Jane B. Palmier

Correlates of Suicide Ideation and Attempt among Youth Living in the Slums of Kampala

While suicidal behavior is recognized as a growing public health problem world-wide, little is known about the prevalence and risk factors for suicidal behaviors among street and slum youth in Africa, and in Uganda, specifically. The number of youth who live on the streets and in the slums of Kampala appears to be growing rapidly, but their mental health needs have not been documented, which has hampered resource allocation and service implementation. This study of youth, ages 14–24, was conducted in May and June of 2011, to assess the prevalence and correlates of suicidal behavior. Participants (N = 457) were recruited for a 30-minute interviewer-administered survey through eight drop-in centers operated by the Uganda Youth Development Link for youth in need of services. Bivariate and multivariate logistic regression analyses were computed to determine associations between psychosocial correlates and suicide ideation and suicide attempt. Reporting both parents deceased Adj.OR = 2.36; 95% CI: 1.23–4.52), parental neglect due to alcohol use (Adj.OR = 2.09; 95% CI: 1.16–3.77), trading sex for food, shelter or money (Adj.OR = 1.95; 95% CI: 1.09–3.51), sadnesss (Adj.OR = 2.42; 95% CI: 1.20–4.89), loneliness (Adj.OR = 2.67; 95% CI: 1.12–6.40) and expectations of dying prior to age 30 (Adj.OR = 2.54; 95% CI: 1.53–4.23) were significantly associated with suicide ideation in multivariate analyses. Parental neglect due to alcohol use (Adj.OR = 2.04; 95% CI: 1.11–3.76), sadness (Adj.OR = 2.42; 95% CI: 1.30–7.87), and expectations of dying prior to age 30 (Adj.OR = 2.18; 95% CI: 1.25–3.79) were significantly associated with suicide attempt in multivariate analyses. Given the dire circumstances of this vulnerable population, increased services and primary prevention efforts to address the risk factors for suicidal behavior are urgently needed.

Alcohol Marketing, Drunkenness, and Problem Drinking among Zambian Youth: Findings from the 2004 Global School-Based Student Health Survey

This study examines the associations between alcohol marketing strategies, alcohol education including knowledge about dangers of alcohol and refusal of alcohol, and drinking prevalence, problem drinking, and drunkenness. Analyses are based on the Global School-Based Student Health Survey (GSHS) conducted in Zambia (2004) of students primarily 11 to 16 years of age (N = 2257). Four statistical models were computed to test the associations between alcohol marketing and education and alcohol use, while controlling for possible confounding factors. Alcohol marketing, specifically through providing free alcohol through a company representative, was associated with drunkenness (AOR = 1.49; 95% CI: 1.09–2.02) and problem drinking (AOR = 1.41; 95% CI: 1.06–1.87) among youth after controlling for demographic characteristics, risky behaviors, and alcohol education. However, alcohol education was not associated with drunkenness or problem drinking. These findings underscore the importance of restricting alcohol marketing practices as an important policy strategy for reducing alcohol use and its dire consequences among vulnerable youth.

Serious violence victimization and perpetration among youth living in the slums of Kampala, Uganda

Introduction Violence among youth is a major public health issue globally. Despite these concerns, youth violence surveillance and prevention research are either scarce or non-existent, particularly in developing regions, such as sub-Saharan Africa. The purpose of this study is to quantitatively determine the prevalence of violence involving weapons in a convenience sample of service-seeking youth in Kampala. Moreover, the study will seek to determine the overlap between violence victimization and perpetration among these youth and the potentially shared risk factors for these experiences. Methods We conducted this study of youth in May and June of 2011 to quantify and describe high-risk behaviors and exposures in a convenience sample (N=457) of urban youth, 14–24 years of age, living on the streets or in the slums and who were participating in a Uganda Youth Development Link drop-in center for disadvantaged street youth. We computed bivariate and multivariate logistic regression analyses to determine associations between psychosocial factors and violence victimization and perpetration. Results The overall prevalence of reporting violence victimization involving a weapon was 36%, and violence perpetration with a weapon was 19%. In terms of the overlap between victimization and perpetration, 16.6% of youth (11.6% of boys and 24.1% of girls) reported both. In multivariate analyses, parental neglect due to alcohol use (Adj.OR=2.28;95%CI: 1.12—4.62) and sadness (Adj.OR=4.36 ;95%CI: 1.81—10.53) were the statistically significant correlates of victimization only. Reporting hunger (Adj.OR=2.87 ;95%CI:1.30—6.33), any drunkenness (Adj.OR=2.35 ;95%CI:1.12—4.92) and any drug use (Adj.OR=3.02 ;95%CI:1.16—7.82) were significantly associated with both perpetration and victimization. Conclusion The findings underscore the differential experiences associated with victimization and perpetration of violence involving weapons among these vulnerable youth. In particular, reporting hunger, drunkenness and drug use were specifically associated with victimization and perpetration. These are all modifiable risk factors that can be prevented. It is clear that these vulnerable youth are in need of additional services and guidance to ameliorate their adverse childhood experiences, current health risk behaviors and disadvantaged living context.

