Abstract
Background:
Early initiation of alcohol use among adolescents can provide a useful indication of the potential future burden among adults including increased risk for academic failure, mental health problems, antisocial behavior, physical illness, risky sexual behavior, sexually transmitted diseases, early onset dementia, and the development of alcohol use disorders. The objective of this study is to measure the prevalence of alcohol consumption and illegal drug use among adolescent students studying in class ninth to eleventh standard in English medium private schools in Tripura, India.
Methods:
A cross sectional descriptive study was carried out in faith based English medium private schools of two selected subdivisions of Tripura, India. Students of class ninth to eleventh standard were selected for this current study. A validated questionnaire was used to find out the prevalence of alcohol and illegal drug intake.
Results:
A total of 565 (boys = 308, girls = 257) students participated in this study from four schools. The prevalence of alcohol intake (ever) among adolescent students was 28.2% [95% confidence interval (CI) 24.6–32.1]. The adolescent students of 1.7% (95% CI 0.9–3.1) consumed alcohol once a week in the past 6 months. It was observed that 4.2% (95% CI 2.8–6.3) of adolescents use illegal drugs. The study participants of 12.7% (95% CI 10.2–15.8) reported having close friends who were using illegal drugs.
Conclusions:
Significant percentages of adolescent students were involved in alcohol intake (ever) and use of illegal drugs.
Keywords: Adolescents, alcohol, illegal drugs, school students
INTRODUCTION
India has the largest population of adolescents globally (253 million people aged 10–19 years), constituting 21% of the population. It is alarming that adolescents as young as 13–15 years of age have started consuming alcohol in India.[1] The World Health Organization (WHO) in its Global Status Report on Alcohol and Health (2018) documents that about half of the global population aged more than 15 years are current (past 12 months) users of alcohol. The WHO Global Burden of Disease study reported that among youth aged 10–24 years, the main risk factor for incident disability-adjusted life years (7%) was alcohol use.[2] The exposure of the adolescent brain to alcohol is shown to result in various cognitive and functional deficits related to verbal learning, attention, visuospatial and memory tasks, and behavioral inefficiencies such as disinhibition and elevated risk-taking.[3] Also, according to the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, among adolescents and young adults (aged 10–24 years), the alcohol-attributable burden is second highest among all risk factors contributing to disability-adjusted life years in this age group.[4] Alcohol consumption in adolescents results in a range of adverse outcomes across several domains and includes road traffic accidents and other non-intentional injuries, violence, mental health problems, intentional self-harm, suicide, HIV and other infectious diseases, poor school performance, drop-outs, and poor employment opportunities. Substance use, including alcohol, is typically established during adolescence and this period is the peak risk for the onset and intensification of substance use behavior that poses risk for short- and long-term health.[5-10] The objective of this study is to measure the prevalence of alcohol consumption and illegal drug use among adolescent students studying in class ninth to eleventh standard in English medium private schools in Tripura, India.
MATERIALS AND METHODS
A cross-sectional descriptive study was carried out during November–December 2021 in four faith-based English medium private schools of Udaipur and Bishramganj subdivision of Tripura, India. The schools were selected based on the convenience of the researcher/investigator.
Out of the four selected schools, three were in rural areas whereas one was in an urban area. Permission for conducting the study was obtained from the school authorities. Consent was obtained from individual students before administering the questionnaires. All the students of classes ninth, tenth, and eleventh standard of the selected schools were included in this study.
The sample size was calculated on the basis of the study conducted by Ningombam et al.[11] for the school students (The prevalence of every alcohol intake was 29%). It was calculated as N = 4pq/r2 = 4p (1-p)/d2 = (4 × 29 × 71)/4 × 4 = 515, where P is the prevalence of alcohol intake (29%), q is the 1-p and d is precision (corresponding to effect size). The level of confidence usually aimed for is 95%, most researchers present their results with a 95% confidence interval (CI).
Indian Adolescent Health Questionnaire developed by Long KNG et al (ref)[12] was used as a study instrument to measure the prevalence of alcohol intake and other illegal drug intakes. Illegal drugs were included as ganja, weed, pot, hash, charas, inhaling fluids, crack, cocaine, heroin, opium, etc. A list of illegal drugs was included in the questionnaire for easy understanding purposes.
