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1. Cannabis and amphetamine use among school-going adolescents in sub-Saharan Africa: a multi-country analysis of prevalence and associated factors

Author

Kwaku Oppong Asante and Prince Atorkey

Subjects
School-going adolescents, amphetamine use, Cannabis use, Sub-saharan Africa, Psychiatry, RC435-571
Abstract

Abstract Background Global evidence indicates that early onset of illicit substance use among adolescents and emerging adults is associated with negative mental-health related-outcomes that can persist into adulthood. However, the lack of quality regional data on adolescent illicit substance use and its determinants remains a common barrier to evidence-based policy-making and the development of school-based interventions in Africa. The purpose of our study was to estimate the prevalence and describe the correlates of cannabis and amphetamine use among school-going adolescents in eight sub-Saharan African countries (SSA) – Benin, Ghana, Liberia, Mauritius, Mozambique, Namibia, Seychelles, and Tanzania. Methods We analysed 15,553 school-going adolescents that participated in the Global School-based Student Health Survey. A two-stage sampling approach was used to generate a nationally representative sample of school children (grades 7–12) in each of these countries. Students responded to a self-administered structured questionnaire that contained information on sociodemographic factors, family involvement factors, mental health factors, school environment factors and past-month cannabis and life-time amphetamine use. Results The overall prevalence estimates of past-month cannabis use and lifetime amphetamine use among school-going adolescents in the eight SSA countries was 4.39% (95% CI = 4.08, 4.72) and 3.05% (95% CI = 2.79, 3.34) respectively. In the multivariable logistic regression analysis, demographic characteristics (age and male gender), mental health factors (suicide ideation and attempt), lifestyle factors (cigarette smoking, past-month alcohol use, lifetime drunkenness and leisure-time sedentary behaviour) and school level factors (truancy and bullying victimisation) showed strong associations with increased odds of both past-month cannabis use and lifetime amphetamine use. Social support at school was associated with increased odds for lifetime amphetamine, while parental monitoring decreases the odds for lifetime amphetamine use. It was also observed that parental tobacco use was associated with increased odds of both past-month cannabis use and lifetime amphetamine use. Conclusion The relatively low overall prevalence estimates of past-month cannabis use and lifetime amphetamine use among school-going adolescents in not surprising. However, the identified risk and protective factors associated with cannabis and amphetamine use underscores the need for these eight countries in SSA to develop contextual and multi-sectoral intervention and school-based prevention programmes that could target school-going adolescents who may be at risk of misusing these illicit drugs.

Published
2023
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2. Clustering of multiple health risk behaviours and association with socio-demographic characteristics and psychological distress among adolescents in Ghana: A latent class analysis

Author

Prince Atorkey, Bsc. (Psyc) Mphil (Clin Psyc) and Christiana Owiredua, B.A. (Psyc) Mphil (Clin Psyc)

Subjects
Clustering, Multiple health risk behaviours, Psychological distress, Adolescence, Ghana, Public aspects of medicine, RA1-1270, Social sciences (General), H1-99
Abstract

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.

Published
2021
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3. Physical activity and sedentary behaviour research in Ghana: A systematic review protocol

Author

Prince Atorkey, Christiana Owiredua, Zaidan Mohammed, and Faustina Twumwaa Gyimah

Subjects
Infectious and parasitic diseases, RC109-216
Abstract

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

Published
2019
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4. Living with diabetes: An exploratory study of illness representation and medication adherence in Ghana

Author

Christiana Owiredua, Emmanuel Nii-Boye Quarshie, and Prince Atorkey

Subjects
diabetes, ghana, illness representation, medication adherence, illness beliefs, patient management, hyperglycemia, Medicine
Abstract

Background: Compared to other chronic conditions, non-adherence to medication in diabetes patients is very high. This study explores the relationship between illness representation and medication adherence in diabetes patients in Ghana. Method: A total of 196 type 2 diabetes patients purposively and conveniently sampled from a tertiary hospital in Ghana responded to the Revised Illness Perception Questionnaire (IPQ-R) and the Medication Adherence Report Scale (MARS-5). The Pearson Moment Product correlation and the hierarchical multiple regression statistical tools were used to analyse the data. Results: Illness consequence and emotional representation were negatively related to medication adherence, while personal control positively accounted for significant variance in medication adherence. However, none of the selected key demographic variables (i.e. age, illness duration, gender, religion and education) independently accounted for any significant variance in medication adherence. Conclusion: Diabetes has a telling consequence on patients’ life; the patient can do something to control diabetes; and the negative emotional representations concerning the disease have a significant influence on the degree of medication adherence by the patients. This observation has implications for the management and treatment plan of diabetes.

Published
2018
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5. Intention to Change Multiple Health Risk Behaviors and Predictors of Behavior Change in Vocational Education Students

Author

Prince Atorkey, Christine Paul, John Wiggers, Billie Bonevski, Aimee Mitchell, and Flora Tzelepis

Abstract

No studies have examined vocational education students' intention to change multiple health risk behaviors and whether baseline characteristics predict behavior change. Participants: Participants were vocational education students in New South Wales, Australia. Methods: Students in the no-intervention control arm of a cluster randomized controlled trial completed an online survey at baseline and 6 months later. Results: Of 450 participants (83.3%) who reported multiple health risk behaviors at baseline, one-third (33.1%) intended to change at least two risk behaviors within 6 months. Participants experiencing symptoms of anxiety [OR = 7.43, 95% CIs 1.26-43.87; p = 0.03] and who intended to change three to four risk behaviors [OR = 23.30, 95% CIs 4.01-135.40; p = 0.001] rather than one behavior had significantly greater odds of changing at least one behavior in 6 months. Conclusions: Interventions could support vocational education students to change behaviors they wish to as well as motivate them to address other risk behaviors.

Published
2024
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6. Suicidal Behaviors in a Nationally Representative Sample of School-Going Adolescents Aged 12–17 Years in Eswatini

Author

Pascal Landindome Navelle, Prince Atorkey, Emmanuel Nii-Boye Quarshie, Samuel Afotey Lomotey, and Karla Patricia Valdés García

Subjects
Intrusion, Parental monitoring, Social support, Intervention (counseling), medicine, Interpersonal communication, medicine.symptom, Psychology, Suicidal ideation, General Psychology, Confidence interval, Odds, Demography
Abstract

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.

Published
2021
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7. Clustering of multiple health-risk factors among vocational education students: a latent class analysis

Author

Flora Tzelepis, Aimee Mitchell, Christine Paul, John Wiggers, Erin Nolan, Christopher Oldmeadow, Emma Byrnes, Prince Atorkey, and Billie Bonevski

Subjects
Adult, Health Behavior, Psychological intervention, Context (language use), Overweight, Young Adult, 03 medical and health sciences, Behavioral Neuroscience, 0302 clinical medicine, Risk Factors, Environmental health, medicine, Cluster Analysis, Humans, 030212 general & internal medicine, Students, Applied Psychology, Vocational Education, 030505 public health, medicine.disease, Obesity, Mental health, Latent class model, Cross-Sectional Studies, Latent Class Analysis, Vocational education, Anxiety, medicine.symptom, 0305 other medical science, Psychology
Abstract

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.

Published
2021
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8. Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020

