David Teye Doku

Socioeconomic Differences in Smoking Among Finnish Adolescents From 1977 to 2007

PURPOSE Persistence of socioeconomic differences in smoking among adolescents over time is unexplored. We investigated the changes in smoking among 12-18-year-old Finns from 1977 to 2007 using multiple indicators of socioeconomic status (SES) to determine whether differences between socioeconomic groups increase over time, with reduced smoking in higher socioeconomic groups. METHODS Nationwide biennial surveys were conducted since 1977 (response rate, 59%-88%; N = 96,747) using familial and individual social position (school performance/career) indicators. Associations between socioeconomic indicators and smoking were evaluated using logistic regression analysis. RESULTS Socioeconomic differences in smoking measured by familial SES or individual social position persisted over time, with higher rates in lower SES groups. Individual social position was more strongly related to smoking than familial SES. Differences between groups assessed by individual social position increased over time: the difference in smoking prevalence between groups with the lowest and highest individual social position among 12-14-year-old girls and boys, respectively, was 22% and 28% in 1977-1983, and 45% and 34% in 2001-2007; and in 16-18-year-old girls, 33% in 1977-1983 and 48% in 2001-2007. Smoking differences in relation to fathers education increased over time: the difference in 12-14-year-old girls and boys, respectively, between the lowest and highest SES groups was 6% and 5% in 1977-1983 and 9% and 8.5% in 2001-2007; and in 16-18-year-old girls and boys, respectively, 7% and 10% in 1977-1983 and 13% and 14.5% in 2001-2007. CONCLUSIONS Differences between socioeconomic groups among Finnish adolescents persisted or increased over 30 years, and predict differences in smoking-related diseases between socioeconomic groups in adulthood.

The prevalence of underweight, overweight, obesity and associated risk factors among school-going adolescents in seven African countries

BackgroundThe burden caused by the coexistence of obesity and underweight in Low and Middle Income Countries is a challenge to public health. While prevalence of underweight among youth has been well documented in these countries, overweight, obesity and their associated risk factors are not well understood unlike in high income countries.MethodsCross-sectional data from the Global School-based Student Health Survey (GSHS) conducted in seven African countries were used for this study. The survey used a clustered design to obtain a representative sample (n = 23496) from randomly selected schools. 53.6% of the sample was male, and participants ranged in age from 11-17 years old. Body Mass Index (BMI) was calculated using age and sex adjusted self-reported heights and weights. Classification of weight status was based on the 2007 World Health Organization growth charts (BMI-for-age and sex). Multivariable Logistic Regression reporting Odds Ratios was used to assess potential risk factors on BMI, adjusting for age, sex, and country. Statistical analyses were performed with Stata with an alpha of 0.05 and reporting 95% confidence intervals.ResultsUnadjusted rates of being underweight varied from 12.6% (Egypt) to 31.9% (Djibouti), while being overweight ranged from 8.7% (Ghana) to 31.4% (Egypt). Obesity rates ranged from 0.6% (Benin) to 9.3% (Egypt). Females had a higher overweight prevalence for every age group in five of the countries, exceptions being Egypt and Malawi. Overall, being overweight was more prevalent among younger (≤12) adolescents and decreased with age. Males had a higher prevalence of being underweight than females for every country. There was a tendency for the prevalence of being underweight to increase starting in the early teens and decrease between ages 15 and 16. Most of the potential risk factors captured by the GSHS were not significantly associated with weight status.ConclusionsThe prevalence of both overweight and underweight was relatively high, demonstrating the existence of the double burden of malnutrition among adolescents in developing countries. Several factors were not associated with weight status suggesting the need to explore other potential risk factors for overweight and underweight, including genetic factors and socioeconomic status.

Factors associated with reproductive health care utilization among Ghanaian women

BackgroundThis study investigates factors determining the timing of antenatal care (ANC) visit and the type of delivery assistant present during delivery among a national representative sample of Ghanaian women.MethodData for the study was drawn from the women questionnaire (N=4,916) of the 2008 Ghana Demographic and Health Survey among 15–49-years-old women. Multivariate logistic regression analysis was used to explore factors determining the type of delivery assistance and timing of ANC visit for live births within five years prior to the survey.ResultsMajority of Ghanaian women attended ANC visit (96.5%) but many (42.7%) did so late (after the first trimester), while 36.5% had delivery without the assistance of a trained personnel (30.6%) or anyone (5.9%). Age (OR=1.5, CI=1.1-1.9, OR for 25-34-year-olds compared to 15-24-year-olds), religion (OR=1.8, CI=1.2-2.8, OR for Christians versus Traditional believers) wealth index (OR=2.6, CI=1.7-3.8, OR for the richest compared to the poorest) were independently associated with early ANC visit. Likewise, age, place of residence, education and partner’s education were associated with having a delivery assisted by a trained assistant. Also, Christians (OR=1.8, CI=1.1-3.0) and Moslems (OR=1.9, CI=1.1-3.3) were more likely to have trained delivery assistants compared to their counterparts who practised traditional belief. Furthermore, the richer a woman the more likely that she would have delivery assisted by a trained personnel (OR=8.2, CI= 4.2-16.0, OR for the richest in comparison to the poorest).ConclusionsDespite the relatively high antenatal care utilisation among Ghanaian women, significant variations exist across the socio-demographic spectrum. Furthermore, a large number of women failed to meet the WHO recommendation to attend antenatal care within the first trimester of pregnancy. These findings have important implications for reducing maternal mortality ratio by three-quarters by the year 2015.