Data was entered and analyzed in the Epi info (version 7.2.5). The demographic profiles like gender, place of residence, education, occupation, consumption of alcohol, and illegal drugs variables were described in percentage (frequency). The Chi-square test was used to evaluate statistical significance, and a two-sided P value of < 0.05 was considered as statistically significant.
RESULTS
A total of 565 students participated in this study from four schools. The number of students participating from classes ninth, tenth, and eleventh standard was 375 (66.4%), 85 (15%), and 105 (18.6%), respectively. The demographic profile of the study participants is described in Table 1. The mean age of the study participants was 15.5 ± 1.2 SD (minimum 13 years, maximum 18 years).
Table 1.
Demographic profile of the students
| Variables | Number | Percentage | 95% CI |
|---|---|---|---|
| Gender | |||
| Boys | 308 | 54.5% | 50.4-58.6% |
| Girls | 257 | 45.5% | 41.4-49.6% |
| Residence | |||
| Rural | 520 | 92% | 89.5-94% |
| Urban | 45 | 8% | 6-10.5% |
| Class | |||
| Class ninth | 375 | 66.4% | 62.4-70.1% |
| Class tenth | 85 | 15% | 12.3-18.2% |
| Class eleventh | 105 | 18.6% | 15.6-22% |
| Age | |||
| 13 years | 6 | 1.1% | 0.5-2.3% |
| 14 years | 119 | 21.2% | 18-24.8%% |
| 15 years | 187 | 33.3% | 29.6-37.3% |
| 16 years | 125 | 22.3% | 19-25.9% |
| 17 years | 82 | 14.6% | 11.9-17.8% |
| 18 years | 42 | 7.5% | 5.4-10.7% |
| Currently Staying | |||
| Hostel | 216 | 38.8% | 34.9-42.9% |
| With relative | 10 | 1.8% | 0.9-3.3% |
| Rented house | 171 | 30.7% | 27.1-34.7% |
| Own house | 159 | 28.6% | 25-32.5% |
Table 2 indicate that the prevalence of alcohol intake (ever) among adolescent students was 28.2% (95% CI 24.6–32.1). 1.7% (95% CI 0.9–3.1) of adolescents consumed alcohol once a week in the past 6 months. Most of the adolescents took alcohol for the first time during the “Puja” religious ceremonies or festivals (8.8%) followed by the wedding ceremonies (7.5%). It was observed that 1.6% (95% CI 0.9–3.1) of the adolescents took alcohol for the first time in school. 9.9% (95% CI 7.7–12.7) of adolescents consumed alcohol until they are intoxicated. 43.2% (95% CI 39.1–47.4) of close friends of the study participants ever consumed some form of alcohol.
Table 2.
Distribution of status of alcohol use among the adolescents
| Variables | Number | Percentage | 95% CI |
|---|---|---|---|
| Consumption of alcohol (ever) (n=543) | |||
| No | 390 | 71.8% | 67.9-75.4% |
| Yes | 153 | 28.2% | 24.6-32.1% |
| Consumption of alcohol in last 6 months (n=542) | |||
| Never | 411 | 75.8% | 72-79.2% |
| Once | 54 | 9.9% | 7.7-12.8% |
| A few times | 49 | 9% | 6.9-11.7% |
| Once a month | 6 | 1.1% | 0.5-2.4% |
| Once a week | 9 | 1.7% | 0.9-3.1% |
| More than once a week | 2 | 0.4% | 0.1-1.3% |
| Occasion of initiation of alcohol consumption (n=546) | |||
| At a wedding ceremony | 41 | 7.5% | 5.6-10% |
| At home | 26 | 4.8% | 3.3-6.9% |
| At school | 9 | 1.6% | 0.9-3.1% |
| At someone else’s home | 15 | 2.7% | 1.7-4.5% |
| I have never tried alcohol | 386 | 70.7% | 66.7-74.5% |
| In a Puja/Festival | 48 | 8.8% | 6.7-11.5% |
| Out on the street or in a park | 5 | 0.9% | 0.4-2.1% |
| Some other place | 16 | 2.9% | 1.8-4.7% |
| If you do drink alcohol, do you typically drink until you are intoxicated? (n=534) | |||
| I do not drink alcohol | 383 | 71.7% | 67.8-75.4% |
| No | 98 | 18.3 | 15.3-21.9% |
| Yes | 53 | 9.9% | 7.7-12.7% |
| Friends who consume alcohol (n=539) | |||
| No | 182 | 33.8% | 29.9-37.9% |
| Yes | 233 | 43.2% | 39.1-47.4% |
| Unsure | 124 | 23% | 19.6-26.7% |
Prevalence of alcohol intake is more in male students (37.8%) as compared to female students (16.9%) and the difference is significant (P-value < 0.001). The proportion of the students who consumed alcohol increased along with years in school, that is, lowest in class ninth (24.6%) and highest in class eleventh (43.1%). The highest prevalence of alcohol intake was observed in students in the age of 18 years (57.9%). Prevalence of alcohol intake was more among the students residing in the rural areas (29.7%) compared to the urban areas (11.3%) and the difference was statistically significant (P-value < 0.009). It was observed that a higher proportion of students staying in hostels (33.2%) were consuming alcohol as compared to the students staying in their homes (18.3%), rented houses (31.1%), and staying with relatives (11.1%) and the difference was statistically significant (P-value = 0.007).
