Dataset Information

Does free schooling affect pathways from adverse childhood experiences via mental health distress to HIV risk among adolescent girls in South Africa: a longitudinal moderated pathway model.

ABSTRACT:

Introduction

Adolescent girls are at high risk of HIV infection in sub-Saharan Africa. Mental health distress, driven by adverse childhood experiences (ACEs) such as abuse, poverty and family HIV, may be an important driver of HIV risk behaviour among adolescent girls, while education may mitigate these risks. This study aimed to develop an empirically based theoretical model between ACEs, mental health distress and HIV risk behaviour among adolescent girls in South Africa and to investigate the potential moderating effects of free schooling provision.

Methods

Self-report questionnaires using validated scales were completed by adolescent girls aged 12 to 17 at baseline in two provinces in South Africa in 2011, with a 99% one-year follow-up in 2012 (n = 1498). Sampling included every household in randomly selected census enumeration areas of four deprived health districts. Confirmatory factor analysis was employed to identify measurement models and a structural equation model was developed to test pathways of risk and protection.

Results

Internalizing and externalizing mental health distress fully mediated the positive relationship between ACEs at baseline and HIV risk behaviour at follow-up among adolescent girls. Internalizing mental health distress was associated with increased sexual risk at follow-up via higher externalizing problems. Free schooling provision at baseline and follow-up eliminated the pathway from internalizing to externalizing mental health distress by moderating the pathway between ACEs and internalizing mental health distress. It also weakened the pathway from externalizing mental health distress to HIV risk behaviour at follow-up through a direct negative effect on externalizing mental health distress.

Conclusions

Reducing ACEs and adolescent mental health distress is essential for reducing HIV risk behaviour among girls in South Africa. Free schooling provision may be an important tool for reducing these problems and mitigating negative pathways to HIV risk among vulnerable adolescent girls.

SUBMITTER: Meinck F

PROVIDER: S-EPMC6416665 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Publications

Does free schooling affect pathways from adverse childhood experiences via mental health distress to HIV risk among adolescent girls in South Africa: a longitudinal moderated pathway model.

Meinck Franziska F Orkin F M FM Cluver Lucie L

Journal of the International AIDS Society 20190301 3

<h4>Introduction</h4>Adolescent girls are at high risk of HIV infection in sub-Saharan Africa. Mental health distress, driven by adverse childhood experiences (ACEs) such as abuse, poverty and family HIV, may be an important driver of HIV risk behaviour among adolescent girls, while education may mitigate these risks. This study aimed to develop an empirically based theoretical model between ACEs, mental health distress and HIV risk behaviour among adolescent girls in South Africa and to investi ...[more]

PMID: 30869202

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Project description:There is strong evidence that adverse childhood experiences (ACEs) negatively impact mental health. However, the association between ACEs and personality, emotions and affect are poorly understood. Therefore, we examined the association between composite ACE score and ACE type and personality, emotions and positive and negative affect. Three waves of data from the Midlife Development in the United States (MIDUS) study were used. ACE was the primary independent correlate. Covariates included demographic variables and survey wave. Outcome variables included generativity, personality traits (agreeableness, conscientiousness, extraversion, neuroticism, openness, agency), and affect (positive, negative.) Statistical analyses included 3 approaches: 1) treatment of ACE as dichotomous, 2) ordinal composite of ACE score, and 3) three individual ACE type components to assess the association between ACE and psychological constructs. Of 6,323 adults in the sample, 53% were female, and 56% had a past ACE. In the adjusted analyses, dichotomized ACE was significantly associated with neuroticism (β=0.10; 95% CI 0.07, 0.13) and conscientiousness (β=-0.03; 95% CI -0.05, -0.01). All ACE scores were significantly and positively associated with neuroticism and negatively associated with conscientiousness. Abuse was significantly associated with neuroticism (β=0.20; 95% CI 0.16, 0.24), openness (β=0.08; 95% CI 0.05, 0.11), conscientiousness (β=-0.05; 95% CI -0.08, -0.02), and agency (β=0.06; 95% CI 0.02, 0.10). All ACE categories, except financial strain, were significantly associated with affect. ACEs are significantly associated with personality, emotions, and affect, with greater effect seen at higher ACE scores and with ACE abuse type, which helps support the cumulative risk hypothesis and our study hypothesis. There is a need for continued research to understand the mechanistic processes and the directionality of the association between ACEs, emotions, and behaviors to help continue to drive biopsychosocial interventions.

