Alcohol Use as a Predictor of Risky Sexual Behaviour among Young Adults in the Western Cape Province of South Africa.

The aim of this study was to investigate the relation between alcohol consumption and risky sexual behaviour (RSB). This study further aimed to examine whether alcohol use, gender, and employment status predicted RSB among young adults in the Cape Flats. A better understanding of these predictors could potentially lead to a more thorough comprehension of the relation between alcohol consumption and RSB among young adults within the South African context. The study employed a cross-sectional correlational survey design, with a sample of 1001 participants aged 18 to 25 (51% women), using the street-intercept method. Participants were selected using purposive sampling, with age and geographical location employed as inclusion criteria. We used the Self-Report Risky Sexual Behaviours Scale (SRSBS) and the Alcohol Use Disorder Identification Test (AUDIT), which were cognitively tested and modified, in English and Afrikaans. The data were analysed via multivariate multiple regression analysis in Stata. The key findings indicate that alcohol consumption is an important predictor of RSB. Alcohol consumption accounted for 23.22% of the variation in RSB. We also found that alcohol consumption and gender were significant (p < 0.1) predictors of RSB, but not employment status (p > 0.01). Being a woman decreased RSB. The model indicates that alcohol use and gender explain 18.41% of the variance in RSB. This study provides support for the growing body of research evidence that has established a significant link between alcohol consumption and RSB, highlighting the need for longitudinal research to determine patterns of risky drinking in the general population.

Narcotics Anonymous attendees' perceptions and experiences of substitute behaviors in the Western Cape, South Africa.

BACKGROUND: Much remains unknown about the dynamics of substitute behaviors during addiction recovery among persons attending recovery support groups. Insight into the nature, motives for, and course of substitute behaviors could help to shape recovery support and harm reduction services. METHODS: Twenty-three semi-structured in-depth interviews (n = 14 males and n = 9 females) were conducted with a convenience sample of Narcotics Anonymous attendees from a number of groups in the Western Cape, South Africa. Participants ranged in age from 22-55 years (M = 39.3, SD = 9.35). RESULTS: Thematic analysis yielded four themes: (i) substance-to-substance substitution; (ii) substance-to-behavior substitution; (iii) substitute behaviors and harm (reduction) and (iv) support needs to manage and resolve substitute behaviors. According to the study, participants' substitute behaviors developed across recovery stages; were temporary or long-term replacements for substance use disorders and were engaged for distraction, isolation from others, calming, assuaging boredom, keeping occupied, filling a perceived experiential void, modifying mood and to self-medicate. While substitutes were utilized for harm reduction or relapse prevention, the potential for ostensibly healthy behaviors to threaten recovery and lead to relapse was also recognized. CONCLUSIONS: Self-monitoring, ongoing vigilance, and awareness of when substitutes become genuine addictions are critical for timely, suitable interventions.

Youths' Perceptions Of The Relation Between Alcohol Consumption And Risky Sexual Behaviour in the Western Cape, South Africa: A Qualitative Study.

The purpose of this study is to explore the factors that youth identify as contributing to alcohol consumption, and more specifically its relation to risky sexual behaviour among youth. We employed an exploratory qualitative method using focus group discussions with 34 young people between the ages of 18-25-years-old in low socio-economic status communities in the Western Cape province of South Africa. Data were analyzed thematically utilizing Braun and Clarke's (2006) six-step thematic analysis process. We identified two thematic domains pertaining to alcohol consumption and risky sexual behaviour, namely individual and social factors, each comprising three themes. The individual factors thematic domain comprises intrapersonal influences, employment and educational attainment; while the social factors thematic domain includes interpersonal influences, social influences, and hope for the future. Youth living in low socio-economic status communities were thought to be at greater risk of alcohol misuse and subsequent risky behaviour, given the political and social history of marginalisation, systematic oppression, and social inequality. To address alcohol use and risky sexual behavior among youth, we recommend interventions with adolescents, parents or guardians, and the community. More specifically, interventions aimed at adolescents should focus on the transition to young adulthood. Interventions with parents should focus on their role in modelling and potentially regulating alcohol consumption. Finally, community interventions should centre on drinking behaviors, levels of drinking, what constitutes harmful drinking, and how to identify when treatment and recovery support is likely to be required.

Youth and Adolescents' Perceptions of Violence in Post-Apartheid South Africa: A Systematic Review of the Literature.

