Prevalence of Substance Abuse among Students of Tehran University of Medical Sciences, Iran.

BACKGROUND: The present study aimed to evaluate the prevalence of substance abuse among students of selected schools of Tehran University of Medical Sciences, Iran.
METHODS: This was a cross-sectional study among students in five schools of Tehran University of Medical Sciences in 2014. Data collection was conducted using a questionnaire which was designed by the researcher. Questionnaires were distributed among participants selected using stratified random sampling. A total of 422 questionnaires were filled and analyzed.
FINDINGS: In total, 422 students aged 19 to 32 years participated in this study among which 233 were women (55.2%) and 187 were men (44.3%). The highest prevalence belonged to smoking (26.3%), alcohol (19.9%), and hookah (14.9%) use, respectively. The results showed that 311 participants (73.7%) had never smoked a cigarette, 111 (26.3%) had smoked at least once, and 84 students (19.9%) had consumed alcoholic drinks at least once in their lifetime. There was no meaningful difference in smoking and alcohol use in terms of students' gender. Mother's educational level (P = 0.006) and financial income (P = 0.049) had significant effect on alcohol consumption.
CONCLUSION: In this study, it was found that gender differences have reduced in cigarette smoking and alcohol consumption as seen in western countries, which should be taken into consideration. The prevalence of alcohol consumption was found to be higher compared to other similar studies conducted in Iran which is significant.

Introduction

Substance abuse and addiction is one of the most important health, social, and political problems in the world.1 The prevalence of substance abuse is at its highest among youth; thus, university students are more vulnerable to this issue.2 Students’ mental health is one of the most challenging concerns for Iranian decision makers. However, only a few researches have been conducted in this field.3

Substance abuse is a nonadoptive model of substance use, which causes many issues and has harmful outcomes. It has a chain of psychological and behavioral expressions, it is also an important social hazard, which not only places the health of the individual and population at risk, but also brings around ethical and mental problems.4 Substance abuse has an impact on increasing antisocial behavior, behavior and psychological disorders, as well as infectious diseases such as AIDS and hepatitis.2 Iran has a large youth population, and thus, major problems in addiction.2 There has been a high increase in cigarettes, alcohol, and opiate abuse especially in youths.2 The exact prevalence of substance abuse among medical sciences students is unknown. Previous studies showed 20% to 40% prevalence of substance abuse.1,5

The results of a study conducted by Kordmirza et al. in 2003 in the University of Tehran, Iran, showed that the prevalence of substance abuse was 16.3%, 8.8%, 6.0%, and 5.1% in art, humanities, engineering, and medical sciences students.6 In the study by Zarrabi et al. in the 2005-2006 academic year in Guilan University of Medical Sciences, Iran, 30.1% of students had a history of substance use at least once during their lives. Cigarette (26.36%), alcohol (17.04%), and opium (3.86%) were the most prevalently used substances.7 Another study conducted by Taremian et al. in the 2005-2006 academic year showed a relatively high prevalence of use of soft drugs [water pipe 34%, cigarette 24%, and alcohol 17%], and low prevalence of hard drugs [opium 2.3%, hashish 2.2%, and ecstasy 0.7%] use among students of six different universities in Tehran, Iran.3 They also found lower rates of drug use among female students in comparison to male students for all drugs.3 A study in 2013 among dormitory students of Shahid Beheshti University of Medical Sciences, Iran, revealed that the prevalence of substance abuse among students was 15.4%, and the highest frequencies belonged to cigarette use (47.4%) followed by hookah use (42.9%).4 Parties and gatherings with friends were common excuses for substance abuse (47.5%).4

Recent studies in Iran showed that the prevalence of abuse of drugs such as tramadol, Ritalin, pethidine, and morphine is significant.3 Studies demonstrated that hookah and cigarette smoking are the most frequently used drugs.2-4,8-10 Moreover, the prevalence of alcohol consumption was one of the top three in various studies.2,3,7-9,11 Multiple studies conducted in Iran have shown a significantly higher prevalence of substance abuse in men in comparison to women.2-4,8-10,12-15

Very few researches have directly studied substance abuse among students in Iran to this date. Increasing prevalence of substance use in student communities, availability of lab-made substances such as crystal meth and ecstasy, lack of reliable data related to substance abuse, and its consequences in students’ lives are all indicative of the necessity of finding possible solutions and early preventive interventions.3 This study aimed to provide prime information on substance use and recent trends and study the relationship between demographic variables and cigarette smoking/alcohol consumption among students of Tehran University of Medical Sciences, Iran.

