Showing papers by "Alan J. Flisher published in 2003"

Sexual behaviour of Cape Town high-school students.

Abstract: Objectives. To document prevalence rates for selected aspects of sexual behaviour among Cape Town high-school students and to conduct a survival analysis of age at first intercourse. Design. Cross-sectional survey. Setting. State high schools in Cape Town. Subjects. A multistage cluster sample of 2 740 grade 8 and 11 students at 39 schools. Outcome measures. Ever having had sexual intercourse; for those who had, age at first intercourse, number of partners during the previous 12 months, time since last intercourse; and, at last intercourse, whether the partner had been known for more than 7 days, whether any method was used to prevent pregnancy or disease, and (if so) what was used. Results. Overall, 29.9% had participated in sexual intercourse, with a higher proportion among males and those in grade 11. By the age of 14 years, 23.4% of males and 5.5% of females had participated in sexual intercourse. By the age of 19 years, these proportions were 71.8% and 58.2% respectively. The median time since last intercourse was 4 weeks, the median number of partners in the past year was 1, and 78.4% had known their most recent partner for more than 7 days. At their last coital episode, 65.4% had used contraception, and the most common methods were condoms and injectable steroids, which were used by 67.7% and 43.2% respectively. Conclusions. The proportion of sexually active students has increased since 1990. Intervention programmes should commence in primary school. Large numbers of students are at risk for pregnancy and sexually transmitted infections. (South African Medical Journal: 2003 93 (7): 537-541)

Community/hospital indicators in South African public sector mental health services.

Abstract: Background: The need to balance resources between community and hospital-based mental health services in the postdeinstitutionalisation era has been well-documented. However, few indicators have been developed to monitor the relationship between community and hospital services, in either developed or developing countries. There is a particular need for such indicators in the South African context, with its history of inequitable services based in custodial institutions under apartheid, and a new policy that proposes the development of more equitable community-based care. Indicators are needed to measure the distribution of resources and the relative utilisation of community and hospital-based services during the reform process. These indicators are potentially useful for assessing the implementation of policy objectives over time. Aims of the Study: To develop and document community/hospital indicators in public sector mental health services in South Africa. Methods: A questionnaire was distributed to provincial mental health coordinators requesting numbers of full-time equivalent (FTE) staff who provide mental health care at all service levels, annual patient admissions to hospitals and annual patient attendances at ambulatory care facilities. The information was supplemented by consultations with mental health coordinators in each of the 9 provinces. Population data were obtained from preliminary findings of the 1996 census. The community/hospital indicator measuring staff distribution was defined as the ratio of staff employed in community settings to all staff, expressed as a percentage. The community/hospital indicator measuring patient service utilisation was defined as the ratio of the annual ambulatory care attendance rate per 100 000 population to the sum of this rate and the annual hospital admission rate per 100 000 population, expressed as a percentage. Results: Of psychiatric public sector staff, 25% are located in community settings in South Africa (provincial range: 11-70%). If hospital outpatient services are included in the definition of ‘‘hospital’’, this figure is reduced to 17% (provincial range: 3-56%). In terms of service utilisation, 66% of patient contacts with mental health services occur through ambulatory care services in South Africa (provincial range: 44-93%). Discussion: Community/hospital staff distribution indicates an overemphasis on centralised hospital-based care in most provinces and inadequate hospital care in certain provinces. Patterns of patient service utilisation indicate an over-reliance on central hospital-based services and substantial unmet need. The findings draw attention to problems in information systems for mental health care in South Africa. Implications for Health Policies: The community/hospital indicators developed for this study form a useful measure for assessing the implementation of mental health policy over time. For the South African context, the community/hospital indicators are a measure of the extent of resource redistribution from hospital to community services and changing patterns of service utilisation over time. Currently, patterns of resource distribution and service utilisation are inconsistent with government policy. Implications for Further Research: Further research is needed into the development of mental health information systems, refining service indicators and improving methodologies for assessing the implementation of mental health policies in service delivery.

Reliability of the Beck Depression Inventory and the Self-Rating Anxiety Scale in a sample of South African adolescents.

Abstract: Objective - This study aimed to assess the reliability of the Beck Depression Inventory (BDI) and the Self-Rating Anxiety Scale for epidemiological investigations of adolescents' symptoms. Method - Self-report questionnaires were administered on two occasions to 104 students in four private high schools in Cape Town, South Africa. Test-retest reliability was assessed using Cohen's kappa and observed agreement. Internal consistency of each scale was assessed using Cronbach's alpha. Resuls - All items of the BDI and all but four of the Self-Rating Anxiety Scale had at least fair Kappa scores. The remaining four items of the Self-Rating Anxiety Scale had reasonable observed agreement and reflect more transient states that are likely to change between administrations. Conclusions - The results give encouraging indication that these instruments may be reliable in developing contexts. However, the study is limited by a sample that is small and not sufficiently representative of the broader South African population. Future studies should include larger and more representative samples, in order to explore item bias in different race and gender subgroups. Validity also needs investigation.

Violence and Substance Use in Adolescents with Increasing Severity of Suicidal Behavior

Abstract: A theoretical pathway of progression of suicidal behavior, from ideation tocommunicating suicidal intent to suicide attempt was examined by investigating whether adolescents at each stage of the pathway could be differentiated from those at the previous stage by their risk behaviors. Cluster sampling produced a sample of 7,340 high-school students who completed a self-administered questionnaire. Bivariate analyses and multivariate logistic regression models were used to investigate the relationships between stage of severity of suicidal behavior and selected risk behaviors. For females, the more severe the suicidal behaviors exhibited, the more likely that the adolescent had been both a perpetrator and victim of violence. For males, attempting suicide was associated with being a victim and perpetrator of violence. Our findings lend partial support to the continuum of severity hypothesis of suicidal behaviors and suggest that clinicians should be alerted to escalating violent behavior as a potential precur...

Book Review: Stages and Pathways of Drug Involvement. Examining the Gateway Hypothesis:

Abstract: Extracted from text ... The notion that there are stages and sequences of substance use was first articulated in the substance abuse literature in the 1970s. According to this notion, there is a series of stages of drug use that begins with alcohol or tobacco, then proceeds to cannabis, and then to "hard" or illicit drugs, such as cocaine and morphine. The term "gateway drug" is closely related to the hypothesis of stages of drug involvement, and usually refers to alcohol and cigarettes, which are generally the first of the stages of drug use. The existence of stages of drug involvement has ..

Book Review Creating Health Behavior Change: How to Develop Community-Wide Programs for Youth by Cheryl L Perry

Abstract: 1999, Sage Publications Inc,Thousand Oaks ISBN 0–7619–1227–4 Journal of Child and Adolescent Mental Health 2003, 15(2): 87