It was observed in the table 3 that 4.2% (95% CI 2.8–6.3) of adolescent students use illegal drugs. 12.7% (95% CI 10.2–15.8) of the close friends of the study subjects were using illegal drugs. More than 1% of adolescents used illegal drugs 10 or more times in the past 1 year. The prevalence of using illegal drugs in injectable form is 2.6% (95% CI 1.5–4.3).
Table 3.
Distribution of status of illegal drug use among the adolescents
| Variables | Number | Percentage | 95% CI |
|---|---|---|---|
| Ever taken any illegal drugs (n=544) | |||
| No | 515 | 94.7% | 92.4-96.3% |
| Yes | 23 | 4.2% | 2.8-6.3% |
| Unsure | 6 | 1.1% | 0.5-2.4% |
| Close friends ever used illegal drugs (n=541) | |||
| No | 384 | 71% | 67-74.6% |
| Yes | 69 | 12.7% | 10.2-15.8% |
| Unsure | 88 | 16.3% | 13.4-19.6% |
| Used illegal drugs during the past year (n=847) | |||
| 1 to 2 times | 14 | 2.6% | 1.5-4.2% |
| 10 or more times | 7 | 1.3% | 0.6-2.6% |
| 3 to 9 times | 6 | 1.1% | 0.5-2.4% |
| Never | 520 | 95.1% | 92.9-96.6% |
| Taken any illegal drugs in injection form (n=546) | |||
| No | 522 | 95.6% | 93.5-97% |
| Yes | 14 | 2.6% | 1.5-4.3% |
| Unsure | 10 | 1.8% | 1-3.3% |
The prevalence of illegal drugs was more in male students (6.4%) as compared to female students (1.6%) and the difference is statistically significant (P-value = 0.02). The percentage of students who use illegal drugs from rural areas (4.2%) and urban areas (4.4%) is almost similar. The prevalence of illegal drug use is more in the students staying at the hostel (6.2%) than staying at their own house (2.6%).
