Monica H Swahn

Kennesaw State University | KSU · WellStar College of Health and Human Services

In northern Tanzania, alcohol use disorders (AUD) are under-diagnosed and under-treated, and current services are mostly limited to men in clinical settings despite significant alcohol-related harm in the community. The study objective was to identify sex differences in alcohol use and alcohol-related harms within and across community and clinical...

Alcohol consumption and harmful and hazardous drinking are significant contributors to the global burden of disease, accounting for about 3 million deaths each year globally. Owing to their stressful work environment, healthcare professionals are at a high risk of experiencing physical and mental health problems, particularly alcohol use disorders....

Introduction: Research indicates a general lack of awareness regarding the link between alcohol consumption and cancer risk, particularly among women in the United States (US). This study aims to explore women's knowledge of alcohol's role in breast cancer risk and its sociodemographic correlates, including risk denial (RD) and risk relativization...

Editorial of the Special Issue Part 1: Alcohol Prevention Research and Policy Development in LMICs

Background Most evidence on suicidal thoughts, plans and attempts comes from Western countries; prevalence rates may differ in other parts of the world. Aims This study determined the prevalence of suicidal thoughts, plans and attempts in high school students in three different regional settings in Kenya. Method This was a cross-sectional study o...

Background Alcohol use is an established yet modifiable risk factor for breast cancer. However, recent research indicates that the vast majority of U.S. women are unaware that alcohol use is a risk factor for breast cancer. There is limited information about the sociodemographic characteristics and alcohol use correlates of awareness of the alcohol...

Young women living in Kampala, Uganda, often face adversities related to Social Determinants of Mental Health (SDoMH) including poverty, food scarcity, environmental stressors such as high levels of community violence, and lack of adequate healthcare access. Two consecutive pilot studies were conducted to assess the feasibility and acceptability of...

Objective The research purpose is to determine alcohol prevention needs in Sierra Leone. Methods We analyzed a cross-sectional survey from fall 2020, distributed by the West African Alcohol Policy Alliance to their partners across nine West African countries. The survey included questions on perceptions of alcohol harm, research priorities, and ca...

Introduction Low-resourced settings often lack personnel and infrastructure for alcohol use disorder treatment. We culturally adapted a Brief Negotiational Interview (BNI) for Emergency Department injury patients, the “Punguza Pombe Kwa Afya Yako (PPKAY)” (“Reduce Alcohol For Your Health”) in Tanzania. This study aimed to evaluate the feasibility o...

The Wellstar College of Health and Human Services (WCHSS) at Kennesaw State University developed a new theoretical model to understand and impact student success by combining two existing frameworks: Whole School, Whole Community, and Whole Child (WSCC) (Willgerodt and Maloy, 2021) and the Student Success Ecosystem (Millet et al, 2020). The WCHSS S...

Many young people in Western countries are abstaining from alcohol consumption, but their Nigerian counterparts are adopting lifestyles that valorize alcohol use and heavy drinking rituals. This study explored heavy drinking practices and alcohol-related harms among young Nigerians (students and nonstudents) who use alcohol. Although participants w...

This research had two aims: (1) to assess how often bisexual and lesbian women self-report screening and counseling for alcohol use in primary care settings; and (2) understand how bisexual and lesbian women respond to brief messages that alcohol increases breast cancer risk. The study sample consisted of 4891 adult U.S. women who responded to an o...

Objective: While alcohol-related harm is a recognized public health priority, the capacity to address and mitigate its harm is lacking, primarily in low-income countries. Recent developments including new tools that can assess readiness for preventing alcohol-related harm, specifically in low-resource settings, can be used to determine strengths a...

This paper examines the link between place and mental health using a qualitative assessment and focus group discussion with young women, ages 18 to 24 years of age, residing in three slums in Kampala, Uganda. The assessment, conducted in August of 2022, engaged 15 women who participated in Uganda Youth Development Drop-in center activities. The obj...

Importance: Increasing evidence suggests that low socioeconomic status and geographic residence in disadvantaged neighborhoods contribute to disparities in breast cancer outcomes. However, little epidemiological research has sought to better understand these disparities within the context of location. Objective: To examine the association betwee...

