AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2688-7517/017
1 School of Public Health, Georgia State University P.O. Box 3995 Atlanta, GA 30302-3995
2 Uganda Youth Development Link P.O. Box 12659 Kampala, Uganda
*Corresponding Author: Monica H Swahn, Department of Population Health Sciences, School of Public Health, Georgia State University P.O. Box 3995 Atlanta, GA 30302-3995
Citation: Sana Nina K. Babihuga, Monica H Swahn, MPH, Shanta R. Dube and Rogers Kasirye; Adverse Childhood Experiences and Alcohol Use Consumption Patterns among Vulnerable Urban Youth in Uganda, J. Addiction Research and Adolescent Behaviour 3(1); DOI: 10.31579/2688-7517/017
Copyright: © 2020, Monica H Swahn, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 02 March 2020 | Accepted: 28 August 2020 | Published: 17 September 2020
Keywords: adverse childhood experiences; alcohol use consumption; vulnerable urban youth
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: The current data analysis is based on a cross-sectional survey conducted in June 2011 which consisted of a convenience sample of youth living in the slums (ages 14-24) attending a drop-in center, Uganda Youth Development Link (UYDEL). Descriptive statistics were computed. Bivariate and multivariable logistic regression analyses were used to determine psychosocial correlates with being an orphan.
Results: Factors associated with alcohol use varied by sex (p<.05) (alcohol use was more common among girls), age (p<.000), (alcohol use more common among youth 18 years of age and older) and alcohol use were also more common among youth who reported the following ACEs; parents hitting each other (p<.000) , parental use of alcohol (p<.000), being hungry (p<.000), having ever lived on the street (p<.000) and having been raped (p<.000).
Conclusions: The prevalence of ACEs were high in this study population which is a great concern. Moreover ACEs were associated with earlier age of alcohol use initiation, frequent and heavy drinking underscoring the need for additional support for past childhood trauma as well as alcohol prevention efforts for these vulnerable youth.
Globally, alcohol is the third-leading risk factor for premature death and disability [1] and it accounts for 5.9% of all deaths and 5.1% of the disease burden [2]. The World Health Organization (WHO) has highlighted the detrimental use of alcohol globally including causing disease, social and economic burden in societies [3]. Disease burden has been found to be closely linked to volume of alcohol consumption, with disproportionate effects on poor people and those marginalized in society [4].
Alcohol use has been found to be associated with alcohol dependence [5,6], other substance use [6], criminal activity [6], unintentional injuries [5,7], suicidal ideation and attempts [8], and is an important risk factor for chronic disease and injury [9,10]. Recent findings from research also suggest associations between harmful alcohol use and infectious diseases such as tuberculosis and HIV/AIDS [11]. Findings have also shown differences and historical trends in alcohol consumption and related harm which can be explained by environmental factors such as economic development, culture, availability of alcohol and the level and effectiveness of alcohol policies [12].
Correlates of alcohol use include: genetic factors [12,13], age [12], gender [12,14,15], family characteristics [12,16], socio economic status [12,17], culture [12] and childhood maltreatment [18,19]. Findings on alcohol consumption particularly in Africa have shown that alcohol use and risky sexual behaviors are linked to drinking venues and alcohol serving establishments, sexual coercion, and poverty [21,22]. These results point to the pressing public health issue of alcohol use in sub-Saharan Africa which is linked to other health-risk behaviors and adverse outcomes.
Alcohol use as a result of ACEs is an important public health concern because of the several detrimental health and social outcomes associated with it [23].
Despite the vast literature on alcohol use and ACEs, there is limited research on alcohol use and ACEs among youth in Kampala, particularly those youth who do not attend school. This is concerning because these youth are vulnerable and have a high prospect to drink alcohol at young ages, drinking frequently and heavily [24]. As such, this study seeks to examine alcohol drinking patterns and ACEs, that is; early alcohol use initiation, frequency and intensity of drinking with the goal of informing program planning and intervention strategies.