Author

Dana Bryazka, Marissa B Reitsma, Max G Griswold, Kalkidan Hassen Abate, Cristiana Abbafati, Mohsen Abbasi-Kangevari, Zeinab Abbasi-Kangevari, Amir Abdoli, Mohammad Abdollahi, Abu Yousuf Md Abdullah, E S Abhilash, Eman Abu-Gharbieh, Juan Manuel Acuna, Giovanni Addolorato, Oladimeji M Adebayo, Victor Adekanmbi, Kishor Adhikari, Sangeet Adhikari, Qorinah Estiningtyas Sakilah Adnani, Saira Afzal, Wubetu Yimam Agegnehu, Manik Aggarwal, Bright Opoku Ahinkorah, Araz Ramazan Ahmad, Sajjad Ahmad, Tauseef Ahmad, Ali Ahmadi, Sepideh Ahmadi, Haroon Ahmed, Tarik Ahmed Rashid, Chisom Joyqueenet Akunna, Hanadi Al Hamad, Md Zakiul Alam, Dejene Tsegaye Alem, Kefyalew Addis Alene, Yousef Alimohamadi, Atiyeh Alizadeh, Kasim Allel, Jordi Alonso, Saba Alvand, Nelson Alvis-Guzman, Firehiwot Amare, Edward Kwabena Ameyaw, Sohrab Amiri, Robert Ancuceanu, Jason A Anderson, Catalina Liliana Andrei, Tudorel Andrei, Jalal Arabloo, Muhammad Arshad, Anton A Artamonov, Zahra Aryan, Malke Asaad, Mulusew A Asemahagn, Thomas Astell-Burt, Seyyed Shamsadin Athari, Desta Debalkie Atnafu, Prince Atorkey, Alok Atreya, Floriane Ausloos, Marcel Ausloos, Getinet Ayano, Martin Amogre ayanore Ayanore, Olatunde O Ayinde, Jose L Ayuso-Mateos, Sina Azadnajafabad, Melkalem Mamuye Azanaw, Mohammadreza Azangou-Khyavy, Amirhossein Azari Jafari, Ahmed Y Azzam, Ashish D Badiye, Nasser Bagheri, Sara Bagherieh, Mohan Bairwa, Shankar M Bakkannavar, Ravleen Kaur Bakshi, Awraris Hailu Balchut/Bilchut, Till Winfried Bärnighausen, Fabio Barra, Amadou Barrow, Pritish Baskaran, Luis Belo, Derrick A Bennett, Isabela M Benseñor, Akshaya Srikanth Bhagavathula, Neeraj Bhala, Ashish Bhalla, Nikha Bhardwaj, Pankaj Bhardwaj, Sonu Bhaskar, Krittika Bhattacharyya, Vijayalakshmi S Bhojaraja, Bagas Suryo Bintoro, Elena A Elena Blokhina, Belay Boda Abule Bodicha, Archith Boloor, Cristina Bosetti, Dejana Braithwaite, Hermann Brenner, Nikolay Ivanovich Briko, Andre R Brunoni, Zahid A Butt, Chao Cao, Yin Cao, Rosario Cárdenas, Andre F Carvalho, Márcia Carvalho, Joao Mauricio Castaldelli-Maia, Giulio Castelpietra, Luis F S Castro-de-Araujo, Maria Sofia Cattaruzza, Promit Ananyo Chakraborty, Jaykaran Charan, Vijay Kumar Chattu, Akhilanand Chaurasia, Nicolas Cherbuin, Dinh-Toi Chu, Nandita Chudal, Sheng-Chia Chung, Chuchu Churko, Liliana G Ciobanu, Massimo Cirillo, Rafael M Claro, Simona Costanzo, Richard G Cowden, Michael H Criqui, Natália Cruz-Martins, Garland T Culbreth, Berihun Assefa Dachew, Omid Dadras, Xiaochen Dai, Giovanni Damiani, Lalit Dandona, Rakhi Dandona, Beniam Darge Daniel, Anna Danielewicz, Jiregna Darega Gela, Kairat Davletov, Jacyra Azevedo Paiva de Araujo, Antonio Reis de Sá-Junior, Sisay Abebe Debela, Azizallah Dehghan, Andreas K Demetriades, Meseret Derbew Molla, Rupak Desai, Abebaw Alemayehu Desta, Diana Dias da Silva, Daniel Diaz, Lankamo Ena Digesa, Mengistie Diress, Milad Dodangeh, Deepa Dongarwar, Fariba Dorostkar, Haneil Larson Dsouza, Bereket Duko, Bruce B Duncan, Kristina Edvardsson, Michael Ekholuenetale, Frank J Elgar, Muhammed Elhadi, Mohamed A Elmonem, Aman Yesuf Endries, Sharareh Eskandarieh, Azin Etemadimanesh, Adeniyi Francis Fagbamigbe, Ildar Ravisovich Fakhradiyev, Fatemeh Farahmand, Carla Sofia e Sá Farinha, Andre Faro, Farshad Farzadfar, Ali Fatehizadeh, Nelsensius Klau Fauk, Valery L Feigin, Rachel Feldman, Xiaoqi Feng, Zinabu Fentaw, Simone Ferrero, Lorenzo Ferro Desideri, Irina Filip, Florian Fischer, Joel Msafiri Francis, Richard Charles Franklin, Peter Andras Gaal, Mohamed M Gad, Silvano Gallus, Fabio Galvano, Balasankar Ganesan, Tushar Garg, Mesfin Gebrehiwot Damtew Gebrehiwot, Teferi Gebru Gebremeskel, Mathewos Alemu Gebremichael, Tadele Regasa Gemechu, Lemma Getacher, Motuma Erena Getachew, Abera Getachew Obsa, Asmare Getie, Amir Ghaderi, Mansour Ghafourifard, Alireza Ghajar, Seyyed-Hadi Ghamari, Lilian A Ghandour, Mohammad Ghasemi Nour, Ahmad Ghashghaee, Sherief Ghozy, Franklin N Glozah, Ekaterina Vladimirovna Glushkova, Justyna Godos, Amit Goel, Salime Goharinezhad, Mahaveer Golechha, Pouya Goleij, Mohamad Golitaleb, Felix Greaves, Michal Grivna, Giuseppe Grosso, Temesgen Worku Gudayu, Bhawna Gupta, Rajeev Gupta, Sapna Gupta, Veer Bala Gupta, Vivek Kumar Gupta, Nima Hafezi-Nejad, Arvin Haj-Mirzaian, Brian J Hall, Rabih Halwani, Tiilahun Beyene Handiso, Graeme J Hankey, Sanam Hariri, Josep Maria Haro, Ahmed I Hasaballah, Hossein Hassanian-Moghaddam, Simon I Hay, Khezar Hayat, Golnaz Heidari, Mohammad Heidari, Delia Hendrie, Claudiu Herteliu, Demisu Zenbaba Heyi, Kamal Hezam, Mbuzeleni Mbuzeleni Hlongwa, Ramesh Holla, Md Mahbub Hossain, Sahadat Hossain, Seyed Kianoosh Hosseini, Mehdi hosseinzadeh, Mihaela Hostiuc, Sorin Hostiuc, Guoqing Hu, Junjie Huang, Salman Hussain, Segun Emmanuel Ibitoye, Irena M Ilic, Milena D Ilic, Mustapha Immurana, Lalu Muhammad Irham, M Mofizul Islam, Rakibul M Islam, Sheikh Mohammed Shariful Islam, Hiroyasu Iso, Ramaiah Itumalla, Masao Iwagami, Roxana Jabbarinejad, Louis Jacob, Mihajlo Jakovljevic, Zahra Jamalpoor, Elham Jamshidi, Sathish Kumar Jayapal, Umesh Umesh Jayarajah, Ranil Jayawardena, Rime Jebai, Seyed Ali Jeddi, Alelign Tasew Jema, Ravi Prakash Jha, Har Ashish Jindal, Jost B Jonas, Tamas Joo, Nitin Joseph, Farahnaz Joukar, Jacek Jerzy Jozwiak, Mikk Jürisson, Ali Kabir, Robel Hussen Kabthymer, Bhushan Dattatray Kamble, Himal Kandel, Girum Gebremeskel Kanno, Neeti Kapoor, Ibraheem M Karaye, Salah Eddin Karimi, Bekalu Getnet Kassa, Rimple Jeet Kaur, Gbenga A Kayode, Mohammad Keykhaei, Himanshu Khajuria, Rovshan Khalilov, Imteyaz A Khan, Moien AB Khan, Hanna Kim, Jihee Kim, Min Seo Kim, Ruth W Kimokoti, Mika Kivimäki, Vitalii Klymchuk, Ann Kristin Skrindo Knudsen, Ali-Asghar Kolahi, Vladimir Andreevich Korshunov, Ai Koyanagi, Kewal Krishan, Yuvaraj Krishnamoorthy, G Anil Kumar, Narinder Kumar, Nithin Kumar, Ben Lacey, Tea Lallukka, Savita Lasrado, Jerrald Lau, Sang-woong Lee, Wei-Chen Lee, Yo Han Lee, Lee-Ling Lim, Stephen S Lim, Stany W Lobo, Platon D Lopukhov, Stefan Lorkowski, Rafael Lozano, Giancarlo Lucchetti, Farzan Madadizadeh, Áurea M Madureira-Carvalho, Soleiman Mahjoub, Ata Mahmoodpoor, Rashidul Alam Mahumud, Alaa Makki, Mohammad-Reza Malekpour, Narayana Manjunatha, Borhan Mansouri, Mohammad Ali Mansournia, Jose Martinez-Raga, Francisco A Martinez-Villa, Richard Matzopoulos, Pallab K Maulik, Mahsa Mayeli, John J McGrath, Jitendra Kumar Meena, Entezar Mehrabi Nasab, Ritesh G Menezes, Gert B M Mensink, Alexios-Fotios A Mentis, Atte Meretoja, Bedasa Taye Merga, Tomislav Mestrovic, Junmei Miao Jonasson, Bartosz Miazgowski, Ana Carolina Micheletti Gomide Nogueira de Sá, Ted R Miller, GK Mini, Andreea Mirica, Antonio Mirijello, Seyyedmohammadsadeq Mirmoeeni, Erkin M Mirrakhimov, Sanjeev Misra, Babak Moazen, Maryam Mobarakabadi, Marcello Moccia, Yousef Mohammad, Esmaeil Mohammadi, Abdollah Mohammadian-Hafshejani, Teroj Abdulrahman Mohammed, Nagabhishek Moka, Ali H Mokdad, Sara Momtazmanesh, Yousef Moradi, Ebrahim Mostafavi, Sumaira Mubarik, Erin C Mullany, Beemnet Tekabe Mulugeta, Efrén Murillo-Zamora, Christopher J L Murray, Julius C Mwita, Mohsen Naghavi, Mukhammad David Naimzada, Vinay Nangia, Biswa Prakash Nayak, Ionut Negoi, Ruxandra Irina Negoi, Seyed Aria Nejadghaderi, Samata Nepal, Sudan Prasad Prasad Neupane, Sandhya Neupane Kandel, Yeshambel T Nigatu, Ali Nowroozi, Khan M Nuruzzaman, Chimezie Igwegbe Nzoputam, Kehinde O Obamiro, Felix Akpojene Ogbo, Ayodipupo Sikiru Oguntade, Hassan Okati-Aliabad, Babayemi Oluwaseun Olakunde, Gláucia Maria Moraes Oliveira, Ahmed Omar Bali, Emad Omer, Doris V Ortega-Altamirano, Adrian Otoiu, Stanislav S Otstavnov, Bilcha Oumer, Mahesh P A, Alicia Padron-Monedero, Raffaele Palladino, Adrian Pana, Songhomitra Panda-Jonas, Anamika Pandey, Ashok Pandey, Shahina Pardhan, Tarang Parekh, Eun-Kee Park, Charles D H Parry, Fatemeh Pashazadeh Kan, Jay Patel, Siddhartha Pati, George C Patton, Uttam Paudel, Shrikant Pawar, Amy E Peden, Ionela-Roxana Petcu, Michael R Phillips, Marina Pinheiro, Evgenii Plotnikov, Pranil Man Singh Pradhan, Akila Prashant, Jianchao Quan, Amir Radfar, Alireza Rafiei, Pankaja Raghav Raghav, Vafa Rahimi-Movaghar, Azizur Rahman, Md Mosfequr Rahman, Mosiur Rahman, Amir Masoud Rahmani, Shayan Rahmani, Chhabi Lal Ranabhat, Priyanga Ranasinghe, Chythra R Rao, Drona Prakash Rasali, Mohammad-Mahdi Rashidi, Zubair Ahmed Ratan, David Laith Rawaf, Salman Rawaf, Lal Rawal, Andre M N Renzaho, Negar Rezaei, Saeid Rezaei, Mohsen Rezaeian, Seyed Mohammad Riahi, Esperanza Romero-Rodríguez, Gregory A Roth, Godfrey M Rwegerera, Basema Saddik, Erfan Sadeghi, Reihaneh Sadeghian, Umar Saeed, Farhad Saeedi, Rajesh Sagar, Amirhossein Sahebkar, Harihar Sahoo, Mohammad Ali Sahraian, KM Saif-Ur-Rahman, Sarvenaz Salahi, Hamideh Salimzadeh, Abdallah M Samy, Francesco Sanmarchi, Milena M Santric-Milicevic, Yaser Sarikhani, Brijesh Sathian, Ganesh Kumar Saya, Mehdi Sayyah, Maria Inês Schmidt, Aletta Elisabeth Schutte, Michaël Schwarzinger, David C Schwebel, Abdul-Aziz Seidu, Nachimuthu Senthil Kumar, SeyedAhmad SeyedAlinaghi, Allen Seylani, Feng Sha, Sarvenaz Shahin, Fariba Shahraki-Sanavi, Shayan Shahrokhi, Masood Ali Shaikh, Elaheh Shaker, Murad Ziyaudinovich Shakhmardanov, Mehran Shams-Beyranvand, Sara Sheikhbahaei, Rahim Ali Sheikhi, Adithi Shetty, Jeevan K Shetty, Damtew Solomon Shiferaw, Mika Shigematsu, Rahman Shiri, Reza Shirkoohi, K M Shivakumar, Velizar Shivarov, Parnian Shobeiri, Roman Shrestha, Negussie Boti Sidemo, Inga Dora Sigfusdottir, Diego Augusto Santos Silva, Natacha Torres da Silva, Jasvinder A Singh, Surjit Singh, Valentin Yurievich Skryabin, Anna Aleksandrovna Skryabina, David A Sleet, Marco Solmi, YONATAN SOLOMON, Suhang Song, Yimeng Song, Reed J D Sorensen, Sergey Soshnikov, Ireneous N Soyiri, Dan J Stein, Sonu Hangma Subba, Miklós Szócska, Rafael Tabarés-Seisdedos, Takahiro Tabuchi, Majid Taheri, Ker-Kan Tan, Minale Tareke, Elvis Enowbeyang Tarkang, Gebremaryam Temesgen, Worku Animaw