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Contents6. Brief resume of the intended work
6.1 Need for the study
6.2 Review of literature
6.3 Statement of the problem
6.6 Operational definitions
Planned Teaching Programme
Psycho-active Substance Abuse
7. Materials and methods
7.2.1 Criteria for selection of sample
7.2.2 Data collection tool
7.2.3 Data analysis method
7.3 Does the study require any interventions or investigations to be conducted on patients or other human beings or animals ?
7.4 Has ethical clearence been obtained?
8. List of references
Signature of the candidate
|RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,|
PROFORMA FOR REGISTRATION OF SUBJECTS
“Half way up the stars isn’t up, isn’t down, it isn’t the nursery, it isn’t the town’ And all sorts of funny thought run around my head. “It isn’t really ` anywhere! It’s somewhere else instead!”
-Milene A A
Adolescence, the age of experimentation, adventure and expiration, is known to be vulnerable to varied forms of risk taking behaviours such as psychoactive substance abuse, premarital sexual activity and anti social behaviours. In recent years more and more adolescents use addictive and psycho-active substances .The reason being disintegration of the old joint family system, lack of parental love, care and safety. The modern families where both parents are working, decline of old religious and moral values, being in conflict with peer group and the need for acting opposite to social rules makes the adolescent vulnerable to anti social behaviours.1
Psycho-active substance abuse is defined as “use of drugs, alcohol and any other mind altering agents to such an extent that it interferes with the person’s biological, psychological or social integrity”. Drug abuse is defined as self administration of a drug for known medical reason, in quantities and frequencies which may impair an individual’s ability to function effectively, which may result in social, physical or emotional harm. Drug and alcohol abuse, already is a widespread problem. Television and radio advertisements entice viewers with the hope of relief from pain and problems .The cultural values portrayed are clear: discomfort should be erased; drinking is vital to a stress free life; drugs are acceptable mediators of emotions. Substance abuse is a major public health issue with grave ramifications. It increases the crime rate are destroyed. Every part of a substance abusers life, social life, family life, work productivity, relationships and physical health is affected.2
Every year June 26 is celebrated as International Day against Drug Abuse and Illicit Trafficking. It is an exercise undertaken by the world community to sensitize the people in general and the youth in particular, to the menace of drugs. With a turnover of around, $500 billion, it is the third largest business in the world, next to petroleum and arms trade. About 190 million people all over the world consume one drug or the other. Drug abuse causes immense human distress and the illegal production and distribution of drugs have spawned crime and violence worldwide .Today, no part of the world is free from the curse of drug trafficking and drug abuse. Millions of drug abusers, all over the world, are leading miserable lives, between life and death.3
Parents may not realize just how available illicit drugs are to their children. They may not realize how young children are when they begin to experiment with alcohol and drugs. Due to the long-lasting effects of consumption of psychoactive substance abuse, it should be made one of the central topics of prevention and health promotion in adolescence. Therefore it is of utmost importance to educate the adolescents about the effects of psycho-active substance abuse.4
Recently, substance abuse has been increasing among children and adolescents as in many states of India; they experiment with drugs quite early in life. Thus arises the need for the study. Youth population is considered as very decisive population for the prosperity of any nation. There are special reasons why we need to concentrate more on youth ,it is the need of time to discover the new behaviour and relationship towards substance use among youths so that it can be corrected at an early stage.5
Substance use is one of the most common causes of preventable human deaths worldwide. Alcohol and tobacco are most commonly used substances throughout the world and in India. Other substances that are used are Ganja (Cannabis), Cocaine, Inhalants, Hallucinogens, Sedatives, Tranquilizers and intravenous drugs. Youth population is the most susceptible population to initiate substance use in India. WHO defined youth as, “the individual belonging to the age group of 15-24 years.” Youths are easily influenced by peer and sibling pressure, substance use by parents, easy availability, cheap cost, attractive packaging of such substances, lucrative advertisements through mass media and lack of awareness regarding consequences of substance use on health.6
India too is caught in this vicious circle of drug abuse and the numbers of drug abusers, are increasing day by day. According to a United Nations’ report, One million heroin addicts are registered in India and unofficially there are as many as five million abusers. What started off as casual use among a minuscule population of high-income group youth in the metro has permeated to all sections of society. Inhalation of heroin alone has given way to intravenous drug use, that too in combination with other sedatives and painkillers. Globally, according to WHO, the extent of world-wide psychoactive substance abuse is estimated as 2 billion alcohol users, 1.3 billion smokers, 129 million cannabis users and 185 million drug users. About 76.3 million are diagnosed with alcohol related disorders and 3.2 % of overall human deaths are caused by alcohol consumption. Tobacco attributes to 4.9 million annual deaths and this figure is expected to rise to 10 million by 2030, out of which 7 million deaths will be occur in developing countries, especially India. The alarming fact still remains that 5,500 adolescents initiate using tobacco every day in India! In India, prevalence rates of use of alcoholic beverages ranges from 23 % to 74 % among males and 80% among the adolescent group.7
