Prevalence and patterns of drug use among high-school students: a replicated study

Sections

Abstract
Introduction
Method
Instruments
Definitions
Results
Discussion

Details

Author: D. MOHAN , M.G. THOMAS, , H.S. SETHI, , G. G. PRABHU
Pages: 77 to 86
Creation Date: 1979/01/01

Prevalence and patterns of drug use among high-school students: a replicated study

D. MOHAN Associate Professor and Head of the Department of Psychiatry, A.I.I.M.S.
M.G. THOMAS, Senior Resident, Psychiatry, L.H.M.C., New Delhi
H.S. SETHI, Senior Resident, Psychiatry, A.I.I.M.S.
G. G. PRABHU Assistant Professor, A.I.I.M.S.

Abstract

A survey of high-school students in Delhi, carried out in 1975, revealed that 34.2 per cent of respondents used psychoactive drugs in the preceding year. The percentage of users of psychoactive substances other than alcohol and tobacco was 15.5 per cent. The percentage prevalence rates by substance ranked as follows: tobacco (35.1), alcohol (26.2), cannabis (12.0), tranquillizers (8.9), amphetamines (5.8), sedatives (4.9) and opium (1.3). The survey was replicated in the same classes of students in 1976. It revealed that the non-response vote was slightly lower, as was also involvement with drugs, though the difference between prevalence rates of drug use in the two years was not statistically significant.

Introduction

In response to the growing concern over the use of drugs by high-school students, a survey was undertaken in 1975 and was replicated in 1976 to determine the prevalence and patterns of drug use among senior high school students. Though the sample size was small, the study provided important information on the emerging trends in drug use among school seniors.

Fear has been expressed by both lay and scientific persons about medico-social problems associated with drug use by youth. In India, only one study has reported on drug use among students in high school seniors ( [ 1] ). It revealed that 34.2 per cent of the respondents in a high school in Delhi had used drugs within a period of one year. Excluding alcohol and tobacco use, the prevalence rate of the use of other drugs was 15.5 per cent. As such a large percentage of drag use caused concern, it was decided to repeat the study after a year to determine whether a change could be detected in the prevalence and pattern of drug use.

Method

The universe of the study in the first year consisted of three classes (IX, X, XI) of a boy's high school in Delhi. Each class consisted of five sections containing nearly forty students, who were between 14 and 17 years old. A stratified random sample was drawn which covered two sections of each class. The total number of students in the first year study was 241, and 237 were in the replicated study. The same classes were resurveyed the next year, with the exception of grade IX, in which the repeat sample was drawn, and class XI which had left the school. The class IX of 1975 became class X of 1976 (group A), and class X of 1975 became class XI of 1976 (group B).

Instruments

The following instruments were employed in the study ( [ 2] ):

Bio-data schedule to obtain information on the socio-demographic variables such as age, parental education, income, occupation, family structure and social dating pattern;

Schedule of patterns and prevalence of drug use;

Orientation scale of the Likert format consisting of seven statements on a five point scale. These indicated the respondents' respective orientation towards the use of drugs;

Schedule of reasons for use of drugs;

Personality profiles.

The study instruments were administered in two sessions, each lasting fifty minutes, to students in each section in a group during school hours, in the absence of school authorities. In the first session the bio-data schedule and the orientation scale were administered. In the second session, the schedules of prevalence and patterns of use, reasons for drug use, and the personality questionnaire were administered. The completed schedules and questionnaires were immediately collected after the session was over.

Students who were absent on either of the two sessions were excluded from the study. It was subsequently ascertained by individual interview that the absenteeism was unrelated to drug use in both studies. This was possible because the questionnaires were coded in a manner, which could lead to respondent identification. None of the respondents scored positive on "Adrenochrome", a drug category used to weed out false responses, hence no false responses by this criterion were detected.

Definitions

The drugs included in this survey were those listed by the WHO in the Technical Report Series 516 ( [ 3] ) in which volatile solvents were excluded from this list while tobacco was added.

