|Year : 2011 | Volume
| Issue : 1 | Page : 42-45
Prevalence of substance use among male adolescents in an urban slum area of Karimnagar district, Andhra Pradesh
Prashant R Kokiwar1, Gopal Rao S Jogdand2
1 Associate Professor, Department of Community Medicine, Chalmeda Anandrao Institute of Medical Sciences, Karim Nagar, Andhra Pradesh, India
2 Professor and Head, Department of Community Medicine, Chalmeda Anandrao Institute of Medical Sciences, Karim Nagar, Andhra Pradesh, India
|Date of Web Publication||30-Jun-2011|
Prashant R Kokiwar
Associate Professor, Department of Community Medicine, Chalmeda Anand Rao Institute of Medical Sciences, Bommakal, Karimnagar, Andhra Pradesh - 505 001
| Abstract|| |
In recent years substance use has increased greatly throughout the world. Adolescence is the critical period when the first initiation of substance use takes place. Interventions at the adolescent age are effective to bring about lifestyle modifications. A community-based, cross-sectional study was carried out among 260 randomly selected adolescents in an urban slum area, with the objective of studying the prevalence and determinants of substance use among adolescents. The adolescent age group was selected as defined by the World Health Organization (WHO) (10 - 19 years). The overall prevalence of substance use was 32.7%. About 31% initiated substance use at 13 - 15 years of age, and the reason was peer pressure in 52.9%. Education of the study subject, education of parents, and substance use by parents and by peers were significantly associated with substance use. Children and parents should be educated to prevent substance use. There was a need to change the social environment.
Keywords: Prevalence, Substance use, Urban slum area
|How to cite this article:|
Kokiwar PR, Jogdand GS. Prevalence of substance use among male adolescents in an urban slum area of Karimnagar district, Andhra Pradesh. Indian J Public Health 2011;55:42-5
|How to cite this URL:|
Kokiwar PR, Jogdand GS. Prevalence of substance use among male adolescents in an urban slum area of Karimnagar district, Andhra Pradesh. Indian J Public Health [serial online] 2011 [cited 2015 Feb 27];55:42-5. Available from: http://www.ijph.in/text.asp?2011/55/1/42/82550
Substance use is defined as, "Persistent or sporadic drug use inconsistent with or unrelated to acceptable medical practice."  In recent years substance use has increased greatly throughout the world. A particularly alarming fact is that the age of initiation into substance use is progressively falling.  Adolescence is the critical period when the first initiation of substance use takes place. Encouragement by peer groups, the lure of popularity, and early availability of many such substances make an adolescent an easy prey. In India, approximately 5500 adolescents practice substance use daily, some as early as when they are ten years old. 
More community-based studies are required to have an insight into the prevalence of substance use and its determinants, so that efforts can be directed to reduce the same. Interventions at the adolescent age are effective to bring about lifestyle modifications. With this background, the present study was undertaken, to study the prevalence and determinants of substance use among adolescents, in an urban slum area.
This community-based, cross-sectional study was carried out in an urban slum area, among the male adolescents, 10 to 19 years of age. This urban slum belonged to the Urban Health Training Center (UHTC), a field practice area under the administrative control of the Department of Community Medicine. The UHTC area was situated about 4 km from the College. The study period was for six months, from April to September 2010. The sample size was calculated following the formula n = 4 pq / L,  taking into consideration the prevalence of substance use as 43.4%,  with an allowable error of 15% and confidence interval of 95%. The calculated sample size was 232. A non-response rate of 10% was added to this, so the final sample size was 256.
Data regarding the population of the urban slum was obtained from the Health Survey Register of UHTC, for the year of 2009. The baseline data of adolescent population was available in the UHTC's adolescent register. Out of 2,612 total adolescents, 1,412 were male. Out of these male adolescents, 260 male adolescents were selected by the simple random sampling technique. Adolescents who were not residents of the above-mentioned slum, but were visiting, and adolescents of families who had moved into the slum within the past one month were excluded from the study, before the sampling.
Ethical clearance from the institution and informed consent from the study population were obtained before the study. The exact age of the subjects was computed from the birth certificate. When data on the exact date of birth was unavailable, the age was verified by the school records available either at home or at school. The Modified Kuppuswamy Scale  was used to classify the subject's families into social classes. The adolescent age group of 10 - 19 years was selected, as it was defined by the World Health Organization (WHO).  Data was recorded in a pre-designed and semi-structured proforma. Data regarding education of parents and social class was obtained from the parents or elderly persons available at the time of interview. School dropout was considered when a person, who after attending the school for few years had left the school education permanently, due to some reason. Primary education meant a person educated to a maximum of fourth standard. Secondary education meant a person educated to a maximum of tenth standard.
