Alcohol and substance use among first-year students at the University of Nairobi, Kenya: Prevalence and patterns

Psychoactive substance use among medical and paramedical undergraduate students of Lucknow

BACKGROUND

Psychoactive drugs are substances that, when taken in or administered into one's system, affect mental processes like perception, consciousness, cognition, mood, and emotions. The use of psychoactive substances often starts at a young age. This study aimed to estimate the prevalence of psychoactive substance use among medical and paramedical undergraduate students of Lucknow.

MATERIAL AND METHODS

A cross-sectional study was conducted among 492 MBBS, BDS, and BSc Nursing students of Lucknow. A predesigned pretested semistructured self-administered questionnaire was used for data collection and analysis by using the SPSS 26.0 version.

RESULTS

The overall lifetime prevalence of "Ever use of the psychoactive substance" was 46.1%, whereas the overall current psychoactive substance use (in the past 3 months) was 35.2%. The prevalence of lifetime alcohol use was the highest at 36.6%, followed by tobacco (22.4%) and cannabis (17.9%). The prevalence was seen to be higher in males than in females and the highest in fourth-year academic students compared to other years.

CONCLUSION

The present study indicates that male students consume more psychoactive substances than female students. Effective interventions and strategies must be planned and implemented to reduce substance use among medical and paramedical students and overcome the issue of substance use by promoting a healthy lifestyle and coping skills.

High prevalence and co-occurrence of modifiable risk factors for non-communicable diseases among university students: a cross-sectional study

Background

Non-communicable diseases (NCDs) are a major global concern. This study aimed to examine the prevalence and co-occurrence of lifestyle risk factors among university students.

Methods

This analytical, cross-sectional study was conducted between January and April 2022. A total of 485 students were included in the study. Lifestyle risk variables for NCDs included physical inactivity, low fruit and vegetable consumption, alcohol use, tobacco smoking, being overweight/obese, and sugar sweetened beverages consumption.

Results

Our results showed that the most frequent risk factor was insufficient physical activity (89.2%), followed by low vegetable (70.5%) and fruit consumption (58.9%). Overall, more than half of the students (51.2%) had four or more risk factors highlighting the urgent need for preventive interventions. The co-occurrence of four or more lifestyle risk factors was significantly greater in students at private universities (aOR: 2.01 95% CI: 1.2; 3.35), those living in student homes (aOR: 3.57 95% CI: 1.96; 6.5), and those with fast food preferences when eating outside (a0R: 2.53 95% CI: 1.62; 3.96).

Conclusion

Targeted university-based interventions, such as promoting physical activity, providing affordable nutritious meals, and educating students on healthy lifestyles, are essential to reduce non-communicable disease (NCD) risk among students. Early action fosters lifelong healthy habits, supports healthy aging, and reduces healthcare costs. Future research should focus on refining these strategies to maximize their impact on university populations.

Embodied cognition driven Qigong: a cross-sectional study and a pilot randomized controlled trial on managing depression and preventing relapse in substance dependence

Objective

Substance use disorders (SUDs) pose a significant challenge to public health systems worldwide, with persistent high relapse rates underscoring the urgency for innovative intervention strategies. This study embarked on a systematic exploration of the factors influencing relapse among individuals with SUDs, alongside the implementation of targeted Health Qigong intervention to mitigate these effects based on the embodied cognition.

Methods

In the cross-sectional survey, a total of 398 male substance users were recruited to complete the questionnaires assessing depression, self-esteem, resilience, and relapse inclination. Subsequently, 60 participants diagnosed with depression were selected for a Pilot RCT, randomly divided into an intervention group, which underwent a 12-week Health Qigong program designed to combat depression through embodied cognition principles, and a control group, which maintained their daily routines.

Results

Structural equation modeling demonstrated that depression not only had a direct effect on substance users' relapse, but also exerted an indirect effect through three paths: firstly, via the mediating role of self-esteem; secondly, via the mediating role of resilience; and thirdly, via the chain-mediated role of self-esteem and resilience. Two-factor mixed-design ANOVA showed that the 12-week targeted Health Qigong training not only mitigated depression in individuals with SUDs, but also enhanced self-esteem and mental resilience, and reducing the propensity for relapse.

