Adolescence and the consumption of psychoactive substances: the impact of the socioeconomic status

Sociodemographic profile of psychoactive substance use among selected secondary school students in rural Nigeria

Objectives Use of Psychoactive substances by young people poses an important public health threat despite mass campaigns and education. There have been documentations of rise in prevalence and use of psychoactive substances by Nigerian adolescents in urban areas of Nigeria. Few reports exist on in-school adolescents in rural areas, and differences in their sociodemographic profile such as public/private school attendance, day/boarding status and socioeconomic status of students. The study determined the rate and sociodemographic profile of psychoactive substance use among secondary school students in selected rural communities in Anambra state, Nigeria. Methods This was a cross-sectional study in which multistage sampling was used to select 494 students from selected secondary schools in Anambra state. Data on age, gender, socioeconomic status, student status, school category, alcohol, tobacco and intravenous drug use were obtained using pretested semi-structured questionnaires. Analysis of data was done using IBM SPSS statistics software version 20.0, frequency, percentages and means were calculated, with cross-tabulation done for variables (Chi-square and Fishers exact test where applicable). Level of significance for tests of association set at 5%. Results A total of 494 participants were studied of which 48.8% (n=241) were males. The mean age was 14.5 ± 1.8 years. The prevalence of lifetime use of psychoactive substance was 22.5%. Prevalence for individual substances were 21.9% (n=108), 1.8% (n=9) and 0.8% (n=4) respectively for alcohol, tobacco and illicit intravenous drugs. Neither gender {6 males (2.5%), 3 females (1.2%), p=0.890}, age {10-13 years (1.3%), 14-16 years (2.1%), >16 years (1.7%), p=0.329}, student status {day (2.6%), boarding (1.2%), p=0.320}, social class {upper (0.9%), middle (0.6%), lower (3.1%), p=0.208 } nor school category {private (1.5%), public (2.1%), p=0.742} of students was significantly associated with smoking and respectively. More males (73/241=30.3%, p<0.001) took alcohol than females (35/253 = 13.8%) and this was statistically significant. Participants from the lower socioeconomic class (30.3%, p<0.001) had a significantly higher rate of alcohol consumption than those from the upper (11.8%) and middle classes (16.7%) respectively. Higher rate was noted among those who attended public schools (30.8%, p<0.001) compared to those who attended private schools (13.8%). Day students (30.2%, p<0.001) indulged more in alcohol than boarding students (14.3%). There was no association between either the class (junior=22.5%, senior=21.3%, p=0.759) or age of participants (10-13 years=20.7%, 14-16 years=20.1%, >16 years=33.3%, p=0.071) and alcohol consumption. No association was found between age (0.7%, 1.1%, p=1.000), gender (male=1.2%, female=0.4%, p=0.362), social class (lower=1.3%, upper=0.9%, p=0.443), student status (day=0.9%, boarding=0.8%, p=1.000), school category (junior=0.8%, senior=0.8%, p=1.000) and intravenous drug use. Conclusions The rate of about 22% alcohol use by secondary school students in rural south eastern Nigeria, which is strongly associated with male gender, low socioeconomic status, day student status and public school attendance is high.

Earlier Alcohol Use and Lower Neuropsychological Performance in Brazilian Adolescence: Is the School Environment Related to This?

OBJECTIVES

The aim of this study was to evaluate impulsivity, inhibitory control, and alcohol use in preadolescents and adolescents aged 10 to 16 from public and private schools.

METHODS

Participants were 190 adolescents selected from public and private schools in Brazil. Neuropsychological measures related to impulsivity (i.e., Barratt Impulsiveness Scale), inhibitory control (i.e., Go/No-go Task), and processing speed (i.e., Five Digits Test) were assessed.

RESULTS

60% of the sample had started drinking alcohol. Early alcohol consumption is not influenced by type of school, indicating that adolescents consume alcohol early, regardless of the type of education or income. Although there were significant differences in neuropsychological performance between types of schools, better neuropsychological performance was found in students from private schools.

CONCLUSIONS

When comparing consumption of alcohol among public and private school students, there were no significant differences, perhaps because the use of early alcohol can be a public health problem. Private school students may perform better in inhibitory control task because they have a good school environment, which serves as a protective factor.