Drug abuse has led to a detrimental impact on the society. It has led to the increase in the crime rate. Addicts resort to crime to pay for their drugs. Drugs remove inhibition and impair judgment making one on to commit offences. Incidence of eve-teasing, group clashes, assault and impulsive murders increase with drug abuse. Apart from affecting the financial stability, addiction increases conflicts and causes untold emotional pain for every member of the family. With most drug users being in the productive age group of 18-35 years, the loss in terms of human potential is incalculable. The damage to the physical, psychological, moral and intellectual growth of the youth is very high. Adolescent drug abuse is one of the major areas of concern in adolescent and young people's behavior. It is estimated that, in India, by the time most boys reach the ninth grade, about 50 percent of them have tried at least one of the gateway drugs. However, there is a wide regional variation across states in terms of the incidence of the substance abuse. For example, a larger proportion of teens in West Bengal and Andhra Pradesh use gateway drugs (about 60 percent in both the states) than Uttar Pradesh or Haryana (around 35 percent).8
A survey was conducted on psycho-active substance use among adolescent students. A cluster sample was drawn on 9 cities. Each city provided two schools from grade 11 senior high school and the total of 18 schools were selected randomly. The results revealed that a total of 2649 students have completed a self- report questionnaire; their mean age was 17.1 +/- 0.9 years. The life-time prevalences of regular substance use were: alcohol 66.1%, NSAID 59.3%, tobacco 27.4%, sedative/hypnotic 5.2%, heroin 3.1%, solvents 2.8%, amphetamine-type stimulants (ATS) 0.7% and cannabis 0.3%. The ‘prevalences of current regular use’ (atleast 15 times in the past month) were: tobacco 4.2%, alcohol 1.6%, NSAID 0.8%, sedative/hypnotic 0.1%, solvents 0.1% and cannabis 0.1%. The prevalences of current use at any level' were: alcohol 15.2%, NSAID 9.6%, tobacco 7.1%, sedative/hypnotic 0.5%, solvents 0.4% , cannabis 0.1%, heroin 0.1%, and ATS 0.04%.The median age at onset of substance use was between 10.7 and 13.4 9.6%. The researchers concluded that drug misuse is a significant problem among teenage students. The most widely used substances were alcohol and cigarettes.9
A cross-sectional study was conducted to assess the prevalence of tobacco use among adolescents in a rural district in Kerala and to understand the extent of awareness about health hazards due to tobacco use and legislation against tobacco consumption. A total of 1473 students were randomly selected from 15 educational institutions in Kerala. The results revealed that the overall prevalence of ‘current tobacco users’ was 8%. A significant association between age and tobacco use was noted among tobacco habitués (P< 0.05). Awareness regarding legislation against smoking in public places was more in the higher age-groups (P<0.05). Females were more aware of the ‘smoking ban’ than males (P<0.05). In the present survey, the awareness regarding the hazards associated with tobacco use revealed that 41.5% of the students knew about the link between oral cancer and tobacco, with the awareness being greater among females than among males (64.3% Vs 35.4%).10
A study was conducted to identify the prevalence and pattern of substance use among pre-university college students of Manipur, India. The study sample consisted of 1020 students who completed a self administered questionnaire. The results revealed that out of the 1020 students, 551 reported prior substance use (prevalence of ever use: 54%, 95% confidence interval [CI] 42%-67%). Prevalence of recent and current user was 35% (95% CI 28%-43%) and 22% (95% CI 17%-28%), respectively. Among ever users, tobacco (46%) was used commonly, followed by alcohol (29%), cannabis (14%) and opiates (12%). On multivariate analysis, substance use was significantly higher among boys (adjusted odds ratio [AOR] 2.6, 95% CI [2.0-3.4], whose father (AOR 2.0, 95% CI 1.6- 2.7) or sibling (AOR 2.1, 95% CI 1.5-3.0) used substance. It was significantly lower among children of Hindu/Jain religion (AOR 0.5%, 95% CI 0.4-0.7). The researchers concluded that prevalence of tobacco and alcohol use is high among adolescence. Familial use of tobacco and friends were the key proximal determinant and the researchers recommended introduction of educational programmes to students about various adverse effects so as to develop refusal skills.11
From the available literature reviewed, it is evident that the rates of substance abuse peek among the adolescents. Moreover substance use initiation appears to occur at increasingly younger ages. Mainly alcohol and mixed type of substance use such as alcohol and cigarettes and alcohol, cigarettes and drugs, are prevalent among adolescents. Properly articulated adolescence based educative programmes can prevent illicit psychoactive substance abuse among adolescents. Hence the researcher found it relevant to evaluate the effectiveness of a planned teaching programme on the ill-effects of selected psychoactive substance abuse for adolescent males in selected educational institutions at Bangalore.
