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Articles Epidemiology of Substance Use Among Secondary School Learners in Atteridgeville, Gauteng

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Articles Epidemiology of Substance Use Among Secondary School Learners in Atteridgeville, Gauteng articles Epidemiology of substance use among secondary school learners in Atteridgeville, Gauteng S V Moodley, MB ChB, DMH (SA), DTM&H, MMed, FCPHM (SA) the individual as well as the number of associated adverse M J Matjila, MB ChB, MMed (Community Health) social consequences.1-6 The association between heavy episodic Department of Public Health Medicine, School of Health Systems and adolescent alcohol use and road traffic accidents, suicide, violence Public Health, University of Pretoria and high-risk sexual behaviour is well documented.2,3 There is evidence that excessive alcohol use in adolescence leads to M Y H Moosa, MB ChB, MCFP (SA), MMed (Psych), FCPsych (SA) alcohol dependence, illicit substance use and criminal behaviour Division of Psychiatry, School of Medicine, University of the in adulthood.2,4 Short-term consequences of cannabis use include Witwatersrand high-risk sexual behaviour and an increase in sexually transmitted infections.5 Frequent use of cannabis can result in dependence and psychosis.6 Introduction. Adolescent substance use has a number of adverse Over the past decade a few studies have assessed the epidemiology consequences for both the individual and society. Anecdotal of substance use among South African learners. The first South evidence suggested the existence of a serious substance use African National Youth Risk Behaviour Survey7 was conducted problem among learners in Atteridgeville, part of the City of among grade 8 - 11 learners in 2002 and reported prevalence rates Tshwane Metropolitan Municipality in Gauteng, South Africa. of 31.8% for past-month alcohol use, 23.0% for past-month binge drinking and 9.1% for past-month cannabis use. Based on the results Objectives. The objectives of the study were to determine the of the three Global Youth Tobacco Surveys, there has been a decline prevalence rates and age of initiation of substance use among in cigarette smoking among grade 8 - 10 learners in South Africa learners attending secondary schools in Atteridgeville, and the between 1999 and 2008.8,9 The prevalence of lifetime cigarette factors, if any, associated with cannabis use. smoking fell from 46.7% in 1999 to 37.6% in 2002, with a further decline to 34.0% in 2008.8,9 The prevalence rate of past-month Methods. This was a cross-sectional study. A cluster sampling cigarette use was found to be 23.0% in the 1999 survey, 18.5% in the technique was employed. Twenty-two of the total of 191 grade 2002 survey and 16.5% in the 2008 survey.8,9 8 - 11 classes in the nine Atteridgeville secondary schools were randomly selected, with all 895 learners in the selected classes At a regional level, a study conducted among high-school pupils being invited to participate. Self-administered questionnaires in rural KwaZulu-Natal found alcohol to be the most commonly were used to collect data. Statistical analysis was conducted used substance, followed by inhalants and cannabis.10 The lifetime using the survey estimation commands in STATA 10.0.. prevalence among township secondary school learners in four education districts in the Free State was found to be above 40% Results. The lifetime prevalence rates for the three most for alcohol use and approximately 5% for cannabis use.11 A commonly used substances were 51.4% (95% confidence study among grade 6 and 7 learners in four primary schools in interval (CI) 41.5 - 61.5%) for alcohol, 25.2% (95% CI 17.1 - 33.3%) an historically disadvantaged area in Tshwane, Gauteng, found for cigarettes and 13.2% (95% CI 8.3 - 18.2%) for cannabis. Alcohol lifetime prevalences of alcohol and cannabis use of 27% and 7%, was also found to have the lowest mean age of initiation at 14.6 respectively, and past-month prevalence rates of 14% for alcohol years (standard deviation 2.0). Based on CRAFFT screening and 4% for cannabis.12 scores, 30.3% (95% CI 24.5 - 36.1%) of learners met the criteria for possible problem substance use. Following multivariate analysis, The association between substance use by learners and several the factors found to be significantly associated with lifetime demographic, environmental, scholastic, psychological and cannabis use were age, gender, lifetime cigarette use, lifetime social factors has been investigated. South African studies have alcohol use, the number of illicit drug users among the learners’ consistently found higher rates of substance use in male learners five closest friends, and an older sibling with a history of illicit than female learners.10,13 Several studies have found that older drug use. learners report significantly higher rates of substance use than younger ones.13-15 A study conducted among adults in three Conclusion. The results of the study suggest that substance communities in Cape Town found that poverty-related factors use among learners in Atteridgeville is widespread and that a were associated with substance use,16 but in a study involving comprehensive intervention strategy is