Binge drinking and associated factors among adolescents in a city in southeastern Brazil: a longitudinal study

Abstract: The aim of this study was to investigate changes in the frequency of binge drinking and associated factors in the city of Belo Horizonte, Minas Gerais State, Brazil. The sample consisted of 436 adolescents. Data collection involved the Alcohol Use Disorders Identification Test and the Alcohol, Smoking and Substance Involvement Screening Test. Ordinal logistic regression was used in the multivariate analysis. An increase in the frequency of binge drinking was found among adolescents who lived in areas of greater social vulnerability (OR = 1.64; 95%CI: 1.01-2.68), those whose mothers consumed alcoholic beverages (OR = 1.75; 95%CI: 1.05-2.92), those whose fathers consumed alcoholic beverages (OR = 2.02; 95%CI: 1.11-3.68), those with an increased risk of tobacco use (OR = 2.82; 95%CI: 1.07-7.42) and those who attended religious services (OR = 2.10; 95%CI: 1.30-3.38). Knowledge regarding factors associated with a change in the frequency of binge drinking among adolescents can assist in the establishment of public policies directed at health promotion and the prevention of adverse health conditions.

The behavioural constellation of deprivation: Compelling framework, messy reality

Pepper & Nettle's (P&N's) argument is compelling, but apparently contradictory data are easily found. Associations between socioeconomic status (SES) and substance abuse are sometimes positive, the poor are sometimes eager to educate their children, and perceptions of local mortality risk can be so distorted as to constitute an implausible basis for contextually appropriate responding. These anomalies highlight the need for more psychological work.

Nonprescribed use of tranquilizers and use of other drugs among Brazilian students

OBJECTIVES

To describe patterns of nonprescribed use of tranquilizers by students aged 10 to 18 years and assess the sociodemographic characteristics of these adolescents and their use of other substances.

METHODS

A randomized and stratified sample of 47,979 students from state and private schools of the 27 Brazilian state capitals completed a self-report questionnaire. Poisson regression was used to estimate the associations between tranquilizer use and sociodemographic factors, as well as the use of other psychotropic substances.

RESULTS

The lifetime prevalence of nonprescribed use of tranquilizers was 3.9%. Use was most common among girls, wealthier adolescents, and those from private schools. An association was found between use of tranquilizers and lifetime use of alcohol (prevalence ratio [PR] = 3.15; 95% confidence intervals [95%CI] 2.58-3.85), tobacco (PR = 2.61; 95%CI 2.31-2.95), illicit drugs (PR = 3.70; 95%CI 3.19-4.29), and other prescription drugs (PR = 7.03; 95%CI 6.18-7.99). As the number of substances adolescents reported having used increased, so did the nonprescribed use of tranquilizers.

CONCLUSIONS

Nonprescribed use of tranquilizers by adolescents might indicate the use of other substances, including high-risk combinations such as tranquilizers and alcohol. The risks of this association should be addressed during the early stages of drug prevention programs.

Social rank and inhalant drug use: the case of lança perfume use in São Paulo, Brazil

BACKGROUND

Lanca perfume (chloroform/ether) is an inhalant used mainly by higher social class students in Brazil. In light of the social and epidemiological features of lanca use, supply, and distribution, this investigation tests hypotheses about the degree to which use of inhalant lanca might be occurring in clusters, consistent with social sharing and diffusion, and might show a direct association with social rank even within the relatively privileged social context of private schools in a large mega-city of Latin America.

METHODS

Epidemiologic self-report survey data were from a large representative sample of urban post-primary private school students in São Paulo city, Brazil, in 2008. Newly incident lanca use was studied, first with estimates of clustering from the alternating logistic regressions (ALR) and then with conditional logistic regressions to probe into the hypothesized direct social rank association.

RESULTS

ALR disclosed a clustering of newly incident lanca users within private school classrooms (pairwise odds ratio (PWOR)=2.1; 95% CI=1.3, 3.3; p=0.002) as well as clusters of recently active lanca use (PWOR=1.9; 95% CI=1.1, 3.3; p=0.02). Occurrence of lanca use within private school classrooms was directly associated with social rank (odds ratio (OR)=0.2; 95% CI=0.1, 0.8; p=0.03 in the contrast of lowest socio-economic status (SES) versus highest SES strata within classrooms). Thereafter, study of other drugs disclosed similar patterns.

