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A study of 548 teenagers from a working-class South African community revealed almost one-seventh of the sample to be school dropouts, likely to have completed less than nine years of schooling. Of the remaining students, a majority were susceptible to suicidal fits but less likely to indulge in substance abuse or promiscuous sexual behavior.

The influence of depression and self-esteem on suicidal behavior in adolescence is studied. Screening for depression and low self-esteem in the family context is discussed as a possible strategy for helping to identify adolescents at risk for suicide attempts.

Information regarding adolescents using alcohol and drugs in Cape Town, Durban and Gauteng province from 1997 to 2001 are studied. The impact of the use of alcohol and drugs on adolescents is very vast especially the use of Cannabis, an illicit drug.

The identification of social and neighborhood correlates of drunkenness among adolescents is focused. A number of environmental factors that should be considered in tackling adolescent drunkenness are highlighted.

Students of grade 8 and 11 of Cape Town, Republic of South Africa gave a test on use of various substances, violent behaviour, suicidality and sexuality. On the basis of test result, the test-retest reliability of self-reported adolescent risk behaviour is judged.

Abstract: Purpose: Although adolescents are at high risk for human immunodeficiency virus (HIV) infection, they have not been, included in HIV vaccine trials. Methods: In preparation for enrollment in HIV vaccine trials, 100 HIV-negative adolescents aged 14–17 years from Cape Town were recruited into a cohort. HIV, syphilis, pregnancy testing, and sexual risk questionnaires were conducted at varying intervals for a year. Results: The mean age of the participants was 15 years, and 70% of them were female. Recruitment was completed within 3 months. Retention was found to be 82% at 1-year follow-up. The main reasons for dropout were as follows: relocation to other communities, phlebotomy, and visit frequency. In a Cox proportional hazards model, only female gender was significantly associated with retention. No change in reported sexual risk occurred, but the proportion of individuals who were aware of their partner''s HIV status was significantly higher (17% at baseline, 83% at 1-year follow-up; p < .001). Five pregnancies were reported during follow-up. Conclusions: To our knowledge, this is the first prospective adolescent HIV-prevention cohort in Southern Africa. Despite reports of risky sexual behaviors and high pregnancy rates, HIV seroconversions did not occur in the retained cohort. HIV-prevention trials with high-risk adolescents will require rigorous efforts to prevent future pregnancies, and may require risk eligibility criteria. Retention may improve with transport provision, visits with incentives, and efforts to retain males. [Copyright &y& Elsevier]

Abstract: Objectives: The purpose of this study is to describe the demographic and clinical profile, mortality rates, and effectiveness of a multifaceted treatment approach in hospitalized children and adolescents with delirium referred to psychiatry. Methods: We report a series of 23 children and adolescents prospectively diagnosed with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, delirium after referral to a consultation–liaison psychiatry service based in a large, regional, dedicated children''s hospital in South Africa. Results: Children and adolescents with delirium referred to psychiatrists appear to represent a subgroup of delirious patients with a high risk of mortality, an underrepresentation of hypoactive cases, and complex, multifactorial, and often uncertain etiologies. A significant minority of these cases may be managed without the use of psychotropic medications. Uncontrolled data provide supportive evidence for the moderate effectiveness of both haloperidol and risperidone in childhood delirium when explicit criteria guiding the use of antipsychotic medications are utilized. Conclusions: Delirium is an important and underresearched disorder in children and adolescents. Although the evidence base for the use of antipsychotic medications in childhood delirium remains relatively slim, tentative threshold criteria for the use of such medications are suggested by this study. Controlled studies comparing different antipsychotic medications with each other and with nonpharmacological strategies are urgently required. [Copyright &y& Elsevier]

Abstract: Objective: Methamphetamine use has become a growing problem in a number of countries over the past two decades, but has only recently emerged in South Africa. This study investigated the prevalence of methamphetamine use among high-school students in Cape Town and whether students reporting methamphetamine use were more likely to be at risk for mental health and aggressive behavior problems. Methods: A cross-sectional survey of 15 randomly selected high schools in Cape Town, of 1561 males and females grade 8–10 students (mean age 14.9), was conducted using the Problem Oriented Screening Instrument for Teenagers (POSIT) and the Beck Depression Inventory (BDI). Results: Findings indicated that 9% of the students had tried methamphetamine at least once. Ordinal logistic regression analyses showed that methamphetamine use in the past year was significantly associated with higher aggressive behavior scores (OR=1.81, 95% CI: 1.04–3.15, p <0.05), mental health risk scores (OR=2.04, 95% CI: 1.26–3.31, p <0.01) and depression scores (OR=2.65, 95% CI: 1.64–4.28, p <0.001). Conclusions: Methamphetamine use has become a serious problem in Cape Town, particularly among adolescents. Screening adolescents in school settings for methamphetamine use and behavior problems may be useful in identifying youth at risk for substance misuse, providing an opportunity for early intervention. These findings have implications for other parts of the world where methamphetamine use may be occurring at younger ages and highlight the importance of looking at co-morbid issues related to methamphetamine use. [Copyright &y& Elsevier]

