Risks Facing Health Adol. Old Saida Pdf

ASSESSMENT OF THE HEALTH & SOCIAL RISK FACTORS FACING ADOLESCENTS IN THE OLD CITY OF SAIDA

FUNDED BY MEDICAL AID FOR PALESTINIAN

17 MARCH, 2006 1

PDF created with pdfFactory Pro trial version www.pdffactory.com

Research Team Lina Mikdashi (MSc.) Marwan Khawaja (Ph.D.) Rima Afifi (Ph.D.)

Field Supervisor Samir Sharari Inga Schei (B.A.)

Field-workers Najah Akawi Mohamad El Ali Ahmed Faqieh Marwa Toutanji

Data Entry Team System Programmer : Mirna Nahas Data Entry : Hiba Hamzi

Report Writing Team Lina Mikdashi (MSc.) Marwan Khawaja (Ph.D.) Rima Afifi (Ph.D.)

2

PDF created with pdfFactory Pro trial version www.pdffactory.com

Introduction In November 2005, the Center for Research on Population and Health (CRPH) at the American University of Beirut was commissioned by Nabaa (Development without Borders) to assist in designing and conducting a study in the Old City of Saida assessing health and social risks facing Adolescents. Nabaa aims to use the study findings to develop and implement health and social projects that would meet some of the needs of adolescents aged 14-19 living in the Old City. The Old City of Saida is a densely populated area with an estimated population of 10,000 individuals. About 60% of its population is Lebanese and 40% are of a Palestinian nationality. The main economic activities of the community are fishing, trade and handicraft. The study consisted of a survey and focus group discussions. This report describes the finding of both parts of the study. The first part of the report explains the methodology followed in all phases of the work. The second part, describes the findings from both household and adolescent questionnaires. The last part of the report deals with focus group data analysis.

I. Methodology: Community Meeting: Nabaa staff held a meeting with community representatives from Old Saida to involve the community and solicit its feedback on sensitive topics to be examined by the study. During the meeting the survey was introduced and discussed and a summary of the project was distributed. A Community Committee was formed to link the project with the local community. The Committee consisted of a Mukhtar, Municipality member, Head of Saida Club, staff member of the Social Movement NGO, and a Social/Health worker. The Community Committee also assisted in finding candidates to interview for the position of "Fieldworker". Recruitment of Fieldworkers (November 2005): We interviewed 8 fieldworkers and selected 4 (2 males and 2 females). Selected fieldworkers were from Saida (3 of them were from Old Saida ) and all had previous fieldwork experience . Sampling Frame: Nabaa provided us with a map of Old Saida. However, no sampling frame was available. As a result, we created our frame through 'quick count' of all households living within the boundaries of Old Saida . The community was divided into 12 blocks. Fieldworkers were trained for one day on mapping techniques and Household listing. The household count was accomplished in 4 days. The number of households living in the Old City totaled 1356 . A sample of 500 households was drawn randomly from the household lists. The sample was selected using systematic random sampling. Developing the instruments: Two questionnaires were formed in coordination with Nabaa, one was performed with households that had adolescent members and the other was conducted with the adolescents. The Household questionnaire included information on nationality and age of all household members(Roster), housing conditions and household income. The adolescent questionnaire investigated 3

PDF created with pdfFactory Pro trial version www.pdffactory.com

prevalent health and social risk behaviors among adolescents. It included 14 sections examining a number of aspects relating to: education, labor force , general health, mental health, violence, smoking (cigarettes and Argyle), future expectation, selfesteem, social support, social relations, recreational activities, Alcohol consumption and drug abuse. Data Collection (December 2005-January 2006): Fieldworkers were trained on the questionnaire and interviewing techniques for 2 days. We also trained a supervisor from Nabaa to monitor fieldwork activities, including editing of completed questionnaires. Pilot test: A Pilot test was later conducted under the supervision of CRPH and Nabaa where fieldworkers tested the questionnaire by performing interviews with adolescents living in selected households. Six households were selected from nonsampled houses and 6 adolescents were interviewed. A debrief was held with the survey team following the Pilot Test where survey results were discussed. Fieldworkers gave their feedback on problems they faced in the field as well as difficulties found with the questionnaire. Fieldworkers specified questions that respondents found difficult to understand, questions that were negatively received by respondents, and answer categories that were irrelevant. As a result of the debrief some questions were reworded and a few taken out. Interviewing: Fieldwork began December 23 and was completed by January 5. Due to cultural considerations and the nature of the topics covered by the questionnaire fieldworkers visited households in pairs (male/female). Out of the 500 households visited 155 were found to have at least one adolescent member. Household questionnaires were completed with those families. The number of adolescents aged 14-19 years totaled 278 and all were interviewed. The majority of interviews were carried out in complete privacy with adolescents, however, in very few cases (4%) the parents insisted on attending the interviews. Ethics: Fieldworkers were given consent letters to be read to parents of adolescents and adolescents themselves to ensure their approval to participate in the study. The letter stated the purpose of the study. We also made sure that fieldworkers understood the importance of confidentiality of all information obtained especially since most of the fieldworkers are from the same community as the participants. Data Editing: The supervisor performed systemic quality checks on all returned questionnaires upon completion of each zone to edit the data before submitting completed questionnaires for data entry. Some questionnaires with missing answers or contradictory ones were returned to the field while some were corrected by fieldworkers after being carefully reviewed. CRPH also carried out random checks on completed questionnaires. Data Entry (January –February 2006): We programmed both questionnaires with all logical and consistency checks using CSpro. One of Nabaa staff received one day training on the software to enter data.. On 16th February data entry was completed and data files were exported to SPSS for data analysis at CRPH. Data Cleaning: Exporting the data resulted in 3 SPSS files, namely Household, Household Roster, and Adolescent files. CRPH then carried out consistency checks on each SPSS file. 4

PDF created with pdfFactory Pro trial version www.pdffactory.com

Focus Groups (January –February 2006): We trained 2 of the fieldworkers on Focus Group moderation for one day. A Moderator guide was devised specifying the questions to be used during the sessions. The aim of the focus groups was to explore further some of the issues that emerged during the survey and to discuss other sensitive topics not covered by the questionnaire. The sessions focused mainly on six topics: Prevalent risky behavior, relationship between parents and adolescents, violence at home, in schools and in the community, recreational activities, and sexual behavior and abuse. Five focus groups were separately held with male and female adolescents. Fieldworkers faced considerable difficulties in finding female participants as parents in Saida City are over- protective of their daughters and girls are seldom allowed outside the house. For this reason, only 2 focus groups were held with girls while 3 sessions were held with boys. We also divided the groups by age, 14-16 and 17-19 years olds. Focus Group sessions were held over 3 days with female sessions being jointly moderated by CRPH. All sessions were taped with the knowledge and approval of participants. Data Analysis (February-March 2006): Data analysis of the Quantitative part of the study (questionnaires) was descriptive using SPSS for frequency distributions and cross tabulations. Background variables were mainly sex and age of adolescents to detect difference in patterns of behavior along gender lines and age distribution. As for the Qualitative part of the study (Focus Groups), thematic analysis was the method of analysis. A grid was conducted with the focus groups on one axis and themes on the other. The themes were the questions. For each focus group, responses to each question were noted in the relevant table cell. Once all the information was included in the table, the researcher then looked for themes arising form the data under each question (across focus group). These became primary concepts that are described in the results section. In this form of analysis, there are no preconceived concepts; rather the data suggested such concepts.Results