Methods

This was a cross-sectional study among students in five schools of Tehran University of Medical Sciences with an entrance academic year between September 2012 and 2014. The study population consisted of 2260 students and the sample size was determined using the Krejcie and Morgan Table as a total of 330 students. A random sample from each school was engaged in a number proportionate to the stratum’s size when compared to the population. These subsets of the strata were then pooled to form a random sample. Questionnaires were distributed among the participants who were selected using stratified random sampling. A total of 500 questionnaires were filled, 422 of which could be analyzed.

The research protocol was approved by the ethics committee and students were included if only they provided consent for participation in the study. They were assured of the confidentiality of their information.

Data collection was conducted through a questionnaire which was designed by the researcher and was reviewed and confirmed by several psychiatrists. The first section of the questionnaire included demographic variables such as age, sex, marital status, and parents’ academic education level and economic status. The second section had substance abuse related questions. The collected data were analyzed using independent t-test (to compare means), and chi-square and Fisher's exact tests (to compare the quantitative variables) in SPSS software (version 19, SPSS Inc., Chicago, IL, USA).

Results

In total, 422 students aged 19 to 32 years participated in this study, among which 233 were women (55.2%). The mean age of students was 22.4 years and 47 (11.1%) were married. The most common educational level of the students’ fathers and mothers was, respectively, bachelor degree (29.9%) and associate degree (31.5%). Furthermore, 249 (59.0%) of the students lived alone and 213 (50.5%) were from higher financial income families.

The results showed that 311 participants (73.7%) had never smoked a cigarette, 111 (26.3%) had smoked at least once, and 36 (8.5%) smoked cigarette on a daily basis (Table 1). The mean age at which they started smoking was 18.33 years and 43 students (39.8%) got their first cigarette from a friend. In addition, 44 of the students (50.0%) declared their motivation to be self-pleasure, and 55 of them (59.1%) smoked with friends. Their most favorable time to smoke was after breakfast (18.0%) and after they woke up from sleep (16.8%). Moreover, 63 of the students (70.7%) declared that they will continue to smoke in spite of the well-known health hazards. Among the students, 28 (31.8%) conceded that they had symptoms like anxiety, and concentration and anger problems when they smoked less or quit smoking. Most of the students (55 students; 65.4%) believed that smoking did not have any effect on their studies. In addition, 13 students (28.2%) alleged that smoking had a positive impact on their relationship with friends, and 20 students (43.4%) believed it has had a negative influence on their relationship with their parents. There was no significant difference between cigarette smoking and gender, marital status, father’s education, mother’s education, family income, and living condition (alone, with a family member, or with a friend). Overall, the prevalence of hookah smoking was 14.9% (63 students), and 13 students (3.1%) used hookah at least once every day.

