|Year : 2010 | Volume
| Issue : 2 | Page : 137-140
Substance use among adolescent high school students in India: A survey of knowledge, attitude, and opinion
Dechenla Tsering1, Ranabir Pal1, Aparajita Dasgupta2
1 Department of Community Medicine, Sikkim Manipal Institute of Medical Sciences (SMIMS) and Central Referral Hospital (CRH), 5th Mile, Tadong, Gangtok, Sikkim-737102, India
2 Department of Community Medicine, All India Institute of Hygiene and Public Health, Chittaranjan Avenue, Kolkata - 73, India
|Date of Submission||31-Mar-2010|
|Date of Decision||26-Apr-2010|
|Date of Acceptance||21-May-2010|
|Date of Web Publication||2-Aug-2010|
Department of Community Medicine, Sikkim Manipal Institute of Medical Sciences (SMIMS) and Central Referral Hospital (CRH), 5th Mile, Tadong, Gangtok, Sikkim-737102
| Abstract|| |
Background: Is knowledge regarding the consequences of substance use among adolescents enough to prevent them from initiating and continuing its use, is a question that needs to be clarified further? Objective: To assess the knowledge regarding harm of use and to obtain information about attitudes among high school students. Also, to discover the opinion of substance use held by users. Materials and Methods: This was a population based cross-sectional study conducted in two high schools of West Bengal, India, among 416 students, in classes VIII, IX, and X, with no interventions. Primary outcome measurements were substance use: knowledge regarding harm, attitude, and opinion. Following this proportions and the chi-square test were used for statistical analysis. Results: Out of 416 students, 52 (12.5%) used or abused any one of the substances irrespective of time and frequency in lifetime; 26 (15.1 %) were among the urban students and 26 (10.7 %) were among their rural counterparts. More than two-thirds (73.07%) of the respondents expressed a desire to quit substance use and 57.69% had tried to stop. 'Easy availability' and 'relief from tension' were the most frequent reasons for continuation of substance use. Level of knowledge on harmfulness of substance use among students was very high (urban - -84.6% and rural - 61.5%) and they stated media as the most frequent source of information. Users were successful in influencing their peers into taking up this habit (urban - 15.4% and rural - 26.9%). Conclusions: Inspite of being aware of the harmful effects of substance use, adolescents take up this habit. This requires comprehensive prevention and control programs in schools and the community, targeted toward adolescents and their parents and other family members. Effective measures are required to encourage shaping the attitude of school children toward self-confidence and adequacy, as also to prevent risk behavior among adolescents.
Keywords: Attitude, knowledge, rural, substance use, urban
|How to cite this article:|
Tsering D, Pal R, Dasgupta A. Substance use among adolescent high school students in India: A survey of knowledge, attitude, and opinion. J Pharm Bioall Sci 2010;2:137-40
|How to cite this URL:|
Tsering D, Pal R, Dasgupta A. Substance use among adolescent high school students in India: A survey of knowledge, attitude, and opinion. J Pharm Bioall Sci [serial online] 2010 [cited 2014 Jul 29];2:137-40. Available from: http://www.jpbsonline.org/text.asp?2010/2/2/137/67005
Use of tobacco, alcohol, and other substances is a worldwide problem and affects many children and adolescents.  Early initiation of substance use is usually associated with a poor prognosis and a lifelong pattern of deceit and irresponsible behavior.  The hope that simple information given through educational programs will be sufficient to prevent drug dependence is frequently expressed, however, there is no evidence to support it and there are many reasons to doubt it.  Knowledge with regard to the consequences of substance use among adolescents enough to prevent them from initiating and continuing its use is a question that needs to be clarified further. Shaping the attitude of children and promotion of a healthy lifestyle, including constructive behavior is essential in the formative years of life. Therefore, keeping in focus the research question - What is the level of knowledge and attitude held by the users with regard to the harm of substance use? - we have formulated the objective of our study, which is, to assess the knowledge regarding harm of use and to obtain information about the attitude among high school students, and also to discover the opinion on substance use held by the users.
| Materials and Methods|| |
This study was a population-based, cross-sectional study, conducted on 416 students in classes VIII, IX, and X, in two high schools, selected by multistage random sampling, in West Bengal, India, with no interventions. A self-administered anonymous questionnaire was administered. From the experience of the researchers in this field, we concluded that:
Therefore the classes chosen represent an ideal population for this study.