Objective This study sought to examine gender differences and the influence of peer and parental perceptions on sexual risk behaviors among an at-risk sample of youth living in Kampala, Uganda. Methods Using the cross-sectional Kampala Youth Survey (2014) based in Kampala, Uganda (n = 1134), bivariate and multivariable logistic regressions were co...

The Wellstar College of Health and Human Services (WCHSS) at Kennesaw State University developed a new theoretical model to understand and impact student success by combining two existing frameworks: Whole School, Whole Community, Whole Child (WSCC) (Willgerodt and Maloy, 2021) and the Student Success Ecosystem (Millet et al, 2020). The WCHSS Stude...

PurposeOur research sought to describe barriers to mammography screening among a sample of predominantly Black women in metropolitan Atlanta, Georgia.Methods The Pink Panel project convened community leaders from faith-based institutions to administer an offline survey to women via convenience sampling at fourteen churches in Atlanta in late 2019 a...

Objective: The purpose of this study was to determine capacity and resource needs for alcohol prevention research among stakeholders across nine countries in West Africa. Method: We analyzed a cross-sectional survey conducted in the fall of 2020, distributed by the West African Alcohol Policy Alliance to their member alliances and stakeholders a...

This study aimed to (a) compute the prevalence of violence exposure types, polyvictimization, and self-reported depression, anxiety, and using substances to cope among youth ages 12–18 years living on the streets or in the slums of Kampala, Uganda, (b) examine the independent associations among orphan status, violence exposure types, and self-repor...

Introduction: To determine the role of alcohol marketing, perceptions of marketing and social norms on heavy alcohol use and problem drinking among vulnerable youth in Uganda. Methods: The Kampala Youth Survey is a cross-sectional study conducted in 2014 with service-seeking youth (ages 12-18 years) living in the slums of Kampala (n = 1134) who...

Background Despite the high prevalence of alcohol use and marketing in many settings across sub-Saharan Africa, few studies have systematically sought to assess alcohol marketing exposure, particularly in vulnerable areas such as urban slums where alcohol is often highly prevalent but where educational programs and alcohol prevention messages are s...

Objective: Alcohol-related harm is a growing concern globally and particularly in West Africa. However, tools for assessing the readiness for prevention of alcohol-related harm in low-resource settings have been lacking. We modified the WHO tool, the Readiness Assessment for the Prevention of Child Maltreatment Short Form (RAP-CM), to assess readin...

Background/introduction: Adolescent pregnancy is a global public health issue and often linked to adverse health outcomes for both the mother and child. Youth and adolescents living in the slums of Kampala, Uganda face many environmental and psychosocial adversities, and are at a high risk of experiencing adolescent pregnancy. The goal of this stu...

Background Recent research highlights how the COVID-19 pandemic has significantly impacted alcohol consumption patterns, yet research thus far has largely overlooked the experience in West Africa. Research also has not addressed how the COVID-19 pandemic has affected access to alcohol treatment, support, and alcohol harm prevention. This study addr...

Masculine gender role norms (i.e., masculinity), in particular those related to patriarchal or hegemonic masculinity, are widely recognized as a risk factor for sexual violence perpetration among boys and men. Toward the goal of better understanding the intersection between masculinity and sexual violence among boys and men, this chapter: (1) revie...

The objective of this paper is to address the scarcity of research on alcohol marketing exposure and underage drinking in sub-Saharan Africa. This study examines perceptions of alcohol advertisements and perceived peer, adult, and parental attitudes regarding alcohol use and intentions to drink among vulnerable youth. The Kampala Youth Survey is a...

The purposes of this study were to determine whether youth who have experienced sexual victimization (SV) have lower self-efficacy to refuse sex and to identify intervention strategies for rape survivors to mitigate further health-risks and harm. Cross-sectional data from the 2014 Kampala Youth Survey (n = 1134) of youth aged 12 to 18 years recruit...

Abstract Background Alcohol use in resource-limited settings results in significant morbidity and mortality. These settings lack the necessary specialty-trained personnel and infrastructure. Therefore, implementing evidence-based interventions from high-income settings, like a brief negotiational intervention (BNI) for alcohol, will require rapid p...

