|Year : 2019 | Volume
| Issue : 2 | Page : 87-91
Sociodemographic determinants of substance use among school-going adolescents in Delhi, India
T Varun Kumar
Department of Community Medicine, Government Medical College and ESI Hospital, Coimbatore, Tamil Nadu, India
|Date of Web Publication||14-May-2019|
Dr. T Varun Kumar
Department of Community Medicine, Government Medical College and ESI Hospital, Coimbatore - 641 015, Tamil Nadu
Source of Support: None, Conflict of Interest: None
BACKGROUND: Adolescents experience a rapid physical and emotional growth. Conflicting and influential cultural messages account for the unique nature of their health concerns. Recent studies have found an increased use of substance among adolescents, and the present study is designed to find the socioeconomic determinants of substance use among adolescents in Delhi, India.
MATERIALS AND METHODS: A descriptive cross-sectional study was conducted using a self-administered questionnaire adapted from the Global Youth Tobacco Survey among school-going adolescents from February 2017 to September 2017 in Delhi, India. All the students studying in classes 11 and 12 were included in the study.
RESULTS: The study found that the prevalence of ever smokers and current smokers was 16.4% and 13.1%, respectively. Alcohol consumption was found in 12.5% of the study participants. Approximately 1.1% and 0.4% of the study participants reported using hashish and solvent, respectively. All forms of substance use were found to be significantly more among male adolescents (P = 0.000).
CONCLUSION: The prevalence of substance use was high among school-going adolescents in Delhi, and there is an urgent need to take effective steps in curbing this problem.
Keywords: Adolescents, school-going, substance use
|How to cite this article:|
Kumar T V. Sociodemographic determinants of substance use among school-going adolescents in Delhi, India. Int J Health Allied Sci 2019;8:87-91
|How to cite this URL:|
Kumar T V. Sociodemographic determinants of substance use among school-going adolescents in Delhi, India. Int J Health Allied Sci [serial online] 2019 [cited 2019 Sep 21];8:87-91. Available from: http://www.ijhas.in/text.asp?2019/8/2/87/258180
| Introduction|| |
The World Health Organization has defined substance use as, “persistent or sporadic use inconsistent with or unrelated to acceptable medical practice.” The mortality attributable to tobacco use in India is estimated to increase from 1% of the total mortality in 1990 to 13% by 2020. According to a United Nations report, one million heroin addicts are registered in India, and, unofficially, there are as many as five million. The prevalence of substance use is found to be high among adolescents because rapid physical and emotional growth, as well as the frequently conflicting and influential cultural messages, accounts for the unique nature of their health concerns. Recent studies have found that the problem of substance use has been increasing among schoolchildren in India, and a sizeable proportion of them experiment with drugs quite early in life.
Late adolescence encompasses the latter part of the teenage years, broadly between the ages of 15 and 19. The major physical changes have usually occurred by this time although the body is still developing. The brain continues to develop and reorganize itself, and the capacity for analytical and reflective thought is greatly enhanced. Peer-group opinions tend to be important at the outset, but their hold diminishes as adolescents gain more clarity and confidence in their own identity and opinions.
Adolescence is also the time of exploration of one's capabilities and potential, experimentation with harmful substances such as tobacco, alcohol, and drugs. Even experimental substance use puts adolescents at risk. These may include accidents, fights, antisocial activities, unwise or unwanted sexual activity, and overdose. Adolescents are also vulnerable to the effects of substance use and are at increased risk of developing long-term consequences, such as mental health disorders, underachievement in school, and substance use disorder.
A number of socioeconomic determinants are found to influence substance use by adolescents. Some of these are a family history of tobacco use by elders, peer influence, experimentation, and easy access to such products along with personality factors and the underlying emotional and psychosocial problems. Weak enforcement of substance use control measures coupled with easy availability, accessibility, and affordability of these products is another factor which leads to the rise of the epidemic of substance use among adolescents in developing countries like India.
There is an urgent need for scientifically sound data about substance use pattern among adolescents that would allow comparisons not only within the country but also internationally. Therefore, the present study was conducted with the objectives of finding the prevalence of substance use and various socioeconomic determinants associated with substance use among adolescents in Delhi, India.
| Materials and Methods|| |
A cross-sectional study was conducted from February 2017 to September 2017 in four government senior secondary schools in a southern district of Delhi located in the field practice area of the Department of Community Medicine, Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital, New Delhi. All students studying in class 11 and class 12 who were present on the day of visit and agreed to take part in the study were included. Complete enumeration of the study participants was done. A self-administered questionnaire was used to collect data from the study participants. Data were obtained from a total of 962 study participants.
