William Byansi

This study examined associations between adverse childhood experiences (ACEs) and anxiety symptoms, depressive symptoms, lifetime suicidal ideation, and lifetime suicide attempt among African‐origin emerging adults in the United States. Data were drawn from a cross‐sectional, nonprobability online panel of 537 participants aged 18–29, comprising foreign‐born first‐generation African immigrants and U.S.‐born second‐generation participants with African‐born parents. We assessed ACEs using an expanded cumulative index that included conventional household adversities and four community‐level adversities. We used separate multivariable linear and logistic regression models to examine associations between ACEs and each mental health outcome. We also ran generation‐stratified models and formal tests of ACEs × generation interactions. Higher ACE scores were associated with greater anxiety, depressive symptom severity, and higher odds of lifetime suicidal ideation and lifetime suicide attempt. Associations were statistically significant within both generational groups. Generation significantly moderated the associations between ACEs and suicidal ideation and suicide attempt, with stronger associations among first‐generation participants. Generation did not significantly moderate the associations of ACEs with anxiety or depression. Second‐generation participants had higher overall odds of suicidal ideation than first‐generation participants. ACEs were consistently associated with adverse mental health outcomes among African‐origin emerging adults in this U.S.‐based online panel. The findings support culturally responsive, trauma‐informed assessment and intervention while underscoring the need for longitudinal research examining how developmental, migration‐related, and sociocultural contexts may contribute to these associations.

Substance use and mental health symptoms frequently co-occur among youth in Nairobi’s informal settlements, yet scalable interventions remain limited. This pilot study evaluated the Youth Empowerment Digital Intervention (YEDI), a brief group cognitive-behavioral therapy model supported by mobile reinforcement. A clustered-community randomized pilot study enrolled 94 adolescents and young adults aged 15–24 years (treatment = 49; control = 45). The intervention group received seven weekly 1-hour manualized group cognitive-behavioral therapy sessions supplemented by mobile skill reinforcement, while control participants received standard health materials. Alcohol, cannabis, and tobacco use risk, along with depression, anxiety, and stress symptoms, were assessed at baseline, 3 months, and 6 months using linear mixed-effects models. YEDI demonstrated promising short-term reductions in alcohol risk, cannabis risk, and depressive symptoms at 3 months, although these differences were not sustained at 6 months. Tobacco risk did not differ between groups, and stress showed counterintuitive relative effects due to reductions in the control group. Delivering YEDI in informal settlements is feasible and provides a proof of concept for brief, early mental health support. Preliminary findings indicate that brief, skill-based models alone cannot offset severe structural stressors. Multi-level interventions integrating behavioral strategies with ongoing community support are required. .

Background: Digital health interventions can enhance sexual health equity among marginalized and underserved populations, including displaced youth. However, there is limited understanding of displaced youth’s digital health literacy (DHL) and its association with knowledge of and access to sexual health products and services. Objective: This study aims to identify patterns of DHL among displaced youth and assess how these patterns are associated with awareness of and access to sexual health products and services, while considering gender differences. Methods: We conducted a cross-sectional tablet-assisted survey in Kampala, Uganda. We used peer-driven sampling to recruit displaced youth aged 16-24 years living in 5 informal urban settlements. We identified DHL patterns using latent profile analysis. Gender-disaggregated multivariate probit models were constructed to estimate the relationship between DHL and awareness of and access to sexual health products and services (eg, sexual and reproductive health [SRH] information, external condoms, condom use training, sexually transmitted infection testing, and HIV testing). Results: Among the participants (N=445), our latent profile analysis identified 4-DHL classes named: low (class 1, 51/444, 11.5%), moderate (class 2, 99/444, 22.2%), high (class 3, 138/444, 31%), and very high (class 4, 157/444, 35.3%). Our adjusted multivariate probit model indicated that, compared to class 1, class 4 participants were more likely to know where to access condom use training (marginal effect [ME]=0.23; P<.001), external condoms (ME=0.19; P<.001), and HIV testing (ME=0.23; P<.001). We also noted gender-based differences. Men with very high DHL, compared with those with low DHL, were more likely to know where to access SRH information (ME=0.46; P<.001) and condom use training (ME=0.40; P<.050), while women with very high DHL were more likely than those with low DHL to report knowing how to access condom use training (ME=0.12, SE=0.06; P<.050), external condoms (ME=0.34; P<.001), and HIV testing (ME=0.22, SE=0.10; P<.050). Regarding access to sexual health products and services in the last 3 months, class 4 respondents reported higher access to condom use training (ME=0.13, SE=0.04; P<.001), external condoms (ME=0.14; P<.050), and HIV testing (ME=0.24; P<.050) than class 1 respondents. Gender differences showed that among men, those with very high DHL were more likely to access condom use training (ME=0.28; P<.010) than those with low DHL. In contrast, among women, those with very high DHL were less likely to access SRH information (ME=–0.20; P<.001). Conclusions: Our findings reveal a generally high level of DHL but suboptimal awareness of and access to SRH services among urban displaced youth in Kampala. Improving SRH among urban displaced populations will require gender-responsive and culturally grounded digital sexual health interventions to increase awareness of and access to sexual health products and services.