CONCLUSIONS

The clustering estimates are consistent with concepts of person-to-person sharing of lanca within private school classrooms as well as other dynamic processes that might promote lanca clusters in this context. An observed direct association with social rank is not specific to lanca use. Direct SES estimates across a broad profile of drug compounds suggests causal processes over and above the more specific initially hypothesized social rank gradients in the lanca diffusion process. A novel facet of the evidence is greater occurrence of drug use among the higher social rank private school students, which should be of interest in the social science community.

Drug Use and HIV Risk Among Middle-Class Young People in Guatemala City

This qualitative study explored the relationship between drug use and risk for HIV transmission among middle-class young people in Guatemala City. It used the PEER methodology, whereby the interviewers were themselves drug users, and each recruited three friends as informants. The 21 peer interviewers recruited a total of 62 informants who participated in three interviews each. The informants viewed drug use favorably: as the social lubricant that facilitates interactions with friends and provides new, pleasurable experiences, free from the conventions of a conservative society. Drug use was limited almost exclusively to noninjection drugs: cocaine, marijuana, ecstasy, lysergic acid diethylamide, and mushrooms. Informants feared pregnancy, detection of their drug use, overdosing, and becoming addicted but did not perceive any risk of HIV. With the recent escalation of drug trafficking in Guatemala, it is important to build the evidence base on drug use in this population and its potential implications for HIV transmission.

Early adolescents and substance use

1300 students (54.3% girls) 13-16 years old were interviewed in the urban area of Bologna during 2010. Random effect multiple logistic regression models were used. Results show a reciprocal relationship between alcohol use, tobacco, and cannabis. Most users were offered cannabis, began using at 14 years of age, and do not believe using is very dangerous. They live with only one parent, have more than 50 euros of spending money per month, and abuse alcohol, abuse that increases relative to the intensity of cigarette smoking. Legal/illegal dichotomy seems to overturn, where alcohol becomes a "drug" and the use of tobacco, similar to other drugs, is motivated as a solution to reduce anxiety, combat boredom, relax, and to ease loneliness.

Fatores de risco para dependência de álcool em adolescentes

OBJETIVO: Identificar os fatores de risco para dependência do álcool na adolescência. MÉTODOS: Revisão integrativa com 21 artigos publicados entre 2000 e 2009, capturados nas bases de dados LILACS, BVS, MEDLINE, COCHRANE e IBECS com as palavras-chave: adolescência, risco para dependência e álcool. RESULTADOS: Há evidências de que o álcool é a droga mais consumida por adolescentes, com início entre 14 a 16 anos. Os fatores de risco para dependência estão relacionados ao início precoce do uso, influência da mídia, relacionamento conturbado com os pais, uso por membro da família, abuso sexual, violência doméstica, baixa autoestima, curiosidade, pressão de colegas, entre outros. Apontam a vulnerabilidade genética para a dependência do álcool e controvérsias em relação ao gênero e classe social. CONCLUSÃO: Os serviços de saúde devem incorporar estratégias preventivas de identificação de riscos para a dependência, controle e acompanhamento específicos ao grupo de adolescentes dependentes.

[Community therapy as a method to address the problem of alcohol abuse in primary care]

This study aimed to identify the potential of community therapy (CT) as a method to address the problem of alcohol abuse in primary care from a user perspective. This study was carried out at the headquarters of the Quatro Varas Project, Fortaleza-CE, Brazil. This qualitative, ethnographic study used semi-structured interview and participant observation. Of the 20 interviewed participants, one was chosen for an in-depth interview. Two thematic units were constructed: the effects of the therapy on alcoholism and therapy as a social support resource for problems related to alcohol use. Results indicate that the dialogue established during therapy promotes re-signification of the problem and redirects the therapy course towards management of one's own life and search for citizenship. We concluded that CT favors the elaboration of a network of systemic relationships that broaden the understanding of problems caused by alcoholism and is an effective strategy to address the problem in the community health sphere.

[Relations between family context and substance abuse in high school adolescents]

This study aimed to describe the family context characteristics of high school adolescents and their relation to psychoactive substance abuse. It is a cross-sectional and descriptive study, with a population of 657 secondary-school students in the city of Leon, Nicaragua, which corresponded to 31% of the research context. Data was collected through an anonymous questionnaire. Results show that 56% of the adolescents were living with both parents and 32% only with the mother, 86% declared a good relationship with the mother, but 24% did not show confidence in the mother figure. Regarding psychoactive substance use within the family context, 52% of the adolescents' family presented previous use events and, in 42% of cases, the father was the user. Results offer important contributions to design public healthcare policies and to outline prevention strategies for use among adolescents.

