Mixed methods study of SKILLZ to reduce drug use and improve gender equity among adolescent males in South Africa

DETAILED SUMMARY

Importance

• Statistics on sexual activity, gender-based violence, rape, and harmful alcohol use show a clear and urgent need to engage adolescent boys on issues of gender and sexuality in South Africa.

Objective

• To evaluate use of a structured soccer league to reduce substance use and gender-based violence among adolescent male students.

Study details

• Study design: Mixed methods study
• Data Collection: Pre and post questionnaires; instant-result urine test for marijuana, cocaine, opiates, methamphetamines, and amphetamines
• Participants: Adolescent boys recruited from grades 10 and 11 in 5 secondary schools in Alexandra, South Africa, based on attendance, performance, and delinquent behavior in school. Age range 15-20 years, mean age 18 years
• Implementation setting: Alexandra, South Africa
• Study period: 6 month period in 2015

Intervention

• Grassroot Soccer Champions League program, consisting of four components:
  • Soccer: Teams of 8-12 led by a Coach with weekly training and league matches
  • Group Learning: Life skills activities implemented weekly to improve sexual behaviors, drug/alcohol use, relationships, violence, communication, and other health regiments.
  • Action: Grassroot Soccer rewarded pro-social behaviors with incentives.
  • Male Mentors: Grassroot Soccer recruited and trained 12 community leaders to be Coaches to deliver both life and soccer skills.

Results

• 96 boys were offered the opportunity to participate; 81 consented to participate (84.4%)
• Drug test results demonstrated increased participant willingness to test (from 59% to 80% opting to test; 35.6% increase) and decreased positive drug tests (from 29% to 0%; 100% decrease).
• Notable questionnaire data included % increase in desirable responses for:
  • Unequal power in relationships, drinking alcohol, and having more than one sexual partner over the same time period can contribute to the spread of HIV: 36%, 35%, and 23% increase respectively.
  • A girl can say no to sex if her boyfriend refuses to use a condom: 16% increase.
  • It is a male’s responsibility to make decisions in a relationship: 19% increase.
• Self-reported attitudes toward gender-equitable beliefs were noted, but self-reported levels of gender-based violence did not show a significant change.
• Quote:
  • “Being together with those Coaches – I saw how they changed people. It made me want to be a Coach because even if you change one person’s life for the better it is worth it. Even if I am not ‘on duty,’ I take time to help my friends and family make healthier choices.” (a former participant turned Coach)

Conclusions and implications

• The study provides encouraging evidence that a soccer-based program can effectively promote pro-social behavior among adolescent males between the ages of 15-20 years. 
• Further adaptations of the Champions League intervention are being made for early or pre-adolescent boys.