Psychosocial characteristics associated with frequent physical fighting: findings from the 2009 National Youth Risk Behavior Survey

The goal of the current study was to determine the prevalence and psychosocial correlates associated with frequent fighting among US high school students. Cross-sectional analyses were conducted using the 2009 Youth Risk Behavior Survey (N=16 410). Multivariate logistic regression analyses determined associations between demographic and psychosocial correlates of frequent fighting. Among students, 13.6% reported fighting once, 15.3% reported fighting 2–11 times and 2.6% reported fighting 12 or more times in the past year. Risk factors associated with frequent fighting were weapon carrying (adjusted OR=10.55; 95% CI 7.40 to 15.05), suicide attempt (adjusted OR=6.16; 95% CI 3.70 to 10.28), binge drinking (adjusted OR=3.15; 95% CI 2.16 to 4.59) and feeling too unsafe to go to school (adjusted OR=3.09; 95% CI 2.00 to 4.77). There is a clear need to better understand the patterns and psychosocial characteristics of frequent physical fighting and the prevention and interventions strategies that may be most relevant for these vulnerable youth.

The Prevalence of Very Frequent Physical Fighting among Boys and Girls in 27 Countries and Cities: Regional and Gender Differences

Objective. Using nationally representative data, this study examined the prevalence of very frequent physical fighting (≥12 times per year) among youth in 27 countries and cities. Frequent physical fighting has rarely been reported in the previous literature despite the implications for research and practice. Methods. Analyses were based on the Global School-based Student Health Survey (2003–2008) and the 2009 US Youth Risk Behavior Survey. Multinomial regression analyses were conducted to determine gender differences in frequent fighting. Countries were categorized into five regions (Sub-Saharan Africa, Central and South America, Asia, Eastern Mediterranean, and the United States), and one-way ANOVA tests were used to determine regional differences. Results. The prevalence of frequent fighting was highest in Zambia (7.7%) and lowest in Myanmar (0.5%). Gender differences were found in 20 countries, with boys being more likely to report frequent fighting than girls. The prevalence of frequent fighting varied by region (F(3,22) = 4.78, P = .01), with the Eastern Mediterranean having a significantly higher prevalence of frequent fighting than Asia (P < .01). Conclusion. The prevalence of frequent fighting varies by gender in many countries and varies across world regions. More cross-national research is needed to better understand the sociocultural context of frequent fighting and to inform youth violence prevention efforts.

Alcohol Exposures, Alcohol Marketing, and Their Associations with Problem Drinking and Drunkenness among Youth Living in the Slums of Kampala, Uganda

This study determined the associations between alcohol use exposures, marketing, education, and problem drinking and drunkenness among youth living in the slums of Kampala. This cross-sectional study of youth was conducted in 2011 to quantify and describe high-risk behavior and exposures in a convenience sample () of urban youth living in the slums, 14–24 years of age, who were participating in a drop-in center for disadvantaged street youth. Logistic regression analyses were computed to determine associations between alcohol use exposures, marketing exposures, alcohol education, and problem drinking and drunkenness while controlling for possible confounders. Among participants, 30.2% reported problem drinking and 32.8% reported drunkenness. In multivariate analyses, obtaining free drinks was associated with problem drinking (AOR: 2.47; 95% CI =  1.23–4.96) and drunkenness (AOR: 2.40; 95% CI = 1.22–4.70) after controlling for potential confounders. Alcohol education measures were not significantly associated with either problem drinking or drunkenness in multivariate analyses. There are important associations between alcohol marketing and drinking among these youth. Moreover, the findings underscore the need for additional research related to the impact of alcohol marketing among vulnerable youth and also the need for policy regulations that restrict alcohol marketing that involve providing free alcohol directly to youth.

