Alcohol Policy 17, Arlington, VA April 6, Monica H Swahn, Ph.D. Rogers Kasirye, M.A. Charles Chandia Lyn Ametewee, LLM, M.B.A., M.A.

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1 Alcohol Policy 17, Arlington, VA April 6, 2016 Monica H Swahn, Ph.D. Rogers Kasirye, M.A. Charles Chandia Lyn Ametewee, LLM, M.B.A., M.A.

2 Funding Acknowledgment Research reported in this presentation was supported by the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health under Award Number R21AA22065 (to Dr. Swahn). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Grant is funded as the development of a structural intervention to delay underage alcohol use and prevent alcohol-related HIV transmissions among youth in the slums of Kampala. Authors have no conflicts of interests to disclose

3 Data Collection Projects: Kampala Environmental scans of alcohol marketing (across slums in Kampala) Youth Survey (N=1,134) Youth Focus groups (10) NGO Leaders Survey (55) NGO Leaders Focus Groups (2)

4 The Larger & Interdisciplinary Research Team Core Team Dr. Monica Swahn ( prof of epidemiology) Mr. Rogers Kasirye (director UYDEL) Dr. Laura Salazar (prof of community psychology) Dr. Dajun Dai (prof of geosciences/spatial analyses) Several MPH and PhD students Consultants: Dr. Nazarius Tumwesigye (prof Makerere Univ.; Uganda) Dr. David Jernigan (prof Hopkins Univ.; USA) Dr. Isidore Obot (prof Uyo Univ.; Nigeria) Wim van Dalen (STAP; Netherlands) Charles Chandia (director TSP; Uganda) Anne Gamurorwa (director CDFU; Uganda) Josephine Ocama (director PADA; Uganda)

5 Alcohol Use: A Pressing Problem in Uganda (and Eastern Africa) Source: WHO Global Status Report on Alcohol

6 Alcohol Marketing in Kampala (1/3)

7 Alcohol Marketing in Kampala (2/3)

8 Alcohol Marketing in Kampala (3/3)

9 Context for NGO Survey Alcohol misuse is highly prevalent across Eastern Africa, but remains a largely unaddressed public health issue The infrastructure is fragmented, policies are often inadequate, limited or not enforced. Prevention, treatment and policy efforts to address alcohol misuse often driven by NGOs Little is known about the approaches used by NGOs to counteract alcohol misuse and alcohol marketing.

10 Purpose of NGO Survey To determine approaches used by NGOs to address alcohol misuse and alcohol marketing. To determine how they may integrate prevention programs and policies in the communities they serve. To identify their needs and interests in partnerships to conduct alcohol research, alcohol countermarketing and other program activities

11 Methods Used for NGO Survey Distributed an online mins survey (Qualtrics) Recruited participants through the Eastern African Alcohol Policy Alliance Network Participants received equivalent of $10 gift card in airtime for mobile phone Response rate 36.6% (N=55) Study was approved by GSU IRB/UNCST in Uganda Countries represented: Uganda (n=28) Kenya (n=10) Tanzania (n=7) Rwanda (n=1) Burundi (n=1) & Other unnamed countries (n=8)

12 NGO Characteristics 80% (n=40) of survey respondents were male 88% (n=43) provide services/program in own country 78% (n=39) had their own website 94% (n=47) prepare annual budget 42% (n=18) meet key program goals w/ budget 60% (n=30) serve 100 or more people/month 70% (n=31) serve local community 77% (n=34) serve both urban & rural communities 84% (n=36) offer alcohol-related programs to youth

13 Survey Design We created survey questions to assess: Organizational structure Operational & strategic priorities Target population Perceptions of best practices Alcohol related concerns in their communities Substantial focus on alcohol marketing And, many others!

14 Findings (1/4) When asked: Do you think alcohol marketing and adverts impact alcohol use in the population you serve? 98% said yes. Is there a need for an alcohol counter marketing intervention in the population you serve? 98% said yes. Do you think alcohol counter marketing intervention could work to delay alcohol use and/or reduce risky sex among youth in the slums? 93% of participants said yes. Would your NGO be interested in implementing an alcohol counter marketing campaign? 100% of participants said yes.

15 Findings (2/4) When asked, which strategies do you think would have most beneficial impact among youth in the slums, participants responded: Highlighting the effects of alcohol and risk for HIV, violence and injuries Mass advertising, promotion and marketing of alcohol prevention messages Enacting laws, regulating local brew making and consumption.

16 Findings (3/4)

17 Findings (4/4)

18 Limitations Pilot project Small sample Cross-sectional design Geographical variability Descriptive/basic data First step to integrate NGOs and expertise to develop community-based alcohol counter-marketing strategies

19 Community Perspectives by Directors from NGOs Twekembe Slum Project: Slum Rating Scale (Charles Chandia) Uganda Youth Development Link: Implications for Policy (Rogers Kasirye)

20 Twekembe Slum Project Community-Based Organization serving the slums in Makindye Division in Kampala Key program activities include: Education (supporting community/orphan school) Empowerment (supporting vulnerable populations) Community-building (sanitation, water access, sports, vocational skills, craft market, fundraising) Consultant to Prof Swahn on slum-rating scale

21 Providing Context to Findings Huge need to address alcohol misuse in communities Clear interest by NGOs/CBOs to work & partner on alcohol prevention & policy strategies But, how do we better communicate this need?

22 Slum Rating Scale (1/2) Environmental scan/needs assessment tool developed by Swahn and colleagues to identify & locate alcohol ads in the community as well as other structural drivers that may impact youth drinking: Alcohol marketing & outlets Alcohol sachets (on ground) Sanitation Building structures/environmental concerns Other goods for sale

23 Slum Rating Scale (2/2) Implemented the slum rating scale in 2015 across 5 communities in Kampala. Supervised 4-member team Collected geospatial data & perceptions of community Data is being analyzed. Will be used to communicate with stakeholders & decision makers about how to move forward and prioritize alcohol prevention.

24 Uganda Youth Development Link (UYDEL) and Georgia State University Collaboration Operates 6 drop-in centers Serve over 1600 youth per day Provides services to youth: Skills/vocational training Mental health/substance use counseling Health clinic referral & screenings Advocate for youth Established community relationship Partnership with GSU

25 Policy Implications Alcohol policies & needs vary in Eastern Africa Need alcohol policies that are consistent, clear & enforced. How do we empower NGOs in their alcohol prevention efforts? Need to deliberately include NGOs in policy development, support programmatic activities, disseminate/translate best practices, identify evidence-based research, provide resources, support academic-ngo partnerships and collaborations.

26 Next Steps Analyze findings from the survey and integrate findings across data collection efforts. Identify strategies to better support NGOs in alcohol prevention Develop the intervention/alcohol counter marketing campaign. Brief decision makers and support alcohol policy development. Contact Information: Monica Swahn, Ph.D. Professor School of Public Health Georgia State University Atlanta, GA, USA

27 Extra Slides

28 Alcohol Marketing among Kampala Youth We conducted a study in 2011 to determine the associations between alcohol use exposures, marketing, education, and problem drinking and drunkenness among youth living in the slums of Kampala. Findings show that obtaining free drinks was associated with problem drinking (AOR: 2.47; 95% CI = ) and drunkenness (AOR: 2.40; 95% CI = ) after controlling for potential confounders. The findings underscore the need for additional research related to the impact of alcohol marketing among vulnerable youth and also the need for policy regulations that restrict alcohol marketing that involve providing free alcohol directly to youth. Source: Swahn et al, 2013;

29 Environmental Scan: Kamwokya