A key area that has yet to be explored is the role of early Adverse Childhood Experiences (ACEs) in early alcohol use initiation and consumption patterns. Research in the U.S. on ACEs shows that; an association between ACEs and alcohol use at an early age which transcends time [20], experiencing 2 or more ACEs increases the risk of alcohol dependence by a similar margin, psychological distress increases the risk of self-reported alcohol problems [6,25] and there are differences in how ACEs affect men and women [6,25] thereby indicating that ACEs likely have a strong association with early alcohol use and alcohol consumption patterns. Alcohol use is frequently used as a coping strategy among youth based on research in North America and Europe. It is very likely that youth in sub-Saharan Africa, and in Kampala specifically, will have similar experiences because research among the youth living in the slums and streets of Kampala has shown that 30.2% report problem drinking and 32.8% report drunkenness [24]. As such, the following study was guided by two research questions: What is the prevalence and socio demographic correlates of ACEs among high -risk youth living in the slums of Kampala? Do high-risk youth living in the slums of Kampala who report ACEs initiate alcohol use earlier and use alcohol frequently and heavily than those who did not experience ACES? In this study, ACES were broadly defined and used indicators to reflect whether youth did not having living biological parents, did not actively talk to parents, saw parents hitting each other, parents hit the youth, parental use of alcohol, hunger, having ever lived on the street and having been raped.
These indicators were guided by extensive previous research [12,24,26,27,28]. Moreover, alcohol use initiation (<13 years and >13 years) was a key outcome as it is a key metric for efforts to delay and reduce alcohol use. Also, having had more than 5 drinks in the past month and having been drunk on more than 5 days in the past month were used to measure frequent and heavy drinking respectively.
Youth in the slums of Kampala lack so many basic needs [24,26,29]. Youth who live in the slums and on the streets rarely attend school and are particularly vulnerable to a range of health risks including substance abuse [30]. As such, early public health interventions are needed and the current study is conducted to inform prevention strategies in resource-poor settings.
Data from the Kampala Youth Survey conducted in May and June 2011 in Kampala, Uganda was used. The study protocol was approved by the Georgia State University Institutional Review Board and also by the Uganda National Council for Science and Technology. The main objective of this cross-sectional survey was to quantify and describe high-risk behaviors and exposures in a convenience sample of urban youth living on the streets or in the slums, 14–24 years of age, who were participating in a Uganda Youth Development Link (UYDEL) drop-in center for disadvantaged street youth. UYDEL is a non-profit making organization that operates in Kampala, Uganda whose goal is to enhance human capital development among the disadvantaged youth in the areas of child rights protection, HIV prevention, substance abuse, sexual and reproductive health, skills training and social research [31].
Face-to-face surveys, lasting about 30 minutes, were administered by social workers or peer educators employed by UYDEL. The study was implemented across eight drop-in centers across Kampala. Detailed methodology from the cross-sectional study has been reported previously [26,27].
Participant Selection, Inclusion and Exclusion Criteria
The youth who were selected to be a part of the study were those who had been currently receiving services from any of UYDEL’s 8 drop-in centers for street youth (UYDEL, 2013), which at that time, served approximately 650 youth per month. For the present study, 507 youth were approached to participate in the survey. Among these, 46 declined and 461 agreed to participate, yielding a participation rate of 90.9%. Four surveys were missing substantial numbers of responses and were therefore excluded, yielding 457 completed surveys for the final analytic sample of youth between the ages of 14 and 24 (31.1% boys and 68.5% girls).
Several variables informed by previous research [12] andthe CDC ACE Study questionnaire [28], were used in the analysis to find relationships between adverse experiences and alcohol use status. Independent variables included were: hunger, having parents, talking to parents, ever having lived on the street, parents hitting each other, parents hitting children and parental use of alcohol, These were dichotomized to form two groups of either possessing the characteristic or not. For all selected variables, all missing values were excluded.
A description of the eight measures used as broad indicators of ACEs are described below; having parents - Participants were asked if their parents (fathers and mothers) were alive at the time of the survey (Categories were: yes, no and N/A were categorized as absence of the indicator). Talking to parents - Participants were asked how often they talked to their fathers and mothers (Categories were: ‘Yes’ for daily, weekly, monthly and annually or ‘no’ for never). Parents hitting each other - Participants were asked if they had seen or heard their parents hitting each other (Categories were: yes, no and N/A were categorized as absence of the indicator). Parents hitting you - Participants were asked if they had ever been hit or beaten by their parents (Categories were: yes, no and N/A were categorized as absence of the indicator). Parental use of alcohol - Participants were asked if their parents used alcohol (Categories were: yes, no and N/A were categorized as absence of the indicator). Hunger – Participants were asked if they were ever hungry (Categories were: yes, no and N/A were categorized as absence of the indicator). Having ever lived on the street – Participants were asked if they had ever lived on the streets or were currently living on the streets (Categories were: yes, no and N/A were categorized as absence of the indicator). Having been raped – Participants were asked if they had ever been raped (Categories were: yes, no and N/A were categorized as absence of the indicator).