Abstract: Objectives: The purpose of this study was to collate all works relating to delirium and probable delirium in children and adolescents published since 1980. Methods: A systematic review of the literature in all languages published between 1980 and March 2009 was conducted. Results: The literature is limited to small case series and case reports including a total of 217 children or adolescents with definite delirium and a further 136 children and adolescents with “probable delirium.” These articles, in addition to unsystematic reviews, overviews, editorials, journal commentaries, and pertinent book chapters, are discussed in relation to prevalence, predisposing and precipitating factors, phenomenology, residual psychopathology, mortality, management, and prevention of delirium in childhood and adolescence. Conclusions: Delirium is an important but neglected disorder of childhood associated with significant morbidity and high mortality. Current clinical practice for management is based on slim empirical evidence. [Copyright &y& Elsevier]

Abstract: Introduction: Health problems are prevalent in chemical dependency (CD) treatment populations, and often precede reductions in substance use among untreated populations. Few studies have examined whether medical problems predict better long-term outcomes in treated individuals, or how primary care utilization and CD/primary care service integration affects long-term outcomes among those with health problems. Method: In a sample of 598 CD patients in a private health plan, logistic regression models examined whether substance abuse-related medical conditions (SAMCs), integrated medical and CD care, and on-going primary care predicted remission of CD problems at 5 years. Results: Those with SAMCs were no more likely than others to be remitted at 5 years except among young adults and those with medical, but not psychiatric SAMCs. Higher levels of medical problem severity at intake and receiving integrated CD and primary care in the index treatment episode predicted remission in the full sample and among those with SAMCs. Among those with SAMCs, individuals with ongoing medical care – 2–10 primary care visits – in the 5 years following intake were more likely to be remitted at 5 years than those with fewer visits. Conclusions: This study highlights the potentially important role of medical services in the long-term treatment of CD disorders. CD treatment may benefit from a disease management approach similar to that recommended for other chronic medical problems: specialty care when the condition is severe followed by services in primary care when the condition is stabilized. [Copyright &y& Elsevier]

Abstract: Purpose: This study aims to describe patterns of inconsistent reports of sexual intercourse among a sample of South African adolescents. Methods: Consistency of reported lifetime sexual intercourse was assessed using five semiannual waves of data. Odds ratios related inconsistent reporting to demographic variables and potential indicators of general and risk-behavior–specific reliability problems. Results: Of the sexually active participants in the sample, nearly 40% reported being virgins after sexual activity had been reported at an earlier assessment. Inconsistent reporting could not be predicted by gender or race or by general indicators of poor reliability (inconsistent reporting of gender and birth year). However individuals with inconsistent reports of sexual intercourse were more likely to be inconsistent reporters of substance use. Conclusions: These results suggest that researchers need to undertake efforts to deal specifically with inconsistent risk behavior data. These may include modification of data collection procedures and use of statistical methodologies that can account for response inconsistencies. [Copyright &y& Elsevier]

Abstract: Objectives: To examine the prevalence of bullying behavior in adolescents from Cape Town and Durban, South Africa, and the association of these behaviors with levels of violence and risk behavior. Method: Five thousand and seventy-four adolescent schoolchildren in grade 8 (mean age 14.2 years) and grade 11 (mean age 17.4 years) at 72 Government schools in Cape Town and Durban, South Africa completed self-report questionnaires on participation in bullying, violent, anti-social and risk behaviors. Results: Over a third (36.3%) of students were involved in bullying behavior, 8.2% as bullies, 19.3% as victims and 8.7% as bully-victims (those that are both bullied and bully others). Male students were most at risk of both perpetration and victimization, with younger boys more vulnerable to victimization. Violent and anti-social behaviors were increased in bullies, victims and bully-victims compared to controls not involved in any bullying behavior (p <.01 in all cases). Risk taking behavior was elevated for bullies and bully-victims, but for victims was largely comparable to controls. Victims were less likely to smoke than controls (odds ratio .83, p <.05). Bully-victims showed largely comparable violent, anti-social and risk taking behavior profiles to bullies. Bully-victims showed comparable suicidal ideation and smoking profiles to victims. Conclusions: Results were in keeping with Western findings. Involvement in bullying is a common problem for young South Africans. Bullying behavior can act as an indicator of violent, anti-social and risk-taking behaviors. [Copyright &y& Elsevier]

