145 results on '"Kajula, Lusajo"'
Search Results
2. Development and implementation of a process evaluation for intervention quality improvement of a community-based behavioral HIV intervention trial in Tanzania
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Balvanz, Peter, Singh, Basant, Mwikoko, Gema, Yamanis, Thespina J., Kilonzo, Mrema N., Conserve, Donaldson F., Mulawa, Marta I., Kajuna, Deus, Kajula, Lusajo J., and Maman, Suzanne
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- 2023
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3. The Intersection of Intimate Partner Violence Perpetration and Sexual Risk Behavior Among Young Men in Tanzania: A Latent Class Analysis of Patterns and Outcomes
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McNaughton Reyes, H. Luz, Maman, Suzanne, Kajula, Lusajo J., and Mulawa, Marta
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- 2022
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4. Understanding the Social Dimensions and Context in HIV Research: Instrument Adaptation Is More Than Just Translation.
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Mtei, Rachel Jared, Kilonzo, Mrema N., Pan, Wei, Kisamo, Diana H., Kisigo, Godfrey, Nyblade, Laura, Kajula, Lusajo, and Relf, Michael V.
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There is a shortage of health-related questionnaires developed specifically for African countries' cultural contexts and local languages. Researchers have translated some tools to the target local languages. However, poor-quality or even high-quality translation can lead to an instrument that is not comparable with the original language if linguistic nuances, and cultural differences are not considered. This can affect the validity and reliability of the research data. The objective of this commentary was to highlight limitations of the commonly accepted forward–backward translation approach and the importance of more rigorous cultural and linguistic adaptation processes in social and behavioral research related to HIV. [ABSTRACT FROM AUTHOR]
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- 2024
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5. Patterns of adverse childhood experiences and subsequent risk of interpersonal violence perpetration among men in Dar es Salaam, Tanzania
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Zietz, Susannah, Kajula, Lusajo, McNaughton Reyes, H. Luz, Moracco, Beth, Shanahan, Meghan, Martin, Sandra, and Maman, Suzanne
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- 2020
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6. Correlates of Anxiety and Depression among Young Men Living in Dar Es Salaam, Tanzania
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Hill, Lauren M., Kajula, Lusajo J., and Maman, Suzanne
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- 2020
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7. Engaging Young Men as Community Health Leaders in an STI and Intimate Partner Violence Prevention Trial in Dar es Salaam, Tanzania
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Kajula, Lusajo J., Kilonzo, Mrema N., Conserve, Donaldson F., Mwikoko, Gema, Kajuna, Deus, Balvanz, Peter, Yamanis, Thespina J., Mulawa, Marta I., Hill, Lauren M., Mbwambo, Jessie K., and Maman, Suzanne
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- 2019
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8. ‘You are looked upon as a luxury tool’: Young Tanzanian women’s perception of community norms supporting partner violence during transactional sex (<italic>kudanga</italic>)
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Rogers, Kate, Kajula, Lusajo, Kilonzo, Mrema Noel, Palermo, Tia, Ranganathan, Meghna, Collins, R. Lorraine, Livingston, Jennifer A., and Yamanis, Thespina
- Abstract
AbstractThis paper explores the definition of, and perceived community attitudes, toward
kudanga , a Swahili street term for a type of transactional sex practised in Dar es Salaam, Tanzania. Rooted in economic and gender disparity, transactional sex increases adolescent girls’ and young women’s vulnerability to HIV and gender-based violence. We sought to understand perceived community attitudes about kudanga, and how the internalisation of norms surrounding gender-based violence relate to the experiences of young women who practise kudanga. Using qualitative data from focus group discussions with 37 young women, we found that community perceptions of kudanga were largely negative, and those who engaged in it were looked down upon and despised. Violence and lack of sexual agency were normalised when doing kudanga. However, young women understood kudanga to often be their best option to obtain economic stability and felt strongly that those who practised kudanga should not be stigmatised. Our research provides further evidence that transactional sex exists on a continuum and highlights the importance of reducing community stigma surrounding transactional sex as a means of decreasing risk of HIV and gender-based violence for young women. To our knowledge, this article is the first to explore kudanga. [ABSTRACT FROM AUTHOR]- Published
- 2024
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9. Economic vulnerabilities, mental health, and coping strategies among Tanzanian youth during COVID-19.
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Zuilkowski, Stephanie Simmons, Quinones, Sarah, Kihanzah, Hassan, Marwerwe, Graca, Prencipe, Leah, Kajula, Lusajo, and Palermo, Tia
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Background: The COVID-19 pandemic has exacerbated struggles for youth living in poor households. Youth in rural Tanzania are particularly vulnerable given widespread poverty, lack of formal sector employment opportunities, and health risks. We examine influences of the pandemic on economic insecurity and mental health and explore the coping strategies employed by youth and their households. Methods: We conducted mixed-method data collection with youth (N = 760 quantitative and N = 44 qualitative interviews) and households (n = 542) via mobile phone among a sub-set of a cohort from an on-going longitudinal sample in two rural regions in Tanzania. In addition to phone interviews, we collected data bi-weekly via SMS messaging. We present mixed-methods, descriptive analysis of the outcomes and longitudinally compare quantitative outcomes pre- and post-COVID-19, within the same individuals. Results: Adverse economic impacts were most salient, and to cope, youth engaged in more labor and domestic chores. Compared to prior the COVID-19 pandemic, youth reported spending more time caring for elderly or sick household members and gathering firewood or nuts. Conclusions: These findings underscore the potential opportunity to promote policies and programs which address risks youth face. Recommended measures include expansion and adaptation of social protection policies, strengthened food and nutrition surveillance and referral systems, and scaling up community-based mental health programming. [ABSTRACT FROM AUTHOR]
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- 2024
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10. Peer network influence on intimate partner violence perpetration among urban Tanzanian men
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Mulawa, Marta I., Kajula, Lusajo J., and Maman, Suzanne
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- 2018
11. How Alcohol, Space, and Time Influence Young People’s Sexual Encounters in Tanzania: A Qualitative Analysis
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Sommer, Marni, Parker, Richard, Msacky, Glory, Kajula, Lusajo, and Kaaya, Sylvia
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- 2019
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12. Structural Network Position and Performance of Health Leaders Within an HIV Prevention Trial
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Mulawa, Marta I., Yamanis, Thespina J., Kajula, Lusajo J., Balvanz, Peter, and Maman, Suzanne
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- 2018
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13. Changes in Anxiety and Depression Symptoms Predict Sexual Risk Behaviors Among Young Men Living in Dar es Salaam, Tanzania
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Hill, Lauren M., Gottfredson, Nisha C., Kajula, Lusajo J., Pence, Brian W., Go, Vivian F., Moody, James, and Maman, Suzanne
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- 2018
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14. Associations Between Peer Network Gender Norms and the Perpetration of Intimate Partner Violence Among Urban Tanzanian Men: a Multilevel Analysis
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Mulawa, Marta I., Reyes, H. Luz McNaughton, Foshee, Vangie A., Halpern, Carolyn T., Martin, Sandra L., Kajula, Lusajo J., and Maman, Suzanne
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- 2018
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15. Evidence of social network influence on multiple HIV risk behaviors and normative beliefs among young Tanzanian men
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Mulawa, Marta, Yamanis, Thespina J., Hill, Lauren M., Balvanz, Peter, Kajula, Lusajo J., and Maman, Suzanne
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- 2016
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16. Social Network Influence on HIV Testing Among Urban Men in Tanzania
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Yamanis, Thespina J., Dervisevic, Ervin, Mulawa, Marta, Conserve, Donaldson F., Barrington, Clare, Kajula, Lusajo J., and Maman, Suzanne
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- 2017
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17. Comparing Perceptions with Actual Reports of Close Friend’s HIV Testing Behavior Among Urban Tanzanian Men
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Mulawa, Marta, Yamanis, Thespina J., Balvanz, Peter, Kajula, Lusajo J., and Maman, Suzanne
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- 2016
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18. Young Men’s Social Network Characteristics and Associations with Sexual Partnership Concurrency in Tanzania
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Yamanis, Thespina J., Fisher, Jacob C., Moody, James W., and Kajula, Lusajo J.
