Multi-Level Risk and Protective Factors for Substance Use Among Zambian Street Youth

ABSTRACT

Background: High rates of substance use have been reported among youth in Zambia. This is particularly concerning given that substance use is one of the biggest risk factors placing young people at risk for HIV infection. Objectives: The purpose of the current study is to examine how multi-level risk and protective factors (i.e., community, family, peers, individual) influence alcohol and marijuana use. Methods: A total of 250 street youth in Lusaka, Zambia were interviewed in the summer of 2014 about their alcohol and marijuana use and reasons for usage. Data were analyzed using descriptive and multivariate methods. Results: Youth reported high rates of alcohol use. At the multivariate level, peer and individual level variables (e.g., using alcohol or drugs for coping or for fun) explained the most variance, followed by family level factors. Community level variables explained the least variance in all models. Conclusion/Importance: A better understanding of multi-level risk and protective factors for young people's alcohol and marijuana use could lead to the development of better intervention strategies to reduce this behavior among Zambian street youth.

KEYWORDS:

• Alcohol
• marijuana
• street youth
• Zambia
• HIV risk

Glossary

• Ecological framework: Developed by Bronfenbrenner (1979), emphasizes risk and protective factors and integrates multiple levels of social elements to understand health outcomes.

• Neighborhood economic conditions: poorer neighborhoods or poorer economic conditions would include, for example, lack of electricity or telephone.

• Resiliency: Protective factors that youth may have such as parents who know where youth are and who they are with (i.e., parental monitoring).

• Risk factors for substance use: Behaviors that increase a youth's susceptibility to using alcohol or drugs (e.g., parental substance misuse and peer substance use).

• Risky sexual behaviors: Behaviors that increase one's risk for HIV such as failure to use condoms during sex and having multiple sexual partners.

• Street youth: Those who spend their days on the street engaging in economic activity such as begging.

• Trading sex: Exchanging sex with an individual for something specific such as for food, shelter, or money.

Acknowledgments

We thank the following people for their participation in this research: Ms. Rose Mtonga, Zambia Alcohol Development Program, Zambia; Mr. Pearson Chilema, Zambia Drug Enforcement Commission, Zambia; and Dr. Clement Gondwe, KS Research Laboratory, University Teaching Hospital, Zambia. Without their help, this study would not be possible.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Funding

This work was supported in part by NIH grants CA75903, GM103509 and the Fogarty AIDS International Training and Research Program D43TW01492 from the NIH to C.W. Ray Handema was Fogarty Fellow.

Additional information

Notes on contributors

Kimberly A. Tyler

Kimberly A. Tyler, Ph.D., is a Professor in the Department of Sociology at the University of Nebraska-Lincoln. Her research interests include homelessness, child abuse and neglect, partner violence, substance use, and other high-risk behaviors among adolescents and youth.

Ray Handema

Ray Handema, Ph.D., is the Deputy Director of the Tropical Diseases Research Center in Zambia. His research interests include HIV Molecular Epidemiology and HIV prevalence and risk factors among most-at-risk populations (MARPs), adolescents and youth in sub-Saharan Africa.

Rachel M. Schmitz

Rachel M. Schmitz, M.A., is a Ph.D. candidate at the University of Nebraska-Lincoln. Her research interests include gender and sexuality, the family, and homeless youth and young adults.

Francis Phiri

Francis Phiri is an Environmental Health Officer with over 20 years of experience in Public Health, HIV/AIDS, Adolescent Reproductive Health and Community Education. His work includes culturally grounded intervention for the prevention of substance abuse problems among Zambia youth. He currently serves as a Volunteer and founder member of Zambia Alcohol and Drug Program, Director of Bwalo Global Development Trust and as Vice Chairperson for Zambia Civic Forum on Housing and Habitat Board of Directors. He is a final year Candidate for MSW (Master in Social Work) degree at St. Eugene University, Lusaka, Zambia.

Kourtney S. Kuyper

Kourtney S. Kuyper, B.A., received her degree from the University of Nebraska-Lincoln. She is currently a first year dental student at Midwestern University in Downers Grove, IL and her interests include modifying risk behavior within at-risk populations.

Charles Wood

Charles Wood, Ph.D., is the Director of the Nebraska Center for Virology and the Lewis Lehr/3 M University Distinguished Professor of the School of Biological Sciences, and the Department of Biochemistry at the University of Nebraska-Lincoln. His research interest is in HIV pathogenesis, and HIV transmission, and co-morbid factors in affecting HIV transmission and disease progression in sub-Saharan Africa.