HIV Vulnerabilities Associated with Water Insecurity, Food Insecurity, and Other COVID-19 Impacts Among Urban Refugee Youth in Kampala, Uganda: Multi-method Findings.

Food insecurity (FI) and water insecurity (WI) are linked with HIV vulnerabilities, yet how these resource insecurities shape HIV prevention needs is understudied. We assessed associations between FI and WI and HIV vulnerabilities among urban refugee youth aged 16-24 in Kampala, Uganda through individual in-depth interviews (IDI) (n = 24), focus groups (n = 4), and a cross-sectional survey (n = 340) with refugee youth, and IDI with key informants (n = 15). Quantitative data was analysed via multivariable logistic and linear regression to assess associations between FI and WI with: reduced pandemic sexual and reproductive health (SRH) access; past 3-month transactional sex (TS); unplanned pandemic pregnancy; condom self-efficacy; and sexual relationship power (SRP). We applied thematic analytic approaches to qualitative data. Among survey participants, FI and WI were commonplace (65% and 47%, respectively) and significantly associated with: reduced SRH access (WI: adjusted odds ratio [aOR]: 1.92, 95% confidence interval [CI]: 1.19-3.08; FI: aOR: 2.31. 95%CI: 1.36-3.93), unplanned pregnancy (WI: aOR: 2.77, 95%CI: 1.24-6.17; FI: aOR: 2.62, 95%CI: 1.03-6.66), and TS (WI: aOR: 3.09, 95%CI: 1.22-7.89; FI: aOR: 3.51, 95%CI: 1.15-10.73). WI participants reported lower condom self-efficacy (adjusted ß= -3.98, 95%CI: -5.41, -2.55) and lower SRP (adjusted ß= -2.58, 95%CI= -4.79, -0.37). Thematic analyses revealed: (1) contexts of TS, including survival needs and pandemic impacts; (2) intersectional HIV vulnerabilities; (3) reduced HIV prevention/care access; and (4) water insecurity as a co-occurring socio-economic stressor. Multi-method findings reveal FI and WI are linked with HIV vulnerabilities, underscoring the need for HIV prevention to address co-occurring resource insecurities with refugee youth.

Exploring a syndemic of poverty, cumulative violence, and HIV vulnerability among refugee youth: multi-method insights from a humanitarian setting in Uganda.

Synergistic associations between social inequities and HIV vulnerabilities - known as a syndemic - are understudied with youth in humanitarian settings. We explored refugee youths' HIV prevention needs in Bidi Bidi Refugee Settlement, Uganda. This multi-methods study involved 6 focus groups and 12 in-depth individual interviews (IDI) with refugee youth (n = 60) aged 16-24, and IDI with refugee elders (n = 8) and healthcare providers (n = 8). We then conducted cross-sectional surveys with refugee youth (16-24 years) (n = 115) to assess: poverty, recent sexual and gender-based violence (SGBV), and condom engagement motivation (CEM) (wanting to learn about condoms for HIV prevention). Multivariable logistic regression was used to estimate adjusted odds ratios for associations between poverty and SGBV with CEM. Qualitative narratives revealed poverty and trauma elevated substance use, and these converged to exacerbate SGBV. SGBV and transactional sex increased HIV vulnerabilities. Among survey participants, poverty and recent SGBV were associated with reduced odds of CEM. The interaction between poverty and recent SGBV was significant: the predicted probability of CEM among youth who experienced both poverty and SGBV was almost half than among youth who experienced poverty alone, SGBV alone, or neither. Findings signal the confluence of poverty, violence, and substance use elevate refugee youth HIV vulnerabilities.

Factors associated with motherhood among urban refugee adolescent girls and young women in informal settlements in Kampala, Uganda.