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- 2016
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19. Adolescents’ Communication with Parents, Other Adult Family Members and Teachers on Sexuality: Effects of School-Based Interventions in South Africa and Tanzania
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Namisi, Francis, Aarø, Leif Edvard, Kaaya, Sylvia, Kajula, Lusajo J., Kilonzo, Gad. P., Onya, Hans, Wubs, Annegreet, and Mathews, Catherine
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- 2015
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20. Parents' and teachers' communication about HIV and sex in relation to the timing of sexual initiation among young adolescents in Tanzania
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KAWAI, KOSUKE, KAAYA, SYLVIA F., KAJULA, LUSAJO, MBWAMBO, JESSIE, KILONZO, GAD P., and FAWZI, WAFAIE W.
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- 2008
21. Dynamics of Parent–Adolescent Communication on Sexual Health and HIV/AIDS in Tanzania
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Kajula, Lusajo J., Sheon, Nicolas, De Vries, Hein, Kaaya, Sylvia F., and Aarø, Leif E.
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- 2014
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22. Transactional sex among adolescent girls and young women enrolled in a cash plus intervention in rural Tanzania: a mixed‐methods study.
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Ranganathan, Meghna, Quinones, Sarah, Palermo, Tia, Gilbert, Ulrike, Kajula, Lusajo, de Hoop, Jacobus, Prencipe, Leah, Groppo, Valeria, Tirivayi, Nyasha, Waidler, Jennifer, Nkolo, Johanna Choumert, Mitti, Respichius, Mallet, Marie, Munanka, Bhoke, Luchemba, Paul, Lukongo, Tumpe Mnyawami, Mulokozi, Aroldia, van Ufford, Paul Quarles, Le Kirkegaard, Rikke, and Eetaama, Frank
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SEXUAL partners ,TRANSACTIONAL sex ,TEENAGE girls ,YOUNG women ,HIV infections ,SOCIAL status ,INTIMATE partner violence - Abstract
Introduction: Transactional sex or material exchange for sex is associated with HIV infection among adolescent girls and young women in sub‐Saharan Africa. The motivations for engaging in transactional sex vary from the fulfilment of basic needs, to enhancing social status or for romantic reasons with the expectation that men should provide. Transactional sex is also associated with HIV risk behaviours, such as multiple sexual partners and other determinants of HIV risk, including partner violence and abuse, alcohol consumption and inconsistent condom use. Methods: We use data from a mixed‐method, cluster randomised controlled trial of the Ujana Salama cash "plus" intervention in rural Tanzania. The data are from the first and third rounds of data collection (2017–2019). The impact evaluation consisted of a parallel mixed‐methods design where the quantitative and qualitative data collection occurred simultaneously, and integration of the findings was done during the discussion. We first examine contextual factors associated with transactional sex using multivariable logistic regression models and then estimate whether the "plus" intervention reduced transactional sex among adolescent girls and young women using analysis of covariance. We used thematic content analysis for analysing qualitative transcripts. Results: The prevalence of transactional sex among unmarried adolescent girls and young women at round 3 was 26%. Findings show that increasing age is a risk factor for transactional sex (OR = 1.80; 95% CI: [1.50, 2.17]), staying in school was negatively associated with engagement in transactional sex (OR = 0.24; 95% CI: [0.14, 0.40]). The cash plus intervention showed no impacts on reducing transactional sex (β = 0.003, p = 0.905). Conclusions: The mechanisms of impact for a cash plus intervention on transactional sex are complex; economic insecurity is an important driver of transactional sex and HIV infection, but psychosocial factors and gendered social norms need consideration in intervention development. Our findings suggest that combination prevention interventions to address the structural drivers of HIV infection should focus on efforts to increase school enrolment and completion. [ABSTRACT FROM AUTHOR]
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- 2022
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23. Intimate partner violence perpetration and sexual risk behaviour: Identifying shared determinants among young men in Tanzania.
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McNaughton Reyes, H. Luz, Maman, Suzanne, Kajula, Lusajo J., and Mulawa, Marta I.
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RISK-taking behavior ,ADVERSE childhood experiences ,GENDER role ,STRUCTURAL equation modeling ,MEN'S health ,FOOD security ,INTERVIEWING ,INTIMATE partner violence ,CRONBACH'S alpha ,DESCRIPTIVE statistics ,QUESTIONNAIRES ,RESEARCH funding ,POVERTY ,UNSAFE sex ,COMORBIDITY ,SECONDARY analysis ,MEDICAL coding - Abstract
In this study we examined factors that predict involvement in different patterns of sexual risk behavior and IPV perpetration among young men in Tanzania (n = 979), with a focus on identifying factors that distinguish men who engage in both behaviours from those who do not. Risk factors were drawn from three domains thought to be upstream drivers of both IPV and sexual risk: poverty, adverse childhood experiences, and inequitable gender norms. A three-step latent class analysis was used to assess whether and how factors from each domain distinguished subgroups of men whose behaviour patterns were characterised as comorbid (involvement in IPV and sexual risk behaviour), IPV-only, sexual risk only, and normative (low risk). Consistent with expectations, greater food insecurity, adverse childhood experiences, and inequitable gender norms related to violence and sexual behaviour predicted increased risk of membership in the comorbid group compared to other sub-groups. Findings support the promise of integrated prevention programmes targeting the common causes of IPV perpetration and sexual risk behaviour. [ABSTRACT FROM AUTHOR]
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- 2022
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24. Social venues that protect against and promote HIV risk for young men in Dar es Salaam, Tanzania
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Yamanis, Thespina J., Maman, Suzanne, Mbwambo, Jessie K., Earp, Jo Anne E., and Kajula, Lusajo J.
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- 2010
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25. Effects of Adolescent-Focused Integrated Social Protection on Depression: A Pragmatic Cluster-Randomized Controlled Trial of Tanzania's Cash Plus Intervention.
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Prencipe, Leah, Houweling, Tanja A J, Lenthe, Frank J van, Kajula, Lusajo, Palermo, Tia, and Team, on behalf of the Tanzania Adolescent Cash Plus Evaluation
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HOME environment ,CONFIDENCE intervals ,MENTAL health ,HEALTH outcome assessment ,RANDOMIZED controlled trials ,DEPRESSION in adolescence ,DESCRIPTIVE statistics ,PUBLIC welfare ,STATISTICAL sampling ,ODDS ratio - Abstract
We assessed the impacts of Tanzania's adolescent-focused Cash Plus intervention on depression. In this pragmatic cluster-randomized controlled trial, 130 villages were randomly allocated to an intervention or control arm (1:1). Youth aged 14–19 years living in households receiving governmental cash transfers were invited to participate. The intervention included an intensive period (a 12-session course) and an aftercare period (9 months of mentoring, productive grants, and strengthened health services). We examined intervention impacts on a depressive symptoms scale (10-item Center for Epidemiologic Studies Depression Scale score (range, 0–30)) and rates of depressive symptomatology (score ≥10 points on the scale), recorded at study baseline (April–June 2017), midline (May–July 2018), and endline (June–August 2019). Using intention-to-treat methodology, we employed logistic and generalized linear models to estimate effects for binary and continuous outcomes, respectively. Quantile regression was used to estimate effects across the scale. From 2,458 baseline participants, 941 intervention and 992 control adolescents were reinterviewed at both follow-ups. At endline, the intervention reduced the odds of depressive symptomatology (adjusted odds ratio = 0.67, 95% confidence interval: 0.52, 0.86), with an undetectable mean scale difference (risk difference = −0.36, 95% confidence interval: –0.84, 0.11). Quantile regression results demonstrated an intervention effect along the upper distribution of the scale. Integration of multisectoral initiatives within existing social protection systems shows potential to improve mental health among youth in low-resource settings. [ABSTRACT FROM AUTHOR]
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- 2022
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26. From Coitus to Concurrency: Sexual Partnership Characteristics and Risk Behaviors of 15–19 Year Old Men Recruited from Urban Venues in Tanzania
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Yamanis, Thespina J., Doherty, Irene A., Weir, Sharon S., Bowling, James M., Kajula, Lusajo J., Mbwambo, Jessie K., and Maman, Suzanne
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- 2013
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27. "Mtoto Wa Nyoka Ni Nyoka," The Child of a Snake is a Snake: A Narrative Analysis of Adverse Childhood Experiences and Perpetration of Interpersonal Violence Among Men in Dar es Salaam, Tanzania.
