Volume 6, Issue 2 (May 2019)                   Avicenna J Neuro Psycho Physiology 2019, 6(2): 67-74 | Back to browse issues page

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Pirdehghan A, Mahmoodi S, Seifrabie M A, Haghighi M. Prevalence of Substance Abuse Among High School Students in Hamedan, Iran in 2015. Avicenna J Neuro Psycho Physiology 2019; 6 (2) :67-74
URL: http://ajnpp.umsha.ac.ir/article-1-117-en.html
1- Department of Community and Preventive Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
2- Research Center for Behavioral Disorders and Substances Abuse, Hamadan University of Medical Sciences, Hamadan, Iran. , haghighi@umsha.ac.ir
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1. Introduction
Abusing drugs such as alcohol, narcotics, analgesics, and other substances is becoming an important health problem in the world [1]. Unfortunately, drug abuse, especially opium use, is prevalent in Iran despite law and religion prohibition issues and the fact that it is not culturally acceptable among Iranian families [2]. Adolescence is a particularly vulnerable period for the initiation of drug use. Cigarette smoking, which is usually referred to as a gate to drug use, is prevalent in Iran. According to different studies, its prevalence increased from 12.6% in 2000 to 14.3% in 2004 [3, 4]. 
Usually, the first experiences of smoking occur in adolescence and most adolescent smokers continue smoking to adulthood. In spite of the recent decline in the prevalence of smoking among the youth in developed countries, the problem has become more prevalent in many developing countries [5]. Hookah smoking is another problem, which is frequently used by adolescents and teenagers in Iran. Unlike so many drugs, which are not accepted in Iranian families, regarding hookah smoking, the families and the society in Iran are more permissive [6]. According to the few studies on social correlates of hookah smoking, the smokers consider it a pleasurable social hobby that promotes a sense of togetherness. They view it as a relatively harmless leisure time activity [7, 8]. The results of a study in university students in Isfahan, Iran, revealed that cigarette and hookah smoking is significantly associated with having smoking friends. 
According to this study, 9.5% of the students were cigarette smokers and 19.5% were hookah smokers [9]. As there is no nationwide survey among adolescents in Iran on alcohol and other drugs, the prevalence of drug use in this group remains unclear in Iran. In a rapid situational assessment in Iran (2007), it was shown that 18.9% of drug abusers were younger than 24 years [10]. Another study has shown that, for many adolescents in Iran, the age of drug use onset is under 18, and many of them used drugs for the first time in schools or their friends’ homes [11]. 
In a systematic review in 2010 about substance abuse among Iranian high school students, drug abuse was a frequent problem among Iranian high school students. This study revealed that the early onset of tobacco smoking with daily use rates between 4.4% and 12.8% in high school students. Also, alcohol was the most frequently abused substance with a lifetime rate of at least 9.9%. Lifetime rates of opiate use were mostly between 1.2 and 8.6% in different parts of the country [10].
Relationship between substance abuse and addictive behaviors in adolescents with other deviants, on the one hand, and its inextricable link with problems such as mental disorders, home escape, aggression, violence in social behaviors, theft and larceny, studying and attempting suicide and prostitution, on the other hand, point to the importance of re-thinking and meditating on this issue.
Few studies have investigated drug use in students in Iran. So, this study aimed at evaluating drug use in high school students in Hamedan, Iran.
2. Materials and Methods
The sample size of the present cross-sectional study was calculated 800 individuals out of 6830 high school students in Hamadan based on similar studies and considering P=0.18, d=0.03, z=1.96, and design effect=2. The sampling was done in a two-stage cluster manner, through which the schools were considered clusters and the schools were selected based on the population. Multistage cluster and random sampling methods were used for sampling. First, based on the population of each educational area, the number of samples was divided between 2 regions. Then, in each area, 5 boys and 5 girls high schools were randomly selected. According to the ratio of the field of study, 1 or 2 classes of each school were randomly selected. Finally, out of 6830 high school students studying in 72 educational units of Hamedan, 800 students were randomly selected.
The inclusion criteria included studying in the high schools of Hamadan in 2015. The exclusion criteria included the lack of willingness and written consent of participating in the study.
We used the United Nations Office on Drugs and Crime substance abuse questionnaire, which was considered to be used in schools and its validity had already been confirmed [12].
