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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 23  |  Issue : 1  |  Page : 25-29

Factors influencing substance use among adolescent slum dwellers of Guwahati City, Assam


1 Department of Community Medicine, Tezpur Medical College, Tezpur, Assam, India
2 Department of Community Medicine, Gauhati Medical College, Guwahati, Assam, India

Date of Web Publication3-Apr-2018

Correspondence Address:
Dr. Tanusri Bardhan
Department of Community Medicine, Tezpur Medical College, Bihaguri, Tezpur - 784 153, Assam
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmgims.jmgims_21_16

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  Abstract 


Introduction: Humans have been using substances in one form or the other for centuries. Adolescents seem to be the most vulnerable group, and the slum dwellers are particularly at risk because of the prevailing environment. Objectives: The objective of this study is to study the prevalence of substance use among adolescents of slums of Guwahati city and to find out various factors influencing substance use among them. Materials and Methods: A cross-sectional study was conducted among the adolescents living in slums of Guwahati, Assam, from February to May 2014. Using cluster sampling method, 23 slums were selected, and desired clusters were obtained by applying probability proportionate to size method. From each slum, equal number of boys and girls were interviewed to get a total of 414 study subjects. Statistical Analysis: Proportions, Chi-square test, and binary logistic regression were used. Results: The prevalence of ever users was 37.68% and 35.02% were current users. Gutkha was the most common substance used. The mean age of initiation of abusive substances was around 12 years for both boys and girls. Age, sex, religion, caste, schooling status, occupation, living status of parents and respondents, peer usage, and relationship with the family members showed significant association with substance use. Binary logistic regression concluded that age group, sex, and peer usage were the most significant factors influencing substance use behavior. Conclusion: As increasing age and peer usage influenced the substance usage, peer group counseling, recreational activities, and skill development programs in the early years hold promising in curbing the problem.

Keywords: Adolescents, factors, slums, substance use


How to cite this article:
Bardhan T, Saikia AM, Baruah R. Factors influencing substance use among adolescent slum dwellers of Guwahati City, Assam. J Mahatma Gandhi Inst Med Sci 2018;23:25-9

How to cite this URL:
Bardhan T, Saikia AM, Baruah R. Factors influencing substance use among adolescent slum dwellers of Guwahati City, Assam. J Mahatma Gandhi Inst Med Sci [serial online] 2018 [cited 2021 Jul 24];23:25-9. Available from: https://www.jmgims.co.in/text.asp?2018/23/1/25/229150




  Introduction Top


Substance use is an age-old practice worldwide, and now it is slowly engulfing the younger segment of the population. As per National Family Health Survey-3, tobacco was used by 28.6% boys and 3.5% girls of 15–19 years age group, and alcohol users were 11% among boys and 1% among girls.[1] The scenario is even grim in Northeastern states.[1] Though the miasmatic environment of the slums adds to this multidimensional problem, studies are limited. This study was conducted with the objectives of studying the prevalence of substance use and various factors influencing its use among adolescent slum dwellers of Guwahati.