Households 1. Demographic Profile: 1.1Family structure The Average household size is 6.1 persons which is considerably higher than the national average (4.8). Still, household size of Palestinian households is 6.4 while that of Lebanese households is 5.6. Each house has 2.90 rooms on average excluding kitchen, verandas, and bathrooms. Male headed households are 95% and only 7% of the households are extended (couples living with at least one of their parents and/or relatives). The vast majority (84%) of households are of one nationality (both parents are either Lebanese or Palestinian) while 16% are mixed i.e. parents are of different nationalities. 2. Socioeconomic Profile: 2.1 Housing Conditions 5

PDF created with pdfFactory Pro trial version www.pdffactory.com

Overcrowding: crowding level is high, and about 30% of the households have 3 or more persons per room. As for the physical infrastructure, the vast majority (96.7%) of households are connected to a sewage network and the main source of running water is either piped water into residence or a container (pipe water) in the residence1. Surprisingly, 91.4% of households indicated that they almost never have problems with their running water and 89% stated that they almost never have problems with there sewage network. This seems to imply that the physical infrastructure for most households is in a relatively good condition. Table 2.1 Housing Condition Indicators

Variable

Percent

Crowing (3 or more persons per room)

29.7

Main Source of Drinking Water Piped into residence Other

95.5 4.5

Main Source of Running Water Piped into residence Container(into residence)

42.6 54.2

Type of Sewage system Connected to sewage network Percolation pit/Other

96.7 3.3

2.2 Household Standard of Living We asked interviewees to estimate household net income for the last 12 months. The larger proportion (87%) of households are in the category of very low/low income bracket . Moreover, about 24% of all households are earning less than 3600000 annually which means that their monthly income is below the minimum wage (300,000 L.L)2 . There is a slight difference between the percentage of Palestinian households (25%) earning less than 3600000 yearly and Lebanese households (around 20%) which fall into the same category.

Table 2.2 Household Annual Income by Nationality (%) Variable 1

Nationality

We discovered after the completion of the household survey that there was a mistake in data collection concerning households' main source of running water as interviewers selected the option Public Container when in fact participants were referring to containers within their houses filled from the water pipes in the building. 2

6

PDF created with pdfFactory Pro trial version www.pdffactory.com

Lebanese Palestinian

Other

Total

32 60 8

24.3 62.5 13.2

Net Income in L.L Very low (Less than 3600000 ) Low (From 3600000 to 6000000) Medium/High (From 9600000 to 1200000)

19.6 64.7 15.7

25.0 61.8 13.2

-Household Durable Goods Due to their very low income only few households own "luxuries" goods like computers (20%) or a car/truck (around 19%) and even less have an air conditioner (12%) or a video camera ( around 6%).The vast majority of households own basic durable goods: 97.4% have refrigerators and 83.2 % have electric fans. Still, despite their poverty, 36% of the households have a mobile phone while 20.6% have an ordinary phone/landline. Table 2.3 Households with Durable Goods

Item

Percent

Refrigerator

97.4

Television set

97.4

Washing machine (clothes)

95.5

Satellite dish (or subscription)

94.8

Gas or electric stove (cooking)

91.0

Gas or electric boiler (heating)

89.7

Electric fan

83.2

Vacuum cleaner

52.9

Mobile telephone

36.1

Mix-master / electric blender

26.5

Sewing machine

25.2

Ordinary telephone

20.6

Personal computer Kerosene /diesel oven (heating) Car / Truck

20.0 14.8 18.7

7

PDF created with pdfFactory Pro trial version www.pdffactory.com

Air conditioner

12.3

Bicycle

8.4

Video camera

5.8

Video camera Bicycle Air conditioner Kerosene /diesel oven (heating) Car / Truck Personal computer Ordinary telephone Sewing machine Mix-master / electric blender Mobile telephone Vacuum cleaner Electric fan Gas or electric boiler (heating) Gas or electric stove (cooking) Satellite dish (or subscription) Washing machine (clothes) Television set Refrigerator 0

10

20

30

40

50

60

70

80

90

100

Percent

We grouped durable goods to create an index of standard of living. We found that 60 % of households with very low income also had low household wealth (accumulation of durable goods). On the other hand, around 58 % of medium/high income households have high household wealth. Hence, the majority of households with very low income also have low living standards while the majority of medium/high income households have high standards of living. With the exception of household physical infra structure, the overall living conditions for households (number of rooms, crowding level, income and durable goods) seem to be very poor. This means that most households in our sample are unable to satisfy their basic needs.

8

PDF created with pdfFactory Pro trial version www.pdffactory.com

Table 2.4 Household Wealth by Household Income Variable

% Household Income

Household wealth

Very Low

Low

Medium/high

Total

60

22.2

-

28.5

Medium

31.4

38.9

42.1

37.5

High

8.6

38.9

57.9

34.0

Low

Adolescents 3. Demographic Profile: About half of the adolescents interviewed were 14-15 year olds while adolescents aged 18-19 were only 17.6%. This proportion of the oldest age group is implausibly low and might be due to them leaving the community to work or to go to college; it might also be due to under enumeration, or due to both. There is a slightly more boys (51.1%) than girls (49.8%). An examination of the sex ratios by age revels less than expected number of girls in older age groups (16-19). This is a known cultural pattern in the region where respondents during surveys, especially mothers, tend to hide girls real age when their daughters are of marriageable age. The proportion of Palestinian adolescents is higher (59%) than Lebanese adolescents (39.5%). This probably is the result of a larger household size in Palestinian than Lebanese household, keeping in mind that 47% of the households in the study are Palestinian.