The three outcome measures of interest were measured by; age of alcohol initiation (<13 years or >13 years), frequency of drinking (< 5 drinks or >5 drinks) and intensity of drinking (< 5 days or >5 days). All three categorical measures were coded to have three levels - presence or absence of the measure under study and the third level was non-drinkers who served as the reference group. Drinking status was assessed by participants’ response to the question “In the past month, on how many days did you drink alcohol? (Current drinking)”; Age of alcohol use initiation was assessed by participants’ response to the question “How old were you when you had your first drink of alcohol? Heavy drinking was indicated for respondents who dank so much that they were really drunk on 5 or more days.
Independent Variables
Indicators to measure ACEs were informed by the World Health Organization [12] and the CDC ACE Study questionnaire [28] and included; hunger, having parents, talking to parents, ever having lived on the street, having ever been raped, parents hitting each other, parents hitting the youth and parental use of alcohol.
Three statistical techniques were used; Chi-Square tests of associations, Bivariate and Multivariate multinomial logistic regression analyses were computed to determine statistical association between ACEs and each of the 3 alcohol use measures among youth. Analyses were conducted using the SPSS statistical software package version 21. Initial bivariate analyses were performed. Measures with significant associations with the outcome variables were also examined in multivariate analyses. All independent variables were dichotomized to indicate the presence or absence of the particular risk factor while all three dependent variables had 3 levels that is; age of initiation (age 13 or under, over age 13 and non-drinkers), frequent drinking (5 drinks or less, more than 5 drinks and non-drinkers) and heavy drinking (5 days or less, more than 5 days and non-drinkers).
The description of indicators used in this study among Kampala youth are presented in Table 1. The prevalence of ACEs and their distribution by demographic characteristics are presented in Table 2. In this study, 36.5% said they did not talk to their mother, 58.4% did not talk to their father, 32.4% had lost their mother, 51.6% had lost their father, 62.6% reported being hit by their parents, 30.9% had witnessed their parents hitting each other, 38.9% reported parental alcohol use, 60.6% reported ever going hungry, 22.1% reported having ever lived on the street while 24.1% reported having been raped.
Table 2. Demographic characteristics and ACEs measures across gender among Kampala youth (N=457)
The characteristics and indicators’ association with alcohol use are presented in Table 3. Factors associated with alcohol use varied by sex (p<.05) (alcohol use was more common among girls), age (p<.000), (alcohol use more common among youth 18 years of age and older) and alcohol use were also more common among youth who reported the following ACEs; parents hitting each other (p<.000) , parental use of alcohol (p<.000), being hungry (p<.000), having ever lived on the street (p<.000) and having been raped (p<.000).
Table 3. Characteristics and risk factors’ association with alcohol useamong Kampala youth (N=457)
Bivariate associations between alcohol use initiation, frequency of alcohol use, intensity of alcohol use and Adverse Childhood Experiences among youth living in the slums of Kampala are presented in Table 4. Bivariate multilogistic regression analyses were performed to; examine associations between ACES and early alcohol use initiation. Early alcohol use initiation was identified as youth who started drinking under age 13 and those who started drinking after they were 13 years old. The reference category was nondrinkers. Findings show that youth who started drinking before age 13 and those who started drinking after age 13 on the measures of; parents hitting each other (p<.001), OR <13=2.30 (95% confidence interval (CI):1.22-4.35), OR>13=2.89 (95% CI:1.85-4.54); parents hitting the youth (p<.05), OR<13=1.31 (95% CI:0.69-2.47), OR>13=1.85 (95% CI:1.16-2.93); parental use of alcohol (p<.001), OR<13=7.21 (95% CI:3.66-14.2), OR>13=4.50 (95% CI:2.86-7.10); being hungry (p<.001), OR<13=4.55 (95% CI:2.06-10.1), OR>13=2.09 (95% CI:1.34-3.29); having ever lived on the street (p<.001), OR<13=4.84 (95% CI:2.41-9.72), OR>13=4.95 (95% CI:2.94-8.32) and having been raped (p<.001), OR<13=3.22 (95% CI:1.63-6.35), OR>13=4.73 (95% CI:2.89-7.72); to identify group differences between youth who had drank alcohol on 5 days or less or more than 5 days in the past month and ACEs. Results indicated that significant differences existed between frequency of drinking and ACEs on the following measures: parents hitting each other (p<.001), OR<5=2.26 (95% CI:1.353.79), OR>5=3.62 (95% CI:2.01-6.52); parental use of alcohol (p<.001), OR<5=3.79 (95% CI:2.24-6.45), OR>5=6.01 (95% CI:3.16-11.4); being