- The understanding level of the students of class VIII onward, allows the administration of a self-administered questionnaire, young students might not understand the questionnaire, which could give rise to false responses and low response rates.
- Initiation of substance use usually begins at the age of 13- or 14 years.
- Students of these age groups are usually present in class VIII, IX, and X.
- Similar studies on student population have been carried out from class VIII onward.
Main outcome measures were substance use: knowledge regarding the harm, attitude, and opinion.
Content validity and reliability of study instruments
The survey module was developed using an anonymous self-administered questionnaire, designed by adopting the questionnaire suggested by the World Health Organization's (WHO) (1980) study team,  prior to the study, for ensuring feasibility, acceptability, time management, validity, and reliability. A pilot study was carried out at the Seventh Day Adventist Day School, Kolkata, among students in class VIII, IX, and X, following which, some of the questions from the interview schedule were modified.
The pre-tested, close-ended questionnaire contained questions relating to addiction and the attitude towards it. These were related to the socio-demographic situation prevailing in India. By initial translation, back-translation, and re-translation, followed by a pilot study, the questionnaire was custom-made for the new study. The data collection tool used for the study was an interview schedule that was developed at the institute with the assistance of the faculty members and other experts. The interview schedule included the demographic variables that covered their personal characteristics such as age and gender, as well as educational level and socioeconomic status. All aspects of substance use were queried including frequency, associated factors, knowledge, attitude, and their opinion regarding substance use.
Data collection procedure
Out of the entire list of Urban and Rural High schools in West Bengal, one school in each category was chosen randomly. Subsequently, all the 478 students in class VIII, IX, and X, in both schools (210 students in the urban area and 268 in the rural area) were initially taken as the study population. Out of the 478 students, 462 (205 students in urban area and 257 in the rural area) could be covered. They were given anonymous self-administered questionnaires. The ultimate response rate was 87.02% and 416 students could be covered in our study.
The permission to conduct the study in these two schools was taken from the Heads of the schools well ahead of the data collection. The school teachers actively co-operated during the whole period of the study. All the participants were explained the purpose of the study and were ensured strict confidentiality. Next verbal informed consent was taken from each of them before the interview. The participants were given the choice of not participating in the study if they did not want to. The collection of the data was from the 1 June, 2003 -to 31 May, 2004, and the completed ones were collected on the same day. Details of the questionnaire can be provided, if required.
Principal investigator collected the data and disseminated information on substance use in health education sessions to complement the findings of the study.
Limitation of the study
- Magnitude of substance abuse in a specified geographic area was not attempted; instead it describes the types and characteristics of a specified population group.
- The findings of the present study cannot be generalized to the entire population, it is specific to school children.
- In order to keep the anonymity, the reasons for incompleteness of responses could not be sorted out.
- Even after repeated visits, few absentees could not be covered.
- Follow up of the users could not be done.
The data collected were thoroughly cleaned and entered into Excel spread sheets and analysis was carried out. The procedures involved were transcription, preliminary data inspection, content analysis, and interpretation. Proportions and Chi-square test were used in this study.
- Ever users (lifetime users): All the users who used or abused drugs irrespective of time and frequency in his/her life.
- Current users: All the users who used or abused drugs at least once during the past 30 days.
- Regular users: All the users who used or abused drugs for 20 or more days during the past 30 days.
| Results|| |
In our study population, the overall prevalence of substance use among high school students was 12.5 percent with 15.1 and 10.7 percent among urban and rural responders, respectively [Table 1].
Prevalence of substance use was associated more with males than with females, as also current and regular use, which was more common among males, both among urban and rural students [Table 2].
Nearly half of the urban and rural users (urban - 69.2% and rural - 46.2%) had communicated that they had tried to quit the habit and around 15 percent of the responders expressed a desire to quit. Of the remaining, 50 percent wanted to continue the habit and others were uncertain about their decision regarding continuation of use [Table 3].
With respect to the reasons for continuation and quitting, there were mixed responses among the urban and rural users. The urban users stated 'easy availability' (11.5%) as the most frequent reason for continuation, whereas, 'relief from tension' (19.2%) was reported by the rural users. The other reasons such as 'acceptance by peers' remained common among the respondents. 'Moral sense' (urban - 42.4% and rural - 15.4%) and 'fear of health problems' (urban - 15.4% and rural - 15.4%) were the most frequent reasons for quitting both among the urban as well as rural users. [Table 4]
A majority of the respondents reported having knowledge about the harm of substance use, especially the licit ones, with almost two-thirds (urban - 84.6% and rural - 61.5%) having knowledge about tobacco and around 50 percent knowing about alcohol (urban - 61.5% and rural - 30.8%) and cannabis which was higher among the rural users (urban - 11.5% and rural - 57.7%) [Table 5].