A literature review is a written summary of the state of evidence on a research problem. It is a little bit like doing a full-fledged study, in the sense that a reviewer must start with a question, formulate and implement a plan for gathering information, analyze and interpret the information. A literature review also plays a role at the end of the study as researchers try to make sense of their findings.12
A population based cross-sectional study was conducted to find out the magnitude of illicit substance use among students and to find out the association between socio-economic and demographic characteristics of the students and habits of use. The study sample consisted of 416 students selected by multistage random sampling. The main outcome measures were substance use namely tobacco, alcohol and cannabis. The results revealed that the overall prevalence rate among rural and urban students were 6.14% and 0.6% for illicit drug use, 8.60% and 11.04% for tobacco and 7.37% and 5.23% for alcohol consumption, respectively. Illicit substance use was associated more with male students. Current and regular use were mostly restricted to tobacco, and the use of a substance by family members, had a significant impact on its use by their children. “Enjoyment” and “curiosity” were found to have the major influence in their decision to use a substance.13
A study was conducted on epidemiology of psychoactive drug use among adolescents in metro-politan areas. The study sample consisted of 4286 students (mean age 15.2) who were anonymously administered a self-report questionnaire. The results revealed that the rate of most of the 14 substances investigated was much higher than reported in any other study on a comparable population. It was estimated that 61.8% of respondents have used one or more psycho-active substances in their life time. The rate of use of addictive substances such as cannabis, heroin and cocaine ranged between 4-4.8%. The researchers concluded that properly articulated educational programmes can facilitate drug demand reduction.14
An exploratory study was conducted to identify psychoactive substance related visits of adolescents to the emergency department and also to determine the differential features in patients according to the kind of psychoactive substances consumed. The study sample consisted of 321 patients. The samples were divided into two groups: group I comprised of clients with alcohol intoxication only and the clients in the group II visited the setting for intoxication with psychoactive substance use. The results revealed that the mean age of the subjects were 16.1years. About 262(78.7%) were alcohol related visits and 110(33%) were related with other psychoactive substance consumption. Of the 262 alcohol- related visits, 223 were only related with alcohol (group I) while the other 110 visits were made by group II. Group II was composed of more males.15
A cross-sectional study was conducted to determine the prevalence of psycho-social dysfunction and depressive symptoms among adolescents who abuse substance and also to identify the influence of socio-demographic factors and type of substance on the pattern of dysfunction. The study sample consisted of 900 adolescents from 29 secondary schools selected by a multistage sampling procedure. The results revealed that out of the 900 participants, a total of 290 students were current substance abusers. The substances mostly abused were alcohol (31.6%), cola nitida (kola nut) (20.7%) and coffee (15.7%). Using the Paediatric Symptom Checklist scale, 70 (24.1%) subjects compared to 29 (10.7%) of the controls had scores in the morbidity range of >or= 28 for psychosocial dysfunction. This was statistically significant (chi2 = 17.57 p = 0.001). About 54 subjects (18.6%) had scores in the morbidity range of >or= 50 for depressive symptoms compared to 21 (7.7%) of controls. This was statistically significant (chi2 = 14.43, p = 0.001). Prevalence of dysfunction was not significantly related to age in both subjects and controls (chi2 = 4.62 p = 0.010, chi2 = 4.8 p = 0.01) respectively. Also using both scales, there was no significant relationship between psychosocial dysfunction and gender or social class in both subjects and control.16
A survey was conducted among students to check, whether the consumption of psychoactive substances depends on such traits as: sex, place of living, subjective evaluation of one's health, the type of university they attend and whether the respondents think that the knowledge passed onto them on the universities about the dangers resulting from consuming such substances is sufficient and whether they know how to help an addicted person. The research was done with the help of 504 students. The results has shown, that most of the students consume alcohol (81.1% of the respondents), followed by caffeine (75.8%). The third place was taken by narcotics (38%) and the fourth by cigarettes (20%).The results showed that most people who smoke are the ones that are renting an apartment by themselves. No statistical difference was found in the usage of cigarettes between women and men. The average age of the initiation into tobacco usage of the respondents was 17 years of age, which is a time when one doesn't have a legal right to obtain cigarettes.17
