Research Articles (Occupational Therapy)

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Doing a leisure activity because there is nothing else to do: Related outcomes and intervention effects for adolescents
(Taylor & Francis, 2019) Motamedi, Mojdeh; Caldwell, Linda L.; Weybright, Elisabeth H.; Jones, Damon; Wegner, Lisa; Smith, Edward A.
This study examined whether a leisure-focused intervention, HealthWise, was related to reduced youth polysubstance use and delayed sexual debut via reducing how often youth did leisure activities because there was nothing else to do. HealthWise was compared to a no-intervention control for 5,610 high school students from eighth to tenth grades in townships near Cape Town, South Africa. Three specific leisure activities were examined: spending time with friends, playing sports, and going to parks. Among girls, spending time with friends because there was nothing else to do significantly mediated the effect of HealthWise on reducing frequent polysubstance use in the past month. For boys, spending time in parks because there was nothing else to do mediated the effect of HealthWise on delayed sexual debut. Results partially supported the HealthWise logic model of impacting risky behaviors via leisure and the value of prevention programs addressing the reasons behind leisure choices.
Healthwise South Africa: cultural adaptation of a school-based risk prevention programme
(Oxford University Press, 2008) Wegner, Lisa; Flisher, Alan J.; Caldwell, Linda L.; Vergnani, Tania; Smith, Edward A.
There is a need for effective prevention programmes aimed at reducing risk behaviour among South African adolescents. Health Wise South Africa is a school-based programme designed to reduce sexual and substance use risk behaviour, and promote positive use of leisure time among high-school learners (students). Based on successful programmes in the United States of America, Health Wise was developed for use in South Africa and pilot tested in four South African high schools. We carried out a process evaluation to establish the fidelity of implementation and make sure HealthWise was culturally relevant. Data sources comprised focus groups with educators and learners, lesson evaluations and observations, and interviews with school principals. Qualitative analysis of data highlighted pertinent cultural and contextual factors and identified areas for modifying Health Wise in order to promote better programme-consumer fit. These areas centred on time, language, and leisure. We noted a dynamic tension between the educators’ desire to adhere to plan, and to make adaptations in accordance with learners’ needs and the context. Ultimately, researchers need to find a balance between fidelity of implementation and programme adaptation to obtain effective programmes that are culturally acceptable to local consumers.
Inconsistent reports of sexual intercourse among South African high school students
(Elsevier, 2008) Palen, Lori-Ann; Smith, Edward A.; Caldwell, Linda L.; Flisher, Alan J.; Wegner, Lisa; Vergnani, Tania
Purpose: This study aims to describe patterns of inconsistent reports of sexual intercourse among a sample of South African adolescents. Methods: Consistency of reported lifetime sexual intercourse was assessed using five semiannual waves of data. Odds ratios related inconsistent reporting to demographic variables and potential indicators of general and risk-behavior-specific reliability problems. Results: Of the sexually active participants in the sample, nearly 40% reported being virgins after sexual activity had been reported at an earlier assessment. Inconsistent reporting could not be predicted by gender or race or by general indicators of poor reliability (inconsistent reporting of gender and birth year). However individuals with inconsistent reports of sexual intercourse were more likely to be inconsistent reporters of substance use. Conclusions: These results suggest that researchers need to undertake efforts to deal specifically with inconsistent risk behavior data. These may include modification of data collection procedures and use of statistical methodologies that can account for response inconsistencies
Leisure boredom, timing of sexual debut, and co-occurring behaviors among South African adolescents
(Springer, 2021-08) Layland, Eric K.; Ram, Nilan; Caldwell, Linda L.
Sex during adolescence is normative; however, there are substantial individual differences in the timing and context of sexual debut. Leisure boredom is an underexplored correlate of sexual behavior that is associated with many adolescent health outcomes. We investigated if and how individual differences in leisure boredom may be associated with timing of sexual debut, and whether individuals engage in safe or risky behaviors at debut. Survival analysis, logistic regression, and Poisson regression were applied to eight-wave longitudinal data obtained from 3,088 South African adolescents (baseline Mage = 13.9 years) to examine associations between leisure boredom and cumulative hazard of sexual debut across adolescence, odds of co-occurring sexual behaviors, and incidence rate of co-occurring sexual risk behaviors at debut. Higher levels of leisure boredom were associated with elevated hazard cumulatively across adolescence. Higher levels of leisure boredom were also associated with lower odds of safe sex and higher odds of substance use during sex and transactional sex at sexual debut, but not casual sex or condom non-use at sexual debut. Although odds of singular risk behaviors were lower for girls than for boys, the association between leisure boredom and the number of risk behaviors at sexual debut was stronger for girls than boys. Higher trait leisure boredom was associated with elevated hazard of sexual debut, greater likelihood that risky behaviors accompanied sexual debut, and greater number of co-occurring risky behaviors at sexual debut. Results support leisure boredom as a potential target for preventing sexual risk behavior among South African adolescents.
Predicting secondary school dropout among South African adolescents: A survival analysis approach
(Education Association of South Africa, 2017) Weybright, Elizabeth H.; Caldwell, Linda L.; Xie, Hui Jimmy; Wegner, Lisa; Smith, Edward A.