Table 3.1 Adolescents by Age Distribution, Sex and Nationality Variable Percent Age Group 14-15

49.6

16-17

32.7

18-19

17.6

Sex Boys

51.1

Girls

48.9

9

PDF created with pdfFactory Pro trial version www.pdffactory.com

Nationality Lebanese

39.5

Palestinian

59.1

Egyptian

1.4

4. Socioeconomic Profile: 4.1 Labor Force Relatively high labor force participation We adopt a simplified version of the International Labor Organization framework in measuring labor force utilization in this study. According to this framework, the population is classified into mutually exclusive categories based on undertaking any economic activities for ‘production’ during the week before the survey. Respondents are classified into economically active (labor force) and inactive populations (out of the labor force) based on questions related to work during the week. Those in the labor force are either working (employed) or actively seeking work (unemployed). Employment is defined as work for pay (whether monetary or in-kind) or profit. Unemployment is defined to include persons not working in the previous work but actively looking for work. Thus, full time students and homemakers who are not working and not looking for work are considered out of the labor force. Although this framework may underestimate the extent of labor utilization, it is widely used internationally. As shown in table 4.1, the overall labor force participation rate was rather high at 34% for an adolescent population. This overall figure hides significant gender differences in labor utilization found elsewhere in our region. In our survey, more than half (55%) of boys were in the labor market compared to about one out of every 10 girls (11%). It should be noted that both of these rates should be considered high in a comparative perspective. Recent studies of refugees and urban populations living in disadvantaged communities in Lebanon and elsewhere (e.g., Jordan) showed rates not exceeding 9% for girls and 40% for boys. These rates reflect lower than expected school enrollments. Indeed, the results from our survey show that very few (5.6%) boys and girls who are in school are also in the labor force. Labor force participation also varies by age and nationality as would be expected. About 23% of those aged 14-15 years are in the labor market compared to 52% of those in the older age group, 18-19 years. The Lebanese adolescents have a higher rate of 38% than the Palestinians (32%), but such a gap is rather small. Table 4.1 also shows that the vast majority of working adolescents make financial contributions to family income, with little differentials by age, sex or nationality. The contributions to family income range from a low of 75% for Lebanese to a high of 87% for girls. The data (not shown) reveal that for those who work, the week is rather long, especially for boys. The average working hours per week for those working was 43.5, with boys putting about 9 more hours than girls, respectively 45 and 36. Overall, 64% of adolescents work full-time (defined as at least 35 hours), again with a higher

10

PDF created with pdfFactory Pro trial version www.pdffactory.com

proportion of boys (69%) than girls (46%) working full time. Interestingly, there are very little variations in hours of work by age or nationality.

Table 4.1 Labor Force Participation by Age, Sex and Nationality (%) Variable

In Labor Force

Contributes to Family income

14-15

23.0

77.4

16-17

40.7

83.8

18-19

52.1

80.0

Boys

54.9

79.5

Girls

11.4

86.7

Lebanese

38.3

75.6

Palestinian

31.5

84.3

Total

33.9

80.6

Age Group

Sex

Nationality

4.2 Education 4.2.1 Parents Level of Education There is usually a correlation between the level of education of parents (especially the father) and the overall living conditions of the whole family. We found that proportion of parents who are illiterate is 11% while the majority (43.5%) of parents have only completed elementary level. The national illiteracy level is 8% with a much higher proportion of illiteracy among women (almost 11%) than men (5.1%). Surprisingly though, in our study the share of illiteracy among Fathers (13.4%) is higher than that of mothers (9%). Similarly, the proportion of mothers (48%) who have reached elementary level is higher than that of fathers (39%), with about equal percentage of fathers and mothers who have reached intermediary level or higher. Table 4.2.1 Parents level of education (%) Variable

Illiterate

Can Read and Write

Elementary

Intermediary plus

Father

13.4

15.9

39.0

31.7

Mother

8.8

12.7

48.1

30.4

Parent

As for adolescents, about 13.4% of the boys are unable to read which is 3 times more than proportion of girls (4%) who indicated they could not read. However, almost all the adolescents (99%) have been to school. 4.2.2 Low enrolment rate among Lebanese and Palestinian adolescents 11

PDF created with pdfFactory Pro trial version www.pdffactory.com

About only 54% of adolescents interviewed were enrolled in School, Institute or University which is much lower than the national enrolment rate (78.3%).The highest enrolment rate (around 69%) is among adolescents aged 14-15 years, while the lowest is among 18-19 year olds 30.6% . It might be that the older age group joins the work force at this age. More girls (around 63%) are enrolled in schools than boys(45%). This can be explained by the percentage of boys who work (52%) compared to a much lower proportion of girls who do (around 11%).

Table 4.2.2 School Enrollment by, Age , Sex and Nationality Enrolled (%) Variable Age Group 14-15

68.9

16-17

43.3

18-19

30.6

Sex Boys

45.0

Girls

62.7

Nationality Lebanese

52.8

Palestinian

53.1

Total

53.6%

Table 4.2.3 Mean years of Schooling by Age Variable Percent Age Group 14-15

6.4

16-17

7.0

18-19

7.5

Sex Boys

6.5

Girls

7.1

Nationality Lebanese

6.8

Palestinian

6.7

As expected, the dropout rate among 18-19 year old adolescents is higher (around 17.%) than those who dropout from younger age groups. The most frequent (39%) 12

PDF created with pdfFactory Pro trial version www.pdffactory.com

reason stated, by boys and girls, for dropping out was "Did not like school/not interested in education". However, there is a difference in reasons given by boys and girls. For example, 13% of dropout girls indicated that "Help needed at home/family problems" led them to leave school. However, only 2.4% of dropout boys gave the same reason. Similarly, 17% of dropout boys said that their poor academic performance caused them to dropout while around 9% of the girls gave the same reason. It interesting to note that despite the poor background of adolescents in this community, only 5% of dropouts attributed their reason for leaving school to financial difficulties. The majority (92%) of participants in this study, including dropouts, went to public/UNRWA schools which are under resourced and are overcrowded. Hence, one can conclude that school environment is unappealing for students. This corresponds with our focus group findings as all participants complained about the attitude of teachers towards students and how they are being beaten and humiliated in school.

Table 4.2.4 Dropout Rate by, Age, Sex and Nationality Variable Percent Age Group 14-15

9.4

16-17

9.9

18-19

17.1

Sex Boys

9.4

Girls

12.1

Nationality Lebanese

14.6

Palestinian

8.7

Total

10.8

5. Health Status 5.1 General Health Status: A person’s sense of health is affected by physical, mental, environmental, and social factors. The majority (67.3%) of adolescents considered their health to be good and 28% reported acceptable health.

13

PDF created with pdfFactory Pro trial version www.pdffactory.com

Table 5.1 Health Self Assessment by Sex (%) Variable

Poor

Acceptable

Good

Boys

3.5

25.4

71.1

Girls

5.9

30.9

63.3

Total

4.7

28.1

67.3

Sex

The source of health information for adolescents determines their level of awareness about physical changes they are under going and about health risks. For this reason it was important to see where these adolescents were seeking information from. Naturally, the youngest group had the highest proportion of adolescents who ask family members about health related issue, where as the majority (59.2%) of 18-19 year olds go to doctors or pharmacists. However, a great disparity appears when comparing the percentage of boys (57%) who go to health professionals with (38.2%) girls who do the same. Most girls (55%) get their information from their family. This has great implications on the type of knowledge these girls are receiving as the majority of parents are poorly educated. Moreover, most of the girls in focus groups indicated that their parents shy away from explaining any matter related to sexual health. There are also some misconceptions about the girls physiology that parents are passing on to the girls. For example the girls mentioned that they were banned from riding bicycles because they will lose their virginity.

