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This paper has the following aims: (i) to explore the extent to which students who received an intervention involving HIV/AIDS and sexuality perceived that their teacher cared for their health and well-being, (ii) to investigate the characteristics of students who reported to have caring teachers and (iii) to document the association between students’ perceptions of care and reported onset of sexual activity. Data were obtained from the second follow-up survey of a prospective study carried out among high school students in South Africa (Cape Town and Mankweng). We analyzed data from 3483 students who met the inclusion criteria. Students from the intervention group perceived greater care from teachers than students in the control group. Female students and students from Cape Town perceived having received more care, and their perception of care was associated with the number of lessons received, how often students expressed their opinions in class and how often teachers talked about HIV/AIDS, condoms and abstinence. Students who perceived that their teacher cared for their health and well-being were less likely to initiate sexual intercourse. This is the first paper to demonstrate the salience of the concept of care in studies of school-based HIV/AIDS prevention programs in sub-Saharan Africa. [ABSTRACT FROM PUBLISHER]

Few studies examine smoking in rural areas of countries in Africa. This study examines the roles of families, community influences, and key sociodemographic factors and school-age smoking among adolescent boys in rural South Africa. A total of 1,116 black male students were included in this analysis. Descriptive analyses were conducted, and multiple logistic regression (MLR) models were developed to analyze outcomes. The dependent variables were lifetime smoking, recent smoking, and age of smoking initiation. Sociodemographic variables and students' perceptions of community, family, and school were employed as independent variables. MLR analysis revealed family structure and discipline were found to be significant predictors of adolescent male smoking behavior as well as age, number of household amenities, town and smoking behavior. Adolescents in developing countries are increasingly subjected to tobacco industry promotion and exploitation. The results show that males in rural South Africa are not isolated from the tobacco epidemic. [ABSTRACT FROM AUTHOR]

This study was designed to evaluate the efficacy of the HealthWise South Africa HIV and substance abuse prevention program at impacting adolescents’ polydrug use and sexual risk behaviors. HealthWise is a school-based intervention designed to promote social-emotional skills, increase knowledge and refusal skills relevant to substance use and sexual behaviors, and encourage healthy free time activities. Four intervention schools in one township near Cape Town, South Africa were matched to five comparison schools (N = 4040). The sample included equal numbers of male and female participants (Mean age = 14.0). Multiple regression was used to assess the impact of HealthWise on the outcomes of interest. Findings suggest that among virgins at baseline (beginning of eighth grade) who had sex by Wave 5 (beginning of 10th grade), HealthWise youth were less likely than comparison youth to engage in two or more risk behaviors at last sex. Additionally, HealthWise was effective at slowing the onset of frequent polydrug use among non-users at baseline and slowing the increase in this outcome among all participants. Program effects were not found for lifetime sexual activity, condomless sex refusal and past-month polydrug use. These findings suggest that HealthWise is a promising approach to HIV and substance abuse prevention. [ABSTRACT FROM PUBLISHER]

Characteristics of learners who become peer educators are rarely explored despite the potential relevance to the success of peer education programmes. Fifteen high schools selected to implement peer education HIV prevention programmes in South Africa were recruited. A total of 2339 Grade 10 learners were surveyed and comparisons were made between socio-demographic characteristics, key skills, school experience and sexual behaviour of those students who had volunteered or been chosen by teachers to be peer educators (n = 295) and their fellow students (n = 2044), the potential recipients of the programme. On most of the socio-demographic variables, school experiences, aspirations, sexual debut and use of condoms at last sex or whether they had been tested for HIV status, there were no significant differences between the two groups. Volunteers and teacher-chosen peer educators tended to be younger than their classmates (16.19 versus 16.52, P < 0.0001), score higher on a goal-orientation scale (3.27 versus 3.15, P =< 0.0001) and had more access to basic resources [electricity (97.9% versus 94.0%, P = 0.006), a bicycle (41.9% versus 32.7%, P = 0.004) or car (50.2% versus 41.0%, P = 0.005)]. Further research is needed to explore specific peer educator characteristics and recruitment and selection approaches that are associated with effective HIV prevention interventions. [ABSTRACT FROM AUTHOR]

A 14-item human immunodeficiency virus/acquired immunodeficiency syndrome knowledge scale was used among school students in 80 schools in 3 sites in Sub-Saharan Africa (Cape Town and Mankweng, South Africa, and Dar es Salaam, Tanzania). For each item, an incorrect or don't know response was coded as 0 and correct response as 1. Exploratory factor analyses based on polychoric correlations showed two separate factors for all sites. Two-parameter item response theory (IRT) analysis (bifactorial multiple indicators multiple causes confirmatory factor analysis models) consistently showed a general first factor and a second ‘method' factor. One single global latent variable seemed to sufficiently well capture most of the systematic variation in knowledge. Some items did not discriminate well between levels of the underlying knowledge latent variable and information values were highest for low levels of knowledge. The scale might be improved by adding items, in particular items that are more difficult to answer. Some differential item functioning effects related to site and socioeconomic status were identified. Scores on the latent knowledge variable were particularly low among females in Dar es Salaam and Mankweng, and were negatively associated with socioeconomic status. This study illustrates advantages of using IRT analysis instead of more conventional approaches to examining psychometric properties of knowledge scales. [ABSTRACT FROM AUTHOR]