Self-rated physical health (SRPH) has been extensively used to assess health status. In this study, we examine how youth living in the slums of Kampala perceive their physical health and the psychosocial correlates of poor health. Cross-sectional data from the 2014 Kampala Youth Survey (N = 1,134) of youth ages 12–18 years was used to conduct the a...

Sex-related beliefs, attitudes, and perceptions have been shown to be associated with HIV-related behaviors. However, little is known about the factors associated with delayed sexual activity among older adolescents in sub-Saharan Africa. This study examined potentially protective beliefs, attitudes, and perceptions associated with delayed sexual i...

The SAVA syndemic is frequently used to describe the co-occurrence of HIV, gender-based violence (GBV), and substance use. In this study we determine the extent to which the typologies of the SAVA syndemic can be described and utilized for intervention strategies among youth living in the slums of Kampala, Uganda. We analyzed the “Kampala Youth Sur...

Objectives : This study examined how socio-demographic, climate and population health characteristics shape the geospatial variability in excess mortality patterns during the COVID-19 pandemic in Mexico. Methods : We used Serfling regression models to estimate all-cause excess mortality rates for all 32 Mexican states. The association between soci...

Background: The diverse forms of unrecorded alcohol, defined as beverage alcohol not registered in official statistics in the country where it is consumed, comprise about one fourth of all alcohol consumed worldwide. Since unrecorded alcohol is usually cheaper than registered commercial alcohol, a standard argument against raising alcohol excise t...

Background: Mexico has suffered one of the highest COVID-19 mortality rates in the world. In this study we examined how socio-demographic and population health characteristics shape the geospatial variability in excess mortality patterns during the COVID-19 pandemic in Mexico. Methods: Weekly all-cause mortality time series for all 32 Mexican state...

Background Harmful alcohol use is a leading risk factor for injury-related death and disability in low- and middle-income countries (LMICs). Brief negotiational interventions (BNIs) administered in emergency departments (EDs) to injury patients with alcohol use disorders (AUDs) are effective in reducing post-hospital alcohol intake and re-injury ra...

Substance use is strongly associated with suicide completions. However, little is known about the patterns of substances used in suicide deaths. The purpose of this analysis is to determine latent classes of toxicology-reported substances among individuals who completed suicide. The sample consists of suicide victims in the National Violent Death R...

Malaria and undernutrition have independently contributed to mortality and morbidity among the under-five population of Nigeria. However, there remains complexity in their association. This study evaluates the association between stunting, underweight, wasting, and malaria among under-five Nigerian children while assessing the effects of sociodemog...

Background: Prolonged use of both electronic cigarettes (e-cigarettes) and traditional cigarettes can increase breathing difficulties and other adverse health effects. Research is needed to provide a deeper understanding of predictors of dual use, particularly given rapid changes in the e-cigarette market and related public health communications a...

The stark racial disparities related to the COVID-19 pandemic in the U.S., wherein minority populations are disproportionately getting infected and succumbing to the disease, is of grave concern. It is critical to understand and address the underlying causes of these disparities that are complex and driven by interacting environmental, social and b...

Background Youth living in the slums of Kampala face many adversities, such as dire environmental conditions, poverty, and lack of government infrastructure. Objective The purpose of this study is to examine the interplay of alcohol use and child maltreatment on suicidal ideation among youth living in the slums of Kampala, Uganda. Participants an...

Purpose: Youth living in the urban slums in Uganda have many unmet needs. The purpose of the current study is to briefly examine the associations between Adverse Childhood Experiences (ACEs) and alcohol use patterns, an understudied area among urban vulnerable youth, in order to provide guidance and insight for service provision for youth. Methods:...

Psychological distress is a priority health issue in low- and middle-income countries; however, it is inadequately addressed among vulnerable youth living in extremely underserved communities (i.e., on the streets and in the slums) who are at a high risk of experiencing adversity. The purpose of this study was to compute the prevalence of self-repo...

