Browsing by Author "Carney, Tara"

Now showing 1 - 10 of 10
  • Thumbnail Image
    Item
    Open Access
    A comparative analysis of pharmacists’ perspectives on codeine use and misuse – a three country survey
    (BioMed Central, 2018-03-27) Carney, Tara; Wells, John; Parry, Charles D H; McGuinness, Padraig; Harris, Richard; Van Hout, Marie C
    Background The misuse of codeine is of increasing concern in a number of countries, particularly as this relates to over -the-counter pain and cough relief medication, and is also supplied as a prescription medicine. The study aimed to obtain and analyse the opinions and experience of pharmacy staff with regard to codeine misuse. Methods A cross-sectional web-based survey of pharmacy staff’s perspectives on this issue was administered through professional or regulatory bodies and completed by samples drawn in South Africa (n = 124), Ireland (n = 464) and the United Kingdom (n = 129). Results The majority of participants reported combination codeine-containing products as most popular, but significantly more pharmacy staff in South Africa reported codeine-containing cough syrups as most commonly popular (X2 = 122.7(2), p < 0.001). Codeine use was also seen significantly more of a public health problem in South Africa than in the other two countries (X2 = 7.6(2), p = 0.02). There was no difference across countries in the level of codeine misuse reported by pharmacy staff. Further findings indicate that professional training and education is desired, with unequivocal findings for the need for greater codeine control (X2 = 12.0(2), p = 0.002). Conclusion In conclusion, there were some inter-country differences, but overall the findings seem to suggest that pharmacists across all three countries view codeine misuse as a problem among their customers. Recommendations centre on risk management, surveillance and staff training.
  • Thumbnail Image
    Item
    Open Access
    Adapting an evidence-based HIV behavioral intervention for South African couples
    (Biomed Central Ltd, 2015) Wechsberg, Wendee; El-Bassel, Nabila; Carney, Tara; Browne, Felicia; Myers, Bronwyn; Zule, William
    BACKGROUND: In South Africa, heterosexual couples are at risk for HIV infection and transmission through substance use, gender-based violence and traditional gender roles, and sex risk behaviors such as having multiple partners and unsafe sex. METHODS: To address these interconnected HIV risks among heterosexual couples, we used the ADAPT framework to modify an existing, efficacious women's HIV prevention intervention (the Western Cape Women's Health CoOp) to include components of an evidence-based couple's intervention from the United States (Project Connect) and components from the Men as Partners program that has been used successfully in South Africa. We conducted focus groups with men, women and couples, and obtained feedback from a long-standing Community Collaborative Board (CCB) to guide the synthesis of elements of these three interventions into a new intervention. We then piloted the adapted intervention for feasibility and acceptability. RESULTS: The new intervention is called the Couples' Health CoOp. This intervention targets men who use alcohol and other drugs and engage in unprotected sex, and their main female sex partners. The intervention addresses substance use, sex risk, HIV and other sexually transmitted infections, gender roles, gender-based violence, communication skills, and goal-setting activities to increase sexy (eroticize) safe-sex behaviors. The Couples' Health CoOp also includes "voices" from the focus group members to ground the intervention in the experiences of these at-risk couples. In addition, it utilizes a participant handbook that reiterates workshop content and includes homework assignments for couples to complete together to increase problem-solving skills within their relationship, and to improve their sexual relationship and help sustain HIV risk-reduction strategies. All of these adaptations were based on participants' suggestions made during formative work and pilot testing. CONCLUSIONS: The Couples' Health CoOp is a couple-based HIV prevention intervention that targets alcohol and other drug use to reduce sexual risk, reduce gender-based violence and offer alternatives for conflict resolution, promote healthy relationships, and modify traditional gender roles in South Africa.TRIAL REGISTRATION NUMBER:NCT01121692.