Adolescent girls and young women (AGYW) in sub-Saharan Africa face a high risk of unintended pregnancy. This risk is compounded in informal settlements, where resources are scarce and access to sexual and reproductive health services is limited. Being a young mother in informal settlements could exacerbate existing experiences of resource scarcity and poor access to sexual and reproductive health services. To explore this, we analyzed the factors associated with motherhood among refugee AGYW in Kampala, Uganda. Between January and March 2018, peer researchers recruited refugee youth aged 15-24 and living in five informal settlements in Kampala to participate in this study. We used a backwards generalized linear model with a log binomial regression to determine if mental health, resource insecurity and sexual and reproductive health variables were associated with motherhood among study participants. Our analysis included 333 AGYW with a mean age of 19.3 years (standard deviation: 2.6). Nearly one-quarter (23 percent; n = 76) of AGYW had children. Having children was associated with greater likelihood of reporting food insecurity (adjusted prevalence ratio [aPR]: 1.96, 95 percent confidence interval [CI]: 1.07-3.61), depressive symptoms (aPR: 2.03, 95 percent CI: 1.09-3.80), and contraception uptake (aPR: 2.37, 95 percent CI: 1.58-3.56) compared to not having children. Mental health and resource insecurity interventions are required for refugee AGYW with children in informal settlements. Sexual and reproductive health services should be promoted to refugee AGYW regardless of motherhood status to prevent unplanned pregnancy.

Exploring the Protective Value of Using Sexting for Condom Negotiation on Condom use Determinants and Practices Among Forcibly Displaced Adolescents in the Slums of Kampala, Uganda.

Given the global growth of adolescent texting, we evaluate texting-based sexual communication as a potential site for interventions encouraging condom use cascades, particularly among displaced adolescents-a population with disproportionate levels of sexually transmitted infections, including HIV. With data from 242 forcibly displaced adolescents in the slums of Kampala, Uganda, we used path analysis to examine pathways from gender/dating relationship to condom determinant (knowledge of where to access condoms) and practices (access/use of condoms), through sexting-based condom negotiation, controlling for sexting practices. We found direct pathways from gender (boys vs. girls) and from dating relationship (dating vs. not) to condom determinant. Sexting-based condom negotiation partially mediated the pathway from gender/dating relationship to condom determinant, and fully mediated the pathways from gender/dating relationship to condom practices. Future digital sexual health interventions should consider the utility of texting-based applications in promoting knowledge and use of condoms among adolescents.

RESUMEN: Dado el crecimiento global de los mensajes de texto de los adolescentes, evaluamos la comunicación sexual basada en mensajes de texto como un sitio potencial para intervenciones que fomenten el uso de condones en cascada, particularmente entre los adolescentes desplazados, una población con niveles desproporcionados de infecciones de transmisión sexual, incluido el VIH. Con datos de 242 adolescentes desplazados por la fuerza en los barrios marginales de Kampala, Uganda, utilizamos el análisis de caminos para examinar los caminos desde la relación de género/citas hasta el determinante del condón (conocimiento de dónde acceder a los condones) y las prácticas (acceso/uso de condones), a través del sexteo. -negociación basada en condones, controlando las prácticas de sexting. Encontramos caminos directos desde el género (niños vs. niñas) y desde la relación de noviazgo (citas vs. no) al determinante del condón. La negociación de condones basada en sexting medió parcialmente el camino de la relación de género/citas al determinante del condón, y medió completamente las vías de la relación de género/citas a las prácticas del condón. Las futuras intervenciones de salud sexual digital deben considerar la utilidad de las aplicaciones basadas en mensajes de texto para promover el conocimiento y el uso de condones entre los adolescentes.

Relational Factors and HIV Testing Practices: Qualitative Insights from Urban Refugee Youth in Kampala, Uganda.

Despite the global phenomenon of refugee urbanization, little is known of relational contexts that shape HIV testing among urban refugee youth. We explored perspectives, experiences, and preferences for social support in HIV testing among refugee youth aged 16-24 in Kampala, Uganda. We conducted five focus groups with refugee youth (n = 44) and five in-depth key informant interviews. Participant narratives signaled relational contexts shaping HIV testing included informal sources (intimate partners and family members) and formal sources (peer educators and professionals). There was heterogeneity in perspectives based on relationship dynamics. While some felt empowered to test with partners, others feared negative relationship consequences. Participant narratives reflected kinship ties that could facilitate testing with family, while others feared coercion and judgment. Peer support was widely accepted. Professional support was key for HIV testing as well as conflict-related trauma. Findings emphasize bonding and bridging social capital as salient components of enabling HIV testing environments.

