Users Online: 9759 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size


Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
Year : 2019  |  Volume : 63  |  Issue : 3  |  Page : 239-242  

Sleep pattern, aggressive behavior and substance use among school students of Manipur: A cross-sectional study

1 Post Graduate Trainee in Community Medicine Department, RIMS, Imphal, Manipur, India
2 Professor and Head, Department of Community Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India

Date of Web Publication20-Sep-2019

Correspondence Address:
Brogen Singh Akoijam
Department of Community Medicine, Regional Institute of Medical Sciences, Imphal - 795 004, Manipur
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijph.IJPH_334_18

Rights and Permissions

Background: Adolescence is a vulnerable period of growth and development. This is the time when habits are inculcated which will carry forward to adult life. Sleeping patterns among adolescents have an impact on their overall health. Early substance use initiation is a serious concern because it is associated with significantly increased risks for developing substance use disorders. In general, aggressive behaviors progress from less to more severe over the course of adolescent development. Objectives: The objectives of this study are to determine the lifestyle behaviors of young adolescents focusing on sleep pattern, aggressive behavior, and substance use. Methods: A cross-sectional study was conducted among 739 students of Class VII and VIII in both government and private schools in Imphal West and Kangpokpi districts of Manipur between August 27 and September 25, 2017. A pretested, structured questionnaire was used, which included the modified version of Buss and Perry Aggression Questionnaire. The data were analyzed using the IBM SPSS software (IBM SPSS for Windows, Version 21.0. Armonk, NY, USA). Results: Only 56.2% of the students had adequate sleep. The proportion of adolescents using alcohol, tobacco, cigarettes, and Ganja was 4.6%, 9.5%, 5.7%, and 1.6%, respectively. Aggressive behavior was shown by 35.3%. Male students were getting more sleep (60.7%), were more aggressive (38.8%), and were using tobacco and cigarettes (82.4%) more than female students. Conclusions: Around two-fifth of the adolescents were not getting enough sleep. The association between aggressive behavior and substance use was found but needs further investigation for its temporal relationship.

Keywords: Adolescents, aggressive behavior, sleep, substance use

How to cite this article:
Lyngdoh M, Akoijam BS, S. Agui R K, Sonarjit Singh K. Sleep pattern, aggressive behavior and substance use among school students of Manipur: A cross-sectional study. Indian J Public Health 2019;63:239-42

How to cite this URL:
Lyngdoh M, Akoijam BS, S. Agui R K, Sonarjit Singh K. Sleep pattern, aggressive behavior and substance use among school students of Manipur: A cross-sectional study. Indian J Public Health [serial online] 2019 [cited 2023 Mar 26];63:239-42. Available from:

   Introduction Top

According to the 2011 census, every fifth person in India is an adolescent. Adolescence is a transitional stage between childhood and adulthood. It is a vulnerable period of growth and development. This is the time when habits are inculcated, which will carry forward to adult life. Sleeping patterns among adolescents have an impact on their overall health. Studies have documented the clear consequences of insufficient and inconsistent sleep for developing adolescents, such as poor academic performance and school absenteeism, drowsy-driving accidents, substance abuse, and emotion regulation difficulties.[1] Substance use among adolescents is also a matter of interest. Individuals who begin using psychoactive substances at an early age, typically defined as before age 13 or 14 are at greater risk of negative psychosocial, educational, and mental health outcomes than individuals who initiate substance use at a later age.[2] Although the adolescent brain may be more resistant to the neurotoxic effects of substance use, drug exposure may interrupt brain potentially leading to cognitive, social, and psychological deficits.[3] Aggression takes many forms – physical, verbal, hostility, and anger. In general, aggressive behaviors progress from less to more severe over the course of adolescent development.[4] Aggression is one key risk factor associated with problem of substance use.[5] Adolescents who have high aggression are prone to indulge in inimical drug use.[6] These various lifestyle behaviors among adolescents need to be looked into with greater detail, especially in a state like Manipur where the prevalence of substance use is quite high.[7] With this background in mind, the present study was conducted to determine the lifestyle behaviors, sleep pattern, substance use, and aggressive behavior among school-going students and also to determine the association of these behaviors with their sociodemographic characteristics.