Table 1

Prevalence of substance abuse in the students

Substance	Every day	Past week	Past month	Past 6 months	Past year	> 1 year ago	Lifetime use
	[n (%)]	[n (%)]	[n (%)]	[n (%)]	[n (%)]	[n (%)]	[n (%)]
Cigarette	36 (8.5)	22 (5.2)	16 (3.8)	9 (2.1)	6 (1.4)	22 (5.2)	111 (26.3)
Alcohol	13 (3.1)	13 (3.1)	18 (4.3)	20 (4.7)	10 (2.4)	10 (2.4)	84 (19.9)
Marijuana/Cannabis	2 (0.5)	3 (0.7)	4 (0.9)	9 (2.1)	4 (0.9)	8 (1.9)	30 (7.1)
Crack	0 (0)	0 (0)	0 (0)	0 (0)	1 (0.2)	0 (0)	1 (0.2)
Heroin	0 (0)	0 (0)	0 (0)	0 (0)	1 (0.2)	1 (0.2)	2 (0.5)
Shire	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)
Opium	3 (0.7)	4 (0.9)	3 (0.7)	3 (0.7)	5 (1.2)	5 (1.2)	23 (5.5)
Crystal meth	1 (0.2)	2 (0.5)	1 (0.2)	0 (0)	0 (0)	2 (0.5)	6 (1.4)
Ecstasy	0 (0)	0 (0)	0 (0)	2 (0.5)	0 (0)	2 (0.5)	4 (0.9)
Sedative-hypnotic pills	2 (0.5)	3 (0.7)	2 (0.5)	1 (0.2)	2 (0.5)	19 (4.5)	29 (6.9)
Tramadol	0 (0)	2 (0.5)	1 (0.2)	1 (0.2)	2 (0.5)	6 (1.4)	12 (2.8)
Steroids	0 (0)	1 (0.2)	1 (0.2)	2 (0.5)	3 (0.7)	3 (0.7)	10 (2.4)

The collected data showed that 84 students (19.9%) had consumed alcoholic drinks at least once in their lifetime and 13 students (3.1%) drank alcoholic beverages every day (Table 1). The mean age at which they started drinking was 18.6 years and 47 (52.2%) students started drinking with their friends. Furthermore, 41 students (48.8%) drank beer as their preferable beverage and 36 students (51.4%) declared their motivation to be self-pleasure. The most preferred time of day for drinking was in the evening (29.3%) and after dinner (29.3%). Among the subjects, 52 (78.7%) stated that they will continue to drink in spite of the health issues it can cause.

Moreover, 52 (82.5%) students stated that they did not experience any symptoms like anxiety, and concentration and anger problems when they did not drink or drank less than usual. Among the students, 40 (67.7%) believed that drinking did not have any effect on their studies. Most students alleged that drinking had negative influence on their relationship with their friends (38%) and parents (30.9%). The collected data revealed that there was a significant difference between alcohol consumption and mothers’ education level (P = 0.006) and financial income (P = 0.049). However, there was no significant difference between alcohol consumption and gender, marital status, father’s education, and living condition (alone, with a family member, or with a friend).

The most well-known drugs among students were opium (34.0%), sedative-hypnotic pills (21.3%), and marijuana (14.5%). Among the students, 30 (7.1%) had used marijuana at least once in their lifetime (Table 1). None of the students had used LSD, cocaine, buprenorphine, and methadone in their lifetime.

Discussion

This study investigated the prevalence of substance abuse among students of Tehran University of Medical Sciences.

This research showed that the most used substances by students were cigarette, alcohol, and hookah followed by marijuana and sedative-hypnotic pills. A similar study conducted on the university students in Tehran showed that hookah, cigarette, and alcohol were the most frequently used substances,3 a finding which is comparable to the study of Dehghani et al. in Yazd, Iran.2

In the present study, 111 students (26.3%) had smoked cigarettes at least once in their lifetime which is similar to the findings of Zarrabi et al. (26.4%),7 Mohamadi et al. (28.4%)11, and other studies.1,3,9,16,17 This study showed that 8.5% smoked every day which is similar to the findings of Ahmadi et al.15 In the present study, no notable difference (P = 0.110) was observed between male and female students; however, previous studies reported a higher prevalence among male students.9,10,12,15,16,18,19 Jafari et al. found that the prevalence of smoking among students of the University of Tehran in 2011 was 27.3% including 35.4% among men and 12.6% among women (P < 0.001).16 This indeed demonstrates the trend of diminishing gender differences in smokers as seen in western countries.20 Among the present study subjects, 36 (8.5%) smoked cigarettes every day. The study by Momtazi and Rawson revealed that the prevalence of daily smoking was between 4.4% and 12.8% among Iranian high school students.21 Among the present study students, 43 (39.8%) got their first cigarette from a friend which was similar to the findings of various studies.4,7,8,22,23 Moreover, 55 students (59.1%) smoked with friends; this result was similar to the results of the study by Babaei et al. (47.5%).4 The most important motivator (50.0%) for starting and continuing smoking was self-pleasure. This finding was in agreement with that of other studies.2,9,24