Sexual and reproductive health factors associated with child, early and forced marriage and partnerships among refugee youth in a humanitarian setting in Uganda: Mixed methods findings.

Preventing early and forced marriage is a global priority, however, sexual and reproductive health (SRH) among youth remains understudied in humanitarian settings. This study examined child, early and forced marriage and partnership (CEFMP) among young refugees in Bidi Bidi refugee settlement, Uganda, and associations with SRH outcomes among young women. This mixed-methods study involved a qualitative phase with young (16-24 years) sexual violence survivors (n=58), elders (n=8) and healthcare providers (n=10), followed by a quantitative phase among refugee youth (16-24 years; n=120) during which sociodemographic and SRH data were collected. We examined SRH outcome differences by CEFMP using Fisher's exact test. Qualitative data showed that CEFMP was a significant problem facing refugee young women driven by stigma, gender norms and poverty. Among youth refugee survey participants, nearly one-third (31.7%) experienced CEFMP (57.9% women, 42.1% men). Among women in CEFMP compared to those who were not, a significantly higher proportion reported forced pregnancy (50.0% vs. 18.4%, p-value=0.018), forced abortion (45.4% vs. 7.0%, p-value=0.002), and missed school due to sexual violence (94.7% vs. 63.0%, p-value=0.016). This study illustrates the need for innovative community-engaged interventions to end CEFMP in humanitarian contexts in order to achieve sexual and reproductive health and rights for youth.

The role of context in shaping HIV testing and prevention engagement among urban refugee and displaced adolescents and youth in Kampala, Uganda: findings from a qualitative study.

OBJECTIVE: To explore experiences, preferences and engagement with HIV testing and prevention among urban refugee and displaced adolescents and youth in Kampala, Uganda, with a focus on the role of contextual factors in shaping access and uptake. METHODS: This qualitative community-based study with urban refugee and displaced youth aged 16-24 living in Kampala's informal settlements involved five focus groups (FG), including two with young women, two with young men, and one with sex workers from March to May 2019. We also conducted five in-depth key informant interviews. We conducted thematic analysis informed by Campbell and Cornish's conceptualisation of material and symbolic contexts. RESULTS: Refugee/displaced youth participants (n = 44; mean age: 20.25, SD: 2.19; men: n = 17; women: n = 27) were from the Democratic Republic of Congo (n = 29), Rwanda (n = 11), Burundi (n = 3) and Sudan (n = 1). Participant narratives reflected material and symbolic contexts that shaped HIV testing awareness, preferences and uptake. Material contextual factors that presented barriers to HIV testing and prevention engagement included transportation costs to clinics, overcrowded living conditions that limited access to private spaces, low literacy and language barriers. Symbolic contexts that constrained HIV testing engagement included medical mistrust of HIV testing and inequitable gender norms. Religion emerged as an opportunity to connect with refugee communities and to address conservative religious positions on HIV and sexual health. CONCLUSION: Efforts to increase access and uptake along the HIV testing and prevention cascade can meaningfully engage urban refugee and displaced youth to develop culturally and contextually relevant services to optimise HIV and sexual health outcomes.

Gender, transactional sex, and HIV prevention cascade engagement among urban refugee and displaced adolescents and youth in Kampala, Uganda.

