{¹Associate Professor, ^5,6,7PG Student, Department of Psychiatry} {²Associate Professor, Department of Community Medicine}

{³Professor, Department of Pathology} Belagavi Institute of Medical Sciences, Belagavi, Karnataka, INDIA.

⁴Private Consultant, Belagavi, Karnataka, INDIA.

Email: drtrcshekar007@gmail.com

Table 1: Socio-demographic data

After analysing questionnaires, 189 (22.83 %) students had history of substance abuse. In present study, pan chewing / gutakha consumption (18.72 %) was most common substance abuse noticed followed by smoking (cigarette/beedis) (16.06 %), alcohol (10.99 %) and least was narcotics (3.38 %).

Table 2: Distribution based on substance abuse.

^*One or more substance abuse may present simultaneously

In tobacco smoking group 81.95 % smoked cigarettes while 18.05 % had beedi smoking. 16.54 % had daily smoking while 13.53 % had weekly smoking. In students who had oral tobacco consumption Gutakha was common in 73.35 % while 26.45 % had pan chewing. 36.77 % had daily oral tobacco, while 14.91 % had weekly oral tobacco. In students had history of alcohol use majority had used single item (52.75 %), only 2.2 % had daily alcohol, while 12.09 % had weekly alcohol consumption.

Table 3: Characteristics of tobacco usage (N=65).

DISCUSSION

Early uptake of these substances increases their likelihood to adopt other risk behaviors as well at a later age, such as multiple substance use, violence, and delinquency.⁷ Other authors have also cited that peer and parental influences are synergistic, with the maximum rates of substance use observed among children of substance‑abusing parents, siblings, and friends.⁸ Narain R et al.,⁹ conducted a cross‑sectional study among school students. of class 7th–12th (ages: 11–19 years) studying in schools through a pretested self‑administered questionnaire through multistage sampling design. “Ever use of substance” (alcohol or tobacco) was found in 14.3% students and was 1.2 times more among boys in comparison to girls (P < 0.05). About 29.5% of these students initiated the habit before 11 years of age and its prevalence was significantly more among boys from government schools as compared to private schools. The habits were 2.2, 3.8, and 4.6 fold higher among students if the father, mother, siblings, or friends also used substances. Substance use was less frequent among children of white‑collared father and more educated parents. One‑third of students up took the habit to make friends. In a study by National Commission for Protection of Child Rights (NCPCR),¹⁰ study sample comprised of 4,024 children between 5-18 years of age (average age: 15.6±2.1years). Girls comprised 4.2% (n=169) of sample. Majority of children reported lifetime use of a variety of substances. Tobacco (83.2%) and alcohol (67.7%) were the most common substances ever used followed by cannabis (35.4%), inhalants (34.7%), pharmaceutical opioids (18.1%), sedatives (7.9%) and heroin/smack (7.9%). Use of injectable substances was reported by a significant proportion (12.6%). The gateway substance appeared to have an early onset before the use of illicit substances. The mean age of onset was lowest for tobacco (12.3 years) followed by onset of inhalants (12.4 years), cannabis (13.4 years), alcohol (13.6 years), proceeding then to use of harder substances -opium, pharmaceutical opioids, heroin (14.3-14.9 years) and then finally use of substances through injecting route (15.1 years). Regarding risk factors in other studies, substance abuse is significantly associated with domestic violence, maltreatment of the child, nuclear families, runaway status and working status of the child. Most of them took to substances as a way of street life or to remain in the peer group.¹¹ Raphael L et al.,¹² studied 402 college student participants using a self- administered pretested semi structured questionnaire, 31.8% used or abused any one of the substances (alcohol, smoking, pan chewing) irrespective of time and frequency in lifetime. Age, gender, place of residence, attitude towards ban were significantly associated with substance abuse. The alarming trend of substance abuse among the youth reveals the urgent need to curb the menace. Adolescent counselling sessions might ensure preventing such behavior from being inculcated in early adolescence. Vartika S et al.,¹³ studied 511 male adolescents, students of 10th to 12th class from the four intermediate schools of the Doiwala block of Dehradun district. 46.9% students accepted substance abuse. In 75.5% cases, friends were providing the substances. 80.2% substance abusers expressed their desire to quit the habit. The study is indicative of need for developing a supportive environment involving both parents and teachers so that adolescent can decide and sustain with the right choices for healthy life. Qadri SS et al.,¹⁴ conducted a descriptive cross-sectional survey, among 1500 students (13-19 years) studying in classes 7th-12t, using the Self-Administered WHO Model Core Questionnaire. Overall prevalence of substance abuse was 60.0% for ever users and 34.93% for regular users. Substance abuse was more among male urban students belonging to nuclear families (p<0.001). Among ever users, alcohol (44.49%) was the most common substance abused while tobacco (14.42%) was mostly consumed by regular users. Substance abuse was more in age group of 17-19 years. Overall 42% were using more than one drug combination. Prevalence of substance use among school children in Northern India is high and causes significant physical and psychosocial problems in this population. A large proportion of those using drugs reported serious adverse effects, raising the necessity of targeted interventions to reduce the risk of subsequent substance dependence and other deleterious consequences. Mahmood et al.,¹⁵ with results on prevalence in Bareilly, Uttar Pradesh with 3.2% children admitted to having consumed alcohol in the past 30 days and 5.2% having consumed alcohol in the past. Jain et al.,¹⁶ reported a prevalence of 4.6%, of which 57.9% were males and 42.1% were females. Mangalore Bukelo et al.,¹⁷ reported in their study with a similar setting that only one boy admitted to having consumed alcohol. Mohammad et al.,¹⁵ reported a past smoking rate of 5.2%, currently smoking adolescents were 4.8%, 4.8% were also noted to be using smokeless tobacco, 2.4% used smokeless tobacco in the past. Puwar et al.,⁶ in Surat reported no adolescent smoking in their study. Jain et al.,¹⁶ reported 1.2% of students all males to have smoked tobacco, and only 4 students to have smoked about 5 cigarettes three times a week in the past 30 days. The main reason reported by students for adopting the substance habit was to make friends and to look smart, whereas other authors have highlighted enjoyment, curiosity, and socialization as the most common reasons for substance use by adolescents.^18,19 Prevention programs should address all forms of drug abuse, alone or in combination, including the underage use of legal drugs (e.g., tobacco or alcohol); the use of illegal drugs (e.g., marijuana or heroin); and the inappropriate use of legally obtained substances (e.g., inhalants), prescription medications, or over-the-counter drugs.²⁰ Educational material regarding substance abuse and their harmful effects can be imparted to teachers and later introduced in school curriculum. Adolescent counselling sessions might help students to reveal family issues and take preventive measures.

