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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 30  |  Issue : 5  |  Page : 532-537

Substance use and associated factors among junior students in a public secondary school in an urban local government area in Rivers State, Nigeria


1 Department of Community Medicine, Rivers State University, Port Harcourt, Nigeria
2 Department of Preventive and Social Medicine, University of Port Harcourt; Department of Community Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

Date of Submission05-Mar-2021
Date of Decision05-Jul-2021
Date of Acceptance10-Jul-2021
Date of Web Publication11-Oct-2021

Correspondence Address:
Dr. Esther Ibinabo Azi
Department of Community Medicine, Rivers State University, Port Harcourt
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/NJM.NJM_51_21

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  Abstract 


Background: Adolescents (aged 10–19 years) are at risk of using substances, as they are known to be impressionable and eager to please. This study set out to investigate the prevalence of substance use and associated factors among junior secondary students (JSSs) in Obio-Akpor Local Government Area (LGA), Rivers State, Nigeria. Methods: A descriptive cross-sectional study employing two-stage sampling was used in this survey to select 398 JSSs in a public secondary school in Obio Akpor LGA. Data were collected using an adapted self-administered WHO Students' Drug Use Questionnaire, analyzed using IBM SPSS version 21.0 software, and statistical significance was set at P < 0.05. Results: The mean age of the respondents was 12.9 (standard deviation = 1.6) years with males accounting for 179 (45%) of respondents. The lifetime prevalence for substance use was 37 (9.4%), while those currently using substances were 4 (1.0%). Alcohol ranked the highest with 17 (45.9%) as the most frequently used substance. Eight (50%) respondents cited street vendors as their main source of getting substances. Of those who used substances, 4 (50%) did so to boost their intelligence. More males reported substance use and this was significant (χ2 = 5.1, P = 0.02; adjusted odds ratio [AOR] =2.08, 95% confidence interval [CI] = 1.03–4.21) and being in Class 2 and 3 (AOR = 2.33, 95% CI = 1.11–4.88) predicted the likelihood of ever using substances. Conclusion: Substance use is present among JSSs though the prevalence is low. This presents an opportunity for primary prevention activities to address future substance use in this age cohort.

Keywords: Junior secondary students, Rivers State, substance use


How to cite this article:
Azi EI, Maduka O. Substance use and associated factors among junior students in a public secondary school in an urban local government area in Rivers State, Nigeria. Niger J Med 2021;30:532-7

How to cite this URL:
Azi EI, Maduka O. Substance use and associated factors among junior students in a public secondary school in an urban local government area in Rivers State, Nigeria. Niger J Med [serial online] 2021 [cited 2021 Dec 8];30:532-7. Available from: http://www.njmonline.org/text.asp?2021/30/5/532/327963




  Introduction Top


Substance abuse is an alarming public health problem, affecting not only the individual but the family and society.[1] Substance use involves regularly taking substances such as alcohol, recreational drugs like heroin, cocaine, etc., to alter mood or feelings, thereby abusing it. When this crosses the line to cause significant impairments, such as failure to meet obligations relating to work, school or family, resulting in health and social issues or disability such as drunk driving, etc., it is termed dependence.[2] Adolescents are persons aged 10–19 years and this consists of early and older adolescents. The developing brain of adolescents has been shown to predispose them to impaired decision-making abilities such as delaying pleasure or gratification and inhibiting negative behaviors causing them to tend toward risky ventures such as experimenting with substances.[3] The period of adolescence is known for curiosity, adventure-seeking, and risk-taking behaviours. These in addition to peer pressure, family and academic expectations have been known to steer young people toward substance abuse.[4] Unlike adults who abuse substances in response to problems in their lives such as losing a spouse or one's job, adolescents abuse substances in response to peer pressure resulting in significant changes in their behaviours such as slacking in school work and having bad grades, using substances in hazardous situations such as driving, joining gangs, etc.[5]