Social factors associated to binge drinking: a cross-sectional survey among Brazilian students in private high schools

BACKGROUND

Binge drinking (BD) seems to be related to health and social complications among adolescents. Considering that knowledge about BD in developing countries is limited and that in Brazil high socioeconomic status is a risk factor for alcohol abuse, this study sheds light about this phenomenon among adolescents from a different cultural background than prior North-American and European studies.

METHODS

Brazilian students (n = 2691) selected through a representative, stratified and clustered sampling method were asked to answer a self-report questionnaire. The questionnaire contained questions about patterns of alcohol consumption, religious beliefs, leisure activities, family structure and relationships. Data were analyzed with basic contingency tables with Chi-square tests followed by a decision tree analysis and weighted logistic regression.

RESULTS

Almost thirty-five percent of the students reported recent binge drinking. BD in the past month was positively associated with older age (aOR = 1.5[1.2-1.7]), male gender (aOR = 1.5[1.2-2.0]) going out with friends almost every night (aOR = 33.9[14.2-80.7]), not living with mother (aOR = 2.4[1.3-4.7]), believing in God with little conviction (aOR = 1.6[1.2-2.0]) and rarely talking to parents about anything (aOR = 1.7[1.3-2.2]) or always about drugs (aOR = 1.8[1.3-2.5]). Factors inversely associated with BD were: paying lower monthly tuition fees (aOR = 0.5[0.4-0.9]), living with people who do not get drunk (aOR = 0.6[0.4-0.7]) and frequent engagement in worships (aOR = 0.7[0.5-0.9]).

CONCLUSION

The habit of BD in adolescents enrolled in private high schools in Brazil is strongly linked to the frequency with which they go out with friends at night. Factors such as religiosity, expressed by trust in God and participation in worship, and being enrolled in a school with cheaper tuition fees were associated with avoidance of BD in this population.

Consumo de drogas en los jóvenes de la ciudad de Guayaquil, Ecuador

El objetivo de esta investigación fue conocer las causas predominantes y el tipo de droga que más consumen los jóvenes de 10 a 18 años que ingresaron en una institución que acoge niños infractores de una ciudad del Ecuador. Se trata de un estudio descriptivo y cualitativo, cuya recolección de datos ocurrió mediante entrevista semiestructurada e individual. Participaron diez jóvenes, con edades entre 10 y 16 años. El análisis de contenido resultó en tres temas: la carencia del apoyo familiar; las influencias del entorno en que se desarrollan los jóvenes y el desconocimiento del efecto que causan las drogas y los planes para el futuro. Se identificó que la droga más consumida fue la marihuana, seguida del alcohol e inhalantes. Explorar las causas que llevaron a estos jóvenes a consumir drogas contribuyó para la identificación de sus necesidades y de los espacios importantes para el cuidado en salud, con énfasis en la promoción de la salud.

Psychosocial problems in adolescents with type 1 diabetes mellitus

Adolescents with diabetes are at increased risk of developing psychiatric (10-20%) or eating disorders (8-30%), as well as substance abuse (25-50%), leading to non-compliance with treatment and deterioration of diabetic control. At high risk are female adolescents with family problems and other comorbid disorders. Impaired cognitive function has also been reported among children with diabetes, mainly in boys, and especially in those with early diabetes diagnosis (< 5 years), or with episodes of severe hypoglycaemia or prolonged hyperglycaemia. Type 1 diabetes mellitus contributes to the development of problems in parent-child relationships and employment difficulties, and negatively affects the quality of life. However, insulin pumps appear to improve patients' metabolic control and lifestyle. The contributions of family and friends to the quality of metabolic control and emotional support are also crucial. In addition, the role of the primary-care provider is important in identifying patients at high risk of developing psychosocial disorders and referring them on to health specialists. At high risk are patients in mid-adolescence with comorbid disorders, low socioeconomic status or parental health problems. Multisystem therapy, involving the medical team, school personnel, family and peer group, is also essential. The present review focuses on the prevalence of nutritional and psychosocial problems among adolescents with diabetes, and the risk factors for its development, and emphasizes specific goals in their management and prevention.