Integrating a peer group intervention for alcohol and other drug use and gender equity beliefs in vocational training

Adolescents and young adults (AYAs) aged 16-24 in sub-Saharan Africa (SSA) are a large, vulnerable population facing increasing mortality and challenges to health and well-being. SSA is the only global region where mortality among AYAs has increased since 1950. Education and/or vocational training (VT) increases the likelihood that AYAs have a successful future, including later sexual debut, decreased risk of HIV, and overall better quality of life. Alcohol and drug (AOD) use is a common but hazardous coping mechanism used by AYAs, increasing their risk of mortality and disability across the lifespan, including later life unemployment. Although social networks play a key role in AOD use, existing evidence-based interventions do not specifically include peers within the intervention. Moreover, adoption of traditional gender norms that favor men are associated with worse health outcomes for both genders, including poorer educational attainment. Thus, key behaviors during the AYA period in SSA underpin well-being across the lifespan, including educational/ vocational attainment, developing healthy coping strategies, and adoption of equitable gender norms.

Aim 1. Culturally adapt and combine two existing evidence-based interventions: RAD-PAL (Reducing Alcohol, Drugs, and Other Risk Behaviors among Adolescent Learners), initially developed in South Africa to reduce adolescent AOD use, and Manhood 2.0., a contemporary evidence-based gender curriculum designed for young people to critically evaluate traditional gender norms. Using qualitative methods, we will adapt the interventions and pilot test the new intervention to ensure it is acceptable and feasible for the target population.

Aim 2. Conduct a randomized clinical trial with AYA peer groups comparing the new intervention to standard of care, which is participation in the standard vocational training program plus referral to local healthcare services for AOD use reduction. We will examine whether the new intervention is superior to standard of care on the following outcomes: (1) frequency and quantity of AOD use; (2) gender equity beliefs; and (3) vocational skills and employment.

Aim 3. Prepare the intervention for scale-up by evaluating organizational and patient characteristics that can foster or hinder intervention dissemination and uptake. We will use quantitative and qualitative methods.

This study will provide real-world evidence as to whether a peer-based intervention to reduce AOD use and improve gender equity beliefs can lead to better health and employment outcomes in vulnerable AYAs in SSA.