Table 5.2 Health Source of Information by Age and Sex % Family Health Professionals Others Variable Age Group 14-15

52.2

39.1

8.7

16-17

40.7

54.9

4.4

18-19

36.7

59.2

4.1

Boys

36.6

57.0

6.3

Girls

55.1

38.2

6.6

Total

45.7

47.8

6.5

Sex

5.3 Mental Health: Mental health is an essential indicator for the health status of individuals especially adolescents who are experiencing a transitional stage between childhood and adulthood. Hence, we attempted to measure the general mental health status of adolescents by using the Mental Health Inventory (MHI5) which is an instrument 14

PDF created with pdfFactory Pro trial version www.pdffactory.com

used to measure psychological distress. MHI5 has a score of 0 to 100 where a score of 100 is considered optimal mental health3 and those who scored below 72 are considered distressed. Around 22% of adolescents have reported distress. It appears however that there are more girls suffering from distress (25%) than boys (18.4%). Table 5.3.1 MHI5 by Age and Sex (%) Variable

Distressed

Not Distressed

Age group 14-15 16-17 18-19

20.4 19.8 28.6

79.6 80.2 71.4

Sex Boys Girls Total

18.4 25.0 21.7

81.6 75.0 78.3

5.3.2 Self- Esteem: None of the adolescents reported low self-esteem. Almost 97% agreed that they have good qualities and 3.2% feel that they are a failure. A slight gender difference appears in a number of statements. However, the proportion of girls who reported selfsatisfaction (87.5%) is less than boys who reported the same (96%).

Table 5.3.2 Self Esteem by Sex (%) Statements measuring Self-Esteem (Agree)

Male

Female

Total

I feel that I have a number of good qualities I feel that I am a person of equal worth with others I feel I have much to be proud of On the whole, I am satisfied with myself I respect myself I am beneficial to others On the whole, I feel I am a failure

97.2 95.8 91.5 95.8 97.2 87.3 2.8

96.3 91.9 84.6 87.5 99.3 88.2 3.7

96.8 93.9 88.1 91.7 98.2 87.8 3.2

6. Risky Behavior 6.1 Weight Control: We found that 33.5% of the adolescents could not estimate their height and 24% did not know their weight, hence we couldn't calculate the body mass for this group.

3

Meltzer, Howard (2003), Chapter 4: Development of a common instrument for mental health, Europhis: Developing Common Instruments for Health Surveys, IOS Press 15

PDF created with pdfFactory Pro trial version www.pdffactory.com

About 18% of adolescents are underweight with the proportion of girls in this category (21%) higher than the boys (around 15%). However, the majority of adolescents (around 60%) are in the normal category which means they are at their optimal weight. Surprisingly, almost one out of 5 girls with normal weight wants to lose weight compared to only 4% of boys in the same category. Only 18% of overweight adolescents were dissatisfied with their weight. It is interesting to note that only 12.5% of overweight girls reported dissatisfaction while a higher percentage of overweight boys (around 22%) indicated they were dissatisfied. Overall, 10% of adolescents are trying to lose weight with more girls 15% than boys (around 6%) reporting attempt to lose weight. However, there are more normal weight girls (19%) than overweight ones (12.5%) trying to lose weight Table 6.1: Body Mass Index by Age and Sex Variable % Underweight

Normal

overweight

22.6 11.8 15.4

53.6 68.6 61.5

23.8 19.6 23.1

Sex Boys

14.8

59.1

26.1

Girls

20.9

60.5

18.6

Total

17.8

59.8

22.4

Age Group 14-15 16-17 18-19

Table 6.1.2 Weight Control by Body Mass Index and Sex % Variable BMI categories Underweight

Normal

Overweight

Total

Gain weight

23.1

9.6

-

9.1

Not doing anything particular

53.8

75.0

87.0

75.0

-

11.5

4.3

8.0

23.1

3.8

8.7

8.0

Gain weight

16.7

-

-

3.5

Not doing anything particular

77.8

71.2

87.5

75.6

Boys

Stay the same weight Lose weight Girls

Stay the same weight Lose weight

5.6

9.6

-

7.0

-

19.2

12.5

14.0

6.2 Lack of Exercise: Only 5% of adolescents reported poor health. However, more than a half (53%) of the participants indicated that they do not engage in physical exercise with a disparity 16

PDF created with pdfFactory Pro trial version www.pdffactory.com

between the proportion of boys (51%) who exercise and that of girls (42%). This low level of physical activity might be the result of lack of public spaces and sports clubs, especially for girls. 6.3 High level of Violence: More than a third of adolescents (37.4%) engaged in physical fights (hitting or assaulting) in the past 3 months. Although physical fights are not an uncommon behavior among adolescents, this percentage is drastically higher than what was reported in a study conducted on adolescents living in Hey-Sellom (19%), Nabaa (15%) and Burj Al Brajneh camp (10%) in Beirut. The proportion of boys (49%) who engage in physical fights is much higher than proportion of girls (25%) who engage in similar behavior. Similarly, a great difference appears between boys and girls when comparing answers about the persons they fought within the last 3 months, as half of the boys reported they fought with complete strangers while only 3% of the girls have reported the same. Moreover, about 35% of the girls reported that they had physical fights with parents/siblings and only 3% of the boys have reported domestic violence. This might be due to the fact that girls are spending most of their time at home as indicated by both quantitative data and focus groups.On the other hand, boys either spend their time in coffee shops, in the street or the internet café. Additionally, this can also mean that girls have more problems with their families and are more subjected to domestic violence. This was also revealed by focus group findings as most participants had fights with their parents for not being allowed outside except to go to school or a friend's house. There is a similarity however in the proportion of boys and girls who had physical fights with their friends, 44.3% and 50% respectively. Table 6.3.1 Involvement in Physical Fights by Age and Sex Variable