The history of South Africa is embedded in violence. Exposure to various forms of violence is a consistent experience of children, adolescents, and young people in this context, negatively impacting various aspects of their lives and overall quality of life. However, these experiences of violence have been narrated from an adult-centric perspective. The current study thus aims to systematically review and synthesis existing empirical studies focusing on youth and adolescents' perceptions of violence in post-apartheid South Africa. We identified 34 articles that were included in the final review, with study samples ranging from youth and adolescents between the ages of 8 to 27-years-old. The included studies were delineated into three overarching themes using thematic analysis, namely: exposure to violence; gender and sexual-based violence; and interpersonal and school violence. We found several contributing factors that resulted in violence, such as: low socio-economic conditions, hegemonic masculinity, and male entitlement over women; which can be linked to the corollaries of apartheid. At a grassroots level, more research is needed to gain deeper knowledge about how youth and adolescents understand, conceptualise, and contextualise violence through various frameworks. Moreover, violence prevention and intervention requires a collaborative approach to exact meaningful change that will be beneficial for all stakeholders. Supplementary Information: The online version contains supplementary material available at 10.1007/s12187-021-09890-5.

Substitute Behaviors following Residential Substance Use Treatment in the Western Cape, South Africa.

The dynamics of substitute behaviors and associated factors remain poorly understood globally, and particularly in low- and middle-income contexts. This prospective study describes the prevalence and types of substitute behaviors as well as predictors, correlates, and motivations associated with substitution in persons (n = 137) admitted to residential substance use treatment in the Western Cape province of South Africa. The brief assessment of recovery capital, overall life satisfaction scale, and an adapted version of the addiction matrix self-report measure were completed during and post-treatment. Results indicate that substitutes were employed consciously for anticipated appetitive effects, for time-spending, (re)connecting with others, and enjoyment. At follow-up, 36% of service users had substituted their primary substance(s) with another substance or behavior; 23% had relapsed and 40% had maintained abstinence. While some service users may be especially vulnerable to developing substitute behaviors, targeted prevention and intervention efforts can reduce this risk.

Prevalence of bullying victimisation among primary school children in South Africa: a population-based study.

OBJECTIVES: Bullying victimisation (BV) among children in South Africa has been identified as a major public health concern. While several studies report on the prevalence rates of BV, there is currently a dearth of research that reports on the prevalence of BV among a national sample of primary school children. This study determines the prevalence rates of BV among a nationally representative sample of school-going children in South Africa across provinces, age, and gender. The sample comprised 7067 children (boys = 45.6%; girls = 54.4%) between the ages of 10-12-years attending 61 primary schools across the nine provincial regions of South Africa. RESULTS: In terms of 'being hit' by other children, percentages range from 22.55% (North West) to 33.34% (Free State). Children in Gauteng (33.59%) and Limpopo (38.54%) had the highest percentage of children being 'left out' or excluded. Additionally, across all provinces more than 30% of children reported that they had been 'called unkind names'. Across gender, boys are more likely to experience all three forms of BV (being hit, left out, and called unkind names). The findings further indicate that 10-year-olds reported being 'hit' and 'left out', whereas a greater percentage of 12-year-olds reported 'being called unkind names' (44.28%).

The Structure of Children's Subjective Well-being.

Research on children's quality of life and subjective well-being has advanced over the past decade largely as a result of developments in childhood theory, children's rights legislation, and the shift toward positive social science. However, in line with the uncertainty regarding the conceptualization of subjective well-being, the structural configuration of children's subjective well-being has not been considered in the literature. In the current study, we present and test a model of children's subjective well-being, which includes global (context-free items assessing overall and general well-being, without reference to a specific aspect of life) and specific (domain-based items assessing a specific aspect of life) cognitive components, and positive and negative affect. We further test the fit structure of a hierarchical structural (second-order) model of children's subjective well-being. Finally, we test the measurement invariance of the hierarchical model across age and gender. We use data from the third Wave of the Children's Worlds Survey. The data source includes a sample of 92,782 participants selected from 35 countries (girls = 49.7%) in two age groups (10- and 12-years-old). We found a good fit for the four-factor confirmatory factor model of children's subjective well-being. Correlations between the various latent factors were as anticipated-with positive correlations between the life satisfaction components and positive affect, and negative correlations with negative affect. We further found a good fit for the hierarchical structural model of children's subjective well-being. Finally, we found the tenability of measurement invariance across age and gender. The study extends the generalizability of the hierarchical structural configuration of the subjective well-being to child samples, and provides a viable model to explore correlates and predictors of children's subjective well-being using the full conceptual model. Finally, we propound the tenability of a quadripartite hierarchical conceptual model of children's subjective well-being.

