Investigation of Investigation of Alcohol use Alcohol use

prevalence and prevalence and Sexual Behaviour Sexual Behaviour

amongst school going amongst school going learners in KwaZulu-learners in KwaZulu-

Natal. Natal.

NN Nyawo, SB Dlamini, M Taylor, CC NN Nyawo, SB Dlamini, M Taylor, CC Jinabhai, G FriedlandJinabhai, G Friedland

Nelson R Mandela School of Medicine Nelson R Mandela School of Medicine Department of Public Health MedicineDepartment of Public Health Medicine

BackgroundBackground• Alcohol- fifth largest risk factor contributing to the Alcohol- fifth largest risk factor contributing to the

global burden of disease, (WHO 2001) global burden of disease, (WHO 2001) South Africa:South Africa:• Underage alcohol consumption- 49% of learners Underage alcohol consumption- 49% of learners

have used alcohol, (DoH 2002)have used alcohol, (DoH 2002)KZN:KZN:• 38.8% of learners use alcohol, (DoH 2002)• Acute alcohol intoxication is associated with

unsafe sexual practices, (MRC, 2003)• Estimated 40.7% ANC woman were HIV positive,

(DOH, 2004). • Alcohol misuse, combined with poor nutritional

status, increases susceptibility to opportunistic diseases by compromising the immune system.

AimAim

• To investigate the prevalence, To investigate the prevalence, determinants and associations of determinants and associations of alcohol use with risky sexual alcohol use with risky sexual behaviour amongst rural and urban behaviour amongst rural and urban learners in KwaZulu-Natal. learners in KwaZulu-Natal.

Theoretical FrameworkTheoretical Framework

Trial

Maintenance

Plans

Performance Skills

Behavior State

Precontemplation

Contemplation

Preparation

Motivation Factors

Attitude:Pros & Cons

Rational & Emotional

SocialInfluences:

NormsModellingPressure

Efficacy: RoutineSocial

SituationalStress

Behavioral factors

PredisposingFactors

Psychological factors

Biological factors

Social Cultural factors

InformationFactors

Risk Perception

Knowledge

Cues to Action

Intention State

Barriers

Ability Factors

Message

Source

Channel

AwarenessFactors

The I-CHANGE ModelDe Vries et al., 2004; 2005

MethodsMethods

Study design:Study design: Cross-sectional study Cross-sectional study

Study Area :Study Area : -Rural -Ugu District– with estimated population- -Rural -Ugu District– with estimated population- 900 000:900 000:-Urban -Umlazi township -300.000-Urban -Umlazi township -300.000

• Both within the province of KwaZulu-NatalBoth within the province of KwaZulu-NatalStudy Participants:Study Participants: • DoE List –random selection-12 public high DoE List –random selection-12 public high

schools schools • One grade 9 class randomly selected in each One grade 9 class randomly selected in each

schoolschool• All students in the class included in the studyAll students in the class included in the study

InstrumentsInstrumentsData collecting toolData collecting tool• Self-reported questionnaire based on I-Change Self-reported questionnaire based on I-Change

Model (de Vries Model (de Vries et alet al, 2003), 2003)• Questions on demographic data & home Questions on demographic data & home

environment, knowledge, attitudes- social environment, knowledge, attitudes- social influences, self-efficacy, alcohol use and sexual influences, self-efficacy, alcohol use and sexual behaviour behaviour

• Likert Scale= Strongly disagree (1) to strongly Likert Scale= Strongly disagree (1) to strongly agree (5)agree (5)

• Administered by fieldworkers in absence of Administered by fieldworkers in absence of teachers (Anonymous)teachers (Anonymous)

AnalysisAnalysis• SPSS program – Univariates, Bivariate, and SPSS program – Univariates, Bivariate, and

Covariates analysesCovariates analyses

Ethics ApprovalEthics Approval

Ethical Approval, Informed Ethical Approval, Informed consent consent

• UKZN-Biomedical Research UKZN-Biomedical Research Ethics Committee, Department of Ethics Committee, Department of Education and School PrincipalsEducation and School Principals

• Written informed consent from Written informed consent from Parents and Learners Parents and Learners

DefinitionsDefinitions

• Risky drinkingRisky drinking: Drinking 5 or more : Drinking 5 or more standard bottles/ glasses drinks one time standard bottles/ glasses drinks one time in a row for males and three or more in a row for males and three or more drinks for females. drinks for females.

• Alcohol Drinker:Alcohol Drinker: Those who have ever Those who have ever had alcohol had alcohol

• Non-drinker:Non-drinker: Those who have never had Those who have never had an alcoholic drink an alcoholic drink

• Underage drinking-Underage drinking- individuals below individuals below the age of 18 years who drink alcohol. the age of 18 years who drink alcohol.