HIV prevention needs among urban refugee and displaced youth engaged in transactional sex are understudied. We examined associations between transactional sex and the HIV prevention cascade among urban refugee/displaced youth in Kampala, Uganda. We conducted a cross-sectional survey with a peer-driven sample of refugee/displaced adolescent girls and young women (n = 324) and adolescent boys and young men (n = 88) aged 16-24 living in Kampala's informal settlements. We conducted gender-disaggregated multivariable linear and logistic regressions to examine associations between past 12-month transactional sex and: lifetime HIV testing, condom self-efficacy, and recent [past 3-month] consistent condom use. Among the 27% of young women reporting transactional sex, 63% reported HIV testing. In multivariable analyses with young women, transactional sex was associated with higher condom self-efficacy, increased consistent condom use, but not HIV testing. Among the 48% of young men reporting transactional sex, 50% reported HIV testing. In multivariable analyses with young men, transactional sex was associated with lower HIV testing but not with condom self-efficacy or consistent condom use. Young men were 68% less likely to report HIV testing if transactional sex engaged. Findings point to urgent HIV testing gaps among transactional sex engaged urban refugee/displaced youth and a need for gender-tailored HIV prevention strategies.

Functional difficulties mediate the association between exposure to adverse childhood experiences and headaches among children: Findings from a population-based study.

BACKGROUND: Adverse childhood experiences (ACEs) are commonly observed in the general population and often have lasting neurological and physiological effects. Previous studies have found links between exposure to ACEs, headaches, and functional difficulties in adults. However, little is known about the mechanisms through which exposure to ACEs is associated with headaches among children. OBJECTIVE: To examine the association between exposure to ACEs and headaches in children, and whether functional difficulties mediate this association. METHODS: Data for this cross-sectional secondary analysis study came from the 2017-2018 National Survey of Children's Health. The sample analyzed in this study was 40,953 children who were between ages 3 and 17 years. We adjusted for the complexity of the sampling design and used structural equation modeling to examine the mediating effect of functional difficulties in the association between exposure to ACEs and headaches. RESULTS: Based on parent reports, we found that 4.1% (1697/40,953) of the children reported frequent or severe headaches, and 9.5% (3906/40,953) were exposed to three or more ACEs. About one in four children (23.4%; 9601/40,953) had at least one functional difficulty. The results show that exposure to ACEs was directly positively associated with functional difficulties (ß = 0.16, p < 0.001, 95% CI = 0.15-0.17), and functional difficulties were in turn positively associated with headaches (ß = 0.17, p < 0.001, 95% CI = 0.12-0.22). The Sobel test of indirect effect showed that functional difficulties partially mediated the association between exposure to ACEs and headaches (ß = 0.027, p < 0.001, 95% CI = 0.022-0.029). Also, older children and children with brain injury were more likely to report experiencing headaches. CONCLUSIONS: The findings from this study suggest an association between exposure to ACEs and headaches among children, and functional difficulties partially mediate this association.

The effectiveness of treatment supporter interventions in antiretroviral treatment adherence in sub-Saharan Africa: a systematic review and meta-Analysis.

This systematic review and meta-analysis evaluated the effectiveness of treatment supporter interventions (TSI) in improving ART adherence and viral suppression among adults living with HIV (PLWH) in sub-Saharan Africa. This review included ten randomized controlled trials (RCT) and six cohort studies comparing treatment support interventions to the standard of care (SOC). Primary outcomes include pill count ART adherence and viral load suppression (VLS). Pooled relative risk ratios (PRR) with 95% confidence intervals were generated using random-effects models. Stratified analyses and meta-regressions were conducted to determine the effect of study type, follow-upperiod, and patient treatment supporters on ART adherence. Treatment supporters included partners, friends, family members, trained community health workers, and HIV positive peers. TSIs were associated with a 7.6% higher ART adherence compared to the SOC group (PRR = 1.076, [95% CI = 1.005, 1.151]). VLS was 5% higher in the treatment group compared to the SOC group (PRR = 1.05, [95% CI = 1.061, 1.207]). There was a significant, positive association between TSIs and VLS in community-based delivery settings but not in facility-based settings. TSIs were statistically significant for VLS in cohort study designs (RR = 1.073, [95% CI = 1.028, 1.121]) but not in RCTs. Findings suggest that TSIs critical in facilitating optimal ART adherence and VLS among PLWHs.