Conclusion

This research identifies critical factors influencing relapse in individuals with SUDs and introduces a novel, non-pharmacological intervention that significantly diminishes relapse rates and enhances recovery outcomes. It highlights the importance of physical activity in promoting mental health improvement and integrates traditional Chinese exercises with contemporary psychological insights, offering a comprehensive approach to drug rehabilitation and the integration of cultural practices in holistic health interventions.

Understanding stigma and attitudes towards hepatitis B among university students in Australia of Chinese and Vietnamese background

INTRODUCTION

Hepatitis B is a significant public health concern and a leading cause of liver cancer across the world. In Australia, hepatitis B is largely endemic in migrant communities, particularly amongst the Chinese and Vietnamese communities. Negative attitudes towards hepatitis B can be a major barrier to hepatitis B testing and linkage to care. This mixed-methods research explores the attitudes and beliefs, including stigma, about hepatitis B among students of Vietnamese and Chinese background in Australia. Students were chosen as participants as there is little research examining hepatitis B among university students in Australia and they provide a point of entry to communities with high prevalence of hepatitis B, that otherwise may be hard to access.

METHODS

Online surveys were distributed in Chinese, Vietnamese, and English via social media and completed by 112 students of Chinese and 95 students of Vietnamese backgrounds. In-depth interviews were also conducted with 13 Vietnamese and 10 Chinese participants to further explore the survey results.

RESULTS

Survey findings suggest that students have varied attitudes towards people living with hepatitis B. Around half of the participants reported they would behave negatively towards other people with hepatitis B and that they would expect to experience stigma or discrimination if they had hepatitis B. While over 70% in both samples reported that people who have hepatitis B should not be isolated by family and friends, 47.6% of the Chinese sample and 28.3% of the Vietnamese sample reported they would avoid close contact with someone with hepatitis B. The qualitative data expands on the quantitative data. Four key themes were identified: (1) Caution not discrimination (2) Hepatitis B as a sign of immoral behaviour (3) Discriminatory behaviour based on perceived effects of hepatitis B and (4) Shifting attitudes.

CONCLUSION

This research provides insights that could inform culturally sensitive health promotion programs to address negative attitudes towards hepatitis B among the broader Chinese and Vietnamese communities living in Australia.

Substance use among young people in sub-Saharan Africa: a systematic review and meta-analysis

Background

The use of substances such as alcohol, tobacco, khat, or drugs among young people is becoming a public health concern globally, with particularly high prevalence rates in low and middle-income settings, where socio-cultural and economic factors contribute to distinct challenges in addressing this problem. This review aimed to summarize the current literature on the prevalence of substance use among young people in sub-Saharan Africa (SSA) and identify gaps in the current body of literature.

Methods

Seven databases and Google were searched for studies reporting on substance use prevalence among young people (aged 10-24 years) in SSA, published between January 2010 and May 2024. Observational studies were included, assessed for methodological quality, and checked for the presence of heterogeneity and publication bias using standard methods. A random effect model was used to estimate the pooled proportions for substance use among young people.

Results

The literature search identified 1,889 hits from the databases and Google. Among these 60 eligible studies involving 83,859 respondents were included in the review. The overall lifetime, 12-month, and current prevalence of any substance use among young people in SSA was found to be 21.0% (95% CI= 18.0, 24.0), 18% (95% CI=10,27), and 15% (95% CI=12,18), respectively. Among young people from SSA, alcohol use problem was the most prevalent (40%), followed by khat use (25%), stimulant use (20%), and cigarette smoking (16%). Other substances used by a smaller proportion of young people included cannabis, cocaine, inhalants, sedatives, shisha, hallucinogens, steroids, and mastics. The prevalence of substance use problems was higher among males compared to females, highest in the southern African region followed by Western and Eastern regions, and in community-based studies compared to institutional-based studies.

Conclusions

In SSA, over a fourth of young people use at least one substance in their lifetime, with higher rates among males than females and in community-based compared to institution-based studies. These results emphasize the need for interventions targeting the wider young population and those in specific subgroups identified as being at higher risk of substance use. This approach allows for the provision of tailored support and resources to those who need it most while also promoting positive health outcomes for the entire population of young people in the region.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022366774, identifier CRD42022366774.