Substitute Addictions in Persons with Substance Use Disorders: A Scoping Review.

BACKGROUND: Substitute addictions, addictive behaviors that sequentially replace each other's functions, have implications for recovery trajectories but remain poorly understood. We sought to scope the extent, range, and characteristics of research on substitute addictions in persons with substance use disorders. Method: Using Arksey and O'Malley's framework for scoping reviews, a systematic search was conducted to identify publications that referenced substitute addictions up to April 2018. Study characteristics were extracted and summarized to provide an overview of the extant literature. Results: The 63 included studies show that substitute addictions are terminologically and conceptually ambiguous. Much of the available literature is concentrated in developed contexts - and in particular the United States of America. While presentations varied, at least two sub-types of substitute addictions appeared: long-term replacement and temporary replacement. Existing theories suggest a multifactorial etiology. Conclusions: The findings suggest a strong need for: increased awareness of substitute addictions and its potential consequences for recovery; interventions that structure prevention and pre-, during-, and post-treatment interactions as well as future research to explore its nature and dynamics drawing on multiple methods.

Substitute addictions in the context of the COVID-19 pandemic.

The global spread of COVID-19, subsequent stay-at-home requirements, spatial distancing measures, and long-term isolation present additional challenges for persons in recovery. Using an illustrative case from South Africa, we discuss COVID-19 related pornography use through the lens of relapse and substitute addiction. South Africa is the epicenter of the pandemic in Africa, and has issued an alcohol and cigarette ban. Historical examples suggest that responses to forced abstinence may include compliance and abstinence, but also seeking alternatives to the original addiction and substitution. Substitution of alternative activities/objects may provide similar appetitive effects to fill the void of the terminated addictive behavior, temporarily or in the long-term. While substitutes do not necessarily portend a relapse, coupled with isolation and reduced recovery support, they can potentiate relapse to the former or 'new' addictive behavior. Addiction professionals should be aware of the potential for such negative impacts during and after the COVID-19 pandemic.

The relation between subjective well-being and career aspirations amongst a sample of adolescents in low socioeconomic status communities in Cape Town.

The study aimed to determine the relation between adolescents' subjective well-being and career aspirations. The study further aimed to determine the extent to which social support mediates this relation. The sample comprised 1082 adolescents in Grades 8-11, selected from schools located in low socioeconomic status communities in Cape Town, South Africa. The overall model demonstrated a nonsignificant relation between adolescents' subjective well-being and career aspirations. Across gender, the results indicated a significant relation between subjective well-being and career aspirations for the male group, but not for females. The results further indicate that social support did not mediate the relation between adolescents' subjective well-being and career aspirations for the pooled sample. However, for females, the study found a significant negative relation between social support and aspirations. We recommend targeting interventions at an institutional level, inclusive of challenging gender roles and providing information about educational and career opportunities for young people.

Children's Hope in South Africa: A Population-Based Study.

A growing body of research has provided evidence for the cognitive motivational construct of hope as a psychological strength, particularly for children in adverse social circumstances. In children, hope is defined as a set of cognitions focused on children's agency to contemplate workable goals, to identify pathways to achieve those goals and the intrinsic beliefs about their capacity to activate sustained movement toward those goals. Using data from the third wave of the Children's Worlds International Survey on Children's Well-Being, the study aimed to explore children's hope amongst a random population-based sample of children in South Africa. The study further aimed to explore children's level of hope across the nine provincial regions of South Africa. Data were collected using Snyder et al.'s (1997) Children's Hope Scale (CHS). Confirmatory factor analysis (CFA) was used to analyze the data, with multi-group CFA used to analyze the data across provincial regions. The study found an appropriate fit structure for the CHS using the overall pooled sample. The mean score on the CHS for the national sample was of 4.781 (SD = 1.082). Measurement invariance demonstrated the tenability of scalar invariance, which indicates comparability across correlations, regressions and mean scores. Mean scores ranged from 4.511 (SD = 1.163) for the Northern Cape to 4.982. (SD = 0.974) for the Western Cape. Five provinces (Eastern Cape, Northern Cape, Free State, Mpumalanga, and KwaZulu Natal) scored below the national mean, while four provinces (North West, Western Cape, Limpopo, and Gauteng) scored above.

Children's Experiences of Bullying Victimization and the Influence on Their Subjective Well-Being: A Multinational Comparison.

