|Year : 2015 | Volume
| Issue : 4 | Page : 192-199
Correlates of psychoactive substance use among Nigerian adolescents
Oluyemi O Akanni1, Ehigiator O Adayonfo2
1 Forensic Unit, Psychiatric Hospital, Uselu Benin City, Benin City, Nigeria
2 Department of Mental Health, University of Benin Teaching Hospital, Benin City, Nigeria
|Date of Web Publication||16-Feb-2016|
Ehigiator O Adayonfo
Department of Mental Health, University of Benin Teaching Hospital, Benin City
Context: The abuse of psychoactive substances which is one of the most important global public health problems begins in adolescence. Adolescents usually start by abusing the gateway substances. They suffer social, economic, physical, and legal consequences on account of use of substances, and this is very worrisome because of the increasing prevalence of use. Aims: The aim was to identify the characteristics of adolescents that use gateway substances. This knowledge shall be utilized in preventive programs. Settings and Design: Cross-sectional study with secondary school adolescents as participants. Subjects and Methods: Multistage sampling technique was used to select 492 respondents and the questionnaire consisted of characteristics of the adolescents, their families and schools and the alcohol, tobacco, cannabis, and stimulant use sections of the World Health Organisation questionnaire for student drug use surveys. Statistical Analysis Used: The data were analyzed using the Statistical Package for Social Sciences, and Chi-square statistics was used. Results: Having a friend who uses substance was significantly associated with tobacco, alcohol, cannabis, and caffeine use while being a male, having a family member that uses substance were significantly associated with tobacco, alcohol, and caffeine use. Older age, lack of satisfaction with the relationship with the teacher and polygamous family background were significantly associated with tobacco use. And finally, lack of satisfaction with the relationship with parents/guardians and having parents or guardians who are not religious were significantly associated with alcohol use. Conclusion: A comprehensive approach is needed to prevent the use of substances; this should target individuals, schools, families, and religious institutions.
Keywords: Adolescents, correlates, gateway substance, psychoactive substance
|How to cite this article:|
Akanni OO, Adayonfo EO. Correlates of psychoactive substance use among Nigerian adolescents. Sahel Med J 2015;18:192-9
| Introduction|| |
Psychoactive substance use is a major public health problem,,, lifetime substance use prevalence among adolescents is sometimes higher than 50%., This study focused on alcohol, tobacco, cannabis, and caffeine. The high prevalence of caffeine use  and its relationship with the brain fag syndrome among students, further justify its inclusion. These “gateway” substances have very high prevalence rates., Adolescents start using them and thereafter use cocaine, heroin etc., with consequent impairment of their development. Thus, this study sorts to identify the characteristics of adolescents that use gateway substances; in a bid to formulate preventive strategies.
| Subjects and Methods|| |
The study was a cross-sectional one carried out among adolescents in class three of senior secondary schools (SSS) in Oredo local government area of Benin City, Nigeria. The city which has an estimated population of 1.14 million people  is made up of three local government areas; namely Egor, Ikpoba-Okha and Oredo. Oredo was selected randomly. The local government area had 13 government-owned (public) and 125 government-approved private schools, and the total population of secondary school students was 62,360 (29,349 males and 33,011 females). There were 23,672 students in public schools and 38,688 students in private schools (a ratio of 1:1.6).
Ethical considerations included getting approval from the Ethical Committee of the University of Benin Teaching Hospital, Benin city to conduct the study and permission was obtained from the Ministry of Education and the authorities of the schools used. Informed consent was obtained from the participants who were 18- and 19-year-old while the parents/guardians of students who were <18 years were required to sign consent forms in addition to the assent of such students. There was observance of confidentiality.
The inclusion (eligibility) criteria were:
- The respondents must be in the final year class of SSS 3 of the selected schools
- They must also be 16–19 years old.
While the exclusion criteria were:
- Students who were outside the age range of 16–19 years
- Any student who did not give consent or assent
- Any student whose parent or guardian did not give consent (this applied to students who were <18 years old).
The sample size n, was calculated to be 384 using the Fisher's formula; thus, the minimum number of participants required was 384. However, the sample size was increased to 492 to improve accuracy, accommodate inadequately completed questionnaires and to maintain the ratio of the population of the students in public to private schools at 1:1.6.