Background: Little is known about the association between methamphetamine use and sexual risk behaviors among young South African women between 13 and 20 years of age. Objective: To examine the association between methamphetamine use and condom use among out-of-school South African female adolescents. Methods: Black and Coloured female adolescents were interviewed and categorized into methamphetamine user ( n = 261) or non-user ( n = 188) groups. Results: Methamphetamine use was reported by 58% of the total sample. Higher methamphetamine rates were found among young Coloured females (87%) than among young Black females (11%). In a multiple logistic regression analysis that adjusted for relevant confounders and included an interaction term for race and methamphetamine use, Coloured female methamphetamine users were over six times more likely than other participants to report not using a condom the last time they had sex (OR = 6.21; 95% CI = 1.21, 31.94). Conclusions and Scientific Significance: Efforts are needed to reduce methamphetamine use and related sexual risk among adolescent females in Coloured communities and to prevent the spread of methamphetamine use in Black African communities. [ABSTRACT FROM AUTHOR]

This study investigated the prevalence and correlates of sexual risk behaviour among high school students in two rural settings in the Eastern Cape, South Africa, using a cross-sectional survey design. One thousand six hundred and thirteen randomly-selected adolescents (58% female) in Grade 11 completed a self-report questionnaire that asked about demographic characteristics and participation in a range of health risk behaviours. The results indicated a high prevalence of sexual risk behaviours, and suggested that rural adolescents are initiating intercourse at a younger age than their urban counterparts and are less likely to use condoms. Socioeconomic status, grade repetition and having lived in a city were inconsistently related to sexual risk behaviour. The findings suggest a particular need for intervention efforts aimed at young people in rural settings. [ABSTRACT FROM AUTHOR]

Health compromising behaviors, such as smoking and other risk behaviors tend to co-occur, and contribute to the leading causes of preventable death, disease, and disability among adolescents and young adults worldwide. The present study assesses a model of the direct and indirect effects of maternal closeness with suicidal ideation on smoking and risky behaviors. The sample consisted of 657 South African youth assessed over two time points with comparison of effects between males and females. Maternal closeness had a significant effect on suicidal ideation among females. Suicidal ideation had a significant effect on risky behaviors among males and lifetime smoking among females. A significant indirect effect was observed from maternal closeness to lifetime smoking among females. These results indicate that suicidal ideation is associated with lifetime smoking and risky behaviors separately among male and female adolescents and highlight the need to focus on the development of mental health preventive interventions for both genders. [ABSTRACT FROM AUTHOR]

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]

Background: Little is known about the prevalence of partner violence among adolescents, nor of the factors with which it is associated. The objectives of this study were to document prevalence rates for partner violence among high school students in Cape Town, and to explore factors that are associated with such violence. Method: The sample consisted of 596 Grade 8 and 11 students attending public high schools in Cape Town, who were selected using a multistage cluster design. They completed an anonymous and confidential questionnaire. The dependent variable was whether they had ever perpetrated partner violence, or intended to do so. The independent variables, which were derived from a modified version of the Theory of Planned Behaviour (TPB), included attitudes, subjective norms (general and peer social influence and outcome expectancy) and self-efficacy. Separate multiple logistic regression models were developed of partner violence intentions or behaviours on the scales derived from the TPB and demographic variables. Regression coefficients from adjusted models were used to examine the potential mediating role of partner violence intentions in the association between each scale and partner violence behaviours using the Sobel test. Results: Among participants who reported being in a relationship, 20.7% reported perpetrating partner violence, and 16.4% reported intending to do so. After adjusting for demographic characteristics and other predictor scales, perpetration of partner violence was significantly associated with attitudes and outcome expectancy, while intention to perpetrate partner violence was significantly associated with attitudes and general social influence. The influence of attitude and general social influence on violent behaviours were each partially mediated by partner violence intentions. Conclusions: There are high levels of partner violence among high school students in Cape Town. Interventions to address this problem should focus on violence-related attitudes and outcome expectancy. [ABSTRACT FROM AUTHOR]

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]

This article describes two studies investigating the reliability and factorial validity of scores on the Self-Esteem Questionnaire (SEQ) for assessing self-evaluations relating to peers, school, family, sports/athletics, body image and global self-worth in South African adolescents. Participants were 900 learners enrolled in Grades 8 and 11 at public schools in Cape Town, and 116 Grades 8 and 11 learners attending independent schools. The results provided general support for the six-factor structure proposed by DuBois, Felner, Brand, Phillips and Lease (1996) and indicated that SEQ scores have good internal consistency and adequate test-retest reliability for English-speaking South Africans. However, minor revisions are needed for all scale scores to have acceptable internal consistency when translated into isiXhosa or Afrikaans. [ABSTRACT FROM AUTHOR]