The questionnaire contains information regarding socioeconomic profile of the adolescents and questions adapted from the Global Youth Tobacco Survey (GYTS) to find the prevalence and pattern of tobacco use. The questionnaire used in this study was pretested among the adolescent students in different areas, and necessary modifications were made to make it more understandable for the students. Prior to data collection, an elaborative briefing about the questionnaire was done to all students in the class.
Data were entered in Microsoft Office Excel spreadsheet and analyzed using SPSS (Statistical Software for the Social Sciences) (IBM, Chicago, USA) version 21. Chi-square test was applied in bivariate analysis with categorical variables.
In this study, substance use is defined as use of tobacco, alcohol, hashish, or solvent sniffing. Ever smoker is one who had smoked cigarettes at least once in his/her lifetime, current smoker is one who smoked cigarettes in the last 30 days, current tobacco chewer is one who used any smokeless tobacco products in the last 30 days, and current alcohol consumer is one who consumed alcohol in the last 30 days. In the category of others, we have included the use of hashish and solvent sniffing.
The study protocol was approved by the Institutional Ethical Review Board of VMMC and Safdarjung Hospital, New Delhi. Permission for conducting the study was also obtained from the school principals. Informed written consent was also obtained from the parents or guardians of the school students. The data collection session was followed by an interactive session, in which the queries of the study participants on what can be done in times of psychological distress were answered. Special health awareness programs were conducted on the ill effects of substance use. Feedback was provided to the school authorities. Modalities of stress management were explained to the study participants, and they were made aware of the Central Board for Secondary Education toll-free helpline numbers.
| Results|| |
Among the 962 study participants, the majority (675 [70.1%]) were of either 16 or 17 years of age. The mean age of the study participants was 16.88 years (standard deviation [SD] = 0.984). Majority were males (524 [54.5%]). A total of 661 (68.7%) study participants belonged to joint family and 759 (78.9%) were Hindu by religion. According to the revised Kuppuswamy's socioeconomic classification 2012, most of the study participants belonged to lower middle class (422 [43.9%]), followed by upper middle class (399 [41.5%]) [Table 1]. In majority of the study participants, the father was working mostly as a clerk, shopkeeper, or farmer (497 [51.7%]), while mothers were homemakers (874 [91%]) in most instances.
|Table 1: Distribution of the study participants according to sociodemographic profile (n=962)|
Click here to view
Prevalence of substance use
Of the 962 study participants, 158 (16.4%) reported having smoked cigarettes at least once in their lifetime, 126 (13.1%) reported having smoked cigarettes in the past 30 days, 120 (12.5%) reported chewing tobacco products in the past 30 days, 120 (12.5%) reported consuming alcohol in the last 30 days, and 11 (1.1%) and 4 (0.4%) participants reported using hashish and sniffing solvent in the last 1 year, respectively. None reported using ecstasy or cocaine [Table 2].
|Table 2: Distribution of the study participants according to substance use (n=962)|
Click here to view
Most of the students (53.3%) initiated tobacco smoking at 13 years of age and 26.4% of the students initiated tobacco smoking at 12 years of age, with the mean age of initiating tobacco smoking being 12.31 years (SD = 1.7). Similarly, 58.1% of the students initiated tobacco chewing at 13 years of age followed by 19.4% of students at 12 years. Of the 962 study participants, 120 (12.5%) reported that they had used smokeless tobacco products in the last 30 days. The most common tobacco product was ghutka (a manufactured smokeless tobacco product and is a mixture of areca nut, tobacco, and some condiments) consumed by 92 (9.6%) participants, followed by Khaini (consists of roasted tobacco flakes mixed with slaked lime) consumed by 62 (6.4%) and paan masala (a balanced mixture of betel leaf with lime, areca nut, clove, cardamom, mint, tobacco essence, and other ingredients) consumed by 41 (4.3%) participants.
More than three-fourth (76.4%) of the students purchased tobacco products directly from the shop followed by 11.6% of students who borrowed them from someone else. Majority of the students (64.1%) had at least one of their family members using tobacco products. Most of them started using tobacco products due to curiosity (41.2%), while 38.5% students used them to relieve their stress and 21.5% started using them due to peer pressure.