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Zietz, Susannah, Kajula, Lusajo, Martin, Sandra, Moracco, Beth, Shanahan, Meghan, and Maman, Suzanne
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RISK of violence , *ADVERSE childhood experiences , *PARENT attitudes , *LIFE change events , *AFFINITY groups , *PSYCHOLOGY of men , *EVALUATION , *RESEARCH methodology , *ECOLOGY , *NARRATIVES , *CRIMINALS , *QUANTITATIVE research , *INTERVIEWING , *RISK assessment , *QUALITATIVE research , *LIFE history interviews , *ATTACHMENT behavior , *SURVEYS , *CASE studies , *PSYCHOLOGICAL adaptation , *POVERTY , *ANGER , *JUDGMENT sampling , *DATA analysis software , *PSYCHOLOGICAL stress - Abstract
Childhood exposure to adversity, including abuse and neglect, is consistently found to be a predictor of intimate partner violence (IPV) and peer violence (PV) perpetration in adulthood. The purpose of this study is to qualitatively examine factors that may facilitate or impede the use of violence among those who have been exposed to adversity early in life. We are particularly interested in protective experiences or environments for these participants. The qualitative data were analyzed through thematic coding and narrative analysis of participant life histories. We found three salient themes: (a) parental acceptance and early attachment is protective for coping with stress with intimate partners in adulthood; (b) certain key life turning points can provide a protective context against violent behavior in adulthood; and (c) poverty in adulthood compromises one's ability to cope with stress and anger in adulthood. Our findings contextualize the different factors that may affect the behavior of perpetration of interpersonal violence among high-risk men in Dar es Salaam who have been exposed to adversity in childhood. These findings provide important information on the risk and protective factors for interpersonal violence spanning from childhood to adulthood. This study highlights the importance of child development interventions in this situation, both for the primary prevention of child adversity and for promoting resilience and mitigating the effects of childhood adversity that put men at risk for perpetration of interpersonal violence in adulthood. [ABSTRACT FROM AUTHOR]
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- 2022
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28. Effects of Government-Implemented Cash Plus Model on Violence Experiences and Perpetration Among Adolescents in Tanzania, 2018‒2019.
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Palermo, Tia, Prencipe, Leah, and Kajula, Lusajo
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DOMESTIC economic assistance ,VIOLENCE ,CRIMES against youth ,TEENAGERS ,SEXUAL assault ,VICTIMS of violent crimes ,POVERTY ,GOVERNMENT programs ,VIOLENCE & psychology ,SELF-perception ,GOVERNMENT policy - Abstract
Objectives. To examine the impacts of a government-implemented cash plus program on violence experiences and perpetration among Tanzanian adolescents. Methods. We used data from a cluster randomized controlled trial (n = 130 communities) conducted in the Mbeya and Iringa regions of Tanzania to isolate impacts of the "plus" components of the cash plus intervention. The panel sample comprised 904 adolescents aged 14 to 19 years living in households receiving a government cash transfer. We estimated intent-to-treat impacts on violence experiences, violence perpetration, and pathways of impact. Results. The plus intervention reduced female participants' experiences of sexual violence by 5 percentage points and male participants' perpetration of physical violence by 6 percentage points. There were no intervention impacts on emotional violence, physical violence, or help seeking. Examining pathways, we found positive impacts on self-esteem and participation in livestock tending and, among female participants, a positive impact on sexual debut delays and a negative effect on school attendance. Conclusions. By addressing poverty and multidimensional vulnerability, integrated social protection can reduce violence. Public Health Implications. There is high potential for scale-up and sustainability, and this program reaches some of the most vulnerable and marginalized adolescents. (Am J Public Health. 2021;111(12):2227–2238. https://doi.org/10.2105/AJPH.2021.306509) [ABSTRACT FROM AUTHOR]
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- 2021
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29. Exploring multilevel social determinants of depressive symptoms for Tanzanian adolescents: evidence from a cross-sectional study.
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Prencipe, Leah, Houweling, Tanja A. J., van Lenthe, Frank J., Palermo, Tia M., and Kajula, Lusajo
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SOCIAL determinants of health ,CONFIDENCE intervals ,SOCIAL support ,CROSS-sectional method ,POPULATION geography ,FAMILIES ,MENTAL health ,ECOLOGY ,SOCIOECONOMIC factors ,SEX distribution ,MENTAL depression ,NATURAL disasters ,INTERPERSONAL relations ,SCHOOLS ,STATISTICAL correlation ,CLIMATE change ,ADOLESCENCE - Published
- 2021
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30. Social and structural determinants of youth alcohol use in Tanzania: The role of gender, social vulnerability and stigma.
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Sommer, Marni, Kaaya, Sylvia, Kajula, Lusajo, Marwerwe, Graca, Hamisi, Hassan, and Parker, Richard
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ALCOHOL drinking ,INTERVIEWING ,MASCULINITY ,MEDICAL care research ,RESEARCH funding ,RISK-taking behavior ,SCHOOLS ,HUMAN sexuality ,SEX customs ,SEX distribution ,GENDER role ,SOCIAL stigma ,TEENAGERS' conduct of life ,QUALITATIVE research ,GENDER inequality ,SOCIOECONOMIC factors ,SOCIAL context ,THEMATIC analysis ,HEALTH & social status ,PSYCHOLOGICAL vulnerability ,ADOLESCENCE - Abstract
Adolescent alcohol use remains an under-addressed population health issue across Africa. Although the literature explores the intersection of alcohol use and vulnerability to HIV and AIDS, there is limited evidence on the gendered uptake and use of alcohol among adolescents. Capturing adolescents' voiced experiences about the societal influences shaping their alcohol usage is essential for identifying contextually relevant interventions to reduce their vulnerability to alcohol and related risky behaviours, such as unsafe sex. We conducted qualitative research in urban Tanzania, including key informant interviews, systematic mapping of alcohol availability, in-depth interviews with adolescents in and out of school and adults, and participatory methodologies with adolescents ages 15-19. The findings described here were drawn from the participatory methodologies (n = 177); and in-depth interviews with adolescents (n = 24) and adults (n = 24). Three key themes emerged: (1) boys' increased social vulnerability to alcohol consumption; (2) the ways in which stigma shapes girls' alcohol usage; and (3) how gendered perceptions of alcohol use reinforce societal inequalities. There exists an urgent need to address the social and gendered vulnerabilities of youth in Africa to the uptake and use of alcohol, and identify interventions that reshape notions of masculinity increasing boy's vulnerability to use. [ABSTRACT FROM AUTHOR]
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- 2021
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31. Anxiety and depression strongly associated with sexual risk behaviors among networks of young men in Dar es Salaam, Tanzania
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Hill, Lauren M., Kajula, Lusajo Joel, Maman, Suzanne, and Kilonzo, Mrema Noel
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This study tested the association between mental health scores and sexual risk behaviors among male members of social groups known as “camps” in Dar es Salaam, Tanzania. Anxiety and depression were measured using the HSCL-25 and condom use and sexual partner concurrency were assessed through self-report. 1113 sexually active men with an average age of 27 years were included in the analyses. Higher anxiety and depression scores were significantly associated with both condom use (Anxiety AOR=0.58, 95% CI: 0.44, 0.77; Depression AOR=0.60, 95% CI: 0.47, 0.77) and concurrency (Anxiety AOR=2.32, 95% CI: 1.73, 3.12; Depression AOR=2.08, 95% CI: 1.60, 2.70). The results of this study provide information salient to the development of effective HIV prevention interventions targeting populations with high burdens of anxiety and depression. The feasibility and effect of integrating mental health promotion activities into HIV prevention interventions should be explored.
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- 2017
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32. Results from a cluster-randomized trial to evaluate a microfinance and peer health leadership intervention to prevent HIV and intimate partner violence among social networks of Tanzanian men.