Burden of alcohol and other substance use and correlates among undergraduate students at Busitema University in rural Eastern Uganda after COVID-19 lockdown

Use of alcohol and other substances remains a major health concern among higher learning institutions. This study aimed at assessing the prevalence of alcohol and other substance use among students at Busitema University in Eastern Uganda. A cross sectional survey was conducted among 658 undergraduate students using a questionnaire consisting of Alcohol, Smoking and Substance Involvement Screening Tool and participant sociodemographic and clinical factors. Logistic regression was used to explore the associations. Two hundred sixty-five (40.3%) students reported ever using alcohol and 158 (24.0%) had used in last 3 months. Seventy-four (11.2%) students reported ever use of other substances including tobacco, cannabis, cocaine, stimulants sedatives and hallucinogens and 36 (5.5%) had used within the recent 3 months. After controlling for potential confounders, recent alcohol use was associated with engaging in romantic relationship (odd ratio (OR) = 1.9, P value (P) = 0.045) while having chronic medical conditions was protective (OR = 0.3, P = 0.031). On the other hand, recent use of other substances was 7 times higher among males (OR = 7.0, P = 0.008) compared to females while fourth year of study was protective (OR = 0.05, P = 0.011). Although alcohol use is a worsening challenge among university students, use of other substances is also highly prevalent after COVID-19 lockdown. There is need for universities to identify students with above factors and design interventions to address them in order to prevent the likely undesirable outcomes of alcohol and substance use.

Exposure to alcohol promotions on web-based media, sex and college risky drinking

Objective: Internet and development of digital media as a tool for online promotions provides avenues for early recruitment of college students into risky drinking. The objective of the study was to examine prevalence of alcohol promotions on web-based media and its possible effects on alcohol drinking by sex among college students in Kenya. Participants and Methods: A sample of 836 out of 1354 (61.7%) second and final year students in the school of education of a public urban university in Kenya participated in this online cross-sectional survey using awareness of online alcohol marketing and TWEAK questionnaires. Results: Facebook attracted most alcohol post per day (χ=3.6) and other apps collectively had least alcohol post per day (χ=0.8). Spearman's correlation show significant association between online alcohol promotions and risky drinking (0.37; p < 0.001). At the overall level of exposure to online alcohol promotions on web-based media and risky drinking, we perceived a statistical significance difference (p < 0.001) in favor of male respondents. The regression model was successful in explaining approximately 56% of the adjusted variance in risky drinking habits. Conclusion: This significant level presence of online liquor promotions suggest that the youth had fairly open access to the mixed beverage creator's items through web-based media stages which could impact youth to take part in early liquor drinking propensity. There was substantial presence of online alcohol promotions via web-based media scene that was related to risky drinking. Lastly, sex and online alcohol promotions could contribute to risky drinking among college students in Kenya.

Adapting a substance use screening and brief intervention for peer-delivery and for youth in Kenya

Background

Substance use is a major problem among youth in sub-Saharan Africa, yet interventions that address this problem are scarce within the region. Screening and brief intervention is a cost-effective, efficacious, and easy to scale public health approach to addressing substance use problems. We conducted a pilot study to evaluate the feasibility of implementing a peer delivered screening and brief intervention program for youth in Kenya. The goal of this paper is to report on the process of adapting the Alcohol Smoking and Substance Involvement Screening Test for Youth- linked Brief Intervention (ASSIST-Y-linked BI) program for peer delivery and for the Kenyan context prior to the pilot.

Methods

The adaptation process was led by a multi-disciplinary team comprised of psychiatrists, pediatricians, and psychologists. We utilized the ADAPT-ITT framework to adapt the ASSIST-Y-linked BI. The ADAPT-ITT framework consists of 8 phases including Assessment, Decision making, Adaptation, Production, Topical Experts, Integration, Training, and Testing the evidence-based intervention. Here, we report on phases 1-7 of the framework. The results of the pilot testing have been published elsewhere.

Results

Overall, we made surface level adaptations to the ASSIST-Y-linked BI program such as simplifying the language to enhance understandability. We maintained the core components of the program i.e., Feedback, Responsibility, Advice, Menu of Options, Empathy, Self-efficacy (FRAMES).