Suicidal Behaviour and Related Risk Factors among School-Aged Youth in the Republic of Benin

Introduction Research on factors associated with suicidal ideation and suicide attempts has been conducted largely in developed countries. Research on West African countries in particular is lacking. Methods Data were obtained from the Global School-based Health Survey conducted in Benin in 2009. This was a cross-sectional study of three grades, spanning Junior and Senior High, which sampled a total of 2,690 adolescents. Data on the occurrence of demographic, psycho-social and socio-environmental risk factors were tested using multinomial logistic regression for their association with suicidal ideation and suicide attempts. Results The survey indicated that 23.2% had thought about suicide and 28.3% had made a suicide attempt in the previous year. Anxiety, loneliness, being bullied, alcohol misuse, illicit drug use, and lack of parental support were independently related to the ideation outcomes, suicidal ideation without planning and suicidal ideation with planning. Multinomial regression analysis, using one suicide attempt and multiple suicide attempts as outcomes, revealed that female sex, anxiety, loneliness, being physically attacked, and illicit drug use were associated these outcomes. Discussion The prevalence of suicide attempts reported in the survey is relatively high. It is possible that there are cultural factors that could explain this finding. Our research indicates that many factors are related to the occurrence of suicidal ideation and suicide attempts among youth in Benin. Illicit drug use and violence in particular are associated with a high rate of suicide attempts in Benin. Measures to address these issues may reduce the risk of self-inflicted violence.

Substance use and risky sexual behaviours among sexually experienced Ghanaian youth

BackgroundThe association between risky sexual behaviours and substance uses among Ghanaian youth were investigated.MethodsAn in-school cross-sectional representative survey was conducted among 12-18-year- old youth in Ghana in 2008 (N = 1195, response rate =90%). Logistic regression analyses were employed to investigate the association between substance use (tobacco use, drunkenness, marijuana use and other drug uses) and risky sexual behaviours (sexual debut, condom use and number of sexual partners).ResultsOf all youth, 25% (28% boys and 23% girls) were sexually experienced. The mean age for first sexual intercourse was 14.8 years (14.4 years for boys and 15.1 years for girls). Among the sexually experienced, 31% had multiple sexual partners. Older age (OR = 3.4, 95% CI = 1.7-3.4) and rural residency (OR = 1.5, 95% CI = 1.1-2.1) were independently associated with sexual debut while only older age (OR = 2.4, 95% CI = 1.7-3.4) was associated with condom use. Additionally, smoking (OR = 3.7, 95% CI = 2.0-6.8), tawa use (OR = 2.4, 95% CI = 1.3-4.7), tobacco use (OR = 2.8, 95% CI = 1.7-4.7) drunkenness (OR = 1.7, 95% CI = 1.1-2.8) and marijuana use (OR = 3.3, 95% CI = 1.6-7.0) were independently associated with sexual debut. Furthermore, all substance uses studied were associated with having one or multiple sexual partners.ConclusionSubstance use seems to be a gateway for risky sexual behaviours among Ghanaian youth. Public health interventions should take into account the likelihood of substance use among sexually experienced youth.

Reproductive health decision making among Ghanaian women

IntroductionWomen’s reproductive health decision-making and choices, including engaging in sexual intercourse and condom use, are essential for good reproductive health. However, issues concerning sexual intercourse and condom use are shrouded in secrecy in many sub-Saharan African countries. This study investigates factors that affect decision making on engaging in sexual intercourse and use of condom among women aged 15–49.MethodA nationally representative sample (N = 3124) data collected in the 2008 Ghana Demographic and Health Survey was used. Multivariate logistic regression was used to study the association between women’s economic and socio-demographic characteristics and their decision making on engaging in sexual intercourse and use of condom.ResultsOne out of five women reported that they could not refuse their partners’ request for sexual intercourse while one out of four indicated that they could not demand the use of condoms by their partners. Women aged 35–49 were more likely to make decision on engaging in sexual intercourse (OR = 1.35) compared to those aged 15–24. Furthermore, the higher a woman’s education, the more likely that she would make decision regarding condom use. Also, if a woman had primary (OR = 1.37) or secondary (OR = 1.55) education, she is more likely to make decision regarding engaging in sexual intercourse compared to a woman who had no formal education. Compared to women in the Greater Accra region (the capital city region), women in the Western region (OR = 2.10), Central region (OR = 2.35), Brong Ahafo (OR = 1.70), Upper East (OR = 7.71) and Upper West (OR = 3.56) were more likely to make decision regarding the use of condom. Women who were in the richest, rich and middle wealth index categories were more likely to make decision regarding engaging in sexual intercourse as well as condom use compared to the poorest.ConclusionInterventions and policies geared at empowering women to take charge of their reproductive health should focus particularly on women from less wealthy backgrounds and those with low educational attainments.