A comparative study was conducted to investigate the relationship between the use of illicit drugs and sexual-risk-behavior in a sample of students aged 14 to 21 years at a public high school. Drug users (N=366) presented a higher frequency of complete sexual intercourse (80.8% of users versus 53.5% of non-users), (N = 323, p < .001). Sexual-risk-behavior increased with the number of drugs used. Alcohol and marijuana use were associated with the highest sexual-risk-behavior. These data are essential for the development of more specific preventive strategies, focusing on male alcohol and marijuana users.18
A two year longitudinal group randomized trial was conducted to examine the longitudinal relationship between exposure and receptivity to tobacco advertisements and progression towards tobacco use among adolescents in India. The study sample consisted of students from 32 educational institutions in Delhi and Chennai. The results revealed that exposure to tobacco advertisements had an impact on progression towards tobacco use. Students exposed at more than four places were 1.5 times (95% CI 1.12 to 1.94; p< 0.05) more likely to progress towards tobacco use at end line versus those not exposed. Among boys, those exposed at more than four places were 1.7 times more likely to progress (95% CI 1.14 to 2.62; p<0.05). These significant results disappeared in multivariate analysis, when other psycho-social risk factors for tobacco use were controlled. In both bivariate and multivariate analysis, the risk of progression was more than two times higher (95% CI 1.28 to 4.32; p<0.05) among boys who were highly receptive than non-receptive boys. The same relationship did not hold among girls.19
A cross-sectional observational study was carried out among 454 urban school boys in the age group of 13-18 years to assess the prevalence, perception and pattern of tobacco use along with associated factors of tobacco use in West Bengal, India. The results revealed that out of 454 students, 201(44.3%) were ever users of tobacco where as 135(29.7%) were current users. Majority of the current users utilized both form of tobacco. Initiation of tobacco before 10years were more in smokeless (11.4%) form than smoking (4.5%), but smokers showed steep rise (49.3%) at 14-15 years. Proportion of current users significantly (p<0.001) increased along with increase in pocket money. Compared to non-users current users had more exposure to tobacco in the family and friends. Though knowledge of harmful effects of tobacco was well perceived but significantly more (p<0.005) non users had shown interest to prohibit smoking in public places.20
A cross-sectional descriptive study was conducted to determine the pattern of psychoactive substance use among adolescents and its triggering factors. A multistage sampling technique was used to interview 280 respondents using self-administered, structured and pretested questionnaires. The results revealed that out of the 280 respondents, 195 (69.6%) are males and 85 (30.4%) are females. The study shows that 157 (56%) use one or more substance or the other. The commonest ones are kola nut followed by cigarette and marijuana. The commonest push factor for use is to experiment (54%). The study also shows, statistically significant relationships between family background psychoactive substance use (chi2 = 21.7, df =2 p<0.05), there was however no statistical significance between age, class of the students and substance use respectively (chi2 = 1.94, df = 2 p>0.05), (chi2 = 0.97, df =2 p>0.05).21
A cross-sectional study was conducted to determine the prevalence of tobacco chewing among adolescents in four villages of Gujarat. The study sample consisted of 930 adolescents in the age group of 16-19 years. The results revealed that 33.12% of the adolescents were addicted with one or other type of tobacco chewing, majority of addicted adolescents were in the age group of 17-19years (36.26%). Tobacco chewing is the most frequent form of using tobacco by adolescents than smoking. Majority of the substances were addicted for more than 12 months (57.47%). Main inducing factor for addiction was found to be friends (61.69%).22
“A study to evaluate the effectiveness of a Planned Teaching Programme on the ill-effects of selected psycho-active substance abuse for adolescent males in selected educational institutions at Bangalore.”