Temesgen, Mohamad-Hani Temsah, Kavumpurathu Raman Thankappan, Rekha Thapar, Nikhil Kenny Thomas, Chalachew Tiruneh, Jovana Todorovic, Marco Torrado, Mathilde Touvier, Marcos Roberto Tovani-Palone, Mai Thi Ngoc Tran, Sergi Trias-Llimós, Jaya Prasad Tripathy, Alireza Vakilian, Rohollah Valizadeh, Mehdi Varmaghani, Shoban Babu Varthya, Tommi Juhani Vasankari, Theo Vos, Birhanu Wagaye, Yasir Waheed, Mandaras Tariku Walde, Cong Wang, Yanzhong Wang, Yuan-Pang Wang, Ronny Westerman, Nuwan Darshana Wickramasinghe, Abate Dargie Wubetu, Suowen Xu, Kazumasa Yamagishi, Lin Yang, Gesila Endashaw E Yesera, Arzu Yigit, Vahit Yiğit, Ayenew Engida Ayenew Engida Yimaw, Dong Keon Yon, Naohiro Yonemoto, Chuanhua Yu, Siddhesh Zadey, Mazyar Zahir, Iman Zare, Mikhail Sergeevich Zastrozhin, Anasthasia Zastrozhina, Zhi-Jiang Zhang, Chenwen Zhong, Mohammad Zmaili, Yves Miel H Zuniga, Emmanuela Gakidou, University of St Andrews. School of Medicine, University of St Andrews. Population and Behavioural Science Division, Department of Public Health, University of Helsinki, Hjelt Institute (-2014), Helsinki Inequality Initiative (INEQ), Clinicum, Helsinki University Hospital Area, Bill & Melinda Gates Foundation, King Edward Medical University (Pakistán), Alexander von Humboldt Foundation, University of Oxford (Reino Unido), Medical Research Council (Reino Unido), NIH - National Institute of Mental Health (NIMH) (Estados Unidos), Canada Research Chairs, National Health and Medical Research Council (Australia), National Heart Foundation of Australia, Ministry of Education, Science and Technological Development (Serbia), Wellcome Trust, NIH - National Institute on Aging (NIA) (Estados Unidos), Finlands Akademi (Finlandia), Panjab University (India), Federal Ministry of Education & Research (Alemania), National Council for Scientific and Technological Development (Brasil), Danish National Research Foundation, Queensland Centre for Mental Health Research (Australia), South African Medical Research Council, National Natural Science Foundation of China, Charles Sturt University (Australia), Ain Shams University (Egipto), Mizoram University (India), Kasturba Medical College (India), Manipal Academy of Higher Education (India), Coordenação de Aperfeicoamento de Pessoal de Nível Superior (Brasil), Ministerio de Ciencia e Innovación (España), Collaborators, GBD 2020 Alcohol, Bryazka, Dana, Reitsma, Marissa B, Griswold, Max G, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbasi-Kangevari, Mohsen, Abbasi-Kangevari, Zeinab, Abdoli, Amir, Abdollahi, Mohammad, Abdullah, Abu Yousuf Md, Abhilash, E S, Abu-Gharbieh, Eman, Acuna, Juan Manuel, Addolorato, Giovanni, Adebayo, Oladimeji M, Adekanmbi, Victor, Adhikari, Kishor, Adhikari, Sangeet, Adnani, Qorinah Estiningtyas Sakilah, Afzal, Saira, Agegnehu, Wubetu Yimam, Aggarwal, Manik, Ahinkorah, Bright Opoku, Ahmad, Araz Ramazan, Ahmad, Sajjad, Ahmad, Tauseef, Ahmadi, Ali, Ahmadi, Sepideh, Ahmed, Haroon, Ahmed Rashid, Tarik, Akunna, Chisom Joyqueenet, Al Hamad, Hanadi, Alam, Md Zakiul, Alem, Dejene Tsegaye, Alene, Kefyalew Addi, Alimohamadi, Yousef, Alizadeh, Atiyeh, Allel, Kasim, Alonso, Jordi, Alvand, Saba, Alvis-Guzman, Nelson, Amare, Firehiwot, Ameyaw, Edward Kwabena, Amiri, Sohrab, Ancuceanu, Robert, Anderson, Jason A, Andrei, Catalina Liliana, Andrei, Tudorel, Arabloo, Jalal, Arshad, Muhammad, Artamonov, Anton A, Aryan, Zahra, Asaad, Malke, Asemahagn, Mulusew A, Astell-Burt, Thoma, Athari, Seyyed Shamsadin, Atnafu, Desta Debalkie, Atorkey, Prince, Atreya, Alok, Ausloos, Floriane, Ausloos, Marcel, Ayano, Getinet, Ayanore, Martin Amogre ayanore, Ayinde, Olatunde O, Ayuso-Mateos, Jose L, Azadnajafabad, Sina, Azanaw, Melkalem Mamuye, Azangou-Khyavy, Mohammadreza, Azari Jafari, Amirhossein, Azzam, Ahmed Y, Badiye, Ashish D, Bagheri, Nasser, Bagherieh, Sara, Bairwa, Mohan, Bakkannavar, Shankar M, Bakshi, Ravleen Kaur, Balchut/bilchut, Awraris Hailu, Bärnighausen, Till Winfried, Barra, Fabio, Barrow, Amadou, Baskaran, Pritish, Belo, Lui, Bennett, Derrick A, Benseñor, Isabela M, Bhagavathula, Akshaya Srikanth, Bhala, Neeraj, Bhalla, Ashish, Bhardwaj, Nikha, Bhardwaj, Pankaj, Bhaskar, Sonu, Bhattacharyya, Krittika, Bhojaraja, Vijayalakshmi S, Bintoro, Bagas Suryo, Blokhina, Elena A Elena, Bodicha, Belay Boda Abule, Boloor, Archith, Bosetti, Cristina, Braithwaite, Dejana, Brenner, Hermann, Briko, Nikolay Ivanovich, Brunoni, Andre R, Butt, Zahid A, Cao, Chao, Cao, Yin, Cárdenas, Rosario, Carvalho, Andre F, Carvalho, Márcia, Castaldelli-Maia, Joao Mauricio, Castelpietra, Giulio, Castro-de-Araujo, Luis F S, Cattaruzza, Maria Sofia, Chakraborty, Promit Ananyo, Charan, Jaykaran, Chattu, Vijay Kumar, Chaurasia, Akhilanand, Cherbuin, Nicola, Chu, Dinh-Toi, Chudal, Nandita, Chung, Sheng-Chia, Churko, Chuchu, Ciobanu, Liliana G, Cirillo, Massimo, Claro, Rafael M, Costanzo, Simona, Cowden, Richard G, Criqui, Michael H, Cruz-Martins, Natália, Culbreth, Garland T, Dachew, Berihun Assefa, Dadras, Omid, Dai, Xiaochen, Damiani, Giovanni, Dandona, Lalit, Dandona, Rakhi, Daniel, Beniam Darge, Danielewicz, Anna, Darega Gela, Jiregna, Davletov, Kairat, de Araujo, Jacyra Azevedo Paiva, de Sá-Junior, Antonio Rei, Debela, Sisay Abebe, Dehghan, Azizallah, Demetriades, Andreas K, Derbew Molla, Meseret, Desai, Rupak, Desta, Abebaw Alemayehu, Dias da Silva, Diana, Diaz, Daniel, Digesa, Lankamo Ena, Diress, Mengistie, Dodangeh, Milad, Dongarwar, Deepa, Dorostkar, Fariba, Dsouza, Haneil Larson, Duko, Bereket, Duncan, Bruce B, Edvardsson, Kristina, Ekholuenetale, Michael, Elgar, Frank J, Elhadi, Muhammed, Elmonem, Mohamed A, Endries, Aman Yesuf, Eskandarieh, Sharareh, Etemadimanesh, Azin, Fagbamigbe, Adeniyi Franci, Fakhradiyev, Ildar Ravisovich, Farahmand, Fatemeh, Farinha, Carla Sofia e Sá, Faro, Andre, Farzadfar, Farshad, Fatehizadeh, Ali, Fauk, Nelsensius Klau, Feigin, Valery L, Feldman, Rachel, Feng, Xiaoqi, Fentaw, Zinabu, Ferrero, Simone, Ferro Desideri, Lorenzo, Filip, Irina, Fischer, Florian, Francis, Joel Msafiri, Franklin, Richard Charle, Gaal, Peter Andra, Gad, Mohamed M, Gallus, Silvano, Galvano, Fabio, Ganesan, Balasankar, Garg, Tushar, Gebrehiwot, Mesfin Gebrehiwot Damtew, Gebremeskel, Teferi Gebru, Gebremichael, Mathewos Alemu, Gemechu, Tadele Regasa, Getacher, Lemma, Getachew, Motuma Erena, Getachew Obsa, Abera, Getie, Asmare, Ghaderi, Amir, Ghafourifard, Mansour, Ghajar, Alireza, Ghamari, Seyyed-Hadi, Ghandour, Lilian A, Ghasemi Nour, Mohammad, Ghashghaee, Ahmad, Ghozy, Sherief, Glozah, Franklin N, Glushkova, Ekaterina Vladimirovna, Godos, Justyna, Goel, Amit, Goharinezhad, Salime, Golechha, Mahaveer, Goleij, Pouya, Golitaleb, Mohamad, Greaves, Felix, Grivna, Michal, Grosso, Giuseppe, Gudayu, Temesgen Worku, Gupta, Bhawna, Gupta, Rajeev, Gupta, Sapna, Gupta, Veer Bala, Gupta, Vivek Kumar, Hafezi-Nejad, Nima, Haj-Mirzaian, Arvin, Hall, Brian J, Halwani, Rabih, Handiso, Tiilahun Beyene, Hankey, Graeme J, Hariri, Sanam, Haro, Josep Maria, Hasaballah, Ahmed I, Hassanian-Moghaddam, Hossein, Hay, Simon I, Hayat, Khezar, Heidari, Golnaz, Heidari, Mohammad, Hendrie, Delia, Herteliu, Claudiu, Heyi, Demisu Zenbaba, Hezam, Kamal, Hlongwa, Mbuzeleni Mbuzeleni, Holla, Ramesh, Hossain, Md Mahbub, Hossain, Sahadat, Hosseini, Seyed Kianoosh, Hosseinzadeh, Mehdi, Hostiuc, Mihaela, Hostiuc, Sorin, Hu, Guoqing, Huang, Junjie, Hussain, Salman, Ibitoye, Segun Emmanuel, Ilic, Irena M, Ilic, Milena D, Immurana, Mustapha, Irham, Lalu Muhammad, Islam, M Mofizul, Islam, Rakibul M, Islam, Sheikh Mohammed Shariful, Iso, Hiroyasu, Itumalla, Ramaiah, Iwagami, Masao, Jabbarinejad, Roxana, Jacob, Loui, Jakovljevic, Mihajlo, Jamalpoor, Zahra, Jamshidi, Elham, Jayapal, Sathish Kumar, Jayarajah, Umesh Umesh, Jayawardena, Ranil, Jebai, Rime, Jeddi, Seyed Ali, Jema, Alelign Tasew, Jha, Ravi Prakash, Jindal, Har Ashish, Jonas, Jost B, Joo, Tama, Joseph, Nitin, Joukar, Farahnaz, Jozwiak, Jacek Jerzy, Jürisson, Mikk, Kabir, Ali, Kabthymer, Robel Hussen, Kamble, Bhushan Dattatray, Kandel, Himal, Kanno, Girum Gebremeskel, Kapoor, Neeti, Karaye, Ibraheem M, Karimi, Salah Eddin, Kassa, Bekalu Getnet, Kaur, Rimple Jeet, Kayode, Gbenga A, Keykhaei, Mohammad, Khajuria, Himanshu, Khalilov, Rovshan, Khan, Imteyaz A, Khan, Moien AB, Kim, Hanna, Kim, Jihee, Kim, Min Seo, Kimokoti, Ruth W, Kivimäki, Mika, Klymchuk, Vitalii, Knudsen, Ann Kristin Skrindo, Kolahi, Ali-Asghar, Korshunov, Vladimir Andreevich, Koyanagi, Ai, Krishan, Kewal, Krishnamoorthy, Yuvaraj, Kumar, G Anil, Kumar, Narinder, Kumar, Nithin, Lacey, Ben, Lallukka, Tea, Lasrado, Savita, Lau, Jerrald, Lee, Sang-woong, Lee, Wei-Chen, Lee, Yo Han, Lim, Lee-Ling, Lim, Stephen S, Lobo, Stany W, Lopukhov, Platon D, Lorkowski, Stefan, Lozano, Rafael, Lucchetti, Giancarlo, Madadizadeh, Farzan, Madureira-Carvalho, Áurea M, Mahjoub, Soleiman, Mahmoodpoor, Ata, Mahumud, Rashidul Alam, Makki, Alaa, Malekpour, Mohammad-Reza, Manjunatha, Narayana, Mansouri, Borhan, Mansournia, Mohammad Ali, Martinez-Raga, Jose, Martinez-Villa, Francisco A, Matzopoulos, Richard, Maulik, Pallab K, Mayeli, Mahsa, Mcgrath, John J, Meena, Jitendra Kumar, Mehrabi Nasab, Entezar, Menezes, Ritesh G, Mensink, Gert B M, Mentis, Alexios-Fotios A, Meretoja, Atte, Merga, Bedasa Taye, Mestrovic, Tomislav, Miao Jonasson, Junmei, Miazgowski, Bartosz, Micheletti Gomide Nogueira de Sá, Ana Carolina, Miller, Ted R, Mini, Gk, Mirica, Andreea, Mirijello, Antonio, Mirmoeeni, Seyyedmohammadsadeq, Mirrakhimov, Erkin M, Misra, Sanjeev, Moazen, Babak, Mobarakabadi, Maryam, Moccia, Marcello, Mohammad, Yousef, Mohammadi, Esmaeil, Mohammadian-Hafshejani, Abdollah, Mohammed, Teroj Abdulrahman, Moka, Nagabhishek, Mokdad, Ali H, Momtazmanesh, Sara, Moradi, Yousef, Mostafavi, Ebrahim, Mubarik, Sumaira, Mullany, Erin C, Mulugeta, Beemnet Tekabe, Murillo-Zamora, Efrén, Murray, Christopher J L, Mwita, Julius C, Naghavi, Mohsen, Naimzada, Mukhammad David, Nangia, Vinay, Nayak, Biswa Prakash, Negoi, Ionut, Negoi, Ruxandra Irina, Nejadghaderi, Seyed