Substance use among adolescents in secondary schools is well established among the senior secondary students, however, the age of initiation is reducing, and junior secondary students (JSSs) are gradually using multiple substances with more females indulging in the practice.[6] In general, junior secondary school adolescents aged 10–14 years belong to Class 1–3, while senior secondary students are older adolescents attending Class 4–6. Young people are usually introduced to substances through gateway drugs such as alcohol, cigarettes and marijuana and progress on to substances such as tramadol, cocaine, and heroin.[7],[8] There is also a gender coloration to substance use as studies have shown that the male gender is more prone to substance use. This is not far-fetched as males are more likely to resort to substances due to peer pressure, the need to muster the courage to do things or cope with academic pressure.[9],[10]

Several factors have been implicated as responsible for substance use among young people. They include non-modifiable risk factors such as genetics or having a parent or family member using substances, and behavioral issues such as peer pressure, curiosity and the need to experiment.[6],[11] Others include socioeconomic characteristics, particularly neighbourhood/environment, increased access to drugs, association with gangs and deviant characters, need to belong or be popular, coping with bullying, and the need to cope with academics and other pressures.[12],[13] The growing use of substances among young people has been traced to easy accessibility to substances in the neighbourhood.[14] Street vendors and even the corner shop that deals with patent medicines have been identified as sources.[11],[15] Indiscriminate dispensing and the illegal sales of prescription-only medicines by these patent medicine vendors have contributed to driving the prevalence of substance use among young people.[14]

Globally, the prevalence of substance use among adolescents is well documented. In the United Kingdom, at least 40% of teenagers 15–16 years have experienced illicit drug use at some point in their lives.[15] In Nigeria, studies carried out nationally, reveal a 29.5% lifetime prevalence of substance abuse in adolescents in Enugu, South-Eastern Nigeria, 26.4% prevalence of alcohol abuse in Osun, South-Western Nigeria, and 27.1% lifetime prevalence of drug abuse in Port-Harcourt, South-South Nigeria.[14],[16]

While all adolescents are at risk of the complications of substance use and abuse, persons in early teenage years, who are likely to be in junior secondary school, are more at risk of the adverse outcomes following substance abuse because of their developing brains.[4],[13] They are also at risk of accidents, fights, unwanted sexual activity, and drug overdose.[17] Studies on the subject matter have been carried out predominantly among senior secondary students.[7],[9],[10],[18],[19] Therefore this study set out to investigate the prevalence, commonly abused substances, and factors associated with substance abuse among JSSs in public schools in Obio-Akpor LGA, Rivers State, Nigeria.


  Methods Top


Study setting

The study was carried out in June 2018, in Obio-Akpor Local Government Area (LGA), one of the sub-urban towns that make up Port Harcourt Metropolis. Its headquarters is Rumuodomaya, and it is made up of indigenous people of four major clans called Akpor, Evo, Apara and Rumueme, making a population of 464,789 persons.[20] The major occupations of residents in Obio-Akpor are farming, trading, and fishing, however, with its transformation into an urban area, the development has evolved to other sectors, including the educational sector. According to records from the Senior Secondary Schools Board, Rivers State, there are 27 government-owned secondary schools in the LGA, 18 of which are schools attended by both boys and girls (co-educational) and 128 registered private secondary schools.

Study design

A descriptive cross-sectional study design was employed.

Study population

All junior secondary school students in public schools across Obio-Akpor LGA were included in the study irrespective of age and sex. Those who were absent due to ill-health were excluded from the study.

Sample size

The sample size was determined using the formula for calculating sample size for a single proportion,[21] a lifetime prevalence of substance use among JSSs in Benue of 21% was used,[22] confidence level of 95%, an acceptable difference of 0.05 and nonresponse rate of 20% bringing the minimum sample to 319.