hungry (p<.001), OR<5=2.31 (95% CI:1.33-4.03), OR>5=3.06 (95% CI:1.56-5.99); having ever lived on the street (p<.001), OR<5=4.45 (95% CI:2.50-7.92), OR>5=8.62 (95% CI:4.63-16.04) and having been raped (p<.001), OR<5=3.54 (95% CI:2.05-6.12), OR>5=5.75 (95% CI:3.16-10.46); to identify group differences between youth who had been drunk on 5 days or less during the past month or were drunk on more than 5 days in the past month. Results indicated that there were significant differences between heavy drinkers and non-heavy drinkers on responses to: parents hitting each other (p<.001), OR<5=2.81 (95% CI:1.69-4.66), OR>5=1.77 (95% CI:.79-3.92); parental use of alcohol (p<.001), OR<5=4.45 (95% CI:2.61-7.60), OR>5=3.49 (95% CI:1.55-7.88); being hungry (p<.001), OR<5=2.99 (95% CI:1.66-5.39), OR>5=2.09 (95% CI:.91-4.83); having ever lived on the street (p<.001), OR<5=6.09 (95% CI:3.51-10.57), OR>5=10.52(95% CI:4.69-23.6) and having been raped (p<.001), OR<5=5.23 (95% CI:3.09-8.83), 2.81 (95% CI:1.27-6.21).
Table 4.Bivariate associations between age of alcohol use initiation, frequent, heavy drinking and ACEs among youth living in the slums of Kampala (N = 457)
The multivariate associations between alcohol use patterns (age of alcohol use initiation, frequency and heavy drinking) and Adverse Childhood Experiences among youth living in the slums of Kampala are presented in Table 5.Multivariate analysis was performed on the measures that came up significant in bivariate analyses. Results indicated that parental use of alcohol, having ever lived on the street and having been raped were all significantly associated with age of alcohol initiation, frequent drinking as well as heavy drinking.
The purpose of this study was to examine the association between ACEs and alcohol consumption patterns among youth living in slums in Kampala. Our findings show that several ACEs vary by sex and age and also are highly prevalent among these youth (Parental alcohol use, being hungry, and ever having lived on the street were common among while having been raped was more common among boys).
These findings of relatively high prevalence of ACEs (> 20% for each indicator) were expected because of the unique circumstances that these youth [26].
Moreover, several ACES are also strongly associated with all three outcome measures examined that is; parents hitting each other (p<.001), parental use of alcohol (p<.001), hunger (p<.001), ever having lived on the street (p<.001) and having been raped (p<.001).
Bivariate analyses showed gender differences for; parental alcohol use (p<.05), being hungry (p<.001), ever having lived on the street (p<.001) and having been raped (p<.001).
Findings from the bivariate analyses also indicated that parents hitting each other (p<.001), parents hitting the youth (p<.05), parental use of alcohol (p<.001), being hungry (p<.001), having ever lived on the street (p<.001), and having been raped (p<.001) were significantly associated with the youth’s age of alcohol initiation, frequent drinking and heavy drinking. These findings were consistent with previous research that has found similar results [30,32,33] as well as latter studies [34,35].
It was surprising that several parental involvement characteristics were not significantly associated with alcohol consumption patterns among these youth but this may be because of the unique circumstances of these youth that make them resilient or that parental involvement is viewed differently in this culture thus its impact on alcohol use would be different.
The indicators that were significant in bivariate analyses were then included in a multivariate model and significant associations were found between parental use of alcohol (p<.001), having ever lived on the street (p<.001) and having been raped (p<.001) for all three dependent variables of; age of alcohol initiation, frequent drinking and heavy drinking. These findings reflect previous research that has found similar results [36].
An interesting finding was the consistency of findings from the multivariate analysis, that is: parental alcohol use, ever having lived on the street and having been raped which were all statistically significant for age of alcohol initiation, frequency and intensity of drinking.
This study, a first of its kind, examined the associations between ACEs and several alcohol measures in an under studied, vulnerable, urban population in Kampala, Uganda and this gives an opportunity for knowledge about this particular population to be shared beyond the borders of the slums in which these high risk youth live thus providing an opportunity for more exploratory research and possibly interventions to improve public health in this and such populations. The study also looked at multiple outcome measures of alcohol consumption patterns, that is; age of initiation, frequency and intensity of drinking to assess their association with ACEs and this was able to give a better understanding of alcohol use behavior and not just current drinking patterns.