Aria, Nepal, Samata, Neupane, Sudan Prasad Prasad, Neupane Kandel, Sandhya, Nigatu, Yeshambel T, Nowroozi, Ali, Nuruzzaman, Khan M, Nzoputam, Chimezie Igwegbe, Obamiro, Kehinde O, Ogbo, Felix Akpojene, Oguntade, Ayodipupo Sikiru, Okati-Aliabad, Hassan, Olakunde, Babayemi Oluwaseun, Oliveira, Gláucia Maria Morae, Omar Bali, Ahmed, Omer, Emad, Ortega-Altamirano, Doris V, Otoiu, Adrian, Otstavnov, Stanislav S, Oumer, Bilcha, P A, Mahesh, Padron-Monedero, Alicia, Palladino, Raffaele, Pana, Adrian, Panda-Jonas, Songhomitra, Pandey, Anamika, Pandey, Ashok, Pardhan, Shahina, Parekh, Tarang, Park, Eun-Kee, Parry, Charles D H, Pashazadeh Kan, Fatemeh, Patel, Jay, Pati, Siddhartha, Patton, George C, Paudel, Uttam, Pawar, Shrikant, Peden, Amy E, Petcu, Ionela-Roxana, Phillips, Michael R, Pinheiro, Marina, Plotnikov, Evgenii, Pradhan, Pranil Man Singh, Prashant, Akila, Quan, Jianchao, Radfar, Amir, Rafiei, Alireza, Raghav, Pankaja Raghav, Rahimi-Movaghar, Vafa, Rahman, Azizur, Rahman, Md Mosfequr, Rahman, Mosiur, Rahmani, Amir Masoud, Rahmani, Shayan, Ranabhat, Chhabi Lal, Ranasinghe, Priyanga, Rao, Chythra R, Rasali, Drona Prakash, Rashidi, Mohammad-Mahdi, Ratan, Zubair Ahmed, Rawaf, David Laith, Rawaf, Salman, Rawal, Lal, Renzaho, Andre M N, Rezaei, Negar, Rezaei, Saeid, Rezaeian, Mohsen, Riahi, Seyed Mohammad, Romero-Rodríguez, Esperanza, Roth, Gregory A, Rwegerera, Godfrey M, Saddik, Basema, Sadeghi, Erfan, Sadeghian, Reihaneh, Saeed, Umar, Saeedi, Farhad, Sagar, Rajesh, Sahebkar, Amirhossein, Sahoo, Harihar, Sahraian, Mohammad Ali, Saif-Ur-Rahman, Km, Salahi, Sarvenaz, Salimzadeh, Hamideh, Samy, Abdallah M, Sanmarchi, Francesco, Santric-Milicevic, Milena M, Sarikhani, Yaser, Sathian, Brijesh, Saya, Ganesh Kumar, Sayyah, Mehdi, Schmidt, Maria Inê, Schutte, Aletta Elisabeth, Schwarzinger, Michaël, Schwebel, David C, Seidu, Abdul-Aziz, Senthil Kumar, Nachimuthu, Seyedalinaghi, Seyedahmad, Seylani, Allen, Sha, Feng, Shahin, Sarvenaz, Shahraki-Sanavi, Fariba, Shahrokhi, Shayan, Shaikh, Masood Ali, Shaker, Elaheh, Shakhmardanov, Murad Ziyaudinovich, Shams-Beyranvand, Mehran, Sheikhbahaei, Sara, Sheikhi, Rahim Ali, Shetty, Adithi, Shetty, Jeevan K, Shiferaw, Damtew Solomon, Shigematsu, Mika, Shiri, Rahman, Shirkoohi, Reza, Shivakumar, K M, Shivarov, Velizar, Shobeiri, Parnian, Shrestha, Roman, Sidemo, Negussie Boti, Sigfusdottir, Inga Dora, Silva, Diego Augusto Santo, Silva, Natacha Torres da, Singh, Jasvinder A, Singh, Surjit, Skryabin, Valentin Yurievich, Skryabina, Anna Aleksandrovna, Sleet, David A, Solmi, Marco, Solomon, Yonatan, Song, Suhang, Song, Yimeng, Sorensen, Reed J D, Soshnikov, Sergey, Soyiri, Ireneous N, Stein, Dan J, Subba, Sonu Hangma, Szócska, Mikló, Tabarés-Seisdedos, Rafael, Tabuchi, Takahiro, Taheri, Majid, Tan, Ker-Kan, Tareke, Minale, Tarkang, Elvis Enowbeyang, Temesgen, Gebremaryam, Temesgen, Worku Animaw, Temsah, Mohamad-Hani, Thankappan, Kavumpurathu Raman, Thapar, Rekha, Thomas, Nikhil Kenny, Tiruneh, Chalachew, Todorovic, Jovana, Torrado, Marco, Touvier, Mathilde, Tovani-Palone, Marcos Roberto, Tran, Mai Thi Ngoc, Trias-Llimós, Sergi, Tripathy, Jaya Prasad, Vakilian, Alireza, Valizadeh, Rohollah, Varmaghani, Mehdi, Varthya, Shoban Babu, Vasankari, Tommi Juhani, Vos, Theo, Wagaye, Birhanu, Waheed, Yasir, Walde, Mandaras Tariku, Wang, Cong, Wang, Yanzhong, Wang, Yuan-Pang, Westerman, Ronny, Wickramasinghe, Nuwan Darshana, Wubetu, Abate Dargie, Xu, Suowen, Yamagishi, Kazumasa, Yang, Lin, Yesera, Gesila Endashaw E, Yigit, Arzu, Yiğit, Vahit, Yimaw, Ayenew Engida Ayenew Engida, Yon, Dong Keon, Yonemoto, Naohiro, Yu, Chuanhua, Zadey, Siddhesh, Zahir, Mazyar, Zare, Iman, Zastrozhin, Mikhail Sergeevich, Zastrozhina, Anasthasia, Zhang, Zhi-Jiang, Zhong, Chenwen, Zmaili, Mohammad, Zuniga, Yves Miel H, Gakidou, Emmanuela, Bryazka, D, Reitsma, Mb, Griswold, Mg, Abate, Kh, Abbafati, C, Kangevari, Ma, Kangevari, Za, Abdoli, A, Abdollahi, M, Abdullah, Am, Abhilash, E, Abu Gharbieh, E, Acuna, Jm, Addolorato, G, Adebayo, Om, Adekanmbi, V, Adhikari, K, Adhikari, S, Adnani, Qe, Afzal, S, Agegnehu, Wy, Aggarwal, M, Ahinkorah, Bo, Ahmad, Ar, Ahmad, S, Ahmad, T, Ahmadi, A, Ahmadi, S, Ahmed, H, Rashid, Ta, Akunna, Cj, Al Hamad, H, Alam, Mz, Alem, Dt, Alene, Ka, Alimohamadi, Y, Alizadeh, A, Allel, K, Alonso, J, Alvand, S, Guzman, Na, Amare, F, Ameyaw, Ek, Amiri, S, Ancuceanu, R, Anderson, Ja, Andrei, Cl, Andrei, T, Arabloo, J, Arshad, M, Artamonov, Aa, Aryan, Z, Asaad, M, Asemahagn, Ma, Burt, Ta, Athari, S, Atnafu, Dd, Atorkey, P, Atreya, A, Ausloos, F, Ausloos, M, Ayano, G, Ayanore, Ma, Ayinde, Oo, Mateos, Jla, Azadnajafabad, S, Azanaw, Mm, Khyavy, Ma, Jafari, Aa, Azzam, Ay, Badiye, Ad, Bagheri, N, Bagherieh, S, Bairwa, M, Bakkannavar, Sm, Bakshi, Rk, Balchut, Ah, Null, T, Barra, F, Barrow, A, Baskaran, P, Belo, L, Bennett, Da, Bensenor, Im, Bhagavathula, A, Bhala, N, Bhalla, A, Bhardwaj, N, Bhardwaj, P, Bhaskar, S, Bhattacharyya, K, Bhojaraja, V, Bintoro, B, 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Nk, Feigin, Vl, Feldman, R, Feng, Xq, Fentaw, Z, Ferrero, S, Desideri, Lf, Filip, I, Fischer, F, Francis, Jm, Franklin, Rc, Gaal, Pa, Gad, Mm, Gallus, S, Galvano, F, Ganesan, B, Garg, T, Gebrehiwot, Mgd, Gebremeskel, Tg, Gebremichael, Ma, Gemechu, Tr, Getacher, L, Getachew, Me, Obsa, Ag, Getie, A, Ghaderi, A, Ghafourifard, M, Ghajar, A, Ghamari, Sh, Ghandour, La, Nour, Mg, Ghashghaee, A, Ghozy, S, Glozah, Fn, Glushkova, Ev, Godos, J, Goel, A, Goharinezhad, S, Golechha, M, Goleij, P, Golitaleb, M, Greaves, F, Grivna, M, Grosso, G, Gudayu, Tw, Gupta, B, Gupta, R, Gupta, S, Gupta, Vb, Gupta, Vk, Nejad, Nh, Mirzaian, Ah, Hall, Bj, Halwani, R, Handiso, Tb, Hankey, Gj, Hariri, S, Haro, Jm, Hasaballah, Ai, Moghaddam, Hh, Hay, Si, Hayat, K, Heidari, G, Heidari, M, Hendrie, D, Herteliu, C, Heyi, Dz, Hezam, K, Hlongwa, Mm, Holla, R, Hossain, Mm, Hossain, S, Hosseini, Sk, Hosseinzadeh, M, Hostiuc, M, Hostiuc, S, Hu, Gq, Huang, Jj, Hussain, S, Ibitoye, Se, Ilic, Im, Ilic, Md, Immurana, M, Irham, Lm, Islam, Mm, Islam, Rm, Islam, Sm, Iso, H, Itumalla, R, Iwagami, M, Jabbarinejad, R, Jacob, L, Jakovljevic, M, Jamalpoor, Z, Jamshidi, E, Jayapal, Sk, Jayarajah, Uu, Jayawardena, R, Jebai, R, Jeddi, Sa, Jema, At, Jha, Rp, Jindal, Ha, Jonas, Jb, Joo, T, Joseph, N, Joukar, F, Jozwiak, Jj, Jurisson, M, Kabir, A, Kabthymer, Rh, Kamble, Bd, Kandel, H, Kanno, Gg, Kapoor, N, Karaye, Im, Karimi, Se, Kassa, Bg, Kaur, Rj, Kayode, Ga, Keykhaei, M, Khajuria, H, Khalilov, R, Khan, Ia, Ab Khan, M, Kim, H, Kim, J, Kim, M, Kimokoti, Rw, Kivimaki, M, Klymchuk, V, Knudsen, Ak, Kolahi, Aa, Korshunov, Va, Koyanagi, A, Krishan, K, Krishnamoorthy, Y, Kumar, Ga, Kumar, N, Ben, Lacey, Lallukka, T, Lasrado, S, Lau, J, Lee, Sw, Lee, Wc, Lee, Yh, Lim, Ll, Lim, S, Lobo, Sw, Lopukhov, Pd, Lorkowski, S, Lozano, R, Lucchetti, G, Madadizadeh, F, Mahjoub, S, Mahmoodpoor, A, Mahumud, Ra, Makki, A, Malekpour, Mr, Manjunatha, N, Mansouri, B, Mansournia, Ma, Raga, Jm, Villa, Fam, Matzopoulos, R, Maulik, Pk, Mayeli, M, Mcgrath, Jj, Meena, Jk, Nasab, Em, Menezes, Rg, Mensink, Gbm, Mentis, Afa, Meretoja, A, Merga, Bt, Mestrovic, T, Jonasson, Jm, Miazgowski, B, de Sa, Acmgn, Miller, Tr, Mini, G, Mirica, A, Mirijello, A, Mirmoeeni, S, Mirrakhimov, Em, Misra, S, Moazen, B, Mobarakabadi, M, Moccia, M, Mohammad, Y, Mohammadi, E, Hafshejani, Am, Mohammed, Ta, Moka, N, Mokdad, Ah, Momtazmanesh, S, Moradi, Y, Mostafavi, E, Mubarik, S, Mullany, Ec, Mulugeta, Bt, Zamora, Em, Murray, Cjl, Mwita, Jc, Naghavi, M, Naimzada, Md, Nangia, V, Nayak, Bp, Negoi, I, Negoi, Ri, Nejadghaderi, Sa, Nepal, S, Neupane, Spp, Kandel, Sn, Nigatu, Yt, Nowroozi, A, Nuruzzaman, Km, Nzoputam, Ci, Obamiro, Ko, Ogbo, Fa, Oguntade, A, Aliabad, Ho, Olakunde, Bo, Oliveira, Gmm, Bali, Ao, Omer, E, Altamirano, Dvo, Otoiu, A, Otstavnov, S, Oumer, B, Mahesh, Pa, Monedero, Ap, Palladino, R, Pana, A, Jonas, Sp, Pandey, A, Pardhan, S, Parekh, T, Park, Ek, Parry, Cdh, Kan, Fp, Patel, J, Pati, S, Patton, Gc, Paudel, U, Pawar, S, Peden, Ae, Petcu, Ir, Phillips, Mr, Pinheiro, M, Plotnikov, E, Pradhan, Pm, Prashant, A, Quan, Jc, Radfar, A, Rafiei, A, Raghav, Pr, Movaghar, Vr, Rahman, A, Rahman, Mm, Rahman, M, Rahmani, Am, Rahmani, S, Ranabhat, Cl, Ranasinghe, P, Rao, Cr, Rasali, Dp, Rashidi, Mm, Ratan, Za, Rawaf, Dl, Rawaf, S, Rawal, L, Renzaho, Amn, Rezaei, N, Rezaei, S, Rezaeian, M, Riahi, Sm, Rodriguez, Er, Roth, Ga, Rwegerera, Gm, Saddik, B, Sadeghi, E, Sadeghian, R, Saeed, U, Saeedi, F, Sagar, R, Sahebkar, A, Sahoo, H, Sahraian, Ma, Rahman, Ksu, Salahi, S, Salimzadeh, H, Samy, Am, Sanmarchi, F, Milicevic, Mm, Sarikhani, Y, Sathian, B, Saya, Gk, Sayyah, M, Schmidt, Mi, Schutte, Ae, Schwarzinger, M, Schwebel, Dc, Seidu, Aa, Seyedalinaghi, S, Seylani, A, Sha, F, Shahin, S, Sanavi, F, Shahrokhi, S, Shaikh, Ma, Shaker, E, Shakhmardanov, Mz, Beyranvand, M, Sheikhbahaei, S, Sheikhi, Ra, Shetty, A, Shetty, Jk, Shiferaw, D, Shigematsu, M, Shiri, R, Shirkoohi, R, Shivakumar, Km, Shivarov, V, Shobeiri, P, Shrestha, R, Sidemo, Nb, Sigfusdottir, Id, Silva, Da, da Silva, Nt, Singh, Ja, Singh, S, Skryabin, Vy, Skryabina, Aa, Sleet, Da, Solmi, M, Solomon, Y, Song, S, Song, Ym, Sorensen, Rjd, Soshnikov, S, Soyiri, In, Stein, Dj, Subba, Sh, Szocska, M, Seisdedos, Rt, Tabuchi, T, Taheri, M, Tan, Kk, Tareke, M, Tarkang, Ee, Temesgen, G, Temesgen, Wa, Temsah, Mh, Thankappan, Kr, Thapar, R, Thomas, Nk, Tiruneh, C, Todorovic, J, Torrado, M, Touvier, M, Palone, Mrt, Tran, Mtn, Llimos, St, Tripathy, Jp, Vakilian, A, Valizadeh, R, Varmaghani, M, Varthya, Sb, Vasankari, Tj, Vos, T, Wagaye, B, Waheed, Y, Walde, Mt, Wang, C, Wang, Yz, Wang, Yp, Westerman, R, Wickramasinghe, Nd, Wubetu, Ad, Xu, S, Yamagishi, K, Yang, L, Yesera, Gee, Yigit, A, Yimaw, Ae, Yon, Dk, Yonemoto, N, Yu, Ch, Zadey, S, Zahir, M, Zare, I, Zastrozhin, M, Zastrozhina, A, Zhang, Zj, Zhong, Cw, Zmaili, M, Zuniga, Ymh, Gakidou, E, Madureira-Carvalho, Am, Ciobanu, LG, Gakidou, Emma, and GBD 2020 Alcohol Collaborators

