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The burgeoning body of evidence suggests that the aggregated 12-month prevalence estimates of suicidal behaviors (ideation, planning, and attempt) are relatively higher among in-school adolescents in Africa, although country-specific data on the phenomena are still inadequate from the continent. We sought to estimate the 12-month prevalence and identify some of the correlates of suicide behaviors among school-going adolescents in Eswatini. We analyzed the nationally representative data from the 2013 Eswatini World Health Organization Global School-based Student Health Survey, using univariate, bivariate, and multivariate statistical approaches. Of the 2,513 analytical samples, 17.0% (95% confidence interval [CI]: 15.4–18.4%) reported suicidal ideation, 21.0% (95% CI: 19.3–22.6%) made a suicide plan, and 15.5% (95% CI: 14.1–16.9%) attempted suicide during the previous 12 months. The final adjusted logistic models indicated health risk behavior (i.e., marijuana use), adverse interpersonal factors within the family (e.g., intrusion of privacy by parents), and school contextual factors (e.g., bullying victimization, physical fights) to be associated with increased odds of suicidal behaviors among females. However, predominantly, school-related interpersonal factors (e.g., bullying victimization, physical fights) showed strong associations with increased odds of suicidal behaviors among males. Generally, parental monitoring, parental understanding, and social support at school were associated with reduced odds of suicidal behaviors. The multi-level nature of our findings underscores the need for multi-contextual and multi-sectoral intervention and prevention programs and policy approaches targeted at mitigating the onset of suicidal ideation and possible transition to suicidal planning, attempt, and potential death by suicide in this young population.

Physical and mental health risks often commence during young adulthood. Vocational education institutions are an ideal setting for understanding how health-risks cluster together in students to develop holistic multiple health-risk interventions. This is the first study to examine clustering of tobacco smoking, fruit intake, vegetable intake, alcohol consumption, physical inactivity, overweight/obesity, depression, and anxiety in vocational education students and the socio-demographic characteristics associated with cluster membership. A cross-sectional survey with vocational education students (n = 1134, mean age = 24.3 years) in New South Wales, Australia. Latent class analysis identified clusters and latent class regression examined characteristics associated with clusters. Four clusters were identified. All clusters had moderate inadequate fruit intake and moderate overweight/obesity. Cluster 1 (13% of sample) had “high anxiety, high inadequate vegetable intake, low tobacco, and low alcohol use.” Cluster 2 (16% of sample) had “high tobacco smoking, high alcohol use, high anxiety, high depression, and high inadequate vegetable intake.” Cluster 3 (52% of sample) had “high risky alcohol use, high inadequate vegetable intake, low depression, low anxiety, low tobacco smoking, and low physical inactivity.” Cluster 4 (19% of sample) was a “lower risk cluster with high inadequate vegetable intake.” Compared to cluster 4, 16–25-year-olds and those experiencing financial stress were more likely to belong to clusters 1, 2, and 3. Interventions for vocational education students should address fruit and vegetable intake and overweight/obesity and recognize that tobacco use and risky alcohol use sometimes occurs in the context of mental health issues.

Non-communicable diseases (NCDs) are associated with modifiable health risk factors. There is a lack of evidence regarding clusters of health-related behaviours among school-going adolescents from sub-Saharan Africa. This study was conducted to identify clustering patterns of health risk factors (i.e. smoking tobacco, inadequate fruit intake, inadequate vegetable intake, physical inactivity, sedentary behaviour, anxiety and depression) and association with sociodemographic factors among school-going adolescents in Liberia. The 2017 Liberian Global School-based Student Health Survey on 2774 adolescents aged 11 years and above (52.5% females) sampled with a two-stage cluster sample design was used. Latent class analysis was used to generate the clusters and latent class regression assessed the associations between sociodemographic factors and the clusters. We identified three clusters labelled as (1) ‘low substance use, moderately active cluster’ (34.8%); (2) ‘inadequate fruit and vegetable cluster’ (48.9%) and (3) ‘risk taking cluster’ (16.3%)’. Compared to cluster 1, adolescent boys [AOR = 1.71, 1.29–2.27, p

