Research Paper (APA STYLE) as soon as possible

Research Paper (APA STYLE) as soon as possible
INSTRUCTION Research Paper You are required to write an 8–10-page paper in APA format. The paper should include a title page, abstract, and reference page (not included in the page total). The paper should also include a minimum of 5 peer-reviewed articles which include research data.You will choose a topic covered in the textbook or course. In your paper, you must include the following sections: description of the crisis, historical context of the crisis (up to 5 years ago), prevalence of the crisis (in the last 5 years), therapeutic interventions used to intervene, and a critical analysis of the pros and cons of the identified crisis in a specific culture. Examples of topics are Substance Abuse among Native Americans in the U.S., or Human Trafficking in Thailand. This assignment must be submitted through SafeAssign by 11:59 p.m. (ET) on Monday of Module/Week 5.
Research Paper (APA STYLE) as soon as possible
PSYC 317 Research Paper Grading Rubric Student: Criteria Points Possible Points Earned Content/Development All key elements of the assignment are covered in a substantive way. 70 Content is comprehensive, accurate, and/or persuasive. Major points regarding the crisis topic are stated clearly and are supported by professional literature or logic. Meaningful use of source material and analytical reasoning to elaborate upon the topic or theme. Research is adequate and timely for the topic. The context and purpose of the writing are clear. Organization The introduction provides sufficient background on the crisis topic and previews major points. 25 Ideas flow in a logical sequence. The structure of the paper is clear and easy to follow. The paper’s organization emphasizes the central theme or purpose. Paragraph transitions are present, logical, and direct the flow of thought throughout the paper. The conclusion logically derives from the paper’s ideas. The conclusion reviews the major points toward the appropriate audience. Format The paper includes a title page, abstract, 8–10 full pages of content, and a reference page. 30 The references page contains at least 5 scholarly sources. 20 The paper follows APA format guidelines. The paper is written in 12-pt. Times New Roman font, double-spaced and 1-inch margins. The work is original giving credit to all borrowed ideas (direct quotes and paraphrasing). Grammar/Punctuation/Spelling Rules of grammar, usage, and punctuation are followed. 15 Spelling is correct. Readability/Style Sentences are complete, clear, and concise. 15 Sentences are well constructed with consistently strong and varied structure. Sentence transitions are present and direct the flow of thought. Words used are precise and unambiguous. Total Points 175 Instructor’s Comments:
Research Paper (APA STYLE) as soon as possible
Familial Influences on Substance Use by Adolescents and Young Adults Author(syf 0 L F K D H O + % R O H 0 D U N 6 D Q I R U G 3 H W H U 6 ] D W P D U L . D W K O H H Q 0 H U L N D Q J D V D Q d David R. Offord Source: Canadian Journal of Public Health / Revue Canadienne de Santé Publique, Vol. 92, No. 3 (MAY / JUNE 2001yf S S 9 Published by: Canadian Public Health Association Stable URL: http://www.jstor.org/stable/41993309 Accessed: 03-08-2017 05:40 UTC REFERENCES Linked references are available on JSTOR for this article: http://www.jstor.org/stable/41993309?seq=1&cid=pdf-reference#references_tab_contents You may need to log in to JSTOR to access the linked references. JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact [email protected] Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at http://about.jstor.org/terms Canadian Public Health Association is collaborating with JSTOR to digitize, preserve and extend access to Canadian Journal of Public Health / Revue Canadienne de Santé Publique This content downloaded from 208.95.50.183 on Thu, 03 Aug 2017 05:40:06 UTC All use subject to http://about.jstor.org/terms Familial Influences on Substance Use by Adolescents and Young Adults Michael H. Boyle , PhD,1 Mark Sanford, MB ChB,1 Peter Szatmari , MD,1 Kathleen Merikangas, PhD,2 David R. Offord, MD1 Substance use by adolescents and young adults is increasing after a decade-long decline in use during the 1980s.1″4 Efforts to understand factors leading to drug use in this age group have focused on genetic, individual and environmental influences (especially family, peer and school environ- mental factorsyf ( Y L G H Q F H V X J J H V W V W K D t genetic factors account for a large share of observed familial aggregation of use and abuse of alcohol and illicit drugs, and that both general and drug-specific genetic influences are at play.6 However, the rela- tive importance of environmental and genetic factors is unclear. For example, a recent population-based twins study found little evidence of family environmental fac- tors causing alcohol-related disorders in contrast to earlier clinic- and court-based studies.7 In contrast, in a U.S. adoption cohort, substantial environmental effects were reported for sibling aggregation (but not for parent-child aggregationyf R I D O F R – hol use and problem drinking (r = 0.24 in non-biological siblings, r = 0.45 in same sex/same age siblings vs. r = 0.01 (p>0.05yf for opposite sex/dissimilar age siblingsyf 8 A criticism of the literature in this area is that very few studies have used representa- tive community-based samples to evaluate these issues free from the referral biases 1. Department of Psychiatry and Behavioural Neuroscience and Centre for Studies of Children at Risk, McMaster University, Hamilton, ON 2. Departments of Psychiatry and Epidemiology, Yale University, New Haven, CT Correspondence and reprint requests: Michael H. Boyle, Centre for Studies of Children at Risk, McMaster University Faculty of Health Sciences and Hamilton Health Sciences Corporation, Patterson Building, Chedoke Division, Hamilton Health Sciences Corporation, Box 2000, Hamilton, ON, L8N 3Z5, Tel: 905-521-2100 ext 77365, E-mail: [email protected] Dr. Michael Boyle is supported by a Canadian Institutes of Health Research Scientist Award and Dr. Peter Szatmari is supported by a Senior Fellowship Award from the Ontario Mental Health Foundation. inherent in clinic samples.9 Two such stud- ies report on sibling effects. In the U.S. National Survey on Drug Abuse, drug use by teenagers correlated with drug use by fathers (from r = 0.17 for current cigarette use to r = 0.31 current marijuana useyf E y mothers (from r = 0.04 (p>0.05yf I R U F X U U H Q t alcohol use to r = 0.30 for lifetime mari- juana useyf D Q G E R O G H U V L E O L Q J V U 7 (p>0.05yf I R U O L I H W L P H F R F D L Q H X V H W o r = 0.30 for lifetime marijuana useyf , Q a second study, alcohol use was highly con- cordant among spouses (r = 0.67yf E X W O H V s so among parents and offspring and sib- lings (from r = 0.25 to r = 0.44yf 1 The objective of this study is to examine family influences on tobacco, alcohol, and marijuana use by 12-24 year olds in a rep- resentative general population sample liv- ing at home. The following questions are addressed: 1yf Z K D W L V W K H S U H Y D O H Q F H R I V X E – stance use among family members?; 2yf G R H V V L E V K L S V W U X F W X U H L Q I O X H Q F H D J J U H J D – tion or clustering of substance use in fami- lies?; 3yf G R H V J H Q G H U R U D J H L Q I O X H Q F e within-family correlations of substance use?; and 4yf L V V X E V W D Q F H X V H D P R Q J R X Q J H U V L E – lings associated more strongly with parental substance use or substance use by older siblings? Answers to these questions will provide insight into the relative importance of parental and sibling effects and whether observed sibling aggregation is likely to be due to shared genetic or environmental effects. METHODS Survey design Information for this research comes from the Ontario Health Survey (OHS: ref. 12yf 7 K H V D P S O H Z D V R E W D L Q H G X V L Q J a stratified multi-stage cluster design: there were 35,479 dwellings selected and 87.5yb of these yielded a person knowledgeable 206 REVUE CANADIENNE DE SANTÉ PUBLIQUE VOLUME 92, NO. 3 ABSTRACT This study uses data from the Ontario Health Survey to examine within-family influences (sibship number, age and sex com- position; family structure and parental sub- stance useyf R Q W K H X V H R I W R E D F F R D O F R K R l and marijuana in households (N=4,643yf among offspring aged 12 to 24 years. Using a modification of the kappa statistic, concor- dance among siblings is modest generally and undifferentiated across substance type. Concordance is stronger among sibships that are either all male or older (19-24 yearsyf D Q d is particularly strong for siblings < two years apart in age. The dominant influence of sub- stance use behaviour appears to be from older siblings to younger siblings and not from parents to offspring. Sibling concor- dance for substance use suggests that the treatment and prevention of substance use (and abuseyf D P R Q J D G R O H V F H Q W V D Q G R X Q g adults might be enhanced by including a family focus, especially where there are two or more siblings at home. ABRÉGÉ L’étude, fondée sur les données de l’Enquête sur la santé en Ontario, porte sur les influences intrafamiliales (nombre, âge et sexe des mem- bres de la fratrie, structure familiale et consom- mation de drogues par les parentsyf V X U O D F R Q – sommation de tabac, d’alcool et de marijuana dans des familles (n = 4 643yf G D X P R L Q V X n parent et un enfant de 12 à 24 ans. Une analyse Kappa modifiée révèle une concordance frater- nelle modeste dans l’ensemble, peu tranchée selon le type de drogue. La concordance est plus prononcée lorsque la fratrie se compose unique- ment de garçons ou comporte un membre plus âgé (19 à 24 ansyf S D U W L F X O L U H P H Q W O R U V T X e l’écart entre les membres est de deux ans ou moins. L’influence dominante, en matière de consommation de drogues, semble s’exercer des aînés aux cadets et non des parents aux enfants. La concordance constatée entre les membres de fratries porte à croire que l’on pourrait améliorer le traitement et la prévention de la consomma- tion (et de l’abusyf G H G U R J X H V F K H ] O H V D G R O H V – cents et les jeunes adultes en y intégrant une composante familiale, surtout lorsqu’il y a plus d’un enfant à la maison. This content downloaded from 208.95.50.183 on Thu, 03 Aug 2017 05:40:06 UTC All use subject to http://about.jstor.org/terms MAY – JUNE 2001 CANADIAN JOURNAL OF PUBLIC HEALTH 207 about the household who agreed to pro- vide information on sociodemographic and general health variables of all residents in a personal interview. Self-administered ques- tionnaires on more personal health issues (including substance useyf Z H U H O H I W I R r completion by all household members aged 12 years and older. Sample for analysis The sample consisted of families with at least one offspring aged 12 to 24 years and at least one natural parent in the home. All household members other than offspring and their natural parent(syf Z H U H H [ F O X G H G . Applying these criteria yielded a potential sample of 23,915 individuals living in 6,976 families. Failure of individuals to return self-administered questionnaires reduced the sample by 24.5yb (5,861/23,915yf 