Indicators for Measuring Material Affluence of Adolescents in Health Inequality Research in Developing Countries

The aim of the present study was to (i) develop a material affluence scale (MAS) for measuring adolescent SES in health inequality research in developing countries, (ii) compare the association of the MAS with the parental SES measures (parental occupation and education), and (iii) evaluate the association of parental SES and MAS with key health and health behaviour indicators. We used school-based cross-sectional survey conducted in thirty districts within three administrative regions in southern Ghana (a West African country) among adolescents ages 12–18-year old (N = 1,195) as an example. Principal Component Analysis (PCA) was used as the main statistical technique. MAS categorised adolescents into material affluence groups (MAS scores for the poorest, poor, average, affluent and most affluent were−1.679, −0.355, 0.354, 0.725 and 1.022 from the first principal component quintile respectively), it has adequate internal coherence (α = 0.622) and moderately correlates with parental SES (r = 0.39, p < 0.001). MAS and parental SES showed similar pattern of strength and direction of association with selected health and health behaviour indicators. MAS presents a viable alternative method for measuring adolescent’s SES in health inequality research in developing countries and could be useful as well in western countries.

Do socioeconomic differences in tobacco use exist also in developing countries? A study of Ghanaian adolescents.

BackgroundIn Western countries, tobacco use is most prevalent among adolescents in lower socioeconomic groups. The association between socioeconomic status (SES) and tobacco use among adolescents in developing countries is unexplored. Using multiple SES measures, we investigated this association among adolescents in Ghana.MethodA school-based survey of a representative sample of 13-18-year-old Ghanaians (N = 1,165, response rate = 89.7%) was conducted in three regions, in 2008. Logistic regression analysis was used to evaluate the relationship of smoking, tawa (smokeless tobacco) use with familial SES (parental occupation and education, material affluence scale, family structure), an adolescents individual social position (school performance, plans after graduation) and inter-generational social mobility (predicted by the differences of familial and individual positions).ResultsSocioeconomic differences existed in tobacco use whether measured by familial SES or individual social position with higher prevalence in lower socioeconomic groups. Low fathers education and living in a non-nuclear family were associated with both forms of tobacco use while low material affluence was associated with tawa use only; individual social position measured by plans after graduation was the strongest predictor of both smoking and tawa use. Inter-generational downward social mobility and particularly staying in low SES was related to both forms of tobacco use.ConclusionsSimilar to Western countries, lower SES is related to an adolescents tobacco use also in developing countries. Cumulative socioeconomic disadvantage over generations increases the probability of tobacco use.

Socioeconomic differences in alcohol and drug use among Ghanaian adolescents.

Socioeconomic differences in experimental alcohol use, drunkenness, marijuana use and other drug uses among adolescents in Ghana was investigated using multiple socioeconomic indicators. A school-based cross-sectional survey of a representative sample of 12-18-year-olds (N=1195, response rate=89.7%) was conducted in Ghana in 2008. Logistic regression analysis was applied to model the associations between substance use and socioeconomic status. Use of marijuana and drugs was associated with lower material affluence while experimental alcohol use was associated with higher material affluence. Living in non-nuclear family was predictive of other drug uses and drunkenness. Other drug uses were associated with lower paternal education and occupation while drunkenness was associated with lower paternal education. Individual anticipated future social position measured by plans after graduation was the strongest predictor of experimental alcohol use, drunkenness, marijuana and other drug uses. Interventions are need to prevent adolescence substance use especially among those in danger of discontinuing schooling and those in less affluence families.

The role of tobacco promoting and restraining factors in smoking intentions among Ghanaian youth

BackgroundIn Western countries, the relationship between smoking intentions and smoking behaviour is well established. However, youth smoking intentions and associated factors in developing countries are largely unexplored and the former may occur for a variety of reasons. We investigated youth smoking intentions in Ghana with regard to several tobacco promoting and restraining factors, including environmental, familial, attitudinal and knowledge measures.MethodsA school-based survey of a representative sample of 12-20-year-olds was conducted in 2008 in Ghana (N = 1338, response rate 89.7%).ResultsIn a bivariate model, both among ever and never smokers, allowing smoking on school compound, exposure to tobacco advertisement and parental smoking were associated with future intention to smoke. Compared to those who agreed that smoking is harmful to health, smoking is difficult to quit and that tobacco should not be sold to minors, those who disagreed or were not sure were more likely to have an intention to smoke. In the multivariate analyses, these associations persisted, except that the attitude measures concerning the difficulty of quitting smoking once started and tobacco sales ban were no longer significantly associated with smoking intentions.ConclusionsThese findings underscore the importance of school smoking policy, parental smoking behaviour and knowledge of the harmful effects of tobacco use in determining Ghanaian youths’ future smoking intentions. Because current high percentages of smoking intentions may turn into high smoking rates in the future, the introduction of effective tobacco control measures at all levels of society to prevent youth smoking in Ghana may be essential.