Uptake of online and telephone services targeting health behaviours is low among vocational education students and barriers and facilitators are unknown. This study aimed to explore barriers and facilitators to uptake of online and telephone services for smoking, nutrition, alcohol, and physical activity (SNAP) risk behaviours via semi-structured individual telephone interviews with fifteen vocational education students. Two authors independently completed thematic analysis, classified themes according to the COM-B (Capability, Opportunity, Motivation, Behaviour) framework, and discussed disagreements until consensus was reached. Facilitators to uptake of online (e.g., desire to learn something new, cost-free, accessible) and telephone services (e.g., prefer to talk to provider, complements online support) primarily related to capability and opportunity. For telephone services, difficulty understanding accent/language was a capability-related barrier. Opportunity-related barriers for online and telephone services were preference for face-to-face interaction and lack of time, while preference for apps/online programs was a barrier for telephone services. For online and telephone services, not wanting to change SNAP behaviours was a motivation-related barrier and being able to change SNAP risk behaviours themselves was a motivation-related barrier for online services. Barriers and facilitators to online and telephone services are relevant for designing interventions vocational education students are more likely to use.

Background: Carbonated soft drinks consumption is associated with weight gain and other chronic diseases. Aim: To examine whether socio-demographic factors, health risk factors and psychological distress are associated with carbonated soft drink consumption among adolescents in selected senior high schools in Ghana. Methods: Data were obtained from the 2012 Ghana Global School-based Student Health Survey (GSHS). Participants consisted of 1756 school-going adolescents sampled using a two-stage cluster sampling method. Binomial logistic regression was used to determine whether socio-demographic factors, health risk factors and psychological distress were associated with consumption of soft drinks. Results: The prevalence of carbonated soft drinks consumption was 34.9%. Males (odds ratio (OR) = 0.73 (95% confidence intervals (CI) 0.59–0.92); p = 0.007), and participants with high socio-economic status (OR = 0.76 (95% CI 0.48–0.97); p = 0.033) had smaller odds for consumption of soft drinks. Also, adolescents in Senior High School (SHS) 3 (OR = 0.72 (95% CI 0.53–0.97); p = 0.034) and SHS 4 (OR = 0.63 (95% CI 0.43–0.91); p = 0.014) had smaller odds for soft drinks intake compared to those in SHS 1. Health risk factors associated with greater odds of high soft drink consumption were tobacco use (OR = 1.68, (95% CI 1.07–2.65); p = 0.025), fast food consumption (OR = 1.88, (95% CI 1.47–2.41); p = 0.011) and alcohol consumption (OR = 1.43, (95% CI 1.02–1.99); p = 0.039). Consuming adequate fruit (OR = 0.19 (95% CI 0.15–0.24); p = 0.000) and adequate vegetable (OR = 0.55 (95% CI 0.34–0.87); p = 0.011) were associated with lower odds for soft drink consumption. Adolescents who reported feeling anxious had smaller odds for soft drink intake (OR = 0.65, (95% CI 0.47–0.91); p = 0.011). Conclusions: The findings from this study show that socio-demographic characteristics, health risk factors and psychological distress are associated with the soft drink consumption among adolescents in Ghana. Interventions aimed at reducing soft drink consumption and other health risk factors are needed.

Health risk factors such as tobacco smoking, inadequate fruit intake, inadequate vegetable intake, risky alcohol consumption, physical inactivity, obesity, anxiety and depression often commence during adolescence and young adulthood. Vocational education institutions enrol many students in these age groups making them an important setting for addressing multiple health risk factors. This systematic review examined (i) co-occurrence of health risk factors, (ii) clustering of health risk factors, and (iii) socio-demographic characteristics associated with co-occurrence and/or clusters of health risks among vocational education students. MEDLINE, PsycINFO, EMBASE, CINAHL and Scopus were searched to identify eligible studies published by 30 June 2020. Two reviewers independently extracted data and assessed methodological quality using the National Heart, Lung and Blood Institute Quality Assessment Tool. Five studies assessed co-occurrence and three studies clustering of health risks. Co-occurrence of health risk factors ranged from 29–98% and clustering of alcohol use and tobacco smoking was commonly reported. The findings were mixed about whether gender and age were associated with co-occurrence or clustering of health risks. There is limited evidence examining co-occurrence and clustering of health risk factors in vocational education students. Comprehensive assessment of how all these health risks co-occur or cluster in vocational education students is required.