0 L V V L Q J G D W D R Q R Q H R r more of the variables needed for the analy- ses reduced the sample by another 14.9yb (3,564/23,915yf $ F R P S D U L V R Q R I U H V S R Q – dents and nonrespondents based on inter- view data is presented in Table I. Most dif- ferences are less than 5yb D Q G Q R Q H D U e larger than 10yb 7 K H I R O O R Z L Q J J U R X S s (>5yb G L I I H U H Q F H V f may be over-represented: one-parent households; parents born in Canada who were younger and better edu- cated; and siblings who were older and female. Variables and measures The substance use variables were mea- sured independently for respondents based on their answers to self-administered ques- tionnaires. Use of cigarettes refers to daily consumption; use of alcohol refers to aver- age weekly consumption of 2 or more drinks in the previous 12 months; use of marijuana refers to lifetime use of marijua- na, cannabis or hash at least 5 times. Sociodemographic variables were derived from responses provided by the knowl- edgeable household member to the interviewer-administered questionnaire. Analysis Prevalences are estimated by the number of users per 100 for each category of sub- stance use. A modification of the kappa statistic proposed by Fleiss13 is used to esti- mate familial aggregation. In this method, TABLE I Distribution of Selected Characteristics of Respondents and Nonrespondents Characteristics Respondents Nonrespondents Households (6976yf f (2333yf Urban residence 74.5 70.2 <6 members in household 93.4 91.8 Income below the poverty line 1 4.4 11 .0 One parent in home 1 8.3 1 3.0 Parents (12,919yf f (5170yf Female 54.1 49.7 Age in years <50 78.4 71 .2 Birthplace Canada 75.5 66.6 Secondary school complete 64.1 58.2 Working 79.1 79.1 Siblings (1 0,996yf f (4255yf Female 49.2 42.2 Age in years 1 8-24 61 .1 54.6 In school 83.0 78.2 TABLE II Substance Use Prevalence per 100 Among Parents and Siblings Tobacco Alcohol Marijuana (currentyf R Q H H D U f (lifetimeyf Parents Mothers (4194yf 5 Fathers (3555yf 5 Siblings Sex Females (3423yf 6 Males (3318yf 7 Age in years 12-14(2073yf 3 15-17(2048yf 9 18-20(1580yf 3 21-24(1040yf 0 TABLE III Family Composition and Aggregation of Substance Use Among Siblings Feature Category (nyf 7 R E D F F R $ O F R K R O 0 D U L M X D Q a Overall (1 727yf f 0.1 5 (0.02yf f Number of siblings 2 (1 405yf f 0.1 4 (0.03yf f >3 (322yf f 0.1 8 (0.03yf f Sex composition All female (368yf f 0.09 (0.05yf f All male (41 5yf f 0.1 7 (0.04yf f Mixed (994yf f 0.1 4 (0.03yf f Age composition All 1 2-1 8 (971 yf f 0.1 6 (0.03yf f All 1 9-24 (1 82yf f 0.25 (0.06yf f Mixed (574yf f 0.03 (0.03yf f * not significant at p<0.05 an analysis of variance approach is taken to adjust for variations in the number of sib- lings per family. Absolute differences between kappas in excess of 0.10 are defined arbitrarily as ‘important’ effects. Considered in this analysis are the effects of sibship structure (sibship size, sex com- position and age compositionyf R Q I D P L O L D l aggregation. Kappa is used also to examine the effects of gender and age on within- family correlations by estimating levels of concordance on substance use between pairs of family members, including spous- es, spouses and siblings and siblings sub- divided by sex and age. Households with four or more siblings [43/4,643 (0.9yb f] are excluded from this analysis to prevent large sibships from exerting undue weight on the analysis. Finally, logistic regression analysis is used to estimate the strength of This content downloaded from 208.95.50.183 on Thu, 03 Aug 2017 05:40:06 UTC All use subject to http://about.jstor.org/terms FAMILIAL INFLUENCES TABLE IV Kappa Estimates of Agreement Between Family Members on Substance Use Members (nyf 7 R E D F F R $ O F R K R O 0 D U L M X D Q a Spouses (3106yf f 0.32(0.02yf f Father-Son (2728yf f 0.09(0.02yf f Father-Daughter (2492yf f 0.06(0.01yf f Mother-Son (3106yf f 0.07(0.02yf f* Mother-Daughter (301 7yf f 0.12(0.02yf f Brothers < 2 yrs (290yf f 0.44 (0.07yf f Brothers > 2 yrs (333yf f* 0.07 (0.04yf f* Sisters < 2 yrs (240yf f 0.34(0.11yf f Sisters > 2 yrs (284yf f* 0.05(0.06yf f Brothers-Sisters <2 yrs (51 6yf f 0.22(0.06yf f Brothers-Sisters > 2 yrs (579yf f 0.1 1 (0.04yf f * not significant at p<0.05 TABLE V Strength of Association Estimated by Relative Odds and 95yb & R Q I L G H Q F e Intervals in Logistic Regression Between Substance Use in Youngest Sibling Characteristic Tobacco Alcohol Marijuana Youngest sibling Male gender 1 .46 (0.99-2.14yf W f 1 .42 (0.93-2.1 7yf Age in years 1 .37t (1 .28-1 .47yf W f 1 .46f (1 .35-1 .59yf Parents Lone parent 1 .36 (0.91 -2.04yf f 1 .24 (0.79-1 .96yf Substance used 1 .37 (0.93-2.03yf f 1 .91 (0.96-3.80yf Siblings >2 in home 0.63 (0.36-1 .11yf f 0.78 (0.43-1 .42yf Substance used 4.08t (2.75-6.05yf I f 5.34t (3.48-8.1 8yf t p<0.001 association between substance use by the youngest sibling in the family (dependent variableyf D Q G X V H R I W K H V D P H V X E V W D Q F H E y parent(syf D Q G R O G H U V L E O L Q J V f. RESULTS Prevalences and sibship structure Prevalences for all substances used are higher among fathers than among mothers and among male siblings than among female siblings (Table IIyf $ P R Q J V L E O L Q J V , there is a gradient of increasing substance use by age that begins to taper off among 21-24 year olds. Table III shows that overall levels of aggregation are modest for use of tobacco, alcohol and marijuana (k=0.19, 0.15, 0.20yf ( V W L P D W H V R I D J J U H J D W L R Q H [ K L E L t small variation by sibship size. Sibships composed entirely of males versus females exhibit higher levels of aggregation for use of tobacco (k=0.2 4 versus 0.09yf D Q G P D U L – juana (k=0.28 versus 0.17yf $ J H F R P S R V L – tion exerts the most potent effect on esti- mates of aggregation: sibships composed entirely of young adults aged 19 to 24 years show the highest levels of aggregation for all categories of substance use. Within family correlations Concordance for the same categories of substance use are much higher between parents (k=0.30 to 0.44yf W K D Q E H W Z H H Q S D U – ents and their children (k=0.05 to 0.16yf (Table IVyf 7 K H U H D S S H D U V W R E H D V P D O l gender-specific effect for tobacco use. Concordance between father-son and mother-daughter are 0.14 and 0.16, respec- tively; between father-daughter and mother- son, they are 0.04 and 0.06, respectively. Concordance on substance use between siblings are influenced by both closeness in age and sex. Siblings more than two years apart in age exhibit low concordance on substance use for all pairings (k=0.02 to 0.14yf 6 L E O L Q J V Z L W K L Q W Z R H D U V R I H D F h other exhibit higher levels of concordance: these estimates are higher for brother (k=0.33 to 0.45yf W K D Q I R U V L V W H U N W o 0.34yf D Q G E U R W K H U V L V W H U S D L U L Q J V N 3 to 0.28yf 7 D E O H , 9 f. Parent and older sibling substance use Table V presents relative odds (ROyf between substance use reported by parents and older siblings and substance use reported by the youngest member of the sibship. Covariates are included to control for family status (one vs. two parentsyf V L E – ship size (3 or more vs. 2yf D Q G W K H D J H D Q d gender of the youngest sibling. The strength of association between parental substance use and use of the same sub- stance by the youngest sibling is small and nonsignificant (R0=1.09 to 1.91yf 7 K H V e contrast with substance use by older sib- lings which is associated strongly and sig- nificantly with substance use by younger siblings (RO=3.77 to 5.34yf . DISCUSSION This study provides evidence for the aggregation of substance use among sib- lings in families. Overall, the effect is mod- est, appears to be undifferentiated across substance type and is stronger among sib- ships that are either all male or older (19- 24 yearsyf : L W K L Q I D P L O F R Q F R U G D Q F H L s particularly strong for spouses and for sib- lings < two years apart in age. Furthermore, the dominant influence of substance use behaviour appears to be from older siblings to younger siblings and not from parents to offspring. There are a number of possible explana- tions for the strong between-sibling associ- ations in substance use observed in this study. First of all, access to tobacco, alco- hol and drugs such as marijuana is deter- mined very much by age. The presence of older siblings already engaging in sub- stance use provides the means for younger siblings to obtain these substances. Second, older siblings constitute important role models, and in some instances the initia- tion of younger siblings into substance use may arise from imitative behaviour. Third, closeness in age will have important influ- ences on socialization processes. Siblings close in age can be expected to spend more time together through childhood and ado- lescence. This will lead to more shared experiences in the family, neighbourhood, at school and with adolescent peer groups. An older sibling engaging in substance use will likely have peers engaged in the same 208 REVUE CANADIENNE DE SANTÉ PUBLIQUE VOLUME 92, NO. 3 This content downloaded from 208.95.50.183 on Thu, 03 Aug 2017 05:40:06 UTC All use subject to http://about.jstor.org/terms activity who, in turn, could serve as impor- tant role models for engaging in substance use and provide additional opportunities to access tobacco, alcohol and marijuana. The relatively weak associations between parental substance use and substance use by younger siblings should not be inter- preted to mean that parental behaviour has no impact on substance use in the family. In addition to substance use behaviour, there are other within-family processes such as afFectional ties, management prac- tices and the resolution of conflict that may have important implications for sub- stance use among siblings.14 Study limitations There are a number of study limitations that the reader should bear in mind when considering the findings. One, all informa- tion was collected by self-administered questionnaire completed at home, without opportunity to corroborate responses. Although studies exist in support of the reliability and validity of this method,15 it is arguable that random error and under- reporting have led to an attenuation of associations. Two, the statistic used to measure concordance on substance use – kappa – is compressed downward by low base rates.16 Three, although respondents and nonrespondents are comparable on sociodemographic characteristics, net data loss at 39.4yb L V K L J K D Q G F R X O G L Q F O X G e sample loss selective for substance use. Four, it is not possible to establish the chronology of substance use within fami- lies because the study design is cross- sectional. Five, data are not available on intensity of contact between siblings or peer substance use, variables that would help to clarify the modifying effects of age on between-sibling agreement in substance use. And six, the study is restricted to the effects of family composition on substance use. There is no attempt to determine whether or not the socioeconomic circum- stances of families act as effect moderators or to model the impact of other important influences on substance use such as family processes and peers. Identification of risk factors associated with substance use by adolescents and young adults is important from both pre- ventive and therapeutic viewpoints. Sibling concordance for substance use points to the importance of environmental effects and suggests that the treatment and pre- vention of substance use (and abuseyf among adolescents and young adults might be enhanced by including a family focus, especially where there are two or more sib- lings at home. Empirical support exists for family-based treatments for substance abuse and family-based preventive inter- ventions are under development.17 Evaluation of the effectiveness of these pre- ventive programs should be a priority for research on interventions. REFERENCES 1. Adlaf EM, Ivis EJ, Smart RG, Walsh GW. The Ontario Student Drug Use Survey: 1977-1995. Toronto: Addiction Research Foundation of Ontario, 1995. 