Statistical analysis was performed using proportions and chi square tests. At the end of the study, an effort was made to change the behavior of all the adolescents found to be having substance use.
The mean age of the participants was 15.03 + 3.0 years. Only 2.7% were found to be illiterate and 3.6% were school dropouts; 38.5% belonged to upper lower class followed by the upper middle class (37.7%).
The overall prevalence of substance use was 32.7%. Substance use increased as the age increased. Age-specific prevalence of substance use is shown in [Table 1]. Prevalence (51.3%) was significantly more in the age group of 18 - 19 years (P < 0.05). The most commonly used substance was tobacco (60%), followed by alcohol (12.9%), and only one admitted the use of ganja, that is, cannabis. Twenty-two adolescents out of 85 substance users (25.9%) used two or more than two substances, which were mainly a combination of alcohol and tobacco. The most common forms of tobacco consumed were khaini, cigarette smoking, gutkha consumption, and tobacco chewing, in decreasing order.
Out of 85 substance users, 30.6% had initiated the use at 13 - 15 years of age, followed by 10 - 12 years (20%). A high percentage, that is, 12.9% initiated substance use very early in their life, that is, at the age of seven to nine years.
The important reasons for initiation of substance use were peer pressure in a significantly higher number of substance users, 52.9%, followed by the reason of enjoyment in 21.1%. Other reasons were love failure, marriage party, mental tension, new year party, thrill, time pass, father pressure, work tension, family problems, on occasion of festivals, and to relieve body pain.
More than 300 cigarettes were smoked by 4.3% in the last month, while 52.2% accepted that they smoked 30 - 150 cigarettes. Out of 10 gutkha consumers 60% were consuming up to 50 sachets (pouches) per month; 54.2% revealed that they consumed up to 50 pegs of alcohol and in 8.4% this quantity went as high as more than 200 pegs.
Among the 14 substance users who attempted to stop the use, 57.1% admitted that they failed to stop it, 28.6% blamed their friends, while 7.1% stated mental tension and love failure.
[Table 2] shows an association of various factors with substance use. Of the factors studied, education of the study subject, education of father and mother, and substance use by parents and peers, were significantly associated with substance use (p < 0.05 or p < 0.001). Other factors like occupation of father and mother, social class, and family problem were not significantly associated with substance use.
The overall prevalence of all types of substance use in the present study was 32.7% and it increased as the age increased, which was also reported by other studies. ,
The most commonly used substances were tobacco and alcohol in their various forms, compared to other drugs. This may be due to the social acceptability of tobacco and alcohol use, and also easy availability.
At the age of seven to nine years, 12.9% initiated substance use. Lisa et al.  reported that the mean age for onset of smoking and alcohol consumption was 16 years and for cannabis use it was 16.75 years. The decrease in age at initiation can be attributed to exposure of adolescents to the media and movies, in which the heroes are shown smoking and drinking, which creates a social environment that favors substance use.
Peer pressure was the leading reason (52.9%) for initiation of substance use in the present study, where other authors reported it as 70%  and 84%  and Jain et al.  found curiosity in 68% of the cases. This difference may be due to the different study setting and different social environment.
Out of 85 substance users 14, that is, 16.5% have attempted to stop the use, but have failed. There may be different reasons of failure to stop the use but it may be due to lack of a strong support mechanism for these adolescents at the family and community level.
Education was strongly associated with substance use (P < 0.001). Other studies also documented a similar finding. ,, Education makes a person aware and brings about a change in his behavior in a desired manner. Education of father and mother was significantly associated with substance use (P < 0.05) in the present study. This factor was not studied by authors who conducted the studies in India or outside India.
There was no significant association between social class and substance use. A similar finding was reported by Kohler et al.  However, Neufeld et al.  observed that the prevalence of substance use was more common in the lower classes compared to the upper classes. This contrast in findings or non-significant association shows that social status may not play an important role in substance use. From whatever strata the adolescent comes, there are other more important determinants of substance abuse.
The association between a family problem and substance use was not significant, which might be due to the presence of only 11 problem families in the present study. Lisa et al.  observed that substance use was significantly high in broken families (51.2%), whereas, Ljubotina et al. reported that substance use was related to poor family relations.
The association between substance use by parents and that by the study subjects was significant (P < 0.05). A similar finding was reported by other studies. , Adolescent behavior was influenced by the behavior of their parents. If the parents were users then the likelihood of their children being users increased many fold. The association between substance use by peers and substance use by the study subjects was also significant (P < 0.05). Other authors also agreed with this finding. , This was because the adolescents preferred to do things that were commonly done by their group.
The study findings indicate that education should be encouraged. Parents should be educated to either stop the substance use or at least not to use any drug in front of their children. There is also a need to change the social environment, and media can play an important role in this regard.
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[Table 1], [Table 2]