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In South Africa, one in five adolescents attempt suicide. Suicide attempts continue to rise. We aimed to identify psychosocial target points for future educational interventions. One-to-one semi-structured interviews were conducted to explore psychosocial factors associated with past suicide attempts among suicide survivors in Limpopo province, South Africa. A total of 14 adolescents (eight girls and six boys) who recently attempted suicide were interviewed. Lack of knowledge of available counsellors, conflicts in interpersonal relationships, perceived accusations of negative behaviour, inadequate social support, past family and peer suicide attempts and poor living circumstances were factors found to be related with suicide attempts. This study suggests that availability and access to counselling is essential in the prevention of suicide among young people, at both the individual level and family level.

The evaluation of the Department of Educations' life skills program on HIV and AIDS prevention among Grade 9 students in 22 randomly allocated schools in KwaZulu-Natal, South Africa, showed only a significant increase in student knowledge about HIV/AIDS in the intervention group compared with the control group. No effects were found on safe sex practices (condom use, sexual intercourse) or on measures of psychosocial determinants of these practices (attitude and self-efficacy). A process evaluation among the teachers showed that some implemented the program fully (seven schools) and some partially (four schools). An exploratory analysis showed that students who received the full intervention were more positive in their perceptions about sexual behavior and social connectedness (at 10-month follow-up) and reported less sex and more condom use (at 6-month follow-up) than students in the partial and control groups. These limited effects therefore call for further analysis of the content and implementation strategies used in the classroom.

Objectives. We conducted a group randomized trial of 2 South African school-based smoking prevention programs and examined possible sources and implications of why our actual intraclass correlation coefficients (ICCs) were significantly higher than the ICC of 0.02 used to compute initial sample size requirements. Methods. Thirty-six South African high schools were randomly assigned to 1 of 3 experimental groups. On 3 occasions, students completed questionnaires on tobacco and drug use attitudes and behaviors. We used mixed-effects models to partition individual and school-level variance components, with and without covariate adjustment. Results. For 30-day smoking, unadjusted ICCs ranged from 0.12 to 0.17 across the 3 time points. For lifetime smoking, ICCs ranged from 0.18 to 0.22; for other drug use variables, 0.02 to 0.10; and for psychosocial variables, 0.09 to 0.23. Covariate adjustment substantially reduced most ICCs. Conclusions. The unadjusted ICCs we observed for smoking behaviors were considerably higher than those previously reported. This effectively reduced our sample size by a factor of 17. Future studies that anticipate significant cluster-level racial homogeneity may consider using higher-value ICCs in sample-size calculations to ensure adequate statistical power. (Am J Public Health. 2010;100: 1714-1718. doi: 10.2105/AJPH.2009.160879)

Introduction: Smokeless tobacco in South Africa is commonly used in the form of “snuff” or chewing tobacco. This paper reports its use among secondary school learners and provides evidence of its association with demographic characteristics, tobacco smoking, and socioeconomic status. Methods: Data were derived from a nationally representative study conducted in 2008 among 10,270 grade 8–11 learners from 192 schools in South Africa. Data were collected in class using self-administered questionnaires. Multiple logistic regression analyses were used to examine correlates of past month smokeless tobacco use. Results: Nationally, 12.4% of learners used smokeless tobacco such as chewing tobacco or snuff in the month preceding the survey, with significantly higher rates among males (13.6%) than females (10.6%). Smokeless tobacco use differed between “race” groups, with African (12.8%) and Colored (11.7%) learners having the highest rates of past month use. Grade 8 learners (15.3%) reported significantly higher rates of use than grade 11 learners (9.1%). Current cigarette smokers (21.3%) reported a higher prevalence of smokeless tobacco use than noncurrent smokers (10.1%). Logistic regression of past month smokeless tobacco use showed significant associations with race, grade, school socioeconomic level, urbanicity, current cigarette smoking, and having first smoked a cigarette before the age of 10 years. Conclusions: These findings provide evidence for policy makers and program developers to develop targeted and tailored interventions for young people regarding smokeless tobacco use. [ABSTRACT FROM PUBLISHER]

In the light of the growing involvement of community advisory boards (CABs) in health research, this study presents empirical findings of the functions and operations of CABs in HIV/AIDS vaccine trials in South Africa. The individual and focus group interviews with CAB members, principal investigators, research staff, community educators, recruiters, ethics committee members, trial participants and South African AIDS Vaccine Initiative (SAAVI) staff members demonstrated differences in the respondents' perceptions of the roles and responsibilities of CABs. These findings question the roles of the CABs. Are they primarily there to serve and be accountable to the community, or to serve the accomplishment of the research objectives? Four emergent themes are discussed here: purpose; membership and representation; power and authority; sources of support and independence. The CABs' primary purpose carries significant implications for a wide range of issues regarding their functioning. The dual functions of advancing the research and protecting the community appear to be fraught with tension, and require careful reconsideration.