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Introduction: Numerous published reports state that the
professional college students are heavy users and abusers of drugs and alcohol.
The everyday pressure of academics with an obligation to succeed, an uncertain
future and difficulties of integrating into the system, urge students to
indulge in habits like smoking, alcohol, caffeine and psychedelic drugs. The
widespread use of drugs for recreational purposes and the changing patterns of
drug use in society at large impede our ability to know the actual extent to which
students use and abuse drugs and alcohol.
Methodology: A questionnaire study was conducted using
modified ASSIST in five professional colleges of Sullia Taluk which provide
undergraduate and postgraduate training of five and three years respectively.
With prior permission of the authorities of the included institutes, students
were approached and included students were surveyed and Questionnaires were
handed out to students in a classroom.
Results: The mean age of the study sample was
21.4+2.3 years, the study showed nearly 100% prevalence of substance use in one
or the form. Non- alcoholic beverages (caffeine) were the most commonly used
reported by 96.4% of the studied population. The other substances used in order
of magnitude were alcohol -21.4% and tobacco smoking -20.5%.
Conclusion: The study indicated 100% prevalence of one
or the other form of substance use. Students affiliated to allopathic sciences
were more involved in substance use. With the advancement of each academic year
the rate of substance use showed an increase.
Public health significance: Substance use is an issue of
public health significance as it affects the younger generation who indulge in
habits at young age which affects their overall personality development.
Keywords: Prevalence, Substance, Alcohol, Tobacco
smoking, Health sciences, Students
INTRODUCTION
Substance abuse refers to the harmful or
hazardous use of psychoactive substances, including alcohol and illicit drugs
[1]. Psychoactive substance use can lead to dependence syndrome - a cluster of
behavioral, cognitive and physiological phenomena that develop after repeated
substance use and that typically include a strong desire to take the drug,
difficulties in controlling its use, persisting in its use despite harmful
consequences, a higher priority given to drug use than to other activities and
obligations, increased tolerance and sometimes a physical withdrawal state [2].
People abuse substances such as drugs, alcohol, and tobacco for varied and
complicated reasons, but it is clear that our society pays a significant cost.
The toll for this abuse can be seen in hospitals and emergency departments
through direct damage to health by substance abuse and its link to physical
trauma. Jails and prisons tally daily the strong connection between crime and drug
dependence and abuse. Although use of some drugs such as cocaine has declined,
use of other drugs such as heroin and “club drugs” has increased. Abused
substances produce some form of intoxication that alters judgment, perception,
attention or physical control [3].
According to
the numerous published reports, the perception that professional college
students are heavy users and abusers of drugs and alcohol persists within the
community. The everyday pressure of academics with an obligation to succeed, an
uncertain future and difficulties of integrating into the system, urge students
to indulge in
habits like
Smoking among health care personnel such as
medical students is an important public health issue [4]. More
effective measures to reduce tobacco smoking among medical students are needed
worldwide. A recent study in Kerala showed that substantial proportion of
physicians and medical students continue to smoke. Alcohol consumption is a
major public health problem in most parts of the world. Alcohol remains one of
the widely used drugs among college students. Earlier initiation of alcohol has
been reported to be associated with increased risk for alcohol related
problems.
Non-medical use of drugs among students has
been investigated in many countries, but the data from India is lacking or
limited. Furthermore, general data on consumption of coffee, tobacco, alcohol
and drugs of non-medical use in the general population are also very scarce in
our country. Data on tobacco consumption are only obtainable from figures of
production, and so are those for alcohol [5]. The only information on the use
of psychedelic and other addictive drugs is public notes from the police and an
annual report from the Supreme Court.
In the more general setting of a study of the
epidemiology of drug abuse in the general population in India, it was decided
to begin with a survey of the substance abuse among students of professional
colleges in Sullia Taluk of Dakshina Kannada district, Karnataka [6,7].
METHODOLOGY
A questionnaire survey was
conducted using modified Alcohol, Smoking and Substance Involvement Screening
Test (ASSIST), after obtaining ethical clearance from Institutional Ethics
committee - KVG Dental College and Hospital Sullia, in five professional
colleges in Sullia Taluk of Dakshina Kannada district providing undergraduate
and postgraduate training of five and three years, respectively. With prior
permission of the authorities of the included institutes, students were
approached by the investigator herself. All candidates will were invited to
participate in the survey and those with consent were handed the survey forms.
Students who were absent on the day of the survey and those under psychiatric
medication were excluded [8-13].
Sample size was accounted to 750
after adding 10% of the sample size to compensate for the sampling loss.
Descriptive data was recorded; percentage distribution, chi-square and Fischer
exact test were conducted using R commander to test significance of the
findings with p value set at ≤ 0.05 [14-19].