   Materials and Methods Top

A cross-sectional study was conducted between August 27 and September 25, 2017, among Class VII and Class VIII school students of Kangpokpi and Imphal, West districts of Manipur. Students who were absent on the day of visit to the school and those who refuse to participate were excluded from the study.

Using a prevalence of aggressive behavior of 17.7% from a previous study,[8] an absolute allowable error of 5%, nonresponse rate of 10% with 95% confidence interval, the sample size was calculated using the following formula: n = 4PQ/L2. The sample size was found to be 247. Since cluster sampling was used, a design effect of 2 was multiplied giving the final sample size of 500.

A one-stage cluster sampling was used where six schools were selected, three from each of the two districts. The six schools were selected purposefully based on the geographic spread of the town and the number of students in an aim to make it representative of the districts.

A pretested, structured questionnaire was used, which consisted of two parts: Part A which had questions on sociodemographic characteristics and Part B with questions on lifestyle behaviors, i.e., sleep pattern, substance abuse, and aggressive behavior (modified version of the Buss and Perry Aggression Questionnaire [BPAQ]).[9]

Operational definition

Adequate sleep was defined as sleeping for 8–10 h/day (National Sleep Foundation).[10]

Aggressive behavior – The modified BPAQ has 29 items subdivided into four factors, namely physical aggression, verbal aggression, anger, and hostility. Physical aggression (9 items) has a score range of 9–45. Verbal aggression (5 items) has a score range of 5–25. Questions on anger (7 items) have a score range of 7–35. Questions on hostility (8 items) have a score range of 8–40. All these domains were further divided into extremely, moderately, and rarely aggressive based on the scores obtained. Those who were extremely aggressive and moderately aggressive in all the four domains were again grouped under “aggressive” and who were rarely aggressive in all the domains under “nonaggressive.”

Before the study initiation, informed written consent was obtained from the principal, and assent was obtained from the students. The participants were briefly explained about the study and reassured about their anonymity. Data were collected using a semi-structured questionnaire.

Data were collected and checked for consistency and completeness. Data were entered in IBM SPSS for Windows, version 21.0. Armonk, NY, USA. Descriptive statistics such as mean, standard deviation, and percentage were used. The Chi-square test was used to assess the association between the lifestyle behavior and sociodemographic factors. P ≤ 0.05 was considered as statistically significant.

Approval was obtained from the Research Ethics Board, Regional Institute of Medical Sciences, Imphal, Manipur. Informed verbal consent was obtained from the participants before data collection. Data collected were kept secured under lock and key. Data collected were made accessible only to the investigators. Identifiers such as name and address were not collected to maintain confidentiality.

   Results Top

There were 739 participants enrolled in the study. Response rate was 92.10%. The mean age of the participants was 13.08 ± 0.872 years. Minimum age was 11 years and maximum age was 17 years.

Among all the participants, 51.0% were male, 88.5% were living at home, 48.4% belonged to the Hindu religion, 57.4% belonged to a nuclear family, 69.6% had only 1 or 2 siblings, and family income was evenly divided among the participants.

[Table 1] shows the sleep pattern of the participants. Nearly 56.2% of the students get adequate sleep, only 29.2% had difficulty in falling asleep, 52.0% wake up once during the night, and 50.7% sleep during the daytime.
Table 1: Sleep pattern of the study participants (n=739)

Click here to view

Regarding substance use, 4.6% of the students have taken alcohol, 9.5% tobacco, 5.7% cigarettes, and 1.6% have tried Ganja. Most of the students have cited curiosity and experimentation as the main reason for alcohol use (72.7%), tobacco use (61.2%), and cigarette use (62.5%) [Table 2].
Table 2: Substance use and reasons for substance use

Click here to view

It was found that 35.3% of the participants exhibit aggressive behavior.