Frequency of use refers to the number of times an individual had used one or more drugs over the past one year. Current users were divided into three categories:

Experimental users-students who were using one or more drugs once a month or less frequently.

Regular users-students who were taking one or more drugs at least once a week or several times a week.

Drug dependents-students who assessed "craving", indicating that they could not function without one or more drugs.

Results

Prevalence of drug use by school class (table 1). The total prevalence rates of drug use in the two studies carried out in 1975 and 1976 do not show significant differences. In class IX, the prevalence remained almost the same, being 35.1 per cent in 1975 and 34.3 per cent in 1976. It was identical (34.7) in class X in both years. In class XI the prevalence declined in 1976 though the difference between the two years was not statistically significant. In both years, the study covered approximately ninety per cent of the sample.

Prevalence of drug use in the replicated classes. Table 2 shows prevalence rates in the classes which were replicated, i.e., class IX of 1975, which became class X in 1976 (Group A) and class X of 1975, which became class XI in 1976 (Group B). There was a decline in total prevalence rates in both classes, though it was more marked in Group B. However, the differences were not statistically significant.

TABLE 1

Prevalence of drug use by school class (total samples)

 

Classes

 

Nine

Ten

Eleven

Total

No. of students
1975
1976
1975
1976
1975
1976
1975
1976
Total number of students in sample
83 80 82 82 76 75 241 237
Total number of respondents
77 70 75 72 73 72 225 214
Percentage of respondents
92.8 87.5 91.5 87.8 96.1 96.0 93.6 90.2
Total number of drug users
27 24 26 25 24 20 77 69
Percentage prevalence rates of drug use
35.1 34.3 34.7 34.7 32.9 27.8 34.2 32.2

NOTE. The difference between respondence rates in the two years was not statistically significant (X 2 = 0.08, df = 2), nor the difference between prevalence rates (X 2 = 0.27, df =, 2).

TABLE 2

Percentage prevalence rates of drug use in replicated classes

 

Group A

Group B

No. of students
1975
1976
1975
1976
Total number of students
83 82 82 75
Total number of respondents
77 72 75 72
Percentage of respondents
92.8 87.8 91.5 96.0
No. of drug users
27 25 26 20
Prevalence of drug use (per cent)
35.1 34.7 34.7 27.8

NOTE. The difference between respondence rates in the two years was not statistically significant (X 2 = 0.66, df = 1 (A); and X 2 = 0.4, df = 1 (B)), nor the difference between prevalence rates of drug use (X 2 = 0.015, df = 1 (A); and X 2 = 0.52, df = 1 (B)).

Prevalence rates by substance. Table 3 shows the prevalence rates of drug use by type of substance in 1975 and 1976. In both years the most commonly used substances were tobacco and alcohol, followed by cannabis. In 1976 there was a decline in the prevalence rates However, the non-response rate on these items was much higher in 1976 than in 1975 which may contribute to the under-reporting of drug use in 1976.

Prevalence rates of drug use by substance in the replicated classes (table 4). In the replicated classes slightly divergent trends are seen in Group 5 A and B. In Group A, there was a decline in tobacco use, but the use of all other substances increased. Opium use was reported for the first time.

In Group B there was a decline in use of most substances. With the exception of opium use which also, as in Group A, appeared for the first time and use of sedatives which remained at the same level, the prevalence rates of other substances decreased.

