing antiretroviral (ART) adherence and AOD reduction. We enrolled 61 participants from HIV care and examined outcomes at 3- and 6-months compared to enhanced treatment as usual (ETAU). Gender significantly moderated the effect of Khanya on ART adherence (measured using electronically-monitored and biomarker-confirmed adherence), such that women in Khanya had significantly lower ART adherence compared to men in Khanya; no gender differences were found for AOD outcomes. Exploratory trajectory analyses showed men in Khanya and both genders in ETAU had significant reductions in at least one AOD outcome; women in Khanya did not. More research is needed to understand whether a gender lens can support behavioral interventions for PLWH with AOD. Trial registry ClinicalTrials.gov identifier: NCT03529409. Trial registered on May 18, 2018. [ABSTRACT FROM AUTHOR]

Background: A cross sectional study was conducted among 350 sexually active, mainly unemployed men between the ages of 18 and 35 in KwaZulu-Natal. This study examined the psychosocial determinants of the intention to be sexually active after having used marijuana or alcohol personally or in instances when the sexual partner is intoxicated. The theory of planned behaviour and cultural notions of responsible manhood were used in developing the measures.Methods: Correlation and hierarchical stepwise linear regression analyses tested determinants of the intention to avoid having sex when personally intoxicated and the intention to avoid sex when the sexual partner is intoxicated.Results: About 78 % of the participants reported regular use of alcohol and 39 % indicated ever-using marijuana. A total of 36.3 % used both alcohol and marijuana, and 73 % said that they engaged in multiple sexual partner behaviour. The intention to avoid sex when personally intoxicated as well as the intention to avoid sex when the sexual partner is intoxicated were significantly associated with subjective norms and perceptions of perceived behavioural control towards the respective behaviours, and less with attitudes towards the respective behaviours.Conclusions: These findings imply that health education interventions should focus on changing the normative beliefs as well as control beliefs of the target population either directly through education and training or indirectly by creating physical and social environments that facilitate safe sexual practices, for example by organizing positive peer support for risk prevention and by making condoms freely available in community alcohol serving establishments. [ABSTRACT FROM AUTHOR]

Background: Despite the array of studies on infant feeding practices of HIV-infected women, gaps still exist in the understanding of the underlying reasons for their infant feeding choices. Potential for behavioural change exists, especially in the light of the 2016 updated World Health Organization guideline on HIV and infant feeding. The aim of this paper is to determine the rate of adoption of exclusive breastfeeding in this cohort, examine the determinants of infant feeding choices of HIV-infected women and assess the underlying reasons for these choices. Methods: This was a mixed methods study conducted between September 2015 and May 2016. It analyses the quantitative and qualitative data of 1662 peripartum women enrolled in the East London Prospective Cohort Study across three large maternity services in the Eastern Cape. Women with HIV reported their preferred choices of infant feeding. In addition, participants explained the underlying reasons for their choices. Descriptive and inferential statistics summarised the quantitative data, while thematic content analysis was performed on qualitative data. Results: Of the 1662 women with complete responses, 80.3% opted to exclusively breastfeed their babies. In the adjusted model, up to grade 12 education level (AOR: 1.81; 95% CI: 1.14, 2.86), rural/peri-urban residence (AOR:1.44; 95% CI: 1.05, 1.96), alcohol use (AOR: 1.65; 95% CI: 1.25, 2.18), negative or unknown HIV status at booking (AOR:1.85; 95% CI:1.27, 2.70), currently married (AOR:1.43; 95% CI:1.01, 2.02) and WHO Clinical Stage 2–4 (AOR:1.77; 95% CI: 1.15, 2.72) were significantly associated with the decision to exclusively breastfeed. Health care providers' recommendations, perceived benefits of breastfeeding, unaffordability of formula feeding, and coercion were the underlying reasons for wanting to breastfeed; while work/school-related demands, breast-related issues, and fear of infecting the baby influenced their decision to formula feed. Conclusion: The majority of HIV-infected women chose to breastfeed their babies in the Eastern Cape. Following up on these women to ensure they breastfeed exclusively, while also addressing their possible concerns, could be an important policy intervention. Future studies should focus on how early infant feeding decisions change over time, as well as the health outcomes for mother and child. [ABSTRACT FROM AUTHOR]