Percent

Age Group 14-15

35.5

16-17

44.0

18-19

30.6

Sex Boys

49.3

Girls

25

Total

37.4

Table 6.3.2 Frequency of Physical Fights within the Past 3 Months

Variable

1-4 times

5-30 times

Boys

25.4

23.9

Girls

15.4

9.6

Total

20.5

16.9

Sex

17

PDF created with pdfFactory Pro trial version www.pdffactory.com

The percentage boys indicating that somebody got injured in their fights was 45% as for the girls about 35% reported the same. This disparity is expected as boys are likely to be more physical in this context. 6.4 Smoking: The proportion of adolescents who reported cigarette smoking is 11% (28 adolescents) out of which only one girl reported smoking. This amount of cigarette smokers is not high especially when compared to an alarming 43% who smoke Argyleh. However, this low rate of cigarette smoking might be an underestimate due to social desirability bias. Conversely, the majority of adolescents (52.5%) believe that Argyleh smoking is more harmful than cigarette and 34.2% think they are equally harmful. Hence, there seems to be no misconception about Argyle smoking being an equally or more risky behavior compared to cigarette smoking. The young (14-15 year olds) have the least proportion of Argyle smokers (28.6%) where as both older groups of adolescents reported a considerably higher percentage of Argyleh smoking, 56.2% of 16-17 year olds and 58% of the oldest group. Adolescents at the age of 18-19 are probably more independent and have more money to spend on such habits. The mean age for smoking initiation is 15 years. Only 27.4% of Argyleh smokers indicated that they were contemplating quitting within the next 6 months. In stating reasons for smoking 46.4% of the smokers reported they smoked out of curiosity. However, there is a disparity between girls who reported they smoked out of curiosity (69.4%) and boys who reported the same (32.2%). The second most frequent reason (39%) was "To imitate adults", here too there is a difference as 52.5% of the boys stated this reason while only 11% of the girls gave the same reason. Table 6.4.1 Argyleh Smoking by Age and Sex Variable

Percent

Age Group 14-15 16-17 18-19

28.6 56.2 58.1

Sex Boys Girls Total

50.8 34.5 43.0

We asked participants to estimate the number of Argyleh heads they consumed on days they smoked Argyleh. It appears that the majority (63.3%) of 14-15 year olds do not smoke more than one Argyleh head a day. However, this is not the case for the oldest group as the majority (52%) of adolescents aged 18-19 indicated that when they smoke they consume 3 or more heads of Argyleh per day. In general, with minor gender differences, about half the adolescent consume one head a day on the days 18

PDF created with pdfFactory Pro trial version www.pdffactory.com

they smoke and 24.5% smoke 2 heads a day while around 27% smoke 3 or more a day.

Table 6.4.2 Consumption of Argyleh heads by Age and Sex (%) Variable 1 Head a day 2 Heads a day 3 Heads or more a day Age Group 14-15 16-17 18-19 Sex Boys Girls Total

63.3

23.3

13.3

48.7

30.8

20.5

32.0

16.0

52.0

50.0

22.4

27.6

47.2

27.8

25.0

48.9

24.5

26.6

6.5 Alcohol and Drug Abuse: Alcohol drinking is an unacceptable behavior in a conservative Muslim community like Old Saida. Drug abuse is similarly intolerable for social and legal reasons. For these reasons, it is most probable that there has been underreporting on alcohol consumption and drug abuse during interviews. Nonetheless, in all focus groups both behaviors, drugs to a less extent, were described as the most prevalent risky behaviors among male adolescents. Only 12.3% of adolescents reported alcohol drinking, only one girl among which, and 79% mentioned that none of their friends drink alcohol. Moreover, the vast majority (84.4%) among those who reported drinking indicated that they were occasional drinkers. As for the use of tranquilizers and drugs only 2% of adolescents reported either. Moreover, 92% stated that none of their friends take tranquilizers and 97% reported that none of their friends have taken any other type of drugs.

7. Social Cohesion and Recreational Activities 7.1 Social Support Relationship with the parents and the overall home environment is an essential factor affecting adolescent's risky behavior. Here too, participants reflected a very healthy perception about their home life. In almost all the answers there are similarities between boys and girls with the exception of proportion of girls (96.3%) who agree that their fathers care about them and that of boys who feel the same (89.2%). Table 7.1 Perception of Social Support by Sex (%) Agree

Boys

Girls

Total

I feel that my mother/her representative cares about me

97.9

97.8

97.8

19

PDF created with pdfFactory Pro trial version www.pdffactory.com

I feel that my Father/his representative cares about me I have a happy home life

89.2

96.3

92.7

91.4

94.8

93.0

7.2 Social Relations and Trust: It is important to see how comfortable adolescents are in their community and surroundings to be able to assess social risk factors. We tried to find out whether adolescents were involved in any groups in their community. Moreover, community attachment was assessed by a question on satisfaction living in the area. We also tried to measure the level of safety they felt walking alone at night in the area. Adolescents were also asked about their extent of trust in people in their community. On the whole, about only 12% of the adolescents are involved in groups in the community with more (13.4%) members in sports teams than other types of groups (social or cultural) (about 11%). However, it is important to look at the gender disparity here as only 2.2% of the girls are involved in sports teams while 24% of the boys are part of some sports team. Similarly, the proportion of boys who are members in other groups (14%) are about twice as high as that of girls (7.4%). This can be explained by our focus groups findings as girls are discouraged by their parents from engaging in any activities that would involve them mixing with boys.

Table 7.2.1 Membership in Groups by Age and Nationality (%) Variable Sports Team Other Groups Age Group 14-15 16-17 18-19

11.6 15.6 14.3

12.3 8.8 10.2

Sex Boys Girls Total

24.1 2.2 13.4

14.1 7.4 10.8

About 68% of adolescents stated that they were happy living in their area with much less girls (62.5%) indicating their satisfaction than boys (about 74%). Additionally, 47% of the girls reported they felt safe walking alone at night in the area where as about 71% of the boys reported the same. In focus groups, girls described the environment in the Old city of Saida as unsafe especially at night where a lot of fights take place with knifes and razors being used. It is striking though that only 7.3% of the adolescents indicated they felt they could trust most/many people in the area while the vast majority (66.5%) stated they trusted only a few people.

20

PDF created with pdfFactory Pro trial version www.pdffactory.com

Table 7.2.2 Perception of Safety, Trust and Satisfaction by Sex and Nationality %

Variable

Feel Safe

Trust many People

Happy living in the area

Sex Boys Girls

70.9 47.0

9.2 5.2

73.8 62.5

Nationality Lebanese Palestinian Total

63.0 58.4 59.3

8.3 6.8 7.3

72.5 64.8 68.2

A vast difference appears between genders when asked about the people they talk to when they have problems. About 60% of the girls indicated they spoke to family members while the majority of boys (almost 55%) reported they confided in their friends. This is probably because girls spend less time with their friends since they have little freedom in their movement. In general, family members (46%) and friends (43.3%) where the two most frequent answers adolescents gave. The percentage of girls who made friends among their neighbors is about 10% compared to 37% of boys who reported the same. Again this disparity is a clear result of girls inability to spend time outside their houses. Overall, only 27% of adolescents have friends among their neighbors which is a low rate especially since the area of the Old City is small and is densely populated. This is probably the result of the high level of mistrust in people living in the area which adolescents reported. The overwhelming majority of girls (77%) had met their friends in school while the corresponding percentage of boys is much lower (45%).