TABLE 3

Percentage prevalence rates of drug use by substance in two years (total samples)

 

1975

1976

Drug type
No. of respondents
Percentage prevalence rates
No. of respondents
Percentage prevalence rates
Tobacco
79 35.1 60 28.0
Alcohol
59 26.2 48 24.4
Cannabis
27 12.0 22 10.3
Tranquillizers
20 8.9 12 5.6
Amphetamines
13 5.8 9 4.2
Sedatives
11 4.9 8 3.7
Opium
3 1.3 2 0.9

TABLE 4

Percentage prevalence rates of drug use by substance in replicated classes

 

Percentage of users

 

Group A

Group B

Drugs
1975
1976
1975
1976
Tobacco
35.1 26.3 28.0 27.7
Alcohol
24.7 25.0 29.3 23.6
Cannabis
7.8 9.7 13.3 12.3
Tranquillizers
5.2 8.3 12.0 4.1
Amphetamines
3.9 5.5 8.0 4.1
Sedatives
2.6 2.8 6.6 6.9
Opium
0.0 1.4 0.0 1.4

TABLE 5

Experimental, regular and dependent users by substances a (total samples)

   

Tobacco

Alcohol

Cannabis

Type of use
Class
1975
1976
1975
1976
1975
1976
Experimental users
Nine
23 18 16 8 3 3
 
Ten
4 5 21 10 6 6
 
Eleven
6 7 17 11 9 5
Regular users
Nine
2 1
-
1
-
-
 
Ten
17 12 4 5 3 2
 
Eleven
17 10 1 3 1 2
Total
  69 53 59 38 22 18
Number of drug-dependent users (based on self-assessed craving)
Nine
2 1
-
-
-
 
 
Ten
16 11 2 1
-
-
 
Eleven
13 10 1 1
-
-
Total number of dependent users
  31 22 3 2
-
-

a

Non-response rate on the items in this table was high.

TABLE 5

Experimental, regular and dependent users by substances a (total samples)

   

Tranquillizers b

Amphetamines b

Sedatives b

Opium b

Type of use
Class
1975
1976
1975
1976
1975
1976
1975
1976
Experimental users
Nine
3 2 1 1
-
-
-
-
 
Ten
7 4 6 2 3      
 
Eleven
5 4 4 4 2 3 3 3
Total number of users
 
15 10 11 7 5 3 3 3

b

No regular or dependent users were detected.

TABLE 6

Experimental, regular and depend users by substance in replicated classes

   

Tobacco

Alcohol

Cannabis

Tranquillizers

Amphetamines

sedatives

Opium

Type of use
Group
1975
1976
1975
1976
1975
1976
1975
1976
1975
1976
1975
1976
1975
1976
Experimental
A
23 4 16 26 3 6 3 10 1 2 0 0 0 0
 
B
4 7 21 11 6 5 7 4 6 4 3 3 0 1
Regular use
A
2 10 0 5 0 2
-
-
-
-
-
-
-
-
 
B
17 10 4 3 3 2
-
-
-
-
-
-
-
-
Total users
  46 32 41 45 12 15 10 14 7 6 3 3 0 1
No. of drug-dependent
users (based on self-
Assessed craving)
A
2 11 0 1
-
-
-
-
-
-
-
-
-
-
 
B
16 10 2 1
-
-
-
-
-
-
-
-
-
-
Total users
  18 21 2 2
-
-
-
-
-
-
-
-
-
-

In both groups, the most commonly used drugs in 1976 remained tobacco, alcohol and cannabis.

Experimental, regular and dependent users (table 5). With the exception of tobacco, use of other substances in the two samples was mainly experimental.

Self-assessed craving for drug use was expressed only for alcohol and tobacco, principally for the latter. A considerable number of respondents in the classes X and XI were dependent on tobacco smoking. However, the high non-response rate on these items may be the reason for small numbers of users indicated on this table.

Experimental, regular and dependent users in the replicated sample (table 6). In the replicated study in both Groups A and B drug use varied from one substance to another.

There was some increase in the regular use of alcohol and tobacco in Group A. Self-assessed craving was confined to

Multiple drug use (table 7). The combination of tobacco with alcohol was most commonly used. This was followed by use of tobacco alone, alcohol alone, and tobacco/cannabis. It should be noted here that tobacco and alcohol were the principal substances used.