2. Adlaf EM, Ivis FJ, Smart RG, Walsh GW. Enduring resurgence or statistical blip? Recent trends from the Ontario student drug use survey. Can J Public Health 1996;87:189-92. 3. Johnston LD, O Malley PM, Bachman JG. National Survey Results on Drug Use from Monitoring the Future Study, 1975-1995, Vol. 2, Secondary School Students [NIH Publication No. 96-4139]. Washington, DC: US Government Printing Office, 1996. 4. Poulin C, Elliott D. Alcohol, tobacco and cannabis use among Nova Scotia residents: Implications for prevention and harm reduction. Can Med Assoc J 1 997; 156:1 387-93. 5. Weinberg NZ, Rahdert E, Colliver JD, Glantz MD. Adolescent substance abuse: A review of the past 10 years. J Am Acad Child Adolesc Psychiatry 1998;37:252-61. 6. Merikangas KR, Stolar M, Stevens DE, et al. Familial transmission of substance use disorders. Arch Gen Psychiatry 1998;55:973-79. 7. Prescott CA, Kendler KS. Genetic and environ- mental contributions to alcohol abuse and depen- dence in a population-based sample of male twins. Am J Psychiatry 1999;156:34-40. 8. McGue M, Sharma A, Benson P. Parent and sib- ling influences on adolescent alcohol use and misuse: Evidence from a U.S. adoption cohort. J Stud Alcohol 1 996;57:8- 1 8. 9. Light JM, Irvine KM, Kjerulf L. Estimating genetic and environmental effects of alcohol use and dependence from a national survey: A “quasi- adoption” study. J Stud Alcohol 1996;57:507-20. 10. Gfoerer J. Correlation between drug use by teenagers and drug use by older family members. Am J Drug Alcohol Abuse 1987;13:95-108. 11. Tambs K, Vaglum P. Alcohol consumption in parents and offspring: A study of the family cor- relation in a general population. Acta Psychiatr Scand 1990;82:145-51. 12. Ontario Ministry of Health. Ontario Health Survey 1990: User’s Guide Vol. I Documentation. Toronto, Ontario Ministry of Health, 1992. 13. Fleiss JL. Statistical Methods for Rates and Proportions 2nd ed. New York: John Wiley & Sons, 1981. 14. Hawkins JD, Catalano RF, Miller JY. Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: Implications for substance use prevention. Psychol Bull 1 992; 1 1 2:64- 105. 15. Needle R, McCubbin H, Lorence J, Hochhauser M. Reliability and validity of adolescent self- reported drug use in a family-based study: A methodological report. Int J Addictions 1983;18:901-12. 16. Feinstein AR, Cicchetti DV. High agreement but low kappa: I. The problems of two paradoxes. J Clin Epidemiol 1990;43:543-49. 17. Hogue A, Liddle HA. Family-based preventive intervention: An approach to preventing sub- stance use and antisocial behaviour. Am J Orthopsychiatry 1999;69:278-93. Received: August 22, 2000 Accepted: January 18, 2001 MAY – JUNE 2001 CANADIAN JOURNAL OF PUBLIC HEALTH 209 This content downloaded from 208.95.50.183 on Thu, 03 Aug 2017 05:40:06 UTC All use subject to http://about.jstor.org/terms
Research Paper (APA STYLE) as soon as possible
31 NUJHS Vol. 5, No.4, 2015, ISSN 2249-7110December Nitte University Journal of Health Science Introduction The abuse of alcohol and illicit and prescription drugs continues to be a major health problem internationally. The United Nations Office on Drugs and Crime (UNODC) reports that approximately 5 per cent of the world’s population used an illicit drug in 2010 and 27 million people, or 0.6 per cent of the world’s adult population, can be classified as problem drug users. It is estimated that heroin, cocaine and other drugs are responsible for 0.1 to 0.2 million deaths per year. In addition to causing death, substance abuse is also responsible for significant morbidity and the treatment of drug Original Article Access this article online Quick Response Code Substance abuse and practices and their consequence s among adolescents and young adults in Mangalore 1 1 1 1 2 Alka Prakash , Vidya B , Wan Nur Suhailah , Anjali Moha nan , Ravi , 3 4 Rashmi Kundapur & Sanjeev Badiger 1 2 3 4 MBBS Students, Medico Social Worker, Professor, Professor, Department of Community Medicine, K. S. Hegde Medical Academy, Nitte University, Mangalore, K arnataka, India. Correspondence Rashmi Kundapur Professor, Department of Community Medicine, K.S. Hegde Me dical Academy, Nitte University, Mangalore – 575 018, Karnataka, India. Mobile : +91 98804 96567 E-mail : dr.rashmi.Kundapur @gmail.com Abstract Introduction: Substance abuse is the recent trend among college students. Studies c onducted in India shows clear indications of increasing prevalence of substance abuse among adolescents. Aims and Objectives: To assess the practice prevalence and consequences of drug abuse amon g adolescent students. Materials and Method: This Institution based cross-sectional study conducted in differen t schools and colleges of Mangalore. Institutions were randomly picked with pen drop method and 5 institution students were selected as study subjects. Totally 487 students between institutions were selected, the age group of 15-25 y ears were included in the study. The data was collected by means of answering a pretested validated questionnaire with anonymity. Results: According to our study the results showed that 8.60% have tried som e substance of abuse such as marijuana (5.51%), LSD (1.10%), cocaine (1.32%) and others (1.76%). Among the Substance users, 1.54% used it regularly, 1.76% occasionally and 2.20% only once. 33.03% said it has affected their daily activities and academics 2 1.05% had picked up a quarrel with friends, family or detained by police. Conclusion : Caffeine consumption in the form coffee is quite common amongs t the students as a habit. Marijuana is the most popular drug among the small fraction of students who have tried drugs. Most of th em tried it first in college, mainly being influenced by peers. Keywords: Substance abuse, adolescents, caffeine use 1 addiction creates a tremendous burden on society. Existing studies have found a high correlation between adolescent abuse and becoming a problem drug user in 1 adulthood; therefore, it can be inferred that many problem drug users start abusing drugs at an early age. Additionally, accidental and intentional fatalities that are associated with drug and alcohol use represent one of the leading preventable causes of death for the 15 to 24-year- old population. Alcohol and other drug use in the adolescent population carries a high risk for school underachievement, delinquency teenage pregnancy, and 1 depression. Drug dependence is described as a state, psychic and sometimes also physical, resulting from the interaction between a living organism and a drug, characterize by behavioral n other responses that always include a compulsion to take a drug on a continuous or 2 periodic basis. The intention of this study was to estimate the prevalence of the problem status among the college going young adults and the knowledge about the de-addiction. The study was conducted with the objective to study the practices and consequences of substance abuse among adolescents and young adults. Material Methods The research approach adopted for the study was a simple descriptive design to assess the practice and consequences among adolescent with regards to substance abuse. The substance abuse definition of WHO includes hazardous use of psychoactive substances, including alcohol and illicit 2 drugs – various drugs including illicit drugs, alcohol, tobacco, caffeine come under this category. We in this study have not considered alcohol and tobacco as they were part of other study. So we included all drugs including illicit drugs and caffeine use and abuse in our study. Institution based cross-sectional study conducted in different colleges of Mangalore. Institutions were randomly picked with pen drop method and 5 institution students were selected as study subjects. Taking 20% practice (by pilot study) as baseline the sample size was calculated with 80% power of the study and 95% confidence interval, the sample size was calculated to be 400 with relative precision being 20% (power of study 80%). Considering 20% non-response, we considered to interview 480 students. Universal sampling method was for the selection of students. Our total sample was 487. A questionnaire with questions on the practices and consequences of drug abuse was prepared. Face validation and linguistic validation of the questionnaire was done. Reliability was checked for the questionnaire. The questionnaire was to be filled anonymously after getting an informed verbal consent. The students were allowed to give back the questionnaire empty, or they could half fill it. The questionnaire was asked to take home get parents concent and fill it. Institutional ethical clearance was obtained. Sufficient time was given to the students to complete the questionnaire. Only students willing to 32 NUJHS Vol. 5, No.4, 2015, ISSN 2249-7110 December Nitte University Journal of Health Science participate with consent given were included. The data obtained were compiled in Microsoft excel and the results were tabulated. Results Among the students included in our study 67.55% consumed tea, 39.42% consumed coffee, 29.77% consumed aerated drinks. When we asked about reason for consuming caffeine 45.58% said because of habit and 12.73% due to stress (table: 1).40.02% of students intended to reduce consumption of caffeine. But 36.75% refused to reduce the consumption of caffeine. Proportion of adolescent students intending to reduce caffeine consumption was different in different institutions in Mangalore. (Shown in Fig 2). Among our subjects 8.41% have tried some substance of abuse such as marijuana (12.19%),LSD (2.43%),cocaine (12.19%) and others (48.78% (Fig no: 1). When asked about the age at which they had first tried, 48.78% said in college ( after 18 years) but 12.19% in secondary schools (09- 12years) (Table no :3). Of the above 7.31% of subjects were influenced by friends and 9.75% used it to try something new and 7.31% was due to stress. Among the users, 21.95% use it regularly. Majority of the users afford these by means of their pocket money (56.09%), loans from others (12.19%) and few of them also resorted to stealing (14.63%). Among the sample 31.7% said it had affected their daily activities and academics. 