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Maman, Suzanne, Mulawa, Marta I., Balvanz, Peter, McNaughton Reyes, H. Luz, Kilonzo, Mrema N., Yamanis, Thespina J., Singh, Basant, and Kajula, Lusajo J.
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INTIMATE partner violence ,SOCIAL networks ,BEHAVIORAL assessment ,MICROFINANCE ,HIV ,PARTICIPANT-researcher relationships ,HUMAN sexuality - Abstract
Despite calls to engage men in HIV and intimate partner violence (IPV) prevention efforts, effective approaches to reach and engage men in low-resource, high-HIV prevalence settings are limited. We identified and engaged social networks of mostly young men in a study designed to evaluate the efficacy of a combined microfinance and peer health leadership intervention to prevent HIV and IPV. We conducted a cluster-randomized trial among 60 social networks locally referred to as "camps" within Dar es Salaam, Tanzania. Camps were randomly assigned (1:1) to a microfinance and peer health leadership intervention or a control condition that received a brief delayed intervention after the study's conclusion. Allocation was not masked to participants or researchers. Behavioral assessments were conducted at baseline and 30-months post-intervention launch, with biological samples drawn at 30-months to test for sexually-transmitted infections (STIs). Primary outcomes included prevalence of STIs and past-year IPV perpetration. Secondary outcomes included STI sexual risk behaviors and past-year HIV testing. Proximal intervention targets included inequitable gender norm attitudes and hope. A modified Poisson regression approach was used to estimate intention-to-treat intervention effects on outcomes assessed at the 30-month follow-up. We enrolled 1,258 men within 60 camps. Of these men, 1,029 (81.8%) completed the 30-month follow-up. There were no differences by condition in STI prevalence, IPV perpetration, or sexual risk behaviors at the 30-month follow-up. Intervention participants reported greater levels of past-year HIV testing, controlling for baseline testing (aRR 1.13 95% CI 1.005–1.28). They also reported significantly lower levels of inequitable gender norm attitudes (adjusted effect -0.11, 95% CI -0.21–0.003). We successfully engaged and retained social networks of men in this multilevel intervention study. While we did not see an effect on the primary outcomes, our intervention successfully improved HIV testing and reduced inequitable gender norm attitudes. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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33. 'Most of the Youth Are Drinking Because They Have Nothing to Do': How Idle Time Facilitates Adolescent Alcohol Use in Urban Tanzania.
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Carney, Allison, Kaaya, Sylvia, Kajula, Lusajo, Ibitoye, Mobolaji, Marwerwe, Graca, and Sommer, Marni
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PSYCHOLOGY of alcoholism ,PSYCHOLOGICAL vulnerability ,ECOLOGY ,RECREATION ,CITY dwellers ,SOCIOECONOMIC factors ,QUALITATIVE research ,CONTENT mining ,GOVERNMENT programs ,ALCOHOL drinking ,PSYCHOSOCIAL factors ,TEENAGERS' conduct of life ,PHOTOGRAPHY ,GOVERNMENT policy ,EMPLOYMENT ,ADOLESCENCE - Abstract
Societal factors influencing adolescent alcohol initiation and use are not well documented in Tanzania. The goal of this qualitative study was to explore the structural and environmental factors influencing adolescent alcohol uptake and use in urban Tanzania. 177 adolescents aged 15–19 from varying socioeconomic backgrounds participated in 16 participatory groups (separated by sex and in-school/out-of-school status) at sites in four different locations in Dar es Salaam, Tanzania. Participatory methods were used, including listing and ranking activities, and photovoice, exploring adolescent's perceptions around youth alcohol use, and recommendations for structural interventions to prevent or reduce adolescent alcohol uptake and use. Themes included: (1) "idle time" shapes adolescent alcohol use in urban Tanzania; (2) societal influences shape the locations where adolescents consume or purchase alcohol; and, (3) adolescents' recommendations about structural approaches for reducing their idle time and vulnerability to alcohol use. Our findings highlight the need for programs and policies aimed at reducing youth idle time as an approach to reducing alcohol use, such as increasing opportunities for employment, extracurricular activities, and entertainment, particularly for adolescent boys in urban Tanzania, given their increased vulnerability to the uptake and use of alcohol. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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34. Vijana Vijiweni II: A cluster-randomized trial to evaluate the efficacy of a microfinance and peer health leadership intervention for HIV and intimate partner violence prevention among social networks of young men in Dar es Salaam Global health
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Leatherman, Sheila, Kajuna, Deus, Singh, Basant, Conserve, Donaldson, Maman, Suzanne, Mulawa, Marta, Mwikoko, Gema, Kajula, Lusajo, Reyes, Heathe Luz Mc Naughton, Hill, Lauren, Balvanz, Peter, Kilonzo, Mrema Noel, and Yamanis, Thespina
- Abstract
BackgroundIntimate partner violence (IPV) and sexually transmitted infections (STIs), including HIV, remain important public health problems with devastating health effects for men and women in sub-Saharan Africa. There have been calls to engage men in prevention efforts, however, we lack effective approaches to reach and engage them. Social network approaches have demonstrated effective and sustained outcomes on changing risk behaviors in the U.S. Our team has identified and engaged naturally occurring social networks comprised mostly of young men in Dar es Salaam in an intervention designed to jointly reduce STI incidence and the perpetration of IPV. These stable networks are locally referred to as “camps.” In a pilot study we demonstrated the feasibility and acceptability of a combined microfinance and peer health leadership intervention within these camp-based peer networks.Methods designWe are implementing a cluster-randomized trial to evaluate the efficacy of an intervention combining microfinance with health leadership training in 60 camps in Dar es Salaam, Tanzania. Half of the camps have been randomized to the intervention arm, and half to a control arm. The camps in the intervention arm will receive a combined microfinance and health leadership intervention for a period of two years. The camps in the control arm will receive a delayed intervention. We have enrolled 1,258 men across the 60 study camps. Behavioral surveys will be conducted at baseline, 12-months post intervention launch and 30-month post intervention launch and biological samples will be drawn to test for Neisseria gonorrhea (NG), Chlamydia trachomatis (CT), and Trichomonas vaginalis (TV) at baseline and 30-months. The primary endpoints for assessing intervention impact are IPV perpetration and STI incidence.DiscussionThis is the first cluster-randomized trial targeting social networks of men in sub-Saharan Africa that jointly addresses HIV and IPV perpetration and has both biological and behavioral endpoints. Effective approaches to engage men in HIV and IPV prevention are needed in low resource, high prevalence settings like Tanzania. If we determine that this approach is effective, we will examine how to adapt and scale up this approach to other urban, sub-Saharan African settings.Trial registrationClinical Trials.gov: NCT01865383. Registration date: May 24, 2013.
- Published
- 2015
- Full Text
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35. Sexual and Social Network Correlates of Willingness to Self-Test for HIV Among Ever-Tested and Never-Tested Men: Implications for the Tanzania STEP Project.
- Author
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Conserve, Donaldson F., Bay, Camden, Kilonzo, Mrema N., Makyao, Neema E., Kajula, Lusajo, and Maman, Suzanne
- Subjects
DIAGNOSIS of HIV infections ,AGE distribution ,AIDS education ,ATTITUDE (Psychology) ,CLUSTER analysis (Statistics) ,CONFIDENCE intervals ,HEALTH promotion ,HEALTH services accessibility ,MEN'S health ,REGRESSION analysis ,RISK perception ,RISK-taking behavior ,HUMAN sexuality ,SOCIAL networks ,SURVEYS ,THERAPEUTICS ,LOGISTIC regression analysis ,SOCIAL support ,EDUCATIONAL attainment ,SEXUAL partners ,SELF diagnosis ,AIDS serodiagnosis ,ODDS ratio - Abstract
We examined factors associated with HIV self-testing (HIVST) willingness among male ever-testers and never-testers who participated in a midpoint survey of a cluster randomized controlled HIV prevention trial in Dar es Salaam. Linear mixed binary logistic regression models were constructed to examine factors (demographic, HIV risk behavior, and sexual/social network) associated with willingness to self-test. Sixtyseven percent of 301 never-testers were willing to self-test for HIV compared to 72% 577 of ever-testers. Among never-testers, having discussed testing for HIV with a sexual partner was the only factor associated with HIVST willingness (2.36, 95% CI: 1.35-4.15). For evertesters, younger men were less willing to self-test than older men while men with higher education were more willing to self-test than less educated men. Having a moderate/great HIV risk perception decreased the odds of HIVST willingness relative to no risk perception (0.40, 95% CI 0.23-0.70) for ever-testers. Discussing HIV testing with a sexual partner and having been encouraged to test for HIV by a friend were associated with higher odds of being willing to self-test (2.22, 2.23; 95% CI 1.34-3.67, 1.14-4.39, respectively) among ever-testers. These findings suggest that HIVST willingness is highly acceptable among both male ever-testers and never-testers. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
36. Microfinance and health interventions: Factors influencing loan repayment success with young men in Dar es Salaam, Tanzania.