DISCUSSION
The present study observed that the prevalence of alcohol intake among adolescent students was 28.2% (95% CI 24.6–32.1). A similar prevalence of alcohol intake was reported among the higher secondary school students of Imphal, Manipur (29%)[11] and Assam (32.2%).[13] However, the prevalence of alcohol intake among the adolescent students of the current study is much more than the overall prevalence of lifetime alcohol intake among adolescents in Ernakulam, Kerala (15%)[14] and adolescents from Udupi, India (5.7%)[15] and Uttarakhand (8.7%).[16] Alcoholic beverage prepared from rice after fermenting is a common and most popular traditional drink prepared by all the tribes of Tripura[17] which may be one of the reasons for high alcohol intake among the adolescent students in Tripura. Cultural differences between northeastern states and other states of India may be reasons for differences in the prevalence of alcohol intake among adolescent students. A systemic review conducted by Nadkarni et al.[1] observed that the prevalence of ever or lifetime alcohol consumption in adolescence age between 10 and 24 years in India ranged from 3.9% to 69.8%. Prevalence of alcohol consumption at least once in the past year ranged from 10.6% to 32.9%. It is important to note that early initiation of alcohol use among adolescents can provide a useful indication of the potential future burden among adults including increased risk for academic failure, mental health problems, antisocial behavior, physical illness, risky sexual behaviors, sexually transmitted diseases, early-onset dementia, and the development of alcohol use disorders.[18-21]
The current study observed that 4.2% (95% CI 2.8–6.3) of adolescent students use illegal drugs but it is less prevalent than the use of cannabis (14%) and opiates (12%) in higher secondary school students of Imphal, Manipur.[11] The overall prevalence rates among rural and urban students of the classes eighth, ninth, and tenth standards in West Bengal were 6.14% and 0.6% for illicit drug use, respectively.[22] The national prevalence of drug use among teenagers and young adults in Bhutan was 3.2%.[23] Tripura also has an open border with Bangladesh whereby a huge cache of drugs has made its way to the market. The rampant drug abuse in the states of northeast India is no secret. Most states sharing borders with Myanmar and Bangladesh have reported a massive inflow of illegal drugs from these countries. Due to porous borders in the form of thick vegetations and jungles in these states, they have become the highway for drug trafficking.[24] Among people who inject drugs, HIV rates range from 6.3% in China to 19% in Malaysia, and HCV ranges from 41% in India and Taiwan to 74% in Vietnam.[25]
The strength of this study is to find out the prevalence of alcohol and illegal drug use among adolescent school students in particular geographical areas. Further, it was noticed that social festivals and wedding ceremonies were the main events that helped adolescent students to take alcohol first time in their lives.
A limitation of this study is the use of self-reported survey, which may have resulted in reporting bias.
CONCLUSION
Early identification of alcohol and illegal drug use and related factors like initiations, frequency, and types (injectable drugs and non-injectable drugs) may be useful to improve the scope of holistic interventions for adolescent students. Appropriate intervention may be useful to prevent non-communicable diseases and HIV infections among adolescent students.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Acknowledgements
The authors would like to thank all students who have given their valuable feedback for this study and all school administrations for their consent and cooperation.
REFERENCES
- 1.Nadkarni A, Tu A, Garg A, Gupta D, Gupta S, Bhatia U, et al. Alcohol use among adolescents in India:A systematic review. Glob Ment Health. 2022;9:1–25. doi: 10.1017/gmh.2021.48. doi:10.1017/gmh. 2021.48. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Gore FM, Bloem PJ, Patton GC, Ferguson J, Joseph V, Coffey C, et al. Global burden of disease in young people aged 10–24 years:A systematic analysis. Lancet. 2011;377:2093–102. doi: 10.1016/S0140-6736(11)60512-6. [DOI] [PubMed] [Google Scholar]
- 3.Spear LP. Effects of adolescent alcohol consumption on the brain and behaviour. Nat Rev Neurosci. 2018;19:197–214. doi: 10.1038/nrn.2018.10. [DOI] [PubMed] [Google Scholar]