Abstract: Purpose: To determine human immunodeficiency virus (HIV) prevalence, sexual risk behaviors, and attitudes toward HIV vaccine trials among 11–19 year-olds in a peri-urban community near Cape Town, South Africa. Methods: We performed HIV antibody testing on oral transudate, and assessed sexual risk behaviors and willingness to participate in HIV vaccine trials using self-administered questionnaires. Results: Of the 510 adolescents selected, 356 (73%) participated. The HIV prevalence of the group was 10.6% (95% confidence interval [CI] 7.5–14.4). One-third of adolescents had experienced sexual debut, with a mean age of 14.6 years. Number of lifetime sexual partners was independently associated with HIV infection (odds ratio [OR] = 1.62; 95% CI 1.1–2.3). In a multivariate analysis, increasing age, female gender, and attending school were independently associated with having had sex. The majority of adolescents (79%) were willing to participate in an HIV vaccine trial. Increasing age and length of residence in the community were significantly associated with willingness to participate (OR = 1.19; 95% CI 1.01–1.4 and OR = 1.14; 95% CI 1.03–1.26, respectively). Conclusions: The prevalence of HIV and risk behavior among adolescents in this community is high. HIV vaccines are required that target preadolescents. HIV vaccine trials in adolescents in this setting will be facilitated by their willingness to participate. [Copyright &y& Elsevier]

Abstract: Background: Given that developing countries (and particularly women in these countries) are at increasing risk for tobacco use, the need for hard data to accurately monitor tobacco use in developing countries is needed. The purpose of this review is to synthesize the available prevalence data on current tobacco use among adults in sub-Saharan Africa (SSA). Methods: Several databases were systematically searched for articles published in peer-reviewed journals at any time during the last century to mid-2005. The search resulted in the retrieval of 54 articles in which the current use of tobacco, cigarettes, cigars and snuff were reported. They were conducted in 14 of the 48 SSA countries. Results: Cross-country comparisons revealed that the prevalence, and intensity (frequency and/or quantity) of tobacco use was higher among males compared to females across all countries. Certain racially classified social groups in South Africa were at increased risk for tobacco use. Males aged between 30 and 49 years used tobacco at higher rates than those younger or older than this age range. Among females, prevalence rates of smoked tobacco use increased steadily with age. There was no clear pattern regarding socio-economic status (SES) or urban/rural differences. The onset of tobacco use mostly occurs in late adolescence or early adulthood. Conclusions: While in many SSA countries the prevalence of tobacco use among adults is relatively low compared to developed and other developing countries, prevention, interventions and policies should work towards reducing these levels by targeting the at risk populations identified from this review. [Copyright &y& Elsevier]

Objective: The aim of this article is twofold: first, to examine the prevalence of being the victim of actual and attempted rape among a large representative sample of Cape Town high school students; and second, to identify the correlates of sexual assault for both boys and girls, including alcohol, tobacco and other drug use, behavioral problems, and suicidality. Method: Data for this study were derived from the 1997 South African Community Epidemiology Network on Drug Use (SACENDU) school survey. A stratified sampling procedure was used to select students in Grades 8 and 11 at non-private high schools in Cape Town. A total of 2,946 students completed a survey consisting of socio-demographic questions and items about substance abuse, sexual activity, and other adolescent health risk behaviors. A subsample of 939 was randomly selected to complete items about sexual violence. Result: The results revealed that 8.4% of respondents were victims of attempted rape, while 5.8% were victims of actual rape. Ordinal logistic regression showed that girls were 3.9 times more likely than boys to have been victims of sexual abuse. Family structure was also significantly related to rape as persons who lived with a single parent (OR = 1.74, CI = 1.00–3.04) and those who resided with one biological parent and one step parent (OR = 2.59, CI = 1.34–5.01) were more likely to have been have been victims of sexual abuse than those living with both biological parents. Alcohol use (OR = 2.0, CI = 1.10–3.62), anti-social behavior (stolen property, caused physical damage to property, bullied others, or been in physical fights) (OR = 1.44, CI = 1.12–1.86), suicidal dialogue (OR = 2.48, CI = 1.19–5.19), and suicidal attempts (OR = 3.2, CI = 1.65–6.30) were also significant predictors of sexual abuse victimization. Racially classified social groups (RCSG), age, drug use, and cigarette smoking were not significant predictors of sexual abuse victimization, while socioeconomic status was found to be marginally significant. Conclusion: This study reinforces the importance of multiple factors including alcohol use, anti-social behavior, suicidal thoughts and actions, and family structure with respect to sexual assault of adolescents in South Africa. Establishing and strengthening intervention programs, school based child protective protocols, professional education of teachers and school personnel, community prevention programs, and initiatives could help prevent adolescent sexual violence and reduce the sequelae associated with this problem. © 2004 Elsevier Ltd. All rights reserved. [ABSTRACT FROM AUTHOR]