This study investigated associations among adolescents’ self-esteem in 6 domains (peers, school, family, sports/athletics, body image and global self-worth) and risk behaviours related to substance use, bullying, suicidality and sexuality.A multistage stratified sampling strategy was used to select a representative sample of 939 English-, Afrikaans- and Xhosa-speaking students in Grades 8 and 11 at public high schools in Cape Town, South Africa. Participants completed the multidimensional Self-Esteem Questionnaire (SEQ;) and a self-report questionnaire containing items about demographic characteristics and participation in a range of risk behaviours. It included questions about their use of tobacco, alcohol, cannabis, solvents and other substances, bullying, suicidal ideation and attempts, and risky sexual behaviour. Data was analysed using a series of logistic regression models, with the estimation of model parameters being done through generalised estimation equations.Scores on each self-esteem scale were significantly associated with at least one risk behaviour in male and female adolescents after controlling for the sampling strategy, grade and race. However, specific self-esteem domains were differentially related to particular risk behaviours. After taking the correlations between the self-esteem scales into account, low self-esteem in the family and school contexts and high self-esteem in the peer domain were significantly independently associated with multiple risk behaviours in adolescents of both sexes. Low body-image self-esteem and global self-worth were also uniquely associated with risk behaviours in girls, but not in boys.Overall, the findings suggest that interventions that aim to protect adolescents from engaging in risk behaviours by increasing their self-esteem are likely to be most effective and cost-efficient if they are aimed at the family and school domains. [ABSTRACT FROM AUTHOR]

This paper aims to provide surveillance information about the extent and consequences of alcohol and other drug (AOD) use by adolescents for three sentinel sites in South Africa (Cape Town, Durban and Gauteng province). From 1997 to 2001, data were gathered from multiple sources, including specialist treatment centres, trauma units, school students, rave party attenders, and arrestees. Since the start of surveillance, an increasing proportion of South African adolescents are using AODs. Surveys point to high levels of alcohol misuse among high school students, with alcohol being the most common substance of abuse. Cannabis is the most frequently reported illicit drug of abuse among adolescents. This is reflected in the large proportion of adolescents receiving treatment for cannabis, cannabis-positive arrestees, and cannabis-positive trauma patients. Cannabis smoked together with methaqualone is the second most common primary drug of abuse in Cape Town. Arrestee data highlights the potentially negative effect of adolescent methaqualone use. Cocaine and heroin are emerging as problem drugs of abuse among adolescents in large metropolitan centres. Ecstasy (MDMA) use occurs mainly among adolescents who attend rave parties and clubs. The study points to the need for AOD intervention programmes that target young people and the need for continued monitoring of adolescent AOD use in the future. [Copyright &y& Elsevier]

A theoretical pathway of progression of suicidal behavior, from ideation tocommunicating suicidal intent to suicide attempt was examined by investigating whether adolescents at each stage of the pathway could be differentiated from those at the previous stage by their risk behaviors. Cluster sampling produced a sample of 7,340 high-school students who completed a self-administered questionnaire. Bivariate analyses and multivariate logistic regression models were used to investigate the relationships between stage of severity of suicidal behavior and selected risk behaviors. For females, the more severe the suicidal behaviors exhibited, the more likely that the adolescent had been both a perpetrator and victim of violence. For males, attempting suicide was associated with being a victim and perpetrator of violence. Our findings lend partial support to the continuum of severity hypothesis of suicidal behaviors and suggest that clinicians should be alerted to escalating violent behavior as a potential precursor to suicide attempt. [ABSTRACT FROM AUTHOR]

: 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]

Abstract: Research has shown a positive relationship between substance use and delinquent-type behaviours among adolescents. The aim of this study is to explore the temporal relationships between these outcomes through secondary data analysis of a longitudinal study of high-school students' risk behaviours. Two regression models were compared and gender, socioeconomic status and repeating a grade were found to be consistent predictors of delinquent-type behaviour. Alcohol (OR: 1.26, CI: 1.02–1.55, p = 0.03) and drug use (OR: 1.10, CI: 1.03–1.16, p = 0.002) in the ordinal regression models were significantly associated with delinquent-type behaviours at Time 2 only. A transition model use was then used to measure delinquent-type behaviours as predicted by the previous time period, and results indicated that gender and delinquency were predictive of delinquency. Smoking also significantly interacted with delinquent-type behaviour to increase future risk of this behaviour. The findings point to the need for intervening early with adolescents who show delinquent-type behaviour. [Copyright &y& Elsevier]