Subjects
Adult, Male, Alcohol Drinking, CONTROL POLICIES, adult, Child, Preschool, Female, Geography, Global Burden of Disease, Global Health, Humans, Middle Aged, Quality-Adjusted Life Years, Risk Factors, NDAS, ALL-CAUSE, GUIDELINES, GBD 2020 Alcohol Collaborators, COST-EFFECTIVENESS, Medicine, General & Internal, DRINKING, SDG 3 - Good Health and Well-being, RA0421, General & Internal Medicine, Quality-Adjusted Life Year, RA0421 Public health. Hygiene. Preventive Medicine, DRINKERS, Child, Preschool, 11 Medical and Health Sciences, METAANALYSIS, MCC, Science & Technology, global burden of disease, Risk Factor, General Medicine, CANCER, alcohol drinking, AC, 3121 General medicine, internal medicine and other clinical medicine, REDUCED MORTALITY, Life Sciences & Biomedicine, Human
Abstract

Background: The health risks associated with moderate alcohol consumption continue to be debated. Small amounts of alcohol might lower the risk of some health outcomes but increase the risk of others, suggesting that the overall risk depends, in part, on background disease rates, which vary by region, age, sex, and year. Methods: For this analysis, we constructed burden-weighted dose-response relative risk curves across 22 health outcomes to estimate the theoretical minimum risk exposure level (TMREL) and non-drinker equivalence (NDE), the consumption level at which the health risk is equivalent to that of a non-drinker, using disease rates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020 for 21 regions, including 204 countries and territories, by 5-year age group, sex, and year for individuals aged 15-95 years and older from 1990 to 2020. Based on the NDE, we quantified the population consuming harmful amounts of alcohol. Findings: The burden-weighted relative risk curves for alcohol use varied by region and age. Among individuals aged 15-39 years in 2020, the TMREL varied between 0 (95% uncertainty interval 0-0) and 0·603 (0·400-1·00) standard drinks per day, and the NDE varied between 0·002 (0-0) and 1·75 (0·698-4·30) standard drinks per day. Among individuals aged 40 years and older, the burden-weighted relative risk curve was J-shaped for all regions, with a 2020 TMREL that ranged from 0·114 (0-0·403) to 1·87 (0·500-3·30) standard drinks per day and an NDE that ranged between 0·193 (0-0·900) and 6·94 (3·40-8·30) standard drinks per day. Among individuals consuming harmful amounts of alcohol in 2020, 59·1% (54·3-65·4) were aged 15-39 years and 76·9% (73·0-81·3) were male. Interpretation: There is strong evidence to support recommendations on alcohol consumption varying by age and location. Stronger interventions, particularly those tailored towards younger individuals, are needed to reduce the substantial global health loss attributable to alcohol. Research reported in this publication was supported by the Bill & Melinda Gates Foundation. S Afzal acknowledges the support for intellectual contributions to this manuscript by the Department of Community Medicine and Epidemiology at King Edward Medical University, Lahore, Pakistan. T Bärnighausen was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. L Belo acknowledges support from FCT in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of UCIBIO and the project LA/P/0140/2020 of i4HB. D Bennett is supported by the UK Medical Research Council Population Health Research Unit at the University of Oxford (Oxford, UK). M Carvalho acknowledges support from FCT in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of UCIBIO and the project LA/P/0140/2020 of i4HB. L Castro-de-Araujo was funded by the Medical Research Council (UK), Grant no. MR/T03355X/1 and by the National Institute of Mental Health Grant no. R01MH128911. FJ Elgar is supported by the Canada Research Chairs program. F Greaves acknowledges support from the NIHR Applied Research Collaboration for NW London. V K Gupta acknowledges funding support from the National Health and Medical Research Council (NHMRC), Australia. VB Gupta acknowledges funding support from the National Health and Medical Research Council (NHMRC), Australia. C Herteliu is partially supported by a grant from the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. C Herteliu is partially supported by a grant from the Romanian Ministry of Research Innovation and Digitalization, MCID, project number ID-585-CTR-42-PFE-2021. S Hussain was supported by the Operational Programme Research, Development and Education –Project, Postdoc2MUNI “(No. CZ.02.2.69/0.0/0.0/18_053/0016952). S M S Islam is funded by the National Health and Medical Research Council and received funding from the National Heart Foundation of Australia. The Serbian part of this GBD-related contribution has been co-financed through Grant OI 175 014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. M Kivimaki was supported by the Wellcome Trust (221854/Z/20/Z), the UK Medical Research Council (MR/S011676/1), the US National Institute on Aging (R01AG056477), and the Academy of Finland (350426). K Krishan is supported by the UGC Centre of Advanced Study (Phase II), awarded to the Department of Anthropology, Panjab University, Chandigarh, India. B Lacey acknowledges support from the UK Biobank, funded largely by the UK Medical Research Council and Wellcome. S Lorkowski acknowledges institutional support from the Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig (Germany; German Federal Ministry of Education and Research; grant agreement number 01EA1808A). G Lucchetti received a productivity scholarship from the Brazilian National Council for Scientific and Technological Development — CNPq (Level 1D). J McGrath was supported by the Danish National Research Foundation (Niels Bohr Professor). J McGrath is employed by the Queensland Centre for Mental Health Research (Australia), which receives support from the Queensland Health Department. C Parry acknowleges the South African Medical Research Council. A Peden is supported by a National Health and Medical Research Council Emerging Leadership Fellowship (Grant ID: APP2009306). M R Phillips was supported in part by the Global Alliance for Chronic Diseases - National Natural Science Foundation of China (NSFC. No. 81761128031). M Pinheiro acknowledges FCT for funding through program DL 57/2016 – Norma transitória. A Rahman acknowledges the support from the Data Science Research Unit in Charles Sturt University (Bathurst, NSW, Australia). U Saeed would like to acknowledge the International Center of Medical Sciences Research (ICMSR), Islamabad, Pakistan. A M Samy acknowledges support from Ain Shams University (Cairo, Egypt) and the Egyptian Fulbright Mission Program. N Senthil Kumar acknowledges the DBT, New Delhi sponsored Advanced State Level Biotech Hub (BT/NER/143/SP44475/2021), Mizoram University (Aizawl, Mizoram, India) for facilitating this work. F Sha is supported by the Shenzhen Science and Technology Program (Grant No. KQTD20190929172835662). A Shetty acknowledges Kasturba Medical College (Mangalore, India) and Manipal Academy of Higher Education (Manipal, India) for all the academic support. R Shrestha acknowledges a career development award from the National Institutes of Health (K01DA051346). D Silva was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brazil (CAPES)-Finance Code 001 and is supported in part by CNPq - Brazil (309589/2021-5). D Sleet acknowledges partial support from Veritas Management Group, Inc and The Bizzell Group, LLC. S Trias-Llimós acknowledges research funding from the Juan de la Cierva-Formación program of the Spanish Ministry of Science and Innovation (FJC-2019-039314-I). Sí