A growing body of evidence points to the complexity of sexual behaviour. HIV risk behaviour is influenced by factors at three levels: within the person, within the proximal context (interpersonal relationships and physical and organisational environment) and within the distal context (culture and structural factors). This paper presents the findings of a review of research on the factors promoting and perpetuating unsafe sexual behaviour in South African youth. Papers included in the review were dated between 1990 and 2000 and addressed sexual behaviour of youth between the ages of 14 and 35 years. Both published works and unpublished reports and dissertations/theses were included. The review concluded that at least 50% of young people are sexually active by the age of 16 years; the majority of school students who had ever experienced sexual intercourse reported at the most one partner in the previous year, with a persistent minority of between 1% and 5% of females and 10–25% of males having more than four partners per year; and between 50% and 60% of sexually active youth report never using condoms. In terms of explanations for unsafe sexual behaviour among South African youth, the findings illustrate the powerful impact of the proximal and distal contexts, and in particular, the pervasive effect of poverty and social norms that perpetuate women''s subordination within sexual relationships. Personal factors and the proximal and distal contexts interact to encourage HIV risk behaviour in ways that are not fully captured by social-cognitive models. The findings will be of interest to researchers and practitioners in the fields of adolescent sexual behaviour and HIV prevention in developing countries. [Copyright &y& Elsevier]

: PurposeThe work reported in this paper was supported by grants from the World Health Organisation Programme on Substance Abuse, the United Nations Development Programme, the South African Medical Research Council, and the Medical Faculty Research Committee of the University of Cape Town.To document the prevalence rates for use of cigarettes, alcohol, and cannabis among high school students in Cape Town, and to investigate whether use of these substances is associated with a set of hypothesized psychosocial correlates.: MethodsA multistage sampling procedure produced a sample of 2930 students in grades 8 and 11 at 39 high schools in Cape Town, who completed a self-administered questionnaire. The questionnaire contained items about whether the students had used various substances and that addressed the potential correlates of interest. We calculated prevalence rates with 95% confidence intervals and constructed a set of generalized estimating equations of use in the past month of cigarettes, alcohol, or cannabis on the hypothesized correlates.: ResultsThe prevalence rates for previous month (recent) use of cigarettes, alcohol, and cannabis were 27%, 31%, and 7%, respectively. Rates were low for black females. Recent use of each of the substances was significantly associated with the number of days absent and the number of years lived in a city. Repeating a grade was significantly associated with previous month use of cigarettes and alcohol by colored (derived from Asian, European, and African ancestry) students and alcohol use by black grade 8 students (race classifications “colored” and “black” are as defined by the repealed population Registration Act of 1950). Not being raised by both parents was significantly associated with cigarette smoking by black and colored students, alcohol use by colored students, and cannabis use by female students. It was inversely associated with cigarette use by black students.: ConclusionsIt is necessary to identify the factors that protect black female adolescents from substance use. It is important to address demographic factors such as race classification and gender analytically if one is to avoid obscuring differences among groups. [Copyright &y& Elsevier]

Presents information on a study which investigated whether there is a covariation between risk behaviors, including suicidality, in a community probability sample of children and adolescents. Studies of the existence of covariation between risk behaviors in children and adolescents; Methodology; Results and discussion.

Abstract: We used adolescent simulated clients to evaluate whether HIV testing services in clinics participating in an adolescent-friendly initiative in Cape Town were superior to regular clinic services. We found improved accessibility to HIV testing, but no impact on adolescent''s experience of negative attitudes from health workers and confidentiality breaches. [Copyright &y& Elsevier]

Abstract: We examined the covariation of substance use and various sexual behaviors in 2204 students from one area of South Africa. There was an association between lifetime substance use and both sexual activity and certain sexual risk behaviors. At the most recent sexual encounter, there was an association between substance use and being unfamiliar with one’s sexual partner, but no association between substance use and condom use. [Copyright &y& Elsevier]

The authors reflect on the issues raised in the article "Sexual and Drug Use Behavior in Perinatally HIV-Infected Youth: Mental Health and Family Influences," by Claude Mellins. They comment on Mellins' finding that HIV positive and HIV negative youths displayed no difference in terms of mental health, sexual and substance use risk behavior and family variables. They also analyze the parental issues that affect the mental health of HIV positive youths.