7.3 Recreational Activities: Adolescents usually have high levels of energy and a lot of free time. If this excess of energy is not used in productive activities (physical and cultural), this would reflect on their behavior, physical and mental well being, and overall intellectual development. T.V watching was the most popular hobby (34.5%) especially among 14-15 adolescents (40.3%). Around 48% of girls watch TV during their free time which is more than double the proportion of boys (22.4%) who reported the same. Practicing sports is extremely low as only 7.4% engage in such activity and surprisingly the youngest group is the least active (4.7%). The proportion of boys (16.4%) is two times higher than the proportion of girls (8%) who use the internet, though the overall percentage of adolescents who use the computer/internet is low (12.4%). This is probably because they come from poor families and can neither buy computers nor 21

PDF created with pdfFactory Pro trial version www.pdffactory.com

regularly visit internet cafes. Of course the situation for girls is worse as they are seldom allowed to go to such cafes. Reading books outside school curricula seems to be the least popular hobby among adolescents (4.7%), and more girls (9%) than boys (around 1%) read. Moreover, only 14% of the participants indicated they read news papers last week, again there is a gender disparity here with (18%) of the girls reporting news paper reading and only 10% of the boys reporting the same. Table 7.3.1 Free Time Activity by Age and Sex (%) Variable Age Group 14-15 16-17 18-19 Sex Boys Girls Total

Watch TV

Listen to music

Meet friends

Computer/internet

Sports

Read books

40.3

27.1

13.2

10.9

4.7

3.9

29.8

29.8

9.5

16.7

9.5

4.8

26.7

37.8

8.9

8.9

11.1

6.7

22.4

32.8

17.2

16.4

10.4

0.7

47.6

26.6

4.8

8.1

4.0

8.9

34.5

29.8

11.2

12.4

7.4

4.7

It is alarming that the majority of adolescent girls (around 57%) do not go out during their free time with a tremendous gender disparity when compared to the corresponding proportion of boys (6%). Around 20% of adolescents spend their free time in the street, most of which are boys (33.3%) while around only 7% of the girls do the same. Coffee shops (‫) ﻗﮭﻮة‬, where Argyleh is served, are the second most popular places for boys(23%), on the other hand, only 4% of the girls go to coffee shops. Almost 15% of the girls like to go to restaurants during their free time and only 2% of the boys do the same. The recurring theme throughout the study is that of girls spending hardly anytime outside the house except in their schools and boys spending a lot of their time outside the house. Naturally, this would create great differences in types of hobbies and choices for hangout places between boys and girls. Focus groups data revealed that both society and parents play a central role in what girls can do and where they can go during their free time. Table 7.3.2 Free time Hangout Place by Age and Sex (%)

Variable

Age Group 14-15 16-17

Most Frequent Hangout Place I Don't Go out

Street

Coffee Shop

Friends House

Restaurant

36.2

20.3

8.0

13.0

5.1

23.3

22.2

16.7

16.7

14.4

22

PDF created with pdfFactory Pro trial version www.pdffactory.com

18-19 Sex Boys Girls Total

28.6

16.3

22.4

6.1

6.1

5.7

33.3

22.7

15.6

2.1

56.6

6.6

3.7

0.3

14.7

30.7

20.2

13.4

13.0

8.3

We asked adolescents about TV programs they watch and the vast majority (79.4%) seemed to be interested in singing and dancing shows the most; there are hardly any gender differences in preference for this type of shows. Disparity in preferences appears in action/violence movies, as an overwhelming majority of boys (86.5%) indicated there preference for such movies while 40% of the girls reported the same. Political programs and the news have less viewers among adolescents (44.4%) with minor difference between girls and boys. Additionally, cultural programs (art, history) have even less viewers as only 32% of adolescents reported they watched such programs. However, the proportion of girls (around 40%) who reported they watched cultural programs is considerably higher than that of boys (24.3%) who indicated the same. As for fashion shows, a larger percentage of boys (around 37%) than girls (25.2%) watch these programs. It is most probable that boys are drawn to such programs because they show women in revealing clothes. Table 7.3.3 TV Programs, Viewers by Sex (%)

Variable Sex Boys Girls Total

Drama/Comedy Song/Dance Action/Violence News/Political Cultural

Fashion

56.7

78.7

86.5

46.4

24.3

36.9

73.5

80.1

40

42.2

39.7

25.2

65

79.4

63.8

44.4

31.9

31.2

8. Expectations and Future Plans We tried to measure the degree to which adolescents are looking up for their future. Overall, the majority (around 58%) seemed to expect Little/average improvement in their lives with hardly any gender differences. This rather pessimism is unusual for young individuals who generally do not have responsibilities to worry about. However, the youngest age group had the highest proportion (44.2%) of optimists. Also, only 4.2% were completely pessimistic about their future stating that they do not expect it to improve at all or were empathetic indicating they do not care how it turns out. More Lebanese adolescents (44%) than Palestinian ones (33%) indicated that they expect the future to improve a lot.

Table 8.1 Expectations about the Future by Age, Sex and Nationality (%)

Variable

Expecting things to Improve A Lot

Average/Little

Age group

23

PDF created with pdfFactory Pro trial version www.pdffactory.com

Not at all/Don't care

14-15 16-17 18-19

44.2 28.6 39.1

52.7 65.5 56.5

3.1 6.0 4.3

Sex Boys Girls

36.8 39.7

59.4 55.6

3.8 4.8

Nationality Lebanese Palestinian Total

44.1 33.1 38.2

52 62.3 57.5

3.9 4.6 4.2

In general, adolescents' perception about their opportunities in life with regards to education and work is central to their outlook on life and their future plans. The majority (64.4%) of adolescents seem to believe they have equal education and employment opportunities compared to adolescents living in other areas in Lebanon. More girls (72%) than boys (around 58%) think they have similar opportunities. As for the rest, 18.2% believe they have less chance with a much higher proportion of Palestinian adolescents (26%) than Lebanese (around 8%) in that category. On the other hand, around 26% of Lebanese adolescents feel they have better opportunities while the corresponding proportion for Palestinians is 11.3%.

Table 8.2 Perception of Opportunities by Sex and Nationality (%)

Variable

Comparing Opportunities with others Similar

Better

Less

Sex Boys Girls

57.7

15.3

27.0

72.0

18.9

9.1

Nationality Lebanese Palestinian

66.7

25.7

7.6

63.5

11.3

25.2

Total

64.4

17.1

18.2

Contrary to general assumptions about girls' desire to get married, we found that there were many more boys 90% than girls 74% who reported their desire to get married.

24

PDF created with pdfFactory Pro trial version www.pdffactory.com

This might be related to the fact that more boys (97%) feel free in choosing their future spouse than girls (83%). A great difference appears again when comparing the proportion of girls who expect they will get married (58.5%) with that of boys (75%). However, when asked if they wanted to have kids, 83% of the girls affirmed and almost 91% of the boys indicated their desire to have kids.

Focus Groups Results of the focus group will be grouped according to the questions asked. Results will be disaggregated by gender or age when such differences were found.