Published
2022

9. Clustering of multiple health risk factors among a sample of adolescents in Liberia: a latent class analysis

Author

Prince Atorkey and Kwaku Oppong Asante

Subjects
medicine.medical_specialty, business.industry, 030503 health policy & services, Public health, Public Health, Environmental and Occupational Health, Psychological intervention, Sample (statistics), Latent class model, 03 medical and health sciences, 0302 clinical medicine, Epidemiology, medicine, Anxiety, Cluster sampling, 030212 general & internal medicine, medicine.symptom, 0305 other medical science, business, Depression (differential diagnoses), Demography
Abstract

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

Published
2021
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11. Diabetes mortality and trends before 25 years of age: an analysis of the Global Burden of Disease Study 2019

Author

Ewerton Cousin, Bruce B Duncan, Caroline Stein, Kanyin Liane Ong, Theo Vos, Cristiana Abbafati, Mohsen Abbasi-Kangevari, Michael Abdelmasseh, Amir Abdoli, Rami Abd-Rabu, Hassan Abolhassani, Eman Abu-Gharbieh, Manfred Mario Kokou Accrombessi, Qorinah Estiningtyas Sakilah Adnani, Muhammad Sohail Afzal, Gina Agarwal, Krishna K Agrawaal, Marcela Agudelo-Botero, Bright Opoku Ahinkorah, Sajjad Ahmad, Tauseef Ahmad, Keivan Ahmadi, Sepideh Ahmadi, Ali Ahmadi, Ali Ahmed, Yusra Ahmed Salih, Wuraola Akande-Sholabi, Tayyaba Akram, Hanadi Al Hamad, Ziyad Al-Aly, Jacqueline Elizabeth Alcalde-Rabanal, Vahid Alipour, Syed Mohamed Aljunid, Rajaa M Al-Raddadi, Nelson Alvis-Guzman, Saeed Amini, Robert Ancuceanu, Tudorel Andrei, Catalina Liliana Andrei, Ranjit Mohan Anjana, Adnan Ansar, Ippazio Cosimo Antonazzo, Benny Antony, Anayochukwu Edward Anyasodor, Jalal Arabloo, Damian Arizmendi, Benedetta Armocida, Anton A Artamonov, Judie Arulappan, Zahra Aryan, Samaneh Asgari, Tahira Ashraf, Thomas Astell-Burt, Prince Atorkey, Maha Moh'd Wahbi Atout, Martin Amogre Ayanore, Ashish D Badiye, Atif Amin Baig, Mohan Bairwa, Jennifer L Baker, Ovidiu Constantin Baltatu, Palash Chandra Banik, Anthony Barnett, Mark Thomaz Ugliara Barone, Francesco Barone-Adesi, Amadou Barrow, Neeraj Bedi, Rebuma Belete, Uzma Iqbal Belgaumi, Arielle Wilder Bell, Derrick A Bennett, Isabela M Bensenor, David Beran, Akshaya Srikanth Bhagavathula, Sonu Bhaskar, Krittika Bhattacharyya, Vijayalakshmi S Bhojaraja, Ali Bijani, Boris Bikbov, Setognal Birara, Virginia Bodolica, Aime Bonny, Hermann Brenner, Nikolay Ivanovich Briko, Zahid A Butt, Florentino Luciano Caetano dos Santos, Luis Alberto Cámera, Ismael R Campos-Nonato, Yin Cao, Chao Cao, Ester Cerin, Promit Ananyo Chakraborty, Joht Singh Chandan, Vijay Kumar Chattu, Simiao Chen, Jee-Young Jasmine Choi, Sonali Gajanan Choudhari, Enayet Karim Chowdhury, Dinh-Toi Chu, Barbara Corso, Omid Dadras, Xiaochen Dai, Albertino Antonio Moura Damasceno, Lalit Dandona, Rakhi Dandona, Claudio Alberto Dávila-Cervantes, Jan-Walter De Neve, Edgar Denova-Gutiérrez, Deepak Dhamnetiya, Daniel Diaz, Sanam Ebtehaj, Hisham Atan Edinur, Sahar Eftekharzadeh, Iman El Sayed, Islam Y Elgendy, Muhammed Elhadi, Mohamed A Elmonem, Mohammed Faisaluddin, Umar Farooque, Xiaoqi Feng, Eduarda Fernandes, Florian Fischer, David Flood, Marisa Freitas, Peter Andras Gaal, Mohamed M Gad, Piyada Gaewkhiew, Lemma Getacher, Mansour Ghafourifard, Reza Ghanei Gheshlagh, Ahmad Ghashghaee, Nermin Ghith, Ghozali Ghozali, Paramjit Singh Gill, Ibrahim Abdelmageed Ginawi, Ekaterina Vladimirovna Glushkova, Mahaveer Golechha, Sameer Vali Gopalani, Rafael Alves Guimarães, Rajat Das Gupta, Rajeev Gupta, Vivek Kumar Gupta, Veer Bala Gupta, Sapna Gupta, Tesfa Dejenie Habtewold, Nima Hafezi-Nejad, Rabih Halwani, Asif Hanif, Graeme J Hankey, Shafiul Haque, Ahmed I Hasaballah, Syed Shahzad Hasan, Abdiwahab Hashi, Soheil Hassanipour, Simon I Hay, Khezar Hayat, Mohammad Heidari, Mohammad Bellal Hossain Hossain, Sahadat Hossain, Mostafa Hosseini, Soodabeh Hoveidamanesh, Junjie Huang, Ayesha Humayun, Rabia Hussain, Bing-Fang Hwang, Segun Emmanuel Ibitoye, Kevin S Ikuta, Leeberk Raja Inbaraj, Usman Iqbal, Md Shariful Islam, Sheikh Mohammed Shariful Islam, Rakibul M Islam, Nahlah Elkudssiah Ismail, Gaetano Isola, Ramaiah Itumalla, Masao Iwagami, Ihoghosa Osamuyi Iyamu, Mohammad Ali Jahani, Mihajlo Jakovljevic, Ranil Jayawardena, Ravi Prakash Jha, Oommen John, Jost B Jonas, Tamas Joo, Ali Kabir, Rohollah Kalhor, Ashwin Kamath, Tanuj Kanchan, Himal Kandel, Neeti Kapoor, Gbenga A Kayode, Sewnet Adem Kebede, Pedram Keshavarz, Mohammad Keykhaei, Yousef Saleh Khader, Himanshu Khajuria, Moien AB Khan, Md Nuruzzaman Khan, Maseer Khan, Amir M Khater, Tawfik Ahmed Muthafer Khoja, Jagdish Khubchandani, Min Seo Kim, Yun Jin Kim, Ruth W Kimokoti, Sezer Kisa, Adnan Kisa, Mika Kivimäki, Vladimir Andreevich Korshunov, Oleksii Korzh, Ai Koyanagi, Kewal Krishan, Barthelemy Kuate Defo, G Anil Kumar, Nithin Kumar, Dian Kusuma, Carlo La Vecchia, Ben Lacey, Anders O Larsson, Savita Lasrado, Wei-Chen Lee, Chiachi Bonnie Lee, Paul H Lee, Shaun Wen Huey Lee, Ming-Chieh Li, Stephen S Lim, Lee-Ling Lim, Giancarlo Lucchetti, Azeem Majeed, Ahmad Azam Malik, Borhan Mansouri, Lorenzo Giovanni Mantovani, Santi Martini, Prashant Mathur, Colm McAlinden, Nafiul Mehedi, Teferi Mekonnen, Ritesh G Menezes, Amanual Getnet Mersha, Junmei Miao Jonasson, Tomasz Miazgowski, Irmina Maria Michalek, Andreea Mirica, Erkin M Mirrakhimov, Agha Zeeshan Mirza, Prasanna Mithra, Abdollah Mohammadian-Hafshejani, Reza Mohammadpourhodki, Arif Mohammed, Ali H Mokdad, Mariam Molokhia, Lorenzo Monasta, Mohammad Ali Moni, Farhad Moradpour, Rahmatollah Moradzadeh, Ebrahim Mostafavi, Ulrich Otto Mueller, Christopher J L Murray, Ahmad Mustafa, Gabriele Nagel, Vinay Nangia, Atta Abbas Naqvi, Biswa Prakash Nayak, Javad Nazari, Rawlance Ndejjo, Ruxandra Irina Negoi, Sandhya Neupane Kandel, Cuong Tat Nguyen, Huong Lan Thi Nguyen, Jean Jacques Noubiap, Christoph Nowak, Bogdan Oancea, Oluwakemi Ololade Odukoya, Ayodipupo Sikiru Oguntade, Temitope T Ojo, Andrew T Olagunju, Obinna E Onwujekwe, Alberto Ortiz, Mayowa O Owolabi, Raffaele Palladino, Songhomitra Panda-Jonas, Seithikurippu R Pandi-Perumal, Shahina Pardhan, Tarang Parekh, Mojtaba Parvizi, Veincent Christian Filipino Pepito, Arokiasamy Perianayagam, Ionela-Roxana Petcu, Manju Pilania, Vivek Podder, Roman V Polibin, Maarten J Postma, Akila Prashant, Navid Rabiee, Mohammad Rabiee, Vafa Rahimi-Movaghar, Muhammad Aziz Rahman, Md. Mosfequr Rahman, Mosiur Rahman, Setyaningrum Rahmawaty, Nazanin Rajai, Pradhum Ram, Juwel Rana, Kamal Ranabhat, Priyanga Ranasinghe, Chythra R Rao, Satish Rao, Salman Rawaf, David Laith Rawaf, Lal Rawal, Andre M N Renzaho, Nima Rezaei, Aziz Rezapour, Seyed Mohammad Riahi, Daniela Ribeiro, Jefferson Antonio Buendia Rodriguez, Leonardo Roever, Peter Rohloff, Godfrey M Rwegerera, Paul MacDaragh Ryan, Maha Mohamed Saber-Ayad, Siamak Sabour, Basema Saddik, Sahar Saeedi Moghaddam, Amirhossein Sahebkar, Harihar Sahoo, KM Saif-Ur-Rahman, Hamideh Salimzadeh, Mehrnoosh Samaei, Juan Sanabria, Milena M Santric-Milicevic, Brijesh Sathian, Thirunavukkarasu Sathish, Markus P Schlaich, Abdul-Aziz Seidu, Mario Šekerija, Nachimuthu Senthil Kumar, Allen Seylani, Masood Ali Shaikh, Hina Shamshad, Md Shajedur Rahman Shawon, Sara Sheikhbahaei, Jeevan K Shetty, Rahman Shiri, K M Shivakumar, Kerem Shuval, Jasvinder A Singh, Ambrish Singh, Valentin Yurievich Skryabin, Anna Aleksandrovna Skryabina, Ahmad Sofi-Mahmudi, Amin Soheili, Jing Sun, Viktória Szerencsés, Miklós Szócska, Rafael Tabarés-Seisdedos, Hooman Tadbiri, Eyayou Girma Tadesse, Md. Tariqujjaman, Kavumpurathu Raman Thankappan, Rekha Thapar, Nihal Thomas, Binod Timalsina, Ruoyan Tobe-Gai, Marcello Tonelli, Marcos Roberto Tovani-Palone, Bach Xuan Tran, Jaya Prasad Tripathy, Lorainne Tudor Car, Biruk Shalmeno Tusa, Riaz Uddin, Era Upadhyay, Sahel Valadan Tahbaz, Pascual R Valdez, Tommi Juhani Vasankari, Madhur Verma, Victor E Villalobos-Daniel, Sergey Konstantinovitch Vladimirov, Bay Vo, Giang Thu Vu, Rade Vukovic, Yasir Waheed, Richard G Wamai, Andrea Werdecker, Nuwan Darshana Wickramasinghe, Andrea Sylvia Winkler, Befikadu Legesse Wubishet, Xiaoyue Xu, Suowen Xu, Seyed Hossein Yahyazadeh Jabbari, Hiroshi Yatsuya, Sanni Yaya, Taklo Simeneh Yazie Yazie, Siyan Yi, Naohiro Yonemoto, Ismaeel Yunusa, Siddhesh Zadey, Sojib Bin Zaman, Maryam Zamanian, Nelson Zamora, Mikhail Sergeevich Zastrozhin, Anasthasia Zastrozhina, Zhi-Jiang Zhang, Chenwen Zhong, Mohammad Zmaili, Alimuddin Zumla, Mohsen Naghavi, Maria Inês Schmidt, Tampere University, Clinical Medicine, QE Econometrics, RS: GSBE other - not theme-related research, Department of Public Health, University of Helsinki, Cousin, E, Duncan, B, Stein, C, Ong, K, Vos, T, Abbafati, C, Abbasi-Kangevari, M, Abdelmasseh, M, Abdoli, A, Abd-Rabu, R, Abolhassani, H, Abu-Gharbieh, E, Accrombessi, M, Adnani, Q, Afzal, M, Agarwal, G, Agrawaal, K, Agudelo-Botero, M, Ahinkorah, B, Ahmad, S, Ahmad, T, Ahmadi, K, Ahmadi, S, Ahmadi, A, Ahmed, A, Ahmed Salih, Y, Akande-Sholabi, W, Akram, T, Al Hamad, H, Al-Aly, Z, Alcalde-Rabanal, J, Alipour, V, Aljunid, S, Al-Raddadi, R, Alvis-Guzman, N, Amini, S, Ancuceanu, R, Andrei, T, Andrei, C, Anjana, R, Ansar, A, Antonazzo, I, Antony, B, Anyasodor, A, Arabloo, J, Arizmendi, D, Armocida, B, Artamonov, A, Arulappan, J, Aryan, Z, Asgari, S, Ashraf, T, Astell-Burt, T, Atorkey, P, Atout, M, Ayanore, M, Badiye, A, Baig, A, Bairwa, M, Baker, J, Baltatu, O, Banik, P, Barnett, A, Barone, M, Barone-Adesi, F, Barrow, A, Bedi, N, Belete, R, Belgaumi, U, Bell, A, Bennett, D, 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I., Collaborators, GBD 2019 Diabetes Mortality, and Lacey, BWH