Conclusions

Our paper provides information which other stakeholders planning to implement the ASSIST-Y-linked BI for youth in sub-Saharan Africa, could use to adapt the intervention.

12-month substance use disorders among first-year university students in Kenya

OBJECTIVES

The period of entry into university represents one of vulnerability to substance use for university students. The goal of this study is to document the 12-month prevalence of substance use disorders among first year university students in Kenya, and to test whether there is an association between substance use disorders and mental disorders.

METHODS

This was a cross-sectional online survey conducted in 2019 and 2020 as part of the World Health Organization's World Mental Health International College Student (WMH-ICS) survey initiative. A total of 334 university students completed the survey. Descriptive statistics were used to summarize the demographic characteristics of the participants. Multivariate logistic regression was used to assess the association between substance use disorder and mental disorders after adjusting for age and gender.

RESULTS

The 12-month prevalence for alcohol use disorder was 3.3%, while the 12-month prevalence for other substance use disorder was 6.9%. Adjusting for age and gender, there was an association between any substance use disorder and major depression, generalized anxiety disorder, bipolar 1 disorder, intermittent explosive disorder, social anxiety disorder, suicidal ideation, suicide attempt, and non-suicidal self-injury.

CONCLUSION

These findings highlight the need to institute policies and interventions in universities in Kenya that address substance use disorders and comorbid mental disorders among first-year students.

Effects of common interest groups on rural women and youth livelihood: A qualitative study from Central Ethiopia

The study was conducted to examine the implications of the Common Interest Group (CIG) scheme for rural livelihood change in the selected areas of the Wara-Jarso woreda, Central Ethiopia. The study focuses on the activities of the CIGs, their effectiveness, Strengths, Weaknesses, Opportunities, and Threats, along with the changes in the livelihood status of CIG members. Four CIGs that fits into the aim of the study were purposively selected from the CIGs operating in the woreda. Among a qualitative research approach, a case study was employed. The data were collected from January 1, 2021 to February 28, 2021. Primary data were gathered using Focus Group Discussions and Key Informant Interviews. A thorough desk review of official documents and other secondary sources was made as an auxiliary method to capture sets of relevant information. The data organization was performed by the MAXQDA 2020 qualitative data analysis package program. The data were analyzed using thematic analysis, relational analysis, and content analysis methods. It was found that the CIGs have encouraged strong social capital among members and becomes an important alternative financial source. It was also found that the CIGs operation has encountered problems related to lack of entrepreneurial education and skill training, monitoring and evaluation, workplace, coordination among stakeholders, inadequate and improper financial use, and non-existence of market linkage. Their strengths, weaknesses, and opportunities were also indicated. For successful rural women and youth livelihood change through the CIGs scheme, the study recommends access to entrepreneurial skill training, coordination among relevant stakeholders, strong monitoring and evaluation, access to market linkage and workplace, and adequate funding.

Polydrug Use among Students in a Public University in a Lower Middle-Income Country

Recreational drug use among students in tertiary institutions remains a public health concern. Despite documentation of drug use in Kenyan universities, most of the studies are based on self-reported history which is prone to social desirability bias. It is in this context that we sought to establish lifetime and current drug use among university students. The study investigated self-reported and confirmed drug use. Using proportionate to size and snowball sampling methods, 380 respondents were enrolled from three university campuses. Actual drug use was confirmed qualitatively using a 6 panel plus alcohol saliva test kit. The study participants' median (IQR) age was 22 (20-23) years, and 262 (69%) were male; 328 (86%) were degree-level students, while 127 (33%) were in their fourth year and above. A total of 221 (58%) students reported a lifetime ever use of drugs, while 193 (51%) tested positive for at least one drug. Alcohol, tobacco products (cotinine), marijuana, and amphetamine or khat were the most preferred drugs. The usage was either solely, concurrently, or simultaneously. Having multiple sexual partners compared to students with no sexual partner (adjusted risk ratio (aRR) of 2.33 (95% CI 1.45, 3.76)) and residing in Mishomoroni and Kisauni (aRR 1.50 (95% CI 1.08, 2.09)) were associated with risk of testing positive for any drug. Having one (aRR of 1.54 (95% CI 1.05, 2.26)) and multiple sexual partners (aRR 2.03 (95% CI 1.27, 3.25) and residing in Mishomoroni and Kisauni (aRR 1.48 (95% CI 1.05, 2.08)) were associated with self-reported drug use. One out of two students was currently using drugs. Irrespective of the method used to record data, alcohol, tobacco products, marijuana, and amphetamine or khat were the most preferred drugs. The usage was solely, concurrently, or simultaneously. Future interventions should focus on continuing students, students' residences, and those who are sexually active.