- Author
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Balvanz, Peter, Yamanis, Thespina J., Mulawa, Marta I., Mwikoko, Gema, Kajuna, Deusdith, Kilonzo, Mrema N., Kajula, Lusajo J., Leatherman, Sheila, and Maman, Suzanne
- Subjects
POVERTY reduction ,BUSINESS ,CREDIT ,DEBT ,ECONOMICS ,EDUCATION ,ENTREPRENEURSHIP ,HEALTH behavior ,INTERVIEWING ,RESEARCH methodology ,MOTIVATION (Psychology) ,POISSON distribution ,RESEARCH funding ,STATISTICAL sampling ,UNEMPLOYMENT ,QUALITATIVE research ,SOCIAL capital ,RANDOMIZED controlled trials ,DATA analysis software - Abstract
Poverty is associated with numerous poor health outcomes. Youth unemployment in Tanzania is approximately 13.7%, and concentrates in urban areas. These youth lack relevant job skills and access to financial capital. Microfinance continues to be implemented globally to address poverty, and increasingly has been linked to health interventions. Men less frequently are recipients of microfinance loans. We offered microcredit to young men in an area of Dar es Salaam with high poverty as part of a randomised controlled-trial to assess the efficacy of a microfinance and health leadership intervention in preventing STI acquisition. We used mixed methods to understand predictors of successful loan repayment. Our qualitative sub-study showed that leader influence, prior business experience, personal motivation, and planning facilitated repayment. Using a modified Poisson approach, our quantitative analysis showed that successful repayment was associated with business experience, education, increasing number of children, community of residence, percentage of network members trained in business, and repayment success of peer leaders. Our results suggest that enforcing group accountability and repayment rules, offering ongoing training, and using successful entrepreneurs as role models could increase repayment success in similar populations. These strategies could provide financial opportunity for men while minimising risk for microfinance institutions. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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- View/download PDF
37. Cluster randomized trial of comprehensive gender-based violence programming delivered through the HIV/AIDS program platform in Mbeya Region, Tanzania: Tathmini GBV study.
- Author
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Settergren, Susan K., Mujaya, Stella, Rida, Wasima, Kajula, Lusajo J., Kamugisha, Hussein, Kilonzo Mbwambo, Jessie, Kisanga, Felix, Mizinduko, Mucho M., Dunbar, Megan S., Mwandalima, Isihaka, Wazee, Hijja, Prieto, Diana, Mullick, Saiqa, Erie, Jennifer, and Castor, Delivette
- Subjects
PUBLIC health ,HUMAN services ,BIOSURVEILLANCE ,HIV ,AIDS - Abstract
The Tathmini GBV study was a cluster randomized trial to assess the impact of a comprehensive health facility- and community-based program delivered through the HIV/AIDS program platform on reduction in gender-based violence and improved care for survivors. Twelve health facilities and surrounding communities in the Mbeya Region of Tanzania were randomly assigned to intervention or control arms. Population-level effects were measured through two cross-sectional household surveys of women ages 15–49, at baseline (n = 1,299) and at 28 months following program scale-out (n = 1,250). Delivery of gender-based violence services was assessed through routine recording in health facility registers. Generalized linear mixed effects models and analysis of variance were used to test intervention effects on population and facility outcomes, respectively. At baseline, 52 percent of women reported experience of recent intimate partner violence. The odds of reporting experience of this violence decreased by 29 percent from baseline to follow-up in the absence of the intervention (time effect OR = 0.71, 95% CI: 0.57–0.89). While the intervention contributed an additional 15 percent reduction, the effect was not statistically significant. The program, however, was found to contribute to positive, community-wide changes including less tolerance for certain forms of violence, more gender equitable norms, better knowledge about gender-based violence, and increased community actions to address violence. The program also led to increased utilization of gender-based violence services at health facilities. Nearly three times as many client visits for gender-based violence were recorded at intervention (N = 1,427) compared to control (N = 489) facilities over a 16-month period. These visits were more likely to include provision of an HIV test (55.3% vs. 19.6%, p = .002). The study demonstrated the feasibility and impact of integrating gender-based violence and HIV programming to combat both of these major public health problems. Further opportunities to scale out GBV prevention and response strategies within HIV/AIDS service delivery platforms should be pursued. Trial Registration: Pan African Clinical Trials Registry No. . [ABSTRACT FROM AUTHOR]
- Published
- 2018
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- View/download PDF
38. “He Told Me to Check My Health”: A Qualitative Exploration of Social Network Influence on Men’s HIV Testing Behavior and HIV Self-Testing Willingness in Tanzania.
- Author
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Conserve, Donaldson F., Alemu, Dawit, Yamanis, Thespina, Maman, Suzanne, and Kajula, Lusajo
- Abstract
Men continue to test for HIV at a low rate in sub-Saharan Africa. Recent quantitative evidence from sub-Saharan Africa indicates that encouragement to test for HIV from men’s network members is associated with higher previous HIV testing and HIV self-testing (HIVST) willingness. Leveraging this positive network influence to promote HIVST among men is a promising strategy that could increase HIV testing. This study investigated the reasons and strategies men used to encourage their peers to test for HIV and the outcomes in order to inform the development of a social network-based HIVST intervention for men called STEP (Self-Testing Education and Promotion). Twenty-three men from networks locally referred to as “camps” were interviewed to explore reasons for encouraging HIV testing, strategies to encourage HIV testing, and outcomes of HIV testing encouragement. Reasons men reported for encouraging their peers to test for HIV included awareness of their peers’ risky sexual behavior, knowing an HIV-positive peer, and having HIV testing experience. Strategies for encouraging testing included engaging in formal and informal conversations and accompanying friends to the clinic. Encouragement outcomes included HIV testing for some men while others remained untested due to lack of privacy in the clinic and fear of HIV stigma. Willingness to self-test for HIV and an interest to educate peers about HIVST were other outcomes of HIV testing encouragement. These findings underscore the potential of leveraging men’s existing HIV testing encouragement strategies to promote HIVST among their peers. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
39. Mate Yako Afya Yako: Formative research to develop the Tanzania HIV self-testing education and promotion (Tanzania STEP) project for men.