This study examined the prevalence of multiple health risk behaviours, the clustering patterns of health risk behaviours, the association between socio-demographic characteristics, psychological distress and clusters and the relationship between number of health risk behaviours and psychological distress among adolescents in Ghana. Participants were senior high school (SHS) students aged 11–19 years who participated in the 2012 Global School-based Students Health Survey (n = 1763). Five health risk behaviours (smoking tobacco, inadequate fruit intake, inadequate vegetable intake, alcohol intake and physical inactivity) were measured. Participants were classified to be at risk if they indicated they smoked tobacco, did not eat fruit ≥ 2 times a day and vegetables ≥ 5 a day, drank alcohol during the past 30 days and did not engage in physical activity for ≥ 60 min per day during the past 7 days. Latent class analysis and latent regression were used to identify the clusters and factors associated with the clusters respectively. Multiple logistic regression was used to determine the relationship between number of health risk behaviours and psychological distress. The prevalence of multiple health risk behaviours (2 or more) was 94.8%. Two clusters emerged: Cluster 1 (“Poor nutrition, inactive, low substance use cluster”; 91%); Cluster 2 (“High Risk Cluster”; 9%). Using cluster 1 as a reference group, adolescents in the 11–15 years category had lower odds of belonging to cluster 2 (OR = 0.21 CI 0.05–0.91, ρ = 0.036) while those experiencing symptoms of depression had higher odds of belonging to cluster 2 (OR = 2.45 CI 1.45–4.14, ρ = 0.001). No significant relationship was found between number of health risk behaviour and psychological distress. Health risk behaviours cluster among adolescents with age and depression associated with the identified clusters. Early interventions that target these clusters are needed at the individual, school and community level to mitigate the burden of non-communicable diseases., Highlights • Prevalence of multiple health risk behaviours among adolescents in Ghana is high. • Multiple health risk behaviours cluster among adolescents in Ghana. • Some demographic and psychological factors are associated with clusters among adolescents.

Background Real-time video communication technology allows virtual face-to-face interactions between the provider and the user, and can be used to modify risk factors for smoking, nutrition, alcohol consumption, physical activity, and obesity. No systematic reviews have examined the effectiveness of individual real-time video counseling for addressing each of the risk factors for smoking, nutrition, alcohol consumption, physical activity, and obesity. Objective This systematic review aims to examine the effectiveness of individually delivered real-time video counseling on risk factors for smoking, nutrition, alcohol consumption, physical activity, and obesity. Methods The MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica Database), PsycINFO, Cochrane Register of Controlled Trials, and Scopus databases were searched for eligible studies published up to November 21, 2019. Eligible studies were randomized or cluster randomized trials that tested the effectiveness of individual real-time video communication interventions on smoking, nutrition, alcohol, physical activity, and obesity in any population or setting; the comparator was a no-intervention control group or any other mode of support (eg, telephone); and an English-language publication. Results A total of 13 studies were eligible. Four studies targeted smoking, 3 alcohol, 3 physical activity, and 3 obesity. In 2 of the physical activity studies, real-time video counseling was found to significantly increase physical activity when compared with usual care at week 9 and after 5 years. Two obesity studies found a significant change in BMI between a video counseling and a documents group, with significantly greater weight loss in the video counseling group than the in-person as well as the control groups. One study found that those in the video counseling group were significantly more likely than those in the telephone counseling group to achieve smoking cessation. The remaining studies found no significant differences between video counseling and telephone counseling or face-to-face counseling for smoking cessation, video counseling and face-to-face treatment on alcohol consumption, video counseling and no counseling for physical activity, and video counseling and face-to-face treatment on BMI. The global methodological quality rating was moderate in 1 physical activity study, whereas 12 studies had a weak global rating. Conclusions Video counseling is potentially more effective than a control group or other modes of support in addressing physical inactivity and obesity and is not less effective in modifying smoking and alcohol consumption. Further research is required to determine the relative benefits of video counseling in terms of other policy and practice decision-making factors such as costs and feasibility.