12.19% had picked up a quarrel with friends, family or detained by police. The students answered saying 55.44% knowing about addiction therapy and 11.29% not answering and 33.26% do not know there is a addiction therapy. Table : Reason for consuming beverages containing caffeine among adolescents (n=487) 1 Reasons No. of students Percentage Stress 62 12.73 Habit 226 45.58 Socializing with peers 39 8 Others 32 6.57 Not answered 135 27.72 33 NUJHS Vol. 5, No.4, 2015, ISSN 2249-7110December Nitte University Journal of Health Science Table : Showing the regularity in substance of abuse consumption (n= 41) 2 Table: Showing percentage of adolescents practicing substance of abuse with age of onset (n=41) 3 NUMBER PERCENTAGE REGULARLY 9 21.95 % OCCASSIONALLY 8 19.51% RARELY 7 17.07% ONLY ONCE 8 1951% NOT ANSWERED 9 21.95% NUMBER PERCENTAGE SECONDARY (9-12 years) 5 12.19% HIGH SCHOOL (13-15 years) 1 2.43% PUC (16-17 years) 5 12.19% COLLEGE ( 18-25 years) 20 48.78% NOT ANSWERED 10 24.39% 12% 2% 12% 50% 24% Marijuana LSD Cocaine Others Not answered Others include – small option like amphetamines, large op tion of caffeine . Figure 1 : Showing distribution of prevalence of substance abuse 0.00% 2.00% 4.00% 6.00% 8.00% 10.00% 12.00% 14.00% 16.00% 18 .00% College 1 College 2 College 3 College 4 Figure 2 : showing the proportion of adolescents wanting to reduce caffeine reduction Discussion Caffeine is a bitter substance found in coffee, tea, soft drinks, cola, nuts, and medicines. It has many effects on the body’s metabolism including stimulating central nervous system. This can make you more alert and give you boost of energy. For most people, the amount of caffeine in 2-4 cups of coffee a day is not harmful. However, too much of caffeine can cause problems. According to our study 12.58% consume caffeine due to stress, 44.37% as a habit, 7.50% when socializing with peers and other reasons 3.97%. A research done by the University of Puerto Rico on their students in the year 2013 showed that 54% consumed caffeine to stay awake , 18% as a part of their routine , other reasons – 19% , for concentration 12% and as meal substitutes 8%. The research showed that there was increase in the consumption of aerated drinks (65.4%) and coffee (55%) in account of stress. This tells us that in our study majority of the students consume it as a habit and 3 the association of caffeine consumption and stress is less whereas in University of Puerto Rico, the association of caffeine consumption and stress is of great significance.² Whatever the reason maybe, with repetitive use, physical dependence or addiction may occur. As caffeine is a psychoactive drug, it is often regulated. In the United States, FDA restricts beverages to containing less than 0.02% caffeine; it would be beneficial if such policies were to be implemented in developing countries as well. Substance abuse is a patterned use of a substance in which the user consumes the substance in amounts or with methods which are harmful to themselves or others. The exact cause of substance misuse is impossible because there is not just one direct cause. However substance abuse and addiction is known to run in families. In the present study use of substances as well as distribution among the students were comparable to the finding of studies of other authors, where we noted both similar and 3,4 dissimilar results with that of other studies .0.8% adolescents gave the history of their initiation to abuse substances started during their secondary schooling. Most of them started during their college time that is about 4.8%.1.10% started from PUC & 0.2% started from high school. Poor decision-making and impulsive behaviour in the teenage years can then have lasting effects. Teens that start abusing alcohol or drugs at an early age are at much greater risk of developing an addiction later in life compared to those who misuse drugs later. In our study 5.51% of students were using marijuana, 1.10%were using 34 NUJHS Vol. 5, No.4, 2015, ISSN 2249-7110December Nitte University Journal of Health Science LSD, 1.32% were using cocaine &1.76%were using other substances. Some people are able to use recreational or prescription drugs without experiencing negative consequences or addiction. For many others, substance use can cause problems at work, home, school & in relationships. Many, try drugs for the first time out of curiosity, to have good time, because friends are doing it, an effort to improve athletic performance or ease another problems like stress, anxiety, depression etc .Use does not automatically lead to abuse and there is no specific level at which drug moves from casual to problematic. It varies with individual. Drug abuse & addiction is less about the amount of substance consumed or the frequency and more 5 to do with the consequences of drug use . Parents need to be aware of the increased risk for teens, and the factors that increase risk. Avoidance of drugs and alcohol at an early age, and friends who use them, is crucial to not becoming an addict. Limitations This study do not have representative sample from all colleges and all the questions were self administered so final truth being unknown. Conclusion Caffeine consumption in the form coffee is quite comm on amongst the students as a habit. Marijuana is the most popular drug among the small fraction of students who have tried drugs. Most of them tried it first in college, mainly being influenced by peers. The study shows that it has some affect on their daily activities and academics mainly because almost all of them have tried it at least once Acknowledgement We thank the head of the department, Dr. Uday Kiran Nalam and all the staff of Community Medicine for their immense support during the study. References 1. Boviton, G ; Epstein ,J ; Baker , E ; Diaz, T; and Ifill – Willian, M. Scho ol based drug abuse prevention with inner-city minority youth, Journal of Child and Adolescent Substance Abuse; 6:5- 19, 1997. 2. WHO (1993). WHO Expert Committee on Drug dependence. Twenty eighth Report ,No.836 available in www.who.int>right_committe e. 3. Josue L Rios, MNSN; Jesmari Betancourt , MHSN:Ideliz Pagan- Caffeinated –beverage Consumption and its association with Socio- demographic Characteristics and Stress in First and Second Year students at the University of Puerto Rico Medical Sciences Campus (UPR –MSC) ; PRHSJ Vol .32 No.2.June ,2013 4. Dechenla Tsering, Ranabir Pal, and Aparajita Dasgupta. Substance u se among adolescent high school students in India: A survey of knowledge, attitude, and opinion; Journal of Pharmcy and bioallied sciences 2010, 2(2): 137– 140 5. Scheier, LL ;Bovtvin , G Diaz, T and Griffin ,K Social skills, competence and drug refusal efficacy as predictors of adolescent alcohol use Journal of Drug Education 29(3):251-278,1999. Copyright ofNitte University JournalofHealth Science isthe property ofNitte University and itscontent maynotbecopied oremailed tomultiple sitesorposted toalistserv without the copyright holder’sexpresswrittenpermission. However,usersmayprint, download, or email articles forindividual use.
Research Paper (APA STYLE) as soon as possible
Substance use among adolescent and young adult cancer survivors Joel Milam 1*, Rhona Slaughter 1, Kathleen Meeske 1,2, Anamara Ritt-Olson 1, Sandra Sherman-Bien 3, David R. Freyer 1,2, Aura Kuperberg 2and Ann S. Hamilton 1 1Keck School of Medicine, University of Southern California, Los Angeles, CA, USA2Children’s Hospital Los Angeles, Los Angeles, CA, USA3Miller Children’s Hospital, Long Beach, CA, USA *Correspondence to: Keck School of Medicine, University of Southern California, 2001 Soto Building, MC9239, Los Angeles, CA, USA. E-mail: [email protected] Received: 7 January 2015 Revised: 10 June 2015 Accepted: 5 August 2015 Abstract Objective: Health-promoting behaviors are recommended to childhood cancer survivors (CCS) to reduce late effects resulting from cancer treatment. Understanding factors associated with substance use is needed, especially among Hispanic CCS who are underrepresented in previous studies. The objective of this study is to examine substance use behaviors of recently treated Hispanic and non- Hispanic CCS. Methods: One hundred ninety-three Los Angeles County CCS who were diagnosed between 2000 and 2007 (54% Hispanic; mean age 19.9 years, SD = 2.8; mean age at diagnosis = 12.1, SD = 3.0; mean years since diagnosis = 7.8, SD = 2.0) provided self-reported information on substance use, demo- graphics, clinical factors, religiosity, and depressive symptoms. Risk and protective factors for substance use were examined using multivariable logistic regression. Results: Prevalence of 30-day substance use was 11%, 25%, and 14% for tobacco, alcohol, and marijuana, respectively. In controlled regression models, age was positively associated with tobacco use, binge drinking, and polysubstance use (use of at least two of the three substances). Male gender, higher depressive symptoms, and higher socioeconomic status were associated with greater marijuana use. In addition, religiosity was negatively associated with the use of all substances. Conclusions: The prevalence rates for substance use in this ethnically diverse representative sample of CCS are lower than those observed in the general population. Older CCS were at higher risk of substance use, and depression was associated with greater marijuana use. No differences by ethnicity were observed. Interventions for substance use prevention/cessation among CCS may be most effec- tive if implemented before the age of 21 years and address mental health as part of survivorship care. Copyright © 2015 John Wiley & Sons, Ltd. Introduction Although treatment advances have dramatically increased survival for childhood cancer [1,2], the majority of survivors subsequently experience early life morbidity [3] and mortality [4,5]. Thus, life-long practice of health- promoting behaviors, including substance use avoidance, is recommended for childhood cancer survivors (CCS) in order to potentially delay or mitigate early life morbidity and mortality, including cancer treatment-related late effects. For example, the Children’s Oncology Group (COG) Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers recommend that all CCS receive counseling about sub- stance use and referral to appropriate clinics (e.g., tobacco cessation) as needed [2,6]. Despite the potential contributing effects of negative health behaviors on subsequent health, young cancer survivors do engage in‘typical’behaviors for their peer groups that include smoking, drug and alcohol use, sunexposure, obesity, and unprotected sex [7]. Generally, 16–29% and 55–90% of CCS report tobacco or alcohol use, respectively [8], which are comparable with, or less than, those of their healthy peers [9–11]. For example, one study found CCS to be significantly less likely to be smokers compared with sibling controls [12,13]. This suggests that some CCS make efforts to follow a healthy lifestyle after treatment has ended. Knowledge of current levels of substance use among CCS is limited because prior work did not include an adequate representation of Hispanic CCS, did not include more recently treated CCS, and/or was based on relatively low levels of volunteer responses [3,4]. Only 5% of the Childhood Cancer Survivor Study (CCSS) cohort is His- panic [14], compared with 16.9% in the US population as a whole [15]. Further, because data from the CCSS only include patients diagnosed between 1970 and 1986, substance use patterns among more recently treated CCS are less clear. In as much as significant nationwide improvements in survivorship care and reductions in the Copyright © 2015 John Wiley & Sons, Ltd. Psycho-Oncology