Co-occurring physical fighting and suicide attempts among U.S. high school students: Examining patterns of early alcohol use initiation and current binge drinking

Introduction: A growing body of empirical research documents a significant co-occurrence of suicide attempts and interpersonal violence among youth. However, the potential role of early alcohol use initiation and current heavy alcohol use as correlates of this comorbidity has not been examined in a nationally representative sample of high school students. Methods: We based our analyses on cross-sectional data from the 2009 Youth Risk Behavior Survey, which includes a nationally representative sample (n=16,410) of high school students in grades 9 through 12 in the United States. Multinomial logistic regression analyses were conducted to test the associations between measures of alcohol use (early alcohol use initiation and heavy drinking) and comorbid suicidal and violent behavior while controlling for potential confounders. Results: Among high school students, 3.6% reported comorbid physical fighting and suicide attempt in the past year. Early alcohol use (prior to age 13) and heavy drinking (5 or more drinks in a row) were strongly associated with comorbid reports of physical fighting and suicide attempts (Adj. odds ratio [OR]=3.12; 95% confidence interval [CI]:2.49–3.89) and (Adj. OR=3.45; 95%CI:2.63–4.52). Conclusion: These findings underscore the importance of both early alcohol use initiation and heavy drinking as statistically significant correlates of comorbid fighting and suicide attempts among youth. While future research is needed to determine the temporal ordering between problem drinking and violent or suicidal behaviors, existing prevention programs may benefit from including components aimed at reducing and delaying alcohol use.

Risk factors for multiple forms of violent experiences: Analyses of the 2009 Youth Risk Behavior Survey

There is a growing body of empirical research indicating a significant co-occurrence of multiple forms of experiences with violence among US youth. However, very little information is available about shared risk factors across forms of violence. Current analyses were based on cross-sectional data from the 2009 Youth Risk Behavior Survey (YRBS). The YRBS includes a nationally representative sample (n = 16,410) of high-school students in 9–12th grades in the US. Multinomial regression analyses were conducted to test the associations between risk factors and reports of multiple violence exposures (i.e. physical fights, dating violence, forced sex, and being bullied at school). Among high-school students, 33.0% reported one experience, 11.4% reported two experiences, and 4.0% reported 3–4 experiences with violence. Multinomial regression analyses indicate that experience with 3–4 forms of violence were highly associated with sadness, feeling too unsafe to go to school, early alcohol use, binge drinking, drug use, weapon carrying, asthma, low academic grades, and suicide attempts relative to those who did not report any experience with violence. These findings underscore that multiple experiences with violence are relatively common among US high-school students. Moreover, multiple experiences with violence are associated with a relatively broad range of risk factors. Youth who report multiple experiences with violence seem to be particularly vulnerable and in need of assistance, in particular because of the strong association between multiple violent experiences and suicidal behaviors.

Early alcohol use and problem drinking among students in Zambia and Uganda

Excessive alcohol use is a serious public health concern worldwide, but less attention has been given to the prevalence, risk and protective factors, and consequences of early alcohol use in low-income, developing countries. The purpose of this study was to determine the associations between early alcohol use, before age 13, and problem drinking among adolescents in Uganda and Zambia. Data from students in Zambia (n=2257; 2004) and Uganda (n=3215; 2003) were obtained from the cross-sectional Global School-Based Student Health Survey (GSHS). The self-administered questionnaires were completed by students primarily 13 to 16 years of age. Multiple statistical models were computed using logistic regression analyses to test the associations between early alcohol initiation and problem drinking, while controlling for possible confounding factors (e.g., current alcohol use, bullying victimization, sadness, lack of friends, missing school, lack of parental monitoring, and drug use). Results show that early alcohol initiation was associated with problem drinking in both Zambia (AOR=1.28; 95% CI:1.02–1.61) and Uganda (AOR=1.48; 95% CI: 1.11–1.98) among youth after controlling for demographic characteristics, risky behaviors, and other possible confounders.The study shows that there is a significant association between alcohol initiation before 13 years of age and problem drinking among youth in these two countries. These findings underscore the need for interventions and strict alcohol controls as an important policy strategy for reducing alcohol use and its dire consequences among vulnerable youth.