*1.1. Migration and Resettlement of African Refugees*

Across the world, the ease of travel and international mobility have increased, including for people from Africa. Additionally, in 2000, the United Nations High Commissioner for Refugees (UNHCR) called for the need to provide resettlement opportunities for refugees who have spent several years in refugee camps in challenging conditions [1], especially from the African continent. Following the UNHCR calls, the Australian Government declared a humanitarian commitment to resettle refugees from African nations, particularly those living in protracted refugee situations from the Horn of Africa. This commitment resulted in a sharp increase in the proportion of refugees resettled from African countries, rising from 33 per cent in 2003 to 70 per cent in 2005 [2]. In 2012–2013, over half of visas granted under the Humanitarian Program were allocated to people born in Sub-Saharan Africa, North Africa, and the Middle-East, with 39.2 per cent of all persons granted visas being aged between 0 and 17 years [3]. There were 317,182 people born in Sub-Saharan Africa in Australia in 2016, and over 20,000 were living in South Australia [4].

During the process of immigration, migrant and humanitarian refugees are exposed to multiple stressors [5,6]. Studies among African migrants (the majority of whom have a

**Citation:** Mwanri, L.; Mude, W. Alcohol, Other Drugs Use and Mental Health among African Migrant Youths in South Australia. *Int. J. Environ. Res. Public Health* **2021**, *18*, 1534. https://doi.org/10.3390/ ijerph18041534

Academic Editor: Paul B. Tchounwou Received: 11 November 2020 Accepted: 2 February 2021 Published: 5 February 2021

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refugee background in Australia) have reported significant stressors relating to inadequate employment, housing, education, and integration following settlement [7–9]. Additionally, there are considerable and diverse migration trajectories experienced between and within refugee groups. Pre-migration contexts such as cultural backgrounds, the country of origin and circumstances surrounding the decision to immigrate can affect groups and individuals in a range of ways, including poor mental health outcomes [10].

#### *1.2. Migrants and Refugee Youths, Alcohol and Other Drug Use and Mental Health*

The age at which a migrant and refugee migrate, and the related settlement opportunities and challenges can have a profound influence on mental health. A study suggests that compared to other migrant groups, migrant youths are more likely to be at a higher risk of suicide [11]. Migrant and refugee youths experience an increased risk of self-harm behaviors and are vulnerable to suicidal ideation because of challenges to the social factors following resettlement, described previously [12]. Migrant and refugee youths are also at risk of increased alcohol and other drugs (AOD) use, which increases individual risks to mental health problems and suicide [13]. AOD use among migrant and refugee youths has also been linked with experiences of social, emotional, and behavioral problems, including feeling depressed [14].

In Australia, these are serious issues because a large proportion of young people who emigrated from war-torn areas in Africa and the Middle East in the last decade arrived unaccompanied, without parents or guardians, in their critical stage in life [3]. It is important to point out that despite the increased risks of migrant and refugee youths to AOD use and mental health, African migrant and refugee youths are resilient, which play protective roles in reducing the use of AOD and related harms [15].

Although previous research has explored the resettlement and integration particularly of African refugees [16], there is a dearth of research examining the beliefs about AOD use and mental health among African migrant and refugee youths in Australia [17]. African migrant and refugees, including youths, are under-serviced by AOD and mental health services. This inequity in service requires more research to enhance an understanding of this community [18].

#### *1.3. Aims of the Study*

This study was commissioned by the African Communities Council of South Australia (ACCSA), an overarching organization for African communities in South Australia, to determine the perspectives of African youths (the majority of whom has a refugee background) in South Australia on suicide, AOD use and mental health following increased suicide among youths in this community. This paper presents part of the findings from this project and explores the perspective of African migrant and refugee youths on AOD use and issues of mental health. This study aims to contribute to the limited existing literature on AOD use and mental health problems in the African communities by understanding the contexts in which AOD use and mental health issue occur among African migrant and refugee youths in Australia. We attempted to achieve this aim by answering the research question: What are the main factors that influence AOD use among African youths in South Australia?

#### **2. Methods**

### *2.1. Theoretical Framework*

We employed the acculturative stress model to guide our data analysis and interpretation. This model focusses on understanding the unique stressors that are rooted in the process of acculturation [19]. Acculturation is a process of cultural change experienced by migrants following a contact with or living in a different cultural environment, and it is understood to be complex and dynamic [20]. According to Berry, Kim, Minde, and Mok [19], the process of acculturation and related stressors can lead to a stressful experience of resettlement and integration. They argue that individuals might have different

experiences during the process of acculturation and that stressors might depend on the degree of their experience.

Culture and identity, reasons for migration, language, demographic characteristics, social practices, and cultural values are reported factors moderating experiences of acculturation and stressors [21]. Acculturative stress is reported to be a risk factor to mental health outcomes among refugees [22]. Although the concept of acculturative stress model has been used in studying different refugee groups, the use of this model is needed to understand the nature of stressors resulting from acculturation of African refugees, particularly youths following their resettlement in Australia.