The sampling method was a three-stage technique. At stage one, Oredo local government area was selected from the three local government areas that make up Benin City by simple random sampling. Stage two entailed the selection of 18 schools from Oredo. The schools were stratified into public and private schools to ensure appropriate representation of students. Since all the private schools in Oredo were mixed schools, selection of schools was restricted to only mixed schools to make a comparison of findings easier. One of the school principal of the five mixed public schools in the local government did not give permission for the study to be carried out in his school. Thus, all the other four mixed public schools were recruited while 15 private schools were selected randomly. At stage three, all eligible students across the four mixed public schools were interviewed, a total of 187 students. Owing to the wide range of population of SSS 3 per private school, it was decided that 20 students (the lower range of the variation) from each private school would be selected. Some of the private schools selected had <20 eligible students, so all the eligible students in such schools were interviewed. The deficits were made up by eligible students from other private schools. Where a private school had surplus eligible students, balloting was done to select participants. Consequently, a total of 492 students were interviewed, 187 from public schools and 305 from private schools (a ratio of 1:1.6).
A self-administered questionnaire was used for the study. It consisted of two sections:
- Section A: This section was designed to gather information about the sociodemographic characteristics of the adolescents, their families and schools
- Section B: This section consisted of the alcohol, tobacco, cannabis, and stimulant use sections of the World Health Organisation Questionnaire for student drug use surveys. This instrument was developed by several persons from different parts of the world including Nigeria. The instrument has been used in different cultures and countries, including Nigeria. A high validity and a mean test – retest reliability of 86.7% have been reported for all items of the questionnaire. An alpha reliability of 0.76 was obtained for this instrument.
The questionnaires were administered to the students in their classrooms during break time with the assistance from two trained research assistants who had tertiary level of education. Each school had to be visited at least twice. The first visit was to distribute the consent forms to the students aged 16 and 17 years to take home for their parents or guardians to give approval, and those aged 18 and 19 years who assented to partake noted. Subsequent visit was to collect the consent forms and administer the questionnaires. Instructions for completing the questionnaires were explained to them at the beginning and subsequently whenever the participants needed clarification. The data collected were analyzed using the SPSS Inc. Statistical Package for Social Sciences version 16 and inferential statistics used.
| Results|| |
A total of 492 questionnaires were administered, all were returned, but 27 questionnaires were either incompletely filled or contained inconsistent responses or both. They were therefore discarded. As a result, a total of 465 questionnaires were analyzed, giving a proper response rate of 94.5%.
[Table 1] shows the comparison of sociodemographic variables of tobacco users and nonusers. The difference in the ages between those that have used tobacco and nonusers was statistically significant. 19 (9.0%) of the respondents who are 16 years use tobacco, this percentage decreased to 5.3% at age 17 but increased steadily to 13% at age 18 and significantly to 20% at age 19. The older the respondents, the more likely they would use tobacco. 30% of the male and 13% of the female respondents used tobacco. This gender difference in the proportion of users was statistically significant; the males being more likely to use tobacco than the females. There was no statistically significant difference in the religion of those that have used tobacco and those that have not used. Similarly, school type did not yield statistically significant difference. Equal percentages of lifetime tobacco use were reported for respondents in both public and private schools. 16% of the respondents from a polygamous family used tobacco as against 7.4% of the respondents from monogamous family. This was statistically significant. Other variables that showed statistically significant association with lifetime use of tobacco included: Having a friend at school or a family member who used any of the substances and dis-satisfaction with respondents' relationship with the teacher.
|Table 1: Comparison of sociodemographic variables of tobacco users and nonusers|
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[Table 2] shows the comparison of sociodemographic variables of alcohol users and nonusers. Apart from gender, where the male gender was significantly associated with lifetime use of alcohol, other demographic variables were not. Other variables that were statistically significantly associated with lifetime use of alcohol included: Having a friend at school or a family member who used any substances, respondents' dis-satisfaction with relationship with parents/guardian and parent/guardian's nonreligiosity.