Abstract: In spite of high levels of poverty in low and middle income countries (LMIC), and the high burden posed by common mental disorders (CMD), it is only in the last two decades that research has emerged that empirically addresses the relationship between poverty and CMD in these countries. We conducted a systematic review of the epidemiological literature in LMIC, with the aim of examining this relationship. Of 115 studies that were reviewed, most reported positive associations between a range of poverty indicators and CMD. In community-based studies, 73% and 79% of studies reported positive associations between a variety of poverty measures and CMD, 19% and 15% reported null associations and 8% and 6% reported negative associations, using bivariate and multivariate analyses respectively. However, closer examination of specific poverty dimensions revealed a complex picture, in which there was substantial variation between these dimensions. While variables such as education, food insecurity, housing, social class, socio-economic status and financial stress exhibit a relatively consistent and strong association with CMD, others such as income, employment and particularly consumption are more equivocal. There are several measurement and population factors that may explain variation in the strength of the relationship between poverty and CMD. By presenting a systematic review of the literature, this paper attempts to shift the debate from questions about whether poverty is associated with CMD in LMIC, to questions about which particular dimensions of poverty carry the strongest (or weakest) association. The relatively consistent association between CMD and a variety of poverty dimensions in LMIC serves to strengthen the case for the inclusion of mental health on the agenda of development agencies and in international targets such as the millenium development goals. [Copyright &y& Elsevier]

Presents information on a study which investigated the psychosocial and risk behavior associated with suicidal ideation and attempts in youth. Methodology; Results of the study; Clinical implications of the study.

Analyzes the HIV transmission in a self-interactive, geographically-focused core group social network. Application of information-theoretic methods; Components of a behavioral code for the transmission; Consequence of external oppressive forces in structure marginalization.

Abstract: Objective: Handheld computers (personal digital assistant, PDA) have the potential to reduce the logistic burden, cost, and error rate of paper-based health research data collection, but there is a lack of appropriate software. The present work describes the development and evaluation of PDACT, a Personal Data Collection Toolset (www.healthware.org/pdact/index.htm) for the Palm™ Pilot handheld computer for interviewer-administered and respondent-administered data collection. Methods: We developed Personal Data Collection Toolkit (PDACT) software to enable questionnaires developed in QDS™ Design Studio, a Windows™ application, to be compiled and completed on Palm™ Pilot devices and evaluated in several representative field survey settings. Results: The software has been used in seven separate studies and in over 90,000 interviews. Five interviewer-administered studies were completed in rural settings with poor communications infrastructure, following one day of interviewer training. Two respondent-administered questionnaire studies were completed by learners, in urban secondary schools, after 15min training. Questionnaires were available on each handheld in up to 11 languages, ranged from 20 to 580 questions, and took between 15 and 90min to complete. Up to 200 Palm™ Pilot devices were in use on a single day and, in about 50 device-years of use, very few technical problems were found. Compared with paper-based collection, data validation and cleaning times were reduced, and fewer errors were found. PDA data collection is easy to use and preferred by interviewers and respondents (both respondent-administered and interviewer-administered) over paper. Data are compiled and available within hours of collection facilitating data quality assurance. Although hardware increases the setup cost of the first study, the cumulative cost falls thereafter, and converges on the cumulative cost of paper-based studies (four, in the case of our interviewer-administered studies). Conclusion: Handheld data collection is an appropriate, affordable and convenient technology for health data collection, in diverse settings. [Copyright &y& Elsevier]

Abstract: Adolescents globally are at high risk for HIV acquisition and are the targets of HIV prevention interventions such as HIV vaccines. In order to understand stakeholders’ attitudes towards the ethical issues of adolescent involvement in HIV vaccine trials, we conducted focus group discussions with key members of a semi-urban, informal Cape Town community with high HIV prevalence in which HIV vaccine trials are taking place. Themes were identified from focus group transcripts by four researchers, and included necessity of guardian consent, age of independent consent, and confidentiality of in-trial medical results. In general, ethical adolescent HIV vaccine trials will be feasible in this community. [Copyright &y& Elsevier]

Examines the psychological factors influencing suicidal ideation and suicide attempts among children and adolescents. Description of research methods utilized; Examination of relationships between suicidal ideation, suicide attempts and psychiatric disorders; Statistical data on the characteristics of the study population.