- Author
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Conserve, Donaldson F., Muessig, Kathryn E., Maboko, Leonard L., Shirima, Sylvia, Kilonzo, Mrema N., Maman, Suzanne, and Kajula, Lusajo
- Subjects
DIAGNOSIS of HIV infections ,PATIENT self-monitoring ,MOBILE health ,SOCIAL networks ,MEDICAL care - Abstract
The purpose of this formative research, guided by the Integrated Behavioral Model, was to assess men’s attitudes and personal agency towards HIV self-testing (HIVST) and confirmatory HIV testing in order to inform the development of the Tanzania STEP (Self-Testing Education and Promotion) Project, a peer-based HIV self-testing intervention for young men in Tanzania. Qualitative in-depth interviews were conducted with 23 men in Dar es Salaam, Tanzania who socialize in networks locally referred to as “camps”. Men reported privacy, confidentiality, and saving time as the primary reasons for their self-testing interest. Most participants had high perceived control and self-efficacy to self-test and seek confirmatory HIV testing. Nevertheless, men reported concerns related to their ability to perform the test and the potential lack of post-test counseling. Specific recommendations for the intervention included providing HIVST education and pre-test counseling, and using mobile health (mHealth) strategies for participants to reach a healthcare professional for further assistance. The findings suggest that while HIVST is highly acceptable among men in Tanzania, future interventions will need to address the challenges that men may face with HIVST before promoting it as an alternative or supplement to facility-based HIV testing. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
40. Perpetration and Victimization of Intimate Partner Violence Among Young Men and Women in Dar es Salaam, Tanzania.
- Author
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Mulawa, Marta, Kajula, Lusajo J., Yamanis, Thespina J., Balvanz, Peter, Kilonzo, Mrema N., and Maman, Suzanne
- Subjects
- *
CONTROL (Psychology) , *CHILD abuse , *CHILD sexual abuse , *ALCOHOL drinking , *QUESTIONNAIRES , *RESEARCH funding , *SEX crimes , *SEX distribution , *PSYCHOLOGICAL stress , *VICTIMS , *VIOLENCE , *DISEASE prevalence , *INTIMATE partner violence , *DATA analysis software , *INDEPENDENT variables - Abstract
We describe and compare the baseline rates of victimization and perpetration of three forms of intimate partner violence (IPV)—psychological, physical, and sexual—among sexually active men (n = 1,113) and women (n = 226) enrolled in an ongoing cluster-randomized HIV and gender-based violence prevention trial in Dar es Salaam, Tanzania. IPV was measured using a modified version of the World Health Organization Violence Against Women instrument. We assess the degree to which men and women report overlapping forms of IPV victimization and perpetration. Sociodemographic and other factors associated with increased risk of victimization and perpetration of IPV are examined. Within the last 12 months, 34.8% of men and 35.8% of women reported any form of IPV victimization. Men were more likely than women to report perpetrating IPV (27.6% vs. 14.6%, respectively). We also found high rates of co-occurrence of IPV victimization and perpetration with 69.7% of male perpetrators and 81.8% of female perpetrators also reporting victimization during the last year. Among men, having ever consumed alcohol and experiencing childhood violence were associated with increased risk of most forms of IPV. Younger women were more likely to report perpetrating IPV than older women. We found evidence of gender symmetry with regard to most forms of IPV victimization, but men reported higher rates of IPV perpetration than women. Given the substantial overlap between victimization and perpetration reported, our findings suggest that IPV may be bidirectional within relationships in this setting and warrant further investigation. Implications for interventions are discussed. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
41. Effect of the PREPARE intervention on sexual initiation and condom use among adolescents aged 12-14: a cluster randomised controlled trial in Dar es Salaam, Tanzania.
- Author
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Mmbaga, Elia John, Kajula, Lusajo, Aarø, Leif Edvard, Kilonzo, Mrema, Wubs, Annegreet Gera, Eggers, Sander Matthijs, de Vries, Hein, Kaaya2, Sylvia, and Kaaya, Sylvia
- Subjects
- *
TEENAGERS' sexual behavior , *ADOLESCENT health , *CONDOM use , *PUBLIC health , *MANAGEMENT , *CLUSTER analysis (Statistics) , *COMPARATIVE studies , *CONDOMS , *LONGITUDINAL method , *RESEARCH methodology , *MEDICAL cooperation , *RESEARCH , *SCHOOL health services , *SELF-evaluation , *HUMAN sexuality , *STUDENTS , *EVALUATION research , *RANDOMIZED controlled trials , *EVALUATION of human services programs - Abstract
Background: Unsafe sexual practices continue to put adolescents at risk for a number of negative health outcomes in Tanzania. While there are some effective theory-based intervention packages with positive impact on important mediators of sexual behaviours, a context specific and tested intervention is urgently needed in Tanzania.Purpose: To develop and evaluate an intervention that will have a significant effect in reducing sexual initiation and promoting condom use among adolescents aged 12-14 in Dar es Salaam, Tanzania.Design: A school-based Cluster Randomised Controlled Trial was conducted during 2011-2014 in Kinondoni Municipality.Methods: A total of 38 public primary schools were randomly selected, of which half were assigned to the intervention and half to the control group based on their size and geographic location. Participants were interviewed using a self-administered questionnaire at baseline before the PREPARE intervention and then, 6 and 12 months following intervention. The primary outcomes were self-reported sex initiation and condom use during the past 6 months. Data analysis was done using Generalized Estimating Equation (GEE) modelling controlling for repeated measures and clustering of students within schools.Results: A total of 5091 students were recruited at baseline, and interviewed again at 6 (n = 4783) and 12 months (n = 4370). Mean age of participants at baseline was 12.4 years. Baseline sociodemographic, psychometric and behavioural characteristics did not significantly differ between the two study arms. The GEE analysis indicated that the intervention had a significant effect on sexual initiation in both sexes after controlling for clustering and correlated repeated measures. A significantly higher level of action planning to use condoms was reported among female adolescent in the intervention arm than those in the control arm (p = 0.042). An effect on condom use behaviour was observed among male adolescent (p = 0.004), but not among female (p = 0.463).Conclusions: The PREPARE intervention had an effect in delaying self-reported sexual initiation among adolescents aged 12-14 in Dar es Salaam Tanzania. The intervention positively influenced action planning to use condoms for both sexes and increased actual condom use among male adolescents only. Future interventions addressing adolescent sexual and reproductive health should focus on impacting mediators of behaviour change.Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12613000900718 , registered on 13 August, 2013. [ABSTRACT FROM AUTHOR]- Published
- 2017
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- View/download PDF
42. Leveraging strong social ties among young men in Dar es Salaam: A pilot intervention of microfinance and peer leadership for HIV and gender-based violence prevention.
- Author
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Maman, Suzanne, Kajula, Lusajo, Balvanz, Peter, Kilonzo, Mrema, Mulawa, Marta, and Yamanis, Thespina
- Subjects
- *
HIV prevention , *VIOLENCE prevention , *ENDOWMENTS , *INTERVIEWING , *LEADERSHIP , *RESEARCH methodology , *SCIENTIFIC observation , *PILOT projects , *AFFINITY groups , *THEMATIC analysis , *DATA analysis software , *DIARY (Literary form) , *DESCRIPTIVE statistics - Abstract
Gender inequality is at the core of the HIV patterns that are evident in sub-Saharan Africa. Gender-based violence (GBV) and lack of economic opportunity are important structural determinants of HIV risk. We piloted a microfinance and health promotion intervention among social networks of primarily young men in Dar es Salaam. Twenty-two individuals participated in the microfinance component and 30 peer leaders were recruited and trained in the peer health leadership component. We collected and analysed observational data from trainings, monitoring data on loan repayment, and reports of peer conversations to assess the feasibility and acceptability of the intervention. Eighteen of the loan recipients (82%) paid back their loans, and of these 15 (83%) received a second, larger loan. Among the loan defaulters, one died, one had chronic health problems, and two disappeared, one of whom was imprisoned for theft. The majority of conversations reported by peer health leaders focused on condoms, sexual partner selection, and HIV testing. Few peer leaders reported conversations about GBV. We demonstrated the feasibility and acceptability of this innovative HIV and GBV prevention intervention. The lessons learned from this pilot have informed the implementation of a cluster-randomised trial of the microfinance and peer health leadership intervention. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
43. Parenting practices and styles associated with adolescent sexual health in Dar es Salaam, Tanzania.
- Author
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Kajula, Lusajo J., Darling, Nancy, Kaaya, Sylvia F., and De Vries, Hein
- Subjects
- *
DISCIPLINE of children , *SEXUAL health , *INTERPERSONAL relations , *INTERVIEWING , *PARENTING , *PARENTS , *PUNISHMENT , *QUESTIONNAIRES , *RESEARCH funding , *QUALITATIVE research , *THEMATIC analysis , *DATA analysis software - Abstract
Parenting styles and practices are suggested to be important predictors of adolescent sexual health, mostly in Europe and North America. Limited research has been conducted on these processes in Sub-Saharan Africa, which has different patterns of adolescent sexual behavior and family traditions. This study qualitatively explored parenting practices and styles associated with adolescent sexual health in Tanzania, with 12 adolescents and 12 parents of adolescents. The themes we identified from the data included parental monitoring, preventive, and punitive behaviors. Parents were reported to use mostly punitive behaviors to correct or prohibit sexual behavior; parents also set clear rules about appropriate sexual behavior (e.g., modesty and abstinence). Parents were also reported to closely monitor their adolescent children’s friendships and sexual behavior to minimize sexual behavior. However, some parents also engaged in positive preventive practices aimed at protecting their adolescent children. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
44. The psychosocial problems of families caring for relatives with mental illnesses and their coping strategies: a qualitative urban based study in Dar es Salaam, Tanzania.