Psycho-Oncology25:1357–1362 (2016) Published online 27 August 2015 in Wiley Online Library (wileyonlinelibrary.com).DOI: 10.1002/pon.3958 prevalence of substance use (e.g., smoking rates) have occurred in the past 30 years, having more recent data on CCS habits are important to determine whether these trends reflect this vulnerable group. Among adolescents and young adults (AYA) without cancer, previous research has shown that higher substance use is associated with older age and higher levels of de- pression [16] and less likely to occur among those with greater religiosity [17] and post-traumatic growth (PTG; defined as the experience of perceived benefits/found meaning from a negative life event) [18]. Studies of CCS have shown that 15–30% show some adjustment and/or emotional problems [19], which may increase their risk of substance use; however, many CCS also experi- ence positive transformations in their lives[18,20–22], such as reporting PTG from their cancer experience [23], which may reduce their risk of unhealthly lifestyle behav- iors. Although prior work among non-CCS adolescents indicates an inverse relationship between post-traumatic growth (stemming from a variety of negative life events such as the death of a loved one, parents getting divorced, or the 9/11 terrorist attacks) and substance use (e.g., alco- hol) [18,20,24,25], it is unclear whether post-traumatic growth stemming from a childhood cancer experience would show a similar protective relationship. The purpose of this analysis was to identify risk and protective factors for substance use among recently treated Hispanic and non-Hispanic AYA CCS (between 15 and 25 years old) in Los Angeles County (LAC). (In LAC, 61.7% of children under the age of 14 years diagnosed with cancer from 2004 to 2008 were Hispanic [26].) We examined both demographic and clinical fac- tors to help determine whether specific subgroups of CCS would be at greater risk for substance use. Consis- tent with prior research on substance use among AYAs, we hypothesized that tobacco, alcohol, and marijuana use would be positively associated with age and depres- sive symptoms and inversely associated with religiosity and posttraumatic growth. Methods The CCS included in this analysis participated in the Project Forward study, a representative cohort of CCS who were diagnosed with any type of cancer (except Hodgkin’s Disease) between ages 5–18 years at Children’s Hospital Los Angeles (CHLA) or at Miller Children’s Hospital (MCH) in Long Beach between 2000 and 2007, and whose age in 2009 was between 15 and 25 years. Methods/procedures have been previously described [27,28]. Briefly, CCS meeting the selection criteria were identified through the Los Angeles Cancer Surveillance Program, the Surveillance, Epidemiology, and End Results (SEER) Cancer Registry covering Los Angeles County and mailed a survey to complete andreturn in a postage-paid envelope. Telephone interviews (n= 4) and online completion (n= 27) of the survey were also made available. Extensive follow-up was conducted in the form of telephone calls, drop by visits, and second mailings. The study was approved by the California Com- mittee for the Protection of Human Subjects, the California Cancer Registry, and the Institutional Review Boards at the University of Southern California, CHLA, and MCH. Measures Substance use: Cigarette and marijuana use was defined as any reported use (at least once) in the prior 30 days. Binge drinking was defined as havingfive or more drinks on the same occasion at least once in the prior 30 days, based on the Centers for Disease Control (CDC) Youth Risk Be- havior Survey [29]. In addition, a combination variable, polysubstance use, was created based on the use of at least two of these three substances within the last 30 days. Demographics: This included current age, age at diag- nosis, race/ethnicity, education level, and socioeco- nomic level (status based on census tract of address at diagnosis; from the Cancer Registry), and these vari- ables were categorized as shown in Table 1. Clinical factors, obtained from the cancer registry included date of diagnosis, cancer site (e.g., leukemia, lymphoma, and brain/CNS), and hospital where diag- nosed (CHLA or Miller’s). Treatment intensity: Intensity of prior cancer treatment was categorized using the Intensity of Treatment Rating Scale 2.0 (ITR-2) [30]. The ITR is a validated scale based upon cancer registry data and medical chart re- view, including cancer site, stage at diagnosis, treatment modalities, and relapse history. Treatment was catego- rized by four levels of intensity: 1 = least intensive (e.g., surgery only), 2 = moderately intensive (e.g., che- motherapy or radiation), 3 = very intensive (e.g., two or more treatment modalities), and 4 = most intensive (e.g., regimens for relapsed disease, including bone marrow transplantation). Post-traumatic growth inventory (PTGI): The PTGI short form is a 10-item measure of personal growth experienced by individuals who have experienced a traumatic event, in this case, cancer [31]. Items reflect different areas of growth, including relating to others, new possibilities, personal strength, spiritual change, and appreciation of life. Each item is based on a 6-point scale ranging from 0 (‘I did not experience this change as a result of my crisis.’)to5(‘I experienced this change to a very great degree as a result of my crisis.’). A PTG total mean score was calculated, where higher scores in- dicate more post-traumatic growth. The Cronbach’s alpha for this scale was .90. Depressive symptoms: The 20-item Center for Epide- miological Studies Depression Scale (CES-D) was used 1358J. Milamet al. Copyright © 2015 John Wiley & Sons, Ltd.Psycho-Oncology25:1357–1362 (2016) DOI: 10.1002/pon to assess symptoms of depression [32]. Participants indicated how often they had experienced symptoms (e.g., depressed mood, loss of appetite, sleep and psy- chomotor disruption, and feelings of guilt and worth- lessness and/or helplessness and hopelessness) during the previous week on a 4-point ordinal scale ranging from‘rarely or none of the time’(less than 1 day) to ‘most or all of the time’(5–7 days). A total score was calculated with higher scores representing elevated levels of depressive symptoms. The Cronbach’s alpha in this sample was .92. In sensitivity analyses, we re- peated all analyses utilizing a dichotomous CES-D score (coded 1/0, using a cut point of 16). Because the pattern of results was similar, we only present thefindings from the continuous CES-D score. Religiosity: This construct was screened with a single item question regarding the number of times the partic- ipant attended church/religious services. Scores were recorded as 0 = never/don’t know, 1 = every few years, 2 = several times per year, 3 = two to three times per month, or 4 = at least once per week, and used as a continuous measure where higher scores indicated more religious worship. Statistical analysis Descriptive data (demographic and clinical characteristics) were examined, including the prevalence of smoking, binge drinking, and marijuana use. Bivariate analysis of the different substance use outcomes was examined bycategories of the demographic, clinical, and psychological variables using chi-square andt-tests. Multivariable logis- tic regression analyses were performed to assess factors associated with each of the substance use variables, as well as use of polysubstance (i.e., endorsement of at least two substances). After including demographics (age, sex, race/ethnicity, and SES) in each model, other variables that demonstrated a univariate association with each out- come variable (atp≤0.10) were selected for inclusion in final multivariable logistic regression models. Data analyses were conducted using SAS statistical software (Version 9.2) (SAS Institute; Cary, NC, USA). Results A total of 235 CCS participated in the study out of 470, resulting in a 50% response rate. We assessed characteris- tics of non-respondents using cancer registry data and found no differences with respondents by age, cancer type (SEER diagnosis), year of diagnosis, age at diagnosis, or race/ethnicity. Women were more likely to respond than men (56.4% vs. 44.8%;p<.05) and those of high socio- economic status (SES; SEER data based on census tract of address at diagnosis) were more likely to respond than those of low SES status (p<.05). (However, among His- panics, there was no response difference by SES). Among the respondents, 42 indicated that they were still receiving treatment, and thus, 193 were included in the analytic sample. Participants (Tables 1 and 2) were evenly divided by sex and over half were Hispanic (54.4%). Age at Table 1.Demographic and cancer diagnoses of participants and bivariate associations with substance use (n= 193) Type of substance use (past 30 days) Tobacco Binge drinking Marijuana Polysubstance use CharacteristicNo. % % yes % yes % yes % yes 11.46% 24.87% 13.68% 16.06% Demographic factors Genderχ 2= 0.21 p= .65χ 2= .002 p= .97χ 2= 1.75 p= .19χ 2= 0.90 p= .34 Female 96 49.7 10.4 25.0 10.4 13.5 Male 97 50.3 12.5 24.7 17.0 18.6 Race/ethnicityχ 2= 2.81 p= .25χ 2= 1.60 p= .45χ 2= 2.88 p= .25χ 2= 2.59 p= .27 Hispanic/Latino 105 54.4 13.5 23.8 11.8 15.2 White 55 28.5 12.7 21.8 20.0 21.8 Other 33 17.1 3.0 33.3 9.1 9.1 Ageχ 2= .80 p= .37χ 2= 17.50 p<.0001χ 2= 1.87 p= .17χ 2= .2.95 p= .09 15–20 years 114 59.1 9.7 14.0 10.8 12.3 21+ years old 79 40.9 13.9 40.5 17.7 21.5 Cancer diagnosis/siteχ 2= 2.81 p= .59χ 2= 2.93 p= .67χ 2= 3.95 p= .41χ 2= 4.25 p= .37 Leukemia 57 29.5 10.5 29.5 14.3 14.0 Brain/CNS 31 16.1 12.9 22.6 12.9 16.1 Bone 10 5.2 0.0 10.0 0.0 0.0 Lymphoma 38 19.7 7.9 31.6 8.1 13.2 Other 57 29.5 15.8 26.3 19.3 22.8 1359 Substance use among cancer survivors Copyright © 2015 John Wiley & Sons, Ltd.Psycho-Oncology25:1357–1362 (2016) DOI: 10.1002/pon participation ranged from 15–25 years (mean = 19.87, SD = 2.82), with 41% 21 years or older. The majority had at least a high school education (70.7%). Clinical characteristics: The most common types of cancer were leukemia (29%), lymphoma (19%), and brain/central nervous system (16%). The majority of patients (81%) received‘moderate/very’intensive treatments. Age at diagnosis ranged from 5 to 19 years old (mean = 12.1, SD = 3.0), and years since diagnosis ranged from 4 to 12 years (mean = 7.8, SD = 2.0). Psychosocial characteristics: PTGI scores ranged from 0 to 50 (M = 35.71, SD = 10.81 ). CES-D scores ranged from 0 to 46 (M = 13.95, SD = 11.23). Thirty-one percent (n= 60) scored at least 16 on the CES-D. Religiosity scores ranged from 0 to 4 (M = 1.82, SD = 1.43). Factors related to tobacco use: Prevalence of 30-day tobacco use was 11%. Based on univariate tests, those who used tobacco had more depressive symptoms, wereolder in age, and had less religiosity than non-tobacco users. In a multivariable logistic regression model (Table 3), older age remained significantly associated with tobacco use. Factors related to binge drinking: Prevalence of 30-day binge drinking was 25%. Based on univariate tests, those who reported binge drinking were older in age, more ed- ucated with at least a high school diploma, and had less religiosity. In a multivariable logistic regression model (Table 3), older age and more depressive symptoms were significantly associated