The average amount of money spent per month on substance use was found to be ₹540. The prevalence of current tobacco chewing was found to be more in males when compared to females, and the difference was found to be statistically significant (P = 0.004). Current alcohol consumption was reported only in males. The prevalence of current alcohol consumption was found to be high among high socioeconomic groups (P = 0.000). Among 524 males, 126 (24%) reported consuming alcohol in the last 30 days. Similarly, hashish use and solvent sniffing were reported only in males. Out of the 524 males included in the study, 11 (2.1%) reported using hashish and 4 (0.7%) reported solvent sniffing in the last 1 year [Table 3].
|Table 3: Distribution of the study participants according to substance use (n=962)|
Click here to view
| Discussion|| |
We found that, in our study, the prevalence of ever tobacco users, ever smokers, and ever tobacco chewers was 16.4%, 15.4%, and 12.5%, respectively. Similarly, the prevalence of current tobacco use was found to be 13.2%. In addition, the prevalence of current alcohol consumption was 13.1%, hashish use was 1.1%, and solvent sniffing was 0.4%. These findings were similar to the results obtained in previous studies conducted among school-going adolescents aged 15–19 years in Delhi. In the National GYTS study conducted in 2004 in India, the prevalence of ever tobacco use was found to be 25.1%, whereas current tobacco use was found to be 17.5%.
Substance use is a male-dominated phenomenon among adolescents in India. In our study, we found that substance use is significantly higher among male students than female students. Similar results have also been obtained in other studies conducted among school-going adolescents in Kolkata. However, recent studies have also shown that tobacco use is on the rise among female adolescents in India.
In our study, we also found that the prevalence of substance use was high in students studying in class 12 when compared to students of class 11. This could be due to increased stress of facing examinations and fear about the future. Similar results were obtained in a study conducted among school students in Dehradun.
We found that the prevalence of substance use did not have any significant difference with the type of family, either joint or nuclear. However, the prevalence was found to be lower in those students living in joint families. Adolescents belonging to joint families are under constant adult surveillance which may reduce their risk-taking behaviors including substance use. In another study conducted in Delhi, it was found that substance use among adolescents was significantly lower in those belonging to joint families.
The likelihood of substance use was found to be high in adolescents belonging to high socioeconomic groups. The prevalence of alcohol consumption was significantly higher in those belonging to high class. Having some amount of pocket money predisposes adolescents to risk-taking behavior out of curiosity. Similar results have been reported from a study conducted in Nepal.
Our study is not without limitations. Since data were collected by self-administered questionnaire, both overreporting and underreporting are possible. Recall bias can also occur. The interpretations are restricted to school-going late adolescent students only. Further studies are needed that cover the groups of adolescents who are out of school, as the prevalence of substance use and health risk behaviors is likely to be higher among such adolescents.
| Conclusion|| |
This study has highlighted the fact that the prevalence of substance use was high among school-going adolescents in Delhi. There is an urgent need to take effective steps, in curbing this problem among adolescents. Peer group educators can be involved in educating adolescents about the harmful effects of substance use. Awareness programs can be launched and parents and teachers may be involved. Advertisements can be given in mass media and various social media which adolescents use.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
World Health Organization. Technical Research Series No. 886. World Health Organization; 1999. p. 48.
Nadeem A, Rubeena B, Agarwal VK, Piyush K. Substance abuse in India. Pravara Med Rev 2009;1:4-6.
Mates D, Allison KR. Sources of stress and coping responses of high school students. Adolescence 1992;27:461-74.
Gupta PC. Tobacco control in India. Indian J Med Res 2006;123:579-82.
Sinha DN, Palipudi KM, Rolle I, Asma S, Rinchen S. Tobacco use among youth and adults in member countries of South-East Asia Region: Review of findings from surveys under the global tobacco surveillance system. Indian J Public Health 2011;55:169-76.
] [Full text]
Sharma R, Grover VL, Chaturvedi S. Tobacco use among adolescent students and the influence of role models. Indian J Community Med 2010;35:272-5.
] [Full text]
Mukherjee A, Sinha A, Taraphdar P, Basu G, Chakrabarty D. Tobacco abuse among school going adolescents in a rural area of West Bengal, India. Indian J Public Health 2012;56:286-9.
] [Full text]
Saxena V, Saxena Y, Kishore G, Kumar P. A study on substance abuse among school going male adolescents of Doiwala Block, district Dehradun. Indian J Public Health 2010;54:197-200.
] [Full text]
Pradhan PM, Niraula SR, Ghimire A, Singh SB, Pokharel PK. Tobacco use and associated factors among adolescent students in Dharan, Eastern Nepal: A cross-sectional questionnaire survey. BMJ Open 2013;3. pii: e002123.
[Table 1], [Table 2], [Table 3]