[Table 3] shows that male students and those with only one or two siblings are getting more adequate sleep, and this was found to be statistically significant.
Table 3: Association between selected sociodemographic characteristics with sleep pattern

Click here to view

[Table 4] shows that male students, those staying in the hostel and those students who use both tobacco and cigarettes, are more likely to be aggressive, and it was found to be statistically significant. No such significant association was found with sleep pattern.
Table 4: Association between selected sociodemographic characteristics with a level of aggression

Click here to view

   Discussion Top

This study highlights the lifestyle behaviors among the young adolescents of the state of Manipur. The response rate was good. As the number of students enrolled in the schools was more, we were able to include a total of 739 students. This was well over the required sample size of 500.

A study conducted by John[11] found that the adolescents slept on an average of 7.68 ± 0.99 h during school days and 8.70 ± 1.63 h on weekends, but there was no mention of the proportion of adolescents getting adequate sleep. The prevalence of adequate sleep in our study is 56.2%, with boys getting more sleep than girls. This might be due to girls being more involved in household chores than boys and might also try to cope with the studies. As such, boys get more extra sleep.

Less than 10% of adolescents reported substance use. The study participants were in the early adolescence period. This is a worrying concern because early initiation of drug use is often associated with poor prognosis and lifelong pattern of disturbed behavior.[12] Our study found that the substance most commonly utilized by adolescents is tobacco (9.5%). This is in line with a study conducted by Penney et al.[13] in the UK where 74.2% reported lifetime tobacco use. The proportion of users is much higher. Alcohol use was also significantly higher (47.8%). Cannabis was the most commonly used drug (17.4%) compared to 1.6% use in our study. The difference might be due to the higher age group of adolescents in the UK study. Tsering et al.[14] reported that easy availability and relief from tension were the main reasons for substance use. In our study, we found that curiosity and experimentation to be the main reason.

The prevalence of aggressive behavior among adolescents was found to be 35.3%. Male students, those staying in the hostel and those who used both cigarettes and tobacco were found to be more aggressive. Talukdar and Deka[15] also reported more aggressive behavior among male adolescents than their female counterparts. This might be due to boys being more impulsive in decision-making. A study by Shahzad and Yasmin[6] suggested that those who use drugs have a high level of aggression than those who do not use drugs. Further, Mathias et al.[5] stated that aggression, particularly specific assaults on another person and school consequences related to aggression, were predictive of early substance use initiation. This study could find not any association between sleep pattern and aggressive behavior unlike the study conducted by Makinde et al.[16] in Nigeria which found that the adolescents who sleep less were more exposed to aggression and they also themselves behaved more aggressively and antisocially.