The study used data from the second wave of the Children's Worlds Survey to explore the relation between children's experiences of bullying victimization (physical and psychological) and their subjective well-being (SWB) across three age groups (8, 10, and 12) and 15 global geographical regions. The sample consists of 47,029 children randomly selected from 15 countries. Data were analyzed using structural equation modeling and multigroup confirmatory factor analysis. The results show appropriate fit structure for the overall model, and that the combined influence of physical and psychological bullying made a significant contribution to SWB across age groups and geographical regions. The findings are interpreted using Cummins's (1995) Homeostasis Theory of SWB.

Adapting and Validating the Family Resilience Assessment Scale in an Afrikaans Rural Community in South Africa.

A family resilience framework understands families as having the potential to not only face adversities but to overcome them; although its measurement is not always agreed upon. The aim of this study is to explain the processes involved in the adaptation of the 54-item family resilience assessment scale into Afrikaans, and to further examine its psychometric properties. Data were collected via the door-to-door method with the assistance of fieldworkers in two rounds. The pilot sample included 82 participants whilst the larger study included 656 participants. The internal consistency and construct validity was assessed using Cronbach's alphas and Exploratory Factor Analysis implementing a Principal Component Analysis and Promax rotation, respectively. The factors which were found are similar to those of Sixbey's, however, a new factor emerged replacing Maintaining a positive outlook which was named Family and community outlook. The processes described in this study facilitated the assessment of the feasibility and efficiency of the full-scale study and reduced the number of unanticipated problems associated with large sample data collection particularly using fieldworkers.

The development of a family resilience-strengthening programme for families in a South African rural community.

The aim of this study was to develop a contextually based family resilience program. Also presented here is a literature review of family resilience interventions suggesting that these 3 processes are the basis for effective family functioning. A close collaboration with the community ensured an adequate understanding of the presenting family challenges and this article describes the process in developing a program based on these challenges. A 3-round Delphi design was used for the study with international and local experts (n = 10) in the field of family and resilience studies and community stakeholders (n = 5). The program has three main aims: to increase family connectedness, family communication processes and social and economic resources. Based on the findings of this study, 4 modules will be presented to participants, "about family," "talking together," "close together," and "working together." A description is provided of the program content and decisions regarding logistical program concerns.

Children's representations of nature using photovoice and community mapping: perspectives from South Africa.

The aim of the study was to explore children's representations and perceptions of natural spaces using photovoice and community mapping. The sample consisted of 28 children aged 12-14 years residing in urban and rural communities in the Western Cape, South Africa. Data were collected by means of a series of six focus groups interviews (three photovoice discussion groups and three community mapping discussion groups). For the photovoice missions, children were provided with a 28-exposure disposable camera and given 1 week to complete their missions. Thematic analysis was employed to analyse the data. Three key themes emerged, namely: safe spaces in nature, unsafe spaces in nature, and children's favourite places in nature. Socio-economic status (SES) was found to be a determining factor in how children make sense of natural spaces. Children from low SES communities indicated being more constricted in their mobility, and were unable to access to safe natural spaces compared to the children from the middle SES community. It is recommended that an expedient starting point would be to work towards and build environmentally and child-friendly communities for children, with children as key contributors in the planning process using a child participation framework.

The use of visual methods to explore how children construct and assign meaning to the "self" within two urban communities in the Western Cape, South Africa.

This study aimed to explore how children construct and assign meaning to the "self" within two urban communities of Cape Town in South Africa. Using a child participation methodological framework data were collected using Photovoice and community maps with 54 participants between the ages of 9 and 12. Feelings of safety, social connectedness, and children's spaces were found to be central to the ways in which the participants constructed and assigned meaning to the "self." The study provides implications for intervention programmes aimed at improving children's well-being to be inclusive of activities aimed at improving children's self-concept, including the construction of safe spaces for children to play, learn, and form meaningful relationships.

A qualitative study of referring agents' perceptions of access barriers to inpatient substance abuse treatment centres in the Western Cape.

BACKGROUND: Despite empirical support for the individual and public health benefits of treating substance use disorders (SUDs) , access to these services is impeded by several barriers. Although many studies on access barriers have been put forward in the literature, few have explored the barriers to accessing state-funded inpatient substance abuse treatment or the views of referral agents. METHODS: A qualitative study was conducted to explore referring agents' perceptions of the barriers to accessing state-funded inpatient substance abuse treatment centres in the Western Cape Province of South Africa. Six individual in-depth interviews were conducted and analysed using theoretical thematic analysis. RESULTS: The key barriers to emerge from the analysis pertained to referring agents' perceptions of the following: service users, the substance abuse referral and treatment system and community dynamics. CONCLUSIONS: Recommendations are made for interventions to address the identified barriers.