Project description:Childhood adversity is a well-established risk factor for mental health problems during adolescence. Using data from the Fragile Families and Child Wellbeing Study and latent class analysis (LCA), we examined patterns of exposure to ten adverse childhood experiences (ACEs), including socioeconomic adversity, among non-Hispanic (NH) White, NH Black, and Hispanic 9 year olds and determined associations between membership in ACE exposure "classes" and depression and anxiety scores at age 15 (N = 2849). Parental separation/divorce, economic hardship, and paternal incarceration were the most common ACEs. ACE prevalence was significantly higher among Blacks and Hispanics. ACEs clustered into four classes for Whites and Hispanics and three classes for Blacks. Over half of Whites were classified in the 'Low Adversity' class. Conversely, most Black and Hispanic adolescents were classified in the 'High Socioeconomic Adversity and Paternal Incarceration' class, characterized by above average probabilities of experiencing family economic hardship, parental separation/divorce, low maternal education, and paternal incarceration. A small share of adolescents in all three racial/ethnic groups were in the 'High Global Adversity' class, characterized by high probability of exposure to most ACEs, including physical and psychological abuse. Finally, ACE class membership was differentially associated with anxiety and depression across the three racial/ethnic groups, with generally larger differences in mental health scores across ACE groups for Whites than for Blacks and Hispanics. Our findings suggest that studies on the associations between ACEs and health outcomes that do not include childhood economic adversity risk underestimating the role of ACEs on mental health among racial/ethnic minorities. Moreover, different patterns of ACE exposure are differentially linked to anxiety and depression, and ACE group membership differences in anxiety and depression vary by racial/ethnic group. Findings suggest the need for racially tailored prevention and intervention strategies.

Project description:OBJECTIVES:One of Africa's most important challenges is to improve maternal and neonatal health. The identification of groups at highest risk for adverse pregnancy outcomes is important for developing and implementing targeted prevention programmes. This study assessed whether young adolescent girls constitute a group at increased risk for adverse birth outcomes among pregnant women in sub-Saharan Africa. SETTING:Data were collected prospectively as part of a large randomised controlled clinical trial evaluating intermittent preventive treatment of malaria in pregnancy (NCT00811421-Clinical Trials.gov), conducted between September 2009 and December 2013 in Benin, Gabon, Mozambique and Tanzania. PARTICIPANTS:Of 4749 participants, pregnancy outcomes were collected for 4388 deliveries with 4183 live births including 83 multiple gestations. Of 4100 mothers with a singleton live birth delivery, 24% (975/4100) were adolescents (?19?years of age) and 6% (248/4100) were aged ?16?years. PRIMARY AND SECONDARY OUTCOME MEASURES:Primary outcomes of this predefined analysis were preterm delivery and low birth weight. RESULTS:The overall prevalence of low birthweight infants and preterm delivery was 10% (371/3851) and 4% (159/3862), respectively. Mothers aged ?16?years showed higher risk for the delivery of a low birthweight infant (OR: 1.96; 95% CI 1.35 to 2.83). Similarly, preterm delivery was associated with young maternal age (?16?years; OR: 2.62; 95% CI 1.59 to 4.30). In a subanalysis restricted to primiparous women: preterm delivery, OR 4.28; 95% CI 2.05 to 8.93; low birth weight, OR: 1.29; 95% CI 0.82 to 2.01. CONCLUSIONS:Young maternal age increases the risk for adverse pregnancy outcomes and it is a stronger predictor for low birth weight and preterm delivery than other established risk factors in sub-Saharan Africa. This finding highlights the need to improve adolescent reproductive health in sub-Saharan Africa. TRIAL REGISTRATION NUMBER:NCT00811421; Post-results.

Dataset Information

Does free schooling affect pathways from adverse childhood experiences via mental health distress to HIV risk among adolescent girls in South Africa: a longitudinal moderated pathway model.

Introduction

Methods

Results

Conclusions

Publications

Does free schooling affect pathways from adverse childhood experiences via mental health distress to HIV risk among adolescent girls in South Africa: a longitudinal moderated pathway model.

Similar Datasets

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