Patterns of drug, alcohol and tobacco use among high school students in Santiago, Chile
Author: R. FLORENZANO URZUA,, E. MANTELLI,, V. MADRID,, A. M. MARTINI, M. E. ZALAZAR
Pages: 33 to 44
Creation Date: 1982/01/01
A. M. MARTINI
M. E. ZALAZAR
Faculty of Medicine of the University of Chile, Santiago, Chile
A survey using a self-administered questionnaire, based on a sample of 1,240 students from four public schools in Santiago, showed that 70.1 per cent of the students used alcohol, 56.3 per cent tobacco, 7.3 per cent cannabis, 2.5 per cent tranquillizers, 1.9 per cent stimulants and 0.7 per cent tranquillizers together with stimulants. Frequent alcohol consumption was found among 14.5 per cent of the students, 11.1 per cent of them smoked more than six cigarettes a day and 1.4 per cent smoked cannabis more than once a week. Consumption of these substances was more frequent among students who came from presumably more affluent residential neighbourhoods. Easy access to drugs played an important role in the occurrence of drug abuse.
The abuse of psychoactive substances among teenagers has emerged as a high-priority health problem during the past decade. Drugs such as cannabis (marijuana) and other natural or synthetic hallucinogens which traditionally have been used infrequently in Western cultures have created greater public concern than, for example, alcohol, tobacco and tranquillizers. lnvestigations into the use of these substances have only begun in recent years.
In Chile, studies undertaken on this subject have generally been limited in scope and have dealt with the use of cannabis [ 1] , alcohol and, more recently, with tobacco [ 2] , [ 3] . In research conducted in 1968 - 1970 by one of the authors [ 1] , a 6.96 per cent prevalence rate of cannabis use was reported among 734 high school students. In that study, students who used alcohol and whose parents used it excessively were more likely to use cannabis. Some of the reasons for the use of psychoactive substances among the young have been traced to the psychological characteristics of adolescence [ 4] . Hendin reported [ 5] , [ 6] that these traits include the search for new experiences, the use of drugs as emotional stabilizers, a challenge to parents and society, a form of rebellion, a passport into the youth culture, and as a facilitator of sexual involvement. For many adolescents, such use of drugs is temporary, but for a few it can become a life-style.
* This paper was presented at the Second Latin American Congress on Alcohol and Alcoholism, Santiago, Chile, 9 - 14 November 1981.
In view of the above, the. authors decided to examine current drug use among teenagers in Santiago, Chile, including the use of alcohol, tobacco, cannabis and prescription drugs. The purpose of this study, which was carried out in 1979, was to find out the extent and patterns of drug use among boys and girls living in different geographical locations and socio-economic environments.
A self-reported questionnaire consisting of 63 questions was administered to 1,240 high school students in four public schools in Santiago, Chile: two of these schools were in the eastern area (Providencia), a middle and upper class residential area and the other two were in the southern area (La Cisterna), an industrial zone and low-income residential sector. There was a boys' school and a girls' school in each of the two areas. Distribution of subjects was homogeneous in the four schools and in the classes of high school.
Classes were selected at random. The questionnaire was administered to the students in their classes by the study investigators. The objectives of the study and the method of answering the questionnaire were explained to the students who thereafter answered the questions anonymously.
The questionnaire had previously been applied in a pilot test in another school in the eastern sector of Santiago in order to verify its validity and reliability. After this trial, some of the original questions were modified.
The questionnaire included a group of questions related to the extent and pattern of drug use and the characteristics of use of the psychoactive substances. For the purpose of this research, frequent users of the following substances are defined below:
Tobacco: persons smoking over six cigarettes a day;
Alcohol: persons taking alcoholic beverages one or more times a week;
Cannabis: persons using cannabis more than once a month.
Data obtained were coded manually and later processed at the Computer Unit of the Faculty of Physics and Mathematical Sciences of the University of Chile.
The study population consisted of 1,240 students. There was no statistically significant difference between the residential areas as far as the distribution of students by age and sex (table 1) was concerned.
The majority of the students (76.7 per cent) were between 14 and 17 years of age; only 1.2 per cent were under 14 years of age and 22.1 per cent were over 17 years of age. The average age of the female students in the sample was somewhat lower than that of the male students.
The occupation of the parents indicated that the socioeconomic status of the eastern area students was higher than that of southern area students. Although the difference was not statistically significant, there were many more professionals and white-collar workers in that area, while labourers were concentrated in the southern area. The majority of fathers were professionals or public servants, while mothers were mostly housewives (see table 2).
The most widely used substance was alcohol (see table 3), which was reported to have been used by 70.5 per cent of the subjects. Tobacco was next (56.3 per cent), followed by cannabis (7.3 per cent). A total of 5.1 per cent of the students used one or more tranquillizers or central nervous system stimulants obtained without medical prescription.