Other substances for which there was no response were not included in [Table 5].
'Media' accounted for the most common source of knowledge regarding harm of substance use (urban - 61.5% and rural - 34.6%). Family members (urban - 46.2% and rural - 34.6%) and teachers (urban - 42.3% and rural - 15.4%) also had an important role to play in imparting knowledge about the harmful effects of use. [Table 6]
Almost one-third (26.9%) of the rural users had influenced their peers into taking up the habit. Although it was less among the urban users, still 11.5 percent influenced their friends into doing the same. [Table 7]
| Discussion|| |
In the present study, ever use of substance as well as distribution among the males and females, were comparable to the findings of studies by other authors, where we noted similar results with that of other studies. ,,
A majority of the users reported trying to end the habit and most of the users expressed a desire to quit the habit. These views were also expressed in other studies, ,, which revealed that all users did not want to continue the habit and they held a positive attitude toward quitting, therefore, motivation on the part of family, friends, and close ones could help the user to come out of this habit.
Easy availability of substances, especially the licit ones, has been the most common reason for continuation, followed by relief from stress, and acceptability among friends. These reasons have been cited even by other authors. ,,,,,, This shows that home and neighborhoods furnish the adolescents with ways to procure and continue using substances. Moreover, as adolescents are in a transitional phase, confusion can sometimes make them susceptible to taking up unfavorable habits. In contrast to this, factors leading to quitting substance use also exist in and around adolescents, as the major reasons stated were moral sense and fear of health problems, which clearly suggests that attitude shaping by parents and knowledge of harmfulness of use can indirectly motivate the user to give up the habit. These findings have also been seen in studies from related areas. ,,,, Knowledge regarding the harmful effects of substance use is considerably high among the users, particularly for licit ones such as tobacco, alcohol, and cannabis. Researchers in related studies have found similar results ,,,,, where the users are not deprived of the knowledge regarding the consequences of consumption of substances. Particularly disturbing is the fact that they continue their use despite knowing the effects. This information has been provided primarily through the media, principally the television and hoardings. A small percentage also reported being taught about it in school and by family members. Therefore, media and close contacts are primarily responsible for imparting knowledge, whether it be pro- or anti-substance use, and these findings are common anywhere, as is seen in other studies. ,,,, Users are mainly responsible for influencing their peers and close contacts into taking up the habit, as is seen in the present study as well as in other studies. Influence of peers and close contacts who use substances are usually responsible for initiating their use in others and this is evident in the present study as well as in related studies ,,,, where users have been accountable for instigating the habit.
| Conclusion|| |
Awareness of the harmful effects of substance use is high. A disturbing aspect that has been noticed is that despite having knowledge of substance use, adolescents initiate and continue its use. Efforts to control the problem in this age-group should also target their parents and other family members, by means of the media. The school being an essential part in a student's life can include and promote an effective and healthy life-style. Interventions that enhance parental self-efficacy in conveying and enforcing attitude shaping for their children could reduce adolescent substance use. Healthy substance use control programs, focusing on youth, are essential, to reduce the burden of related diseases. Repeat surveys would help in monitoring the tobacco epidemic in schools and in evaluating the efficacy of state level tobacco control programs.