- Author
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Iseselo, Masunga K., Kajula, Lusajo, and Yahya-Malima, Khadija I.
- Subjects
- *
PEOPLE with mental illness , *PSYCHOLOGICAL adaptation , *QUALITY of life , *CAREGIVERS , *MEDICAL care , *PSYCHOSOCIAL factors - Abstract
Background: Mental illness may cause a variety of psychosocial problems such as decreased quality of life of the patient's family members as well as increased social distance for the patient and the family caring for the patient. Psychosocial challenges are enhanced by the stigma attached to mental illness, which is a problem affecting not only the patient but also the family as a whole. Coping mechanisms for dealing with mentally ill patients differ from one family to another for a variety of reasons. The aim of the study was to determine the psychosocial problems of mental illness on the family including the coping strategies utilized by family members caring for a person with mental illness. Method: A qualitative study was conducted, involving four focus group discussions and 2 in-depth interviews of family members who were caring for patient with mental illness at Temeke Municipality, Dar es Salaam. Purposive sampling procedure was used to select participants for the study. Audio-recorded interviews in Swahili were conducted with all study participants. The recorded interview was transcribed and qualitative content thematic analysis was used to analyse the data. Results: Financial constraints, lack of social support, disruption of family functioning, stigma, discrimination, and patients' disruptive behaviour emerged as the main themes in this study. Acceptance and religious practice emerged as the major coping strategies used by family members. Conclusion: Familial care for a person with mental illness has its advantages, yet it has multiple social and psychological challenges. Coping strategies and skills are important for the well-being of the caregiver and the patient. Addressing these psychosocial challenges requires a collaborative approach between the health care providers and government so that the needs of the family caregivers and those of the patients can be addressed accordingly. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
45. Vijana Vijiweni II: a cluster-randomized trial to evaluate the efficacy of a microfinance and peer health leadership intervention for HIV and intimate partner violence prevention among social networks of young men in Dar es Salaam.
- Author
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Kajula, Lusajo, Balvanz, Peter, Kilonzo, Mrema Noel, Mwikoko, Gema, Yamanis, Thespina, Mulawa, Marta, Kajuna, Deus, Hill, Lauren, Conserve, Donaldson, McNaughton Reyes, Heathe Luz, Leatherman, Sheila, Singh, Basant, Maman, Suzanne, and Reyes, Heathe Luz McNaughton
- Subjects
- *
MICROFINANCE , *HIV , *VIOLENCE prevention , *SEXUALLY transmitted diseases , *PUBLIC health , *HEALTH outcome assessment , *HIV prevention , *PREVENTION of sexually transmitted diseases , *COMPARATIVE studies , *EXPERIMENTAL design , *HEALTH education , *LEADERSHIP , *RESEARCH methodology , *MEDICAL cooperation , *RESEARCH , *RESEARCH funding , *RISK-taking behavior , *HUMAN sexuality , *PILOT projects , *AFFINITY groups , *SOCIAL support , *EVALUATION research , *RANDOMIZED controlled trials , *DISEASE incidence , *DISEASE prevalence , *IMPACT of Event Scale , *ECONOMICS - Abstract
Background: Intimate partner violence (IPV) and sexually transmitted infections (STIs), including HIV, remain important public health problems with devastating health effects for men and women in sub-Saharan Africa. There have been calls to engage men in prevention efforts, however, we lack effective approaches to reach and engage them. Social network approaches have demonstrated effective and sustained outcomes on changing risk behaviors in the U.S. Our team has identified and engaged naturally occurring social networks comprised mostly of young men in Dar es Salaam in an intervention designed to jointly reduce STI incidence and the perpetration of IPV. These stable networks are locally referred to as "camps." In a pilot study we demonstrated the feasibility and acceptability of a combined microfinance and peer health leadership intervention within these camp-based peer networks.Methods Design: We are implementing a cluster-randomized trial to evaluate the efficacy of an intervention combining microfinance with health leadership training in 60 camps in Dar es Salaam, Tanzania. Half of the camps have been randomized to the intervention arm, and half to a control arm. The camps in the intervention arm will receive a combined microfinance and health leadership intervention for a period of two years. The camps in the control arm will receive a delayed intervention. We have enrolled 1,258 men across the 60 study camps. Behavioral surveys will be conducted at baseline, 12-months post intervention launch and 30-month post intervention launch and biological samples will be drawn to test for Neisseria gonorrhea (NG), Chlamydia trachomatis (CT), and Trichomonas vaginalis (TV) at baseline and 30-months. The primary endpoints for assessing intervention impact are IPV perpetration and STI incidence.Discussion: This is the first cluster-randomized trial targeting social networks of men in sub-Saharan Africa that jointly addresses HIV and IPV perpetration and has both biological and behavioral endpoints. Effective approaches to engage men in HIV and IPV prevention are needed in low resource, high prevalence settings like Tanzania. If we determine that this approach is effective, we will examine how to adapt and scale up this approach to other urban, sub-Saharan African settings.Trial Registration: Clinical Trials.gov: NCT01865383 . Registration date: May 24, 2013. [ABSTRACT FROM AUTHOR]- Published
- 2016
- Full Text
- View/download PDF
46. Uptake of HIV testing among adolescents and associated adolescent-friendly services.
- Author
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Kidman, Rachel, Waidler, Jennifer, Palermo, Tia, On Behalf of the Tanzania Adolescent Cash Plus Evaluation Team, Groppo, Valeria, Kajula, Lusajo, de Hoop, Jacobus, Prencipe, Leah, Nkolo, Jennifer Waidler Johanna Choumert, Mitti, Respichius, Munanka, Bhoke, Luchemba, Paul, Lukongo, Tumpe Mnyawami, Mulokozi, Aroldia, Gilbert, Ulrike, van Ufford, Paul Quarles, Le Kirkegaard, Rikke, Eetaama, Frank, and Tanzania Adolescent Cash Plus Evaluation Team
- Subjects
REPRODUCTIVE health services ,TEENAGERS ,HEALTH facilities ,PUBLIC health - Abstract
Background: HIV testing remains low among adolescents. Making public health services more adolescent-friendly is one strategy used to encourage testing. However, it remains unclear whether government-led initiatives have a meaningfully impact.Methods: The current study is observational and utilizes two sources of data (health-facility and adolescent-level) from one round of data collection of an on-going, longitudinal impact evaluation of a pilot cash plus program targeting adolescents. This study linked data from adolescent surveys (n = 2191) to data collected from nearby government-run health facilities (n = 91) in two rural regions of Tanzania. We used log binomial regression models to estimate the association between specific adolescent-friendly health service (AFHS) characteristics and adolescents' uptake of 1) HIV testing and 2) visiting a health care facility in the past year for sexual and reproductive health (SRH) services.Results: Most adolescents (67%) lived in a village with a health facility, and all offered HIV services. We find, however, that AFHS have not been fully implemented. For example, less than 40% of facilities reported that they had guidelines for adolescent care. Only 12% of facilities had a system in place for referral and follow-up with adolescent clients, yet this was an important predictor of both past-year HIV testing (RR = 1.28, p < 0.1) and SRH visits (RR = 1.44, p < 0.05). Less than half (44%) offered services for survivors of gender-based violence (GBV), a significant predictor of past-year HIV testing (RR = 1.20, p < 0.05) and SRH visits (RR = 1.41, p < 0.01) among sexually-active adolescents.Conclusions: We find that national guidelines on AFHS have not been fully translated into practice at the local level. We highlight particular gaps in adolescent referral systems and GBV services. Scaling up these two essential services could encourage greater HIV testing among a high-risk population, in addition to providing much needed support for survivors of violence. [ABSTRACT FROM AUTHOR]- Published
