High prevalence of substance use and associated factors among high school adolescents in Woreta Town, Northwest Ethiopia: multi-domain factor analysis

BMC Public Health High prevalence of substance use and associated factors among high school adolescents in Woreta Town, Northwest Ethiopia: multi-domain factor analysis Anteneh Messele Birhanu 0 1 Telake Azale Bisetegn 1 3 Solomon Meseret Woldeyohannes 1 2 0 Department of Nursing, College of Medicine and Health Sciences, University of Gondar , Gondar , Ethiopia 1 Authors' information 1. AM is Lecturer, Department of Nursing, College of Medicine and Health Sciences at University of Gondar, Ethiopia. AM has Bachelor of Science Degree in Nursing and Masters Degree in Public Health-Reproductive Health. 2. TA is Assistant Professor of Public Health, Department of Reproductive Health, Institute of Public Health at University of Gondar, Ethiopia. TA has Diploma in Nursing, Advanced Diploma in Psychiatry Specialize Nursing, Bachelor of Science Degree in Public Health Officer, Masters Degree in Public Health and A PHD candidate in Psychiatry Epidemiology. 3. SM is an Assistant Professor of Biostatistics, Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Ethiopia. SM has Bachelor of Science Degree in Statistics, Masters Degree in Public Health - Biostatistics and Epidemiology and A PHD candidate in Public Health 2 Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar , Gondar , Ethiopia 3 Department of Reproductive Health, Institute of Public Health, University of Gondar , Gondar , Ethiopia Background: Substance use is a major public health concern in global settings, and is very common during adolescence period leading to physical and/or mental health complications. This study assessed the prevalence of substance use and associated factors among high school adolescents in Woreta Town, Northwest Ethiopia, 2012. Methods: A school based cross-sectional study was conducted from April 7 to April 15, 2012 amongst 684 9th to 12th grade high school students in the town of Woreta. Participants were selected by stratified sampling, and data were collected using an anonymous questionnaire adapted from the 2008 Community That Care Youth Survey. Bivariate and multivariate logistic regression analysis was performed to identify factors associated with substance use. Results: A total of 651 students participated in the study with a response rate of 95.2%. The current prevalence of substance use among Woreta high school students was 47.9% and life-time prevalence was 65.4%. The current and lifetime prevalence of alcohol use was 40.9% and 59% respectively. Siblings' use of substances (AOR [95% CI]: 2.72 [1.79, 4.14]), family history of alcohol and substance use (AOR [95% CI] 2.24 [1.39-3.59]) and friends' use of substances (AOR [95% CI] 2.14 [1.44-3.18]) were factors positively associated with substance use. On the other hand, religiosity and social skill were found to be 54% (AOR [95% CI] 0.46, [0.31-0.68]) and 39% (AOR [95% CI] 0.6 [0.40-0.91]) negatively associated with substance use. Conclusions: The prevalence of substance use amongst adolescents was high for the three substances namely alcohol, cigarette and khat with alcohol being the most common. Community norms favorable to substance use, family history of alcohol and substance use, siblings' substance use, poor academic performance, low perceived risk of substances and friends' use of substances had positive association with adolescent substance use while religiosity and social skills were found to have negative association with adolescent substance use. Initiate public awareness campaigns to inform adolescents and adults, particularly parents, of the risk of substance use. Developing culture friendly, gender based adolescent and family based programs and initiating public awareness are recommended to decrease substance use by adolescents. Adolescence; Alcohol; Associated factors; Cigarette; Khat; School and substance use - Background High level of peer influence, risk taking behavior and experimentation with substances are normal developmental changes in adolescence [1]. Globally, substance use of products such as alcohol, cigarette, and khat leaves (Catha edulis) has become a major public health concern with accompanying socio-economic problems. Studies show that substance use, particularly in developing countries, has dramatically increased [2]. Substances are used and abused widely among African youth. This situation poses serious social and public health problems similar to those in most Western societies [3]. A study among Nigerian high school students indicated that lifetime prevalence of substance use was 87.3% whereas current use was 69.2% with multiple substance use being 57.4% [4]. Lifetime prevalence rate of any substance use was found to be 69.8% among college students in Kenya [5]. In Ethiopia the commonly used substances were alcohol, cigarettes, khat and cannabis which frequently lead to addiction [6]. Substance use is harmful leading to decreased academic performance, increased risk of contracting HIV and other sexually transmitted diseases (STDs), or psychiatric disorders such as lethargy, hopelessness, insomnia [7] and depressive symptoms [8]. Alcohol is a serious public health problem. Globally, harmful use of alcohol results in the death of 2.5 million people annually. Alcohol contributes nearly to 4% of deaths with 6.2% of all male deaths related to alcohol compared to 1.1% death of females worldwide. Annually, 320000 young people aged 1529 years die from alcoholrelated causes resulting in 9% of all deaths in that age group globally [9]. Early onset of drinking increases the likelihood of alcohol-related injuries, motor vehicle crash involvement, unprotected intercourse, and interpersonal violence [10]. Alcohol use also contributes to youth suicides, homicides and fatal injuries [11]. The World Health Organization (WHO) report shows that beer 33%, spirits 22%, others 43% and wine 2% are consumed by people whose age is 15+ in Ethiopia [12]. A study of high school students in Dire Dawa showed the prevalence of life time and current alcohol drinking is 34.2% and 19.6% respectively [13]. Khat chewing is common in Africa and mostly in countries of the horn of Africa [13-15]. Khat consumption has a negative impact on family and social life [16,17]. It may act as a factor that exacerbates family disruption [18]. Khat is a legal drug like cigarette and alcohol in Ethiopia, openly sold at markets and chewed in streets. It has different legal status in Africa; legal in Djibouti, Kenya, Yemen and Uganda, but illegal in Tanzania and Eritrea. Several studies show that Khat is widely used among Ethiopian adolescents. A study done among high school adolescents in Eastern Ethiopia showed that the prevalence of khat chewing was 24.2% [19]. Another study in Dire Dawa showed the prevalence of life time and current chewing of khat was 18.4% and 10.9% respectively [13]. Globally, direct tobacco smoking causes the death of more than 5 (...truncated)