Education is one of the strongest predictors of health worldwide. In South Africa, school dropout is a crisis where by Grade 12, only 52% of the age appropriate population remain enrolled. Survival analysis was used to identify the risk of dropping out of secondary school for male and female adolescents and examine the influence of substance use and leisure experience predictors while controlling for demographic and known predictors using secondary, longitudinal data. Results indicated being male, not living with one’s mother, smoking cigarettes in the past month, and lower levels of leisure-related intrinsic motivation significantly predicted dropout. Results support comprehensive prevention programmes that target risk behaviour and leisure.
Predicting substance use behavior among South African adolescents: The role of leisure experiences across time
(SAGE Publications, 2011) Sharp, Erin Hiley; Coffman, Donna; Caldwell, Linda L.; Smith, Edward A.; Wegner, Lisa; Vergnani, Tania; Mathews, Catherine
Using seven waves of data, collected twice a year from the 8th through the 11th grades in a low-resource community in Cape Town, South Africa, we aimed to describe the developmental trends in three specific leisure experiences (leisure boredom, new leisure interests, and healthy leisure) and substance use (cigarettes, alcohol, and marijuana) behaviors and to investigate the ways in which changes in leisure experiences predict changes in substance use behaviors over time. Results indicated that adolescents’ substance use increased significantly across adolescence, but that leisure experiences remained fairly stable over time. We also found that adolescent leisure experiences predicted baseline substance use and that changes in leisure experiences predicted changes in substance use behaviors over time, with leisure boredom emerging as the most consistent and strongest predictor of alcohol, cigarette, and marijuana use. Implications for interventions that target time use and leisure experiences are discussed.
Through the lens of a peer: understanding leisure boredom and risk behaviour in adolescence
(Occupational Therapy Association of South Africa, 2011) Wegner, Lisa
There has been very little research investigating leisure boredom and risk behaviour among adolescents in South Africa. Using a qualitative approach, this study investigated adolescents’ perceptions of leisure boredom and risk behaviour during free time. The sample of participants comprised three groups of adolescent: a community group, a school group and a group who had dropped out of school. Participants documented their free time experiences by taking photographs that were later discussed in focus groups. The findings showed that the participants were bored in their free time mainly because they had nothing to do. The low socio-economic environment where they lived contributed to occupational deprivation and imbalance in their free time, maintaining or ‘trapping’ the adolescents within the situation and contributing to feelings of boredom. The participants spent much of their free time ‘hanging out’ on street corners or in backyards, which allowed them to socialise, but inevitably led to boredom. Participants felt that boredom was part of life, although some perceived it to be ‘dangerous’ because it often led to risky behaviour. In conclusion, the study showed that for the participants, leisure is an occupational concern due to the occupational deprivation and imbalance occurring within their free time. Occupational therapists should consider how leisure boredom influences adolescent health, wellbeing and development, and plan interventions accordingly.
Trajectories of adolescent substance use development and the influence of healthy leisure: a growth mixture modeling approach
(Elsevier, 2016) Weybright, Elizabeth H.; Caldwell, Linda L.; Ram, Nilam; Smith, Edward A.; Wegner, Lisa
Considerable heterogeneity exists in adolescent substance use development. To most effectively prevent use, distinct trajectories of use must be identified as well as differential associations with predictors of use, such as leisure experience. The current study used a person-centered approach to identify distinct substance use trajectories and how leisure is associated with trajectory classes. Data came from a larger efficacy trial of 2.249 South African high school students who reported substance use at any time across 8 waves. Growth mixture modeling was used to identify developmental trajectories of substance use and the influence of healthy leisure. Results identified three increasing and one stable substance use trajectory and subjective healthy leisure served to protect against use. This study is the first of its kind to focus on a sample of South African adolescents and serves to develop a richer understanding of substance use development and the role of healthy leisure.
With a little help from my friends? A longitudinal look at the role of peers versus friends on adolescent alcohol use
(Elsevier, 2019) Weybright, Elizabeth H.; Beckmeyer, Jonathon J.; Caldwell, Linda L.; Wegner, Lisa; Smith, Edward A.
Introduction: Alcohol is the most commonly used substance by South African adolescents. Social norms play a key role in alcohol use, although distinctions are not always made between descriptive and injunctive norms and peer proximity. Additionally, little research identifies factors attenuating social norms, peer proximity, and alcohol use, such as one's ability to resist peer influence. Methods: The current study investigates the relationship between adolescent alcohol use in 9th Grade and descriptive peer and injunctive friend norms in 8th grade, the moderating role of resistance to peer influence, and sex differences. Data were from South African students (N=3592; Mage=14) participating in the HealthWise South Africa implementation quality trial. Results: Path model results indicated injunctive friend norms, but not peer norms, influenced alcohol use. Resistance to peer influence did not moderate relationships and group comparisons found no sex differences. Conclusion: Findings suggest social proximity shapes influences of alcohol use. Despite a differing cultural context, findings were consistent with those from the United States, indicating social proximity is relevant cross-culturally.

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