Sampling technique

A two-stage sampling method was employed in this study. The first stage involved simple random sampling of one school from the list of 18 co-educational public secondary schools in Obio-Akpor LGA. The second stage involved the selection of respondents from the three arms of the junior secondary school. The junior secondary school had a total of 705 students across the three arms with 234, 236, and 235 in JS1, JS2, and JS3, respectively. The sample size of 319 was divided across the three arms such that a minimum of 107 participants were needed per arm. This stage, therefore, involved selecting eligible respondents from each arm based on systematic sampling. A sampling interval (k) of 2 was calculated by dividing the total number of students in the arm by the number assigned to each arm. The first respondent was chosen by simple random sampling via ballot between the first two students listed for that arm (sampling frame), before applying the sampling interval.

Data collection method

The instrument used was a modified WHO Students' Drug Use Questionnaire that has been validated and adapted for our local environs.[23] The questionnaire was constructed in a structured format; the first section inquired about sociodemographic characteristics and prevalence of substance abuse; the second section related to associated factors, the knowledge of adverse effects following substance abuse. The case definition of lifetime use was ever having used any of the listed substances. Current use was defined as the use of the listed substances in the last 12 months or continued usage in the past 30 days preceding the survey. Substances explored in the survey included tramadol, cocaine, alcohol, heroin, cigarette, and codeine.

Data collection was done over two weeks, with the aid of trained research assistants.

Data were entered into Microsoft Excel, cleaned, and exported to the IBM Statistical Package for Social Sciences (SPSS version 21), United States. Descriptive and inferential statistics were performed. Descriptive data were analyzed using mean and standard deviation (SD) (for the continuous variable of age), while frequencies and percentages were the summary statistics used for categorical variables. Inferential statistics was performed using Chi-square, level of significance was set at P < 0.05. Bivariate and multi-variable logistic regression was also done with odds ratio and confidence interval set at 95%.

Ethical approval

Ethical approval was gotten from the Research Ethics Committee of the University of Port-Harcourt Teaching Hospital with Reference Number: UPTH/ADM/90/S.II/VOL.XI/746. The school authorities granted permission, and assent was gotten from the students, who were assured of anonymity and confidentiality.


  Results Top


A total of 398 respondents in junior secondary school, aged between eight and 18 years old, participated in the study. The mean age was 12.9 years (SD = 1.6) with the most prevalent age group for the respondents studied as 11–13 years, 240 (60.3%). Sex disaggregation of the respondents were males 179 (45%) and females 219 (55%). Respondents in JSS 1 numbered 151 (37.9%) followed by those in JSS 2 120 (30.2%) and 127 (31.9%) in JSS 3 [Table 1].
Table 1: Sociodemographic characteristics of the respondents

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The result shows that 392 (98.5%) had heard of substance abuse, and 164 (48.1%) got the information from their school [Table 2].
Table 2: Awareness of substance/drug abuse

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A total of 358 (90.6%) respondents surveyed had never used the substances explored in this study, while 37 (9.4%) had used substances at one point in their lives, out of which those currently using were 4 (1%). Among substances used, alcohol ranked highest, with 17 (45.9%) respondents using it, while codeine was the least reported 2 (5.5%).

Out of the respondents who had ever used substances, 8 (50%) got their supplies from street vendors and 3 (18.8%) from the open market. 7 (70%) of respondents used substances of their own accord, while 1 (10%) were introduced by their peers. The commonest reason cited by the respondents for substance use was to boost intelligence, 4 (50%) and 1 respondent (12.5%) used substances to please friends [Table 3].
Table 3: Pattern of substance use

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On knowledge of adverse effects of substance use, 6 (66.7%) respondents knew that mental illness was a side effect of substance use only 1 (11.1%), respondent noted that it could lead to the contraction of HIV/sexually transmitted infections. Four (44.4%) respondents had tried to stop using substances with the help of a pastor, while 1 (11.2%) person solicited the help of a health professional [Table 4].
Table 4: Substance use and attempt at cessation

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More males 23 (62.2%) used substances compared to females 14 (37.8). This difference was significant (χ2 = 5.1, P < 0.02). In addition, male sex (adjusted odds ratio [AOR] = 2.08, 95% confidence interval [CI] = 1.03–4.21) and being in Class 2 and 3 (AOR = 2.33, 95% CI = 1.11–4.88) predicted the likelihood of ever using substances [Table 5] and [Table 6].
Table 5: Relationship between sociodemographic characteristics and lifetime use of substances