with binge drinking. Factors related to marijuana use: Prevalence of 30-day marijuana use was 14%. Based on univariate tests, those who reported marijuana use were older in age. In a multivariable logistic regression model (Table 3), higher depressive symptoms, being male (versus female), and higher socioeconomic status were significantly associ- ated with marijuana use. Table 2.Psychosocial and other characteristics of participants and bivariate associations with substance use (n= 193) Tobacco Binge drinking Marijuana Polysubstance use Psychosocial factors M (SD) Yes No Yes No Yes No Yes No Post-traumatic growth 35.71 (10.81) 36.0 (9.9) 35.7 (10.9) 36.0 (9.0) 35.6 (11.4) 34.6 (10.3) 35.9 (11.0) 35.4 (9.2) 35.8(11.1) t= 0.15p= .87t= 0.18p= .85t= 0.58p= .56t= 0.15p= .88 Depressive symptoms 13.95 (11.23) 19.0 (10.6) 13.2 (11.1) 16.6 (12.2) 13.1 (10.8) 16.5 (11.0) 13.4 (11.1) 18.2 (11.1) 13.2 (11.1) t= 2.29p= .02t= 1.84p= .07t= 1.26p= .21t= 2.26p= .03 Religiosity 1.82 (1.43) 1.32(1.1) 1.90(1.4) 1.42 (1.2) 1.96 (1.5) 1.50 (1.2) 1.87 (1.4) 1.39 (1.1) 1.91 (1.5) t= 2.19p= .04t= 2.55p= .01t= 1.41p= .17t= 2.01p= .05 Other factors Current age 19.87 (2.83) 20.9(2.3) 19.7 (2.9) 21.4 (2.0) 19.4 (2.9) 21.4 (2.1) 19.4 (2.9) 20.9 (2.2) 19.7 (2.9) t= 1.76p= .05t= 4.60p=<.001t= 4.60p<.001t= 2.24p= .03 Time since diagnoses 7.78 (2.00) 7.9 (2.1) 7.8 (2.0) 8.13 (1.9) 7.7 (2.0) 8.3 (2.1) 7.7 (2.0) 8.3 (2.1) 7.7 (2.0) t= 0.20p= .84t= 1.39p= .17t= 1.42p= .16t= 1.47p= .15 SES (1 :low– 5 :high) 2.84 (1.47) 2.68 (1.5) 2.86 (1.5) 2.77 (1.4) 2.87 (1.5) 2.77 (1.4) 2.87 (1.5) 3.00 (1.5) 2.65 (0.8) t= 0.54p= .59t= 0.42p= .68t= 0.42p= .69t= 0.67p= .50 Treatment Intensity 2.62 (0.79) 2.36 (.79) 2.65 (.79) 2.56 (.85) 2.64 (.77) 2.54 (.81) 2.64 (.79) 2.56 (.86) 2.65( .76) t= 1.61p= .12t= 0.55p= .58t= 0.58p= .56t= 0.67p= .50 Table 3.Multivariable logistic regression models of substance use (n= 193) Substance Tobacco Binge drinking Marijuana Polysubstance use CharacteristicAdjusted odds ratio95% CI95% CIpAdjusted odds ratio95% CI95% CIpAdjusted odds ratio95% CI95% CIpAdjusted odds ratio95% CI95% CIp Depressive symptoms 1.04 1.00 1.08 0.06 1.03 1.00 1.07 0.05 1.04 1.01 1.09 0.04 1.03 1.00 1.06 0.10 Religiosity 0.82 0.58 1.19 0.30 0.80 0.61 1.05 0.10 0.89 0.62 1.28 0.54 0.77 0.59 0.99 0.04 Current age 1.20 1.01 1.44 0.04 1.33 1.61 1.55 .001 1.15 0.97 1.36 0.11 1.33 1.17 1.52 .001 Gender Female (versus male) 0.55 0.20 1.55 0.26 0.87 0.41 1.84 0.72 .33 0.12 0.91 0.03 0.81 0.40 1.62 0.54 Race/ethnicity White 1.0 1.0 1.0 1.0 Hispanic/Latino (vs. White)1.05 0.22 4.94 0.25 1.10 0.34 3.60 0.77 2.26 0.55 9.34 0.12 1.84 0.61 5.49 0.29 Other (vs. White) 0.18 0.02 1.73 0.11 1.61 0.52 5.04 0.37 0.64 0.14 2.93 0.23 1.25 0.42 3.74 0.86 SES 1.03 0.64 1.67 0.90 0.96 0.68 1.35 0.82 2.06 1.28 3.30 .002 1.22 0.89 1.68 0.22 Treatment intensity 0.58 0.31 1.08 0.09 0.90 0.57 1.43 0.66 0.88 0.49 1.60 0.68 0.87 0.56 1.33 0.52 1360J. Milamet al. Copyright © 2015 John Wiley & Sons, Ltd.Psycho-Oncology25:1357–1362 (2016) DOI: 10.1002/pon Factors related to polysubstance use: Prevalence of using at least two of the three substances was 16%. The inter- relationships between the substances, smoking and mar- ijuana use (r= .28), binge drinking and smoking (r= .39), and binge drinking and marijuana use (r= .40) were significant (allp’s<.01). Based on univariate tests, those who reported polysubstance use had higher depressive symptoms, had lower levels of religiosity, and were older in age. Twelve percent of CCS under the age of 21 years reported polysubstance use versus 22% of those aged 21 years and older. In a multivariable logistic regression model (Table 3), only lower religiosity and older age were significantly associated with polysubstance use. Discussion We found that among CCS diagnosed between 2000 and 2007 at two major pediatric hospitals in Los Angeles County, who were now AYAs (between 15 and 25 years of age), substance use was higher among older CCS. This increase in substance use with age, primarily driven by alcohol consumption, is similar to data from the general US population (e.g., YRBSS). Thus, broader education efforts among CCS concerning risk behaviors may be best focused when CCS transition from pediatric to adult care settings (i.e., during the ages from 18 to 21 years). Substance use among the CCS in this study is lower than those in the general population. For example, among high schools students nationwide, the 30-day percentage of students who smoke cigarettes, binge drink, or smoke marijuana is 15%, 21%, and 23%, respectively [33]. Among those high school-aged CCS in this study (ages 15–17 years), the 30-day percentage of students who smoke cigarettes, binge drink, or smoke marijuana was 0.0%, 0.0%, and 0.53%, respectively. Among young adults (ages 18–25 years) sampled nationwide [34], the 30-day percent- age (2013) of young adults who smoked cigarettes or marijuana was 31% and 19%, respectively (vs. 11.5% and 13.2%, respectively, among similar aged CCS in this sam- ple). The nationwide 2013 percentage of young adults who binge drink was 29% for those aged 18 to 20 years and 43% for those aged 21 to 25 years (vs. 8.3% and 16.6%, respectively, among similar aged CCS in this sample). These lower rates may reflect a greater concern by CCS about their health. Because substance use initiation is impacted by social influence, an alternate explanation would be that these lower rates of substance use among CCS are due to delayed social development (i.e., missed/lost social experiences). Future research is needed to further examine this possibility. Substance use did not vary by clinical factors. These results suggest that health promotion interventions are needed regardless of cancer diagnosis or time since diagnosis/treatment. Because rates of substance use were not significantly lower among CCS who received the most intensive therapies (i.e., those who are at greater risk fortreatment-related effects on morbidity/mortality later in life), extra efforts should be made for interventions among this subgroup. We did notfind that substance use varied by ethnicity. There is a paucity of research information for Hispanic CCS. For example, in a CCSS report including substance use, only 1.6% of the participants were Hispanic. Al- though there were no ethnic differences in substance use in this study, additional research is needed, including the assessment of cultural beliefs among Hispanic CCS [21]. Although PTG was not associated with substance use, the presence of depressive symptoms was, particularly for binge drinking and marijuana use. Because the rela- tionship with depressive symptoms was consistent across all outcomes, these data suggest that targeted interventions focused on mental health, and mitigating negative affect among CCS may also benefit substance use behavior. The lack of associations with PTG suggests that programs promoting purpose/meaning that is derived from the cancer experience may not be relevant for substance use behaviors among CCS. Religiosity was inversely associated with tobacco use, binge drinking, and polysubstance use. Prior work among adolescents has found religiosity/spirituality to be a consistent protective factor for substance use [17]. These results suggest that tailoring intervention efforts, by incor- porating existing religious orientations into successful adaptation to the cancer experience and follow-up, should prove beneficial. This study is limited because it does not include CCS diagnosed under the age of 5 years and only included CCS who were seen at two prominent hospitals in the Los Angeles area. Although the recruitment rate of 50% for this cancer registry-based study was similar/higher than other recently formed registry cohorts among adoles- cent and young adults (e.g., 43%; [22]), our results may be biased because 50% did not participate. If a bias did exist, it is likely that more health-conscious CCS would be more likely to respond, and thus, our results could have underestimated substance use in this population. Like- wise, our definition of binge drinking was limited tofive drinks at one sitting, which is not consistent with a four- drink threshold used to define binge drinking for women. This may have underestimated binge drinking among the women in this sample. Although the prevalence of substance use among CCS is lower or similar than the general population, it remains a concern for CCS because they are at higher risk to experience early life morbidity and mortality. Thus, substance use prevention and cessation programs should be integrated into the long-term follow-up care of CCS. (e.g., [35]). This study indicates that these programs would benefit CCS at younger ages (under 21 years) and address the mental health (i.e., treatment of depressive symptoms) and religiosity of their patients. 1361 Substance use among cancer survivors Copyright © 2015 John Wiley & Sons, Ltd.Psycho-Oncology25:1357–1362 (2016) DOI: 10.1002/pon Acknowledgements This project was supported by 1R03CA144851 from the National Cancer Institute of the National Institutes of Health and the Whittier foundation. Additional support was provided by P30CA014089 and T32CA009492 from the National Cancer Insti- tute and 1R01MD007801 from the National Institute on Minority Health and Health Disparities of the National Institutes of Health. The content is solely the responsibility of the authors and doesnot necessarily represent the official views of the National Cancer Institute or the National Institutes of Health. Conflict of interest The authors have declared that there is no conflict of interest. References 1. Prasad PK, Bowles T, Friedman DL. Is there a role for a specialized follow-up clinic for survivors of pediatric cancer?Cancer Treat Rev2010;36(4):372–376. 2. Schwartz CLH, Constine LS, Ruccione KS. In Survivors of Childhood and Adolescent Can- cer(2nd edn), Schwartz CL, Hobbie WL, Constine LS, Ruccione KS (eds.), Pediatric Oncology, vol.22. Springer: St. Louis, 2005; 345. 3. Jones BL. 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265 Mater Sociomed. 