Tobacco, Alcohol, Substance use Patterns and Associated Risk Factors in a Representative Sample of High School Students in Corum, Turkey

  

    
Characteristics 
    
Lifetime Smoking (n:799)
    
Regular Smoking(past-month)    (n:259)
    
Past 30-day Alcohol Consumption(n:231) 
    
Lifetime Drug Use (n:128)
  
  

    
%
    
AOR(95% Cl)
    
%
    
AOR(95% Cl)
    
%
    
AOR(95% Cl)
    
%
    
AOR(95% Cl)
  
  

    
Sex*
    
Male
    
44.7
    
2.9(2.4-3.6)
    
18.7
    
7.1(4.8-10.6)
    
16.2
    
5.2 (3.5-7.6)
    
8.2
    
2.3 (1.5-3.6)
  
  

    
Female
    
20.4
    
1
    
2.9
    
1
    
3.1
    
1
    
2.9
    
1
  
  

    
(reference)
  
  

    

    
15
    
22.7
    
1
    
4.2
    
1
    
5.6
    
1
    
3.6
    
1
  
  

    
Age(year)*
    
16
    
30.6
    
0.7 (0.5-0.9)
    
9.8
    
0.5 (0.3-0.7)
    
8.4
    
0.7 (0.5-1.2)
    
4.4
    
0.8(0.5-1.5)
  
  

    

    
17
    
39.4
    
0.4 (0.3-0.6)
    
14.2
    
0.3 (0.2-0.7)
    
12.3
    
0.4 (0.3-0.7)
    
7.7
    
0.4(03-1.7)
  
  

    

    
18
    
41.3
    
0.2 (0.1-0.4)
    
18.4
    
0.2(0.1-0.3)
    
12.6
    
0.4 (0.2-0.7)
    
5.6
    
0.6(0.3-1.1)
  
  

    

    
18+
    
51
    
2.9 (2.4-3.6)
    
17.6
    
7.1(4.8-10.6)
    
11.8
    
0.5(0.2-1.5)
    
8.2
    
0.3(0.1-1.1)
  
  

    
Duration of Mother's education*
    
=5year
    
38.3
    
1.4 (1.1-1.7)
    
13.4
    
1.6 (1.1-2.2)
    
7.1
    
1.8 (1.3-2.5)
    
4
    
1.8 (1.2-2.9)
  
  

    
>5year
    
28.5
    
1
    
8.8
    
1
    
12.9
    
1
    
7.7
    
1
  
  

    
Living place
    
Urban
    
34.3
    
1.4 (1.1-1.7)
    
10.8
    
1.2(0.9-1.6)
    
11.2
    
1.8(1.3-2.5)
    
6.8
    
2.0 (1.3-3.3)
  
  

    
Rural
    
30
    
1
    
10.4
    
1
    
7.5
    
1
    
3.8
    
1
  
  

    
High school type
    
Vocational 
    
39.1
    
1.1(0.9-1.3)
    
17.7
    
1.7(1.2-2.3)
    
15.7
    
1.7(1.3-2.4)
    
9.1
    
1.8 (1.2-2.8)
  
  

    
General 
    
29.1
    
1
    
7.3
    
1
    
6.6
    
1
    
3.8
    
1
  
  

    
Parental smoking*
    
At least one
    
38
    
1.6 (1.3-1.9)
    
12.7
    
1.7 (1.3-2.3)
    
10.8
    
1.5(1.2-2.2 )
    
5.8
    
1.2 (0.8-1.8)
  
  

    
Neither
    
28.1
    
1
    
8.8
    
1
    
8.1
    
1
    
4.9
    
1
  
  

    
*p<0.05
      
 
  

Table 2: Patterns of Smoking, Alcohol, Drug Use and Associated Risk Factors in the Students (Corum/Turkey, 2015).

Drug use

The lifetime prevalence of drug use was 5.4% (Table 1). The most frequently used types of drugs were, in decreasing order, cannabis (29.7%), the glue named Bally^® (28.9%), bonsai (19.5%), thinner (14.0%), heroin (11.7%), Jamaica (4.6%) and other drugs (10.9%). One in five respondents (19.5%) reported using multiple drugs. Upon evaluation of frequency of use, it was determined that 51.2% had used 1 to 2 times while 25.6% had used for 10 times or more frequently.

No effect of educational status and economic status on adolescent’s use of tobacco, alcohol and drugs was noted (p>0.05). The risk factors which have been determined to effect on using tobacco at least once during lifetime, becoming regular user, having used alcohol within the last 30 days and using drug at least once during lifetime are shown in (Table 2).

Upon comparison of respective frequencies of having smoked tobacco within the last 30 days with those of having used alcohol and drugs, it was determined that the number of days in which alcohol was used within the last 30 days in regular smokers was statistically increased in comparison to nonsmokers and intermittent smokers (X2= 543.0; p<0.001). In a similar fashion, the frequency of lifetime drug use was also found to be statistically increased in regular smokers as compared to others. (X2= 275.0; p<0.001).

Discussion

The frequency of adolescent tobacco use is a global problem despite variation across countries. While the ratios of using tobacco at least once during lifetime were determined to be 41% and 54% in USA [15] and European countries [7], respectively, the ratio determined in our study, which is 32% is lower. Even though the point prevalence is higher in male students, the increasing prevalence in female students in recent is noteworthy and troubling [15]. Male gender is a known risk factor for adolescent lifetime and regular smoking [16-17].