Subjects
Adult, Endocrinology, Diabetes and Metabolism, CHILDHOOD, universal health coverage, Global Health, 3121 Internal medicine, Global Burden of Disease, 1117 Public Health and Health Services, Endocrinology, SDG 3 - Good Health and Well-being, Risk Factors, RA0421, Internal Medicine, Humans, Diabetes mortality, diabetes, mortality, global burden of disease, under 25 years, COHORT, health care services, COMPLICATIONS, CHALLENGES, Diabetes, Mortality trends, Age-specific diabetes, 1103 Clinical Sciences, Public Health, Global Health, Social Medicine and Epidemiology, BRAZIL, Type I Diabetes, INSULIN, 3142 Public health care science, environmental and occupational health, the Socio-demographic Index, Treatment, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, 1101 Medical Biochemistry and Metabolomics, diabete, 3121 General medicine, internal medicine and other clinical medicine, ACCESS, RA, RC
Abstract

Background:Diabetes, particularly type 1 diabetes, at younger ages can be a largely preventable cause of death with the correct health care and services. We aimed to evaluate diabetes mortality and trends at ages younger than 25 years globally using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods:We used estimates of GBD 2019 to calculate international diabetes mortality at ages younger than 25 years in 1990 and 2019. Data sources for causes of death were obtained from vital registration systems, verbal autopsies, and other surveillance systems for 1990–2019. We estimated death rates for each location using the GBD Cause of Death Ensemble model. We analysed the association of age-standardised death rates per 100 000 population with the Socio-demographic Index (SDI) and a measure of universal health coverage (UHC) and described the variability within SDI quintiles. We present estimates with their 95% uncertainty intervals. Findings:In 2019, 16 300 (95% uncertainty interval 14 200 to 18 900) global deaths due to diabetes (type 1 and 2 combined) occurred in people younger than 25 years and 73·7% (68·3 to 77·4) were classified as due to type 1 diabetes. The age-standardised death rate was 0·50 (0·44 to 0·58) per 100 000 population, and 15 900 (97·5%) of these deaths occurred in low to high-middle SDI countries. The rate was 0·13 (0·12 to 0·14) per 100 000 population in the high SDI quintile, 0·60 (0·51 to 0·70) per 100 000 population in the low-middle SDI quintile, and 0·71 (0·60 to 0·86) per 100 000 population in the low SDI quintile. Within SDI quintiles, we observed large variability in rates across countries, in part explained by the extent of UHC (r2=0·62). From 1990 to 2019, age-standardised death rates decreased globally by 17·0% (−28·4 to −2·9) for all diabetes, and by 21·0% (–33·0 to −5·9) when considering only type 1 diabetes. However, the low SDI quintile had the lowest decline for both all diabetes (−13·6% [–28·4 to 3·4]) and for type 1 diabetes (−13·6% [–29·3 to 8·9]). Interpretation:Decreasing diabetes mortality at ages younger than 25 years remains an important challenge, especially in low and low-middle SDI countries. Inadequate diagnosis and treatment of diabetes is likely to be major contributor to these early deaths, highlighting the urgent need to provide better access to insulin and basic diabetes education and care. This mortality metric, derived from readily available and frequently updated GBD data, can help to monitor preventable diabetes-related deaths over time globally, aligned with the UN's Sustainable Development Targets, and serve as an indicator of the adequacy of basic diabetes care for type 1 and type 2 diabetes across nations. Funding: Bill & Melinda Gates Foundation.

Published
2022
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12. The global burden of adolescent and young adult cancer in 2019: a systematic analysis for the Global Burden of Disease Study 2019

Author

Elysia M Alvarez, Lisa M Force, Rixing Xu, Kelly Compton, Dan Lu, Hannah Jacqueline Henrikson, Jonathan M Kocarnik, James D Harvey, Alyssa Pennini, Frances E Dean, Weijia Fu, Martina T Vargas, Theresa H M Keegan, Hany Ariffin, Ronald D Barr, Yana Arturovna Erdomaeva, D Sanjeeva Gunasekera, Yetunde O John-Akinola, Tyler G Ketterl, Tezer Kutluk, Marcio Henrique Malogolowkin, Prashant Mathur, Venkatraman Radhakrishnan, Lynn Ann Gloeckler Ries, Carlos Rodriguez-Galindo, Garik Barisovich Sagoyan, Iyad Sultan, Behzad Abbasi, Mohsen Abbasi-Kangevari, Zeinab Abbasi-Kangevari, Hedayat Abbastabar, Michael Abdelmasseh, Sherief Abd-Elsalam, Amir Abdoli, Haimanot Abebe, Aidin Abedi, Hassan Abidi, Hassan Abolhassani, Hiwa Abubaker Ali, Eman Abu-Gharbieh, Basavaprabhu Achappa, Juan Manuel Acuna, Isaac Akinkunmi Adedeji, Oyelola A Adegboye, Qorinah Estiningtyas Sakilah Adnani, Shailesh M Advani, Muhammad Sohail Afzal, Mohamad Aghaie Meybodi, Bahman Ahadinezhad, Bright Opoku Ahinkorah, Sajjad Ahmad, 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R.A., Rafiee A., Rafiei A., Rafiei S., Rahim F., Rahimzadeh S., Rahman M., Rahman M.A., Rahmani A.M., Rajesh A., Ramezani-Doroh V., Ranabhat K., Ranasinghe P., Rao C.R., Rao S.J., Rashedi S., Rashidi M., Rashidi M.-M., Rath G.K., Rawaf D.L., Rawaf S., Rawal L., Rawassizadeh R., Razeghinia M.S., Regasa M.T., Renzaho A.M.N., Rezaei M., Rezaei N., Rezaeian M., Rezapour A., Rezazadeh-Khadem S., Riad A., Rios Lopez L.E., Rodriguez J.A.B., Ronfani L., Roshandel G., Rwegerera G.M., Saber-Ayad M.M., Sabour S., Saddik B., Sadeghi E., Sadeghian S., Saeed U., Sahebkar A., Saif-Ur-Rahman K.M., Sajadi S.M., Salahi S., Salehi S., Salem M.R., Salimzadeh H., Samy A.M., Sanabria J., Sanmarchi F., Sarveazad A., Sathian B., Sawhney M., Sawyer S.M., Saylan M., Schneider I.J.C., Seidu A.-A., Sekerija M., Sendo E.G., Sepanlou S.G., Seylani A., Seyoum K., Sha F., Shafaat O., Shaikh M.A., Shamsoddin E., Shannawaz M., Sharma R., Sheikhbahaei S., Shetty A., Shetty B.S.K., Shetty P.H., Shin J.I., Shirkoohi R., Shivakumar K.M., Shobeiri P., Siabani S., Sibhat M.M., Siddappa Malleshappa S.K., Sidemo N.B., Silva D.A.S., Silva Julian G., Singh A.D., Singh J.A., Singh J.K., Singh S., Sinke A.H., Sintayehu Y., Skryabin V.Y., Skryabina A.A., Smith L., Sofi-Mahmudi A., Soltani-Zangbar M.S., Song S., Spurlock E.E., Steiropoulos P., Straif K., Subedi R., Sufiyan M.B., Suliankatchi Abdulkader R., Sultana S., Szerencses V., Szocska M., Tabaeian S.P., Tabares-Seisdedos R., Tabary M., Tabuchi T., Tadbiri H., Taheri M., Taherkhani A., Takahashi K., Tampa M., Tan K.-K., Tat V.Y., Tavakoli A., Tbakhi A., Tehrani-Banihashemi A., Temsah M.-H., Tesfay F.H., Tesfaye B., Thakur J.S., Thapar R., Thavamani A., Thiyagarajan A., Thomas N., Tobe-Gai R., Togtmol M., Tohidast S.A., Tohidinik H.R., Tolani M.A., Tollosa D.N., Touvier M., Tovani-Palone M.R., Traini E., Tran B.X., Tran M.T.N., Tripathy J.P., Tusa B.S., Ukke G.G., Ullah I., Ullah S., Umapathi K.K., Unnikrishnan B., Upadhyay E., Ushula T.W., Vacante M., Valadan Tahbaz S., Varthya S.B., Veroux M., Villeneuve P.J., Violante F.S., Vlassov V., Vu G.T., Waheed Y., Wang N., Ward P., Weldesenbet A.B., Wen Y.F., Westerman R., Winkler A.S., Wubishet B.L., Xu S., Yahyazadeh Jabbari S.H., Yang L., Yaya S., Yazdi-Feyzabadi V., Yazie T.S., Yehualashet S.S., Yeshaneh A., Yeshaw Y., Yirdaw B.W., Yonemoto N., Younis M.Z., Yousefi Z., Yu C., Yunusa I., Zadnik V., Zahir M., Zahirian Moghadam T., Zamani M., Zamanian M., Zandian H., Zare F., Zastrozhin M.S., Zastrozhina A., Zhang J., Zhang Z.-J., Ziapour A., Zoladl M., Murray C.J.L., Fitzmaurice C., Bleyer A., Bhakta N., Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), Microbes in Health and Disease (MHD), NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), HUS Comprehensive Cancer Center, University of Helsinki, Bill & Melinda Gates Foundation, American Lebanese Syrian Associated Charities, St. Baldrick's Foundation, NIH - National Cancer Institute (NCI) (Estados Unidos), Epidemiologie, and RS: NUTRIM - R3 - Respiratory & Age-related Health