Background The Kilimanjaro region has one of the highest levels of reported alcohol intake per capita in Tanzania. Age at first drink has been found to be associated with alcohol problems in adulthood, but there is less information on the age of first drink in the Kilimanjaro region and its associations with alcohol‐related consequences later in li...

The prescriptive and rigid nature of masculine gender roles has repeatedly been associated with a host of physical and mental health consequences for men and women alike. In particular, a body of literature demonstrates a significant relationship between boys' and men's conformity to masculine gender roles and their perpetration of violence against...

Background Each year, alcohol use causes 3.3 million deaths globally and accounts for nearly 30% of injuries treated at Kilimanjaro Christian Medical Center (KCMC) in Moshi, Tanzania. Prior research found significant stigma toward patients reporting alcohol use in general and among healthcare providers for this population. Methods This mixed‐metho...

In Nigeria, one in four females has experienced some form of sexual abuse. Therefore, it is imperative to examine risk factors associated with sexual violence victimization of Nigerian girls and young women to identify targets for prevention and help stakeholders prioritize response efforts. The present article focuses on secondary data analyses of...

This study examined factors associated with alcohol related condom-less sex (ARCS) among youth living in Kampala, Uganda. Analyses are based on 2014 cross-sectional survey data of urban service-seeking youth participating in a Uganda Youth Development Link (UYDEL) drop-in center. The analytic sample consisted of only youth reporting alcohol use (n...

Background: The purpose of this paper is to investigate the prevalence and context of alcohol use, problem drinking and alcohol-related harm among boys and girls in the slums of Kampala, Uganda. Methods: The Kampala Youth Survey is a cross-sectional study conducted in 2014 among youth (ages 12-18 years) living in the slums of Kampala (n = 1133)...

The purpose of this analysis was to examine the associated factors of self-reported HIV/STI co-infection among youth living in the slums of Kampala. The study sample consists of a cross-sectional survey. Participants comprised a convenience sample (N = 1134) of youth living on the streets or in the slums (age 12–18). Multinomial logistic regression...

Background Alcohol is a leading risk factor for road traffic injury in low- and middle-income countries, such as Tanzania. This research seeks to explore the drinking patterns, perceptions, and stigma of drink driving behavior of injury patients at Kilimanjaro Christian Medical Center in Moshi, Tanzania. Methods This mixed methods study incorporat...

The opioid abuse epidemic represents a major public health threat to global populations. The role social media may play in facilitating illicit drug trade is largely unknown due to limited research. However, it is known that social media use among adults in the US is widespread, there is vast capability for online promotion of illegal drugs with de...

The purpose of this study is to examine the factors associated with intimate partner violence (IPV) among youth living in the slums of Kampala. This analysis is based on a cross-sectional study of youth living in the slums of Kampala conducted in spring 2014 ( N = 1,134). The participants (12–18 years of age) were attending Uganda Youth Development...

Introduction: A previous review on brief alcohol interventions in sub-Sahara Africa showed most of the interventions were implemented in East and Southern Africa. We carried a scoping review to assess the current amount and types of alcohol interventions in SSA. Methods: We searched six databases (MEDLINE, EMBASE, Global Health, Africa-wide, CINAHL...

Abstract Background Human immunodeficiency virus (HIV) rates are high in Uganda (6.7%), and rates are especially high among at-risk groups such as youth living in the slums of Kampala, Uganda. The objective of this study was to assess the psychosocial correlates, particularly alcohol use, associated with HIV among youth living in the slums of Kampa...

Cryptomarkets are commercial websites on the web that operate via darknet, a portion of the Internet that limits the ability to trace users’ identity. Cryptomarkets have facilitated illicit product trading and transformed the methods used for illicit product transactions. The survellience and understanding of cryptomarkets is critical for law enfor...

Introduction: Intimate partner violence (IPV) results in deaths of both primary and corollary (i.e., nonintimate partner) victims. Alcohol use is a known risk factor for IPV, yet the relationship between alcohol policies and IPV homicides is unclear. This repeated cross-sectional study characterizes alcohol involvement, and the relationship betwee...