RESULTS
Nine hundred and eighty two
students were approached for the study. Nearly 200 students refused to
participate citing various reasons like lack of time, disinterest and
reluctance to participate in the survey. The response rate was 79.63%. The 782
participants with consent were handed out with questionnaire in a classroom and
the duration given was 10 minutes to complete the form. A total of 750
questionnaires were analysed after excluding 32 incomplete forms [20,21].
The mean age of the study sample was 21.4 +
2.3 years, with 57.6% male students and 43.4% female students. Basic
demographic details of the study population are described in Table 1.
The study showed nearly 100% prevalence of
substance use in one or the form. Non-alcoholic beverages (caffeine) were the
most commonly used reported by 96.4% of the studied population. The other
substances used in order of magnitude were alcohol -21.4% and tobacco smoking -20.5%
as described in Table 2.
Substance use in relation to the demographic
details of the study population is described in the Table 3.
DISCUSSION
Use of
substances such as alcohol and tobacco has become one of the rising major
public health and socio-economic problems worldwide [22,23]. Recent trends
indicate that the use of substances have dramatically increased particularly in
developing countries. Alcohol, especially in high doses, or when combined
tobacco, continues to claim the lives of many people [24-26]. It is estimated
that 9% of the global population aged 12 or older are classified with
dependence on psychoactive substances such as alcohol [27].
The problem of
substance use has historically been linked to health professionals due to their
close proximity to the drugs. This problem highly impairs the practice of
medicine with reasonable skill and safety to patients because of their illness
or dependence on drugs [23]. Tobacco consumption has been the main risk factor
for chronic diseases such as cancers, chronic lung disease, diabetes and
cardiovascular diseases, however; its use has become a growing concern among
college students in many parts of the world [24]. Furthermore, the use of drugs
and alcohol among medical students has become a growing concern. Studies also
suggest differentials in alcohol and other drug use between adolescents and
young adults with regard to sexual identity among undergraduate students [26].
The use of
alcohol, tobacco among adolescents can be harmful, leading to decreased
academic performance, increased risk of contracting HIV and other sexually
transmitted diseases, or other psychiatric disorders such as lethargy,
hopelessness and insomnia [27]. Furthermore, it exposes students to legal
repercussions or jeopardizes their enrolment at the university. Substance use
behaviors among medical students have important implications for the health of
the general population since physicians and future physicians are important
role models in terms of health related behaviors [21,28].
This study
clearly indicates the concern of substance use among the professional college
students. Nearly 100% prevalence of substance use in one or the other form was
observed among the study population and consumption of caffeine in the form of
coffee or tea was found to be the highest (96.7%), followed by alcohol (21.4%).
The alcohol prevalence is closer to that reported by Deressa et al. (22%) [10]
WHO’s Global Information System on Alcohol and Health reported past alcohol use
in India is between 0.4-19% [29]. The prevalence of smoking in this study was
reported to be 20.5% while a similar study by Ganesh et al. [13] reported
22.4%, while a study by Anjali et al. [3] reported the smoking prevalence as
little as 4.5%. According to the data from WHO’s Report on the Global Tobacco
Epidemic 2013, the prevalence of current tobacco use in India is between
12.1-19.8%. Alcohol and smoking was the most common combination of substances
used by the subjects (19.86%) followed by the combination of caffeine and
smoking (7.4%) [27,28]. The percentage of substance use was observed more among
males than females similar to a study reported by Naskar et al. [21]. These
differences might partly represent sex differences in the opportunities to use
substances, in which men have greater opportunities to try substances than
women do. WHO’s World mental health survey reported large variations between
countries in sex differences in the opportunity to use drugs and in progression
to use [20]. In some countries, differences between sexes were small at both stages
(particularly for alcohol) whereas in other countries they were apparent at
both stages; and in the remainder, men had a much higher chance of being
offered substances (particularly illicit drugs) than women, accounting for sex
differences in use [24]. In no country were alcohol or drugs more available for
women or were women more likely than men to take up the opportunity to use
substances [25,29].
Although
statistically insignificant 1.3% of the study population reported the use of
inhalants and 1.9% reported the use of Psychedelic drugs at least once in their
lifetime. While the UN Office on Drugs and Crime’s 2015 World Drug Report has
no data reported on the use of psychedelics (cannabis and cocaine) [30]. It is
admirable that 19.2% of the study population has tried quitting the habit of
smoking and alcohol in the past three months and however only 9.2% reported
that they have successfully tried and quit the habit.
A limitation of
this study included the use of self-reported data, which can lead to inaccurate
information and a high risk of response bias. Under reporting continues to be
an important confounder however it must be accepted. A detailed interview and
assessment of substance dependence is recommended for the further studies [31].
CONCLUSION
Substance use is
an issue of public health importance as it affects the younger generation who
indulge in habits at young age which affects their overall personality development.
We health professionals have a key role in educating community as patients
expect information, help and guidance from us on a number of health-related
matters thus we become the primary focus of implementing healthier lifestyle in
the community.
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