- 2020
- Full Text
- View/download PDF
47. Examining determinants of gender attitudes: evidence among Tanzanian adolescents.
- Author
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Palermo, Tia, Chzhen, Yekaterina, Balvin, Nikola, Kajula, Lusajo, Tanzania Adolescent Cash Plus Evaluation Team, Groppo, Valeria, de Hoop, Jacobus, Prencipe, Leah, Waidler, Jennifer, Choumert Nkolo, Johanna, Mitti, Respichius, Sivewright, Nathan, Leuveld, Koen, Munanka, Bhoke, Luchemba, Paul, Mnyawami Lukongo, Tumpe, Mulokozi, Aroldia, Gilbert, Ulrike, Quarles van Ufford, Paul, and Le Kirkegaard, Rikke
- Subjects
ATTITUDE (Psychology) ,STRUCTURAL equation modeling ,GENDER ,ECOLOGICAL models ,TEENAGERS ,ADOLESCENCE - Abstract
Background: The shaping of gender beliefs and attitudes in early adolescence affects the way young people internalize and self-enforce prevalent notions of masculinity and femininity, with lifelong consequences for sexual and reproductive health. This cross-sectional study examines determinants of gender attitudes among some of the poorest and most vulnerable adolescents in Tanzania using an ecological model.Methods: Data come from baseline interviews with 2458 males and females aged 14-19 years conducted as part of a larger impact evaluation. Structural equation models are used to examine how factors at the community-, household-, and individual-levels influence gender attitudes in the four domains measured by the Gender Equitable Men (GEM) Scale (i.e. violence, sexual relationships, reproductive health and disease prevention, and domestic chores and daily life).Results: A structural equation model of the four latent domains of the GEM scale regressed on individual, social-interactional and structural level characteristics indicated that secondary school attendance was associated with more equitable gender attitudes, while females held less equitable attitudes than males in the sample. Having had sexual intercourse was associated with more gender equitable attitudes among females, but the reverse was true among males.Conclusions: Addressing gender inequity requires understanding gender socialisation at the socio-interactional level. As females had more inequitable gender attitudes than males in the study, a special emphasis on highlighting the rights of women to girls should be considered. This study will inform future analysis of programme impacts on gender attitudes and sexual and reproductive health. [ABSTRACT FROM AUTHOR]- Published
- 2020
- Full Text
- View/download PDF
48. The influence of gender-equitable attitudes on sexual behaviour among unmarried adolescents in rural Tanzania: a longitudinal study.
- Author
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Rogers K, Ranganathan M, Kajula L, Lorraine Collins R, Livingston JA, and Palermo T
- Subjects
- Male, Humans, Female, Adolescent, Tanzania, Longitudinal Studies, Sexual Behavior, Gender Equity, Single Person
- Abstract
Plain Language Statement: Gender norms that centre men and disadvantage women create gender inequality, which can lead to risky sexual behaviour. This study examined how both community and individual attitudes toward gender norms influenced risky sexual behaviour in adolescents, and whether that influence was different between males and females. We found that higher gender-equitable attitudes were linked to increased odds of HIV testing in the last 12 months, and decreased odds of engaging in a sexual relationship with a much older partner. Individual high gender-equitable attitudes among girls were also linked to higher odds of them using condoms and contraceptives. Gender-equitable attitudes did not seem to influence early sexual debut, engagement in transactional sex, having multiple sexual partners at the same time, or the number of sexual partners a participant had in the last 12 months. Based on these findings, programming designed to increase gender-equitable attitudes might be helpful in increasing HIV testing and condom and contraceptive use, but it needs to involve the entire community, not just individual boys and girls.
- Published
- 2023
- Full Text
- View/download PDF
49. Climate distress, climate-sensitive risk factors, and mental health among Tanzanian youth: a cross-sectional study.
- Author
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Prencipe L, Houweling TAJ, van Lenthe FJ, Kajula L, and Palermo T
- Subjects
- Adolescent, Female, Humans, Male, Cross-Sectional Studies, Risk Factors, Tanzania epidemiology, Depression epidemiology, Mental Health
- Abstract
Background: Climate change threatens youth mental health through multiple mechanisms, yet empirical studies typically focus on single pathways. We explored feelings of distress over climate change among Tanzanian youth, considering associations with climate change awareness and climate-sensitive risk factors, and assessed how these factors relate to mental health., Methods: Tanzanian youth (aged 18-23 years) from a cluster randomised controlled trial in Mbeya and Iringa regions of Tanzania were interviewed between Jan 25, and March 3, 2021, and included in this cross-sectional study. A threshold of at least 10 on the ten-item Centre for Epidemiological Studies Depression Scale was used to classify symptom severity indicative of depression. Regardless of climate change awareness, respondents were asked about their feelings of distress on climate change using inclusive language (changing weather patterns or changing seasons). We estimated rate differences in climate change distress (slight or moderate or extreme vs none) by youth characteristics, extent of climate awareness, and climate-sensitive livelihoods (eg, agriculture, tending livestock) and climate-sensitive living conditions (eg, food or water insecurity), using generalised linear models. We compared depression prevalence by extent of climate change distress and climate-sensitive living conditions., Findings: Among 2053 youth (1123 [55%] were male and 930 [45%] were female) included in this analysis, 946 (46%) had reported any distress about climate change. Distress was higher among female, more educated, more religious, older youth, and those working in extreme temperatures. Adjusting for climate awareness-a factor strongly associated with climate distress-helped to explain some of these associations. Depression was 23 percentage points (95% CI 17-28) higher among youth who had severe water insecurity than those who did not. Similarly, youth who had severe food insecurity had 23 percentage points higher depression (95% CI 17-28) compared with those who did not. Those reporting climate change distress also had worse mental health-extremely distressed youth had 18 percentage points (95% CI 6-30) higher depression than those reporting none., Interpretation: Living in conditions worsened by climate change and feeling distressed over climate change have mental health implications among young people from low-resource settings, indicating that climate change can impact youth mental health through multiple pathways., Funding: Erasmus Trustfonds, Centre for Global Health Inequalities Research, UK's Foreign, Commonwealth, and Development Office, Oak Foundation, UNICEF, UK's Department of International Development, the Swedish Development Cooperation Agency, Irish Aid., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2023
- Full Text
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50. Adolescent dating violence prevention programmes: a global systematic review of evaluation studies.
- Author
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McNaughton Reyes HL, Graham LM, Chen MS, Baron D, Gibbs A, Groves AK, Kajula L, Bowler S, and Maman S
- Subjects
- Adolescent, Bullying, Child, Crime Victims, Evaluation Studies as Topic, Female, Humans, Male, Risk Factors, Socioeconomic Factors, Young Adult, Intimate Partner Violence prevention & control
- Abstract
Adolescent dating violence negatively affects millions of young people worldwide. Through a global systematic review, we synthesised evidence from rigorous studies of prevention programmes for adolescent dating violence. Our aims were to: (1) describe the breadth of research in this area and evidence of programme effects, and (2) identify gaps in the evidence base. We included experimental and controlled quasi-experimental programme evaluations, published before Jan 1, 2020, that assessed effects on victimisation or perpetration, or both, in adolescent dating violence and in which at least half of the study population was 10-19 years old. Study design, programme elements, and outcomes were compared between evaluations implemented in high-income countries (HICs) and low-income and middle-income countries (LMICs). 52 evaluations met inclusion criteria, of which 20 (38%) were implemented in LMICs. Evaluations in HICs were more likely to assess effects on adolescent dating violence victimisation and perpetration, rather than just victimisation, than those in LMICs, and they were also more likely to include boys and girls, as opposed to just a single sex. Overall, 26 (50%) of the 52 evaluations reported a significant preventive effect on at least one outcome for adolescent dating violence, of which nine were implemented in LMICs. Across LMICs and HICs, findings suggest research is needed to shed light on how adolescent dating violence prevention programmes work and to identify whether programme effects generalise across different settings, outcomes, and subgroups. TRANSLATIONS: For the Chinese, French and Spanish translations of the abstract see Supplementary Materials section., (Copyright © 2021 Elsevier Ltd. All rights reserved.)
- Published
- 2021
- Full Text
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