   Conclusions Top

Around two-fifth of the adolescents were not getting enough sleep. Male students exhibit more aggressive behavior. Substance use was prevalent in this sample of students. Prevention programs can be initiated to spread awareness about the ill-effects of substance use and its association with aggressive behaviors. Further studies with larger sample size, covering all districts will help to develop a better policy for school health and counseling.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Wolfson AR. Adolescents and emerging adults' sleep patterns: New developments. J Adolesc Health 2010;46:97-9.  Back to cited text no. 1
Kingston S, Rose M, Cohen-Serrins J, Knight E. A qualitative study of the context of child and adolescent substance use initiation and patterns of use in the first year for early and later initiators. PLoS One 2017;12:e170794.  Back to cited text no. 2
Doran N, Luczak SE Bekman N, Koutsenok I, Brown SA. Adolescent substance use and aggression: A review. Crim Justice Behav 2012;39:748-69.  Back to cited text no. 3
Loeber R, Hay D. Key issues in the development of aggression and violence from childhood to early adulthood. Annu Rev Psychol 1997;48:371-410.  Back to cited text no. 4
Mathias CW, Duffing TM, Ashley A, Charles NE, Lake SL, Ryan SR, et al. Aggression as a predictor of early substance use initiation among youth with family histories of substance use disorders. Addict Disord Their Treat 2015;14:230-40.  Back to cited text no. 5
Shahzad S, Yasmin S. Aggression as risk for delinquency and substance abuse in adolescents. Int J Prev Treat Subst Disord 2015;1:106-18.  Back to cited text no. 6
Ningombam S, Hutin Y, Murhekar MV. Prevalence and pattern of substance use among the higher secondary school students of Imphal, Manipur, India. Natl Med J India 2011;24:11-5.  Back to cited text no. 7
Sharma MK, Marimuthu P. Prevalence and psychosocial factors of aggression among youth. Indian J Psychol Med 2014;36:48-53.  Back to cited text no. 8
[PUBMED]  [Full text]  
Buss AH, Perry M. The aggression questionnaire. J Pers Soc Psychol 1992;63:452-9.  Back to cited text no. 9
National Sleep Foundation. Teens and Sleep; 2017. Available from: [Last accessed on 2017 Sep 10].  Back to cited text no. 10
John B. Sleep duration and sleep hygiene practices in adolescents: Age and gender differences. NITTE Univ J Health Sci 2014;4:65-8.  Back to cited text no. 11
Jiloha RC. Prevention, early intervention, and harm reduction of substance use in adolescents. Indian J Psychiatry 2017;59:111-8.  Back to cited text no. 12
[PUBMED]  [Full text]  
Penney J, Dargan PI, Padmore J, Wood DM, Norman IJ. Epidemiology of adolescent substance use in London schools. QJM 2016;109:405-9.  Back to cited text no. 13
Tsering D, Pal R, Dasgupta A. Substance use among adolescent high school students in India: A survey of knowledge, attitude, and opinion. J Pharm Bioallied Sci 2010;2:137-40.  Back to cited text no. 14
Talukdar R, Deka R. A study on aggression level among adolescents. Int J Soc Sci Humanit Res 2014;2:91-4.  Back to cited text no. 15
Makinde O, Österman K, Björkqvist K. The association between sleep deprivation, aggression, and antisocial behavior in adolescents in Ejigbo, Lagos, Nigeria. Eur J Interdiscip Stud 2018;4:154-8.  Back to cited text no. 16


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

This article has been cited by
1 Associations between tobacco and alcohol use and aggressive behavior among adolescents in 55 Low- and Middle-Income countries
Houfu Liu, Xiaoyun Ma, Leiming Shi, JuJu Wang, Jennifer Tan Hui Juan, Dongmei Ma, Jiahong Sun
Journal of Affective Disorders. 2023;
[Pubmed] | [DOI]
2 Prevalence and determinants of aggressive behavior among adults with problematic substance use in Northwest Ethiopia: a cross-sectional survey
Getasew Legas, Habte Belete, Sintayehu Asnakew
BMC Psychiatry. 2022; 22(1)
[Pubmed] | [DOI]
3 Association of psychosocial factors with aggression among school going rural adolescents in Haryana
Ramesh Verma, Gopal Kumar, RohtasKanwar Yadav, Vinod Chayal, Meenakshi Kalhan, Kapil Bhalla, Rohit Dhaka, Ginni Agrawal, Aman Sachdeva, Jitesh Satija, Pankaj, Vidya Sagar
Journal of Family Medicine and Primary Care. 2021; 10(10): 3720
[Pubmed] | [DOI]
4 Association of Serotonergic Pathway Gene Polymorphisms With Behavioral Parameters in Patients With Opioid Dependence
Siddharth Sarkar, Renu Singh, Arundhati Sharma, Muzaffar A Pandit, Ranjan Gupta, Deepika Singhal, Raka Jain, Yatan P Balhara
Cureus. 2021;
[Pubmed] | [DOI]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
    Materials and Me...
    Article Tables

 Article Access Statistics
    PDF Downloaded338    
    Comments [Add]    
    Cited by others 4    

Recommend this journal