Association of Social Network Characteristics with Substance Use among College-Going Young Adults: A Cross-Sectional Study

Background

Family members, peers, and significant others are part of a college student's social network. This cross-sectional study aimed to Assess substance use prevalence and patterns among college students,Compare the social network characteristics of substance users (SUs) and non-users (NUs), andExplore the association of social factors with substance use.

Methods

The study involved 902 students from 11 Government and aided private degree colleges. Demographic and clinical data sheet, ASSIST, and Social Network Questionnaire were used to collect the data.

Results

Prevalence of substance use was 26.9% and higher among males (21.5%). Alcohol (20%) and tobacco (15.5%) were the commonly used substances. SUs' network was composed of unmarried persons (p<0.002), male members (p<0.001), and friends (p<0.001) with substance use. In contrast, the NUs' network comprised parents (p<0.016) and siblings (p<0.001). NUs had a higher number of influential members in the network, whereas SUs had more closeness with members and received higher financial support (p<0.001). Participant's age (OR 1.27), family history of substance use (OR 2.46), parents' occupation (Business: OR 1.79, being employee in the government or industry: OR 1.76),and having three substance-using members in the network (OR .211) were found to be risk factors.

Conclusion

Social network has an association with substance use among college students. Social-network-based interventions may benefit them.

Current state of cannabis use, policies, and research across sixteen countries: cross-country comparisons and international perspectives

INTRODUCTION

Varying public views on cannabis use across countries may explain the variation in the prevalence of use, policies, and research in individual countries, and global regulation of cannabis. This paper aims to describe the current state of cannabis use, policies, and research across sixteen countries.

METHODS

PubMed and Google Scholar were searched for studies published from 2010 to 2020. Searches were conducted using the relevant country of interest as a search term (e.g., "Iran"), as well as relevant predefined keywords such as "cannabis," "marijuana," "hashish," "bhang "dual diagnosis," "use," "addiction," "prevalence," "co-morbidity," "substance use disorder," "legalization" or "policy" (in English and non-English languages). These keywords were used in multiple combinations to create the search string for studies' titles and abstracts. Official websites of respective governments and international organizations were also searched in English and non-English languages (using countries national languages) to identify the current state of cannabis use, policies, and research in each of those countries.

RESULTS

The main findings were inconsistent and heterogeneous reporting of cannabis use, variation in policies (e.g., legalization), and variation in intervention strategies across the countries reviewed. European countries dominate the cannabis research output indexed on PubMed, in contrast to Asian countries (Thailand, Malaysia, India, Iran, and Nepal).

CONCLUSIONS

Although global cannabis regulation is ongoing, the existing heterogeneities across countries in terms of policies and epidemiology can increase the burden of cannabis use disorders disproportionately and unpredictably. There is an urgent need to develop global strategies to address these cross-country barriers to improve early detection, prevention, and interventions for cannabis use and related disorders.

Family Function Impacts Relapse Tendency in Substance Use Disorder: Mediated Through Self-Esteem and Resilience

BACKGROUND

Substance abuse has been a public health concern, and even after detoxification treatment, the relapse rate is still high. Family function is closely related to substance dependence. However, studies on psychological mechanisms between them are rare.

OBJECTIVES

We aimed to explore the mediating role of self-esteem and resilience in the pathway that family function impacts the relapse tendency among patients with substance use disorder (SUD).

METHODS

A total of 282 SUD patients were recruited, and standard questionnaires were administered for each patient. The relapse tendency, family function, self-esteem and resilience were assessed by the family care index questionnaire, the Connor-Davidson resilience scale, the Rosenberg self-esteem scale and the relapse tendency questionnaire. Bootstrap method was conducted for mediation analysis to test the effects of how family function affects relapse tendency mediated through self-esteem and resilience.