  • Thumbnail Image
    Item
    Open Access
    Effectiveness of early interventions for substance-using adolescents: findings from a systematic review and meta-analysis
    (BioMed Central Ltd, 2012) Carney, Tara; Myers, Bronwyn
    BACKGROUND: Information on the impact of available interventions that address adolescent substance use and delinquency can inform investment choices. This article aims to identify and evaluate early interventions that target adolescent substance use as a primary outcome, and criminal or delinquent behaviours as a secondary outcome.METHOD:A systematic review of early interventions for adolescent substance use and behavioural outcomes was conducted. RESULTS: We identified nine studies using specific search strategies. All but one of the studies reported the use of brief intervention strategies. Only seven studies contained information which allowed for the calculation of an effect size, and were therefore included in the meta-analysis. The overall effect size for all outcomes combined was small but significant (g=0.25, p<0.001). The overall outcome for substance use was also small but significant (g=0.24, p<0.001). For studies with behavioural outcomes, the overall effect size reached significance (g=0.28, p<0.001). In general, subgroup analysis showed that individual interventions with more than one session had a stronger effect on the outcomes of interest. CONCLUSIONS: Early interventions for adolescent substance use do hold benefits for reducing substance use and associated behavioural outcomes. Interventions are most promising if delivered in an individual format and over multiple sessions. One intervention in particular had large effect sizes. As all the interventions were tested in developed countries, further testing is needed in low- and middle-income countries where there is a lack of research on evidence-based interventions for adolescent risk behaviours. Additional recommendations for policy and practice are provided in this paper.
  • Thumbnail Image
    Item
    Open Access
    Ethnic differences in alcohol and drug use and related sexual risks for HIV among vulnerable women in Cape Town, South Africa: implications for interventions
    (BioMed Central Ltd, 2013) Myers, Bronwyn; Kline, Tracy; Browne, Felicia; Carney, Tara; Parry, Charles; Johnson, Kim; Wechsberg, Wendee
    BACKGROUND: Alcohol and other drug (AOD) use among poor Black African and Coloured women in South Africa compounds their sexual risk for HIV. Given South Africa's history of ethnic disparities, ethnic differences in sex risk profiles may exist that should be taken into account when planning HIV risk reduction interventions. This paper aims to describe ethnic differences in AOD use and AOD-related sexual risks for HIV among vulnerable women from Cape Town, South Africa.METHOD:Cross-sectional data on 720 AOD-using women (324 Black African; 396 Coloured) recruited from poor communities in Cape Town were examined for ethnic differences in AOD use and AOD-related sexual risk behavior. RESULTS: Ethnic differences in patterns of AOD use were found; with self-reported drug problems, heavy episodic drinking and methamphetamine use being most prevalent among Coloured women and cannabis use being most likely among Black African women. However, more than half of Black African women reported drug-related problems and more than a third tested positive for recent methamphetamine use. More than a third of women reported being AOD-impaired and having unprotected sex during their last sexual encounter. Coloured women had four-fold greater odds of reporting that their last sexual episode was AOD-impaired and unprotected than Black African women. In addition, close to one in two women reported that their sexual partner was AOD-impaired at last sex, with Coloured women having three-fold greater odds of reporting that their partner was AOD-impaired at last sex than Black African women. CONCLUSIONS: Findings support the need to develop and test AOD risk reduction interventions for women from both ethnic groups. In addition, findings point to the need for tailored interventions that target the distinct profiles of AOD use and AOD-related sex risks for HIV among Black African and Coloured women.