Psychosocial Syndemics and Sexual Risk Practices Among U.S. Adolescents: Findings from the 2017 U.S. Youth Behavioral Survey.

BACKGROUND: The present study aims to (1) identify classes of psychosocial syndemics among adolescents in the U.S. based on psychological factors, such as depression and suicidal ideation, and social factors, such as binge drinking, alcohol use, and drug use; (2) identify correlates of psychosocial syndemics; and (3) examine the independent associations between psychosocial syndemic factors and sexual risk practices. METHOD: We used latent class analysis and a sample of 14,762 U.S. high school students who participated in the 2017 Youth Risk Behavior Surveillance System to examine youth population profiles based on shared characteristics of syndemics. Adjusting for sociodemographic factors, we conducted logistic regression to explore the connections between psychosocial syndemic factors and three sexual risk practices, namely, early initiation of sexual intercourse, condom use, and sex with multiple partners. RESULTS: The study results indicate that three classes of risk exist among the sample: substance misuse (class 1, n = 3872, 26.2%), normative (class 2, n = 8791, 59.6%), and mental health problems (class 3, n = 2099, 14.2%). Class membership of psychosocial syndemics was significantly different by gender, age group, and race. The odds of initiating sexual intercourse before age 13 were positively associated with participants belonging in the substance misuse class and the mental health problem class. The odds of using condoms during the last sexual intercourse for currently sexually active adolescents were lower for participants classified in the substance misuse class. The likelihood of reporting having sex with four or more partners in a lifetime was higher among participants belonging to the substance misuse class. CONCLUSION: The study advances our understanding of the heterogeneity of class membership associated with psychosocial syndemic risk factors among adolescents and extends our understanding of syndemics in the area of adolescent health. Thus, practitioners and policymakers can design multicomponent and multilevel school-based HIV/STI prevention programs that meet the needs of adolescents.

The importance of self-efficacy and educational aspirations for academic achievement in resource-limited countries: Evidence from Ghana.

INTRODUCTION: Research on the influence of academic self-efficacy and educational aspirations on academic performance is underdeveloped in resource-limited countries. This study replicates and expands on earlier research that investigated a complex network of relationships between academic self-efficacy, educational aspirations, and academic performance. METHODS: Data from 4282 adolescents in Ghana and path analysis were used to test the causal pathways, and path invariance analysis was used to assess the moderation role of gender. Instrumental variable techniques were used to validate the path models. RESULTS: Increase in academic self-efficacy indirectly accounts for improvement in academic performance through the mediational role of educational aspirations. The effects of self-efficacy on educational aspirations, and educational aspirations were stronger for boys than for girls. CONCLUSIONS: These findings suggest that in resource-limited countries where the financial burden of schooling tends to be a demotivating factor, interventions that target adolescents' academic self-efficacy may be an effective means to boost educational aspirations and academic performance. Interventions should be tailored to meet the needs of all students so that all children can think of school as an important part of their lives and aspire to achieve, now and in the future.

School-based HIV/AIDS education, risky sexual behaviors, and HIV testing among high school students in the United States.

This study assessed the practical value of HIV/AIDS education among at-risk adolescents in the United States. Data were drawn from the 2013 Youth Risk Behavior Surveillance System spanning students in grades 9-12 who have engaged in sexual intercourse. A multivariate hierarchical logistic regression analysis was employed to test: (1) the individual effects of school-based HIV/AIDS education and risky sexual behaviors on the probability of HIV testing and (2) the interaction effects to estimate the degree to which the education effect varied by specific risky sexual behavior. The results indicated that students who engaged in risky sexual activities and received HIV/AIDS education were more likely to test for HIV compared to those who did not receive HIV/AIDS education. The relationship between education and HIV testing also varied according to the number of recent sexual partners. The findings have policy and practice implications. Specifically, HIV/AIDS education that promotes HIV testing should be encouraged particularly with the high-risk student population.

Pathways between depression, substance use and multiple sex partners among Northern and Indigenous young women in the Northwest Territories, Canada: results from a cross-sectional survey.