Subjects
adolescent cancer, global burden of disease, epidemiology, Adult, Male, Adolescent, 3122 Cancers, UNITED-STATES, Disability-Adjusted Life Year, Adolescents, Socioeconomic Factor, Global Health, Global Burden of Disease, Young Adult, Life Expectancy, SDG 3 - Good Health and Well-being, Risk Factors, WORLDWIDE, Neoplasms, Cause of Death, Prevalence, Humans, 1112 Oncology and Carcinogenesis, Oncology & Carcinogenesis, Mortality, Cancer burden analyses, Cancer, ACUTE LYMPHOBLASTIC-LEUKEMIA, disease, Global burden, OUTCOMES, CHILDHOOD-CANCER, Incidence, Risk Factor, the GBD 2019 methodology, Disability-Adjusted Life Years, GBD 2019 Adolescent Young Adult Cancer Collaborators, CARE, Cancer control efforts, Socioeconomic Factors, Oncology, Neoplasm, Female, Young adults, Human
Abstract

Funding: J A Loureiro acknowledges support from Base Funding UIDB/00511/2020 of the LEPABE funded by national funds through the FCT/MCTES (PIDDAC) and Scientific Employment Stimulus (FCT) [CEECINST/00049/2018]. Background: In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15–39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods: Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15–39 years to define adolescents and young adults. Findings: There were 1·19 million (95% UI 1·11–1·28) incident cancer cases and 396 000 (370 000–425 000) deaths due to cancer among people aged 15–39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59·6 [54·5–65·7] per 100 000 person-years) and high-middle SDI countries (53·2 [48·8–57·9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14·2 [12·9–15·6] per 100 000 person-years) and middle SDI (13·6 [12·6–14·8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23·5 million (21·9–25·2) DALYs to the global burden of disease, of which 2·7% (1·9–3·6) came from YLDs and 97·3% (96·4–98·1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation: Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Funding: Bill & Melinda Gates Foundation, American Lebanese Syrian Associated Charities, St Baldrick's Foundation, and the National Cancer Institute. publishersversion published

Published
2022
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13. Barriers and Facilitators to the Uptake of Online and Telephone Services Targeting Health Risk Behaviours among Vocational Education Students: A Qualitative Study

Author

John Wiggers, Flora Tzelepis, Christine Paul, Billie Bonevski, Prince Atorkey, and Aimee Mitchell

Subjects
Health, Toxicology and Mutagenesis, barriers, Psychological intervention, multiple health risk behaviours, Article, Health Risk Behaviors, Humans, Health risk, Students, Accent (sociolinguistics), Qualitative Research, Vocational Education, Medical education, Risk behaviour, Public Health, Environmental and Occupational Health, vocational education students, Preference, Telephone, Vocational education, uptake, facilitators, Medicine, Thematic analysis, Psychology, Qualitative research
Abstract

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.

Published
2021

14. Poster Abstracts

Author

John Wiggers, Prince Atorkey, Christine Paul, Aimee Mitchell, Emma Byrnes, Flora Tzelepis, and Billie Bonevski

Subjects
Further education, Oncology, Nursing, business.industry, Psychological intervention, Medicine, General Medicine, Health risk, business, Disease burden
Published
2019
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15. Consumption of carbonated soft drinks among Ghanaian adolescents: associations with socio-demographic factors, health risk factors and psychological distress

Author

Prince Atorkey, Winifred Asare-Doku, and Mariam Akwei

Subjects
Consumption (economics), Male, Nutrition and Dietetics, Adolescent, business.industry, Socio demographics, Medicine (miscellaneous), Psychological distress, Carbonated Beverages, General Medicine, Psychological Distress, Ghana, Risk Factors, Environmental health, Medicine, Humans, medicine.symptom, Health risk, business, Weight gain, Demography
Abstract

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.

Published
2021

16. The Effectiveness of Virtual Reality Interventions on Smoking, Nutrition, Alcohol, Physical Activity and/or Obesity Risk Factors: A Systematic Review

Author

Peter Tatnell, Prince Atorkey, and Flora Tzelepis

Subjects
Virtual Reality Exposure Therapy, Health, Toxicology and Mutagenesis, Smoking, Virtual Reality, Public Health, Environmental and Occupational Health, Humans, Obesity, Exercise
Abstract

To our knowledge, no systematic reviews have examined the effectiveness of virtual reality (VR) interventions across all smoking, nutrition, alcohol, physical activity, and/or obesity (SNAPO) risk factors. This systematic review assessed the effectiveness of VR interventions on reducing SNAPO risks compared to control groups or other interventions. MEDLINE, EMBASE, Scopus, PsycINFO, and CENTRAL were searched to identify eligible studies published to 7 October 2021. Two reviewers independently completed screening, data extraction and quality assessment. Twenty-six studies were included, five on smoking, twelve on physical activity (PA), six on obesity, one on PA and obesity, one on obesity and nutrition, and one on obesity, nutrition and PA. VR was effective for smoking cessation in three studies and for smoking reduction in four studies. Seven studies had significantly higher PA in the VR group, and one study found significantly higher PA in a comparator group. Two studies showed VR was more effective at reducing BMI or weight than comparators. Three multiple health risks studies showed mixed results. The remaining studies found no significant difference between VR and control/comparators. VR appears promising for the treatment of smoking, nutrition, PA, and obesity risks; however, further randomised trials are needed.

Published
2022
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17. Multiple Health Risk Factors in Vocational Education Students: A Systematic Review

Author

Christine Paul, Billie Bonevski, Flora Tzelepis, Prince Atorkey, John Wiggers, and Judith Byaruhanga

Subjects
Adult, Adolescent, Alcohol Drinking, Health, Toxicology and Mutagenesis, Scopus, MEDLINE, lcsh:Medicine, Review, PsycINFO, CINAHL, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Environmental health, co-occurrence, medicine, Humans, Obesity, 030212 general & internal medicine, Young adult, Students, Vocational Education, 030505 public health, business.industry, lcsh:R, Public Health, Environmental and Occupational Health, vocational education students, medicine.disease, Vocational education, multiple health risk factors, Anxiety, medicine.symptom, 0305 other medical science, business, clustering
Abstract

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.

Published
2021

18. Clustering of multiple health risk behaviours and association with socio-demographic characteristics and psychological distress among adolescents in Ghana: A latent class analysis

Author

Prince Atorkey and Christiana Owiredua

Subjects
Health (social science), Psychological intervention, Psychological distress, Logistic regression, Ghana, Article, Clustering, Odds, 03 medical and health sciences, 0302 clinical medicine, Environmental health, Medicine, 030212 general & internal medicine, lcsh:Social sciences (General), Association (psychology), Depression (differential diagnoses), Reference group, Multiple health risk behaviours, 030505 public health, business.industry, lcsh:Public aspects of medicine, Health Policy, Smoking Tobacco, Public Health, Environmental and Occupational Health, lcsh:RA1-1270, Latent class model, Adolescence, lcsh:H1-99, 0305 other medical science, business
Abstract

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.

Published
2020

19. Uptake of Proactively Offered Online and Telephone Support Services Targeting Multiple Health Risk Behaviors Among Vocational Education Students: Process Evaluation of a Cluster Randomized Controlled Trial (Preprint)

Author

Prince Atorkey, Christine Paul, Billie Bonevski, John Wiggers, Aimee Mitchell, Emma Byrnes, Christophe Lecathelinais, and Flora Tzelepis

Abstract

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. CLINICALTRIAL Australian New Zealand Clinical Trials Registry: ACTRN12618000723280; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375001.

Published
2020
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20. Effectiveness of Individual Real-Time Video Counseling on Smoking, Nutrition, Alcohol, Physical Activity, and Obesity Health Risks: Systematic Review (Preprint)

Author

Judith Byaruhanga, Prince Atorkey, Matthew McLaughlin, Alison Brown, Emma Byrnes, Christine Paul, John Wiggers, and Flora Tzelepis

Abstract

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.

Published
2020
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21. Effectiveness of Individual Real-Time Video Counseling on Smoking, Nutrition, Alcohol, Physical Activity, and Obesity Health Risks: Systematic Review

Author

Prince Atorkey, Judith Byaruhanga, Flora Tzelepis, Emma Byrnes, Christine Paul, John Wiggers, Matthew Mclaughlin, and Alison Brown

Subjects
Gerontology, Counseling, Male, obesity, 020205 medical informatics, Alcohol Drinking, telehealth, medicine.medical_treatment, Population, Nutritional Status, physical activity, Health Informatics, 02 engineering and technology, PsycINFO, Telehealth, Review, lcsh:Computer applications to medicine. Medical informatics, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Telephone counseling, videoconferencing, law, Weight loss, Risk Factors, 0202 electrical engineering, electronic engineering, information engineering, medicine, Humans, 030212 general & internal medicine, education, Exercise, education.field_of_study, mobile phone, business.industry, lcsh:Public aspects of medicine, Smoking, lcsh:RA1-1270, Telemedicine, smoking cessation, Systematic review, Smoking cessation, lcsh:R858-859.7, Female, medicine.symptom, business, diet
Abstract

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.

Published
2020

22. Uptake of Proactively Offered Online and Telephone Support Services Targeting Multiple Health Risk Behaviors Among Vocational Education Students: Process Evaluation of a Cluster Randomized Controlled Trial

Author

Prince Atorkey, Christine Paul, Flora Tzelepis, Billie Bonevski, Emma Byrnes, John Wiggers, Aimee Mitchell, and Christophe Lecathelinais

Subjects
Adult, Male, Further education, medicine.medical_specialty, 020205 medical informatics, online support services, Population, Health Informatics, 02 engineering and technology, lcsh:Computer applications to medicine. Medical informatics, Odds, law.invention, Health Risk Behaviors, 03 medical and health sciences, 0302 clinical medicine, telephone support services, Randomized controlled trial, law, Hotlines, Intervention (counseling), 0202 electrical engineering, electronic engineering, information engineering, Humans, Medicine, 030212 general & internal medicine, Students, education, Vocational Education, Original Paper, Internet, education.field_of_study, business.industry, proactive offer, lcsh:Public aspects of medicine, lcsh:RA1-1270, vocational education students, Odds ratio, multiple health risk behaviors, Telemedicine, Clinical trial, uptake, Vocational education, Family medicine, lcsh:R858-859.7, Female, business
Abstract

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.

Published
2021
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