Adverse childhood experiences (ACEs), such as abuse, neglect, and household dysfunction, are linked to adverse mental health outcomes, particularly among adolescents and young adults living in informal urban settlements, where poverty, unemployment, and exposure to violence exacerbate early life adversity. Despite this, research on ACEs and mental health in these contexts remains limited, especially among youth living in informal urban settlements in Nairobi, Kenya. Between September and December 2024, we conducted a community-based study involving 94 youth aged 15 – 24 years living in two informal settlements in Nairobi. Participants were recruited through peer-driven sampling if they had used alcohol or drugs in the past 30 days prior to the study. Data were collected using tablet-based surveys administered in English or Swahili on mental health outcomes of depression (using PHQ - 9), anxiety (assessed by GAD - 7), stress (assessed by stress scale), and ACEs (evaluated by the ACEs scale). We conducted generalized linear models to examine the relationship between ACEs (0 – 2 vs. 3+ experiences) and mental health outcomes. The median age was 21. Most participants were male (54%) and reported three or more ACEs (56%). Even though depression and anxiety scores were low, youth with 3+ ACEs had significantly higher depression and anxiety scores than those with fewer ACEs, but no significant association with stress symptoms was observed. There is a need for early identification of ACEs and the integration of psychosocial support into community-based youth services to prevent the long-term effects of childhood adversity.

This study examined the relationship between self-esteem and attitudes toward alcohol and other substance use (ASU) among undergraduate students in Nairobi, Kenya, focusing on sex differences. Studies across Africa have shown a high rate of ASU among university students due to the normalization of alcohol consumption and the accessibility of drugs. We analyzed data from 406 undergraduate students (51% male), with an average age of 19 years, at Self-Esteem, attitudes towards alcohol and other substance use among undergraduate students in Nairobi, Kenya: A sexdisaggregated cross-sectional analysis a public university in Nairobi. Alcohol andsubstance use were measured using the Assessment of Smoking and Substance Involvement Test (ASSIST), self-esteem was measured using the Rosenberg scale, and attitudes toward alcohol were assessed using the Attitudes Towards Alcohol scale. Sex disaggregated, modified Poisson regression models estimated the relative risk of ASU associated with covariates (self-esteem and attitudes towards alcohol use) as the primary explanatory variables of interest. Each per-point increase in social ease reduced the risk of current alcohol use by 17% in females and 18% in males. Living at home or in private residences consistently increased the risk of ASU for both sexes. These findings underscore the influence of social and contextual factors on ASU and highlight the need for universitybased prevention trategies to inform the ASU-related attitudes among students.