  Materials and Methods Top


A community-based cross-sectional study was conducted from February 1, 2014, to May 31, 2014 among the adolescents living in slums of Guwahati city. The sample size was calculated applying the formula, n = 4pq/L2, taking into consideration the prevalence of substance use among adolescents as 43.4% (p),[2]q as 100 − p, absolute precision of 7% (L) and confidence interval of 95%. The calculated sample size was 200.5. Considering a design effect of 2, a sample size of 401 was obtained. According to Guwahati Development Department, Government of Assam (2009), there are 90 notified slums in Guwahati city with an approximate total population of 167,796, spread over 31 municipal wards encompassing 27,966 households approximately.[3] From the total 90 urban slums, 1/4th, i.e., 23 slums were selected by cluster sampling method. The desired clusters were selected by applying PPS (Probability proportionate to size) method. From each slum, equal number of boys and girls were recruited. Thus, 18 adolescents (nine boys and girls each) were interviewed, and a total of 414 adolescents were taken into consideration. All adolescents (as defined by the WHO),[4] residing in the slums for at least last 6 months and consenting to the interview were included whereas critically ill adolescents were excluded from the study. At the outset, an adequate rapport was built up with the community/opinion leaders and family members of the respondents, and they were interviewed mostly in the afternoon as per their convenience. A house-to-house visit was made in the selected slums till the desired sample size was met. The first household in each slum was selected at random and all the adolescents fulfilling the inclusion criteria were interviewed. If the required number of sample units was not met in that slum, the adjacent slum was taken to get the remaining sample units. The principal investigator interviewed the adolescents and while interviewing, privacy, and confidentiality were assured to them. A predesigned and pretested schedule was used for data collection. All efforts were made to obtain the correct age of the adolescents by making use of all available conventional tools such as local events, calendar, or age of other siblings. In some cases, where available, birth certificates and school records were used for assessing the correct age.

Ethical Clearance was obtained from the Institutional Ethics Committee before the start of the study. Informed consent/assent was obtained either from the study participants or their parents/guardians before the interview. At the end of the interview, the appropriate referral was suggested for the adolescents using the substance(s).

For the study purpose, the principal investigator considered the various psychoactive substances based on International Classification of Diseases-10 classification.[5] Data were analyzed using SPSS version 16.0, trial version (SPSS Inc., Chicago). Proportions were calculated for different study variables, and Chi-square test was used for analysis of categorical variables. Criterion of significance used in the study was P < 0.05. Factors, which were found significant in univariate analysis, were considered in the multivariate analysis. Binary logistic regression with enter method was used to find out most significant predicted factors.

Working definitions

Never user

The respondent, who has not taken any of the substances ever in life, or who used fewer than 10 times in his/her entire lifetime.

Ever user

The respondent, who accepts having taken one or more substances in his/her lifetime for more than 10 times, and may continue to take the same or has given up taking the substance(s). This is further classified as current user and ex-user.

Current user

The respondent, who has taken substance(s) for more than 10 times in his/her lifetime and is currently using them for the past 1 month.

Ex-user

The respondent, who has taken substance(s) for more than 10 times in his/her lifetime, but has given up using for at least the past 1 month.

School dropout was considered when the respondent, who after attending the school had left school education permanently.

Occupation of the adolescents was divided into “students,” who were attending school/college; “employed” as those who were engaged in any activities (unskilled, semiskilled or skilled) to earn their livelihood.

While assessing the relationship of the participants with the family members, the experience of frequent arguments/verbal fights/physical fights was considered “tensed,” otherwise it was considered “good.”


  Results Top


Out of the total of 414 adolescents interviewed, 40.34%, 29.71%, and 29.95% were in the age group of 10–13 years, 14–15 years, and 16–19 years, respectively. The mean ages of the boys and the girls were found to be 14.21 (±2.64) years and 13.88 (±2.71) years, respectively. The overall point prevalence of substance users (ever users) was found to be 37.68%. Of the 414 respondents, 207 boys and girls each, 145 (35.02%) were current users, and 11 (2.66%) were ex-users. The mean age of initiation of the abusive substances was 12.08 (±2.009) years for boys and 12.38 (±1.803) years for girls. Tobacco, in the form of gutkha, was the most common substance of use (83.45%) among the ever users [Figure 1]. In addition, 57.69% of them were using more than one substance.
Figure 1: Types of substances used among all current users

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While analyzing the relationship between various variables and substance use status, ex-users (n = 11) were excluded, and only current users (n = 145) were taken into consideration. [Table 1] shows the various factors influencing the substance use behavior. It reveals that age group, sex, religion, caste, schooling status, occupational status, living status of parents, living status of respondents, relationship with family members, and substance use by peers were significantly associated to the substance use behavior. Factors, found significant in univariate analysis, were further considered for multivariate analysis. Binary logistic regression with enter method was used to find out most significant predicted factors. Moreover, it was found that among the various factors considered, age group, sex, and substance use by peers were the most significant factors predicting the substance use behavior [Table 2].
Table 1: Various factors influencing the substance use behavior