Health risk behaviors When asked to mention health risk behaviors that young people in old Saida engage in, both boys and girls focused mainly on risk behaviors of boys. They mentioned smoking (cigarettes and Argyleh), getting drunk, using drugs, staying out late, hanging out with ‘bad company,’ having sex daily, and masturbation Only the older boys group mentioned sex and masturbation. Drinking and smoking (mentioned in all focus groups) were felt to be much more prevalent than the other behaviors mentioned. With respect to girls, only smoking and dating boys was mentioned. Youth defined ‘risky’ behavior: The youth in Old Saida added to the usual (professional defined) list of risky behaviors. Interestingly, they considered staying out late, dating boys, and masturbating as risky behaviors.

Determinants of engaging in these behaviors Three main themes predominated when focus group participants were asked why young people in Old Saida engaged in these behaviors. Almost all the groups mentioned problems between parents(home environment) as a determinant. Also, the theme of entertainment was mentioned in almost all groups. Finally, either a lack of education (of parents or the youth) or unemployment (or lack of money) were mentioned as root social determinants. Other less frequently mentioned reasons included peer pressure, lack of guidance from parents, to show off, out of boredom, imitation, and curiosity (adolescents want to try everything). There were no results that were specific to age group or gender.

Relationships with parents When asked about the relationship that young persons in Saida have with their parents, some of the youth mentioned that they get along with their parents, but many indicated conflict between parents and children. Hitting of children seemed commonplace: parents hit boys when they smoke, drink, or stay out late; and hit girls if they talk to boys or mix with them or go out. Both boys and girls mentioned the hitting of boys for smoking, but only the girls’ focus group mentioned the hitting of girls. All age groups spoke of the conflicts between parents and children. There was s general sense that parents are very strict, especially with their daughters, and that they were ‘old fashioned.' They also talked about how uneducated parents have a communication problem with their educated children, one participant stated:

25

PDF created with pdfFactory Pro trial version www.pdffactory.com

Youth discussed how technology had changed the world, but not all agreed that this was a positive change. But, there was a general sense that this change has provided the youth with options (satellite dish, mobile phones, internet) which were not available for their parents as they grew up. These innovations changed the life style of the youth in ways that the parents can neither cope with nor accept.

Violence Violence is quite prevalent in old Saida, according to the youth. In addition, it occurs in a variety of settings. The discussion around this question was most extensive. Both boys and girls spoke of the prevalence of street fight: boys fight all the time. They mentioned that weapons, such as razors, knives, and even guns, are often used in these fights. The fights are often over the fact that boys slurred girls, and then the girl’s brother or father come to defend her. Girls mentioned that slurring of girls was very common, even young boys (9 years old) would throw slur words at girls passing by. They felt that the solution was for them themselves to hit the boys that slurred them. Girls also spoke of violence at school. Teachers often use verbal or physical violence with students - both males and females. Students will sometimes then hit teachers back or threaten them with their parents. However, one of the boys who participated stated that he had let school because he felt oppressed by the teachers. Girls also mentioned violence between siblings. Older siblings will hit younger siblings to get them to do things or because they don’t like their behavior. Youth again mentioned violence between parents and children. Parents will use belts to hit children. This violence sometimes extends to the wife if she tries to defend the children. Also, when extended family members are living at home, the violence may come from them. In one group 2 unrelated participants spoke of their uncles beating them. Others said this was an exception as uncles usually treat their nieces/nephews very well. The general theme that emerges from listening to the youth speak is of a cycle of violence or violence breading violence. Youth learn from their parents and teachers that violence is a solution, and they then in turn use it against strangers or friends or family members or teachers. All those who stated that they hit their siblings said they had been beaten by their parents. They found hitting to be a tension releaser, they let out their frustration on their younger siblings. Moreover, they seemed to take the issue very lightly and felt no shame in admitting that they sometimes inflicted "minor" injuries upon their younger sisters or brothers. One female participant stated: 4

"‫ ﯾﺎ ﺑﻀﺮب ﻋﻠﻰ اﻷﺟﺮﯾﻦ أو اﻷﯾﺪﯾﻦ ﺑﺲ اذا ﻋﻠﻰ اﻟﺮأس ﺑﯿﺼﯿﺮ ﺷﻲ‬،‫"اﻧﺎ ﻣﺎ ﺑﻀﺮب ﺑﻤﻄﺮح ﯾﻮﺟﻊ‬

Recreational activities for boys and girls Both boys and girls mentioned that there were many options for recreational activities for boys. In general, boys are not restricted in their activities. However, girls are very restricted. They stay at home, go to their friend’s homes, or in rare cases might go to an internet café. In all cases, they must come home early. In terms of sports, although they might play basketball or karate, both of the focus groups with girls 4

“ I do not hit on areas that might hurt, I either hit on the legs or hands/arms, but something (bad) might happen if I hit on the head” 26

PDF created with pdfFactory Pro trial version www.pdffactory.com

mentioned that they were not allowed to ride bicycles as it might make them ‘lose their virginity.’ Boys stated that the differences stem from traditions and norms. They also said that girls’ honor must be protected. Girls seemed to feel that the differences stemmed from potential for gossip. People gossip when girls go out or stay out late. Parents fear these rumors and therefore restrict their daughter’s activities. Girls felt they needed a place to go that parents felt was safe.

Sexual relationships Both boys and girls generally thought that most boys are having sex. They thought few girls were having sex. Boys mentioned that some of the boys having sex used condoms (and one group mentioned that they use plastic bags when they run out of condoms). Girls were less sure if protection was being used, and were quite unaware of types of protection. Some of the girls did not know what a condom was. Even boys mentioned the need for more awareness raising about methods of protection against pregnancy and STIs. Younger girls and boys were less informed than their older counterparts, but in general, discussions of sex and related issues seemed not to be common among adults (parents, teachers) and youth. Both boys and girls brought up stories of girls who had had sex and gotten pregnant. These were not all one case, but different cases. This suggests that unprotected sex is taking place - sometimes with dire consequences, among youth in Saida. The older groups mentioned that young boys who are sexually active are not really concerned with protection and would even have sex with prostitutes who are HIV infected. Interestingly, both boys groups brought up the issue of pornographic movies. They stated that these are common and easily accessible. With respect to sexual abuse, participants mentioned some case that everyone knew about,. However, they also mentioned other examples such as an older man who employs young boys at an apprentice shop and then pays them extra for sex. Every focus group had at least one additional case to report that was not common to the other focus groups. This suggest potentially dangerous situations.

Other important issues When youth were asked about other issues of importance to them, two main themes emerged. Both boys and girls mentioned the ‘mentality’ in Old Saida as a problem. Rumors are started whenever a boy and girls are seen together, even if they are just walking home form school. Participants also brought up the issue of trust between the parents and their children. Parents are suspicious of their children especially their daughters, and would even sometimes believe rumors that people start. The other theme was that of unemployment due to lack of skills. Youth stated that the public schools were not giving them math and language skills that they needed to find jobs.

