title: A Qualitative Analysis of Substance Use among Liberian Youth: Understanding Behaviors, Consequences, and Protective Factors Involving School Youth and the School Milieu.
abstract: OBJECTIVE
  Substance use is a significant and common problem among school-aged youths throughout Africa. Like other countries on this continent, the West-African nation of Liberia is recovering from civil war. A well-educated population of young people is critical to the recovery efforts and long-term success of Liberia. Substance use by school-aged youths has important public health consequences that could undermine Liberia's post-conflict recovery efforts. We wanted to better understand the culturally significant themes and subthemes related to substance use among youths attending public schools in Monrovia, Liberia.
  
  
  METHODS
  A qualitative research design was used to collect data from 72 students attending public school in Monrovia, Liberia. Nine focus groups of 6-8 students from three public schools were facilitated using a semi-structured format to guide discussions on substance use. Student narratives were translated and re-occurring themes and subthemes were coded and analyzed.
  
  
  RESULTS
  Four emergent themes described in this study were: Behaviors associated with substance useConsequences associated with individual useConsequences of substance use that affected the school milieuSchool-related factors that were protective from substance use.Subthemes associated with substance use included concealment of substances, intoxication and disruption of the classroom environment, expulsion from school, school drop-out, and school as protective against substance use.
  
  
  CONCLUSIONS
  Liberian school-aged youths described important themes and subthemes associated with substance use occurring within the school milieu. These data have germane public health ramifications, and could help inform larger epidemiologic study methods and public health interventions for Liberia and countries with similar profiles.
authors.affiliation: St. Luke's Health System Department of Psychiatry and Behavioral Health, Boise ID, USA.
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Pullen
authors.affiliation: Division of Global Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; University of Texas at Austin School of Social Work, Austin, TX, USA.
authors.forename: Liana
authors.initials: L
authors.lastname: Petruzzi
authors.affiliation: Division of Global Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Yale School of Public Health, New Haven, CT, USA.
authors.forename: Brittany Cl
authors.initials: BC
authors.lastname: Lange
authors.affiliation: Division of Global Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Parnarouskis
authors.affiliation: Division of Global Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston MA, USA.
authors.forename: Silvia
authors.initials: S
authors.lastname: Dominguez
authors.affiliation: AM Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Harris
authors.affiliation: Bay Area Children's Association, Oakland, CA, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Quiterio
authors.affiliation: Boston University School of Medicine, Department of Psychiatry, Boston Medical Center, Boston, MA, USA.
authors.forename: Michelle P
authors.initials: MP
authors.lastname: Durham
authors.affiliation: AM Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia.
authors.forename: Gondah
authors.initials: G
authors.lastname: Lekpeh
authors.affiliation: AM Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia.
authors.forename: Burgess
authors.initials: B
authors.lastname: Manobah
authors.affiliation: Christ Jubilee International Ministries, Lowell, MA, USA.
authors.forename: Siede P
authors.initials: SP
authors.lastname: Slopadoe
authors.affiliation: Christ Jubilee International Ministries, Lowell, MA, USA.
authors.forename: Veronique C
authors.initials: VC
authors.lastname: Diandy
authors.affiliation: Christ Jubilee International Ministries, Lowell, MA, USA.
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Payne
authors.affiliation: Division of Global Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston MA, USA; Boston University School of Medicine, Department of Psychiatry, Boston Medical Center, Boston, MA, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Henderson
authors.affiliation: Division of Global Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston MA, USA.
authors.forename: Christina Pc
authors.initials: CP
authors.lastname: Borba
keywords: Children and adolescents; Focus groups; Post-conflict Liberia; School; Substance use