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Table 6: Predictors of drug/substance use

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  Discussion Top


Substance use among young people is a significant public health issue, as documented by various studies, which show a decreasing age of onset and an alarming increase in the use of gateway substances such as alcohol and tobacco.[2],[13],[24]

Most respondents in this study had never used substances, with a low lifetime prevalence of substance use, this is of public health importance considering the age of the study group (early adolescents). This contrasted with studies done in Lagos and Port-Harcourt with an appreciable lifetime prevalence of substance use.[16] This may be explained by the fact that these studies on substance abuse were carried out among senior secondary school students as against this study which focused on JSSs. The low prevalence of substance use found among JSSs is in keeping with a study done in Benue State,[22] while higher prevalence rates were recorded among older adolescents in a study in Owerri, South-East of Nigeria.[19] This is not far-fetched as the behavioural and physiological developmental process of experimentation begins at this stage of early adolescence and transforms into a full-blown habit in later years. Well-crafted behaviour change communication targeted at this age group will go a long way to prevent the initiation and eventual use of substances. Alcohol was the most common substance abused followed by tramadol and cocaine. This is in keeping with other studies done among senior secondary and undergraduate students in the South-South and South-West where alcohol was found among young people as a gateway substance to move to other substances.[6],[25],[26] This can be supported by the fact that alcohol is easily available and accessible to these adolescents around the home and community, with no standard way of ascertaining the legal age when purchasing it, as they do so in the guise of running errands.[27]

Respondents who had ever used substances in this study were able to access substances from street vendors and patent medicine shops for similar reasons cited above. This agreed with a study done in Osun State which recommended stricter regulations for patent medicine vendors.[14] As documented in the study done among senior secondary students in Ibadan, the commonest reason for using substances in this study was to boost intelligence.[16] Students have been known to consume substances particularly stimulants when preparing for examinations, a fire-brigade approach that is done in the hope of keeping awake to read longer and make good grades.[14],[28]

Some respondents with lifetime use of substances were aware that chronic use of substances could lead to mental illness and poor academic performance. This agrees with the study done in Yenagoa, Bayelsa State that highlighted the complications stemming from substance use.[12],[13] A variation from this position was observed from the study done in Lagos where the majority of the respondents did not perceive that any side effects could follow the abuse of substances.[16],[29]

The study revealed that males and those in higher junior classes (JS2 and JS3) were more likely to abuse substances than females and those in the lower junior class (JS1). While some meta-analysis studies reflect this same pattern, they explain it as a genetic trait of males to be adventure-seeking and risk-takers, sociocultural factors were however highlighted by the study done in Bayelsa, which revealed that males resort to substances to cope with challenges, while females are able to cope with life's pressures by speaking up. Society also culturally frowns at women brazenly using substances and condones men drinking, smoking or using substances, these indirectly act as a deterrent to most females using substances.[14],[30],[31],[32],[33]

Findings from this study point to the fact that interventions for primary prevention if started in early secondary school years may be effective in aborting experimentation with substances. The strength of this research is that it studied a unique population that is yet to be adequately researched. The limitation of the study, however, was that it studied respondents from one school and its reliance on self-reporting for sensitive questions around substance use in a young population, generated several nonresponses. A qualitative component to further explore reasons and perceptions are potential areas to consider for further studies.


  Conclusion Top


The prevalence of substance use among JSSs in Obio-Akpor LGA is low but important among a vulnerable age group. The few who had ever used substances were introduced by their peers and did so when faced with academic pressures, despite knowing the adverse effects of substance use. It is imperative to include health education on substance use in the educational curriculum of JSSs. This will arm them with the life skills such as resilience, refusal skills, and coping mechanisms to protect and prevent them from initiating or continuing substance use.

Limitation

Reliance on self-reporting for lifetime and current use of substances and the absence of a qualitative component which could have further explored reasons, mindset, and perceptions.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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