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Table 2: Multivariate analysis of various factors influencing substance use

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  Discussion Top


The prevalence of ever users in the present study was 37.68%. In a study conducted in 2008 in urban slums of Sambalpur, Odisha revealed the prevalence of substance abuse to be 43.4%.[2] Similarly, Benegal et al. in slum children of Bengaluru found the prevalence of substance use higher than that found in the present study.[6] The lower prevalence of substance use in the present study could be attributed to the inclusion of equal numbers of males and females. However, the study conducted by Kokiwar and Jogdand in urban slum area of Karimnagar district, Andhra Pradesh, revealed the overall prevalence of substance use as 32.7%,[7] which is lower than the finding of the present study.

Gutkha, was the most common substance, used by adolescents in the present study. This finding is in conformity with other studies.[2],[6],[8],[9],[10] In another study done in Assam, the prevalence of tobacco use was found to be 40.1%, alcohol use 36.5%, and other substances 3.4%.[11] Another remarkable finding of the present study was that a good number of (about 21%) adolescents used glue as inhalational substance. This could be attributed to easy availability and accessibility as well as nonimposition of restriction of sale of glue or related products. In contrast to this, Benegal et al. found that only 2% of the children were using adhesives whereas the overall prevalence of inhalant use was 48%.[7] Glue sniffing was found in 36.6% ≤20 years population in Spain [12], and Hynes-Dowell et al. found that the lifetime prevalence of inhalant abuse ranges from 2.67% in Paraguay to 16.55% in Brazil.[13] This needs immediate interventions in the form of awareness generation, counseling, and restriction of sale of glue.

The prevalence of multiple substance users was high (57.69%) in the present study, which was not consistent with the study done by Kokiwar and Jogdand.[7] Basu et al. in their study to document changes in the trend of psychoactive substance abuse over three decades revealed the percentages of the individuals dependent on two or more substances in the three successive decades were 8.7, 28.9, and 62.7%, respectively.[14] Owing to the adverse drug effects and drug–drug interactions, polysubstance use could pose a challenge for controlling the menace of substance use.

Substance use was found to increase with increasing age (P = 0.000). Various studies conducted across the country substantiate this finding.[2],[7],[15] High prevalence of substance use among the males in the present study was consistent with various other studies.[2],[9],[15],[16],[17],[18],[19] Biological characteristics, social norms, and culture might be a few contributing factors for the high prevalence of substance users among males. A statistically significant association was seen between religion and substance use status (P = 0.008). Malhotra et al. found 61.8% Hindus as smokers.[20] Contrastingly, in another study, religion was found to be associated only with alcohol use and not with tobacco use.[11] Here, in this study, most of the current users belonged to the general caste (55.17%). Kumar and Prabhu found that 21.1% of the drug users belong to scheduled caste/tribe.[10] Bala et al. revealed that in scheduled tribe population tobacco use was tobacco found to be comparatively higher than in other castes and was least in privileged caste.[21] A higher proportion (44.14%) of the current users as school dropouts in comparison to never users (7.36%) was a significant observation. Sarangi et al. revealed that majority of the substance abusers either never went to school (54.4%) or were school dropouts (51.7%).[2] It is very important to elicit whether the school dropout is the cause or effect of substance use. Counseling in the schools regarding substance use seems to play a significant role. Hazarika et al. found that literacy had no impact on use of tobacco; however, a strong impact was seen between alcohol use and literacy.[11] Interestingly, Bala et al. revealed that the prevalence of tobacco was high in illiterates and in literates with <7 years of schooling, but decreased significantly with increase in education status.[21] Meena et al. found a lower prevalence among illiterates and graduates/postgraduates,[22] which is in contrast with Ghulam et al., who reported that as the literacy rate increases there is steep increase in drug abuse.[17] Preventing school dropouts can have significant impact on practicing high-risk behavior in this vulnerable age group. Among the current users, 37.2%, 35.2%, and 27.6% were employed, student, and unemployed, respectively, which is similar to the findings of Hazarika et al.[11] Living with parents was not significantly associated with substance use behavior. This is in conformity with other study.[8] A statistically significant association was found between relationship with the family members and the substance use status (P = 0.000). Studies have identified broken families as a factor for substance use.[2],[6],[23] Whereas Saxena et al., strikingly found that more substance abuse was seen among adolescent with good relationship with family members (44.3%) in comparison to adolescents having tensed (37.7%) family relationship.[8] Higher prevalence of substance in the peers of current users is a significant observation in the present study. Similar observations cited in other studies substantiate this finding.[2],[7],[10],[24] From this observation, it can be deduced that intervention-like peer group counseling among this vulnerable population can help in reducing the menace. Use of substances by the parents was not found to be associated with the current users.