The results stated here should be viewed in light of several limitations; the study participants were not randomly selected, but were youth who self-selected to attend the drop-in centers and to take part of the study therefore, the findings may not be representative of street and slum youth in Kampala and may not be generalizable to populations elsewhere. The definition of youth who live in the slums was broad and included a range of circumstances and family contexts (both street youth who were homeless and youth who lived in the slums but may have had a stable living arrangement). Due to limited literacy rates, participants were read the questionnaire which could have led to bias. Most of the questions regarding alcohol use and high-risk behaviors were selected from previously established self-administered surveys, specifically the Youth Risk Behavior Survey conducted in the U.S. and the Global School-based Student Health Survey conducted primarily in Africa, Asia, and Latin America where the wording of the questions used was simplified in most cases and the response options narrowed to facilitate the administration of the survey by the interviewers. As such, the reliability and validity of some of the measures may have been altered. With the cross-sectional nature of the survey, the temporal ordering of ACEs and alcohol use cannot be determined, nor can causation be inferred.
For public health practice, it is important to recognize that evidence-based strategies used elsewhere may not be relevant for a low-income country such as Uganda or for vulnerable youth with particular needs and circumstances. With the limited healthcare resources available for treatment and prevention of infectious and other diseases in this and similar settings, it is clear that public health issues such as alcohol use and ACEs have been given less priority. However, the findings from this study can be used to advocate for the urgency of providing more resources and services to these vulnerable youth, most of who have lost one or more parents and have faced significant ACEs thereby compounding existing problems including alcohol abuse and its rippling effects. As such, resources need to be focused on awareness and emphasize primary prevention of harmful alcohol use and ACEs among youth. The priority of providing more services to vulnerable youth needs to be considered complimentary to, and not competing with, other prevention efforts underway to address other critical health problems including disease, hunger and poverty.
Lastly, it is important to create a national child protection plan with local community support so that future interventions, policies, and resource allocation can produce the impact needed and to improve the conditions and health outcomes of children and vulnerable youth later in life.
Including ACEs into alcohol abuse prevention efforts could prevent a number of negative consequences and have significant impact on a range of serious health problems [37]. Specifically, prevention efforts cab be supported by: collecting ACE data to inform policy makers, increasing awareness of ACEs nationwide and at the community-level, emphasizing the relevance of ACEs to multiple behavioral health disciplines, and using ACEs research and collected data to identify groups of people who may be at higher risk for substance abuse and related behavioral health problems and tailoring interventions to best assist them [38].
The WHO highlights the need for a multi-sectoral approach in preventing child maltreatment and to maximize the effects of prevention and care, and recommends that interventions are delivered as part of a four-step public health approach: defining the problem; identifying causes and risk factors; designing and testing interventions aimed at minimizing the risk factors; disseminating information about the effectiveness of interventions and increasing the scale of proven effective interventions [39].
Additional research is needed to replicate these findings since they are primarily based on a convenience sample of youth who have sought out services offered by a drop-in center. As such, their experiences may be different than that of other youth and should be documented in greater detail and also preferably in a longitudinal cohort to better determine the initiation of risk behaviors and the identification of modifiable factors that may be suitable for prevention.
Future research is also needed to better determine strategies for providing additional services and treatment to these youths who may be difficult to reach. This is particularly troubling given the acute shortage of psychiatrists, psychologists, nurses, and social workers in Africa and Uganda specifically.
Despite the large health, social and economic burden associated with harmful use of alcohol, it has remained a relatively low priority in public policy, including in public health policy particularly in Africa [12]. More culturally appropriate research is needed in Uganda and sub-Saharan Africa at large in the area of youth alcohol consumption and ACEs and their association with social and behavioral problems that these individuals face later in life.
This study sought to assess the prevalence of ACEs among high-risk youth living in the slums of Kampala and whether the prevalence varies by sex and to examine if ACEs are associated with alcohol use initiation, frequent alcohol use and level of intensity of alcohol use. ACEs have serious long lasting implications on the life of the individual including susceptibility to alcohol use and this is especially true for high risk youth who have limited resources and support to improve their lives.
Alcohol has serious long lasting implications on the life of the individual especially for those who experience adversity early on in life. This is more pronounced among high risk youth who lack resources and support to improve their lives. The destructive use of alcohol should be made a priority for researchers and policy makers particularly in understudied populations like the one studied here but also largely in sub-Saharan Africa.
Research reported in this manuscript was conducted as part of an MPH thesis by the lead author Nina K. Babihuga under the supervision of the co-authors Drs. Swahn and Dube.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