Learners are vulnerable to alcohol use and its negative effects, largely due to accessibility of alcohol products, especially in the localities with poor socioeconomic status and infrastructure. This study aimed to determine the accessibility, motivations and effects of alcohol use among high school learners (n = 403) in Tshwane North and West, South Africa, using a descriptive, cross-sectional design. Data were collected using a validated questionnaire and analysed using STATA 17. Learners (16 ± 2 years) had poor demographic status and lifestyle behaviors. Availability of alcohol outlets (54%) near schools was reported, and learners indicated easy access (65%) to taverns and bottle stores (30%), and purchasing alcohol without a proof of identity document (70%). Motivations for alcohol use were self-pleasure (36%), coping with stress (24%) and increasing self-esteem (19%). Almost half of the learners (49%) introduced themselves to alcohol use, while others were influenced by friends (36%) and family (14%). Reported alcohol related effects were a negative impact on health (56%), brain function (25%) and school work (12%), in addition to social harms, including problems with friends (25%) and parents (17%), physical fights (19%) and engaging in risky sexual behaviour (11%). Effective strategies are necessary to address underage alcohol use and should include regulating the proximity of alcohol outlets to schools, life skills training to address learners' drinking motives and constantly alerting parents about the relevance of modeling behaviour. [ABSTRACT FROM AUTHOR]

Limited research has explored how emotional intimate partner violence (IPV) shapes HIV risk behaviors. Using cross-sectional data from the HPTN 068 post-trial visit (N = 1942), we assessed the association between emotional IPV and its sub-domains (verbal abuse and threats) with condomless sex, transactional sex, and frequent alcohol use among young women in South Africa. In adjusted multivariable logistic regression models, any emotional IPV and verbal IPV were associated with increased odds of condomless sex (aOR: 1.47; 95% CI: 1.15, 1.87; and aOR: 1.48; 95% CI: 1.15, 1.89), transactional sex (aOR: 2.32; 95% CI: 1.74, 3.08; and aOR: 2.02; 95% CI: 1.51, 2.71) and alcohol use (aOR: 1.88; 95% CI: 1.39, 2.53; and aOR: 1.87; 95% CI: 1.37, 2.55). Threats were associated with transactional sex (aOR: 3.67; 95% CI: 2.62, 5.14). Future research should examine this relationship over-time and HIV prevention programs should consider and address emotional IPV. [ABSTRACT FROM AUTHOR]

Abstract: While attention to the socio-ecological and political economic influences on health grows, there remains a paucity of political ecological analyses of health (King, 2010). At the same time, the growing burden of non-communicable diseases (NCDs) in the Global South demands new conceptual and pragmatic engagements with their modifiable risk factors. Drawing on the example of South Africa, this paper argues that alcohol consumption might usefully be theorised in political ecological lexicon as a “disaster”. To do so, it draws attention to the upstream causes of vulnerability, rather than just the downstream effects of risky drinking. This reorientation is needed for sustainable, publicly acceptable alcohol policies. To realise this, it draws on Blaikie et al.’s (1994, 2003) political ecological approach to risk, vulnerability and coping and, more specifically, applies their Pressure and Release model to explore liquor as a situated “disaster” in South Africa’s Western Cape province. In so doing, it aims to mark out an under-explored research agenda that considers alcohol as a pervasive governance dilemma. In addition, it also reflects on the model’s utility as a means of communicating findings that might reorient policy discussions on alcohol control in both South Africa and countries of the Global South. [Copyright &y& Elsevier]