The study revealed that 14.5 per cent of the students used alcohol frequently (see table 4). Thirty-two per cent of the students reported having been intoxicated by alcohol, 3.4 per cent one or more times a week. Use of alcohol took place predominantly at parties or social gatherings (39 per cent), and less frequently with meals (11.8 per cent) or other occasions. A small percentage of students used alcohol occasionally, when alone, sad or depressed (0.4 per cent). Different types of mixed drinks were consumed, but hard liquor was mostly used when only one substance was consumed, and in far higher percentages than for wine or beer.
Tobacco smoking was, for the most part, occasional (45.6 per cent smoked less than five cigarettes a day), while only 1.7 per cent of the subjects smoked over 11 cigarettes a day. Among tobacco smokers, 33.8 per cent indicated that they smoked at parties or social gatherings. Only 6.8 per cent of the subjects stated that they smoked to fight anxiety or depression.
Almost 17 per cent of the subjects surveyed had tried cannabis and 7.3 per cent continued to use it. Three quarters of these used it occasionally (less than once a month) and only 12 (1.4 per cent) did so several times a week or daily. The main reason for cannabis use was curiosity (55.6 per cent).
Male students used alcohol more frequently than female students and were more often intoxicated by it. Tobacco smoking was similar in both sexes, but there were more males among the frequent smokers. The use of cannabis was more frequent among males than females. (See table 4.)
The graph shows an increase in the use of alcohol, tobacco and cannabis between the first and third year of high school, with a slight decrease in the fourth year. In the use of psychoactive prescription drugs there is no relationship between level of use and the year of high school.
Table 5 shows the distribution of the total sample of frequent users of alcohol (n = 182), cannabis (n = 24), and tobacco (n = 132), by sex and place of residence. Most of the frequent users of these substances were male students of the eastern area, which is populated by people from the higher income groups. There were no significant differences with respect to school grades between the frequent users and the total sample.
Table 6 shows that the majority of the frequent users of alcohol, cannabis and tobacco lived with both parents. The percentage of subjects who lived with one parent or with other persons ranged between 30.7 per cent to 37.5 per cent in all three groups. In the total sample the proportion of these was only 23 per cent. Therefore, living arrangements with respect to parents seemed to be related to a certain extent to drug use.
In the majority of cases the father was a professional, public employee or merchant. Among mothers, the highest percentage were housewives, as in the total group. However, it is important to note that there was a higher percentage of professional mothers of students in the group of frequent users of psychoactive substances than in the total sample.
With regard to permission by parents for the use of alcohol, tobacco and cannabis, most respondents said that they were forbidden by their parents or guardians to use these substances. This fact coincided with the total sample. It is noteworthy that in the homes of frequent drinkers prohibition of alcohol use (20.9 per cent), and in the homes of excessive smokers prohibition of smoking (16.9 per cent), was less pronounced than in the total sample (38.3 per cent and 37.9 per cent respectively) (see table 7).
In analysing the response to the question how the students perceived the relationships with their parents, it was found that there were more conflicts with parents in the group of frequent users of alcohol, cannabis and tobacco than in the total sample. This conflict could either be with the father or with the mother and it was especially high among frequent users of either cannabis or tobacco smokers (see table 8).
Frequent users of cannabis showed less interest and greater difficulty in establishing friendly relationships with other students or with the opposite sex. They also showed a lower degree of adaptation to their classmates than excessive drinkers and smokers or students in the total sample (see table 9).
As with all self-reported data, the results of this study must be carefully interpreted, since under-reporting is particularly likely to occur. The authors believe, however, that the estimates of prevalence found were conservative, vis-a-vis reality.
The sample used was made up of urban high school students. They were therefore not representative of the average Chilean adolescent. Frequent users were arbitrarily defined. Cannabis users constituted a small group. Because of the small number of cases, users of volatile solvents were not analysed.
In general, the use of psychoactive substances among the students was occasional, alcohol and tobacco being the principal substances used. This was probably due to the high level of general social acceptance of alcohol and tobacco, combined with ignorance about their harmful effects on health and of their dependence-producing nature.
With respect to tobacco smoking by sex, age of initiation and a trend towards occasional use, the results of this study coincide with an earlier study carried out in the northern area of Santiago [ 2] . Research by Salas [ 3] undertaken in Providencia in 1979 showed a prevalence rate of tobacco smoking of 58.3 per cent among adolescents of the third high school year, a figure very similar to the findings of this research (56.3 per cent) for the total sample and 59.4 per cent for the adolescents in Providencia. This coincidence occurred even though their research utilized weekly, rather than the daily, frequency used in this survey. Occasional tobacco smoking was frequent among female students, while male students tended to smoke more often.