OBJECTIVES: Sexual and mental health disparities exist in the Northwest Territories (NWT) compared with other Canadian regions. STI rates are 10-fold higher, and youth suicide rates double the Canadian average. Scant research has examined associations between mental and sexual health among youth in the NWT. The study objective was to explore pathways from depression to multiple sex partners (MSP) among young women in the NWT, Canada. METHODS: We implemented a cross-sectional survey in 2015-2016 with a venue-based recruitment sample of young women aged 13-17 attending secondary schools in 17 NWT communities. We conducted path analysis to test a conceptual model examining associations between depression and a history of MSP, examining substance use and peer support as mediators. RESULTS: Participants (n=199; mean age: 13.8, SD: 1.27) mostly identified were Indigenous (n=154; 77.4%) and one-fifth (n=39; 20.5%) were sexually diverse/non-heterosexual. Almost two-thirds (n=119; 63.3%) reported depression symptoms. One-quarter (n=53; 26.6%) were currently dating, and 16.1% (n=32) reported a lifetime history of >1 sex partner (classified as having MSP). There was no direct effect between depression and MSP (ß=0.189, p=0.087, 95% CI 0.046 to 0.260). Depression had a direct effect on substance use (ß=0.023, p<0.050, 95% CI 0.118 to 0.500), and an indirect effect on MSP through substance use (ß=0.498, SE=0.10, p<0.001, 95% CI 0.141 to 0.280). Depression was associated with lower peer support (ß=-0.168, p<0.010, 95% CI -0.126 to 0.280); peer support was not associated with MSP (ß=-0.158, p=0.130, 95% CI -0.126 to 0.001). CONCLUSION: This research is among the first to identify mental health factors associated with STI vulnerability among young women in the NWT. Findings demonstrate the importance of addressing depression and substance use in sexual health interventions in Northern contexts.

Pathways from Resilient Coping to Safer Sex Communication Among African, Caribbean, and Black Women in Toronto, Canada: Results from a Cross-sectional Survey.

PURPOSE: African, Caribbean, and Black (ACB) women in Canada are disproportionately impacted by HIV and other sexually transmitted infections. Although there is reported suboptimal consistent condom use with ACB women, limited research has explored safer sex communication among this population. Coping frameworks highlight the role that resilient coping and condom use self-efficacy may play in facilitating safer sex communication. Structural perspectives stress the need to explore associations between HIV vulnerabilities and food insecurity. We examined pathways from resilient coping to safer sex communication through the mediator of condom use self-efficacy among ACB women in Toronto. METHOD: We conducted a cross-sectional survey with a purposive sample of ACB women aged 16 and older across Toronto, Canada. We conducted path analysis to test the direct effects of resilient coping on safer sex communication, and indirect pathways through the mediator (condom use self-efficacy) while controlling for food insecurity. RESULTS: Participant (n = 80; mean age 27, SD 7.93) ethnicities included African (58.8%, n = 47), Caribbean (30%, n = 24), and others (11.3%, n = 9). Participants with food security reported significantly higher safer sex communication. We found no direct effect of resilient coping on safer sex communication. Findings support the hypothesized mediation process; resilient coping was associated with condom use self-efficacy, which in turn was associated with safer sex communication. CONCLUSION: Findings that condom use self-efficacy mediated the association between resilient coping and safer sex communication align with theoretical assertions of the protective role of adaptive coping strategies. Findings can inform tailored HIV and STI preventive interventions with ACB women.

Kukaa Salama (Staying Safe): a pre-post trial of an interactive informational mobile health intervention for increasing COVID-19 prevention practices with urban refugee youth in Uganda.