As well as the frequency of lifetime smoking frequency, the frequency of beginning to smoke tobacco at an early age is also high at a concerning level. The frequency of smoking at and before the age of 13 has been found to be 22%, 15%, 9% and 13.8% in European countries, China, USA and this study, respectively [7,18,19]. Even though it is expressed in certain studies that beginning at an early age does not affect becoming a regular smoker, there are studies available that report 70% of regular smokers had started smoking at and before the age of [20]. This ratio has been determined as 51% in this study. It is also known that starting smoking at an early age increases the probabilities of smoking for a longer time, becoming a heavier smoker and nicotine addiction [21]. As those who begin smoking at and before the age of 13 develop a stronger dependence, their probability of quitting is fairly low as compared to those who begin at an older age [20]. Due to the potential of continuous prevalence increase in the pool of regular tobacco smokers at adulthood, such high ratio in beginning smoking at an early age has been evaluated as an adverse finding in respect to public health. As a result of the activities carried out in this scope, it has been determined that the ratio of smoking tobacco in population older than 15 years of age has declined in our country [22]. However, no available data on adolescent age groups has been found in this respect. Attaching particular importance to this age group and ensuing that students quit smoking before becoming regular smokers are importance in activities against smoking. The most ideal behavior expected for adolescents should be having never tried smoking.

As it has been also determined in our study, while there is an inversely proportional relationship between the frequency of adolescent smoking and the educational status of parents, it has been determined that smoker parents and urban life are directly proportional to this frequency [16,23]. We are of the opinion that low educational level of mothers may cause children to acquire inadequate or inaccurate health behaviors and the use of parents, who are the role models at home, of addictive substances may constitute an important factor in the unwanted behaviors of adolescents. Furthermore, adolescents living in the urban area can access any addictive substance and enter into settings at which such substances are available, much more easily as compared to those living in the rural areas.

A different finding in this study that has not been come across in any other study is the fact that adolescents who attend to vocational high schools have a high potential risk in regard to all of the addictive substances. Due to the fact that these schools, which deliver education in the relevant fields with the purpose of having students acquire occupations within a short period of time, are preferred by students with low levels of school success, we are of the opinion that these places with higher risk groups should be the priority in addiction prevention programs addressed at adolescents.

The frequencies of using both alcohol and drug in regular smokers have been found to be significantly high in this study as it has been determined in other study as well [24]. The dependence of a particular substance generally paves the way for using other addictive substances as well. For instance, it is commonly seen in smokers to use alcohol along with tobacco and use other drugs along with alcohol [25]. Therefore, alcohol and tobacco use is considered as a gateway to drug addiction. The basic reason for this is the widespread availability of other substances in places where these substances are available [3]. Even though we have not been able to demonstrate this in this study, it has been indicated in other studies that high levels of economic status affect on use of tobacco, alcohol and drugs. These substances may be available at the homes of adolescents due to their user parents as well as access to these substances is possible owing to their capability to buy them with their own allowances despite legal preventions [26].

Alcohol use has a higher rate than other addictive substances in adolescents in several countries. While the frequency of lifetime alcohol use has been reported as 73% in USA, it has been reported to be above 90% in Northern Europe [27]. The frequency of using alcohol within the last 30 days has been found to be 16-46% at Southern American countries, 4-58% in African countries, 17-79% in European countries and 45% in USA [6,7,28]. Both lifetime use and use within the last 30 days were quite lower as compared to other studies. It has been found that while the lifetime alcohol use ratio varies between 4-65%, the frequency of use within the last 30 days is 2-28% in various regional studies within our country [29]. The fact that the data on alcohol use frequency vary among different countries or among different regions of the same country suggests that reasons may include, in addition to differences in regard to family, religion, economic status and environment; factors such as legal measures and easy access to alcohol.

The risk factors determined in alcohol use are in parallel to tobacco use. Even though male gender is perceived as a risk factor in several studies, there are studies available that report gender is not a risk factor [16,19,30]. Low levels of educational status of family, urban life and co-using tobacco and drugs with alcohol are among other important risk factors [29].

The obvious differences among countries in regard to adolescent drug use are also noteworthy. Frequency of lifetime drug use has been reported as 3-79% in South American countries, 2-37% in African countries and 4-42% in European countries [6,7]. The frequency of drug use has been determined to be 5.1% in this study. While it is pleasant news that drug use is not as common as alcohol and tobacco use, it should be remembered that it poses a dire potential hazard for adolescents and youngsters. Taking measures before it becomes widespread within the country would be a correct public health policy in respect to preventive health services.

Conclusion

It is noteworthy that the risk factors about adolescent use of addictive substances such as tobacco, alcohol and drugs are in parallel to each other. In response to this, we are of the opinion that addressing the addictive substances as a whole in prevention programs targeting at mitigating risky behaviors would be the correct approach. A contribution to solution would be societal instructive media campaigns targeting at the popular products among youngsters through prevention and control strategies with proven effect including accessibility, pricing and regulations for all addictive substances. Furthermore, it would prove useful for healthcare professionals to ask adolescents whether they use addictive substances at all opportunities and advising and encouraging on quitting if an adolescent is using such substances in respect to making use of opportunities.

Strengths and Limitations

The strengths of the study include that a relatively large sample has been selected in a manner to represent all high school students in the province and high participation rate. As it is in several other studies, the fact that socioeconomic status and use of addictive substances of each student was determined based on only verbal statement is a limitation of this study.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Acknowledgement

We would like to express our gratitude to Corum Provincial Directorate of National Education, School Principals and guidance teachers for facilitating the study and all participating students for their valuable support.

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