RESULTS

The average score of relapse tendency of the patients was 28.47 (SD = 11.89). Intermediary analysis found that self-esteem played an intermediary role in the relationship between family function and relapse tendency. Resilience plays an intermediary role in the relationship between family function and relapse tendency. Further, the path analysis showed that family function not only had a direct association with relapse tendency, but also indirectly related to relapse tendency through self-esteem and resilience.

CONCLUSIONS

Self-esteem and resilience are the key factors in the relationship between family function and relapse tendency of SUD patients.

Substance use patterns among university students in Egypt

Background

In the past few years, there has been an expanding global interest in the problem of substance use. A variety of studies conducted within the past decade have investigated the prevalence of substance use among university students. The study aimed to detect the prevalence and associates of substance use among Egyptian students at Mansoura University. This cross-sectional, questionnaire-based, observational study was conducted during the period from February to July 2019 on 1138 university students at Mansoura University in Egypt. The university students were randomly divided into three classes (medical, practical, and theoretical). The data were assembled using questionnaires of sociodemographic, clinical attributes, and drug use disorders identification test (DUDIT).

Results

Lifetime substance use among students was 6.5%. Of the users, 18 (24.3%) used cannabis, 14 (18.9%) used tramadol, 10 (13.5%) used alcohol, 5 (6.8%) used benzodiazepines, and 1 (1.4%) used heroin. Only 35.1% used polysubstance, of those, 10 (13.5%), 12 (16.2%), 3 (4.1%), and 1 (1.4%) used cannabis and tramadol; cannabis and alcohol; cannabis and inhalant; and cannabis, alcohol, and tramadol respectively. There was a substantial association between substance use and male sex, age above 20 years, smoking, and living in urban areas. In the group that used substances, 50 (4.4%) suffered substance-related problems and 6 (0.5%) encountered dependency.

Conclusion

In total, using the mono substance is more than using poly substances in which cannabis, tramadol, and alcohol were the most often utilized substances. The highest percentage of drug-related problems was among medical students while dependence was highest among practical students. These results should be considered in future substance preventive programs.

Depression and its associated factors: perceived stress, social support, substance use and related sociodemographic risk factors in medical school residents in Nairobi, Kenya

BACKGROUND

Little data exists regarding depression and its associated factors in medical residents and doctors in Sub-Saharan Africa. Residents are at high risk of developing depression owing to the stressful nature of their medical practice and academic training. Depression in medical residents leads to decreased clinical efficiency, and poor academic performance; it can also lead to substance abuse and suicide. Our primary aim was to measure depression prevalence among medical residents in Kenya's largest national teaching and referral hospital. Secondary aims were to describe how depression was associated with perceived stress, perceived social support, substance use, and educational environment.

METHODS

We sampled 338 residents belonging to 8 different specialties using self administered questionnaires in this cross-sectional survey between October 2019 and February 2020. Questionnaires included: sociodemographics, the Centres for Epidemiology Depression Scale - Revised, Perceived Stress Scale, Multidimensional Scale of Perceived Social Support, Alcohol, Smoking and Substance Involvement Screening Test, and Postgraduate Hospital Educational Environment Measure. Bivariate and multivariate linear regression were used to assess for risk factors for depression.

RESULTS

Mean participant age was 31.8 years and 53.4% were males. Most residents (70.4%) reported no to mild depressive symptoms, 12.7% had moderate, and 16.9% had severe depressive symptoms. Most residents had high social support (71.8%) and moderate stress (61.6%). The educational environment was rated as more positive than negative by 46.3% of residents. Bivariate analyses revealed significant correlations between depressive symptoms, perceived stress, substance use, perceived social support, and educational environment. Multivariate analysis showed that depression was strongly associated with: fewer hours of sleep (β = - 0.683, p = 0.002), high perceived stress (β = 0.709, p < 0.001) and low perceived social support (β = - 2.19, p < 0.001).

CONCLUSIONS

Only 30% of medical residents in our study had moderate and severe depressive symptoms. Most residents in our study reported high levels of social support, and moderate levels of stress. Though their overall appraisal of medical residency experience was positive, mental health support and self-care skills in the training of medical professionals needs prioritization.