  • Thumbnail Image
    Item
    Open Access
    Evidence-based screening, brief intervention and referral to treatment for substance-using adolescents with delinquent-type behaviours
    (2014) Carney, Tara; Myers, Bronwyn Jane; Louw, Johann
    Background: Both substance use and delinquent-type behaviours are prevalent among adolescents in Cape Town, South Africa. However, early interventions in developed countries for adolescents with similar problems are not available in many low and middle income countries, including South Africa. This is a concern as providing evidence-based interventions that address these dual behavioural problems may prevent their progression. There is thus a need for identifying and understanding the kinds of interventions that would be able to address both of these problems Aim: The aim of this thesis is to identify an evidence-based intervention for reducing adolescent substance use and delinquent-type behaviours and adapt it for use among adolescents in Cape Town, South Africa. Method: This study comprised six parts. Study I utilised a longitudinal data set to examine the association between substance use and delinquent-type behaviours, as well as the trajectory of these behaviours among school-going adolescents in Cape Town. As one needs to know how to identify adolescents who would benefit from such an intervention, Study II identified suitable screening tools for identifying these adolescents. While screening tools are generally brief instruments to identify problems with substance use, assessment instruments for those adolescents who screen positive would more comprehensively assist in the further evaluation of their problem behaviours, as well as measure other risk factors for substance use and delinquent-type behaviour. Study III therefore tested and adapted assessment tools for those adolescents who screen positive for substance use and delinquent-type behaviour. The next step was to identify a suitable evidence-based brief intervention that addressed substance use and delinquent-type behaviours in an integrated manner. Study IV consisted of a systematic review and meta-analysis to identify such an intervention. As only studies from developed countries were included in the review, the final two studies concentrated on adapting the intervention identified in Study IV with service providers and adolescents in focus groups 6. Study V consisted of a cultural adaptation which tested the ecological validity of the identified brief intervention in Cape Town communities. Study VI was a content adaptation that modified the brief intervention for adolescents in this context, and to include a focus on delinquent-type behaviours. Results: The final result is a screening, brief intervention and referral to treatment (SBIRT) package that is ready to be tested for efficacy on substance use and delinquent type behavioural outcomes. Each study contributes to the different components that make up this package. The results from the longitudinal study indicated that while substance use is not predictive of delinquent-type behaviours, these two behaviours co-occur at different stages of adolescence. In addition, adolescents that smoked and were delinquent were at significantly higher risk of engaging in later delinquent-type behaviour. This suggests that it would be efficient to address the two risk behaviours simultaneously using an integrated intervention. The GAIN-SS was identified as an easy-to-use and psychometrically sound short screener for identifying adolescents with both problems who may benefit from a brief intervention. The comprehensive assessment tool developed for use if an adolescent screens positive and may therefore be eligible for such a brief intervention, measured the following core domains: substance use, delinquency, parenting practices, peer substance use and readiness to change. These were modified based on both adolescent participants’ and experts’ recommendations. Following assessment, Teen Intervene was identified as the brief intervention which was the most effective in reducing early adolescent substance use and consequences related to substance use. While this promising intervention addresses substance use and behavioural outcomes broadly, it did not do so in an integrated and comprehensive manner. Teen Intervene was also only tested in one population, and the results of the qualitative studies (V and VI) were therefore helpful in the adaptation of the intervention. Qualitative work found that the context that adolescents in the study have been exposed to within their home setting, school and community, as well as their relationships with people within these settings, influence their engagement in risk behaviours. Therefore ensuring ecological validity is important when modifying the identified intervention for use in Cape Town. The intervention was expanded to include a focus on delinquent-type behaviours and a handbook was developed for adolescents that contained information from the, skills-building exercises, as well as goal setting from the original intervention for the individual adolescent. Recommendations for the implementation of this intervention showed that the types of recruitment strategies in place may affect the uptake of services, and organisational factors (organisational readiness, staff issues, available resources) may affect the delivery of intervention services. Such issues should be taken into account before implementation takes place. Conclusion: This thesis is one of the first to investigate the relationship between substance use and delinquent-type behaviours in a developing country setting. It describes the identification of an SBIRT package for substance use and delinquent type behaviours among adolescents, and how these were adapted to develop an integrated intervention that addresses both of these problems. This adapted intervention may provide an option of tailor-made services for adolescents in disadvantaged communities in Cape Town, where adolescents are often affected by a host of social problems but where a lack of resources are available to address these problems. The contextual and content-based adaptation processes highlighted the importance of working with adolescents directly to ensure that the intervention adequately addressed the local context as well as the specific issues that they face, at their level of understanding. The engagement of service providers, who may be trained to deliver this integrated intervention package, was also important to address possible challenges that could occur while delivering the intervention. The next steps in the process would be to implement the adapted version of the intervention to iron out some of the potential implementation issues that were alluded to above, and ultimately to assess its efficacy in addressing the very real social conditions described in Chapter 1.