Youth defined solutions

27

PDF created with pdfFactory Pro trial version www.pdffactory.com

All focus groups mentioned the critical importance of dialogue, mostly between parents and children, but also between teachers and children. They saw this as an important alternative and preventive mechanism to fight. They also believe that parents need awareness on how to deal with their teenage children. Girls specifically mentioned the need for recreational activities and places where they could go out. Girls also mentioned the need for extra tutoring sessions in summer to strengthen their language skills. Boys also mentioned the need for extra activities, but this in order to prevent them from smoking or drinking.

II. Discussion The results of the quantitative and qualitative studies indicate that youth in Old Saida are living in a precarious situation economically, socially, and from a health perspective. At a time in the life cycle when privacy and meeting of basic needs may be all important, they live in families with a lot of other individuals and little space, and in households that may not be able to meet their basic needs. Perhaps as a result, many of the youth, especially older boys, are working, and contributing at least parts of their income to help their families cope. Although this may be assisting in meeting of basic needs, it is exposing to the hazards of the workplace at an early age. Youth are working many hours at probably for low pay. The study found that many youth are out of school, collaborating the evidence of labor force participation. Conceivably reflecting the problem of school drop out for work, over one in ten boys state they are unable to read. Despite the fact that few health problems face youth generally, only about 2/3 of youth in old Saida rate their overall health as good. Corroborating this, about 1 in 4 girls and 1 in 5 boys report experiencing mental distress. Quite a few adolescents are not able to state their height and weight, perhaps suggesting that they have not had a recent visit to a health professional. Several risky behaviors were explored. Clearly violence, smoking (at least of the argyle), and lack of exercise are priority problem behaviors. The cycle of violence was a clear theme of the focus groups. Youth also attributed their engagement in risky behaviors to problems in the home environment. From the focus groups, unprotected sexual behavior also seems to be a potentially dangerous practice, for boys at least. With respect to social aspects of life, youth in Old Saida are not members of groups. However, in the focus group, youth mentioned a variety of recreational options for boys, although the very limited ones for girls. Youth in old Saida trust few people in their neighborhood. This lack of trust extends into the home as suggested by the focus groups. The lack of trust is also one of the factors limiting activities especially of girls who are kept at home so that others will not start rumors about them. In the focus groups, youth lamented about the poor relationship they have with their parents. They attributed part of this to a generation gap linked to educational opportunities, access to technology and the internet. At a time when life often seems brightest, the condition in old Said described above are leading to some pessimism about the future. This is perhaps noticed most acutely 28

PDF created with pdfFactory Pro trial version www.pdffactory.com

with the data on marriage and for girls. In a culture where everyone gets married, especially girls, only slightly more than 50% of the girls in old Saida expect to marry. This is much less than a similar population in urban areas of Beirut Where 92% of the girls (13-19 years) stated they would like to get married, And 70% of the girls thought they would likely get married. Options to ease the stresses of life for youth in Old Saida must be considered. The analysis pointed to some possible solutions.

III. Recommendations Some of the issues discussed above are linked to structural issues which are not amenable to change. It is unlikely that a solution to overcrowding and low socioeconomic status can be found easily. However, some of the issues suggest avenues for intervention. Four main principles should be kept in mind. First, youth in old Saida as elsewhere are part of a family and a community. It is inconceivable that solutions can target youth without also working with families and communities. In fact, such solutions would be unethical for youth. Second, the data suggest that there are many differences between girls and boys. Therefore, interventions should be tailored to them differentially. Solutions that work for boys will be different than those that work for girls. Third, the principle of participation begun by asking youth their opinions through the survey and focus groups, should continue as solutions to these problems are sought. In fact, participation of youth in planning for themselves, in and of itself, may be a solution to some of the issues brought up and may give some additional hope for the future. Finally, the engagement of adults in the community, begun through the community meetings must continue. Few interventions will work, especially those directed to girls, without community support. Specific interventions which the data suggest may be considered include: • Basic access of the youth to health professionals on a routine and annual basis. This fits the recommendations for preventive care, and would provide opportunities for youth to ask questions as needed. This is an intervention needed for both boys and girls, although the characteristics of the health professional providing such care to boys vs. girls would need to differ. • Provision of recreational activities, especially for girls. One possible intervention would be to develop a girls club where they can practice sports, have access to the internet and engage in other activities. This needs to be done in coordination with the community so that girls would have a safe and acceptable place to go. There would have to be a lot of work before hand with parents to ensure that they perceived this place to be a gossip-free, rumor free recreational place for girls. • Sexual education is a clear need especially for younger groups (14-16 years). This education has to be provided in a way that is informative to the youth and answers their needs and questions; but is, at the same time, culturally acceptable and appropriate. • Interventions should also consider decreasing tobacco use, especially the argyle. Providing opportunities for other recreational activities may serve this purpose as well, as youth often mention that they smoke to fill time. Education about the dangers of argyle smoking is also needed. Awareness 29

PDF created with pdfFactory Pro trial version www.pdffactory.com

•

•

related to the specific dangers is low, despite the stated sound bite that argyle use is more dangerous than cigarette use. Clearly, the issue of violence needs to be dealt with. However, this is a systemic problem, and cannot be solved with youth alone. All parties (parents, teachers, and youth) must understand the implications of use of violence, and learn to use other coping mechanisms or other strategies for discipline. Implementing an intervention around violence with youth alone is unfair to them, and will not solve the problem. The solution must be comprehensive and multisectoral. The evidence base for violence prevention interventions is growing, and specific strategies for violence prevention are numerous in the literature. A thorough review of possible interventions should be conducted, and one selected that is most relevant to the context of youth and their families in old Saida.5 Problem solving techniques, alternative thinking strategies, and interpersonal communication skill building are critical for al parties concerned. Therefore interventions can include youth, parents, and teachers, separately and together. Opportunities to talk to each other seem rare, but dialogues is critical to an increased understanding of the other. Other interventions for parents should also be considered. Parents also need support to cope with the rapidly changing context of their children's lives. Understanding youth development and developmental needs may ease this transition phase for youth and their parents. Strategies to cope with technology and increasing opportunities but not lose 'culture' need to be discussed with parents and children.

While encouraging intervention planning and implementation, the research team also strongly recommends that an evaluation component is considered for the interventions. Investing in interventions without planning for their evaluation does not contribute much to the lives of youth, as it does not indicate which ideas are working, and thus does not suggest avenues for investment in the health of youth. More research may be needed to explore ???

5

The US Centers for Disease Prevention and Control, National Center for Injury Prevention and Control has published " Best Practices of Youth Violence Prevention: A Sourcebook for Community Action." http://www.cdc.gov/ncipc/dvp/bestpractices.htm In addition, the National Center for Mental Helath Promotion and Youth Vuiolence Prevention highlights evidence based interventions in practice http://www.promoteprevent.org/grantees_at_work/evidence_based/. 30

PDF created with pdfFactory Pro trial version www.pdffactory.com