BACKGROUND Digital health interventions can enhance sexual health equity among marginalized and underserved populations, including displaced youth. However, there is limited understanding of displaced youth’s digital health literacy (DHL) and its association with knowledge of and access to sexual health products and services. OBJECTIVE This study aims to identify patterns of DHL among displaced youth and assess how these patterns are associated with awareness of and access to sexual health products and services, while considering gender differences. METHODS We conducted a cross-sectional tablet-assisted survey in Kampala, Uganda. We used peer-driven sampling to recruit displaced youth aged 16-24 years living in 5 informal urban settlements. We identified DHL patterns using latent profile analysis. Gender-disaggregated multivariate probit models were constructed to estimate the relationship between DHL and awareness of and access to sexual health products and services (eg, sexual and reproductive health [SRH] information, external condoms, condom use training, sexually transmitted infection testing, and HIV testing). RESULTS Among the participants (N=445), our latent profile analysis identified 4-DHL classes named: low (class 1, 51/444, 11.5%), moderate (class 2, 99/444, 22.2%), high (class 3, 138/444, 31%), and very high (class 4, 157/444, 35.3%). Our adjusted multivariate probit model indicated that, compared to class 1, class 4 participants were more likely to know where to access condom use training (marginal effect [ME]=0.23; P<.001), external condoms (ME=0.19; P<.001), and HIV testing (ME=0.23; P<.001). We also noted gender-based differences. Men with very high DHL, compared with those with low DHL, were more likely to know where to access SRH information (ME=0.46; P<.001) and condom use training (ME=0.40; P<.050), while women with very high DHL were more likely than those with low DHL to report knowing how to access condom use training (ME=0.12, SE=0.06; P<.050), external condoms (ME=0.34; P<.001), and HIV testing (ME=0.22, SE=0.10; P<.050). Regarding access to sexual health products and services in the last 3 months, class 4 respondents reported higher access to condom use training (ME=0.13, SE=0.04; P<.001), external condoms (ME=0.14; P<.050), and HIV testing (ME=0.24; P<.050) than class 1 respondents. Gender differences showed that among men, those with very high DHL were more likely to access condom use training (ME=0.28; P<.010) than those with low DHL. In contrast, among women, those with very high DHL were less likely to access SRH information (ME=–0.20; P<.001). CONCLUSIONS Our findings reveal a generally high level of DHL but suboptimal awareness of and access to SRH services among urban displaced youth in Kampala. Improving SRH among urban displaced populations will require gender-responsive and culturally grounded digital sexual health interventions to increase awareness of and access to sexual health products and services.

We investigated how COVID-19-related disruptions influenced antiretroviral therapy (ART) adherence among young adults living with HIV (YALHIV) in Southern Uganda, a region with limited resources and high rates of HIV. Data were analyzed from 499 YALHIV aged 19 to 25, participating in the Suubi+Adherence-R2 COVID-19 Supplement study. The study measured COVID-19 disruptions using an 8-item Coronavirus Impact Scale and evaluated ART adherence through self-reported measures. Our analytical framework was informed by the Health Belief Model and generalized estimating equations were estimated. We find no statistically significant association between COVID-19 disruptions, as quantified by the COVID-19 Impact Score, and sub-optimal ART adherence (OR = 0.99, 95% CI [0.87–1.14]). However, findings revealed that being employed (OR = 1.99, 95% CI [1.07–3.71]) and older age (OR = 1.18, 95% CI [1.02–1.37]) was associated with higher likelihood of poor adherence highlighting the complex interplay between economic activity, working schedules, and health management. Other notable predictors included marital status, with cohabiting individuals showing decreased odds of poor adherence (OR = 0.25, 95% CI [0.08–0.74]) compared to single and separated YALHIV. These insights emphasize the need for multifaceted intervention strategies that consider both individual and systemic factors affecting ART adherence. Tailored interventions must address the socioeconomic challenges intensified by the pandemic and leverage the inherent resilience within this population to enhance ART adherence outcomes for YALHIV in challenging environments. Trial Registration ClinicalTrials.gov, ID: NCT01790373.

Family functioning plays a critical role in childhood disruptive behavior disorders ( The Family Journal , 2003, 11 (1), 33–41; Research in Nursing and Health , 2016, 39 (4), 229–243). Yet, there is limited research on the impact of evidence‐based family strengthening interventions on improving family cohesion as a protective factor among children experiencing behavioral challenges. To address this gap, we analyzed data ( N = 636) from the SMART Africa‐Uganda study (2016–2022), a cluster randomized clinical trial testing an evidence‐based family‐strengthening intervention called Amaka Amasanyufu (translated as "Happy Families" in the local language). Children aged 8–13 and their caregivers were recruited from 26 public primary schools that were randomized to: (1) control condition receiving generalized psychosocial literature (10 schools), (2) intervention delivered via parent peers (eight schools), and (3) intervention delivered via community healthcare workers (eight schools). Children completed the family cohesion questionnaire at baseline, 8 weeks, 16 weeks, and 6 months post‐intervention completion. The intervention effectiveness was evaluated via a three‐level logistic mixed effects model with pairwise comparisons across study conditions within each time point. Participants in the parent–peer intervention group had greater odds of being in the higher family cohesion group than participants in the control group at 8 weeks (OR = 3.24), 16 weeks (OR = 1.88) and 6 months (OR = 2.07). At 8 weeks, 16 weeks, and 6 months, participants in the community health worker group had 3.98, 2.08, and 1.79 times greater odds of being in the higher family cohesion group than participants in the control group, respectively. Our findings strengthen the evidence base for Amaka Amansayufu as an effective intervention that can be utilized in SSA to improve family cohesion in families with children experiencing behavioral challenges.