Results:Results:Description of LearnersDescription of Learners

• n=657 respondents n=657 respondents • Mean age-15.6 years (SD 1.68)Mean age-15.6 years (SD 1.68)• Males- (49.5%), Females- (50.5%)Males- (49.5%), Females- (50.5%)• Prevalence Underage Drinking -Prevalence Underage Drinking -

38.1%38.1%• (No significant differences in (No significant differences in

religious beliefs or watching of religious beliefs or watching of television)television)

Prevalence of Underage Prevalence of Underage Drinking by Gender, (n=657)Drinking by Gender, (n=657)

Female drinkersMale drinkersFemale non-drinkersMale non-drinkers

36.2%

63.8%

40.9%

59.1%

Prevalence (%) of Underage Prevalence (%) of Underage Drinking by School Drinking by School Location (n=657)Location (n=657)

41

5962

38

0

10

20

30

40

50

60

70

Non-drinkers Drinkers

Urban schoolsRural school

P<.005

(%)

Predisposing Factors of Under Predisposing Factors of Under Age Drinking for KZN High Age Drinking for KZN High

School LearnersSchool Learners

Variable Variable Non-Non-drinkersdrinkers

DrinkersDrinkers P-valueP-value

Live with Live with Mom and Mom and DadDad

69.9% 69.9% 37.1% 37.1% <0.005<0.005

Mom’s Mom’s education**education**

71.1% 71.1% 28.9% 28.9% 0.050.05

Read mags. Read mags. & n/papers& n/papers

62.1% 62.1% 37.9% 37.9% 0.040.04

** Mothers who have grade 10 –grade 12 / tertiary education

Intrapersonal Determinants Intrapersonal Determinants Influencing Underage Alcohol Use Influencing Underage Alcohol Use

Amongst High School Learners Amongst High School Learners (n=657)(n=657)

Variable Variable Non-Non-drinkersdrinkers

(n)(n)

DrinkersDrinkers

(n)(n)P-P-valuevalue

Age Age (years)(years)

15.40 15.40 15.81 15.81 .007.007

Drink for Drink for fun*fun*

1.73 1.73 2.50 2.50 <.005<.005

Drinking Drinking – – problemsproblems**

1.83 1.83 2.25 2.25 <.005<.005

Drink- Drink- confidentconfident**

1.84 1.84 2.54 2.54 <.005<.005

*Likert Scale: Strongly disagree (1) – Strongly agree (5)

Interpersonal Determinants Interpersonal Determinants Influencing Underage Alcohol Use Influencing Underage Alcohol Use

Amongst High School Learners Amongst High School Learners (n=657) (n=657)

Variable Variable Non-Non-drinkersdrinkers

DrinkersDrinkers P-value P-value

Close Close friends friends drinkdrink**

3.42 (313) 3.42 (313) 3.05 (187)3.05 (187) .005 .005

Friends Friends approve approve use* use*

2.51 (329) 2.51 (329) 2.90 (193)2.90 (193) .002 .002

Difficult Difficult to refuse to refuse a drinka drink**

2.63 (287) 2.63 (287) 3.03 (183)3.03 (183) .004 .004

*Likert Scale: Strongly disagree (1) – Strongly agree (5)

Learners’ Knowledge and Learners’ Knowledge and Attitudes about Attitudes about HIV/AIDSHIV/AIDS

((n=623)n=623)

(%)

P<.005

UnderageUnderage alcohol use and alcohol use and Sexual History of Learners Sexual History of Learners

in KZN in KZN

37

63

37

63

40

59

0

10

20

30

40

50

60

70

Ever had sex Sex in 3 moths Sexual partner

Non- Drinkers Alcohol Drinkers

(%)

P<.005

Underage Alcohol use and Underage Alcohol use and Risky Sexual behaviour of Risky Sexual behaviour of

Learners in KZNLearners in KZN

8

4237

18

64

17

40

60

0

10

20

30

40

50

60

70

Alcohol sex Condom use Use condcasual partner

No. of sexualpartners

Non-Drinkers Alcohol Drinkers

(%)

P=.001

Significant Factors Significant Factors Associated with Underage Associated with Underage

Alcohol UseAlcohol Use• After adjusting for sex, age and school After adjusting for sex, age and school

location – non significance observed location – non significance observed – Drink to run way from problems Drink to run way from problems – Close friends drink Close friends drink – Friends will approve if I drink Friends will approve if I drink

• But “drink to be confident” and “drink to But “drink to be confident” and “drink to have fun” were still highly significant have fun” were still highly significant (P<.005)(P<.005)

• I find it difficult to refuse alcohol in a party- I find it difficult to refuse alcohol in a party- was highly significant (P=.019) was highly significant (P=.019)

SummarySummary• Study confirms that males use alcohol more Study confirms that males use alcohol more

than females than females • This study has confirmed the prevalence of This study has confirmed the prevalence of

underage alcohol drinking and it association underage alcohol drinking and it association with unsafe sexwith unsafe sex

• Learners perceived that alcohol benefits their Learners perceived that alcohol benefits their social livessocial lives

• Learners’ knowledge about HIV did not Learners’ knowledge about HIV did not influence their sexual behaviour influence their sexual behaviour

• In the context where HIV/AIDS epidemic is so In the context where HIV/AIDS epidemic is so prevalent, alcohol is a significant risk factor and prevalent, alcohol is a significant risk factor and this has been shared with schools and learnersthis has been shared with schools and learners

• Factors that protect are mothers’ higher Factors that protect are mothers’ higher education education

ConclusionConclusion

• Study has identified key areas for Study has identified key areas for behaviour change behaviour change

• The I-Change model assists in The I-Change model assists in developing focused interventions developing focused interventions

• Implementation of interventions need Implementation of interventions need to be targeted at a primary levelto be targeted at a primary level

• Strengthen alcohol age restriction Strengthen alcohol age restriction policy implementation on the grass-policy implementation on the grass-root level root level

AcknowledgementsAcknowledgements

• World AIDS FoundationWorld AIDS Foundation• Department of EducationDepartment of Education• PrincipalsPrincipals• ParentsParents• LearnersLearners• Colleagues Colleagues