Binary logistic regression concluded that adolescents in the age group of 14–15 years were five times and late adolescents were nine times more into the substance use than the early adolescents. In addition, boys were about five times more currently using substances than girls. Use of substances by peers, especially among current users (odds ratio = 3.714) calls for immediate attention of the policy-makers for effective interventions. This needs a combined effort from the government, civil society, and nongovernmental organizations (NGOs).


  Conclusion Top


Highlighting the grave situation, this study strongly recommends peer group counseling as an important intervention. As substance use increases significantly with increasing age a strong and concrete foundation of the youngsters that will further engage them into meaningful and productive lifestyle is desired. A focused strategy on recreational and skill development programs in the early years could be the solutions in this direction. Last, but not the least, a holistic approach is required well encompassing the efforts from the government, NGOs, civil societies, media, and judiciary for combating such menace. A social awakening in the form of “Nasha Mukti Abhiyan” is the need of the hour.

Acknowledgment

The authors thank the Department of Biotechnology, Ministry of Science and Technology, Government of India, for its financial support for the study.

Financial support and sponsorship

Financial grant from the Department of Biotechnology, Ministry of Science and Technology, Government of India, supported the study.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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International Institute for Population Sciences. National Family Health Survey (NFHS-3), India 2005-2006. Vol. 1. Mumbai: 2007. p. 590.  Back to cited text no. 1
    
2.
Sarangi L, Acharya HP, Panigrahi OP. Substance abuse among ado0lescents in urban slums of Sambalpur. Indian J Community Med 2008;33:265-7.  Back to cited text no. 2
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Guwahati Development Department. Notification No. GDD.55/2006/185: Dispur, Guwahati, Government of Assam,; February, 2009.  Back to cited text no. 3
    
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World Health Organization. Adolescent Friendly Health Services: An Agenda for Change. Geneva: World Health Organization; 2002. p. 5.  Back to cited text no. 4
    
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World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. 10th ed. Geneva: World Health Organization; 1993. p. 23.  Back to cited text no. 5
    
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Benegal V, Seshadri S, Karott M. Drug Abuse among Street Children in Bangalore. A Project in Calibration between NIMHANS, Bangalore and the Bangalore Forum of Street Children, Monograph Funded by CRY; 1998.  Back to cited text no. 6
    
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Kokiwar PR, Jogdand GR. Prevalence of substance use among male adolescents in an urban slum area of Karimnagar district, Andhra Pradesh. Indian J Public Health 2011;55:42-5.  Back to cited text no. 7
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Saxena V, Saxena Y, Kishore G, Kumar P. A study on substance abuse among school going male adolescents of Doiwala block, district Dehradun. Indian J Public Health 2010;54:197-200.  Back to cited text no. 8
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    Figures

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