  • Thumbnail Image
    Item
    Open Access
    I want to look like that : the role of ideal-type media in disordered eating behaviours
    (2003) Carney, Tara; Louw, Johann
    The relationship between media exposure and disordered eating disordered behaviours is not without complexity and contestation in the existing literature. Much knowledge of this relationship in a sample of South African university students, who could be expected to have reasonably high levels of media exposure. It examined the relationship via both quantitative and qualitative methods. In the quantitative part, 222 second-year psychology students at the University of Cape Town completed the Eating Attitudes Test (EAT -26). Analyses of the EAT-26 scores and demographic variables using multiple regression showed that both the sex subjects (ß=0.23, p<0.001) and their levels of media exposure (ß=0.17, p<0.001) were significantly related to a higher risk of the development of symptoms of anorexia nervosa.
  • No Thumbnail Available
    Item
    Open Access
    Intimate Partner Violence among Adolescent Girls and Young Women in Bulawayo, Zimbabwe and perceived barriers and facilitators to the provision of psychosocial interventions in salons
    (2023) Ndondo, Nonhlanhla Lindelwe; Carney, Tara; Richter, Marlise; Van Der Westhuizen, Claire
    Background. Women are disproportionately affected by intimate partner violence (IPV), particularly those in low-to-middle-income countries (LMIC). Recent research data suggests that IPV prevalence among adolescent girls and young women (AGYW) in Zimbabwe is estimated to be 36.5%. Innovative intervention models that leverage gendered spaces to provide IPV support have shown great potential in high income countries, but little is known about these in LMIC settings, including in Zimbabwe. The current qualitative study explored the experiences of IPV among AGYW as well as the feasibility of the use of pre-existing female spaces such as salons to provide psychosocial interventions in Bulawayo, Zimbabwe. Methods. Nine AGYW who had experienced IPV participated in virtual and in-person key-informant interviews. Two focus groups were conducted with salon and spa workers to explore the potential use of salon-based interventions (n=10). Purposive sampling was used as a recruitment strategy. Thematic analysis was used to analyse the data. Results. The findings indicated that in this study, AGYW participants' experiences of IPV consisted mainly of physical IPV such as being beaten with an object, being slapped, or punched with a fist, followed by psychological and lastly, sexual IPV. The results of the study highlighted the factors that seemed to predispose AGYW participants to IPV such as sociocultural influences, economic disempowerment and partner characteristics and behaviours. AGYW participants also discussed the negative physical and mental health impact of the psychological and sexual abuses they had encountered. Both salon workers and the AGYW interviewed identified peer support facilitated by the positive social capital created in salons, as well as the female-centeredness of salons as conducive elements for an acceptable intervention. However, some speculations around confidentiality and accessibility to salons were some of the potential barriers identified for implementing salon based IPV interventions. Conclusion. The findings of this study indicated that there is a need to identify and address IPV, as well as the mental health consequences that AGYW experience due to IPV. While the use of predominantly female spaces, in this case salons, were discussed as feasible spaces to incorporate into IPV support models for AGYW, there were certain barriers which will need to be addressed for this to be considered. In addition, it was clear that the content of such interventions needed to include not only IPV and associated mental health issues, but also include other components such as economic empowerment of AGYW, while also challenging traditional gender norms through salon-based interventions. Furthermore, AGYW alluded to their preference for IPV psychosocial support interventions to be peer-based and female-driven. Salons typically provide these aspects, hence increasing their viability as a choice for community based IPV support
  • Thumbnail Image
    Item
    Open Access
    Perceived need for substance use treatment among young women from disadvantaged communities in Cape Town, South Africa
    (BioMed Central Ltd, 2014) Myers, Bronwyn; Kline, Tracy; Doherty, Irene; Carney, Tara; Wechsberg, Wendee
    BACKGROUND: Initiation of treatment for substance use disorders is low among young women from disadvantaged communities in Cape Town, South Africa. Yet little is known about the factors that influence perceived need for treatment (a determinant of treatment entry) within this population. METHODS: Baseline data on 720 young, drug-using women, collected as part of a randomized field experiment were analyzed to identify predisposing, enabling and health need factors associated with perceived need for treatment. RESULTS: Overall, 46.0% of our sample perceived a need for treatment. Of these participants, 92.4% wanted treatment for their substance use problems but only 50.1% knew where to access services. In multivariable logistic regression analyses, we found significant main effects for ethnicity (AOR=1.54, 95% CI=1.05-1.65), income (AOR=0.96, 95% CI=0.93-0.99), anxiety (AOR=1.22, 95% CI=1.05-1.45), and not having family members with drug problems (AOR=1.45, 95% CI=1.05-2.04) on perceived need for treatment. When the sample was stratified by methamphetamine use, income (AOR=0.87, 95% CI=0.79-0.96), awareness of treatment services (AOR =1.84, 95% CI=1.03-3.27), anxiety (AOR =1.41, 95% CI=1.06-1.87) and physical health status (AOR=6.29, 95% CI=1.56-25.64) were significantly associated with perceived need for treatment among those who were methamphetamine-negative. No variables were significantly associated with perceived need for treatment among participants who were methamphetamine-positive. CONCLUSIONS: A sizeable proportion of young women who could benefit from substance use treatment do not believe they need treatment, highlighting the need for interventions that enhance perceived need for treatment in this population. Findings also show that interventions that link women who perceive a need for treatment to service providers are needed. Such interventions should address barriers that limit young women's use of services for substance use disorders.
