Regional Health Forum WHO South-East Asia Region(Volume 6, Number 2)

Research

Substance and Drug Abuse: Knowledge, Attitude and Perception of Schoolgoing Adolescents in Bangladesh
Syed Masud Ahmed*, AKM Masud Rana# Shamim Matin Chowdhury**, Anne Mills, Sara Bennett**

Introduction

Drug abuse has been a rising social and economic problem in post-war Bangladesh ^{(1,2, 3,4,5,6)}. The number of drug addicts in Bangladesh is estimated to be about two million, of which more than half live in the capital city Dhaka ⁽⁷⁾. Of concern to the public health professionals and social scientists is the spread of this epidemic among adolescents. This is the period of life for exploration and experimentation - the means by which ‘adolescents learn who they are and what they want to do with their lives’, and trying out new things and making first-time choices ^{(8, 9)}. These make adolescents vulnerable to experiment drugs, which is marketed through a wide retail network in the cities. Drug abuse in young people has dire consequences such as unnatural death in the form of homicide or suicide, premature morbidity from STDs, needle-borne infections and noxious agents etc., and accidental injuries ⁽¹⁰⁾. High socioeconomic status, lack of academic achievement, disenfran-chisement from mainstream activities, ‘boredom’, peer acceptance, marginalized status, disabling family environment, and personal characteristics (such as high curiosity, tolerance for risk, lack of self-esteem, the need to look older, etc.) are implicated for abuse of drugs by adolescents ^{(11, 12, 13)}. Family influences in the form of parental use and opinions about tobacco, alcohol and drugs have a profound effect on adolescent drug abuse behaviour ⁽¹⁴⁾. The situation is compounded by the rapidly changing social and sexual mores leading to wide permissiveness in society in the last few decades.

Another aspect of the problem is the rapid spread of tobacco smoking among teenagers in Bangladesh, especially males ⁽¹⁵⁾. Smoking in peer networks and schools as well as family environment helps in initiating and continuing smoking ^{(16, 17, 18)}. This is alarming, because tobacco is considered to be a "gateway drug", the use of which may lead to alcohol, marijuana, and other drug abuse ^{(19, 20, 21)} and high-risk behaviours ^{(22, 23)} in the long term.

In public health practice, the saying goes: prevention is better than cure. It would be much more cost-effective and socially beneficial if the epidemic of substance/ drug abuse in Bangladesh could be managed by preventive interventions specifically targeted at the adolescents, based on their knowledge base and mindset. However, very little information is available on this issue in Bangladesh. To bridge this knowledge gap, BRAC, a national NGO, and the Central Treatment Centre for Drug Addicts (CTC), Government of Bangladesh, initiated a joint study to explore the knowledge, attitudes and perceptions of the school going adolescents on substance/drug abuse. World Health Organization (WHO) funded the study, and it was expected that the insight gained from it would help them in designing a preventive campaign for school-age adolescents.

Methodology

This descriptive study involving tenth graders (age 14-17 years) of secondary schools was undertaken in the six metropolitan cities of Bangladesh during June-July 2001. A self-administered semi-structured questionnaire was used for collecting information. A list of all secondary schools in each thana of the six metropolitan cities was obtained from the Bangladesh Bureau of Educational Statistics (BANBES), Dhaka. Systematic random sampling was done to select two government and two nongovernment schools (one boys and one girls), from each thana, if available. Thus, the final sample included 33 government schools and 170 non-government schools. The study was facilitated by trained field enumerators who obtained consent from the school headmaster/ mistress, fixed a suitable time in consultation with the class teacher, and administered the research instrument. From among the tenth graders present on the day of the survey, 20 were selected by systematic sampling. They were briefed about the purpose and methods of the survey as well as the contents of the self-administered questionnaire. The partici-pants were assured of the confidentiality of the information provided and also its irrelevance to their academic evaluation. When the facilitators were satisfied that the students understood the procedure and consented to participate, the questionnaires were distributed among them to fill in anonymously within about half-an-hour. The sitting arrangement was such that the students were discouraged from talking or consulting with each other. At the end of the session, the facilitators checked whether all the items were touched, and coded the questionnaire for school type and sex of the participant. Data were analyzed to compare the responses of the boys (n=1890) and the girls (n=2145) and the socioeconomic differentials, where relevant.

The instrument

The self-administered questionnaire was divided into four parts and collected information on the students personal and socioeconomic conditions; knowledge on the nature of addictive drugs/ substances, use and mode of intake, harmful effects, etc.; attitudes and perceptions about drug/ substance abuse; and in-depth information on tobacco smoking among peer network, respectively.

Results

Prior to the presentation of results, a useful context is provided by a brief profile of the demographic and socioeconomic charac-teristics of the study participants. Majority of them were Muslim (91%), hailed from nuclear families (68%), and were the first forms of their parents (35%). Ninety-two percent of them resided with their parents. Forty-nine percent of their fathers had about 12 years of schooling, while 52% of their mothers had about eight years of schooling. Service and business were the two most common occupations of the participants’ fathers (49% and 32% respectively) while most of the mothers were engaged in ‘household domestic chores’ (89%).

Knowledge on addictive substances and drugs

The participants appeared to possess a fair level of knowledge about the addictive properties of tobacco, alcohol and drugs commonly available in Bangladesh as well as their harmful effects on the body and mind (Table 1). However, when probed to test the depth of their knowledge, a very small proportion could correctly name the active ingredients in tobacco (27%) and alcohol (9%). Interestingly, not much difference was observed between the responses of the boys and the girls.

Table 1. Knowledge on addicting substances/drugs by sex (%)

* multiple responses considered

Availability, route of intake and source of knowledge

The study participants were quite knowledgeable about the sources of addictive drugs as well as routes of intake (Table 2). Mass media e.g., TV (74%), newspaper (63%) emerged as major source of acquiring the prevalent knowledge on addictive substances/drugs while the importance of textbooks (67%) and peer network (40%) could not be ignored. No appreciable sex difference was seen in most of the above responses.

Table 2. Place of availability, route of intake and source of knowledge on addicting substances/drugs by sex (%)*

* multiple responses considered