South African Adult Caregivers As “Protective Shields”: Serving As a Buffer between Precarious Neighborhood Conditions, Food Insecurity, and Youth Risk Behaviors

Background: Low income youth in KwaZulu-Natal (KZN), South Africa are surrounded by serious threats including community violence, food insecurity, and the highest prevalence of HIV worldwide. Living in extreme poverty, these youth are at elevated risk for exposure to neighborhood violence, substance use, and instability, conditions which can exponentially increase their risk of HIV. Further, these conditions can also encourage youth to perpetrate violence and engage in criminal activity.  However, some of these community “toxins” can be mitigated by the presence of protective caregivers. Adult caregivers can serve as “protective shields” buffering their children’s exposure to stressors associated with living and developing in dangerous communities. To do so in KZN, caregivers must protect both their children and themselves from community violence and the constant threat of food insecurity. In South Africa, 13 million people go hungry daily, and over half of the country’s 53 million people risk facing hunger in the future. The current study examines potential mediating effects of caregiver mental health on the relationship between neighborhood conditions (social cohesion, disorganization, and social control) and child risk behaviors, while also examining their exposure to food security.

Methods:  A secondary analysis of baseline data of 478 child-caregiver dyads was conducted. Data was drawn from the Collaborative HIV prevention Adolescent Mental health Program in South Africa (CHAMPSA; R01 MH55701).  Multivariate analyses were used to identify direct, indirect and total effects of neighborhood stressors and caregiver mental health on child behavior. 

Results:  Mediation analysis showed significant indirect effects of neighborhood conditions on child risk behaviors (.33)(.08)=.03. The significance was tested using bootstrapping procedures. Caregiver mental health partially mediated the effect of neighborhood conditions on child risk behaviors. Improved neighborhood conditions was associated with better caregiver health (b=.33, SE=.05, p<.05), which was associated with lower child risk behaviors (b=.08, SE=.03, p <.001). After controlling for the mediator, neighborhood conditions remained significantly associated with child risk behaviors, consistent with partial mediation (b=.06, SE=.03, p<. 05). More specifically, multiple regression revealed, neighborhood cohesion (B=.15, SE=.06, p<.001), disorganization (B=.136, p<.05), social control (B=.08, SE=.02, p <.05) and food security (B=.09, SE=.02, p<. 001) respectively, had statistically significant associations with caregiver mental health (R²=.128 F(4, 460) =16.95, p<.000). Lastly, 74% of caregivers reported having gone without food at least once in the past month.

Conclusion: Caregiver mental health is integral to the ability to provide an emotionally supportive environment that fosters optimal development of children. Families living in extreme poverty are often exposed to numerous community-level stressors. However, caregivers with healthy emotional wellbeing are better equipped in helping their children avoid risk taking. Fostering the adult protective shield for youth living in HIV-impacted communities can reduce the risk of children engaging in risky behaviors and aid in the prevention of HIV seroconversion. This has global HIV intervention research and care implications, as future interventions may benefit from addressing both child and caregiver mental health needs.