- 4.GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: A systematic analysis for the global burden of disease study 2019. Lancet. 2020;396:1223–49. doi: 10.1016/S0140-6736(20)30752-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Hall WD, Patton G, Stockings E, Weier M, Lynskey M, Morley KI, et al. Why young people's substance use matters for global health. Lancet Psychiatry. 2016;3:265–79. doi: 10.1016/S2215-0366(16)00013-4. [DOI] [PubMed] [Google Scholar]
- 6.DeWit DJ, Adlaf EM, Offord DR, Ogborne AC. Age at first alcohol use:A risk factor for the development of alcohol disorders. Am J Psychiatry. 2000;157:745–50. doi: 10.1176/appi.ajp.157.5.745. [DOI] [PubMed] [Google Scholar]
- 7.Hallfors DD, Waller MW, Bauer D, Ford CA, Halpern CT. Which comes first in adolescence—sex and drugs or depression? Am J Prev Med. 2005;29:163–70. doi: 10.1016/j.amepre.2005.06.002. [DOI] [PubMed] [Google Scholar]
- 8.Anthony JC, Petronis KR. Early-onset drug use and risk of later drug problems. Drug Alcohol Depend. 1995;40:9–15. doi: 10.1016/0376-8716(95)01194-3. [DOI] [PubMed] [Google Scholar]
- 9.Hadland SE, Harris SK. Youth marijuana use:State of the science for the practicing clinician. Curr Opin Pediatr. 2014;26:420–7. doi: 10.1097/MOP.0000000000000114. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Schmid B, Hohm E, Blomeyer D, Zimmermann US, Schmidt MH, Esser G, et al. Concurrent alcohol and tobacco use during early adolescence characterizes a group at risk. Alcohol Alcohol. 2007;42:219–25. doi: 10.1093/alcalc/agm024. [DOI] [PubMed] [Google Scholar]
- 11.Ningombam S, Hutin Y, Murhekar MV. Prevalence and pattern of substance use among the higher secondary school students of Imphal, Manipur, India. Natl Med J India. 2011;24:11–15. [PubMed] [Google Scholar]
- 12.Long KNG, Long PM, Pinto S, Crookston BT, Gren LH, Mihalopoulos NL, et al. Development and validation of the Indian adolescent health questionnaire. J Trop Pediatr. 2013;59:231–42. doi: 10.1093/tropej/fmt006. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Medhi GK, Hazarika NC, Mahanta J. Tobacco and alcohol use among the youth of the agricultural tea industry in Assam, India. Southeast Asian J Trop Med Public Health. 2006;37:581–6. [PubMed] [Google Scholar]
- 14.Jaisoorya TS, Beena KV, Beena M, Ellangovan K, Jose DC, Thennarasu K, et al. Prevalence and correlates of alcohol use among adolescents attending school in Kerala, India:Alcohol use among adolescents in India. Drug and Alcohol Rev. 2016;35:523–9. doi: 10.1111/dar.12358. [DOI] [PubMed] [Google Scholar]
- 15.Mohanan P, Swain S, Sanah N, Sharma V, Ghosh D. A study on the prevalence of alcohol consumption, tobacco use and sexual behaviour among adolescents in urban areas of the Udupi district, Karnataka, India. Sultan Qaboos Univ Med J. 2014;14:104–12. doi: 10.12816/0003343. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.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. doi: 10.4103/0019-557X.77260. [DOI] [PubMed] [Google Scholar]
- 17.Debbarma K, Narayanaswamy, Debnath A. An overview of traditional rice beer of Tripura. Biotica Research Today. 2021;3:243–5. [Google Scholar]
- 18.Dawson DA, Goldstein RB, Patricia Chou S, June Ruan W, Grant BF. Age at first drink and the first incidence of adult-onset DSM-IV alcohol use disorders. Alcohol Clin Exp Res. 2008;32:2149–60. doi: 10.1111/j.1530-0277.2008.00806.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Hingson RW, Heeren T, Winter MR. Age at drinking onset and alcohol dependence:Age at onset, duration, and severity. Arch Pediatr Adolesc Med. 2006;160:739–46. doi: 10.1001/archpedi.160.7.739. [DOI] [PubMed] [Google Scholar]
- 20.King KM, Chassin L. A prospective study of the effects of age of initiation of alcohol and drug use on young adult substance dependence. J Stud Alcohol Drugs. 2007;68:256–65. doi: 10.15288/jsad.2007.68.256. [DOI] [PubMed] [Google Scholar]
- 21.Nordström P, Nordström A, Eriksson M, Wahlund LO, Gustafson Y. Risk factors in late adolescence for young-onset dementia in men:A nationwide cohort study. JAMA Intern Med. 2013;173:1612–8. doi: 10.1001/jamainternmed.2013.9079. [DOI] [PubMed] [Google Scholar]
- 22.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. doi: 10.4103/0976-3147.71721. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Wangdi K, Jamtsho T. Drug use among teenagers and young adults in Bhutan. Indian J Psychol Med. 2019;41:535–40. doi: 10.4103/IJPSYM.IJPSYM_348_19. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Hasan A, Tawfeeq Alee N. Mental health and psychological problems in north east India. IAHRW Int J Soc Sci Rev. 2018;6:817–20. [Google Scholar]
- 25.Hser YI, Liang D, Lan YC, Vicknasingam BK, Chakrabarti A. Drug abuse, HIV, and HCV in Asian countries. J Neuroimmune Pharmacol. 2016;11:383–93. doi: 10.1007/s11481-016-9665-x. [DOI] [PubMed] [Google Scholar]