Male students were more prone to drinking alcohol and the fact that the percentage was highest in the third year of high school suggests that prevention programmes should be initiated with younger adolescents or children. Percentages for occasional use and frequent use of alcohol in this sample were similar to the findings of a recent study in Talca, Chile [ 7] , which showed that 84.9 per cent of the adolescents in the sample used alcohol and 12.5 per cent were excessive drinkers. This is particularly interesting because alcohol is easily available in the Talca region of Chile, known as a vineyard and wine-producing area. Thus, greater frequency in the use of psychoactive substances in general in the eastern area of Santiago, compared with the southern area, could be explained by the fact that families in the eastern area had higher incomes and, therefore, greater accessibility to drugs. This could also be attributed to cultural factors. The fact that a larger number of children of professional parents were among frequent users of psychoactive substances also supported the assumption that the family's socio-economic status and the concurrent accessibility to drugs were factors contributing to the occurrence of drug use.
It is interesting to note that the percentages of cannabis users have not differed from the results of our 1969 study which showed 7.3 per cent of cannabis smokers. A difference that should be noted is that the 1969 study was carried out in an experimental co-educational school in the eastern area. The current study used four public schools. Therefore, the populations studied might not be comparable.
The use of psychoactive prescription drugs was different between male and female students. The use of both tranquillizers and stimulants was predominant among females, as has been found in some other studies [ 8] . It is also of interest to note that the substances which were considered harmful by adolescents were the least used [ 9] , [ 10] , while those considered less harmful (tobacco and alcohol) were most frequently used. These findings should be taken into account in planning prevention campaigns.
Stability of family relationships is crucially important in understanding the reasons for frequent use of psychoactive substances. A high proportion of the frequent users either did not live with their parents or lived with only one of them. At the same time, the frequent users of psychoactive substances who lived with both parents, but had a closer relationship with their mother, had more conflicts than the total sample. From this type of study it is impossible to conclude whether this phenomenon is a cause or a consequence of a difficult family relationship.
Attitudes towards the use of alcohol and tobacco were more permissive in the homes of frequent users of psychoactive substances than in the total sample. The imposition of restrictions on the consumption of drugs was unrelated to greater use of cannabis. It appears that the conduct of the parents regarding their own use of the substance was more important than the imposition of restrictions. For example, the use of alcohol by parents, particularly by mothers, was greater among frequent drinkers than in the total sample.
The ability to create positive relationships with others seemed to be lower among cannabis users than in other groups. The cannabis users perceived themselves to have more difficulties in relating to friends, persons of the opposite sex and to their classmates.
Frequent use of, and intoxication with, alcohol among adolescents should encourage the development of preventive and treatment programmes. This study indicated that the families of adolescents were directly associated with their children's problems. Primary preventive activities should, therefore, be directed towards the family, emphasizing greater communication between parents and their children as well as stability and integration of the family.
This study also indicated that the use of psychoactive substances which were considered by the public as being harmful was moderate and occasional among the young people. The public attitudes were reflected in a positive perception of such substances by adolescents. However, the use of alcohol and tobacco was more common although such use was potentially harmful, but it was not perceived by adolescents and their parents or the public to be a real problem.
l. M. Gomberoff, R. Florenzano and J. Thomas, "A study of the conscious motivations and the effects of marihuana smoking on a group of adolescents in Chile", Bulletin on Narcotics (United Nations publication), vol. 24, No. 3 (1972), pp. 27 - 33.002
S. Pacheco, A. Avendano and C. Valenzuela, "Consumo de cigarrillo en 1989 mujeres y 2275 varones escolares de ensenanza media en el Area Norte de Santiago", Pediatria, vol. 20, No. 1 (1977), pp. 60 - 69.003
I. Salas, "Prevalencia de tabaquismo en adolescentes de la Comuna de Providencia y Las Condes ", Revista Medica de Chile , vol. 108, No. 5 (1980), pp. 453 - 461.004
R. Florenzano, "El problema del abuso de drogas y farmacodependencias : actualización bibliográfica ", Boletin del Hospital "San Juan de Dios", vol. 26, No. 4 (1979), pp. 249 - 258.005
H. Hendin, "Marihuana use among college students", Journal of Nervous and Mental Disease , vol. 156, No. 4 (1973), pp. 259 - 270.006
H. Hendin, "College students and LSD: who and why? Journal of Nervous and Mental Disease , vol. 156, No. 4 (1973), pp. 249 - 258.007
S. Villalobos,"La ingestión de alcohol en el escolar adolescente", Cuadernos Medico-Sociales,vol.21,No.1 (1980), pp.53-58.008
H.Reiskin and H.Wecholer,"Drinking among college students using a campus mental health center " Journal of Studies on Alcohol . vol.42, No.9 (1981), pp.716-724.009
D. Kandal,I. Adler and M. Sudit,"The epidemiology of adolescent drug use in France and Israel", American Journal of Public Health , vol. 71, No.3 (1981), pp.256-265.010
Ch. Lowman, "Alcohol use as an indicator of psychoactive drug use among the nation's senior high school students", Alcohol and Research World (National Institute of Alcoholism and Alcohol Abuse (NIAAA-USA) vol.6 (1981-1982), pp.46-51.