Co-design of an intervention to address alcohol use among adolescent boys and young men in Tanzania

The project addresses a critical evidence gap in how to comprehensively address alcohol initiation, use and abuse amongst adolescent boys and young men (ABYM) in sub Saharan Africa (SSA). The most recent survey of global health found that alcohol is the biggest risk factor for death among 15-49 year old men in the world. Death from preventable causes in Africa, such as interpersonal violence among male adolescents (aged 10-19 years) is higher than in any other region. Adolescent alcohol use is an important cause of these problems and predominantly amongst boys and young men. Drinking at an early age makes it more likely that you will be an alcoholic in adulthood, and causes poor adult health and bad effects on family, employment, and society.
Interventions to decrease alcohol use among male adolescents could decrease death and illness in Africa and let boys reach their full potential. Some studies in rich countries have shown that these interventions might work, but very few have been tested in sub Saharan Africa. The way young people drink in Tanzania is like many other places in East and Central Africa. Our research will therefore be useful to other African settings. Also, our research team has experience and skill in adolescent health research in Tanzania with in-country partnerships and networks already in place.
Local teachers, people who work with young people and key people from the ministries of health and education have asked us to help develop interventions for their male adolescents, in recognition that current international focus has been on the girl-child. Our research also supports the World Health Organisation (WHO) Global Strategy to Reduce the Harmful Use of Alcohol and will help fill gaps in alcohol policy in East Africa.
The project is a partnership between two leading UK and Tanzanian research and learning institutes, a Tanzanian referral hospital and research centre, three Tanzanian based community based organisation, and local government authorities nationally and within two districts of Tanzania.
Our overall aim is to co-create a package of school and community interventions and develop strategies to optimise the interplay between them in order to prevent, delay and reduce alcohol use among adolescent males in high alcohol use settings in Tanzania.

This will be achieved through 4 specific objectives:

OBJECTIVE 1: To understand what people in the community think about what makes adolescent boys and young men drink and how and where that drinking happens

OBJECTIVE 2: To work with people in the community do design activities in the community and schools that will prevent and decrease alcohol use among adolescent boys and young men.

OBJECTIVE 3: To assess the whether the relevant people like the intervention and believe that it will work

OBJECTIVE 4: To collect information to help design a bigger study that will see if the intervention actually works.

Our research project will directly benefit Tanzanian adolescent boys and young men, their communities, teachers and school officials as well as local and national government.

We will discover new ways to develop complex interventions to decrease drinking amongst young people, especially those who are vulnerable. What we learn will be shared with politicians, people who work with with young people and researchers. It will also help us plan a larger study to test how the intervention works on a large scale.

Alcohol is a leading driver of preventable morbidity and mortality worldwide and a driver of injury, violence, and risk behaviours among male youth in Africa. Early initiation leading to hazardous drinking predisposes to long term alcohol abuse across the life-course. While interventions exist in western countries few have been adopted in African settings. Large gaps remain in what complex interventions can be embedded within communities which promote the necessary local ownership and engagement to enable implementation to be sustained and scaled up. Our overall aim is to co-create a package of school and community interventions and develop strategies to optimise the interplay between them in order to prevent, delay and reduce alcohol use among ABYM in Tanzania.
We will scope current laws and statues, identify and collaborate with key stakeholders within the ministry and community, and conduct qualitative studies (focus group discussions, key informant and in-depth interviews, participatory mapping) to define drivers and risk factors influencing uptake, and barriers to current alcohol strategies. Findings will be used to develop a logic model theory of change with stakeholders to select intervention approaches to create a multi-component intervention. We will collaboratively assess stakeholder and participant satisfaction, adequacy of community resources for a large-scale trial examining the impact of a multi-component intervention on drinking culture among boys, prevalence of alcohol initiation, frequency of drunkenness, and subsequent harms.

Our project will build capacity in field research, writing and analysis and we will inform alcohol prevention policy and programmes at national and international level by widely disseminating reviews, materials, tools, and findings.