School-based programs have been a mainstay of youth pregnancy prevention efforts in the USA. We conducted a systematic review and meta-analysis to assess their effectiveness. Eligible studies evaluated the effect on pregnancy rates of programs delivered in elementary, middle, or high schools in the USA and Canada, published between January 1985 and September 2016. The primary outcome was pregnancy; secondary outcomes were delay in sexual initiation, condom use, and oral contraception use. Randomized controlled trials (RCTs) and non-RCTs with comparator groups were eligible. We developed a comprehensive search strategy, applied to major bibliographic databases, article bibliographies, gray literature, and contact with authors. We calculated risk ratios (RR) with 95% confidence intervals (CI) for each outcome and pooled data in random effects meta-analysis. We used Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess evidence quality. Ten RCTs and 11 non-RCTs conducted from 1984 to 2016 yielded 30 unique pooled comparisons for pregnancy, of which 24 were not statistically significant. Six showed statistically significant changes in pregnancy rates: two with increased risk (RR 1.30, 95% CI 1.02-1.65; and RR 1.39, 95% CI 1.10-1.75) and four with decreased risk ranging from RR 0.56, 95% CI 0.41-0.77, to RR 0.75, 95% CI 0.58-0.96. All studies were at high risk of bias, and the quality of evidence was low or very low. Identified evidence indicated no consistent difference in rates of pregnancies between intervention recipients and controls.
Fishing communities in Uganda have high rates of excessive alcohol consumption and negative health outcomes related to alcohol consumption, such as HIV acquisition and transmission and intimate partner violence victimization and perpetration. Research lacks understanding of alcohol use in Ugandan fishing communities, underlying reasons for excessive drinking among fishermen or how their community perceives negative health outcomes linked to excessive alcohol consumption. This qualitative study was conducted among Ugandan fisherfolk to determine why excessive alcohol consumption has overtaken their communities. Through analyzing in-depth interviews and focus group discussions, reasons for drinking and community perceptions of drinking were explored using the Socio Ecological Model and the Time Perspective Theory. Interviews were coded into two content themes: social influences on drinking and using alcohol to cope with stress. Participants acknowledged links between excessive alcohol consumption and negative health outcomes within their families and communities. These findings highlight the need for alcohol-related reduction interventions that are sensitive to contextual factors and self-identified contributors to problematic alcohol use within individuals and their communities. Such interventions must consider the social, ecological and economic conditions within fishing sites, focusing not only on individual-level behavioral change but also challenging the underlying structures that foster excessive alcohol consumption.
Background Harmful alcohol use is a leading cause of morbidity and mortality in sub‐Saharan Africa (sSA); however, the effects of non‐pharmacological alcohol interventions in this region are unknown. Design A systematic review and meta‐analysis of the available literature through 14 March 2019 was undertaken. Two authors extracted and reconciled relevant data and assessed risk of bias. Meta‐analyses were conducted. The review protocol is registered on International Prospective Register of Systematic Reviews (PROSPERO) (CRD42019094509). Setting Studies conducted in sSA were eligible for inclusion. Participants Individuals participating in interventions aimed at reducing alcohol use. Interventions Randomized and non‐randomized controlled trials testing non‐pharmacological interventions (psychosocial and structural) on alcohol consumption in sSA. Measurements Eligible outcomes included the Alcohol Use Disorders Identification Test (AUDIT) scores; alcohol abstinence; measures of drinking quantity and frequency; and biomarkers of alcohol consumption. Findings Nineteen intervention trials (18 reports) testing psychosocial interventions (no structural interventions included), judged of moderate quality, were included in meta‐analyses. A beneficial effect was identified for psychosocial interventions on alcohol abstinence at 3–6 months [odds ratio (OR) = 2.05, 95% confidence interval (CI) = 1.20–3.48, k = 5, n = 2312, I2 = 79%] and 12–60 months (OR = 1.91, 95% CI = 1.40–2.61, k = 6, n = 2737, I2 = 63%) follow‐up. There were no statistically significant effects found for AUDIT score [2–3 months: mean differences (MD) = −1.13, 95% CI = −2.60 to 0.34, k = 6, n = 992, I2 = 85%; 6 months: MD = −0.83, 95% CI = −1.92 to 0.26, k = 6, n = 1081, I2 = 69%; 12 months: MD = −0.15, 95% CI = −1.66 to 1.36, k = 4; n = 677; I2 = 75%], drinks per drinking day (3 months: MD = –0.22, 95% CI = −2.51 to 2.07, k = 2, n = 359, I2 = 82%; 6–36 months: MD = −0.09, 95% CI = −0.49 to 0.30, k = 3, n = 1450, I2 = 60%) or percentage of drinking days (3 months: MD = −4.60, 95% = −21.14 to 11.94; k = 2; n = 361; I2 = 90%; 6–9 months: MD = 1.96, 95% CI = −6.54 to 10.46; k = 2; n = 818; I2 = 88%). Conclusion Psychosocial interventions show promise at increasing self‐reported alcohol abstinence in sSA, but clinical, methodological and statistical heterogeneity across meta‐analytical outcomes suggests that results should be interpreted with caution.
Introduction Uganda has one of the highest rates of alcohol use in sub-Saharan Africa but prevalence and correlates of drinking are undocumented in the Rakai region, one of the earliest epicenters of the HIV/AIDS epidemic in East Africa. Methods We analyzed cross-sectional data from 18,700 persons (8,690 men, 10,010 women) aged 15–49 years, living in agrarian, trading and fishing communities and participating in the Rakai Community Cohort Study (RCCS) between March 2015 and September 2016. Logistic regression models assessed associations between past year alcohol use and sociodemographic characteristics, other drug use and HIV status, controlling for age, religion, education, occupation, marital status, and household socioeconomic status. Results Past year alcohol prevalence was 45%. Odds of drinking were significantly higher in men (versus women) and fishing communities (versus agrarian areas). Odds of drinking increased with age, previous (versus current) marriage and past year drug use. By occupation, highest odds of drinking were among fishermen and (in women) bar/restaurant workers. Alcohol-related consequences were more commonly reported by male (vs. females) drinkers, among whom up to 35% reported alcohol dependence symptoms (e.g., unsteady gait). HIV status was strongly associated with alcohol use in unadjusted but not adjusted models. Conclusions Alcohol use differed by gender, community type and occupation. Being male, living in a fishing community and working as a fisherman or restaurant/bar worker (among women) were associated with higher odds of drinking. Alcohol reduction programs should be implemented in Uganda’s fishing communities and among people working in high risk occupations (e.g., fishermen and restaurant/bar workers).
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