Numerous studies have shown that the pattern of substance abuse among the students of western universities is contrary to its pattern in Iran.9,25,26 Based on several studies performed at universities in western countries, alcohol was the first and the most commonly used substance among students, which was used by almost 44% of students.27 The percentage of alcohol use in studies carried out in Iran was significantly lower than that of foreign studies, which can be due to religious beliefs and the unlawfulness of alcohol use in Islam.4 In the majority of previous studies in Iran, alcohol was the second most popular substance in students after tobacco.9,12,28,29

Data showed that 84 students (19.9%) had consumed alcoholic drinks at least once in their lifetime which is consistent with other studies in Iran. Zarrabi et al. showed that the prevalence of alcohol use in students of Guilan University of Medical Sciences, was 17.04%.7 Taremian et al. reported the prevalence of alcohol use to be 17.0% among university students in Tehran.3 The data revealed that the prevalence of alcohol use in the previous year was 17.5%; however, it was 6.9% in the study by Abbasi-Ghahramanloo et al. among medical sciences students in Tehran.30 In a study conducted by Jalilian et al., Alcohol drinking during the past three months among male medical students of universities in Isfahan and Kermanshah was 10.1%.29 Nevertheless, we found that 10.5% of students had drunk alcohol in the last month. In Tabriz, Iran, 7.7% of students had used alcohol in the past 30 days.13 This indicates the increasing trend in alcohol consumption in Iranian students.

Alcohol consumption had significant association with mother's education and financial income (P < 0.050), but it did not have a significant difference with the student's gender. It seems that the difference between students in terms of families with higher income was related to affording the cost of substances as well as the different lifestyles of students from different socioeconomic groups, which affect their behavior, such as their propensity to substance abuse.9

Hookah (14.9%) and marijuana (7.1%) were the next two most popular drugs abused by the students. The prevalence of lifetime hookah use was 14.9% which was similar to the results of the study by Dehghani et al. (15.9%).2 Some studies have reported a higher prevalence of hookah use (from 18.0% up to 42.9%) in students.3,5,10 The study by Heydari et al. showed that 5.2% of students in Jahrom, Iran, used marijuana9 and Nazarzadeh et al. indicated that the prevalence of cannabis lifetime use (CLU) was 5.0% in college students.14 We found that 3.4% of students used cannabis in the past 6 months. In the study by Jodati et al., 6.0% of students had used cannabis in the previous 6 months.31 Ghanizadeh reported that 12.0% of students in Shiraz, Iran, had tried cannabis and 5.0% had used cannabis in the 6 months before the survey.32

The present study results showed that the prevalence of lifetime opium use was 5.5%, and the prevalence of its use in the past 6 months was 3.1%. These figures were lower than a study performed in Shiraz, in which 21.0% of students had used opium in their lifetime and 10.0% in the last 6 months.32 This may be indicative of opium being replaced by other addictive substances among students.

Conclusion

In this study, it was found that gender differences in cigarette smoking and alcohol consumption have reduced as seen in western countries, which should be taken into consideration. The high prevalence of cigarette, alcohol, hookah, and marijuana use shows the changing of trend in substance use among students and demonstrates the importance of raising awareness in the student community. Considering the result of this research, the prevalence of substance abuse (especially smoking and drinking alcohol) was relatively high in the students, and thus, the effective group of the society requires designing and implementing of drug prevention programs to protect them. Such programs including life skills training and drug education are necessary for the Iranian youth as early as primary school.