INTRODUCTION:

"Preventing teen substance use is one of the best opportunities we have to both improve the future prospects for our children and significantly reduce costs to taxpayers."

Jeb Bush

A study stated that drug abuse among children and adolescents is higher than the general population. This is notably because youth is a time for experimentation and identity forming. In developed countries drug abuse among youth is generally associated with particular youth subcultures and lifestyles. This causes an acceptance by members of the subcultures of drugs and their use. In Asia figures of drug abuse are hard to find but after cannabis, Amphetamine-type Stimulants (ATS) are the most commonly used amongst children and youth.¹Alongitudinal study was done on general population sample followed from age 5-10 years to adolescence and then on to early adult life. They found that both childhood aggression (incorporating anger and impulsivity) and intrapsychic distress predicted adolescent illicit drug use.² Adolescents with an inhalant use disorder may represent a subgroup of highly troubled youths with multiple vulnerabilities. Because early use is associated with progression to abuse and dependence, prevention programs should target elementary school-age children.³

OBJECTIVES:

· To assess the knowledge and attitude of substance abuse among school children.

· To evaluate the effectiveness of planned health teaching on knowledge and attitude of substance abuse among school children.

· To correlate knowledge and attitude of children towards substance abuse with selected demographic variables.

MATERIALS AND METHODS:

Setting and participants:

The study was conducted in selected English medium schools. The reason for selecting these schools was convenience, easy transport, administrative support and cooperation and availability of subjects. Systematic random sampling technique was used. The selection of subjects depends upon the inclusion criteria that are formulated consisting of age, gender, standard of education and medium of instruction. The investigator preferred this sampling technique as it best serves the purpose by enhancing representativeness. The sample size for the present study is 100 children between the age group of 10-15 years in selected schools. The sample size was calculated based on prevalence rate of substance abuse among children in India. School children within the age group of 10-15 yrs and who can understand English were included. School children who cannot respond due to any physical illness were excluded.

Tools and Techniques:

The tool for data collection consists of the following sections: Section I: Questionnaire to assess demographic data, Section II: Structured questionnaire to assess the knowledge: and Section III: Modified (Michael S. Goodsadt) attitude scale.

Description of the intervention:

Pre test has been conducted by using the structured questionnaire and attitude scale prepared on knowledge and attitude regarding substance abuse. The questionnaire had been distributed to the school children. Completed questionnaire were collected back. Following pre-test, planned health teaching had been administered by the investigator on the same day of the pre test. Post test had been conducted on 5^th day of planned health teaching by administering the same questionnaire and attitude scale on the same school children.

Ethical considerations:

• The proposal of the study was sanctioned by Institutional Ethical Committee.

• Permission was obtained from concerned authority of the selected schools in advance.

• Informed written consent was taken from the subjects and parents.

• Confidentiality of the records was maintained by utilizing code numbers instead of name of the subjects. The raw data was also kept confidential.

Statistical methods:

The analysis of the collected data was done with the help of descriptive and inferential statistics. The data was then processed using SPSS 11 statistical software, frequency, percentage, mean and standard deviation whereas Mann Whitney test, Wilcoxon test and ANOVA been used in order to analyze data and co-relate the findings as per the objectives. P value less than 0.05 considered as significant.

RESULTS:

Section I: Distribution of sample in relation to demographic data and socio economic profile:

Out of 100 subjects, majority 56 (56%) of them who participated in the study belonged to the age group of 13-15 yrs and 44 (44%) who participated in the study belonged to the age group of 10-12 yrs. Majority of subjects 54 (54%) of them were males whereas remaining 46 (46%) of them were females. Subjects were equally distributed in 6^th, 7^th, 8^th, 9^th and 10^th ie. 20 (20%). 71 (71%) of them were Hindu, 12 (12%) of them were Muslim, 12 (12%) of them were Buddhist and remaining 5 (5%) were Christian. Out of 100 subjects, 70 (70%) of them were from nuclear family and remaining 30 (30%) were from joint family. 90 (90%) of their parents were educated and remaining 10 (10%) of their parents were uneducated. 43 (43%) had a monthly family income of Rs. 5000-10, 000, 28 (28%) had monthly family income Rs. 10, 001-15, 000, 19 (19%) had monthly family income Rs. <5000 and remaining 10 (10%) had monthly family income Rs. >15, 000. Study reveals high prevalence and early initiation of substance abuse among street children. Continuing school education has beneficial role in prevention of substance abuse.⁴

