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

Research Article

Austin J Public Health Epidemiol. 2016;3(5): 1052.

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

Terzi O and Dundar C*

Department of Public Health, Ondokuz Mayis University, Turkey

*Corresponding author: Dundar C, Department of Public Health, Ondokuz Mayis University, 55200-Atakum/Samsun, Turkey

Received: October 20, 2016; Accepted: December 28, 2016; Published: December 30, 2016


Background: Taking measures against addictive substance would be a correct public health policy in adolescent health. The aim of this study is to determine the frequency of addictive substances use and associated risk factors among adolescent in Corum / Turkey.

Methods: The target population of this cross-sectional study has been layered based on the place and type of high school in order to determine the respective numbers of students in the sample from these layers according to their ratios within the target population. A structured questionnaire was used to collect data. Chi-square test and multivariate logistic models was used for statistical analysis and significance level was deemed to be p<0.05 for tests.

Results: The lifetime prevalence of smoking, alcohol consumption and drug use were 32.3%, 18.7% and 5.1%, respectively. The frequency of drug use and alcohol use during lifetime were found to be statistically increased in regular smokers as compared to others (p<0.001). Male gender, starting to smoke before the age of 13 and lower level education of mother have been found as a risk factor for Turkish adolescents (p<0.05).

Conclusion: 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.

Keywords: Adolescent; Student; Smoking; Alcohol use; Drug use


Adolescence is defined as the period of life between the ages of 10 and 19, starting from the end of childhood and accepted as the transitional stage to adulthood by World Health Organization. Despite the low probability of occurrence of serious health issues in adolescence, risky health behaviors with life-long influences are often acquired within this period. Inadequate and imbalanced nutrition, tobacco and alcohol use, predisposition to violence, attempted suicide and motor vehicle injuries are risky behaviors that are frequently observed within this period. These problems lead to dramatic increases in the adult disease, disability and mortality [1,2].

Studies have indicated that the frequency of adolescent substance dependence is on the increase and has become an important health issue. Even though most commonly used addictive substances among adolescents consist of tobacco and alcohol, drug use is fairly widespread as well [3-5]. In the Global School-based Student Health Survey (GSHS) on screening the frequency of addictive substance use in students at 92 countries, it has been determined that the respective frequencies of having used tobacco and alcohol within the last 30 days range between 5 to 25% while lifetime illegal drug use ranges between 3 to 79% at Southern American countries. These ranges are between 4-17%, 4-58% and 2-37% for tobacco, alcohol and drug use, respectively in African countries [6]. Among European countries [7], the frequency of having smoked tobacco within the last 30 days is between 10-43%, the same frequency for alcohol use is 17-79% and lifetime use of illegal drugs is between 4-42%.

Risky behaviors such as tobacco, alcohol and drug use are significant risk factors for existing and future mortality, disease and disabilities (e.g., cardiovascular disease, cancers, chronic pulmonary disease, depression, violence, substance dependence, injuries, HIV/ AIDS, etc.) [8-9]. Furthermore, the earlier the age of starting these risky behaviors is, the higher the levels of adulthood dependence risk and difficulty in quitting become [10-11].

Addictive behaviors and their associated problems result in a high number of public health issues in respect to physical and mental health, from which protection is possible most of the time. Therefore, the most ideal time for healthcare professionals to invest in health promotion and preventive healthcare services is during adolescence [3,12].

Determination of risk factors on the development of risky behaviors within this period is of importance for the formulation of societal and political policies towards mitigation of these risky behaviors. The aim of this study is to determine the prevalence of addictive substance use and associated risk factors among high school students in Corum Province of Turkey.

Materials and Methods

Çorum, where the study was conducted, is a province located at the Central Black Sea Region with a population of 534,578. It ranks 50th among 81 provinces of Turkey with respect to socioeconomic development index. Its major means of livelihood are agriculture and food industry [13].

Target population of the study consists of 28,520 students attending to high school in Çorum province in 2014-2015 academic years. The study power has been calculated as 80% with a margin of error for a deviation of 4% and the prevalence of having used tobacco at least once during lifetime in a similar study [14] has been calculated as 66.5% through the use of Minitab program, and the sample size has been determined to be 2574 students accordingly.

The target population of the study was layered based on the place (urban and rural) and type of school (vocational and general) in order to determine the respective numbers of adolescents in the sample from these layers according to their ratios within the target population. Schools and classrooms targeted for study were selected from 84 schools in the city and districts through a simple random sampling method. All official permits required to carry out the study were obtained from the Corum Governorate and Provincial Directorate of National Education. This study was conducted according to the ethical guidelines of the Helsinki declaration. In addition, ethics committee approval was not required because no patients were involved.

A questionnaire form was developed and the pilot study was conducted on 30 high school students at a school excluded from the sample, upon which misunderstood or incomprehensible questions were revised. Prior to the survey, all students were informed of the contents of the research and the voluntary basis of participation by reading a standard directive. The questionnaire form was given to students, who volunteered to participate in the study, for selfcompletion in their classrooms under the supervision of their guidance teachers.

In addition to sociodemographic questions such as age, sex, type of school, parental educational status, location of residence and economic status of family based on the subjective question “In your opinion, how is the economic status of your family?” with either “good” or “not good” as the possible answers. Questions addressing at tobacco, alcohol and illegal drug use were asked. For the illegal substances they use, if any, options including inhalant (thinner, Bally® [Bally is a glue that is commonly sniffed by Turkish youth]), cannabis, heroin, marijuana, bonsai (a synthetic cannabinoid), LSD were given in addition to an open-end answer for other substances, if any. Abogus drug (Relaktin) was included as a quality control measure. An adolescent is categorized as being a nonsmoker if he/she reports never having tried even a puff or two of cigarettes), an intermittent smoker (those who reported smoking on at least one day but not daily during the past 30 days), or a regular smoker (those who reported smoking on a daily basis in the past month).

The questionnaire forms of 80 students (3.1% of the sample), were excluded from the analyses. These included 45 students with unreliable answers and 35 students with inadequate answers.

Data were analyzed using the Statistical Package for Social Sciences, Version 22.0 (SPSS for Windows, SPSS Inc., Chicago, IL, USA).The data were expressed as arithmetic means ± standard deviation, numbers and percentages. Chi-square tests were conducted on independent variables considered as risk factors. Variables found to be significantly associated with smoking, alcohol and drug use, were included as covariates in multivariate logistic models. Statistical significance level was deemed to be p<0.05 for all tests.


A total of 2494 students completed the questionnaire. The average age of the respondents was 16.2 ± 1.1 years; 49.9% were male students. Selected socio demographic features of the respondents, 54.3% of whom attend to schools at the city center, are presented in (Table 1).

Citation: Terzi O and Dundar C. Tobacco, Alcohol, Substance use Patterns and Associated Risk Factors in a Representative Sample of High School Students in Corum, Turkey. Austin J Public Health Epidemiol. 2016; 3(5): 1052. ISSN:2381-9014