Introduction Mortality caused by preventable non-communicable diseases such as diabetes, cancer, stroke and cardiovascular disease is on the increase. In 2016, noncommunicable diseases (NCDs) caused 41 million of the world's 57 million deaths. Two modifiable behavioural health risk factors namely physical inactivity and sedentary behaviour are associated with many of these NCDs. In Ghana, several studies have reported the prevalence of physical activity and/or sedentary behaviours. However, to date no systematic review has synthesised the findings from these studies. The aim of this systematic review is to synthesise studies that reported the prevalence of physical activity and/or sedentary behaviours in Ghana. Methods The Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) guideline will be followed to conduct and report the outcomes of this systematic review. EMBASE, MEDLINE (OVID), PsycINFO, PsychARTICLES, CINAHL and SCOPUS are electronic databases that will be searched to identify eligible studies. Only quantitative studies that reported the prevalence of physical activity and/or sedentary behaviours using cross-sectional design, observational cohort design and case-control design will be included. Two members of the review team will independently screen the articles to determine eligibility, ascertain the quality of eligible studies, and extract data. Any discrepancy that arise at any stage of the review will be resolved through discussion between the two. The outcome of the review will be reported as a narrative synthesis if there is no homogeneity across studies and a meta-analyses will be conducted if there sufficient homogeneity across studies. Discussion This systematic review will synthesise the available literature on prevalence of physical activity and/or sedentary behaviours in Ghana. It is expected that the outcome of this systematic review will provide an understanding of the trend of these two health risk factors among Ghanaians. Systematic review registration PROSPERO CRD42019119574

Background A high proportion of vocational education students smoke tobacco, have inadequate nutrition (ie, low fruit and vegetable intake), drink alcohol at risky levels, or are physically inactive. The extent to which vocational education students will sign up for proactively offered online and telephone support services for multiple health risk behaviors is unknown. Objective The aim of this study is to examine the uptake of proactively offered online and telephone support services for smoking, nutrition, alcohol consumption, and physical activity risk behaviors, individually and in combination, among vocational education students in the Technical and Further Education (TAFE) setting. The characteristics associated with the uptake of online or telephone services for smoking, nutrition, alcohol consumption, and physical activity risk behaviors were also examined. Methods Vocational education students enrolled in a TAFE class in New South Wales, Australia, which ran for 6 months or more, were recruited to participate in a cluster randomized controlled trial from May 2018 to May 2019. In the intervention arm, participants who did not meet the Australian health guidelines for each of the smoking, nutrition, alcohol consumption, and physical activity risk behaviors were provided electronic feedback and proactively offered online and telephone support services. Uptake of support was measured by whether participants signed up for the online and telephone services they were offered. Results Vocational education students (N=551; mean age 25.7 years, SD 11.1; 310/551, 56.3% male) were recruited into the intervention arm. Uptake of the proactive offer of either online or telephone services was 14.5% (59/406) for fruit and vegetables, 12.7% (29/228) for physical activity, 6.8% (13/191) for smoking, and 5.5% (18/327) for alcohol use. Uptake of any online or telephone service for at least two health behaviors was 5.8% (22/377). Participants who were employed (odds ratio [OR] 0.10, 95% CI 0.01-0.72) and reported not being anxious (OR 0.11, 95% CI 0.02-0.71) had smaller odds of signing up for online or telephone services for smoking, whereas participants who reported not being depressed had greater odds (OR 10.25, 95% CI 1.30-80.67). Participants who intended to change their physical activity in the next 30 days had greater odds (OR 4.01, 95% CI 1.33-12.07) of signing up for online or telephone services for physical activity. Employed participants had smaller odds (OR 0.18, 95% CI 0.06-0.56) of signing up for support services for at least two behaviors. Conclusions Although the uptake of proactively offered online and telephone support services is low, these rates appear to be higher than the self-initiated use of some of these services in the general population. Scaling up the proactive offer of online and telephone services may produce beneficial health outcomes. Trial Registration Australian New Zealand Clinical Trials Registry: ACTRN12618000723280; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375001.