Correlates of alcohol experimentation and drunkenness episodes among secondary-school students in Nigeria.

Background: Alcohol is the most used substance among adolescents in Nigeria. While risk factors for alcohol use among adolescents are well documented in Europe and the US, they have received less attention in the literature on African countries. This study aimed to investigate the factors associated with alcohol experimentation and drunkenness episodes in a national sample of Nigerian adolescents. Methods: A total sample of 4,078 secondary-school students participated in the survey during the school year 2015-2016. The survey involved 32 secondary schools of six geopolitical zones (South-South, South-West, South-East, North-Center, North-West, and North-East) and two metropolitan cities (Abuja and Lagos) of Nigeria. Sociodemographic characteristics, parental alcohol use and permissiveness, friends' alcohol use, risk perceptions and beliefs were investigated as correlates of alcohol experimentation and drunkenness episodes through multilevel, mixed-effect logistic regression models. Results: The prevalence of alcohol experimentation was 34.0%, while the prevalence of drunkenness episodes was 13.4%. Results showed that male gender, family structure different from both parents' families, parental and friends' alcohol use, parental permissiveness to drink, low risk perceptions on drinking alcohol, and positive beliefs on consequences of alcohol use were associated with an increased probability of alcohol experimentation and drunkenness episodes. Family affluence and one-parent family structure were related to an increased probability of alcohol experimentation but not of drunkenness episodes. Conclusions: The majority of risk factors analyzed in this study generalize across drinking-behavior outcomes. Since the young population is dominant in Nigeria, alcohol use could become a big public health problem in the near future. High investment in adolescents' well-being by addressing the factors that contribute to drinking behavior might help to reduce the burden of the problem. Evidence-based prevention curriculum addressing knowledge, risk perceptions, beliefs on consequences of alcohol use, and parental behaviors should be implemented as widely and early as possible.

Effects of the "Unplugged" school-based substance use prevention program in Nigeria: A cluster randomized controlled trial.

BACKGROUND: School-based programs are the most convenient interventions to tackle substance use among youth. "Unplugged" is a Social Influence universal school curriculum developed and tested in the "EU-Dap" project. In 2015, Nigeria implemented a large-scale project to promote healthy lifestyles in schools, families and communities. Within the project, the effectiveness of "Unplugged" was evaluated through a cluster randomized controlled trial. METHODS: The program was adapted to the Nigerian context, assembling suggestions from monitoring forms and interviews, and performing fidelity checks on content and method. Thirty-two secondary schools were extracted from a list provided by the Federal Ministry of Education, and randomly allocated to intervention and control arms. A self-completed anonymous questionnaire was used for baseline and follow-up surveys. The analysis sample finally included 2685 pupils (mean age 14.2 years). Multilevel models were run to estimate program effects on prevalence of self-reported cigarettes, alcohol, and marijuana use. Mediation analysis was performed to identify possible mediators of program effect on alcohol use. RESULTS: Unplugged significantly reduced the prevalence of recent alcohol use in intervention vs control pupils. The effect on prevalence of cigarette and marijuana use was not statistically significant. The program prevented progress and encouraged regress across stages of intensity of alcohol use. Negative beliefs, risk perceptions, and class climate mediated the effect of Unplugged on alcohol use. CONCLUSIONS: Unplugged was effective in preventing alcohol use improving beliefs, class climate and risk perceptions among Nigerian students. The implementation of the program at a larger scale in the country should be supported.

Correlates of cannabis and other illicit drugs use among secondary school adolescents in Nigeria.

BACKGROUND: The burden of cannabis and other illicit drug use among youth represent a serious public health problem. The aim of the present study is to explore factors associated with cannabis and other illicit drug use among Nigerian secondary school adolescents of the six geopolitical zones of the country. METHODS: A total sample of 4078 secondary school adolescents of 32 schools from the six geopolitical zones of Nigeria participated in a cross-sectional survey in December 2015-January 2016. The association of sociodemographic characteristics, parental smoking, parental permissiveness to drink, friends' marijuana or other drugs use, risk perceptions and beliefs with the risk of lifetime cannabis and other illicit drugs use was examined through multilevel logistic regression models. RESULTS: The mean age of the students involved in the study was 14.7 years. Older age, living in one-parent or family structures different from both parents household, parental smoking, parental permissiveness to drink alcohol, friends' use of marijuana or other drugs, low risk perception of harmful effects, and positive beliefs on marijuana or drugs use were associated with the risk of cannabis and illicit drugs use. The indicator of socioeconomic status was associated to the risk of using cannabis, but not to the risk of using illicit drugs. CONCLUSIONS: The present study highlights some correlates that influence the uptake of cannabis and drugs among Nigerian adolescents. Preventive programs addressing these factors could help to reduce the burden of the problem. Specific attention should be given to interventions to contrast the incorrect beliefs and perceptions.

A rapid situation and response assessment of the female regular sex partners of male drug users in South Asia: factors associated with condom use during the last sexual intercourse.

OBJECTIVES: We carried out a rapid assessment among the female regular sex partners of drug users/injecting drug users recruited from Bangladesh, Bhutan, India, Nepal and Sri Lanka with the objective of designing appropriate responses targeting them. We examined the correlates of condom use among them. METHODS: Data was collected from 4612 female regular sex partners recruited by different NGO partners spread across the five countries in the region. We carried out univariate and multivariate logistic regression analysis to determine variables associated with condom use during their last sexual intercourse. RESULTS: Of the total sample, 22% admitted to using drugs ever in their life and 21% reported condom use during the last sexual act. A fourth of the participants have not heard of HIV/AIDS and only 17% have been tested for HIV. In a multivariate model, women engaged in sex work, from Nepal, used drugs before last sexual intercourse, heard of HIV/AIDS, ever used drugs and approached by someone with information on HIV were likely to have used condoms during the last sexual intercourse about twice or more: (AOR=4, 95% CI: 3, 5.3; AOR=3.4, 95% CI: 2.4, 4.9; AOR=2.5, 95% CI: 1.9, 3.3; AOR=2.1, 95% CI: 1.5, 3; AOR=2, 95% CI: 1.5, 2.6; AOR=1.7, 95% CI: 1.4, 2 respectively). Condom use was negatively associated with women with a single sex partner (AOR=0.6, 95% CI: 0.5, 0.7). CONCLUSIONS: Condom use is low among the female regular sex partners and is primarily associated with women exhibiting risky practices. Apart from sustaining and expanding HIV prevention programmes that aim to increase the HIV/AIDS related knowledge and scale-up HIV testing among the drug users and their regular sex partners, there is an urgent need to reach out to the women in stable marital relationship with drug users. This study has demonstrated that it is feasible to access this population and the priority is to design and implement individual, couple and group level interventions that ensure consistent condom use with their primary partners.