|Table 2: Comparison of sociodemographic variables of alcohol users and nonusers|
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[Table 3] shows the comparison of sociodemographic variables of cannabis users and nonusers. Although more of the respondents who were older, males, Muslims, in public schools, and from polygamous homes had used cannabis in their lifetime, none of these variables was significantly associated with lifetime use of cannabis. There was a significant association of lifetime use of cannabis and having a friend in school that uses any of the substances.
|Table 3: Comparison of sociodemographic variables of cannabis users and nonusers|
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[Table 4] shows the comparison of sociodemographic variables of caffeine users and nonusers. Only the male gender was significantly associated with lifetime use of caffeine, other demographic variables were not. Other variables that were significantly associated with lifetime use of caffeine included: Having a friend at school or a family member who uses any substance.
|Table 4: Comparison of sociodemographic variables of caffeine users and nonusers|
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| Discussion|| |
Like in many other studies,, males had a higher prevalence of use of all the psychoactive substances. The lifetime use of caffeine, alcohol, and tobacco was noted to be significantly associated with male gender. Although more males than females had used cannabis in their lifetime, the difference was not significant. This finding of nonsignificance has been reported in another study. It is, however, important to note that conflicting reports exist with regard to the relationship between gender and lifetime use of cannabis. In general, males tend to engage more in risky behaviors  which include the use of psychoactive substances; and this inclination to undertake risky behaviors has been linked with the greater quantity of testosterone in males. Furthermore, parents, guardians, and society at large are likely to frown more at females who engage in risky behaviors including the use of psychoactive substances. In a nutshell, society may be more permissive to the use of psychoactive substances by males. Our child rearing practices seem to impose more restrictions on females than males. Therefore, more males are likely to go about to places (and with persons) unknown to their parents and guardians, where they may be introduced to the use of psychoactive substances. In addition, for a substance like alcohol, females are more vulnerable to the negative health effects. This may serve as deterrence for other females who would have used alcohol. The finding that lifetime use of cannabis was not significantly associated with gender may be explained by the relative paucity of respondents who reported use of cannabis (only 12).
Age was generally not significantly associated with lifetime use of substances except for tobacco where increasing age was significantly associated with tobacco use. Several studies have reported an association between substance use and older age.,, The finding in this study may be due to the narrowness of the age groups studied. In addition, the relatively high level of acceptance of alcohol and caffeine may also explain this. Tobacco appears to be less acceptable and as earlier noted only 12 respondents answered affirmatively to lifetime use of cannabis.
School type (whether public or private) was not associated with the use of the substance. This is comparable to a previous report, which also did not show any significant association between school type and substance use. But it is worthy of note that other school-related factors such as having a friend in school that uses a substance was generally associated with lifetime substance use. This shows that activities in school may be more predictive of substance use than the school type. This brings to light the role peers may play in substance use.
The religious affiliation did not associate significantly with lifetime use of any substance. This is in keeping with existing findings., Virtually, all the respondents were either Christians or Moslems and these two religions are largely similar. In general, family background did not have a significant association with lifetime substance use in this study except for tobacco use in which polygamous family showed a significant association. This is unlike previous studies , which have reported substance use to be significantly associated with polygamous family background. Though, family background did not generally have a significant association with substance use, other family factor such as having a family member who uses a substance generally did. Having a family member who uses a substance was significantly associated with lifetime use of all substances except for cannabis. The finding supports the theory of use of the substance as a learned behavior. Having a family member who uses a substance was a risk factor for substance use regardless of family background.
More studies of this kind are recommended and should be extended to adolescents not captured in this study. This is expected to shed more light on the magnitude of the problem of substance use. A comprehensive approach should be used to reduce the prevalence of substance use; it should target schools, families, religious congregation, and other foci where the target population are likely to be found. Family-oriented intervention will be rewarding in the light of the significant association of adolescent substance use with the presence of a family member that uses substances. Intervention should aim at discouraging and re-orienting significant others in the family concerning the use of the substance. Mass awareness campaigns to schools and the inclusion of substance abuse in the curriculum of schools will go a long way to mitigate the use of substances. Since male gender was found to be associated with substance use, more attention should be given to male students when preventive programs are being designed.
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[Table 1], [Table 2], [Table 3], [Table 4]
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