required. Cape Town learners no significant association was found between substance use and a proxy indicator of socio-economic status.17 Reddy et al.13 found that past-month alcohol and cannabis use Adolescent substance use is a serious concern owing to potential was associated with poor academic performance among learners short- and long-term outcomes for the health and safety of in South Africa. There is evidence that parental substance use 2 Volume 18 No. 1 February 2012 - SAJP Mylan Corporate CNS Advert_paths.indd 1 2012/02/23 6:58 PM articles increases the likelihood of adolescent substance use.18 Simons- was not significantly influenced by gender, race or age. In a recent Morton19 found that alcohol use by an adolescent was related to the review by Dhalla et al.24 of the CRAFFT’s psychometric properties, number of drinkers among the individual’s five closest friends. Peers the instrument’s internal consistency was found to be between 0.65 were found to have had a greater influence on learners initiating and 0.86, sensitivity between 0.61 and 1.00 and specificity between substance use than the family, school and media among learners in 0.33 and 0.97. The values for validity were obtained at optimal cut- the Free State.11 points. 24 The present study was conducted in Atteridgeville, South Africa. Ethical considerations and procedures Atteridgeville is a township located south-west of the Pretoria The study received ethics approval from the Research and Ethics central business district and forms part of the City of Tshwane Committee of the University of Pretoria. Authorisation to conduct Metropolitan Municipality.20 Established in 1939 by the then the study was granted by the Gauteng Department of Education. government as a township for black Africans, it is today home A ‘passive’ parental consent procedure was employed. A leaflet to approximately 250 000 people.20 There are nine high schools was sent to the learners’ guardians, which gave them information in Atteridgeville. A number of media reports since 2006 have about the nature of the research and their right to refuse their child’s highlighted the existence of substance use, particularly the use of a participation. A refusal form was attached to the leaflet. If this form combination of cannabis, heroin and cutting agents, a combination was not returned, it was assumed that consent had been given by referred to locally as nyaope, by learners in Atteridgeville. The a learner’s guardian. Informed assent was then sought from those objectives of this study, conducted among learners attending high learners whose parents did not refuse to allow them to participate. schools in Atteridgeville, were to determine the prevalence of use Those learners whose parents did not want them to participate of various substances, the age of initiation of substance use, the were not given a questionnaire, and those who themselves wished proportion of learners who may require further intervention for their not to participate were asked to leave the questionnaire blank. substance use, and the factors associated with cannabis use. Data analysis Methods All data were analysed using the statistical package STATA version Design and sampling 10.0. As cluster sampling was employed in the study, statistical This was a cross-sectional study of learners attending the nine high analysis needed to take intra-cluster correlation into account. This schools in Atteridgeville. Because grade 12 learners were preparing was accomplished by using the survey estimation commands in for national examinations they were excluded from the survey, as STATA. Prevalence rates with 95% confidence intervals (CIs) were were learners who were absent on the day of the survey. A single- calculated for lifetime and past month use of various substances. stage cluster sampling technique was employed with each class Frequencies and summary statistics were obtained for age of of learners being regarded as a primary sampling unit. A single initiation of substance use. A total CRAFFT score was calculated sequential list was compiled of all 191 grade 8 - 11 classes in the nine for each participant, and the proportion of learners with a CRAFFT secondary schools. Twenty-two classrooms were then selected from score of two or more was determined. Multiple logistic regression this list by simple random sampling. All the learners in the selected 22 was used to determine the factors associated with lifetime cannabis classrooms were invited to participate in the survey. use. The independent variables that were significantly associated with lifetime cannabis use at a significance level of 90% in bivariate Measurement tools analysis were entered into the initial full regression model. The measurement tool for learners was a self-administered Backwards stepwise regression was then carried out. questionnaire, available in English and Northern Sotho (Sepedi). It included questions related to socio-demographic characteristics, Results socio-economic characteristics, scholastic characteristics, use of A total of 22 classes comprising 895 learners were invited to alcohol, cigarettes and illicit substances, sites where substances participate in the study.
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