| References|| |
|1.||WHO study group on drug dependence. WHO Tech Rep Ser No 407; 1969. p. 6-8. |
|2.||Tripathi BM, Lal R. Substance abuse in children and adolescents. Indian J Pediatr 1999;66:557-67. [PUBMED] |
|3.||Older J. Anti - smoking language that the young understand. World Health Forum 1986;7:74-8. |
|4.||Smart RG, Hughes PH, Johnston LD, Anumonye A, Khant U, Mora ME, et al. A Methodology for student drug-use surveys. WHO offset publication No. 50, Geneva: World Health Organization; 1980. |
|5.||Madu SN, Matla MQ. Illicit drug use, cigarette smoking and alcohol drinking behaviour among a sample of high school adolescents in the Pietersburg area of the Northern Province, South Africa. J Adolesc 2003;26:121-36. [PUBMED] [FULLTEXT] |
|6.||Chen KT, Chen CJ, Fagot-Campagna A, Narayan KM. Tobacco, betel quid, alcohol, and illicit drug use among 13- to 35-year-olds in I-Lan, rural Taiwan: prevalence and risk factors. Am J Public Health 2001;91:1130-4. [PUBMED] [FULLTEXT] |
|7.||Sutherland I, Willner P. Patterns of alcohol, cigarette and illicit drug use in English adolescents. Addiction 1998;93:1199-208. [PUBMED] [FULLTEXT] |
|8.||Mpabulungi L, Muula AS. Tobacco use among high shool students in Kampala, Uganda: questionnaire study. Croat Med J 2004;45:80-3. [PUBMED] [FULLTEXT] |
|9.||Sutherland I, Shepherd JP. Adolescents' beliefs about future substance use: a comparison of current users and non-users of cigarettes, alcohol and illicit drugs. J Adolesc 2002;25:169-81. [PUBMED] [FULLTEXT] |
|10.||Franco JA, Pιrez Trullιn A, Garcνa A, Marrσn R, Clemente ML, Rubio E. Tobacco use among young people in informal education settings: a survey of behaviors and opinions. Arch Bronconeumol 2004;40:10-6. |
|11.||Komro KA, Maldonado-Molina MM, Tobler AL, Bonds JR, Muller KE. Effects of home access and availability of alcohol on young adolescents' alcohol use. Addiction 2007;102:1597-608. [PUBMED] [FULLTEXT] |
|12.||Sargent JD, Beach ML, Dalton MA, Mott LA, Tickle JJ, Ahrens MB, et al. Effect of seeing tobacco use in films on trying smoking among adolescents: cross sectional study. BMJ 2001;323:1394-7. [PUBMED] [FULLTEXT] |
|13.||Kwamanga DH, Odhiambo JA, Amukoye EI. Prevalence and risk factors of smoking among secondary school students in Nairobi. East Afr Med J 2003;80:207-12. [PUBMED] |
|14.||Maziak W, Mzayek F. Characterization of the smoking habit among high school students in Syria. Eur J Epidemiol 2000;16:1169-76. [PUBMED] [FULLTEXT] |
|15.||Sinha DN, Gupta PC, Pednekar M. Tobacco use among students in Bihar (India). Indian J Public Health 2004;48:111-7. |
|16.||Singh V, Gupta R. Prevalence of tobacco use and awareness of risks among school children in Jaipur. J Assoc Physicians India 2006;54:609-12. [PUBMED] |
|17.||Sinha DN, Roychowdhury S. Tobacco control practices in 25 schools of West Bengal. Indian J Public Health 2004;48:128-31. |
|18.||Feldman L, Harvey B, Holowaty P, Shortt L. Alcohol use beliefs and behaviors among high school students. J Adolesc Health 1999;24:48-58. [PUBMED] [FULLTEXT] |
|19.||Courtois R, Caudrelier N, Legay E, Lalande G, Halimi A, Jonas C. Influence of parental tobacco dependence and parenting styles on adolescents' tobacco use. Presse Med 2007;36:1341-9. [PUBMED] [FULLTEXT] |
|20.||Ljubotina D, Galiζ J, Jukiζ V. Prevalence and risk factors of substance use among urban adolescents: questionnaire study. Croat Med J 2004;45:88-98. |
|21.||Sinha DN, Gupta PC, Pednekar MS. Tobacco use among students in the eight North-eastern states of India. Indian J Cancer 2003;40:43-59. [PUBMED] |
|22.||Gajalakshmi V, Asma S, Warren CW. Tobacco survey among youth in South India. Asian Pac J Cancer Prev 2004;5:273-8. [PUBMED] |
|23.||Wolska A, Latak D. Smoking tobacco among young people in grammar-school, secondary-school and high-school and knowledge of relating wholesome threats. Przegl Lek 2005;62:1108-11. [PUBMED] |
|24.||Madan Kumar PD, Poorni S, Ramachandran S. Tobacco use among school children in Chennai city, India. Indian J Cancer 2006;43:127-31. |
|25.||Yang MS, Yang MJ, Liu YH, Ko YC. Prevalence and related risk factors of licit and illicit substances use by adolescent students in southern Taiwan. Public Health 1998;112:347-52. [PUBMED] |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]