The study protocol was approved by the Ethics Committee of Hamadan University of Medical Sciences. After receiving an allowance from the education and training organization and school officials, followed by introducing themselves and the research goals to students and accenting on the confidentiality of information, the executives distributed the questionnaires among the students. The executives asked the participants to put the questionnaire inside the box in the class after its nameless fulfillment so that the confidentiality of information would be ensured.
The questionnaire includes two parts; demographic information and questions about the use of 40 different substances or drugs, in which “never use” was coded as 0, “having at least one experience” as 1, and “more than once” as 2. Other information about the age of the first experience and encouragers for substance use were also asked. Finally, the data were analyzed by the Logistic Regression Model and Chi-Square or Fisher exact test, using SPSS v. 14. P<0.05 was considered statistically significant.
In this study, Mohammadkhani’s drug use questionnaire was used and supervised by social medicine specialists. The drug use questionnaire (in Persian) is a researcher-made tool based on the United Nations Office on Drugs and Drug Addiction to determine the rate of smoking, alcohol, and other types of materials in domestic and foreign research. It has good psychometric properties and its reliability coefficient is 87% [11].
3. Results
Out of the 800 distributed questionnaires among the students, 29 were not completed and the response rate to the questionnaire was 96.4%. Of the 771 studied students, 367 (47.6%) were female and 404 (52.4%) were male. The Mean±SD age of the students was 17.36±1.96 years. Around 80% of the students studied in governmental schools and 22% of them had jobs while studying in high school. Table 1 presents the demographic information of the students.
The most commonly used substances were hookah (24.2%) and cigarette (15.3%). Lighter gas, ecstasy, Ritalin®, phenobarbital, lysergic acid diethylamide (LSD), and heroin were the least frequent. Among the unsubscribed substances, codeine (n=51; 6.6%) was the most frequent (Table 2).
Concerning alcohol consumption, as presented in Table 3, non-alcohol use was significantly higher in girls than boys (98.3% vs. 77.4%). Alcohol consumption more than once was significantly higher in boys than girls (15.1% vs. 1.1%). There was no significant difference between the two sexes in alcohol consumption once.
Compared to girls, boys showed an increased prevalence of addictive substance abuse once or more. The observed differences were statistically significant, with hookah and cigarette showing the highest prevalence in boys (Table 3). In addictive substances, girls were always less likely to use than boys with a significant difference except for hashish.
The history of educational failure, which was also similar to less than 17 years, was associated with a significant increase in the consumption of more addictive substances among the students; however, this association was not observed in the abuse of medication without a physician’s prescription (Table 4).
One of the factors that contributed to the higher risk of consuming addictive substance was the employment of students in jobs while studying in high school, which increased the risk of drug abuse. Meanwhile, cigarette and hookah were the most consumed substances among such students (Table 5).
4. Discussion
The present study aimed at identifying the prevalence of substance addiction and its association among high school students in Hamedan. In total, 47.22% of the students (18.4% of boys and 4% of girls) abused addictive substances at least once. The most commonly used addictive substances among all the students were hookah, cigarette, alcohol, codeine, hashish, anabolic-androgenic steroids (AAS), opium, morphine, methadone, diphenoxylate, crystal, heroin, LSD, Ritalin®, and lighter gas. Furthermore, the most common substances in girls were hookah, cigarette, alcohol, and codeine. In boys, the most common addictive substances were hookah, cigarette, hashish, alcohol, and bodybuilding drugs. In most studies, the most commonly used substances were hookah, cigarette, alcohol, opium, bodybuilding drugs, ecstasy, hashish, heroin, cocaine, crystal, crack cocaine, morphine, and LSD, which is in line with the findings of the present study compared to alcohol. The prevalence of substance abuse is at least one of the addictive drugs mentioned in the present study. In students of this study, cocaine and phencyclidine abuse were not reported, and in other studies, the abuse was reported from 0.2% to 0.49%. In addition, in this study, hashish was ranked fifth, preceded by the bodybuilding drugs and opium [13-16].
Experience of at least once abuse of addictive substance, experience among the girls, and experience among the boys in this study were less than those of the same studies; however, this rate was more than the rates mentioned in studies by Pirdehghan et al. [17] in Yazd, Agahi in Isfahan, and Mohammadpoor in Tabriz. The above-mentioned studies explained the differences in addictive substances studied in particular studies, including or not including smoking cigarettes or hookah. Therefore, it seems that the homogeneity of epidemiological techniques helps to understand the experience of abuse more accurately.