Section II: Effectiveness of planned health teaching on knowledge and attitude

There was highly significant difference between pre and post test knowledge score as the P value was <0.0001. The planned health teaching is highly effective in improving the knowledge of substance abuse among school children in the study group. A study hypothesized that the lack of adequate curriculum, exposure to end-stage addiction, and lack of faculty expertise all may contribute to negative attitudes.⁵ There was highly significant difference between pre and post test attitude score as the P value was <0.0001. The planned health teaching was highly effective in improving the positive attitude towards substance abuse among school children in the study group.

Table 1: Comparison of pre and post test knowledge score in study group

Parameter	Pre test	Post test	Wilcoxon Z Value	P Value
Knowledge score	Mean ± SD (n=100)	Mean ± SD (n=100)	Wilcoxon Z Value	P Value
Knowledge score	9.18 ± 2.23	18.22 ± 1.24	8.73	<0.0001

Graph 1: Bar diagram showing comparison of pre and post test knowledge score in study group

Graph 2: Bar diagram showing comparison or pre and post test attitude score in study group

Table 2: Comparison of pre and post test attitude score in study group

Parameters	Pre test	Post test	Wilcoxon Z Value	P Value
Parameters	Mean ± SD (n=100)	Mean ± SD (n=100)	Wilcoxon Z Value	P Value
Attitude score	74.28 ± 10.40	104.21 ± 4.07	8.68	<0.0001

Section III: Comparison of pre test knowledge and attitude score with selected demographic variables:

There was significant difference seen in pre test knowledge score according to gender as the P value was <0.05 (ie. Knowledge score was significantly more in male than female) and education as the P value was <0.0001. There was significant difference seen in pre test attitude score according to monthly family income as the P value was <0.005.

Table 3: Comparison of pre test Knowledge score according to gender in study group

Knowledge score	Male	Female	MW test Z Value	P Value
Knowledge score	Mean ± SD (n=46)	Mean ± SD (n=54)	MW test Z Value	P Value
Pre test	9.76 ± 2.01	8.69 ± 2.31	2.22	<0.05

Graph 3: Bar diagram showing comparison of pre test knowledge score according to gender in study group

Graph 4: Bar diagram showing comparison of pre test knowledge score according to Education in study group

Table 4: Comparison of pre test Knowledge score according to Education in study group

Education	N	Knowledge score
		Pre test
		Mean ± SD
6^th	20	7.50 ± 2.37
7^th	20	9.95 ± 1.78
8^th	20	8.35 ± 1.89
9^th	20	9.95 ± 1.93
10^th	20	10.25 ± 1.94
F Value		7.15
P Value		<0.0001

Table 5: Comparison of pre test attitude score according to monthly family income in study group

Monthly income	N	Attitude score
		Pre test
		Mean ± SD
<5000	19	79.32 ± 5.66
5001 – 10000	43	72.09 ± 9.29
10001 – 15000	28	71.79 ± 13.10
>15000	10	81.10 ± 7.84
F Value		4.52
P Value		<0.005

Graph 5: Bar diagram showing comparison of pre test attitude score according to monthly family income in study group.

DISCUSSION:

A cross-sectional study was undertaken by involving 217 children. Majority i.e. 113 out of 217 subjects were boys and mostly belongs to Muslim religion (144). The mean age of substance abuse for males was 11.3 years old and 8.83 years old for females.⁶Educational programs based on clinical theories of behavior change and sound instructional practices are effective at both reducing problem behaviors and increasing a wide range of social and emotional competencies.Children should be educated about the causes and consequences of drug abuse through research-tested prevention programs.⁷It was found that illicit drug use by men has twice the reported prevalence rate of women's drug use. The trajectory for these patterns of drug use may be found in childhood, where drug use is generally higher in boys than in girls.⁸ Similarly, in this study knowledge score was significantly high in male than female (p value <0.05). A study has identified psychosocial skills as fundamental to prevent drug and substance abuse. Integral interventions that promote the building of a network of support from school, home and community and integrate life-skills training, specific information about substance abuse prevention and friendly materials can be considered as best practice. Students ́ (n= 3191) results revealed significant changes, showing an increase in decision making skills and changes in attitudes toward themselves and life. Results showed strong attitudes against drug use, and an increase in critically analyzing drug advertisements and messages after the program.⁹Educational intervention was effective in increasing the knowledge among the respondents about drug abuse.¹⁰Similarly in this study, planned health teaching was highly effective in improving knowledge and positive attitude towards substance abuse among school children.