BACKGROUND: Tailored coronavirus disease 2019 (COVID-19) prevention strategies are needed for urban refugee youth in resource-constrained contexts. We developed an 8-wk interactive informational mobile health intervention focused on COVID-19 prevention practices informed by the Risk, Attitude, Norms, Ability, Self-regulation-or RANAS-approach. METHODS: We conducted a pre-post trial with a community-recruited sample of refugee youth aged 16-24 y in Kampala, Uganda. Data were collected before (T1) and immediately following (T2) the intervention, and at the 16-wk follow up (T3), to examine changes in primary (COVID-19 prevention self-efficacy) and secondary outcomes (COVID-19 risk awareness, attitudes, norms and self-regulation practices; depression; sexual and reproductive health [SRH] access; food/water security; COVID-19 vaccine acceptability). RESULTS: Participants (n=346; mean age: 21.2 [SD 2.6] y; cisgender women: 50.3%; cisgender men: 48.0%; transgender persons: 1.7%) were largely retained (T2: n=316, 91.3%; T3: n=302, 87.3%). In adjusted analyses, COVID-19 prevention self-efficacy, risk awareness, attitudes and vaccine acceptance increased significantly from T1 to T2, but were not sustained at T3. Between T1 and T3, COVID-19 norms and self-regulation significantly increased, while community violence, water insecurity and community SRH access decreased. CONCLUSIONS: Digital approaches for behaviour change hold promise with urban refugee youth but may need booster messaging and complementary programming for sustained effects.

Exploring ecosocial contexts of alcohol use and misuse during the COVID-19 pandemic among urban refugee youth in Kampala, Uganda: Multi-method findings.

Urban refugees may be disproportionately affected by socio-environmental stressors that shape alcohol use, and this may have been exacerbated by additional stressors in the COVID-19 pandemic. This multi-method study aimed to understand experiences of, and contextual factors associated with, alcohol use during the pandemic among urban refugee youth in Kampala, Uganda. We conducted a cross-sectional survey (n = 335), in-depth individual interviews (IDI) (n = 24), and focus groups (n = 4) with urban refugee youth in Kampala. We also conducted key informant interviews (n = 15) with a range of stakeholders in Kampala. We conducted multivariable logistic regression analyses with survey data to examine socio-demographic and ecosocial (structural, community, interpersonal) factors associated with ever using alcohol and alcohol misuse. We applied thematic analyses across qualitative data to explore lived experiences, and perceived impacts, of alcohol use. Among survey participants (n = 335, mean age= 20.8, standard deviation: 3.01), half of men and one-fifth of women reported ever using alcohol. Among those reporting any alcohol use, half (n = 66, 51.2 %) can be classified as alcohol misuse. In multivariable analyses, older age, gender (men vs. women), higher education, and perceived increased pandemic community violence against women and children were associated with significantly higher likelihood of ever using alcohol. In multivariable analyses, very low food security, relationship status, transactional sex, and lower social support were associated with increased likelihood of alcohol misuse. Qualitative findings revealed: (1) alcohol use as a coping mechanism for stressors (e.g., financial insecurity, refugee-related stigma); and (2) perceived impacts of alcohol use on refugee youth health (e.g., physical, mental). Together findings provide insight into multi-level contexts that shape vulnerability to alcohol mis/use among urban refugee youth in Kampala and signal the need for gender-tailored strategies to reduce socio-environmental stressors.

Effect of Financial Literacy on Poverty Reduction Across Kenya, Tanzania, and Uganda.

Financial literacy can be critical to reducing poverty, but limited evidence exists on the mechanisms of change. Guided by the financial capability framework, this study examines the direct effects of financial literacy on poverty and the indirect effect through financial inclusion and entrepreneurship, using data from wave 5 of the InterMedia Financial Inclusion Insights Program for Kenya, Tanzania, and Uganda. We also examined how the relationships differ by gender and locality. Overall, the endogeneity-corrected results suggest that an increase in financial literacy is associated with a 6.9% decrease in poverty. We found that entrepreneurship and financial inclusion act as mechanisms of change through which financial literacy decreases poverty, with the findings differing by gender and locality. These findings point to the poverty-reducing effect of financial literacy, mainly in Tanzania, followed by Kenya and Uganda. The results contribute to understanding how financial literacy and poverty interact and can inform contextually relevant interventions and policies.