Generally, 14% of the cigarette smokers and 40% of the hookah smokers are considered abusing at least once because of the cultural and religious backgrounds, the explicit and unconditional prohibition of the use of other substances, and the teaching of such denial since childhood. But, the absence of religious, social, and cultural prohibitions, as a decisive factor in cigarette and hookah smoking, can justify the high prevalence in such studies. Furthermore, the freedom to smoke and the risk of using narcotics, especially hookah, is high, which is because of the lower expectations of hookah risks in the mind of the abusers [18].
According to the results of this study, the experience of cigarette smoking at least once, as well as hookah as an independent risk factor, can multiple the chance of experiencing other substances, especially alcohol and opioids. Hence, the importance of carefully considering, problem-solving, and preventing the prevalence of cigarette and hookah smoking among students is of high importance.
In the present study, 7 (0.9%) students at least once and 10 (1.3%) more than once experienced the abuse of bodybuilding drugs, which was a higher rate compared with other studies; however, it was with a lower prevalence compared to the studies of Pirdehghan et al. in Yazd [17] and Ziaoddini et al. in Kerman.
In the current study, one of the independent risk factors and also the predictors of the addictive substance abuse experience, which is 17 times more likely, was gender. It was common among the boys. Also, the experience of at least once and more than once was significantly dominant in males than in females. This principle is similar to the result of numerous studies in this field [10, 17-19]. The possible causes of the gender difference in the prevalence of narcotic drugs in Iran is the availability of more facilities and family freedom of children mentioned in such families. The possibility of earning money and, on the other hand, more accurate control of families on the type of their girls’ relationship is another possible factor for such differences [20]. Besides, girls’ attitude toward substance was significantly worse than the boys and they consider it a serious issue that can indicate differences in cultural approaches toward gender. 
In recent years, there has been an increase in leniency in the tendency of girls to consume the addictive substance, and the gap between the genders has decreased in substance abuse [21]. Moreover, in studies conducted in European countries, in particular in Great Britain and France, the relative frequency of cigarette abuse in both genders is close together and even girls have a false belief in cigarette usefulness in body fitness than boys, which makes this difference [22, 23]. Also, this study does not indicate any statistically significant difference in the tendency of substance abuse in both genders.
In this research, the Grade Point Average (GPA) of the previous year and the history of resubmission or rejection are among the independent factors and predictors of risk of substance abuse. Thus, abusing cigarettes, hookah, alcohol, and hashish were significantly higher in students with an average GPA of less than 17 and a history of educational failure was significantly higher than students with an average GPA of +17 or no history of educational failure.
One of the possitive points of the present study is the relatively large number of materials compared with previous studies and further consideration of more confusing variables. However, among the limitations of this study, the actual prevalence of abuse in some certain substances (substances except cigarettes, hookah, alcohol, addictive drugs, and bodybuilding) is likely to be higher in students. The cultural conditions of society, the perceived crime of substance abuse, and the possibility of disturbing the course of lifestyle and education justify this affair.
5. Conclusions
Considering the high prevalence of abuse in adolescents, life skills and preventive ways to avoid substance abuse in primary and secondary schools must be developed. It increases the awareness of students and their families and reduces the prevalence and complications of substance abuse. The use of hashish and AAS are at a high level compared to studies in other parts of Iran and are on the top of the category of drug administration without physicians’ prescription. Target groups for changing attitudinal programs to prevent potential addictive substance abuse include male students, senior ages, the family of the last child, those studying in non-profit or vocational schools or studying in a mathematics course, those with school resubmission (re-examination) or educational failure, and those with unemployed father.
Ethical Considerations
Compliance with ethical guidelines
All ethical principles were considered in this article. The participants were informed about the purpose of the research and its implementation stages; they were also assured about the confidentiality of their information; Moreover, They were allowed to leave the study whenever they wish, and if desired, the results of the research would be available to them.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Authors' contributions
All authors contributed equally in preparing all parts of the research.
Conflict of interest
The authors declared no conflict of interest.

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Article Type: Research Article | Subject: Substance abuse, dependence, addiction
Received: 2018/12/10 | Accepted: 2019/03/12 | Published: 2019/05/1

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