2013 Dec; 25(4): 265-269 • PROFESSIONAL PAPER Frequency of Substance Abuse Among Adolescents Frequency of Substance Abuse Among Adolescents Salih Mesic 1, Sokolj Ramadani 2, Lejla Zunic 3, Amira Skopljak 2, Almir Pasagic 2, Izet Masic 2 Public health institute of Canton Sarajevo, Sarajevo, Bosnia and Herzegovina 1 Faculty of medicine, Sarajevo University, Sarajevo, Bosnia and Herzegovina 2 Faculty of Health Sciences, University of Zenica, Zenica, Bosnia and Herzegovina 3 ABSTRACT Introduction: Drug addiction is one of the most prominent problems in many countries in transition, including Bosnia and Herzegovina. Age limit of drug addiction is shifted to the younger age groups, especially is troubling the increase in number of injection drug users. Our study was aimed to investigate the habits, attitudes and practices related to drug use among young people from the area of Sarajevo city. We can still feel the effects of the war, among which are the most important life without closest relatives, banishment and various types of war and post-war trauma. Goals: To determine the frequency of substance abuse among adolescents; Identify potentially relevant biological, psychological and socio economic characteristics of the adolescents; To explore adolescents attitudes towards drug use; Examine the general level of knowledge of adolescents about drugs and their effects. Material and Methods: The study was conducted on randomized sample of 502 students in two primary and three secondary schools in Sarajevo and Gracanica. To study used survey method. Survey instrument was a self-made questionnaire with the research variables. The obtained data were processed by a computer and statistically correlated. The study is of combined, retrospective, prospective and transversal type. Results: To the question „How many times have you consumed cannabis in the last 30 days“ about 6% of the respondents have tried once or twice, while 1.5% use it daily, ecstasy have tried one or two times 2.25%, while 0.5% have daily use. Based on the obtained results it can be concluded that students at schools in Sarajevo consumed drugs 50% more than the children in Gracanica. Analyzing the age at which the subjects consumed the drug for the first time, we came to the conclusion that in the third year of high school only 8% of adolescents have tried any drugs before they turned 15 years. This percentage among eighth graders is about three times higher. Conclusion: Presented research results clearly suggest a strong contamination of the living environment of young people with different types of psychoactive substances. Offer of drugs is extensive and distribution network covers all the places where young people visits, including schools. It is clear that today’s teenagers sooner or later hear about drugs, see, get in touch with a „junkie“ and have a chance to take the drugs if they want to. From our research, we found that the following factors: Marital status of parents, employment of parents, the number of family members, type of school and satisfaction with oneself are not crucial for the eventual drug use among young people. While, the biological status of the parents, educational status of parents, financial status of parents, the tendency of parents tobacco and alcohol use, adolescents’ attitude to parents, the harmony of relationships between parents, school performance, positive attitude toward the so-called light drugs, represent significant risk factors for adolescent populations. Key words: Drug use, adolescence, risk and protective factors, Bosnia and Herzegovina. 1. INTRODUCTION Drug addiction is one of the most prominent problems in many countries in transition, including Bosnia and Herzegovina (1-10). Age limit of drug addiction is shifted to the younger age groups, especially is troubling the increase in number of injec – tion drug users. Our study was aimed to investigate the habits, attitudes and practices related to drug use among young people from the area of Sarajevo city. We can still feel the effects of the war, among which are the most important life without closest relatives, banishment and various types of war and post-war trau – ma. General situation is making much worse unemployment, insufficient and inadequate space for recreation and entertain – ment of young people. Open borders and lack of link between police and judicial institutions contribute to the widespread of psychoactive substances illegal trade. The drugs are available to everyone, at many places in the city. The main reasons for taking drugs are the current dissatisfaction with the social and political, and especially economic situation. Although the drug addiction is recognized as a major socio-medical problem, still in the fight against it there is no necessary interconnections of different segments of the society. Drug use is an attempt to es – cape from reality. Only a small number of addicts are ready for treatment. To solve the problem of drug abuse it is necessary to include in the joint work several sectors, but of course the role of the family and a healthy upbringing has the primary position. 1.1. The etiology and pathogenesis of drug abuse among adolescents Carr (1999) classified different explanations of psychoac – tive substances abuse of among adolescents into the following PROFESSIONAL PAPER Mater Sociomed. 2013 Dec; 25(4): 265-269 Received: 23 June 2013; Accepted: 18 September 2013 Conflict of interest: none declared. © AVICENA 2013 DOI: 10.5455/msm.2013.25.265-269 PROFESSIONAL PAPER • Mater Sociomed. 2013 Dec; 25(4): 265-269 Frequency of Substance Abuse Among Adolescents 266 theoretical groups: biological theories, theories of intrapsychic deficits, behavioral theory, family systems theory, social theory and the theory of multiple risk factors. Predisposing factors for substance abuse are creating psy – chological vulnerability or susceptibility for the development of the disorder. Personal predisposing factors ■ Conduct disorder, emotional problems, specific learning difficulties, positive beliefs about drug use, risk-taking and creating excitement, problematic temperament, low self-esteem, externally control focus. Environmental predisposing factors ■ Factors related to the parent–child relationship in child – hood: problems of emotional attachment, inconsistent pa – rental discipline, lack of intellectual stimulation, authori – tative parenting, indulgent parenting, parents neglect. ■ Exposure to family problems in early childhood: abuse of psychoactive substances by parents, parent’s psychological problems, criminal behavior of parents, marital discord or violence, family disorganization, deviant behavior of siblings. ■ Stressful situations in childhood: loss, separation, abuse, social difficulties, growing up in an institution. ■ Precipitating factors for substance abuse are „triggers“ or they encourage the development of the disorder. ■ Curiosity about drugs, peer pressure to take drugs, the desire to control the negative mood with the help of drugs, the benefits of the use of drugs, acute stress situations, ill – ness or injury, abuse, being violated by peers. ■ Maintaining factors contribute to the maintenance of psychological problems once they have already occurred. Personal maintaining factors ■ Biological factors: physical addiction, HIV, hepatitis and other diseases associated with drug use can cause negative emotional reactions, which maintains drug abuse. Environmental maintaining factors ■ Treatment factors: problem denial by family, family am – bivalence toward solving problems; family that for the first time encountered a similar problem. ■ Family factors: family support model of drug abuse through drug use, expressing positive attitudes about drug use and tolerance of drug use. ■ Parental factors: misleading information about drug abuse, insecurity in relationships, and low self-esteem of parents. ■ Factors of social network: the use of drugs in order to achieve certain goal; association with a group of peers who abuse drugs, adverse social environment, high levels of crime, low employment opportunities. ■ Protective factors preventing further deterioration en – hance and maintain the healthy development and have strong implications for prognosis and treatment. Personal protective factors ■ Biological factors: good physical health. ■ Psychological factors: high IQ, good temperament, high self-esteem, high self-efficacy, optimistic attributional style; mature defense mechanisms. Environmental protective factors: ■ Treatment factors: family that accepts and wants to solve the problem, families who previously faced a similar prob -lem; family that accepts the treatment plan. ■ Family factors: secure parent-child relationship; authori – tative parenting, clear family communication, flexible, family organization, the involvement of the father. ■ Parental factors: good adaptation of parents; incorrect expectations regarding drug use, high self-esteem, high self-efficacy, safety in relationships with others; mature defense mechanisms, functional strategies of coping with stress. ■ Factors of social network: a good network of social sup – port, low levels of family stress, positive educational en – vironment, high socioeconomic status. 2. GOALS To determine the frequency of substance abuse among ado – lescents; Identify potentially relevant biological, psychological and socio economic characteristics of the adolescents; To explore adolescents attitudes towards drug use; Examine the general level of knowledge of adolescents about drugs and their effects. 3. METHODOLOGY Material The study was conducted on randomized sample of 502 stu – dents in two primary and three secondary schools in Sarajevo and Gracanica. Methods To study used survey method. Survey instrument was a self- made questionnaire with the research variables. The survey was anonymous and contained 20 questions. For most of the questions respondents had to circle the answers on YES or NO principle, or multiple choice questions. Given is the possibility that the respondent chooses one answer from those available, and for some it sought a written reply. The obtained data were processed by a computer and statistically correlated. The study is of combined, retrospective, prospective and transversal type. 4. RESULTS Results are presented in tabular and graphical form. The answers given are grouped according to the issues in relation to the school in which the survey was conducted, for more ac – curate comparisons of some answers. The tables show data in absolute and relative numbers, somewhere was performed and the correlation among tested variables. The gender structure dominated girls (62, 55%) compared to the number of boys (37.45%).The survey covered two primary and three secondary schools in the two cities (Sarajevo and Gracanica). The largest number of respondents was from the Mixed Secondary School in Gracanica. The polling included 502 students of which 110 (22%) at eight grade of primary, 120 (24%) from the first, then 130 (26%) in the second and 142 (28%) from the third grade of high school. On average 6% of respondents had consumed marijuana in the past month. In the schools in the city of Sarajevo data show that 9.5% of respondents consumed once in a lifetime marijuana, ecstasy 5.25%, 4% LSD and speed, 2.5% sedatives, 1.5% cocaine and heroin and 5% inhalants. Of the total of 200 respondents in schools in Gracanica 5.75% of them tried marijuana, 1.5% speed and LSD, 1.25% ecstasy and inhalants, sedatives 1%, 0.5% co – caine and 0.25% heroin with statistically significant difference 267 Mater Sociomed. 