Introduction Uganda is experiencing a significant increase in the prevalence of non-communicable diseases including hypertension and obesity. Frequent alcohol use is also highly prevalent in Uganda and is a key risk factor for both hypertension and obesity. This study explores the association of alcohol with hypertension and obesity across differen...

Homelessness poses serious health risks, and those risks may be exacerbated among slum-dwelling youth in the developing world. We administered a cross-sectional survey to youth receiving services from a community organization in Kampala, Uganda. This secondary analysis explores the relationships between homelessness and various health outcomes. We...

Opioid abuse epidemics is a major public health emergency in the US. Social media platforms have facilitated illicit drug trading, with significant amount of drug advertisement and selling being carried out online. In order to understand dynamics of drug abuse epidemics and design efficient public health interventions, it is essential to extract an...

Alcohol misuse contributes substantially to the global morbidity and mortality burden. Unrecorded alcohol, alcohol that is purchased by means which precludes regulation, represents a substantial proportion of the alcohol consumed in East Africa. In Kenya, homebrew also known as traditional brew, has been linked to several fatalities and hospitaliza...

Alcohol abuse treatment in low resourced settings lacks trained personnel and infrastructure. Implementing evidence based interventions, like a Brief Intervention (BI) administered to Emergency Department injury patients, will require adaptation to the setting, population and culture. This study aims to rapidly optimize and evaluate the impact of a...

Obtaining formal education is associated with a decreased risk of HIV transmission among youth in sub-Saharan Africa. However, little is known about the role vocational skills training programs may have on risk behaviors linked to HIV transmission among vulnerable youth in sub-Saharan Africa. This study examined the characteristics and risk behavio...

Importance Motor vehicle crashes are a leading cause of mortality. However, the association between the restrictiveness of the alcohol policy environment (ie, based on multiple existing policies) and alcohol-related crash fatalities has not been characterized previously to date. Objective To examine the association between the restrictiveness of s...

This paper examines problem drinking, alcohol-related violence, and homelessness among youth living in the slums of Kampala—an understudied population at high-risk for both alcohol use and violence. This study is based on a cross-sectional survey conducted in 2014 with youth living in the slums and streets of Kampala, Uganda (n = 1134), who were at...

This study examined risk factors to determine associations with commercial sexual exploitation of children and youth (CSEC) in a convenience sample of adolescents living in the slums in Kampala, Uganda. Individual-level factors included demographic, adverse experiences (ever living on the streets; victim of dating violence, parental abuse, or rape)...

Background This study examines the association between mental disorders and neighborhood conditions in a nationally representative sample of US children. Methods Data from US children aged 6–17 years (N = 95,677) were obtained from the 2011/12 National Survey of Children's Health. Analysis examined neighborhood conditions and demographic and psych...

Purpose: Sexual violence (SV) perpetration on college campuses is a serious and prevalent public health issue in the U.S. In response, incoming male freshmen are mandated to receive SV prevention programming. To provide a more effective response, however, we need to understand the SV behaviors of male freshmen before they arrive on campus and the...

Background Globally, alcohol is responsible for 3.3 million deaths annually and contributes to 5.9% of the overall global burden of disease. In Sub-Saharan Africa, alcohol is the leading avoidable risk factor accounting for a substantial portion of death and disability. This project aimed to determine the proportion of injuries related to alcohol a...

The purpose of this study is to examine the factors associated with suicidal ideation among youth living in the slums of Kampala, Uganda. Analyses are based on cross-sectional survey data, collected in 2014, of a convenience sample (n = 1134) of urban service-seeking youth participating in a Uganda Youth Development Link drop-in center. Logistic re...

Objectives: Following changes in federal regulations, the current study was an examination of differences in institutional responses to sexual violence among Georgia colleges and universities during 2013 and 2014. Participants: A total of 24 four-year institutions located in the state of Georgia were included. Method: Data were collected from vario...

Annually, alcohol causes 3.3 million deaths; countless more alcohol-related injury patients are treated in Emergency Departments (ED) worldwide. Studies show that alcohol related injury patients reduce their at-risk alcohol use behavior with a brief-negotiational interview (BNI) in the ED. This project aims to identify potential perceived barriers...