CONCLUSION

Alarming rise in substance use (alcohol, cigarette/beedis smoking, pan chewing / gutakha, narcotics) was noted in students of 16-19 years. Preventive measures should be geared in form of awareness in classes, disadvantages of unhealthy habits during adolescence, awareness to parents to reduce bad influence of family to reduce substance use in students. Government should also pro-actively ban on such substances.

REFERENCES

1. The group of investigators for the National Survey on Extent and Pattern of Substance Use in India (2019). Magnitude of Substance Use in India. New Delhi: Ministry of Social Justice and Empowerment, Government of India.
2. Browning MHEM, Larson LR, Sharaievska I, Rigolon A, McAnirlin O, Mullenbach L, et al. (2021) Psychological impacts from COVID-19 among university students: Risk factors across seven states in the United States. PLoS ONE 16(1): e0245327.
3. Chen C-Y, Lin K-M. Health consequences of illegal drug use. Curr Opin Psychiatry 2009; 22 : 287-92.
4. Sarangi L, Himanshu P, Acharya O, P Panigrahi. Substance abuse among adolescents in urban slums of Sambalpur. Indian J Community Med 2008;33:265-7.
5. Bansal RK, Banerjee S. Substance use by child laborers. Indian J Psychol 1993;35:159-61.
6. Puwar aT, Saxena D, Yasobant S, Savaliya S. Noncommunicable Diseases among School ‑ going Adolescents- A Case Study on Prevalence of Risk Factors from Sabarkantha District of Gujarat , India. Indian J Comm Med. 2018;43(1)S33.
7. Bonomo YA, Bowes G, Coffey C, Carlin JB, Patton GC. Teenage drinking and the onset of alcohol dependence: a cohort study over seven years. Addiction 2004;99:1520-8.
8. Tsering D, Pal R, Dasgupta A. Licit and illicit substance use by adolescent students in eastern India: Prevalence and associated risk factors. J Neurosci Rural Pract 2010;1:76‑81.
9. Narain R, Sardana S, Gupta S. Prevalence and risk factors associated with substance use in children: A questionnaire‑based survey in two cities of Uttar Pradesh, India. Indian J Psychiatry 2020;62:517-23.
10. Assessment of pattern, profile and correlates of substance use among children in India, National Commission for Protection of Child Rights (NCPCR), 5th Floor, Chanderlok Building, 36 Janpath, New Delhi-110 001
11. Sharma N, Joshi S. Preventing substance abuse among street children in India: a literature review. Health Sci J 2013; 7: 137-48
12. Raphael L, Raveendran R, Sajna MV. Prevalence and determinants of substance abuse among youth in Central Kerala, India. Int J Community Med Public Health 2017;4:747-51.
13. Vartika Saxena, Yogesh Saxena, Gaurav Kishore, Pratap Kumar, A Study on Substance Abuse among School Going Male Adolescents of Doiwala Block, District Dehradun, Indian Journal of Public Health, Volume 54, Issue 4, October-December, 2010
14. Qadri SS, Goel RKD, Singh J, Ahluwalia SK, Pathak R, Bashir H. Prevalence and pattern of substance abuse among school children in northern India: A rapid assessment study. Int J Med Sci Public Health 2013; 2:273-282.
15. Mahmood SE, Bilal Khan KM, Agrawal AK. Study of lifestyle disease risk factors among school going adolescents of urban Bareilly, Uttar Pradesh, India. Int J Community Med Public Heal. 2017;4(2)516.
16. Dhanawat J, Kotian Ms, Angeline R, Jain A. Assessment of risk factors of non-communicable diseases among high school students in Mangalore, India. Int J Heal Allied Sci. 2012;1(4)249.\
17. Bukelo MF, Kiran D, Ramakrishna GB, Bukelo MJ, Kiran PR, Kulkarni V, et al. Risk factors for Non-Communicable diseases among rural adolescents- A school-based cross-sectional study. Asian J Pharm Clin Res. 2015;8(2)284- 287.
18. Tsering D, Pal R, Dasgupta A. Licit and illicit substance use by adolescent students in eastern India: Prevalence and associated risk factors. J Neurosci Rural Pract 2010;1:76‑81.
19. Kapil U, Goindi G, Singh V, Kaur S, Singh P. Consumption of tobacco, alcohol and betel leaf amongst school children in Delhi. Indian J Paediatr 2005;72:993.
20. Johnston, L.D.; O’Malley, P.M.; and Bachman, J.G. Monitoring the Future National Survey Results on Drug Use, 1975–2002. Volume 1: Secondary School Students. Bethesda, MD: National Institute on Drug Abuse, 2002.