6.4 OBJECTIVES OF THE STUDY:
The objectives of the study are to:
The following hypotheses will be tested at 0.05 level of significance :
H1: There is a significant difference between the mean pre-test and post-test knowledge scores of adolescent males regarding the ill-effects of selected psychoactive substance abuse.
H2: There is a significant association between the mean pre test knowledge scores of the adolescent males regarding the ill-effects of psycho-active substance abuse with their selected socio-demographic variables.
It refers to the process used for the assessment of knowledge of adolescent males regarding ill-effects of selected psycho-active substance abuse.
It refers to the extent to which the Planned Teaching Programme produces the intended results among the adolescent males regarding the ill-effects of selected psycho-active substance abuse as measured in terms of significant gain in mean post test knowledge scores, which is measured as adequate knowledge, moderately adequate knowledge and inadequate knowledge.
It refers to a method of providing an educational programme regarding the ill-effects of selected psycho-active substance abuse for adolescent males.
It refers to the extent to which selected psycho-active substance abuse produces unfavourable consequences.
It refers to the use of psychoactive drugs, alcohol and any other mind altering agents to such an extent that it interferes with person’s biological, psychological or social integrity. The selected substances include alcohol, cigarettes, tobacco, cannabis and non steroidal ant-inflammatory drugs.
In this study, it refers to the juvenile boys between the age of puberty and legal adulthood.
Selected socio-demographic Variables:
It refers to age, religion, educational status, father’s occupational status, monthly income, place of residence, type of family, presence of any psycho-active substance abusers among family members and previous information received regarding ill-effects of selected psychoactive substance abuse.
The study is based on the following assumptions:
The study is delimited to:
7.1 SOURCE OF DATA:
Adolescent males in the age group of 16 to19 years.
7.2 METHODS OF DATA COLLECTION:
Research method : Quantitative Quasi Experimental method
Research design : One group pre test - post test design
Sampling technique : Probability, simple random sampling
Sample size : 100 adolescent males
Setting of the study : Selected educational institutions refers to
Indian Academy PU College, Jyothi PU
Composite College, National PU College
and Christhu Jayanthi College Bangalore
The study includes “adolescent males”;
The study excludes “adolescent males”;
A planned teaching programme will be prepared by the investigator regarding ill-effects of selected psycho-active substance abuse which covers the content in the areas of biological, psychological and sociological health aspects of psychoactive substance abuse. A structured interview schedule will also be prepared to assess the knowledge of the adolescent males regarding the ill-effects of selected psychoactive substance abuse. Content validity of the tool along with the planned teaching programme will be ascertained in the consultation with the guide and experts in the field of psychiatric nursing. Reliability of the tool will be established by split half method.
Prior to this study, a formal administrative permission will be also obtained from the concerned administrative authority of the settings. A written consent will be obtained from the participants regarding their willingness to participate in the study. The tentative period of data collection will be in August 2012.
Data will be analyzed by using descriptive and inferential statistics. Frequency and percentage distribution will be used to analyze demographic variables. The demographic variables will also be described descriptively by using diagrams. (Columns, bar, cone and pie diagrams). Measures of central tendency such as mean and standard deviation will be used to determine the mean knowledge scores of adolescent males regarding the ill-effects of selected psychoactive substance abuse.
A ‘t’ test will be done to compare the mean pre-test and post-test knowledge scores of the adolescent males regarding the ill-effects of selected psychoactive substance abuse. A chi-square (χ²) test will be done to find out the association between the mean pre-test knowledge scores of adolescent males regarding ill-effects of psychoactive substance abuse and their selected socio-demographic variables.
A structured interview schedule regarding the ill-effects of selected psycho-active substance abuse to evaluate the subject’s knowledge regarding ill-effects of psycho-active substance abuse will be used. A Planned Teaching Programme also will be administered among the adolescent males regarding the ill-effects of psycho-active substance abuse. No other physical or laboratory procedures will be conducted or done on the samples.