  • Thumbnail Image
    Item
    Restricted
    Prejudice and social contact in South Africa: A study of integrated schools ten years after apartheid
    (2005) Holtman, Zelda; Louw, Johann; Tredoux, Colin; Carney, Tara
    In this article the relationship between intergroup contact and racial prejudice in formerly segregated schools in Cape Town, South Africa, is investigated. A total of 1 119 black African, coloured, Afrikaans-speaking and English-speaking white learners were surveyed, using three measures of intergroup prejudice, a self-report intergroup contact measure and a racial identifi cation scale. In general, quality of contact with individuals of other race groups and an increase in contact both in and outside of the school improved learners’ race attitudes. Higher levels of demographic integration within schools were also positively related to race attitudes, but a high degree of identifi cation with one’s own race led in several instances to less positive attitudes towards other race groups. Intergroup contact seemed to be the single most important predictor of attitudes for all four groups in this study
  • Thumbnail Image
    Item
    Open Access
    The Young Women’s Health CoOp in Cape Town, South Africa: Study protocol for a cluster-randomised trial for adolescent women at risk for HIV
    (BioMed Central, 2018-07-11) Wechsberg, Wendee M; Browne, Felicia A; Carney, Tara; Myers, Bronwyn; Minnis, Alexandra; MacDonald, Robert; Ndirangu, Jacqueline W; Turner, Leslie B; Howard, Brittni N; Rodman, Nathaniel
    Background South Africa remains the global epicentre of HIV infection, and adolescent women have the highest incidence of HIV in the country. South Africa also has high rates of alcohol and other drug (AOD) use, violence, and gender inequality. Violence converges with AOD use, gender inequities and other disparities, such as poverty, to increase sexual risk and poor educational attainment for adolescent women. This study seeks to test the efficacy of peer recruitment and cofacilitation of the Young Women’s Health CoOp (YWHC), a comprehensive gender-focused intervention to reduce HIV risk behaviours and increase the uptake of HIV counselling and testing (HCT) among out-of-school, adolescent women who use AODs. The YWHC is facilitated by local research staff and supported by peers. Methods This cluster-randomised trial is enrolling participants into two arms: a control arm that receives standard HCT, and an intervention arm that receives the YWHC. Participants are enrolled from 24 economically disadvantaged communities in Cape Town, South Africa. These geographically distinct communities serve as clusters that are the units of randomisation. This study uses adolescent peer role models and research field staff to recruit marginalised adolescent women. At baseline, participants complete a questionnaire and biological testing for HIV, recent AOD use, and pregnancy. The core intervention is delivered in the month following enrollment, with linkages to health services and educational programmes available to participants throughout the follow-up period. Follow-up interviews and biological testing are conducted at 6 and 12 months post enrollment. Discussion The study findings will increase knowledge of the efficacy of a comprehensive HCT, gender-focused programme in reducing AOD use, victimisation, and sexual risk behaviour and increase uptake services for out-of-school, adolescent women who use AODs. The trial results could lead to wider implementation of the YWHC for vulnerable adolescent women, a key population often neglected in health services. Trial registration Trial registration no: NCT02974998 , November 29, 2016.