Sources of introduction to drug use (table 8). The drugs were usually first suggested by school friends or from the group labelled off-school friends. It is interesting to note that socially accepted substances such as alcohol and tobacco were in some cases introduced by family members, as were tranquillizers and amphetamines. The role of peer group was seen important in the introduction to illicit drug use.

Reasons for drug use (table 9). The most common reasons for using drugs seemed to be curiosity, recreation and the facilitation of social interaction. Tranquillizers seemed to be used mainly by individuals with personal problems. Use of drug to "deepen self-understanding" ranked relatively high for opium and sedatives

TABLE 7

Multiple drug use (total samples)

 

Number of users a

Combination of drugs used
1975 (N = 77)
1976 (N = 69)
Tobacco alone
14 16
Alcohol alone
13 13
Alcohol/tobacco
49 48
Tobacco/cannabis
11 10
Tobacco/alcohol/sedatives/amphetamines
7 5
Alcohol/sedatives/tranquillizers
4 2
Tobacco/cannabis/amphetamines/tranquillizers
3 2
Tobacco/alcohol/cannabis/tranquillizers/amphetamines/opium
3 2

a.) The figures indicate the number of events, while N shows the number of individual users.

TABLE 8

Source of introduction to drug use (in percentages)

Substances

Self

Brother and/or sister

Campus friends

Off-campus friends

Tobacco
8.2 7.4 42.6 41.8
Alcohol
4.7 3.7 60.7 30.8
Cannabis
-
-
45.8 54.2
Tranquillizers
-
12.5 65.6 21.9
Amphetamines
-
4.5 50.0 45.4
Sedatives
-
-
26.3 73.7
Opium
-
-
-
100.0

TABLE 9

Reasons for drug use (in percentages)

 

Substances used

Reasons
Tobacco
Alcohol
Cannabis
Tranquillizers
Amphetamines
Sedatives
Opium
Satisfy curiosity
37.2 (2) 42.7 (1) 8.9 (4) 21.4 (1) 9.1 (4) 29.2 (1) 28.6 (1)
Recreational
2.1 (4) 22.1 (2) 35.5 (1) 14.3 (3) 22.7 (1) 11.8 (3) 21.4 (2)
Facilitate social experience
52.1 (1) 5.3 (5) 22.2 (2) 3.6 (5) 18.2 (2) 17.6 (2) 7.4 (4)
The "In" thing to do (currently in fashion)
7.4 (3) 12.2 (3) 15.5 (3)
-
13.6 (3)
-
14.3 (3)
Relieve tension
1.1 (5) 2.3 (7) 2.2 (7) 14.3 (3) 4.5 (5) 5.9 (4)
-
Escape personal problems
-
0.8 (9)
-
14.3 (3) 4.5 (5) 5.9 (4)
-
Challenge social values
-
3.8 (6) 6.7 (5)
-
-
-
-
Ease depression
-
1.5 (8)
-
17.9 (2)
-
17.6 (2)
-
To feel high
-
8.4 (4) 4.4 (6) 7.1 (4) 9.1 (4)
-
14.3 (3)
To facilitate self understanding
-
-
4.4 (6)
-
-
11.8 (3) 14.3 (3)
Stay awake to study
-
0.8
-
7.1 (4) 18.2 (2)
-
-

NOTE. Figures in parentheses denote rank order.

Discussion

The results of this study indicated that though there were no significant alterations in the over-all group prevalence rates, there were substantial changes in patterns of drug use. Primarily due to the fact that the sample size was too small to permit broad generalizations, only trends could be observed. In the West, Johnston studied drug use during school years ( [ 5] ). He observed that illicit drug use increased for all drugs except heroin. Smart and Fejer repeated cross-sectional studies which observed similar trends ( [ 6] ), as have Buikhuisen and Tim-merman ( [ 7] ) in the Netherlands, where the use rates almost doubled in school children after a two-year follow-up. In this study, though the over-all prevalence rates remained approximately the same, there was a tendency toward increasing regular use of drugs as students were promoted from grade nine to the next, and the trend indicated some increase in regular use of alcohol, tobacco and cannabis. This trend would seem to be insignificant to an observer from the West, because alcohol and tobacco are very much an accepted part of social life there. Berg pointed out that surveys of students which covered alcohol and tobacco use showed use rates well above ninety per cent ( [ 8] ). In our society the findings of this study are an issue of concern. The reasons for concern are as follows:

First, drugs which are socially accepted may be used more commonly. As their use is a definite public health hazard, this country may pay a heavy cost in morbidity and mortality in years to come;

These drugs provide the breakdown of the psychological barrier from abstinence to use (National Committee Report) ( [ 9] );

In the future the use of other psychoactive substances, e.g. benzodiazepines, and particularly their combination with alcohol may lead to more accidental deaths; an increase in tobacco smoking may lead more people to experiment with cannabis and other inhalants.

The results of this study support our earlier observations regarding college freshmen in this country. Drug use is, in a large majority, experimental, and declines somewhat as examination time approaches due to two sets of parallel phenomena, which work toward the same direction. The first is that in the Indian culture excelling on examinations is an important consideration ( [ 10] ). Second, this type of experimental use is more prevalent among the small, urban, upper class elite, who have the following characteristics:

Both parents are professional or working and live within a nuclear family structure;

Combined with the above, they show tendency towards modernization which is exemplified in increased drug use in those who show dating behaviour; and

Peer group pressure which promotes the normal youngster's drive for curiosity to seek new experiences ( [ 11] , [ 12] ).

These observations were supported by the scores on the personality inventory test (MPI) used in this study. The MPI test tended to confirm the personality profile of drug users clustered more often in right upper quadrant characterized by a higher neuroticism and extraversion scores among whom risk-taking behaviour is likely to occur.

The last two observations also deserve attention: (i) in spite of comparatively easy availability of cannabis, opium, as well as other drugs, the use rates of these drugs are still relatively low; (ii) opium use is beginning to make its appearance at school level, even though in statistically insignificant proportions, a trend which requires careful attention in India.

References

001

D. Mohan, M.G. Thomas, G.G. Prabhu. "Prevalence and pattern of drug abuse amongst high school students", Ind. J. Psychiat., 20 :20-24, 1978.

002

M.G. Thomas. "A study of drug abuse among high school students", unpublished M.D. thesis, A.I.I.M.S., 1974.

003

Youth and Drugs, Techn. Rep. Ser. 516, WHO, Geneva, 1970.

004

D. Mohan, M. G. Thomas (Mrs. G. Shasi), G.G. Prabhu. "Personality and attitudes co-relates of drug abuse: a replicated study", Ind. J. Med. Res., 69 :990, 1976.

005

L.D. Johnston. "Drug use during and after high school", results of a longitudinal national survey, Am. J. Public Health (Supplement), 64 :29 (1974).

006

R.G. Smart, D. Fejer. "Six years of cross-sectional surveys of student drug use in Toronto", Bulletin on Narcotics , XXVII: 2, 11, Apr.-Jun. 1975.

007

W. Buikhuisen, H. Timmerman. "The development and drug taking among secondary school children in Netherlands", Bulletin on Narcotics , XXIV: 14, 2, 1972.

008

D.F. Berg. "The non-medical use of dangerous drugs in United States: a comprehensive view", Int. J. Addict, 5 :777, 1970.

009

Drug abuse in India, Report of the Expert Committee, Ministry of Health, F.W. New Delhi, 1976.

010

D. Mohan. "Social and psychological themes in education", Indian J. Clin. Psychol., 2 , 159-162, 1975.

011

B.R. Nazar. "Modernisation imperative and Indian planning", Vika publishers, N.D., 1977.

012

D. Mohan, A.K. Prabhakar (Mrs. M. Mohun), B. Chitkara. "Factors associated with the prevalence of drug abuse among Delhi University students", Indian J. Psychiat., 20 :332-38, 1978.