2013 Dec; 25(4): 265-269 • PROFESSIONAL PAPER Frequency of Substance Abuse Among Adolescents between adolescents in Sarajevo and Gracanica (p <0.05). Of the total of 502 respondents in the survey, 15.25% of them consumed marijuana, about 6% ecstasy, speed, LSD and inhal – ants, sedatives, with 4% and 2% cocaine and heroin. Variable % School performance Excellent 6 Very good 50 Good 40 Sufcient 4 Family status Lives with… Both parents 70 With mother 15 With father 7 Stepmother and father 3 Father and stepmother 2 Other 3 Parents employment Both parents employed 25 Only father employed 50 Only mother employed 20 Both unemployed 5 Number of siblings 1 67 2 20 3 9 4 3 5 and more 1 Parents education Father Mother College 75 Higher school 1511 Secondary school 6661 Primary school 918 Don’t know 45 Table 1. The socio-demographic data We note that 50% of respondents completed previous class with very good grades. The 70% of respondents living with both parents, and 22% live with a single parent. In case of 70% of respondents only one parent is employed and only in 25% of cases both parents are employed. As many as 67% of respondents have only one sibling. Over 60% of parents have a high school diploma and about 7% are college-educated. Most respondents (60%) are very satisfied with themselves. Variable % Do your parents know that you use drugs? Ye s 9 No 85 Maybe 2 Don’t know 5 What do your parents think about smoking marijuana? Very negative 83 Negative 10 Somewhat negative 6 Does not have negative opinion 1 Mutual relationship of adolescents and parents Father Mother Very poor 74 Mostly poor 107 Unstable 1813 Good 2021 Excellent 4555 Table 2. Knowledge and attitudes of parents about drug use among adolescents The absolute majority of parents (85%) do not know that their children are consuming drugs. The absolute majority of the parents of the respondents (83%) have a very negative opinion on drugs. Most respondents have excellent relationship with their parents (50%), while about 20% have poor, mostly poor or very poor relationship with parents Variable % Have you tried any drugs before the age of 15? 8 grade of primary school 19 1 grade of secondary school 14 2 grade of secondary school 15 3 grade of secondary school 8 Why do young people take drugs? Afrmation of one’s peers 19 Personal problems 23 Family problems 9 Hedonism 5 Reduction of discomfort 10 Curiosity 30 Unfavorable living conditions 3 Ignorance 1 Sources of information about the harmful effects of drugs Parents 30 Teachers 20 Friends 19 Older adolescents 4 Internet, TV and magazines 20 Professional literature 3 Other 4 Table 3. Age, the causes of drug use and sources of information about the harmful effects of drugs At the third year of high school only 8% of adolescents have tried some drugs before the age of fifteen, while the percentage of eighth grade students is about 3 times higher. The highest per – centage of respondents listed curiosity, a personal problem and recognition among peers. Most information about the harmful effects of drugs adolescents have received from parents, teachers and over the internet and media. The drug is available at all places, even within the school premises. Most drug users choose to take this step at its own initiative or as offer from a close friend. Exactly 20% of the eighth grade and even 60% of the high school third grade came in contact with a person who consumed an illicit drug. 5. DISCUSSION The study included a total of 502 students from two primary and three secondary schools. The survey was conducted among students in the cities of Sarajevo and Gracanica. The ratio of 6 is employed and only in 25% of cases both parents are employed. As many as 67% of respondents have only one sibling. Over 60% of parents have a high school diploma and about 7% are college -educated. Figure 1 . The degree of satisfaction with oneself Most respondents (60%) are very satisfied with themself. Table 2 . Knowledge and attitudes of parents about drug use among adolescents Variable % Do your parents know that you use drugs? Yes 9 No 85 Maybe 2 Don’t know 5 What do your parents think about smoking marijuana? Very negative 83 Negative 10 Somewhat negative 6 Does not have negative opinion 1 Mutual relationship of adolescents and parents Father Mother Very poor 7 4 Mostly poor 10 7 Unstable 18 13 Good 20 21 Excellent 45 55 The absolute majority of parents (85%) do not know that their children are consuming drugs. The absolute majority of the parents of the respondents (83%) have a very negative opinion on drugs. Most respondents have excellent relationship with their parents (50%), while about 20% have poor, mostly poor or very poor relationship with parents 60% 20% 10% 7%3% 0 10 20 30 40 50 60 70 Very satisfied Quite satisfied SometimesQuite unsatisfied Very unsatisfied Figure 1. The degree of satisfaction with oneself PROFESSIONAL PAPER • Mater Sociomed. 2013 Dec; 25(4): 265-269 Frequency of Substance Abuse Among Adolescents 268 respondents was 66% female respondents (318) and 33% of male respondents (188). Most of the respondents completed previous class with very good grades, followed by a good success, average, etc. The larg – est number of respondents is living with both parents (70%). When it comes to the employment of parents of respondents of 70% of respondents work only one parent, while in 25% of cases both parents are employed. Also 67% of patients had only one brother or sister. Examining the level of parental education, we have found that 66% of parents have completed secondary education and only 7% have higher education. To the question „Do you have consumed any of the drugs?“ 15% of respondents said that they had tried or regularly consume marijuana, about 6% of the respondents had tried or regularly consume ecstasy, speed, LSD, sedatives and inhalants, while cocaine and heroin have tried around 2% of respondents. To the question „How many times have you consumed can – nabis in the last 30 days“ about 6% of the respondents have tried once or twice, while 1.5% use it daily, ecstasy have tried one or two times 2.25%, while 0.5% have daily use. Based on the obtained results it can be concluded that students at schools in Sarajevo consumed drugs 50% more than the children in Gracanica. Analyzing the age at which the subjects consumed the drug for the first time, we came to the conclusion that in the third year of high school only 8% of adolescents have tried any drugs before they turned 15 years. This percentage among eighth grad – ers is about three times higher. As for parent’s knowledge about whether they know that their children are taking drugs, we get that 85% of parents do not know that their children are using any of the drugs, while only 8% are aware of this fact. We also found that 83% of par – ents have a very negative opinion of drugs. Most respondents experiencing drugs are readily available, even within the school premises. Living environment of today’s adolescents is character – ized by high availability of drugs, and is likely the contact with people who consume drugs. Most adolescents who consume drugs decide to take this step on its own initiative or at the urging of close friends (2, 6, 8, 11). When it comes to informing pupils about the negative effect of drugs on the body, adolescents re – ceived most information from parents, teachers, over the Internet and from the literature. The most com – mon motive of drug consumption by the opinion of adolescent is curiosity, then affirmation among peers. Adolescents’ relation to parents in 50% is excel – lent, while 20% have a poor or mostly poor. From the survey we received information that the adolescents are generally satisfied with them self. Important role in preventing use of illicit drugs among youth have parents. They should observe the child’s behavior, they should be informed about the symptoms that arise due to the consumption of drugs, especially if the family belongs to a high risk group. It is necessary to make better contact with the teach – ers and spent more leisure time with children. Young people need to create a negative image of narcotics, but it should find a modus how to do it and that it does not cause counter effect. Perhaps it would be advisable to use once the shock therapy, that is, to show to young people any danger due to the consumption of intoxicants. The media also play an important role. Through them we can organize content which will inform young people about the harmfulness of drugs, and the program content should present persons who consume intoxicants. In parallel with these should be adopted more stringent regulations, or at least the consistently apply cur – rent ones. In addressing the problem of drug addiction should be involved parents, schools, cultural and sporting institutions, health care workers and so on. 6. CONCLUSIONS Presented research results clearly suggest a strong contamina – tion of the living environment of young people with different types of psychoactive substances. Offer of drugs is extensive and distribution network covers all the places where young people visits, including schools. It is clear that today’s teenagers sooner or later hear about drugs, see, get in touch with a „junkie“ and have a chance to take the drugs if they want to. It seems that the fear from the drugs weakens from genera – tion to generation and first experiences with drugs adolescents acquire earlier, often as early as in elementary school. Smaller are genders differences in interest for opiates and at the level of experimentation among girls keep pace with the boys. Drugs today are not asking for financial status, does not care in which neighborhood adolescents live, where they go to school, or to what subculture they belong. Research has shown that tobacco smokers showed a greater preference for consum – ing other drugs, compared with their nonsmoking peers. The same goes for users of alcohol, where we find that significantly more users of alcohol consumed other drugs compared to teens that do not drink alcohol. Reciprocal links do not show up only on the qualitative level (consume–not consume), but also include the quantitative aspect. So among heavy smokers of tobacco (or marijuana) we found a higher rate of consumption of other drugs than among moderate smokers. We also found quite solid chronological sequence of consum – Variable% Availability of drugs In school At the school At the cafe Cannot / do not know 302540 Possible but difcult 202545 Possible and easy 221563 Offering and soliciting for drug use No one ever 50 I’ve decided to try myself 15 Friend 20 Girlfriend, boyfriend 5 older adolescents 5 Drug dealers 2 Other 3 Come in contact with a person who consumes one illicit drug 8 grade of primary school 20 1 grade of secondary school 30 2 grade of secondary school 40 3 grade of secondary school 60 Table 4. The availability of drugs and methods of spreading 269 Mater Sociomed. 2013 Dec; 25(4): 265-269 • PROFESSIONAL PAPER Frequency of Substance Abuse Among Adolescents ing different types of drugs. Teens prone to drug use, as a rule, are entering the world of narcotic substances trough alcohol and tobacco, followed by marijuana and then other illicit drugs. From our research, we found that the following factors: Marital status of parents, employment of parents, the number of family members, type of school and satisfaction with oneself are not crucial for the eventual drug use among young people. While, the biological status of the parents (both parents died), educational status of parents (and higher university degree), fi – nancial status of parents (extreme poverty and extreme wealth), the tendency of parents tobacco and alcohol use (father smokes, father drinks), quantitative aspects of education (weak presence of the mother, the weak presence of the father), adolescents’ at – titude to parents (poor relationship with the mother or father), the harmony of relationships between parents (poor relations between parents), school performance (poor grades, grade rep – etition), the harmfulness of drugs (low perception of harmful – ness of drugs ), positive attitude toward the so-called light drugs (moderately negative attitude), knowledge about drugs (user knowledge, misconceptions about drugs), represent significant risk factors for adolescent populations. 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