CONCLUSION:

Awareness of the harmful effects of substance use is high. A disturbing aspect that has been noticed is that despite having knowledge of substance use, adolescents initiate and continue its use. Peer influences have been found to be among the strongest predictors of drug use during adolescence. Efforts to control the problem in this age-group should also target their parents and other family members, by means of the media. The school being an essential part in a student's life can include and promote an effective and healthy life-style. Interventions that enhance parental self-efficacy in conveying and enforcing attitude shaping for their children could reduce adolescent substance use. Healthy substance use control programs, focusing on youth, are essential, to reduce the burden of related diseases. The findings presented here can help other researchers to carry out comparative study in order to assess the knowledge and attitude of substance abuse among children studying in rural and urban schools and to assess the effectiveness of various teaching methods regarding substance abuse among school children.

SOURCE OF SUPPORT:

Nil.

CONFLICT OF INTEREST:

None declared.

ACKNOWLEDGEMENT:

The author acknowledges the contributions of Mrs. Shubhada Kale, Associate Professor, TGINE, who was the guide for this study and Mrs. Shubhangi Dumbray, Principal, TGINE. I also acknowledge language translators and editor for their effort in translating the tool and improvising the study. I also acknowledge my husband who was a source of encouragement throughout the project.

REFERENCES:

1. Sanjay Gupta, Jose PE, Wilkins H. National panel to study drug abuse among children. IANS Publications; 2005; 25:23.

2. Brook, Abadinsky.H, Milhorn HT. Quantity and frequency of drug use. 2009; 41(7):838.

3. Pilowsky, Babson KA, Leen Feldner EW. Treating and Preventing Adolescent Mental Health Disorders. 1^st edition. Oxford University press: New York; 2004.

4. Poonam R. Naik, Severson, H., & James, L. Street children of Mumbai: Demographic profile and substance abuse. Biomedical Research 2011; 22(4):495-8.

5. Geller, Hadengue A and Gache P. Academic Related Variables and Attitudes toward Substance Abuse among Secondary School Adolescents. World journal of Education. 2008[cited 2013 Jan 19];1(1): Available from http://www.sciedu.ca/journal/index.php/wje/article.

6. Eccles & Gootman. Substance Abuse Prevention for Children and Families. 2002; 33(4):256-8.

7. Christy Bowles. Education for Children about Substance Abuse. 2010; Sep 13[cited 2012 Jan 09]. Available from: http://www.livestrong.com/article/243084-ed

8. Harolyn M. E. Belcher, Harold E. Shinitzky. Substance abuse in children: Prediction, protection and prevention. Pediatric Adolescent Medicine. 2009 November [cited 2012 Dec 10]; 152(10):952-60. Available from: http://www.pam assn.org/pam/pub/category/1736.html./

9. Martha Givaudan, Susan Pick. A Preventive Program for Substance Abuse: Best Practices. 2005 [updated 2005 September 15; cited 2012 Dec 24]. Available from: http://www.mentorfoundation.org/pdfs/prevention_perspectives/3pdf

10. Shrestha Ta. Effects of Educational Intervention on Awareness about Drug Abuse among School Going Adolescents. Journal of Health Research. 2002 April [cited 2012 Dec 13]; 5(1). Available from: http://www.nhrc.org.np/ojs/index.php?journal=nhrc&page=article&op=viewFile&path[]=113&path[]=157.

Received on 26.04.2018 Modified on 06.07.2018

Int. J. Nur. Edu. and Research. 2018; 6(4):355-359.

DOI: 10.5958/2454-2660.2018.00086.8

Post test

Post test

Mean ± SD (n=100)

Female

Mean ± SD (n=54)

Knowledge score

Attitude score